Gonioscopy skills and techniques.

All glaucoma patients must undergo a thorough gonioscopy examination as part of their ophthalmic assessment

Airbag related ocular injuries: a short case series

Airbags are designed to protect occupants of motor vehicles from injuries in the event of a crash but have been implicated in some serious ocular injuries after road traffic accidents (RTAs). Diagnosis of airbag related ocular injuries requires a high index of suspicion. Using a retrospective hospital‑based, noninterventional study design, we evaluated the frequency and severity of airbag‑related ocular injuries in patients presenting with ocular trauma to the eye clinic over a 4 years period. The case notes of patients managed for varying degrees of ocular injuries over a 4 years period in an eye clinic were reviewed. Patient demographics, the cause of injury, type of vehicle, speed, specific ocular structures injured, visual morbidity, and visual outcome were assessed. An 150 cases were identified and enrolled in the study. Only 8 (5.3%) of them were victims of RTAs. Airbag deployment was the mechanism of injury in 2 (1.33%) patients. Details of these two patients are reported. There was bilateral involvement in the two patients that had airbag‑related ocular injuries. Each of the patients sustained a ruptured globe in one eye, and one of them became bilaterally blind from airbag‑related ocular injuries. Airbag‑related ocular injuries can be very severe, and this mechanism of injury should be considered during the assessment of victims of RTAs with ocular injuries.Keywords: Airbag injuries, ocular trauma, road traffic accident

Comparison of intraocular pressure reduction of initial and adjunct selective laser trabeculoplasty for primary open angle glaucoma in Nigerians

Objective: The objective was to compare the intraocular pressure (IOP) lowering effect of selective laser trabeculoplasty (SLT) as initial and adjunct therapy in primary open angle glaucoma (POAG).Subjects and Methods: Retrospective chart review of POAG patients who had SLT either as initial or adjunct therapy over a period of 1‑year. Each patient had SLT done in 360° of the anterior chamber angle. IOP measurement with the Goldmann applanation tonometer was done at baseline, 60 min post procedure, days 1, 7, 30, 90, and 180.Results: Mean baseline IOP was 15.4 ± 3.5 mmHg and 17.5 ± 5.5 mmHg for initial and adjunct, respectively (P = 0.153); not significant. Mean IOP at 90 days was 10.5 ± 1.8 mmHg and 16.2 ± 6.3 mmHg for initial and adjunct, respectively (P = 0.013); statistically significant. Records at 180 days revealed mean IOP of 14.1 ± 3.9 mmHg and 15.7 ± 7.7 mmHg (P = 0.465) for initial and adjunct, respectively; not significant. The maximal mean IOP reduction in both groups was at 7 days. 70% of patients in the initial had IOP reduction of >20% compared to 63.5% of adjuncts throughout the study period. Initial sustained mean reduction of ≥3 mmHg from day 1 to 90, while the adjunct was till day 30.Conclusion: Initial SLT showed a sustained reduction in IOP, compared to adjunct with marginally lower measurements.Keywords: Adjunct, initial, primary open angle glaucoma, selective laser trabeculoplast

Neo-vascular glaucoma: etiology and outcome of treatment in Lagos

Objective: To determine the causes and the intraocular pressure (IOP) outcome of neo-vascular glaucoma at the Guinness Eye Centre of the Lagos University Teaching Hospital, Lagos, Nigeria. Materials and Methods: The case records of all patients with the diagnosis of neo-vascular glaucoma who presented at Guinness Eye Centre from January 1st, 2008 to December 31st, 2012 were reviewed. Information extracted from their records included the bio-data, eye affected, best corrected visual acuity, intra-ocular pressure, etiology of neo-vascular glaucoma, ocular co-morbidity, systemic co-morbidity and forms of treatment received. Cases of retinoblastoma were excluded from the study. Data were analyzed using the SPSS V.17.1Results: A total of 31 cases of neovsacular glaucoma were reviewed. The male to female ratio was 1.8:1 and the age range was from 26 to 83 years. Patients aged 51 years or older were 22 (70.4%). The presenting best corrected visual acuity in the affected eye or in the worse affected eye was counting fi ngers in 30 (96%) patients. The presenting IOP was 30 mmHg or higher in 26 (83.2%). Both eyes were affected in three (9.6%) patients. Patients with diabetes mellitus, hypertension or both constituted 57.8% of the total number of patients. Primary open angle glaucoma and retina vein occlusion were the etiologies of neo-vascular glaucoma in 14 (45.2%) patients. A total of 15 (48.4) patients failed to turn up for repeat appointments. Only 5 (16.0%) patients (who received ocular medications, intravitreal bevacizumab and pan-retina photocoagulation) showed a significant IOP reduction.Conclusion: Late presentation, loss to follow up and lack of full and complete treatment regime were important findings in this study. A significant IOP reduction occurred with only in the patients who had a combination therapy of IOP lowering medications, intravitreal bevacizumab and pan-retina photocoagulation. A routine eye examination for patients at risk is essential for early detection and treatment in order to minimize visual loss in neo-vascular glaucoma.Keywords: Combination therapy, early detection, late presentation, neo-vascular glaucom

Comparative analysis of one year outcomes of selective laser trabeculoplasty versus argon laser trabeculoplasty in Primary Open Angle Glaucoma patients in Nigeria

Background: There are several challenges associated with trabeculectomy and medical management in Nigeria. This makes laser trabeculoplasty a viable option in glaucoma management. This study compares Selective Laser Trabeculoplasty (SLT) with Argon Laser Trabeculoplasty (ALT) in Nigerians with open angle glaucoma.Methods: This was a retrospective study performed on 26 eyes of 26 patients who had ALT and were recruited consecutively at the glaucoma clinic of the University College Hospital (UCH), and 25 eyes of 25 patients who had SLT recruited from the Guinness Eye Centre, Lagos University Teaching Hospital, Lagos (LUTH). The main outcome measure was intraocular pressure (IOP) at one month, three months, six months and one year. Success was defined as IOP reduction of 3mmHg or more without additional intervention (glaucoma surgery) from the pretreatment IOP.Results: The mean age of the patients who had ALT was 58.0±7.1 years (range of 40.0-70.0 years) while the mean age of patients who had SLT was 53.52 ± 14.65 years (Range 22 – 74 years). There was no statistically significant difference in IOP between the two groups at the different time periods. Based on our criterion for success, 84.5% of the patients had successful outcome at six months in the ALT group while 70.5% were successful in the SLT group (P=0.6). At one year, there was no statistically significant difference between the two groups on log rank test/Mantel Cox (Chi square 3.36, df=1, P=0.07.)Conclusion: This study highlights the efficacy and safety of both lasers in Nigerians and adds to knowledge that the adjunctive IOP reducing effect of both lasers is comparable in the short term in this indigenous African population

Surgical output and clinic burden of glaucoma in lagos, Nigeria.

PURPOSE: To estimate the outpatient clinic burden and surgical workload related to glaucoma in Lagos, Nigeria. METHODS: A multicentre study involving the 2 tertiary eye institutions, 7 secondary eye centers with eye care facilities, and the largest private eye hospital in Lagos state, Nigeria. Data on outpatient department (OPD) visits were collected over a 4-week period, using a specially designed tally sheet. Theater records were examined in each hospital over a 1-year period (2009) for the number and types of glaucoma surgeries performed. RESULTS: A total of 6240 patients visited the OPD over the 4-week period, out of which 1577 (25.3%) were glaucoma patients. OPD visit per ophthalmologist were 274, 323, and 61, whereas glaucoma visits per ophthalmologist were 75, 70, and 23 in the tertiary, secondary, and private centers, respectively. Glaucoma surgeries constituted 8.6% of total surgeries (n=4050). Trabeculectomy with intraoperative 5-fluorouracil was the most common procedure (81.0%). Number of glaucoma surgeries per ophthalmologist per month in the tertiary, secondary, and private centers were 0.5, 0.9, and 1.4, respectively. Overall number of glaucoma surgery per ophthalmologist per month was 1. CONCLUSIONS: Glaucoma visits constitute a significant proportion of eye clinic visits in Lagos state, Nigeria, and therefore, necessary manpower, infrastructure, and equipments should be mobilized for its optimal management. Also, there is a relatively low output of glaucoma surgeries that needs to be further investigated and appropriate measures taken to manage it

Self-reported adherence rates in glaucoma patients in Southwest Nigeria

Context: Nigerian glaucoma patients have an aversion to surgery and often rely on medical therapy to prevent disease progression. For medical therapy to be effective, the drugs have to be used as prescribed. Compliance has been reported to be low in the previous Nigerian studies. Aims: To evaluate the adherence rates of primary open angle glaucoma (POAG) patients on medical therapy using patient self-report. Settings and Design: A hospital-based cross-sectional design was used to assess consecutive POAG patients attending a glaucoma clinic in a Tertiary Hospital in Lagos, Nigeria. Subjects and Methods: Self-reported adherence was evaluated by trained interviewers. Comprehensive clinical assessment including intraocular pressure, gonioscopy, visual field assessment, and dilated binocular funduscopy using the slit lamp and + 78D fundus lens was done. Statistical Analysis Used: Data analysis was done using MedCalc Statistical Software. Results: One hundred and fourteen patients reported adherence rates ranging from 10% to 100% with a mean adherence rate of 82.33% ± 19.25%. Only 31 respondents (27.2%) reported 100% adherence. Duration of the disease was the only significant factor on multiple regression analysis. Conclusions: The development of strategies to improve compliance and persistence in glaucoma patients is crucial for the reduction of disease progression and blindness

Risk factors associated with Amblyopia among primary school pupils in Kosofe Town, Lagos State, Nigeria

Aim: To investigate the risk factors associated with amblyopia among primary school pupils in Kosofe town, Lagos State, Nigeria. Materials and Methods: A descriptive, cross-sectional, school-based study was conducted, in which a multistage random sampling technique was employed for recruiting the children. Data were collected using self-administered questionnaires by the parents or caregivers and from detailed ocular examinations performed by the investigators. Data analysis was performed using the IBM Statistical Package for Social Sciences software version 20.0.Results: A total of 1702 children participated in the study, with over 90% of the children being aged 4–10 years. Most (78.5%) of the mothers were aged 20–39 years at childbirth, and the mean age was 30.5 ± 7.8 years. Amblyopia was detected in 24 (1.41%) children. Following multivariate logistic regression analysis, children whose mothers had no formal education at childbirth had an 11-fold greater risk of having amblyopia [odds ratios (OR)=11.25, 95% confidence intervals (95% CI)=1.25–1.49], while those with birth weight <2500 g were 10 times more likely to have amblyopia at the time of examination (OR=10.15, 95% CI=0.70–0.90). In addition, children with a positive family history of crossed eyes had an eightfold greater risk of having amblyopia (OR= 8.14, 95% CI =0.24–0.46).Conclusion: Mother’s educational qualification at childbirth, low birth weight, and a positive family history of crossed eye were found to be strongly associated with the development of amblyopia.Keywords: Amblyopia, primary school pupils, risk factor

Practice of external ocular photography among Ophthalmologists in Nigeria, sub-Saharan Africa

Background: External ocular photography (EOP) has become an essential tool in the day-to-day practice of ophthalmology as it entails the imaging of the external eye, ocular adnexa, face, and the anterior segment of the eye. The aim of this study was to assess the practice of EOP among  ophthalmologists in Nigeria with a view to providing baseline information that will be useful in the advancement of ophthalmic practice.Materials and Methods: An online cross-sectional survey among practicing ophthalmologists in Nigeria. Information regarding reasons for external photography, type of camera, ownership of camera and barriers to external photography were obtained. The data obtained were analysed using IBM Statistical Package for the Social Sciences version 22.0 software for Windows (IBM Corp., Armonk, NY, USA).Results: A total of 183 out of 355 ophthalmologists completed the survey (51.5% response rate), with a mean age of 43.9 ± 8.1 years. Of the  respondents, 84.7% use EOP in their practice with 53.6% making use of smartphones. Indications for the use of EOP were documentation (71.0%), teaching purposes (54.2%), patient’s communication (47.1%), and  surgical/treatment planning (45.8%). Among the users of EOP, 87.1% obtained consent and only 5% use written informed consent. There is an association between obtaining consent and younger years in practice (P=0.005). Conclusion: The use of EOP is high among ophthalmologists in Nigeria and with its increasing popularity comes the need for ethical and medicolegal considerations, especially in oculoplastic practices. Most importantly,  whenever the effective concealment of patient’s identity and privacy cannot be guaranteed during clinical photography, the use of oral consent may be inadequate.Keywords: External ocular photography, Nigeria, ophthalmologist, practice, Sub-Saharan Afric