Eliminating the barriers to uptake of cataract surgery in a resource‑poor setting: A focus on direct surgical cost

Background: Cataract remains a leading cause of blindness worldwide. Despite the high therapeutic efficacy of cataract surgical interventions, surgical uptake has been sub‑optimal, especially in low‑ and middle‑income countries.Objective: The objective was to investigate the effect of surgical fee reduction on the uptake of cataract surgical services at the University of Nigeria Teaching Hospital (UNTH) Enugu.Methods: In a retrospective comparative study, all patients who underwent cataract surgery at UNTH between January 2008 and December 2011 were identified from the eye theatre’s surgical logbook. Their clinical charts were recalled and relevant demographic and clinical data were abstracted, categorized into pre (January 2008 to December 2009, Group A), and post (January 2010 to December 2011, Group B) surgical fee reduction groups. Descriptive and comparative statistical analyses were performed.Results: A total of 376 cataract surgeries (Group A, 164 [43.6%]; Group B, 212 [56.4%]) was performed during the 4‑year study period. The surgeries were performed on 217 males, and 159 females aged 55.4 ± 23.4 standard deviation years (range, 7 months to 89 years). The average annual uptake of cataract surgery was 94 overall, 82 pre and 106 postsurgical fee reductions. The two groups did not differ significantly by age (P = 0.8750) or gender (P = 0.8337).Conclusion: There is low uptake of cataract surgery at UNTH Enugu. Direct surgical fee reduction alone caused only a modest increase in uptake without alteration in age and gender balance. Further fee reduction and exploration of other uptake barriers are warranted.Key words: Cataract surgery, surgical cost, uptak

Short term results of pterygium surgery with adjunctive amniotic membrane graft

Objective: The objective of this study is to present the 3 months results of pterygium excision with adjunctive amniotic membrane graft.Materials and Methods: In a non‑comparative case series study, the medical records of all patients who had pterygium excision with adjunctive amniotic membrane transplant on bare sclera from December 2009 to August 2010 were reviewed. All the patients were followed up for 3 months. The data collected were sex, age, occupation, type of pterygium (primary or recurrent), extent of pterygium, post‑operative complications and recurrent pterygium growth.Results: Thirty eyes of 30 consecutive patients were operated on. There were 14 males and 16 females (M:F =1:1); age range 25 to 70 years (mean: 48.3 SD + 12.01). Twenty‑six eyes had primary and 4 recurrent pterygia. Stage 3 pterygium accounted for most of the cases (53.3%) followed by stage 2 (36.7%) and stage 4 (10%). Nineteen patients (63.3%) had occupations with considerable exposure to actinic damage. Of these, manual laborers accounted for the highest number contributing 13 (43.3%) out of the 19 cases. Of the 30 patients 2 had a reoccurrence giving a recurrence rate of 6%. One patient developed dellen 1 week post‑operatively with complete resolution following conservative large soft contact lens application.Conclusion: Short term results suggests that adjunctive amniotic membrane transplant with pterygium excision is effective and safe. A larger randomized clinical trial with a longer follow‑up period is however recommended.Key words: Amniotic membrane graft, pterygium, recurrenc

Refractive ocular conditions and reasons for spectacles renewal in a resource-limited economy

<p>Abstract</p> <p>Background</p> <p>Although a leading cause of visual impairment and a treatable cause of blindness globally, the pattern of refractive errors in many populations is unknown. This study determined the pattern of refractive ocular conditions, reasons for spectacles renewal and the effect of correction on refractive errors in a resource-limited community.</p> <p>Methods</p> <p>A retrospective review of case records of 1,413 consecutive patients seen in a private optometry practice, Nigeria between January 2006 and July 2007.</p> <p>Results</p> <p>A total number of 1,216 (86.1%) patients comprising of (486, 40%) males and (730, 60%) females with a mean age of 41.02 years SD 14.19 were analyzed. The age distribution peaked at peri-adolescent and the middle age years. The main ocular complaints were spectacles loss and discomfort (412, 33.9%), blurred near vision (399, 32.8%) and asthenopia (255, 20.9%). The mean duration of ocular symptoms before consultation was 2.05 years SD 1.92. The most common refractive errors include presbyopia (431, 35.3%), hyperopic astigmatism (240, 19.7%) and presbyopia with hyperopia (276, 22.7%). Only (59, 4.9%) had myopia. Following correction, there were reductions in magnitudes of the blind (VA<3/60) and visually impaired (VA<6/18-3/60) patients by (18, 58.1%) and (89, 81.7%) respectively. The main reasons for renewal of spectacles were broken lenses/frame/scratched lenses/lenses' falling off (47, 63.4%).</p> <p>Conclusions</p> <p>Adequate correction of refractive errors reduces visual impairment and avoidable blindness and to achieve optimal control of refractive errors in the community, services should be targeted at individuals in the peri-adolescent and the middle age years.</p

Tuberculosis and the eye

No Abstract. Nigrian Journal of Clinical Practice Vol.9 (1) 2006: pp.68-7

Amblyopia: Types, Presentation And Treatment – A Review

A review of types, presentation and treatment of amblyopia was done. There are four major types of amblyopia namely: strabismic, ametropic (isoametropic), anisometropic and deprivation. The critical or sensitive period for each varies, although almost all cases present within 7 - 8 years of age. Amblyopia treatment should, therefore, be carried out as early as possible, with the co-operation of the patient=s family or other care-givers. Amblyopia treatment essentially aims at: i. Optimizing the clarity of the retinal image in the amblyopic eye by surgery or optical correction of refractive errors and; ii. Enhancing the neural stimulus to the visual cortex, in most cases by occlusion therapy. Conclusions: (i) Being among the top three causes of monocular visual loss in the adult age group from 18-85 years, this suggests that the condition persists well beyond the childhood years. (ii) Also, in spite of successful occlusion therapy in amblyopia patients, it has been found that visual acuity still diminished over time in some patients. The question therefore remains: Are childhood screening programmes for amblyogenic factors effective? Nigerian Journal of Ophthalmology Vol. 11(2) 2003: 54-6

Sino-orbital aspergillosis with central nervous system complication: a case report

Aim: To report a case of sino-orbital aspergillosis presenting as a proptosis in an adult immunocompetent Nigerian woman. Case report: A 60 year-old woman first presented to the eye clinic more than a month after initial symptoms of catarrh and nasal blockage and two weeks after the development of proptosis. From the results of radiological investigations and fungal culture it was found that the patient primarily had aspergillosis of the paranasal sinuses with secondary involvement of the orbit. A central nervous system (CNS) complication (cerebral abscess) was diagnosed following seizures in the patient. The patient died a few days later. Conclusion: The diagnosis of aspergillosis of the orbit was only made from fungal culture after the patient's death. It requires a high index of suspicion to make a diagnosis of aspergillosis of the orbit. In this era of HIV/AIDS, with increasing incidence of aspergillosis, ophthalmologists are advised to be on the alert for this disease and rule it out in every patient that presents to them with proptosis. Nigerian Journal of Ophthalmology Vol. 13(2) 2005: 62-6

A Critical Analysis Of The Management Of Acute Postcataract Surgery Endophthalmitis In The Gambia

Objectives: To report the pattern of presentation and the outcome of management of postcataract surgery endophthalmitis at the Royal Victoria Hospital (RVH), Banjul, The Gambia, and to critically analyse the methods employed. Methods: The records of four consecutive cases of acute endophthalmitis following cataract surgery, seen over a one-year period (October 2000 to September 2001) at the eye unit of RVH, Banjul, were analysed. Results: Early diagnosis of endophthalmitis, based on clinical signs only, was made within the first 14 post-operative days in all 4 patients (3 females and l male aged between 50 and 60 years.) Prompt treatment with a variety of broad spectrum systemic, topical and subconjunctival antibiotics was administered to each patient. Despite this treatment, vision was eventually lost in all the eyes. Conclusion: Because of the poor outcome of the treatment of these patients, one may conclude that the current management of acute postcataract surgery endophthalmitis in the Gambia does not seem to be effective. A new evidence-based management protocol is proposed using the results of the Endophthalmitis Vitrectomy Study (EVS) as a guide. Nigerian Jnl Ophthalmology Vol.11(2) 2003: 80-8

Diabetic Eye Disease in Enugu South-Eastern Nigeria – A Preliminary Report

Objectives: To determine the pattern of ocular complications seen among patients being managed in a diabetic clinic. Methods: Patients were randomly selected from the diabetic clinic of UNTH Enugu and examined over a 3 year-period between 1997 and 2000. The procedures carried out on each patient comprised: blood pressure check with patient standing; assessment of visual acuity; slit-lamp and torchlight examination of the anterior segment; tonometry using the Perkin's handheld applanation tonometer; and fundoscopy using the directive ophthalmoscope. Results: Out of the 149 patients examined, 3 (2.0%) were blind and 23 (15.4%) had visual impairment. Nineteen patients (12.75%) had diabetic retinopathy; 33 (22.1%) had cataracts; and 7 (4.7%) glaucoma. Nine (47.3%) of those with diabetic retinopathy were found to be hypertensive, four of which had maculopathy. Conclusion: From this preliminary report, it is obvious that diabetic eye disease is also an important public health problem in southeastern Nigeria. Health education, screening for early detection, and prompt treatment of ocular complications will reduce visual loss in the patients [Nig. J. Ophthalmology Vol.11(1) 2003: 30-33

Cataract Extraction With Intraocular Lens Implant: Early Experience In University Of Nigeria Teaching Hospital (U.N.T.H.), Enugu, South-Eastern Nigeria

Objectives: To audit our early experience of cataract surgery with intraocular lens implant, in the University of Nigeria Teaching Hospital (U.N.T.H.), Enugu. Methods: In a retrospective, non-comparative case-series study, the records of all patients who had cataract extraction with intraocular lens implant between January 2001 and October 2002 and were followed up for at least eight weeks were analyzed. Information on age, sex, type of cataract, co-existing ocular and systemic disease, pre- and postoperative visual acuity and postoperative complications was collected. Results: Forty four eyes of 40 patients were studied; mean age of the patients was 52.2 years (range: 8-87 years). Thirty seven eyes had age-related (senile) cataract; 2 post-uveitis cataract and 5 traumatic cataract. Associated systemic diseases were diabetes mellitus (4); hypertension (4); asthma (1); rheumatism (1) and diabetes and hypertension (1). Preoperative visual acuity was /=6/18. With refraction those with visual acuity of >/= 6/18 increased to 14 out of the 18 who had refraction (77.8%). Cause of persistent poor visual acuity was ascertained in only 1 eye and was endophthalmitis. Postoperative complications included corneal oedema/striae (91%); astigmatism (18.2%); poor wound apposition (18.2%) and endophthalmitis (2.3%). Conclusion: The final visual outcome in 77.8% of patients who had refraction post-surgery was good (>/= 6/18.) confirming that Cataract surgery with IOL implant is safe and effective in restoring vision to the cataract blind in this part of the world. Most of the cases of postoperative astigmatism were corrected with refraction. Key Words: cataract extraction; intraocular lens implant Orient Journal of Medicine Vol.15(3&4) 2003: 31-3