Comparison of Ocular Biomery in Primary Open Angle Glaucoma and Non-glaucoma in South West Nigeria.

Background: Glaucoma is a public health problem in Nigeria. The number of individuals affected by glaucoma in Nigeria is much higher than the individuals known to have the disease. Ocular parameters such as intraocular pressure, central cornea thickness, axial length and refractive error have all been documented as risk factors of glaucoma especially among Caucasians and African Americans, with little documentation in Africa where there's an alarming rate of blindness. Aim and Objectives: To compare central cornea thickness (CCT), intraocular pressure (IOP), axial length (AL) and refractive state in participants with primary open angle glaucoma (POAG) and non-glaucoma in South-West Nigeria. Materials and Methods: This hospital-based case-control study was carried out among 184 newly diagnosed POAG and non-glaucoma adult participants attending the outpatient clinic of Eleta eye institute. The CCT, IOP, AL and refractive state were measured in each participant. Test of significance between proportions in categorical variables were assessed using chi square test (χ2) in both groups. The means were compared using independent t-test while correlation between parameters were analyzed using Pearson correlation coefficient. Results: The mean age of the POAG participants was 57.16 + 13.3 years and the mean age of the non-glaucoma participants was 54.15 + 13.4 years. The mean IOP in the POAG group was 30.2 + 8.9mmHg while non- glaucoma group was 14.2 + 2.6mmHg (P < 0.001), other ocular parameters were not significantly different in both groups. In the POAG group, decreased spherical equivalent refractive error (i.e increasing myopia) was significantly associated with increased axial length (r= -0.252, P = 0.01), but not significant in the non- glaucoma group. However, in the non-glaucoma group, central cornea thickness increased with increasing intraocular pressure (r= 0.305, P = 0.003), which was not significant in the glaucoma group. Conclusion: Patients with POAG had much higher IOP and thus, IOP remains a significant risk factor in its development. There was a significant relationship between refractive state and axial length in the POAG group while a significant relationship was identified between central cornea thickness and intraocular pressure in the non- glaucoma group.

Visual outcome after cataract surgery at the university college hospital, ibadan.

AIM: The aim of this study was to determine the visual outcome of patients who had cataract surgery in the University College Hospital Ibadan. METHODOLOGY: This is an observational descriptive, longitudinal study of consecutive patients undergoing cataract surgery at the University College Hospital conducted between May and October 2007. A total of 184 patients who presented to the hospital and met the inclusion criteria were recruited into the study. Patients were examined preoperatively, 1st day postoperatively and 8th week postoperatively. RESULTS: The mean age was 66.5 years; and the male to female ratio was 1.2:1. Preoperatively, 137 patients (74.5%) were blind in the operated eye, while 39 patients (23.6%) were blind in both eyes at presentation. At 1st day postoperatively, 87 patients (47.3%) had pinhole visual acuity of 6/6-6/18. Best corrected vision after refraction eight weeks postoperatively showed that 127 patients out of 161 patients (78.8%) had good vision while 28 patients (17.4%) had borderline vision, and six patients (3.8%) had severe visual impairment after refraction. The number of bilaterally blind patients also reduced from 39 (23.6%) to one (0.6%). Uncorrected refractive error was the commonest cause of poor vision prior to refraction. Glaucoma was the commonest ocular co-morbidity accounting for poor vision in 9.1% of patients eight weeks after cataract surgery. CONCLUSION: This study demonstrates that good results can be obtained with cataract surgery and intraocular lens implantation in the developing world. More attention should be directed towards ensuring that successful outcomes are indeed being realized by continued monitoring of postoperative visual outcomes and prompt refraction for all patients.

Visual Outcome after Cataract Surgery at the University College Hospital; Ibadan

Aim: The aim of this study was to determine the visual outcome of patients who had cataract surgery in the University College Hospital Ibadan. Methodology: This is an observational descriptive; longitudinal study of consecutive patients undergoing cataract surgery at the University College Hospital conducted between May and October 2007. A total of 184 patients who presented to the hospital and met the inclusion criteria were recruited into the study. Patients were examined preoperatively; 1st day postoperatively and 8th week postoperatively. Results: The mean age was 66.5 years; and the male to female ratio was 1.2:1. Preoperatively; 137 patients (74.5) were blind in the operated eye; while 39 patients (23.6) were blind in both eyes at presentation. At 1st day postoperatively; 87 patients (47.3) had pinhole visual acuity of 6/6-6/18. Best corrected vision after refraction eight weeks postoperatively showed that 127 patients out of 161 patients (78.8) had good vision while 28 patients (17.4) had borderline vision; and six patients (3.8) had severe visual impairment after refraction. The number of bilaterally blind patients also reduced from 39 (23.6) to one (0.6). Uncorrected refractive error was the commonest cause of poor vision prior to refraction. Glaucoma was the commonest ocular co-morbidity accounting for poor vision in 9.1of patients eight weeks after cataract surgery. Conclusion: This study demonstrates that good results can be obtained with cataract surgery and intraocular lens implantation in the developing world. More attention should be directed towards ensuring that successful outcomes are indeed being realized by continued monitoring of postoperative visual outcomes and prompt refraction for all patients

Visual impairment from age-related cataract among an indigenous African population.

AIM: To determine the magnitude of visual impairment (VI) resulting from lens opacity/cataract among a rural population in southwestern Nigeria. METHOD: A population-based cross-sectional survey using a multistage sampling method to select subjects >or=50 years. Participants with pinhole visual acuity of

Case control study of dry eye and related ocular surface abnormalities in Ibadan, Nigeria.

BACKGROUND: Tear instability is associated with symptoms of ocular discomfort and irritation. Many patients with dry eyes remain untreated due to improper diagnoses. OBJECTIVE: To identify symptoms and surface abnormalities associated with dry eyes. MATERIALS AND METHODS: One hundred and fifty-six eyes of 78 subjects attending the Eye Clinic of the University College Hospital Ibadan were screened for dry eyes/tear instability using rose Bengal stain (graded 0-9), tear break-up time (TBUT), Schirmer's 1 tests, tear meniscus height and a standardised symptoms questionnaire. Grades 4-9 rose Bengal staining were considered as positive dry eye and were compared with grades 0-3 staining eyes as negative controls. RESULTS: Mean tear meniscus height, Schirmer's test and TBUT were lower among cases than their corresponding control eyes. The difference between the mean Schirmer's test values of cases and their controls were statistically significant (P = 0.00 for right eyes and P = 0.002 for left eyes). Rose Bengal grades were inversely correlated with the mean Schirmer's values (Pearson correlation -0.429, P = 0.05 for right eyes and -0.335, P = 0.03 for left eyes) and TBUT (Pearson correlation -0.316, P = 0.05 for right eyes and -0.212, P = 0.06 for left eyes). About 95.8% of the cases were symptomatic, as opposed to 70.4% of the controls (P = 0.01, Fisher's exact test) and 95.8% of dry right eyes compared to 61.1% of their controls had ocular surface abnormalities (P = 0.001), while 89.5% of dry left eyes compared to 62.7% of controls had surface abnormalities (P = 0.07). CONCLUSION: A close relationship exists between ocular irritation symptoms, surface abnormalities and functional evidence of tear instability. Such patients should be treated empirically or screened for dry eyes.

Upper lid skin bacterial count of surgical eye patients in Ibadan, Nigeria.

Infective endophthalmitis can follow contamination from eyelid of surgical eye patients. Information about peri-ocular skin bacterial isolates and their determinants would help in planning appropriate interventions. This study aimed to determine the upper lid skin bacterial count and factors related to high counts if any, among surgical eye patients. A cross section of consenting new surgical eye patients seen at the Eye clinic of the University College Hospital Ibadan between May and July 2006 was studied. They were interviewed with a standard questionnaire, and swab of the upper eyelid skin taken. Specimens were Gram-stained, bacterial counts and culture were carried out using standard techniques. A total of 80 subjects were studied, age range 13 to 87 years (mean 57.8 +/- 15.8) years. Females were 42 (52.5%) while males were 38 (47.5%). Bacterial culture was obtained from 76 (95.0%) of those studied, with 24 (30.0%) having Staphylococcus aureus sensitive to gentamycin and amoxicillin + clavulanic acid combination while 52 (65.0%) had coagulase negative Staphylococcus. The mean bacterial count was 218 +/- 321 colony forming units (CFUs) per ml. Higher bacterial counts (> 50 CFUs per ml) were found amongst non-literates, patients older than 60 years of age, and male gender. Older age and male gender remained significantly associated with a high bacterial count using the logistic regression model (OR = 4.9, P = 0.03 and OR = 8.06, P = 0.005 respectively). The conclusion reached was that risk of having positive bacterial culture from the upper lid skin increases with older patient age and male sex of eye surgery patients. Adequate care should be taken to ensure proper skin preparation of elderly and male patients to prevent contamination of operation site.

The effect of timolol maleate on tear film break-up time in Nigerians.

The aim of this study was to evaluate the effect of Timolol maleate on tear film break-up time in a Nigerian population. 192 eyes of 96 subjects were examined in a hospital based case-control study after being administered pre-coded questionnaires. The mean tear film break-up time was measured. There was significant difference (t = 10.164, P < 0.001) in the mean break-up time of cases (10.45 secs) and controls (30.18 secs). Half of the cases had some ocular discomfort with the instillation of Timolol maleate, a significant number of them having just been commenced on the medication (chi2 = 8.889, P = 0.003). Long-term instillation of Timolol maleate impairs tear film stability. The ocular discomfort experienced by patients on Timolol may contribute to poor drug compliance observed in patients on chronic drug therapy. Regular screening of patients on Timolol maleate for tear film instability and dry eyes is important and drug manufacturers should explore the possibility of incorporating artificial tears in Timolol maleate preparation.

Tear break-up time in eyes with pterygia and pingueculae in Ibadan.

BACKGROUND: Ultraviolet (UV) rays and chronic irritation to dust have been implicated in the pathogenesis of degenerative conditions of the cornea and conjunctiva like pterygium and pinguecula. It has been postulated that exposure to these environmental factors cause corneal and conjunctival drying by disruption of the tear film. While some researchers have found tear film dysfunction in eyes with pterygia and pingueculae, others have found no such abnormalities. The differences in findings may be due to different methods of investigation, or differences based on geography and climate. STUDY DESIGN: The tear film has been studied using tear break-up time (TBUT) in adults with pterygia and pingueculae disorders, TBUT was measured in 73 eyes with pterygia and 74 eyes with pinguecula and were compared to TBUT in 74 eyes of age and sex matched normal controls. Abnormal TBUT was defined as TBUT less than 15 secs. Unstable tear film was defined as TBUT less than 10 secs. RESULTS: The mean TBUT was lower in eyes with pterygia (17.90 secs) than in control eyes (19.86 secs), although the mean difference was not statistically significant. Abnormal TBUT, defined as TBUT less than 15 secs, was found in 29 eyes out of 73 eyes with pterygia (39.7%), compared with 13 eyes out of 74 eyes with pingueculae (17.6%) and in 17(23.0%) of 74 control eyes (X2 = 10.01, df = 2, P = 0.0006). A TBUT of less than 15 secs was more significantly associated with eyes with pterygia compared to control eyes. Unstable tear film (TBUT less than 10 secs) was found in 12(16.4%) eyes with pterygia, compared to 4(5.4%) eyes with pingueculae and 4(5.4%) control eyes. Unstable tear film was significantly associated with eyes with pterygia (P = 0.027). CONCLUSION: Tear film abnormalities are associated with pterygium but not with pinguecula in the subjects studied. TBHT may vary in different populations.

5-fluorouracil vs. beta-irradiation in the prevention of pterygium recurrence.

The aim of this study was to compare 5-fluorouracil (5-FU) with beta-irradiation in the prevention of pterygium recurrence. A retrospective non-randomised review of cases of fleshy pterygium treated with bare scleral excision and adjuvant 5-FU were compared with similar morphologically appearing pterygia, matched for age and sex, treated with bare scleral excision and adjuvant beta-irradiation. All surgeries were carried out at the university college hospital and Ojulowo eye hospital, Ibadan, Nigeria. Twenty-seven eyes of 24 patients who had pterygium excision with adjuvant treatment with 5-FU were compared with 31 eyes of 24 patients who were treated with excision and beta-irradiation. The mean age for the 5-FU group was 46.1 years while that for the beta-irradiation group was 46.9 years. Both sexes were equally represented, 12 males and 12 females. There were seven (25.9%) initial recurrences in the 5-FU group but four of these became atrophic, and therefore, cosmetically acceptable leaving three eyes (11%) with unacceptable recurrent pterygia. The beta-irradiation group, however, had seven (22.5) initial recurrence but five of these became atrophic and fell short of the cornea, leaving two (6.5%) with clinically unacceptable recurrence. The difference was, however, not statistically significant (Zc = 0.74 and p > 0.1). The associated complications were mostly mild in both groups and included cornea opacity of 10 (37%) complications, conjunctivitis of three (11%) complications, sclera granuloma of three (11%) complications and conjunctiva necrosis of one (3.7%) complication for the 5-FU group, and while the beta-irradiation group had corneal opacity of one (3.7%) complication and conjunctivitis of three (11%) complications. The non-statistical significance of a lower-pterigium recurrence rate with use of beta-irradiation for the treatment of fleshy pterygium compared with 5-FU may have been partly due to the small number of patients studied. A randomised-controlled study using a larger sample size is therefore proposed. However, the fact that over half of those with initial recurrence in the 5-FU group became atrophic (and therefore cosmetically acceptable) over time as well as less cost implication in the purchase of 5-FU relative to Strontium-90 association with few and mild complications makes it a desirable adjuvant therapy in depressed economies. However, beta-irradiation still has a place when cost issue is not an inhibiting factor in view of its clinically superior outcome.

Visual outcome of pressurised bottled drinks related eye injuries in Ibadan.

Records of 15 patients presenting with pressurised bottled drinks related eye injuries between January 1996 and 2001 were reviewed to identify factors contributing to accidental eye injuries from pressurised bottled drinks, reason for poor outcome and to make recommendations. In all, 16 eyes of 15 patients were studied out of which 7 were males (M:F, ratio 1:1.1). Age range, 3 years-49 years, mean 23.6 years. The majority of those affected were students 46.7%, and traders 26.7%. The commonest activity leading to injury was explosion during the process of arranging the bottles or crates of drinks (43.8%) and accidental fall of bottle from hand or height (37.5%). Drinks implicated include, Coca-cola 50%, beer 25%, others (Fanta, Legend stout, Mirinda, Grape juice) 25%. Complications arising from the injury included, hyphema 43.8%, vitreous haemorrhage 12.5%, and retinal detachment 12.5%. The globes were retained in 12 (75%) cases, 3 defaulted and one eye became phthisical. The final visual acuity was 6/18 or better in 25%, between 6/24 and 6/60 in 12.5% and less than 6/60 in 31.3%. The final visual acuities of three patients who were lost to follow up were unknown. Reason for poor visual outcome include severity of injury with resultant serious complications, and delay with instituting surgical treatment. Eye injuries resulting from exploding bottled drinks are potentially very serious and therefore best prevented. It is recommended that conversion of bottled drinks to canned or plastic containers be considered by the manufacturers. Greater care should be taken with the handling of bottled drinks by the sellers, factory workers and consumers. High risk occupations such as bottled drink sellers and factory workers may need to wear protective goggles during handling. Public health education on need to seek prompt and proper treatment as well as need for Government to institute the National health insurance scheme to cater for indigent patients.

Evaluation of the effectiveness of post-operative beta-irradiation in the management of pterygium.

A retrospective review of cases of pterygium excision using the bare sclera method followed by application of 2500-3500 rads of Sr 90 beta-radiation carried out between 1994 and the year 2000 at Ojulowo Eye clinic Ibadan and St Mary's Catholic Specialist Eye Hospital Ago-Iwoye, Nigeria. Follow up period was between six months and six years. A total of 124 eyes from 95 patients were operated. 58 (61.1%) were males and 37 (38.9%) were females. The youngest patient was 10 years old while the oldest was 89 years mean 46.1 +/- 2 STD of 13.5. Most pterygia were unilateral and nasal in location. Improvement in visual acuity of between 2-6 lines on snellen chart occurred in 6 (4.8%) of operated eyes. Recurrence necessitating repeat surgery and additional radiation occurred in 8 eyes (6.9%). The complications of surgery and beta radiation consisted of conjunctiva inflammation 10 (8.6%), cornea opacities 4 (3.2%), gritty sensation 3 (2.6), cataract 1 (0.8%). No case of sclera necroses was observed. Post-operative beta-radiation is safe and effective in preventing recurrence of pterygium.

Orbital histoplasmosis due to Histoplasma capsulatum var. duboisii: successful treatment with Septrin.

Four children with orbital histoplasmosis caused by Histoplasma capsulatum var. duboisii (one of whom had been unsuccessfully treated with amphotericin-B) were treated with a combination of trimethoprim and sulphamethoxazole (Septrin) and surgical drainage. All patients improved markedly during therapy with resolution of the lesions, and with no recurrence of infection in three patients, 1 year later. The fourth patient was lost to follow-up. Treatment was devoid of side effects. These findings clearly indicate that Septrin could be a safe alternative to amphotericin-B for the treatment of African histoplasmosis, especially in patients presenting with solitary or localized lesions.