Risk Factors for Couching Practices in Plateau State, Nigeria: Results from a population-based survey

Aim: To assess the trend and risk factors for couching practices among individuals aged 50 years or more in Plateau State, Nigeria.Method: A population-based, cross-sectional survey. Multistaged stratified random sampling, with probability proportional to size was used to select a representative sample of the state. The study instrument was thestandardized Rapid Assessment of Cataract Surgical Services (RACSS) pro-forma. Records of participants who had their eye(s) couched were analysed for age at time of couching, duration of involvement in couchingpractice prior to the survey, senatorial district of residence, visual outcome in the couched eyes and use of glasses.Results: Four thousand, one hundred and fifteen persons were examined (coverage: 98%). One hundred and nineteen (2.9%) persons had had cataract surgery before the survey. Of these, 27 (22.7%) persons had couched eyes. Eight (6.7%) persons had both eyes couched. Couching practice increased significantly with age from 7.4% at the age of 50-54 years to 29.6% at the age of 65-69 years, (p<0.01). Couching practice was lowest in Plateau North Senatorial District with 2 (4.2%) couched eyes, and highest in Plateau Central Senatorial District with 28 (58.3%) couched eyes (p<0.01).Conclusions: The elderly and those who live far from the state capital are more at risk of being involved in couching practices. The findings from this study have revealed an urgent need for ophthalmologists in PlateauState to increase practical, effective and safe surgery to underserved communities in the state.Key words: cataract, couching, risk factor

Site of trabeculectomy and control of intraocular pressure: a preliminary report

Background/Objective: To determine the extent to which the site of trabeculectomy affects the extent of drop in intraocular pressure in an African population. Methods: A prospective study involving 54 eyes randomly allocated to a nasal, central and temporal trabeculectomy group and followed up for a period of six months. Results: The nasal group had consistently lower intraocular pressures though there was no statistically significant difference between the groups. A good number of patients were lost to follow up. Conclusion: Surgeons performing primary trabeculectomy should consider the nasal site leaving the easily accessible temporal and central sites for repeat trabeculectomies when the need arises. Key Words: Trabeculectomy, intraocular pressure, site, control Nig. J. of Surgical Research Vol.4(3-4) 2002: 94-9

Preoperative Biometry in Jos

Purpose: To assess the accuracy of preoperative biometry in predicting emmetropia and evaluate the visual outcome following cataract surgery with intraocular lens (IOL) implantation in eyes that had biometry.Methodology: This is a hospital based retrospective study of eyes that had preoperative biometry at the Jos University Teaching Hospital, Jos in Plateau State, north-central Nigeria from February 2005 to January 2007.  Children, patients with complicated and traumatic cataracts, patients with coexisting ocular morbidity, patients with difficult keratometry and patients with grade 3 intraoperative complications were excluded from the study. The SRK II formula was used in determining the IOL power necessary to achieve emmetropia. The visual outcomes at discharge and at 1 week as well as the refraction results at 6 weeks were all recorded. The accuracy of biometry was determined at 6 weeks.Results: Five hundred and sixty eight eyes had cataract extraction during the study period but only 300 eyes (53%) of 286 patients met the study criteria and were analysed. One hundred and sixty five eyes (55%) had documented refractions at 6 weeks. Sixty one percent of eyes refracted were within ±1D of the intended refraction while 88% were within ± 2D. Proportion of eyes with a good outcome increased from 40% before correction to 83% with correction at 6weeks.Conclusion: Preoperative biometry in Jos achieved a fairly good degree of accuracy. Retraining of residents who perform biometry as well as periodic monitoring of the accuracy of measurements is recommended for better results

Problems Of Managing Retinoblastoma In Jos University Teaching Hospital – A 6 Year Review Of Cases

Aim: To review the cases of retinoblastoma patients who presented to Jos University Teaching Hospital during the 6year period, between 1997 to 2001 and to determine the problems in managing the patients. Methods: Patients records were retrieved from the library. Information on age, sex, clinical presentation, past medical history, family history, clinical examination, laboratory results and treatment received before and after presentation. A total of 27 cases of patients were reviewed. Results: 27 cases were reviewed out of which 20 (74%) presented with fungating mass and proptosis. Leukocoria was seen in 5 (18.52%) and only 2 (7.41%) patients presented with poor vision and redness. Late presentation was seen in 15 (55.55%) patients. This was attributed to visits to peripheral clinics by 18 (66.67%) patients and to alternative healers by 14 (51.58%). Only 8 (29.63%) patients benefited from surgery and cytotoxic drugs. The two years survival rate was 3.7%. Conclusion – Ignorance of the disease, inadequate health education, poor financial status of most patients, late presentation to the hospital contributed to high mortality KEY WORDS: Retinoblastoma, Problems, Management Highland Medical Research Journal Vol.2(1) 2004: 49-5

Eyelid Injuries: A Nine Year Review Of Management

BACKGROUND: Eyelid injuries are usually associated with injury to the eyeball therefore they are mostly reported along with such injuries. This report is a review of cases of eyelid injuries managed in the Jos University Teaching Hospital (JUTH), Jos Central Nigeria. PATIENT AND METHOD: This is a retrospective study of patients with eyelid injuries that were managed over 9 years. The information obtained from the patient's case notes included demographic data, cause, location and type of injury as well as the object responsible for the injury and modality of treatment. RESULT: Sixty six patients with eyelid lid injuries were managed. Fifty seven were males and 9 were females giving a male: female ratio of 6.3:1. The age ranged from one year to 62 years with a mean of 24.8 ± 13.4 years. Thirty percent of the patients were within the third decade of life. There were 36 (54.5%) cases of laceration, 20 (30.3%) cases of abrasions/bruises and 7 (10.6%) cases of avulsions. Road traffic accidents were responsible for most of the injury (27.3%) followed by fights/assault (21.2%) and sports/recreation activities (18.4%). The most frequent objects associated with the injuries were metals (41.0%), fist/feet (13.6%), stone (12.1), and wood (10.6%). There were more injuries to the upper eyelid, while eyeball trauma was the most common associated injury. Twenty three (34.9%) patients who were managed conservatively had no need for suturing or reconstruction. Flaps were used for reconstruction in three (4.5%) patients while direct closure was undertaken in forty (60.6%) patients where such closure will not impair eyelid function. CONCLUSION: Eyelid injury can occur with or without extensive trauma to the eyeball. The upper eyelid is commonly affected and complex reconstruction may be required in cases with extensive injury. KEYWORDS: Eyelid injury, causative factor, repair, reconstruction Nigerian Journal of Orthopaedics and Trauma Vol.3(2) 2004: 118-12

Cataract burden and uptake of cataract surgical services: Results from a population-based survey.

Background: Global estimates suggest that approximately two thirds of the blind population are females. Cataract accounts for over half of all blindness worldwide. Surgery is curative. However, in many parts of Sub-Saharan Africa, people have limited access to services. We estimated the burden of “operable cataract” and assessed for any gender inequality in the uptake of cataract surgical services.Method: Using a multi-staged stratified random sampling with probability proportional to size, three local government areas in Plateau state were selected. The study instrument was the Rapid Assessment of Cataract Surgical Services (RACSS) Proforma.Results: 4115 persons were examined (coverage: 98%). Prevalence of “operable cataract” (VA <6/60 in the better eye) was 3.3%, more among females 78 (3.6%) than males 57 (2.9%). Prevalence of unilateral “operable cataract” was 7.2%. The Cataract surgical coverage (persons) was 43.8%, among males it was 49.1% and for females 39.1% ( p>0.05.) The burden of cataract would have been reduced by 28.1% if the CSC was equal for both genders.Conclusion: The burden of cataract is high; uptake of services is low especially among females.Keywords: Epidemiology, Africa, Surgery, Gender, Ocula