Ocular complications of malaria treatment

Malaria is endemic in Nigeria. With the emergence of chloroquine resistance various modes of treatment including parenteral quinine are employed with consequent untoward effects. This article reports two cases of severe ocular toxicity, including mimicry of intracranial space‑occupying lesion, from treatment of malaria with various drugs including quinine. Medical practitioners are advised to exhaust other less toxic modes of therapy before using drugs with great potential for severe untoward effects such as quinine. Keywords: Eye, malaria, quinineNigerian Journal of Clinical Practice • Jan-Mar 2012 • Vol 15 • Issue

Initial Experience with Bevacizumab (AvastinTM) in the Treatment of Neovascular Age-related Macular Degeneration in Nigerian Patients

Objective: To report on the early experience with the treatment of neovascular AMD with intravitreal injection of bevacizumab (Avastin) in Nigeria. Materials and Methods: Eight eyes (7 patients) with neovascular AMD who met the inclusion criteria were treated with intravitreal 1.25mg bevacizumab between September 2008 and May 2009. Injections were given every 4-6 weeks. In total, 2–4 injections were given. One patient had bilateral treatment. All the patients were regularly followed up until December 2009. Results: The presenting visual acuity ranged from light perception (LP) to counting fingers (CF). In 2 patients (2 eyes) their visual acuity improved 2 weeks after injection from CF to 6/36 and remained stable for 4 months. In another 2 patients (2 eyes) acuity improved from LP to CF. In yet 2 other patients (4 eyes) the visual acuity remained unchanged (HM in 2 eyes; CF in 2 eyes) after 9 months and 4 injections. Clinically the subretinal blood was observed to resolve, albeit slowly, in all the patients within 2 months from the start of treatment. Conclusions: This preliminary experience suggests that intravitreal bevacizumab is safe and beneficial in Nigerian Africans with neovascular AMD. However careful patient selection, regular follow up and aseptic injection techniques are advised when treating these patients.Key words: age-related macular degeneration, vascular endothelial growth factor (VEGF) inhibitors, Nigeri

Survey of Cataract Surgical Techniques in Nigeria

Objective: To determine the techniques of cataract surgery as currently being practiced by ophthalmologists in Nigeria. Materials and Methods: A self-administered questionnaire was administered to practising ophthalmologists in Nigeria, selected by simple random sampling. Information sought included the type of cataract surgery performed and how often performed; the type of IOL (if any) used; mode of after-surgery care; and availability of biometry and YAG laser facilities. Results: Of the 90 ophthalmologists selected, 84 returned the questionnaire, giving 93.3% response rate. All the ophthalmologists perform cataract surgery. The more frequently employed techniques were the ECCE/IOL (73.8%) and SICS/IOL (29.8%); 2.4% occasionally perform phacoemulsification, while 26.2% occasionally perform intracapsular cataract extraction without intraocular lens implant. Ambulatory (day case) surgery was practiced by 20.2%. The PMMA lenses were most commonly used IOL (94.1%). Only 47.6% of the ophthalmologists have access to ocular biometry and YAG laser was available only to 10.7%. Conclusions: This survey suggests that the most popular cataract surgery technique in Nigeria at present is the wide incision ECCE/IOL and facilities for biometry and Nd:YAG laser are not commonly available. It is recommended that ophthalmologists in Nigeria upgrade both surgical techniques and instrumentation for better post-operative visual outcome for cataract patients.Key words: cataract, surgical techniques, Nigeri

Age-related macular degeneration in Onitsha, Nigeria

Objectives: To determine the incidence, pattern and ocular morbidity associated with age-related macular degeneration (AMD) at the Guinness Eye Center Onitsha Nigeria.Materials and Methods: The case files of all new patients aged 50 years and above seen between January 1997 and December 2004 were reviewed. The files of patients with AMD were further studied. Information on age, gender, occupation, duration of symptoms, type of maculopathy, visual acuity, ocular and systemic co-morbidities were abstracted into a standard proforma and analyzed using the chi-square test, student t-test and confidence interval estimation.Results: Two hundred and fifty-six of 7966 (3.2%) new patients had AMD; M:F = 2:3; 60 -79 year age group constitute 70% of the cases. Non-neovascular AMD occurred in 210 (82%) patients with 182 (71.1%) having early AMD and 28 (10.9%) geographic atrophy. Neovascular AMD occurred in 46 (18%) patients. AMD was bilateral in 221 (86.3%) patients. Most patients presented late. Systemic co-morbidities were hypertension and diabetes; the main ocular comorbidities were cataract and glaucoma. Thirty-four (13.3%) patients were bilaterally blind and130 (50.8%) had bilateral visual impairment. Of the blind patients 13(38.3%) had neovascular AMD and 6 (17.7%) had geographic atrophy. This makes AMD the cause of blindness in 7.4% of the patients. An affected eye was more likely to have low vision than an unaffected eye (95%CI: 0.07, 0.21; P<0.05); persons aged 70 years and above were more likely to be blind (χ2 – 7.26, df -1; P<0.05); females were also more likely to be blind than males (t – 2.857, df – 8; P<0.05) and neovascular AMD significantly causes more blindness than the non-neovascular type (95% CI: 0.11, 0.37; P<0.05).Conclusions: AMD was the main cause of blindness in 7.4% of the patients. Treatment facilities including low vision aids for AMD patients should be provided in eye hospitals in Nigeria. Health education of the public highlighting the risk factors for AMD should be mounted as part of Vision 2020 programme in Nigeria. A community based study is required to fully define the epidemiologic characteristics of AMD in Nigerians

Pattern and Risk Factors for Retinal Vein Occlusion in Onitsha, Nigeria

Objectives: To determine the pattern and risk factors for retinal vein occlusion at the Guinness Eye Center, Onitsha, Nigeria. Materials and Methods: Case files of all patients with retinal vein occlusion between May 1997 and April 2004 were reviewed. Information on age, sex, visual acuity, ocular complications and associated risk factors were abstracted into a standard proforma and analysed. Results: 45 patients (48 eyes) were seen with a mean age of 58 years; range - 41-77 years. There were 16 (35.6%) male patients and 29(64.4%) female patients. Thirty-eight (84.4%) patients (40 eyes) had central retinal vein occlusion (CRVO), 7 (15.6%) patients (8 eyes) had branch vein occlusion (BRVO), and 29 (60.4%) eyes (all CRVO) had ischaemic vein occlusion. Twenty-eight (58.3%) eyes were blind, while 18 (37.5%) had visual impairment. Twenty-five (55.6%) patients had hypertension, 10 (22.2%) were diabetic and 10 (22.2%) had glaucoma. Conclusions: Retinal vein occlusion is an important retinal vascular disease that causes visual loss. The incidence of the disease could be reduced if the associated risk factors were detected and treated early. A prospective study was carried out to clearly identify the modifiable risk factors for the disease in our environment. Keywords: retinal vein occlusion, incidence, pattern, risk factors, NigeriaNigerian Journal of Ophthalmology Vol. 16 (1) 2008: pp. 30-3

Herpetic Eye Disease in a Public Eye Hospital in Nigeria

Objective: To determine the aetiology, pattern and complications of herpetic eye disease seen at the Guinness Eye Centre, Onitsha, Nigeria. Materials and Methods: The case files of all patients with herpetic eye disease who presented at the centre between January 1998 and December 2003 were reviewed. Information on age, sex, aetiological diagnosis, visual acuity, ocular complications and HIV status were abstracted into a standard proforma and analysed. Results: Sixty-two patients (64 eyes) – 35 male and 27 female – were seen. Age range was 14 months to 80 years. Thirtyone (50%) patients (32 eyes) had herpes simplex keratitis, 30 had cytomegalovirus retinitis. Twenty-nine patients were HIV positive. Fifty per cent of the affected eyes had low vision. Common ocular complications were: corneal opacity (20 patients); herpetic neuralgia (9 patients); uveitis (8 patients); and superimposed bacterial infections (6 patients). Conclusions: Herpetic eye disease is an important cause of ocular morbidity. Herpes zoster and cytomegalovirus infections, especially in young people, should raise the suspicion of coexisting HIV infection. Corneal scarring is the most common complication of the disease and requires keratoplasty to restore vision. Keywords: herpetic eye disease, Onitsha, NigeriaNigerian Journal of Opthalmology Vol. 15 (2) 2007: pp. 35-3

The anterior chamber angle width in adults in a tertiary eye hospital in Nigeria

Objective: The objective was to determine the anterior chamber angle width in adult Nigerian patients seen at the Guinness Eye Center Onitsha Nigeria.Materials and Methods: Consecutive new adult patients (aged ≥21 years) seen between March and July 2006 were the subjects of this study. Exclusion criteria included refusal to consent to the test, previous intraocular surgery that could distort the angle integrity and anterior segment pathology precluding the visualization of the angle. Each patient had visual acuity assessment, visual field analysis, ophthalmoscopy, intraocular pressure measurement, refraction, and gonioscopy. The angle grading was by the Shaffer method.Results: Of the 328 patients (648 eyes), aged 21–85 years (median age 59 years), 195 (59.5%) were females and patients older than 50 years constituted 64.9%. Gonioscopy showed that 245 eyes (37.8%) had wide open angles (grades III and IV); 227 (35.0%) had grade II angles; 176 (27.2%) had narrow angles (grade I or slit), 9 of which were deemed occludable. Of the 80 patients with chronic simple glaucoma, 20 (25%) had at least grade III angle; 34 (42.5%) had grade II angle; and 26 (32.5%) had grade I angle. Peripheral anterior synechiae were observed in three eyes. Compared with nonglaucomatous eyes, the angles of the glaucomatous eyes were significantly narrower (P <0.01). Similarly patients older than 50 years were more likely to have narrower angles (P < 0.001). However there was no significant difference between the angle width of male compared to female patients (P >0.05).Conclusions: A little more than a third of adult patients seen in our hospital have wide open angles; a third of the glaucoma patients usually taken as open angle cases actually have very narrow angles some of which are occludable. A population-based study is therefore recommended to clearly define the epidemiologic characteristics of glaucoma including the anterior chamber width in different parts of Nigeria

Incidence and risk factors for traditional eye medicine use among patients at a tertiary eye hospital in Nigeria

Objective: To determine the incidence and risk factors for traditional eye medicine use among patients at the Guinness Eye Center Onitsha, Nigeria.Materials and Methods: Consecutive new adult ophthalmic patients seen at the Guinness Eye Center Onitsha between January and April 2007 were interviewed on the use of traditional eye medicines and the type of traditional eye medicine used.Results: Of the 500 patients interviewed, 66 (13.2%) had used traditional eye medicines (TEM). The 66 patients, aged 18-84, were made up of 32 males and 34 females. The commonly used TEM were liquid from plant leaves and roots and other concoctions of unknown origin. Conjunctivitis and cataract constituted 54.5% of the ocular problems; 15(22.7%) patients had visual impairment while 5(7.6%) other patients were blind. Risk factors for TEM use include age above 50 years (P<0.001); residence outside Onitsha metropolis (P<0.001) or ≥25 kilometres away from our hospital (P<0.02) and lack of any formal education (P<0.02). Decision to use TEM was not affected bygender (P>0.05); chronic nature (P>0.05) or painfulness of the ocular disease (P>0.05).Conclusions: Traditional eye medicine is highly patronized by the people. Health education programmes with emphasis on safe eye care practices need be intensified in traditional healers and among the groups at risk

Retrobulbar versus subconjunctival anesthesia for cataract surgery

Objectives: To compare the effectiveness, in terms of pain relief and akinesia of retrobulbar and subconjunctival an aesthesia during cataract surgery and also to compare the degree of postoperative ptosis associated with each technique.Materials and Methods: Consecutive adult patients undergoing cataract surgery between March and June 2008 at the Guinness Eye Center Onitsha, were randomized into retrobulbar and subconjunctival an aesthesia by simple random sampling. Patients’ subjective perception of pain was graded into none, mild, moderate and severe; eyeball movement during surgery was graded into none, slight, moderate excessive. Two weeks after surgery, the palpebral fissure width was measured with the metre rule to determine the degree of post-operative ptosis.Results: Of the 90 patients studied, 55 (61.1%) patients had subconjunctival an aesthesia while 35(38.9%) had retrobulbar injection. In the retrobulbar injection group 25 (71.4%) patients had none or mild pains compared to 44 (80.0%) in the subconjunctival injection group; while 10 (28.6%) patients in the retrobulbar group experienced moderate to severe pains, 11 (20%) patients in the subconjunctival group had moderate pains and none experienced severe pains. But the difference in the degree of pain perception between the 2 groups is not statistically significant (χ2 = 0.01; df – 1; P>0.05). In the retrobulbar injection group, there was none or slight movement of the globe in 30 (85.7%) patients compared to 49 (89.1%) patients in the subconjunctival group. While 5 (14.3%) patients in the retrobulbar injection group had moderate globe movement, no patient in this group had excessive movement. In the subconjunctival injection group, 5 (9.1%) patients had moderate movement and 1 (1.8%) patient had excessive eyeball movement. The difference in the movement of the eyeball between the retrobulbar and the subconjunctival injections group was not significant (χ2 = 0.004; df – 1; P>0.05). In the retrobulbar injection group, the palpebral fissure width was within ≥10mm in 18 (51.0%) patients compared with 29 (53.0%) patients in the subconjunctival group. This difference was not statistically significant (χ2 = 0.0006; df – 1; P>0.05).Conclusions: Both retrobulbar and subconjunctival an aesthetic techniques are effective and safe for cataract surgery although the pain experience may be slightly more for patients being operated upon under retrobulbar anaesthesia

Outcome of cataract surgery in HIV-positive patients

Objective: To determine the visual outcome of cataract surgery in HIV-positive patients at the Guinness Eye Center Onitsha.Materials and Methods: The case files of HIV-positive patients who had cataract surgery at the Guinness Eye Center Onitsha between 2006 and 2014 were retrieved. Information obtained included socio-demographics, co-morbidities, pre- and post-operative visual acuity and surgical complications.Results: Twenty six eyes of 18 patients (7 males, 11 females); age range: 32-73 years; median – 51 years had cataract surgery. Preoperatively, 22 eyes (84.6%) had visual acuity <3/60; 6 months after surgery 17 (65.4%) had attained acuity ≥ 6/18, with 9 (34.6%) having acuity ≥ 6/6. Post-operative blindness and low vision were due to pre-existing co-morbidity, uveitis, endophthalmitis and posterior capsule opacity.Conclusions: The visual outcome of cataract surgery in HIV-positive patients is encouraging. However, the patients need to be regularly followed up post-surgery