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. Key Words: Aetiology, blindness, Benin City Annals of African Medicine Vol.3(2) 2004: 87-8

Intermediate Term (3-6 Years Post Surgery) Outcome of Keratoprosthesis in 5 Nigerian Eyes

Objective: The aim of this study is to report on the intermediate (3-6 years post surgery) outcome of keratoprosthesis implant surgery in Nigerian eyes. Methods: This is a descriptive study of 5 eyes of 5 consecutive Nigerian patients that had keratoprosthesis at University of Benin Teaching Hospital and DDS Eye Surgery, Benin City, between February 1994 and May 1995. The 5 eyes were followed up for 3-6 years. The visual acuity and observed complications were monitored in each eye. Results: All the patients in this study were male, with an age range 30 to 76 years and a mean age of 42 years. Preoperatively, one eye had corneal decompensation following cataract extraction, while the other 4 eyes had scarred and vascularized cornea from various causes; all 5 eyes had light perception (LP) vision pre-operation. Post-operatively, the 5 eyes had VA ranging from 6/60 to NLP, after a variable follow-up period of 3-6 years. Complications included development of tough vascularized retroprosthetic membrane (4 eyes) and infective endophthalmitis in one eye. Conclusion: The intermediate-term outcome of keratoprosthesis surgery in Nigerian eyes shows that it is unsuitable, largely because of the problem of retroprosthetic membrane. Keywords: keratoprosthesis, retroprosthetic membrane, corneaNigerian Journal of Opthalmology Vol. 15 (2) 2007: pp. 39-4

A review of the changes in the ophthalmic and visual system in pregnancy

Pregnancy is often associated with ocular changes which may be more commonly transient but occasionally, permanent. It may be associated with the development of new ocular conditions, or can exacerbate pre-existing conditions. The ocular effects of pregnancy may be physiological or pathological or may be modifications of pre-existing conditions. Adnexial changes include chloasma, spider angiomas and ptosis. Anterior segment changes include a decrease in conjunctival capillaries and an increase in the granularity of conjunctival venules and in corneal curvature, changes in corneal thickness, refractive index, accommodation and refractive errors, and a decrease in intraocular pressure. Posterior segment changes include worsening of diabetic retinopathy, central serous chorioretinopathy, increased risk of peripheral vitreochorioretinal dystrophies and retinal detachment, and a beneficial effect on non-infectious uveitis. Systemic disorders of importance include preeclampsia, Graves disease and multiple sclerosis. Intracranial disorders with ocular effects in pregnancy include Pseudotumor cerebri, prolactinomas and Sheehan’s syndrome (Afr J Reprod Health 2008; 12[3]:185-196)

Indications for Surgical Removal of the Eye in Irrua, Nigeria

Objective: To determine the reasons for removal of the eye at the Irrua Specialist Teaching hospital, Irrua, Edo State, southern Nigeria. Method: A retrospective study of all cases of enucleation and evisceration carried out over a 10-year period – July 1997 to June 2007 – at the Irrua Specialist Teaching Hospital. Data from theatre records and case notes were analysed with respect to age, sex, interval between onset of symptoms and presentation, indications for surgery and type of surgery done. Results: A total of 42 patients had enucleation or evisceration during the period, accounting for 6.96% of all ophthalmic surgeries (603) over the same period. Eight eyes were enucleated (19.05%) and 34 eyes were eviscerated (80.95%). There were 21 males (50%) and 21 females (50%). The most common reason for removal of the eye was a ruptured globe secondary to severe ocular trauma (35.71%). This was followed by panophthalmitis (26.19%) and intraocular tumours (9.52%). Forty patients (95.2%) presented after one week of onset of ocular lesions; 20(47.6%) had used traditional eye medication, and 4 (9.5%) had used eye drops containing corticosteroids. Conclusion: Health education programmes aimed at increasing public awareness on dangers of self medication, the use of native medication and the need to present early to hospital are highly recommended. Also, protective goggles and helmets with plastic facial coverings are recommended for workers who are at risk for eye trauma. Keywords: eye, enucleation, evisceration, NigeriaNigerian Journal of Ophthalmology Vol. 16 (1) 2008: pp. 16-1

Safety and effectiveness of primary transscleral diode laser cyclophotoablation for glaucoma in Nigeria.

IMPORTANCE: To investigate the safety, effectiveness and follow-up rates after transscleral diode laser cyclophotocoagulation as primary treatment for seeing eyes with primary open angle glaucoma in Bauchi, Nigeria. BACKGROUND: There is a high prevalence of primary open angle glaucoma in Africa where adherence to medical treatment and acceptance of surgery are poor. DESIGN: Prospective case series. PARTICIPANTS: New glaucoma patients where surgical intervention was recommended. METHODS: A diode 810 nm laser G-probe was used under retrobulbar anaesthesia to deliver approximately 20 shots for 2000 ms, titrating the power. If both eyes were treated the first was the study eye. Repeat treatment offered if the intraocular pressure (IOP) was >21 mmHg on two consecutive visits. MAIN OUTCOME MEASURES: IOP < 22 mmHg, change in ≥2 lines of Snellen visual acuity (VA), and complications. RESULTS: 201 out of 204 eyes with complete data analysed. Mean age 52 years, 17 (8.3%) eyes were re-treated. Mean pre-treatment IOP was 39 (SD 11) mmHg. 106 (53%) attended at 12 months when the mean IOP was 19 (7-45) mmHg; 77 (73%) had IOP < 22 mmHg. VAs were better in 13 (12.3%) and worse in 23 (21.7%) eyes. Postoperative complications included mild uveitis (5.5%), corneal oedema (2.5%), severe uveitis (0.5%) and transient hypotony (2.0%). No hypotony at 12 months. CONCLUSIONS AND RELEVANCE: Transscleral diode laser cyclophotocoagulation controlled IOP in almost three quarters of eyes at 12 months with short-term preservation of vision and minimal complications. Poor follow-up in this setting highlights the need for an effective, safe and acceptable treatment where regular follow-up is less critical

Anterior segment intraocular metallic foreign body causing chronic hypopyon uveitis

Intraocular foreign body (IOFB) is a common association of penetrating ocular trauma. Early diagnosis and removal of IOFBs especially if they are metallic is very important to determine further management and the final result of treatment. Missed IOFB may present in different clinical aspects that may limit its detection and symptoms may only become apparent after a prolonged period of time. We report a case of a missed metallic intraocular foreign body in the anterior chamber over a 2-year period without causing severe inflammatory reaction and presented with uveitis later. A 42-year-old man presented with a progressive blurring of vision, pain, photophobia, and redness in the left eye for 3 months. He had a history of traffic accident 2 years ago and he was accepted to intensive care unit for 3 days. Three months ago, in another center, he was admitted to hospital for 1 week and intravitreal antibiotics and medical treatment were given for pain, photophobia, and redness in his left eye. In five o’ clock meridian of the angle, there was an IOFB coated with hypopyon was observed under biomicrocopic magnification. Plain X-ray and computed tomography confirmed the foreign body in the left eye. After obtaining informed consent from the patient, the foreign body was removed under local anesthesia

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)

A Review Of The Choice Of Therapy In Primary Open Angle Glaucoma

We are in the midst of a therapeutic revolution and the choice of therapy in the management of glaucoma can no longer be based on long-held beliefs. The choice between medical, surgical and argon laser trabeculoplasty as primary therapy for glaucoma has been a matter of debate and research for many years. Arguments are based mainly on 3 factors: efficacy, safety and cost. In Africa, other factors that must be considered include acceptability of surgery, compliance with medical therapy, scarcity and expense of modern drugs, absence of laser facilities among others. It is generally accepted that trabeculectomy surgery is the most acceptable form of therapy in Africans mainly because of its efficacy, late presentation and problems encountered during medical therapy. However many African patients are reluctant to have surgery for glaucoma mainly because of fear and the fact that there will be no visual improvement after the surgery. There are now several potent modern drugs, which though expensive have acceptable safety profile, and fewer problems with compliance. The decision on the choice of therapy should be individualized and not be based on long-held beliefs.Key Words: Therapy, glaucoma, choiceNigerian Journal of Clinical Practice Vol 8(1) 2005: 29-3

Glaucomatocyclitic Crisis In Edo State, Nigeria: Report Of Two Cases

Objective: To report two classical cases of glaucomatocylitic crisis in tertiary Health Centres in Edo State, Nigeria Method: Two cases of glaucomatocylitic crisis seen at Irrua Specialist Teaching Hospital, Irrua, and University of Benin Teaching Hospital, Benin City, both in Edo State, Nigeria are reported. Diagnosis was based on typical history and findings on examination. Results: The first was a female who presented in December 2002 at Irrua Specialist Teaching Hospital and the second was a male who presented at the University of Benin Teaching Hospital, in March 2004. Both presented with blurring of vision in the affected eye and seeing halos around light. The intraocular pressures in the affected eyes were markedly elevated, there were fine keratic precipitates in the corneal endothelium of the involved eyes and the optic discs and visual fields were normal. Repeated episodes of the symptoms confirmed the diagnosis of glaucomatocyclitic crisis. Conclusion: This report shows that typical cases of glaucomatocylitic crisis occur in Nigerians but require a high index of suspicion for the diagnosis. Keywords: Glaucomatocylitic crisis, Posner-Schlossman syndrome, Nigeria Nigerian Journal of Clinical Practice Vol. 11 (2) 2008: pp. 162-16