Optic Disc Size in Glaucoma Patients Attending a Tertiary Institution in Nigeria.

Background: Assessment of optic disc size is an important component of optic nerve head examination which is often overlooked in the diagnostic evaluation for glaucoma. Measured values of optic disc size vary with the measurement technique utilized. The actual disc size varies with race and possibly other demographic characteristics. Disc size is also associated with variation of specific anatomical structures of the optic nerve head and the retinal nerve fiber layer. These disc size-dependent variations are risk factors for glaucoma or affect the likelihood of glaucoma diagnosis [1]. Aim: To report the clinical (measured by biomicroscopy) disc diameters of small, average and large optic discs and produce data on the disc sizes of Nigerian patients who have been diagnosed with glaucoma and are currently undergoing treatment. Materials and Methods: One hundred eyes of 100 glaucoma subjects were studied. Disc diameter was measured using stereo biomicroscopy (78 D). Discs were classified into small (<1.3 mm2), average (1.3-1.75 mm2) and large (>1.75 mm2) using the European Glaucoma Society Guidelines [2,3]. The relationship between disc size and age, sex and type of Glaucoma was also assessed. Results: One hundred eyes of 100 individuals were studied comprising 64 (64.0%) males and 36 (36.0%) females. Age range was 20- 80 years with a mean age of 50±13.66. Mean disc size was 1.99±0.239. Eighty-two percent of discs were large size (>1.75 mm2). Males (61%) had larger discs than females (21%) (p=0.001). There was no correlation between disc size and age (p=0.87) or clinical types of glaucoma (p=0.59). Conclusion: Majority had large optic discs in our study (82%). Large discs have large cup: Disc ratio. These differences must be considered while evaluating the optic disc to prevent over diagnosis of glaucoma and its attendant economic burden on the patient.

The Relationship between Body Mass Index and Intra-ocular Pressure in Port Harcourt Nigeria.

Background: There are conflicting reports regarding the relationship between body mass index (BMI) and intraocular pressure (IOP). There is a need to evaluate these contradicting findings in our environment. Aim: To examine the relationship between intraocular pressure and body mass index (BMI) in a population screened for glaucoma at the University of Port Harcourt, Nigeria Materials and Method: This study was part of a one-day screening exercise for glaucoma at the University of Port Harcourt. All subjects participated with willful consent. Demographic data included age, sex, race and occupation. Height was measured with a wall-mounted tape and weight with a bathroom scale. Intraocular pressure was measured with Perkins hand-held applanation tonometer and funduscopy was carried out with a direct ophthalmoscope. BMI was calculated as weight in kilograms divided by the square of height in meters (Weight/Height2). Results: A total of 491 subjects were screened. There were 230 males (46.8%) and 261 females (53.2%). About 50% (n=246/491) of the participants had normal BMI, 28.7%(n=141) were overweight while 17.7%(n=87) were obese. The mean BMI was 25.39 ± 4.82. Most obese participants were females (n= 63/87; 72.4%) while most males had normal body weight (n=131; 53.2%). The relationship between BMI and gender was statistically significant (P=0.00). The mean intraocular pressure of all participants was 16.21±5.01mmHg. Most overweight (88.6%; n=241/272) and obese persons (n=149; 87.6%) had normal IOP. There was however no statistically significant relationship between BMI and IOP (P=0.473; r2 =0.02). Conclusion: In a population screened for glaucoma at the University of Port Harcourt, Nigeria, we found no statistically significant relationship between BMI and intraocular pressure but there was a statistically significant relationship between BMI and age.

Visual and Auditory Complications of Chronic Myeloid Leukemia: A Case Report.

Hearing loss and visual impairment are not common presentations of Chronic Myeloid Leukemia (CML). We report such a case who presented in the chronic phase with profound hearing loss, visual impairment, progressively enlarging spleen, anaemia, and weight loss. Laboratory evaluation showed Packed Cell Volume – 10%, Total White Cell Count – 1,343 x 109/ L, Platelets – 589 x 109/ L. Blood chemistry showed Uric Acid level of 530mmol/L. Karyotyping showed the Philadelphia chromosome. Chemotherapy was instituted and she improved remarkably with minimal improvement in perception of sound.

Simple Vision Screening in Lower Primary School Children in Port Harcourt City

Background: Vision disorders are significant causes of morbidity worldwide and in children; can lead to life long visual impairment or blindness. Thus; the impact on a child's education and life if not detected and ameliorated on time; can constitute a huge socio-economic burden to the child; family and community. Aim: To determine the prevalence of reduced vision in lower primary school children in Port Harcourt city. Methods: A multi-staged sampling technique was used to select 1;234 lower primary school pupils from 12 schools in Port Harcourt for visual screening. Visual acuity (VA) measurements using Snelling's charts; and a basic eye examination using a pen torch was carried out in all the pupils. Vision was regarded as reduced if VA is 6/18; in which case a pinhole was presented to the affected eye and VA repeated; to check for presence of refractive error. Results: A total of 1;234 school children were screened; 73 pupils had reduced vision in one or both eyes giving a prevalence of 5.9. Refractive errors accounted for 72.6of cases of reduced vision. Gross external eye abnormalities accounted for 9.6of cases of reduced vision; with corneal opacity and nystagmus being the most commonly seen. Conclusion: Reduced vision is an important cause of visual disability in primary school pupils in Port Harcourt city; mostly due to correctable refractive errors. There is therefore a need for routine vision screening of all pupils; especially on commencement of school for early detection and treatment; to prevent life long visual disability

Prevalence of Glaucoma Suspects and Pattern of Intra-Ocular Pressure (IOP) Distribution in Ahoada-East Local Government Area of Rivers State

Background: Glaucoma is the commonest cause of irreversible blindness in the world. Some glaucoma patients start out as glaucoma suspects for years. Aim: To determine the prevalence of glaucoma suspects and pattern of intra-ocular pressure distribution in glaucoma suspects. Methods: This survey was carried out in Ahoada-East local government area (LGA) of Rivers State. The study took place in 6 communities in the LGA. Multi-stage sampling technique was used to select the study sample which consisted of 960 persons drawn from the 6 communities. Ocular examination was carried out and consisted of visual acuity; basic eye examination and direct funduscopy. Subjects with pathologically cupped discs or cup/disc asymmetry of ? 0.2 had their intra-ocular pressures (IOP) measured. Data was recorded primarily on the WHO/PBL eye examination form and entered into Epi-Info version 6 for analysis. Results: A total of 34 subjects who had vertical cup/disc ratio 0.5 had their intra-ocular pressures measured. Of this; 23 were glaucoma suspects. There were 15 males (65.2) and 8 females (34.8) and those aged 40-79 years made up 69.6of the study sample. Most eyes (97.8) had normal intra-ocular pressures (10-21mmHg) while one had an IOP of 8 mmHg. Out of 866 subjects; 23 were glaucoma suspects giving a prevalence of 2.7. Conclusion: Since glaucoma is a leading cause of irreversible blindness in the world; the availability of data on glaucoma suspects; the type of glaucoma they have and the age groups most at risk would facilitate early diagnosis and follow up thus preventing unnecessary blindness from glaucoma

Screening for Congenital Color Vision Deficiency in Primary Children in Port Harcourt City; Teachers' knowledge and performance

Background: One hundred and thirty teachers were studied to evaluate their knowledge of congenital Color Vision Deficiency (CVD); and their ability to perform the Ishihara color vision test; so as to determine if they can provide color vision screening services for their pupils. Methods: The teachers were randomly selected from 13 schools in Port Harcourt City (PHC) and given a six hours training workshop on vision disorders in children and congenital color vision screening. They were given a self administered pre and post test questionnaires before and after training respectively. Subsequently; they screened 1;300 of their school pupils for congenital vision deficiency using the Ishihara color vision chart; and their results compared to that of the research team. Results: Female teachers constituted 84.6and males 15.4of the study population. Seventy three teachers (53.8) were from public schools while 46. 2were from private schools. Prior to the training workshop; only 6.2of teachers had heard of the Ishihara color vision chart and none of the teachers could identify or knew how to use the chart. However with training there was significant improvement in knowledge of CVD. Comparison of the teachers' performance of color vision screening using the Ishihara chart to that of the research team showed a sensitivity of 67.6with a specificity of 99.1. The prevalence of congenital color vision deficiency in the 1;300 primary school screened was 2.6; with males having a significantly higher prevalence than females. Conclusion: The study thus concludes that congenital color vision deficiency is prevalent amongst primary school children in Port Harcourt City; and with training; teachers can effectively perform color vision screening; and as such modify their teaching methods to accommodate the child with color vision deficiency

Simplified and Safe Pterygium Surgery in Nigerians

Objective: To advocate a simplified and safe method of pterygium surgery to Ophthalmologists in Nigeria. Methods: After the routine standard preparation of the eyes for pterygium excision; 114 eyes that had the new procedure did not have the head of the pterygium shaved off the cornea with blade or knife in the usual standard manner; but was avulsed off the cornea unto the sclera . The cornea was then polished with the rough side of a broken ordinary razor blade. The pterygium was excised with a curved conjunctival scissors. Haemostasis and mitomycin C application were carried out in the usual standard manner. Results : All the 114 eyes that were operated using the new procedure had satisfactory cosmetic outcome of the pterygium excision and there was no complication encountered. Conclusion: The simplified method is both safe and effective for pterygium surgery

Bilateral Congenital Microphthalmos

Background: Microphthalmos ia a rare congenital anormaly of the eye. Aim: to report a case of microphthalmos in an otherwise normal neonate. Case report: A one-week-old full-term female neonate delivered by elective caesarian section to a mother who received ante-natal care in one of the choicest obstetric clinics in Port Harcourt is presented. The only congenital anomaly present was bilateral congenital microphthalmia. Conclusion: Microphthalmos is an uncommon condition whose management is very challenging. High motivation on the part of the parents can make the child live a fulfilled life and appear cosmetically acceptable

Live Adult Loa-Loa in the Anterior Chamber of a Nigerian female

Background: Live adult loa loa is not usually found in the anterior chamber of the eye. Where this occurs the diagnosis may be missed because of its rare occurrence. As such there has to be a high index of suspicion to be able to make a diagnosis of ocular loaiasis. Aim: To report a case of live adult loa-loa in the anterior chamber of the left eye of a 23-year-old Nigerian female and discuss the management and visual outcome following treatment. Setting: Department of Ophthalmology; University of Port-Harcourt Teaching Hospital; Port Harcourt. Case Report: A case report of live adult loa-loa in the anterior chamber of a 23-year-old Nigerian female is here presented. In May 2006; a 23 year old female presented at the Eye Clinic with a 3-week history of pain; itching and redness and a one-week history of poor vision in the left eye. Her presenting visual acuity was hand movement on the left and 6/5 on the right. She had a steamy cornea with a sluggishly reactive pupil and an elevated left intra-ocular pressure. An initial diagnosis of pan-uveitis with secondary glaucoma was made and patient commenced on treatment. Patient came back two days and a live adult loa-loa was extracted from the anterior chamber of the left eye. Patient's vision however remained at Counting Fingers despite aggressive treatment with topical and systemic steroids; and systemic diethylcabamazine. Conclusion: Ophthalmologist working in this environment should entertain loaiasis as a differential diagnosis of uveitis since it could masquerade as one and also know the current mode of treatment

Non-Laser Management of Post-Extraction Opacification of the Posterior Capsule

The objective of this study is to describe an alternative procedure to laser for the management of posterior capsule opacifications after extra capsular cataract extraction and posterior chamber intraocular lens implantation. Thirty-one patients with posterior capsule opacification had non-laser secondary capsulotomy. The procedure was performed with the aid of a 25 G capsulotomy needle through the opening of the peripheral iridectomy after injection of visco elastic between the posterior capsule and the intraocular lens. There was improvement in the visual acuity of all the patients and there was no significant intraoperative or postoperative complications. The technique described provides an alternative to Nd: yag Laser capsulotomy particularly in centers that do not have yag laser facilities

Autologous whole Blood Patch in Repair of Leaking Filtering Bleds : Case Report on Initial Experience

Aim: To show the value of autologous whole blood patch in the management of leaking filtering blebs in Nigerian eyes.Methods: Two male patients who had trabeculectomy and adjunctive application of mitomycin C subsequently developed leaking blebs at the University of Benin Teaching Hospital; Benin City; Nigeria. A 27-gauge needle was used to inject 0.75- 1.0ml of whole blood under the conjunctival buttonhole.Result: The procedure succeeded in arresting the bleb leak but the trabeculectomy failed after 7 and 10 months respectively. Repeat trabeculectomy using another site remained successful after 2 years and 18 months respectively.Conclusion: Autologous whole blood patch is successful in sealing leaking blebs complications following trabeculectomy

Age and sex distribution of blindness in Ahoada East Local Government Area; Rivers State; Nigeria

Background: Differences exist in the impact of blindness by age and sex; the overall risk of death being higher for blind males than females. Aim: To describe the age and sex differences among the blind in Ahoada-East Local Government Area (LGA) of Rivers State; Nigeria. Methods: Age and sex data were analyzed for 24 blind persons seen during a cross-sectional; community-based study of blindness in Ahoada East LGA. A total of 866 subjects were studied and ocular examination included visual acuity; pen torch examination; fundoscopy and applanation tonometry. Ages were estimated from historic events or verified using hospital/immunization cards. Results: Of the 866 subjects examined; there were 400 males and 466 females. Children and adolescents (0-19 years) formed 44.1while those = 60 years old were 16. Of the 24 blind persons; 21 (87.5) were over 60 years while 3 (12.5) were less than 50 years old; the difference in age among the blind was statistically significant (P 0.05). The age-specific prevalence of blindness in the study population increased from 0.6in adolescence to 38.3in those =90 years. The sex specific prevalence of blindness was 4.5for males and 1.3for females. Males were more likely to be blind than females (Relative Risk=3.49; 95CI=1.40-8.72). Conclusion: This study found blindness to be commoner in the older age groups; and the male gender appeared to be an important risk factor. Eye health education must target such vulnerable groups. Males especially should be enlightened on social habits and environmental factors that increase their risk