Visual outcome of patients with pituitary adenomas following surgery and its contributory factors at a tertiary hospital in Ghana

BACKGROUND: Craniotomy and transphenoidal microsurgery are surgical options for treatment of pituitary adenoma at Korle Bu Teaching Hospital(KBTH). Despite major advances and reported success rates of transphenoidal resection globally, paucity of local data regarding visual outcome of either procedure exists. We evaluated the visual outcome of patient with pituitary adenoma following surgery in a tertiary hospital in Ghana. METHODS: This is a prospective study of 18 of 45 consecutive new patients with pituitary adenoma seen from November 2010 to July 2013 at Korle-Bu Teaching Hospital(KBTH), Accra, Ghana. Sixteen (88.9%) of the 18 had surgery by transphenoidal route and 2(11.1%) by craniotomy. All patients had macroadenoma (tumour size >1cm) and histological confirmation of diagnosis. Pre-operative and post-operative visual acuity and its relationship to tumour size and duration of symptoms before diagnosis were evaluated. RESULTS: Data on 18 patients aged 33-60 years, mean (SD) 45.9±8.5, was analysed. Eleven (61.1%) were females.Visual blur, 15(83.3%), and headache,13(72.2%), were predominant presenting complaints.Common neuro-ophthalmic signs included unilateral or bilateral optic atrophy, 17(94.4%), Relative Afferent Pupillary Defect (RAPD) in 8(44.4%) and impaired colour vision in 32 of 36(88.9%) eyes. Preoperatively, 8(22.2%) and 13(36.1%) of 36 eyes were visually impaired or blind respectively. Postoperatively, 6(16.7%) eyes were visually impaired and 17(47.2%) eyes blind. Blindness was associated with late presentation (p<0.005) and larger tumour width (p<0.036). CONCLUSIONS: More than a third of eyes of patients with pituitary adenoma were blind before and after surgery. Blindness was associated with late presentation and larger tumours. Transphenoidal surgery may be beneficial following early diagnosis to avoid irreversible blindness/visual impairment

Uniocular Blindness among Children in the Gambia

Background: Uniocular blindness in children though not uncommon has not been given prominence; as emphasis is placed on binocular blindness.Aim: To determine the common causes of uniocular blindness in children; and to suggest strategies for prevention.Methods: A prospective study involving children seen at the Eye Clinic of the Royal Victoria Hospital; The Gambia was undertaken; from the 1st December 1999 to 30th June 2000. All newly diagnosed cases of children who attended the clinic and were blind in one eye during the period of the study were included. A history was taken; visualacuity using age specific methods and ocular examinations were carried out. When necessary an examination under anaesthesia was performed.Results: Out of 470 children; 45(10) had uniocular blindness; 39(86) were aged 6-15years. The male - female ratio was 4:1. Common causes were trauma 28(62); uveitis 4(9); and corneal ulcer 3(7) . Others included congenital cataract; glaucoma and retinoblastoma.Conclusion: The commonest cause of uniocular blindness was ocular trauma. Focus should be directed towards the prevention; early referral and appropriate treatment of ocular trauma in children. Strategies for the prevention of childhood blindness would also be applicable to uniocular blindness in The Gambia

Prevalence and causes of blindness in the Congo

A population-based survey on the prevalence of blindness and eye disease has been conducted throughout the Congo. This was the first time such a survey had been carried out in a central African country with an equatorial climate. In comparison with data available from other African countries, the two rather unexpected characteristics resulting from the survey were lower blindness prevalence rates and the extremely rare cases of bilateral corneal scarring. In accordance with sampling procedures recommended by the WHO Programme for the Prevention of Blindness, 7041 people were selected and examined. The prevalence of blindness (visual acuity less than 3/60 in the better eye) was 0.3% (5700 people). The prevalence of low vision (visual acuity between 6/24 and 3/60 in the better eye) was 2.1% (40,000 people). The major causes of blindness and low vision were cataract (81% and 80%, respectively) and glaucoma (9% and 3.4%, respectively). A total of 22,000 people in the Congo require cataract surgery. Almost four-fifths of the current burden of blindness in this country is potentially curable through the provision of cataract surgery and aphakic glasses