Cataract surgery in Ibadan, Nigeria: Visual outcome and post-operative refractive error

Background: Cataract is the leading cause of blindness worldwide and can be treated by various surgical techniques with good visual outcome.Objective: To describe the visual outcome and post-operative refractive status among patients who had cataract surgery in a tertiary centre.Methods: In a retrospective study, the demographic data, type of cataract, surgical procedure and complications, visual outcome and post-operative refractive status of the treated eye were retrieved from the hospital records of all adult patients who had cataract surgery.Results: Four hundred and sixty eyes of 456 patients (mean age 61.2 ± 17.3 years, Male: Female = 1.1: 1) had cataract surgery during the study period January 2012 and December 2014. The pre-operative visual acuity was < 3/60 in 415 (90.2%) eyes. All the surgeries were performed under local anaesthesia with 331 (72%) eyes undergoing extracapsular cataract extraction while 129 (28%) had small incision cataract surgery. Visual outcome in those who had a minimum of six weeks follow-up revealed unaided visual acuity of ≥ 6/18 in 185 (56.9%) eyes. Following refraction, 237 (72.9%) eyes had acuity of ≥ 6/18. Post-operative spherical refractive error ranged from ­6.75D to +4.50D (mean -1.61 ± 1.41D) while cylindrical error ranged from 0.00DC to 6.00DC (mean 2.33 ± 1.80DC). Pre-existing ocular problems contributing to poor post-operative visual outcome included glaucoma (50; 15.4%), and age-related macular degeneration (10; 3.1%). Conclusion: Extracapsular cataract extraction gave better visual outcome compared with small incision cataract surgery, but a higher incidence of post-operative cylindrical error was observed

Dry eye disease in an adult population in South-West Nigeria.

AIM: To determine the prevalence and factors associated with dry eye disease (DED) in an adult population in south-west Nigeria. METHOD: A descriptive cross-sectional community-based study was conducted among respondents aged 40 years and above. Questionnaires were administered on symptoms of DED, followed by ocular examination to elicit signs of DED by determining the tear film break-up time, corneal fluorescein staining score, and Schirmer I tests. Dry eye was diagnosed by the simultaneous presence of at least one symptom experienced "often or all of the time" and at least one sign in either eye. RESULT: The respondents (n=363; females 188) were aged 59.1±13.1years. The prevalence of DED was 32.5% (95% CI=27.7-37.3), and the most commonly reported symptoms were grittiness (53.4%, 95% CI=44.4-62.4) and burning/stinging sensation (48.3%, 95% CI=39.3-57.3). On multivariate analysis, DED was significantly associated with age (OR 2.89, 95% C.I=1.67-4.93, p<0.001) but not use of benzalkonium containing topical medications, previous ocular surgery, household fuel use, menopausal status and presence of pterygium. CONCLUSION: The outcome of the study shows that the prevalence of DED among adults above 40 years in south-west Nigeria is 32.5% and the associated risks include older age.

Comparison of Peribulbar with Posterior Sub-Tenon's Anesthesia in Cataract Surgery Among Nigerians.

PURPOSE: To compare the akinetic and the analgesic effects of peribulbar and posterior sub-Tenon's anesthesia in patients undergoing cataract surgery. METHODS: In a hospital-based randomized comparative interventional study, patients aged 50 years and above who underwent elective surgery for uncomplicated cataract were randomized to receive either peribulbar block or posterior sub-Tenon block. Pain during injection, surgery, and after surgery was assessed using numerical reporting scale (NRS). Limbal excursion was measured with a transparent meter rule. RESULT: A total of 152 eyes of 152 patients were studied. Peribulbar and sub-Tenon regional blocks provided comparable adequate akinesia (P = 0.06) and similar levels of analgesia (P = 0.10) during cataract surgery. Both techniques also provided similar levels of analgesia to the patient during injection and in the immediate postoperative period. Ninety-two percent of patients who had peribulbar and 97% of those who had sub-Tenon blocks reported either mild pain or no pain at all during surgery (P = 0.49). There was no report of severe pain in all patients during the stages of the surgery. Occurrence of chemosis and subconjunctival hemorrhage was more common in sub-Tenon than peribulbar anesthesia. CONCLUSIONS: This study shows that peribulbar and posterior sub-Tenon routes of administering anesthetic substances is comparable in providing adequate akinesia and analgesia for cataract surgery with minimal complications. Therefore, both techniques are effective and safe for cataract surgery among Nigerians.

Prevalence of presbyopia in a semi-urban population of southwest, Nigeria: a community-based survey.

Uncorrected presbyopia is a major cause of poor near vision in the developing countries. To determine the prevalence and demographic characteristics of presbyopia among adult populations (40 years and above) in a sub-urban population, southwest Nigeria, a population-based cross-sectional study was carried out from April to May 2014. A multi-stage sampling method was used to select eligible respondents. All participants had distance visual acuity assessment done and participants with visual acuity of less than 6/6 were refracted. Near vision was then assessed at 40 cm with distance correction in place if required. Information on near vision was obtained from the participants using interviewer administered questionnaires. Data collected were analysed using SPSS version 22. A total of 440 subjects aged 40 years and above were studied. Prevalence of presbyopia was 75 % and was significantly associated with increasing age. There was higher prevalence of presbyopia among females than males (76.3 % vs. 73.5 %), though not statistically significant. Also prevalence of presbyopia was not significantly associated with educational and occupational status in the study. This study demonstrated a high prevalence of presbyopia. There is need for improved awareness on presbyopia screening and available correction in the local government.

Survey of low vision among students attending schools for the blind in Nigeria: a descriptive and interventional study.

PURPOSE: The aim of this study is to determine the prevalence of low vision among students attending all the schools for the blind in Oyo State, Nigeria. The study set out to determine the proportion of students with low vision/severe visual impairment after best correction, to determine the causes of the low vision, to document the associated pathologies, to determine the types of treatment and visual aid devices required, and to provide the visual aids needed to the students in the schools. MATERIALS AND METHODS: All schools students for the blind in Oyo State were evaluated between August 2007 and January 2008. All the students underwent a thorough ophthalmic examination that included measurement of visual acuity, retinoscopy and subjective refraction, tests for visual aids where indicated, and a structured questionnaire was administered. RESULTS: A total of 86 students were included in the study and the mean age was 19.4 ± 8.19 years. Twenty six (30%) were under 16 years of age. The most common cause of blindness was bilateral measles keratopathy/vitamin A deficiency (VAD) in 25 students (29.1%). The most common site affected was the cornea in 25 students (29.1%), the lens in 23 (26.7%), and the retina/optic nerve in 16 (18.6%). Preventable blindness was mainly from measles keratopathy/VAD (29.1%). Eleven students benefited from refraction and correction with visual aids; two having severe visual impairment (SVI), and nine having visual impairment (VI) after correction. CONCLUSION: The prevalence of low vision in the schools for the blind in Oyo State is 2.3%, while the prevalence of visual impairment is 10.5%. These results suggest that preventable and treatable ocular conditions are the source of significant childhood blindness in Oyo State.

5-Fluorouracil versus mitomycin C as adjuncts to conjunctival autograft in preventing pterygium recurrence.

To compare the efficacy of 5-fluorouracil (5-FU) with mitomycin C (MMC) in preventing pterygium recurrence when used as an adjuvant following pterygium excision with conjunctival autograft. Low-dose MMC combined with conjunctival autograft is an effective treatment for preventing recurrence following pterygium excision, but safety, cost, and availability limit its use in developing countries. There is a paucity of data on the efficacy of 5-FU when used in Africa as an adjuvant to conjunctival autograft following pterygium excision. This is a randomized controlled prospective trial using either 50 mg/ml 5-FU or 0.01% MMC. Eighty eyes of 80 subjects were studied. Forty-six subjects with a mean age 49.8 ± 13.8 years were treated with 5-FU (USD 13.0 per unit), while 34 patients with a mean age 51.9 ± 12.1 years were treated with MMC (USD 20.0 per unit). There was no significant difference in mean age between the two groups (p = 0.48). The ratio of male to female patients in both groups was similar at 0.92:1 for the 5-FU group and 1:1 for the MMC group (p = 0.85). Mean follow-up period was 35.2 ± 29.1 weeks. Recurrence rate in the 5-FU group was 8.7% compared to 11.8% in the MMC group (recurrence risk ratio = 0.71, 95% CI 0.17-3.1, p = 0.7). One patient from the MMC-treated group had corneoscleral melting. Other complications were mild and not sight threatening. In the prevention of pterygium recurrence, 5-FU appears to compare favorably with low-dose MMC when used as an adjuvant following pterygium excision and conjunctival autograft. Further studies are required to assess the long-term effect of using 5-FU in such cases.

Awareness and utilization of protective eye device among welders in a southwestern Nigeria community.

OBJECTIVE: To determine the level of awareness and practice of use of protective eye devices among welders in Ile-Ife. METHODS: This is a cross-sectional descriptive study of 405 consenting welders. A pretested proforma was utilized to obtain information on sociodemographic characteristics, as well as awareness and use of protective eye device. RESULTS: The age of the respondents ranged from 16 to 80 years. The mean age was 39 ± 13 years. A large proportion (315, 78%) of the welders was aged between 21 and 50 years. The youngest group aged ≤ 20 years accounted for 15 (4%) of all welders, while the oldest group aged > 60 years accounted for 21 (5.2%). 402 were males (99.3%) and three were females (0.7%). Three hundred thirty-six (83%) of the welders had practiced for 6 years and above. There was a high level of awareness of protective eye devices among the welders (367, 90.6%), being higher among arc welders compared with gas welders (P < 0.001). Less than half (186, 45.9%) of the welders possessed protective eye devices. Of these, only 39 (9.6%) made use of the devices always. Some of the reasons for not using the protective eye devices include discomfort and poor visibility (56, 13.6%) and inadequate appreciation of the necessity to wear it (49, 12.1%). CONCLUSION: The findings of this study suggest that a significant proportion of welders in Ile-Ife were not utilizing protective eye device. Health education and awareness campaigns about the importance and benefits of utilizing protective eye devices are recommended.

Effect of face washing with soap and water and cleaning with antiseptics on upper-lid bacteria of surgical eye patients.

OBJECTIVE: To determine the effect of face washing with soap and water and cleaning with povidone iodine and cetrimide/chlorhexidine gluconate (Savlon) on upper-lid bacteria. DESIGN: Prospective, nonrandomized clinical trial. PARTICIPANTS: Eighty patients attending the Eye Clinic, University College Hospital, Ibadan, Nigeria. METHODS: Eighty patients assigned to 4 groups had swabs of the upper eyelid skin taken before and after face wash with soap and water, and cleansing with Savlon and 5% povidone iodine. Specimens were cultured and Gram stained. Bacterial counts were carried out using standard techniques. RESULTS: Face washing with soap and water increased the proportion of patients with bacterial isolates from 80.0% to 87.5%. The average colony count increased from 187.1 to 318.5 colony units per mL (p = 0.02). Application of 5% povidone iodine without face washing with soap and water reduced the proportion of patients with bacterial isolates from 82.6% (mean count 196.5) to 28.6% (mean count 34.1)(p = 0.001); in comparison, the application of 5% povidone iodine after face washing with soap and water reduced the proportion from 71.4% (mean count 133.9) to 40.0% (mean count 69.0)(p = 0.01). Application of Savlon without face washing with soap and water reduced the proportion of patients with bacterial isolates from 100% (mean count 310.9) to 41.2% (mean count 19.8)(p = 0.004) compared with the application after face washing, which reduced the proportion from 89.5% (mean count 240.3) to 41.2% (mean count 82.9)(p = 0.02). CONCLUSIONS: Both povidone and Savlon are effective in reducing periocular bacteria in an African setting. Prior face washing with soap and water had no added benefit in reducing bacterial colony count.

Distribution pattern of lens opacity among a rural population in South Western Nigeria.

PURPOSE: To determine prevalence of the morphological types of age-related lens opacity in Southwestern Nigeria as part of need assessment survey towards planning an eye health care service. METHOD: Multistage cluster sampling was used in selecting a representative cross-sectional sample of persons 50 years of age or older among the residents of the rural wards in Akinyele Local Government Area in southwestern Nigeria. Lens opacity was graded using the World Health Organization cataract grading system. RESULTS: One thousand two-hundred persons were recruited for the survey and 1031 (85.9%) had grading of lens opacity. The mean age of the participants was 64.9 years and 51.1% were male. Five hundred and ninety persons had definite lens opacity (crude prevalence rate 57.2%; 95% Confidence interval [CI] 54.1-60.3) (standardized prevalence 47.0%; 95% confidence interval 46.7-47.3). The prevalence for participants aged 70 years and above (82.5%; 95% CI 78.2-86.3) was three times more than for participants aged 50-59 years (29.2%; 95% CI 24.2-34.6). Nuclear opacity was the most prevalent type of lens opacity (20.9%; 95% CI 18.4-23.5). Sixty percent of the grade 3 lens opacity was found among participants aged 70 years and above. CONCLUSION: This is the first population-based survey on prevalence of lens opacity subtype in this West Africa subregion. The prevalence of lens opacity in the rural Akinyele local government is high. Nuclear sclerosis was the most prevalent form among this rural population.

Retinoblastoma: the challenges of management in Ibadan, Nigeria.

BACKGROUND: Retinoblastoma is a common highly malignant tumor of the eye. Late presentation leads to poor survival rate in many developing countries. OBJECTIVE: To identify problems associated with management of retinoblastoma. METHODS: A retrospective review of cases of retinoblastoma at the University College Hospital, Ibadan, between January 1992 and December 2007. RESULTS: A total of 32 eyes of 26 patients were studied. Sixteen were males and 10 were females. Minimum age at presentation was 4 months and maximum age was 60 months (mean 30.69+/-14.2 mo). Over 90% presented after 1 month of onset. Reasons for late diagnosis included late presentation for unknown reasons, missed diagnosis, and mismanagement in a previous hospital. Eleven of 26 patients defaulted to avoid removal of the eye, and treatment was only completed in 5 patients. Problems included financial constraint regarding investigations and procurement of drugs, as well as availability of the chemotherapy. CONCLUSIONS: Retinoblastoma is a problematic malignancy of childhood associated with management problems often related to difficulty with patients accepting removal of the affected eye and financial constraint for treatment.

Visual impairment from fibrous dysplasia in a middle-aged African man: a case report.

INTRODUCTION: Fibrous dysplasia is a benign tumour of the bones and is a disease of unknown aetiology. This report discusses a case of proptosis and visual deterioration with associated bony mass involving the right orbit. CASE PRESENTATION: A 32-year-old Nigerian man of Yoruba ethnic origin presented to the eye clinic of our hospital with right-eye proptosis and visual deterioration of 7-year duration. Presentation was preceded by a history of trauma. Proptosis was preceded by trauma but was non-pulsatile with no thrill or bruit but was associated with bony orbital mass. The patient reported no weight loss. Examination of his right eye showed visual acuity of 6/60 with relative afferent pupillary defect. Fundal examination revealed optic atrophy. Computed tomography showed an expansile bony mass involving all the walls of the orbit. The bony orbital mass was diagnosed histologically as fibrous dysplasia. Treatment included orbital exploration and orbital shaping to create room for the globe and relieve pressure on the optic nerve. CONCLUSION: Fibrous dysplasia should be considered in the differential diagnosis of slowly developing proptosis with associated visual loss in young adults.

Intraepithelial and invasive squamous neoplasms of the conjunctiva in Ibadan, Nigeria: a clinicopathological study of 46 cases.

BACKGROUND/AIMS: To retrospectively evaluate the clinicopathological features, treatment modalities and factors affecting prognosis in patients with both conjunctival intraepithelial and invasive squamous neoplasms. METHOD: Review and analysis of clinical and pathological records of all cases histologically diagnosed in the Department of Pathology, University College Hospital, Ibadan, Nigeria between January 1990 and December 2004. RESULTS: There were a total of 46 cases in 45 patients (eight intraepithelial carcinomas, 37 invasive squamous cell carcinomas (SCC) and a single case of mucoepidermoid carcinoma in a 71-year-old man). The intraepithelial neoplasms occurred in patients aged between 20 and 90 years. Seven of these patients had actinic changes on histology. For invasive SCC, patients' ages ranged from 18 to 84 years with a mean age of 53 years. Male to female ratio was 1:1. The majority presented with an orbital mass and loss of vision. Twenty-two (60%) of the patients with invasive SCC had enucleation or exenteration as the primary modality of treatment with or without radiotherapy or chemotherapy. Altogether for intraepithelial and invasive squamous neoplasms, the duration of presenting complaints ranged from 1 month to 5 years with an average of 2 years. Human immunodeficiency virus (HIV) infection and smoking were not significantly associated with these cases but a significant number had outdoor occupation. Low socioeconomic status and inability to afford treatment was common among our patients. CONCLUSION: Patients with invasive SCC in Nigeria present late and have significant delay before having any form of treatment. This contributes to the poor outcome. Human papilloma virus (HPV) and actinic aetiology are possible strong causative agents in Nigerians.

Cataract surgical outcomes in diabetic patients: case control study.

PURPOSE: To determine the visual outcome of cataract surgery in diabetes mellitus with advanced cataract in a tertiary institution in Nigeria. DESIGN: A retrospective case control study conducted at the University College Hospital, Ibadan Nigeria. SUBJECTS: Twenty three consecutive patients with diabetes and 23 age and sex matched non-diabetic control patients who had extracapsular cataract extraction for advanced cataract between 2002-2005. MAIN OUTCOME: Mean post operative visual acuity and surgical complications. RESULTS: Twenty three patients with diabetes mellitus and 23 non diabetic controls were studied; mean duration of diabetes was 8.1 +/- 7.2 years. The mean post operative visual acuity in diabetics was 0.11+/-0.38, 0.33+/-0.57 and 0.38+/-0.49 at one week, two months and six months compared with 0.23+/-0.19, 0.46+/-0.37 and 0.48+/-0.31 in non diabetics. (p=0.207, 0.403 and 0.465 respectively). Improvement in preoperative visual acuity was noted in 84.2% and 90% in diabetics and non-diabetics respectively. Poor visual outcome in diabetics was mainly due to diabetic retinopathy, maculopathy or diabetes related surgical complications. CONCLUSION: Visual improvement was seen following surgery for advanced cataract in diabetics in this study population. Post operative monitoring for treatment of diabetic retinopathy may enhance visual outcome.

Self-reported visual impairment and impact on vision-related activities in an elderly Nigerian population: report from the Ibadan study of ageing.

BACKGROUND: Studies have shown an association between visual impairment and poor overall function. Studies from Africa and developing countries show high prevalence of visual impairment. More information is needed on the community prevalence and impact of visual impairment among elderly Africans. METHODS: A multi-stage stratified sampling of households was implemented to select persons aged 65 years and over in the south-western and north-central parts of Nigeria. Impairments of distant and near vision were based on subjective self-reports obtained with the use of items derived from the World Health Organization multi-country World Health Survey questionnaire. Impairment was defined as reporting much difficulty to questions on distant and near vision. Disabilities in activities of daily living (ADL) and instrumental activities of daily living (IADL) were evaluated by interview, using standardized scales. RESULTS: A total of 2054 subjects 957 (46.6%) males and 1097 (53.4) females responded to the questions on vision. 22% (n = 453) of the respondents reported distant vision impairment, and 18% (n = 377) reported near vision impairment (not mutually exclusive). Fifteen percent (n = 312), however, reported impairment for both far and near vision. Impairment of distant vision increased progressively with age (P < 0.01). Persons with self-reported near vision impairment had elevated risk of functional disability in several IADLs and ADLs than those with out. Distant vision impairment was less associated with role limitations in both ADLs and IADLs. CONCLUSION: The prevalence of self-reported distant visual impairment was high but that for near visual impairment was less than expected in this elderly African population. Impairment of near vision was found to carry with it a higher burden of functional disability than that of distant vision.

Inflammatory orbital pseudotumor simulating retinoblastoma in a one year old girl.

The case report of a one year old girl with a clinical diagnosis of retinoblastoma who following enucleation was histologically diagnosed as a case of inflammatory orbital pseudotumour is presented. The literature is reviewed and the conclusion is reached that inflammatory orbital pseudotumour be considered in the list of deferential diagnosis of proptosis in early childhood.