Aetiology of Blindness in Benin City, Nigeria

Background/purpose: To determine the main causes of blindness in Benin-city, Nigeria. Method: The medical records of 1,698 new patients attending the consultant outpatient eye clinic of the University of Benin Teaching Hospital between May 2001 and April 2003 were reviewed and the causes of blindness recorded. Results: One hundred and twenty eight patients (7.54%) presented with binocular blindness while 248 patients (14.6%) presented with uniocular blindness. The major causes of binocular blindness were cataract (34.4%), glaucoma (25%) and age related macula degeneration (8.59%). The main causes of uniocular blindness were cataract (23.79%), glaucoma (22.58%) and trauma (11.69%). Conclusion: Avoidable causes of blindness remain the leading causes of blindness but age related macula degeneration, which was not reported in earlier studies, is now the third major cause of blindness. Preventive and curative measures should be instituted to tackle the leading causes of blindness

Hereditary Atypical Retinitis Pigmentosa

This report presents four generations of hereditary atypical (pericentric) retinitis pigmentosa in an Itsekiri family of Warri, Delta state of Nigeria. The patients presented with nyctalopia, waxy disc pallor, arteriolar attenuation, pigment deposits around the optic nerve and visual field loss. The cases were typically mild with satisfactory vision beyond the fifth decade of life. The mode of inheritance was most probably autosomal dominant.L'objet de ce rapport est de pr\ue9senter quatre g\ue9n\ue9rations de pigmentolyse r\ue9tinite (pericentrique) atypique h\ue9r\ue9ditaire chez une famille d'Itsekiri de Warri, \uc9tat de Delta au Nig\ue9ria. Les patients se sont pr\ue9sent\ue9s atteints de la nyctalopie, waxy disc pallor, att\ue9nuation art\ue9riolaire, d\ue9p\uf4t du pigment autour de la nerve optique et la perte du champ visuel. Les cas \ue9taient typiquement b\ue9nins avec la vision satiffaisante au d\ue9l\ue0 de la cinqui\ue8me d\ue9c\ue9nnie de la vie. La m\ue9thode d'h\ue9ritage \ue9tait plus probablement autosome dominant

Cost Analysis of Medical versus Surgical Management of Glaucoma in Nigeria

Purpose: To analyze the cost of glaucoma medical therapy and compare it with that of surgical management in Nigeria. Methods: The cost of glaucoma drugs and that of surgical therapy in patients who attended the eye clinic of the University of Benin Teaching Hospital, Benin City, Nigeria, between December 2002 and November 2008 were calculated over a 3 year period of follow-up. Costs of medical and surgical therapy were compared based on November 2008 estimates. Results: One hundred and eight patients met the inclusion criteria of the study, of which, 90 patients (83.33%) received medical therapy and 18 patients (16.67%) underwent surgery. The most expensive drugs were the prostaglandin analogues, travoprost (Travatan) and latanoprost (Xalatan). The least expensive topical drugs were beta-blockers and miotics. The mean annual cost of medical treatment was US$273.47΁174.42 (range,$41.54 to $729.23) while the mean annual cost of surgical treatment was US$ 283.78΁202.95 (range, $61.33 to$592.63). There was no significant difference between the mean costs of medical and surgical therapy over the 3-year period (P = 0.37). Older age (P = 0.02) and advanced glaucoma (P < 0.001) were associated with higher costs of therapy. Conclusion: The cost of medical therapy was comparable to that of surgical therapy for glaucoma in Nigeria over a 3-year period

Adapted motivational interviewing to improve the uptake of treatment for glaucoma in Nigeria: study protocol for a randomized controlled trial.

BACKGROUND: Glaucoma is a chronic eye disease associated with irreversible visual loss. In Africa, glaucoma patients often present late, with very advanced disease. One-off procedures, such as laser or surgery, are recommended in Africa because of lack of or poor adherence to medical treatment. However, acceptance of surgery is usually extremely low. To prevent blindness, adherence to treatment needs to improve, using acceptable, replicable and cost-effective interventions. After reviewing the literature and interviewing patients in Bauchi (Nigeria) motivational interviewing (MI) was selected as the intervention for this trial, with adaptation for glaucoma (MIG). MI is designed to strengthen personal motivation for, and commitment to a specific goal by eliciting and exploring a person's reasons for change within an atmosphere of acceptance and compassion. The aim of this study is to assess whether MIG increases the uptake of laser or surgery amongst glaucoma patients where this is the recommended treatment. The hypothesis is that MIG increases the uptake of treatment. This will be the first trial of MI in Africa. METHODS: This is a hospital based, single centre, randomized controlled trial of MIG plus an information sheet on glaucoma and its treatment (the latter being "standard care") compared with standard care alone for glaucoma patients where the treatment recommended is surgery or laser.Those eligible for the trial are adults aged 17 years and above who live within 200 km of Bauchi with advanced glaucoma where the examining ophthalmologist recommends surgery or laser. After obtaining written informed consent, participants will be randomly allocated to MIG plus standard care, or standard care alone. Motivational interviewing will be delivered in Hausa or English by one of two MIG trained personnel. One hundred and fifty participants will be recruited to each arm. The primary outcome is the proportion of participants undergoing laser or surgery within two months of the date given to re attend for the procedure. MIG quality will be assessed using the validated MI treatment integrity scale. DISCUSSION: Motivational interviewing may be an important tool to increase the acceptance of treatment for glaucoma. The approach is potentially scalable and may be useful for other chronic conditions in Africa. TRIAL REGISTRATION: ISRCTN79330571 (Controlled-Trials.com)

Stroke prevalence amongst sickle cell disease patients in Nigeria: a multi-centre study

Background: Stroke is a life-changing, debilitating complication of sickle cell disease (SCD). Previous studies had recorded high stroke prevalence amongst this group of patients. Nigeria has a large population of people affected by this condition and this study aims to assess the stroke prevalence in this large population.Methodology: Stroke prevalence data from 14 physicians working in 11 tertiary health centres across the country was collated by doctors using the sickle cell registers and patient case notes. This data was then collated and used to obtain the overall stroke prevalence in adult and children.Results: The stroke prevalence in sickle cell disease patients in Nigeria was observed to be 12.4 per 1000 patients. Prevalence in the adult patients was 17.7 per 1000 patients and 7.4 per 1000 patients in children. Twenty three percent of the affected patients had more than stroke episode.Conclusion: The stroke prevalence in Nigeria is lower than previously recorded rates and further studies will be required to investigate other factors which may play a role.Keywords: sickle cell, stroke, Nigeria, prevalenc

CASE REPORT - Maxillary Herpes Zoster with Corneal Involvement in a HIV Positive Pregnant Woman

Corneal involvement in maxillary herpes zoster is very rare. This report presents the case of a 32 years old 7 months pregnant para2+1 female, who presented with vesiculopapular rashes with hyperpigmented crusts over the maxillary area of the face on the left side with periocular oedema, conjunctivitis and mild punctate keratitis in the left eye. She was HIV positive and was on treatment with the highly active antiretroviral therapy. She was treated with topical and systemic acyclovir with rapid resolution of the ocular features. Les herpès maxillaries de zona avec les atteintes cornéennes chez la femme enceinte séropositive L\'atteinte cornéenne dans les herpès maxillaries de zona est très rare. Le cas d\'une femme pare2+1 âgée de 32 ans et qui est enceinte de 7 mois, qui a présenté des éruptions papulovésiculeuses avec des croûtes hyperpigmentés à travers la région maxillaire à côté gauche du visage avec l\'oedème périoculaire, la conjuctivite, une kératite ponctuée faible dans l\'oeil gauche. Elle était séropositive et suivait un traitement à l\'aide de la thérapie antirétrovirale hautement active. Elle a été traitée à l\'aide de l\'acyclovir systémique et topique avec une résolution rapide des manifestations oculaires Keywords: maxillary, herpes zoster, HIV positive, cornea African Journal of Reproductive Health Vol. 11 (1) 2007: pp. 133-13

Ophthalmic Manifestations of Lymphoma

Background: Ophthalmic involvement in lymphoma is a relatively rare condition that can result from a primary intraocular lymphoma or an intraocular manifestation of systemic lymphoma. This report reviews the ophthalmic manifestations of lymphoma. Methods: Review of relevant information from journal articles and Internet search. Results: Almost all the structures in the orbit, adnexiae and eye can be involved in lymphoma. Lymphoma of the eye and adnexiae are most frequently of B lineage. Most of the ocular manifestations frequently masquerade as other more benign intraocular conditions including allergic or infectious conjunctivitis, uveitis, multiple evanescent white dot syndrome, acute retinal necrosis or herpetic retinitis. Correct diagnosis thus depends on a high index of suspicion and frequently requires radiologic imaging, histologic analysis, particularly vitreous biopsy or flow cytometry, subretinal aspiration and retinal biopsy. Diagnosis is often delayed and may lead to a fatal outcome. Recognition of its modes of presentation facilitates early diagnosis and treatment that may improve prognosis. Conclusions: It is important to review the ocular manifestations of lymphoma to assist the ophthalmologist to play a pivotal role in the prompt diagnosis and treatment of ocular lymphoma, and the haematologist/oncologist to recognize the need for a complete ophthalmic evaluation in the diagnosis, follow-up and management of lymphoma patients.Introduction: La participation ophtalmique dans lymphome est une condition rélativement rare qui peut être provoqué par lymphome intraoculaire primaire ou une manifestation intraoculaire du lymphome systématique. Ce rapport fait une rétrospective des manifestation ophtalmique du lymphome. Méthodes: Une rétrospective des informations pertinentes des articles dans les journaux et des recherches dans l&apos;internet. Résultats: Prèsque toutes les structures dans l&apos;orbite, adnexiae et l&apos;oeil peuvent participer dans lymphome. Lymphome de l&apos;oeil et d&apos;adnexiae sont le plus souvent du lignage B. La plupart des manifestations oculaires les plus souvent mascarade comme d&apos;autre conditions intraoculaire plus bénigne y compris des infections conjunctivite ou allergique, uveite, syndrome tacheté du blanc évanescent multiple, nécrose aigue rétine ou rétinite herpetique. Donc diagnostique correcte dépend d&apos;index plus élevé du soupçon et l&apos;imaging radiologique est très fréquemment éxigé, analyse histologique, la biopsie vitreouse en particulier ou bien écoulement cytométrie, aspiration sousrétine et la biopsie rétine. Le diagnostique est souvent rétardé et pourrait aboutir à un résultat sérieux. Réconnaissance de son mode de présentation facilitera un diagnostique précoce et un traitement qui pourrait améliorer la prognose. Conclusion: C&apos;est très important de faire une rétrospective des manifestations oculaires du lymphome afin d&apos;aider l&apos;ophtamologiste de jouer un rôle clef dans un diagnostique précoce et traitement du lymphome oculaire, et pour aider l&apos;hématologiste et oncologiste de réconnaitre le besoin pour une évaluation ophtalmique dans le diagnostique, des soins post-hospitaliers et la prise en charge des patients atteints du lymphome

CASE REPORT - Maxillary Herpes Zoster with Corneal Involvement in a HIV Positive Pregnant Woman

Corneal involvement in maxillary herpes zoster is very rare. This report presents the case of a 32 years old 7 months pregnant para2+1 female, who presented with vesiculopapular rashes with hyperpigmented crusts over the maxillary area of the face on the left side with periocular oedema, conjunctivitis and mild punctate keratitis in the left eye. She was HIV positive and was on treatment with the highly active antiretroviral therapy. She was treated with topical and systemic acyclovir with rapid resolution of the ocular features.Les herpès maxillaries de zona avec les atteintes cornéennes chez la femme enceinte séropositive L&apos;atteinte cornéenne dans les herpès maxillaries de zona est très rare. Le cas d&apos;une femme pare2+1 âgée de 32 ans et qui est enceinte de 7 mois, qui a présenté des éruptions papulovésiculeuses avec des croûtes hyperpigmentés à travers la région maxillaire à côté gauche du visage avec l&apos;oedème périoculaire, la conjuctivite, une kératite ponctuée faible dans l&apos;oeil gauche. Elle était séropositive et suivait un traitement à l&apos;aide de la thérapie antirétrovirale hautement active. Elle a été traitée à l&apos;aide de l&apos;acyclovir systémique et topique avec une résolution rapide des manifestations oculaires