Primary Open Angle Glaucoma And Intraocular Pressure In Patients With Systemic Hypertension

Objective: To investigate the association between Primary Open Angle Glaucoma (POAG), Intraocular Pressure (IOP) and systemic hypertension.Design: Cross-sectional, convenient and controlled study.Setting: Eye Clinic of the Lagos University Teaching hospital, Idi-Araba, Lagos, Nigeria. Subjects: Consecutive new patients with documented history of hypertension medication of over three months and current attendees at hypertension clinic of the same hospital were enrolled into the study.Results: A total of 150 hypertensive patients and 50 age-sex matched controls were studied. Age range of hypertensives was 34-54 years and controls 31-71 years. The mean age for hypertensive group was 56 years (±12.95) and controls 54.76 years (±9.65) p>0.1. The mean IOP was 28.45mmHg (±10.3) in hypertensive group and 15.2mmHg (±5.09) in controls (

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

Familiarity with modern health management trends by West African Surgeons

Objectives: To collate the self-reported assessment of familiarity with some aspects of managerial competencies on the part of some surgeons and their observations on the managerial environment of their health institutions and draw appropriate policy implications.Design: Cross-sectional study using a structured questionnaire.Setting: The study was conducted during the 50th Annual Scientific Conference of the West African College of Surgeons, which was held in Calabar, Nigeria, from 6th to It 12 th February 2010.Subjects: One hundred and ten out of 150 surgeons who were attending the conference returned their filled questionnaires.Results: Their familiarity with business and financial concepts was lacking on crucial ones related to marketing strategies. Respondent largely found the listed objections to advertisement of medical services as very appropriate. They preferred largely to interact with themselves in professional associations rather than with others in crossculturalgroupings. Funding (66.4%) and political/ethnic influences (43.9%) were rated as impacting very negatively on their health institutions, while the deployment of information communication technology to institutional processes was adjudged to be unsatisfactory.Conclusions: Most of the indices of core competencies in modern health leadership and management appeared deficient among our study participants and their health institutions managerial environments were equally deficient. We recommend for a well-focussed short time duration health management course for all physicians particularly specialists

Pattern of intraoccular pressure in Lagos

Objective: To study the pattern of normal intraocular pressure (IOP) in Lagos, Nigeria.Study Design: Prospective non-randomized uncontrolled hospital-based study.Methodology: Consecutive new patients coming into three different eye clinics between June and August 2001 had their IOP measured by applanation. The demographic characteristics and laterality of the IOP measured were documented. Excluded were: patients with glaucoma, ocular trauma, ocular surgery, ocular inflammation, retinal/choroidal detachment, family history of glaucoma, myopia; patients on corticosteroid or antiglaucoma therapy; patients who had had an anaesthetic administered; and patients with systemic diseases such as hypertension, diabetes and thyroid disease. Statistical testing of significance was done using the student t-test, and level of significance was taken to be p0.1). Mean IOP was 14.81mmHg for the right eye and 15.41mmHg for the left, and was not statistically significant (p>0.055). IOP increased with age from 13.85mmHg in the second decade to 16.21mmHg in the ninth decade.Conclusion: The IOP range and mean IOP values are similar to those from other studies. IOP generally increased with age, tending to drop slightly after the seventh decade in males but rising steadily in females. The sex of the patient and laterality of IOP did not have a significant effect on IOP.Keywords: intraocular pressure, glaucoma, intraocular pressure distributionNigerian Journal of Ophthalmology Vol. 13 (1) 2005: 1-

Intraocular Pressure Changes Post Selective Laser Trabeculoplasty in the Contralateral Untreated Eyes of Nigerian Patients With Primary Open Angle Glaucoma

Background: Glaucoma is the commonest cause of irreversible blindness in Nigeria and raised intraocular pressure (IOP) is the only modifiable risk factor. Selective laser trabeculoplasty (SLT), one of the treatment modalities, has been reported to have a cross-over effect on the fellow untreated eyes.Objectives: To determine the IOP lowering effect of SLT on the contralateral untreated eyes in patients with primary open angle glaucoma.Methods: This was a retrospective chart review of patients who underwent SLT at Guinness Eye Centre, Lagos from June 2011 – June 2012. Information on bio-data, diagnosis and modality of treatment were retrieved. Excluded were patients who had glaucoma surgery or needed additional medications. Each patient had SLT in one eye either as primary or adjunctive treatment. IOPs were measured post-operatively in both treated and untreated eyes at various time points using the Goldmann applanation tonometer. Data was analysed using paired and unpaired two-tailed t-test for comparison of means with level of significance set at p&lt;0.05.Results: Forty eyes of twenty subjects were included. 60% (12) were males and 40% (8) were females. The mean age was 48.9 ± 17.0 years (range, 23 – 74 years). Reduction in IOP from baseline was found in both the treated and the fellow untreated eyes at the various time points. Mean IOP reduction was maximal at 3 months; 8mmHg or 26% (p=0.024) in the treated eyes and 7mmHg or 25.9% (p=0.097) in the untreated eyes. Mean IOP reduction from baseline were 1.3 ± 5.9mmHg or 6.3% (P=.624) in the treated eyes and 2.9 ± 7.5 mmHg or 9.7% (P=.418) in the untreated eyes at 6months.Conclusion: This study shows that there is a sustained IOP reduction in the fellow untreated eyes following SLT in patients with POAG. In view of the retrospective nature of the study, small sample size, non-randomization and lack of control definite conclusions cannot be drawn from the findings.Keywords: Intraocular pressure, Selective laser trabeculoplasty, Primary open angle glaucom

An Appraisal of Asymptomatic Bacteriuria in Pregnancy-The Lagos State University Teaching Hospital Experience

Background Obstetric care aims at reducing maternal (and perinatal) mortality and morbidity making the identification and management of related risk factors, such as asymptomatic bacteriuria in pregnancy of paramount importance. This study aimed at determining the prevalence of asymptomatic bacteriuria in the booking antenatal patients as no such data exist for this centre. Methods Three hundred and fifty two (352) patients attending the antenatal booking clinic who had not used any antibiotic within the last 3 months prior to presentation were recruited into the study after informed consents were obtained. Having been taught the art of urine collection, a mid-stream urine specimen was taken and immediately plated on and cultured in Cysteine-Lactose Electrolyte Deficient (CLED) media and Mac-Conkey agar1 at the medical laboratory under aerobic condition at 370C. Results Out of the 352 patients in the study, 31 [8.8%] were excluded from the analysis because they had symptoms relating to the urinary tract infections. Among the remaining 321 patients whose urine samples were cultured, 36 [11.2%] samples yielded significant growth of bacteria (greater than 1x105 per ml of urine). Ninety seven (97) samples yielded mixed growths of organisms of no significance while there was no growth in 188 samples. The bacterial species identification showed a preponderance of Escherichia coli (48.5%). Discussion The finding of a prevalence of 11.2% for asymptomatic bacteriuria in the booking antenatal patients in this study shows that attention should be given to pregnant patients to prevent sequelae such as pyelonephritis in the mother and adverse fetal outcome. The high incidence of Klebsiella species (12.3%) is a cause for concern. Conclusion Proper surveillance will reduce maternal and perinatal mortality and morbidity. Keywords: Asymptomatic bacteriuria, booking antenatal patients, pregnanc

Vernal keratoconjunctivitis at Guinness eye centre, Luth (A five year study)

No Abstract

Ocular Findings in Acquired Immunodeficiency Syndrome Patients in Lagos, Nigeria.

Background: There is paucity of studies on the prevalence and pattern of ocular complication in HIV patients in developing countries where 90% of all HIV sufferers live. Most studies were carried out in industrialized countries and are not representative of the spectrum of ocular complication of HIV and it's prevalence in developing countries.Objective: To determine the prevalence of ocular disorders in adult (&gt;15 years ) AIDS patients at PEPFAR clinic in Lagos, Nigeria.Material and Methods: All consecutive adult Seropositive HIV/AIDS patients of PEPFAR Clinic at the Lagos University Teaching Hospital between February 1st - March 15th 2008 were enrolled into the study Cross sectional and non randomized, convenient study was used. Biodata and medical history were recorded on interviewer administered questionnaire. Participants were examined according to standard protocol comprising visual acuity, intraocular pressure, anterior segment examination with slit lamp biomicroscopy, dilated fundoscopy and fundus photograph where necessary. PCV, CD4+ count, viral load at diagnosis, stage of HIV disease were extracted from patients' records. Details of drug were regimen also recorded. Data analysis was performed with EPI-Info 6.04 version; Chi square and student t test used to describe statistical association.Results: A total of 400 patients were studied. Male:female ratio was 1.7 and mean age was 40 years (S.D.+ 9.12). Ocular disorders seen in 78.5% of patients; HIV related ocular disorders occurred in 45 (11.3) patients. Conjunctival microvasculopathy 166 patients (41.5%), pingueculum in 114 (28.5%), pterygium in 76 (19.0%), refractive error in 93 (23.3%), cataract in 12 (3.0%), and 22 (5.5%) Glaucoma suspects. HIV retinopathy and allergic eye disease in one patient each (0.3%). Presumed Cytomegalovirus retinitis 7 (1.8%), 14 (3.5%) Toxoplasmosis, 8 (2.0%) HZO, and 15 (3.8%) Presumed Squamous cell carcinoma. Eighty six (21.5%) of the patients had no abnormality. 91.4% of eyes examined had visual acuity with best correction of &gt; 6/18. CD4+ in 79.3% of the patients was &gt;200cells/ul and &lt;5% had counts&lt;50cells with an overall mean of 406cell/ul. 375 (93.8%) patients were on Highly Active Antiretroviral therapy (HAART), and 25 (6.2%) were not.Conclusion: Study revealed low prevalence of HIV related ocular disorders. This could be due to few patients at low level of immunosuppresion where the infections occur.Keywords: Aids, Ocular Manifestation, Prevalenc

A comparison of the NEIVFQ25 and GQL-15 questionnaires in Nigerian glaucoma patients

Chigozie A Mbadugha, Adeola O Onakoya, Olufisayo T Aribaba, Folashade B AkinsolaGuinness Eye Centre, Department of Ophthalmology, Lagos University Teaching Hospital, Lagos State, NigeriaAim: To compare two vision-specific quality of life (QOL) instruments &amp;ndash; the disease-specific 15-item Glaucoma Quality of Life questionnaire (GQL-15) and the nonglaucoma-specific 25-item National Eye Institute Visual Function Questionnaire (NEIVFQ25).Methods: The QOL of 132 glaucoma patients being managed in Lagos University Teaching Hospital and an equal number of controls matched for age and sex was assessed using two vision-specific instruments: GQL-15 and the NEIVFQ25. The categorization of the severity of glaucoma into mild, moderate, and severe disease was determined using the degree of visual field loss. The Statistical Package for the Social Sciences (version 15; SPSS Inc, Chicago, IL) software program was used for analyzing the data obtained. Spearman&amp;rsquo;s correlation coefficients were used to assess the correlation between the scores from the two questionnaires.Results: Patients had the greatest difficulty with activities affected by glare and dark adaptation in the GQL-15. Driving and general vision were the factors most affected in the NEIVFQ25. The Spearman rho values showed strong correlations (rho &amp;gt; 0.55) between the NEIVFQ25 and GQL-15 QOL scores for the total number of participants (rho: &amp;ndash;0.75), total number of cases (rho: &amp;ndash;0.83), and the mild (rho: &amp;ndash;0.76), moderate (rho: &amp;ndash;0.75), and severe (rho: &amp;ndash;0.84) cases. There was a moderate correlation (rho: &amp;ndash;0.38) for QOL scores of controls. Cronbach&amp;rsquo;s alpha was 0.94 for the GQL-15 and 0.93 for the NEIVFQ25, showing high internal consistency for both questionnaires.Conclusion: The GQL-15 and the NEIVFQ25 questionnaires showed high internal consistency, correlated strongly with each other, and were reliable in the assessment of glaucoma patients in this study.Keywords: primary open-angle glaucoma, quality of life questionnaires, GQL-15, NEIVFQ2

Pattern of Conjunctival Masses Seen At Guinness Eye Centre Luth Idi-Araba

Background: Conjunctival masses are growth on the surface of the outer eye; which may represent benign or malignant transformations.Objective: To determine the pattern of presentation of conjunctival masses at the Guinness Eye Centre (GEC), Lagos University Teaching Hospital (LUTH) Idi-Araba over a 13 year period (Jan 1995- Dec 2007).Method: A retrospective review of the clinical notes of all patients that presented to GEC with conjunctival masses during the study period was carried out. The bio-data, clinical features, stage, laterality and associated features of the masses were noted. The diagnosis, treatment and complications of treatment were also recorded.Results: Case notes of 612 eyes of 393 patients were included in the study. There were 219 (55.7%) males, 174 (44.3%) females with ages ranging from 4-85years with a male to female ratio of 1.26: 1. Three hundred and eightyeight patients (98.7%) presented as elective cases to the outpatient department while 5 (1.3%) presented as emergencies on account of associated ocular inflammation. There were 220 (56%) bilateral masses while 44% were uniocular. Pterygium was the leading conjunctival mass affecting 548 eyes (89.5%) of 329 patients. Pingueculae occurred in 53 eyes (8.7%), conjunctival cysts in 5 (0.8%) eyes, neoplastic growths in 3 (0.5%) eyes, conjunctival granulomas in 2 (0.3%) eyes and limbal teratoma in 1 (0.2%) eye. Most of these patients defaulted from surgery as only 141 eyes (23%) of 121 patients had surgery. Post-operative complications occurred in 33 eyes (5.4%) of 30 patients. The commonest postoperative complication was pterygium recurrence which occurred in 18 eyes of 15 patients.Conclusion: Pterygium was the commonest conjunctival mass and preventive strategies need to be advocated. Prevention of recurrence remains a challenge in the management of pterygium as recurrence after surgical excision occurred in 13.2% of eyes. Our study however did not confirm outdoor occupations as a risk factor for pterygium.Key words: Conjunctival masses, pterygium, pingueculu