PATIENT-RELATED FACTORS AND CLINICAL MANAGEMENT OUTCOMES OF RETINOBLASTOMA IN CALABAR, NIGERIA.

Background: Retinoblastoma is curable in industrialized countries. However, it is associated with mortality in resource-poor nations due to disparities and poor access to eye care. Aim was to determine the relationships between patient-related factors and clinical outcomes of Retinoblastoma management in a tertiary hospital in Nigeria. Materials and methods: This was a retrospective study of all children who were diagnosed and treated for Retinoblastoma from January 2017 through December 2022. Information obtained from their records included biosocioeconomic data, symptoms, lag time from initial symptoms, staging, treatment and outcome (dead or alive). Results: Fifty-three patients, aged 6 to 88 months on first hospital presentation were recruited. There were 29(54.7%) females and 20(37.7%) patients died. Parental low socioeconomic class, rural residence and poor nutrition occurred more in those that survived, though not significantly (p>0.05). Median(interquartile) age at diagnosis [24(18-36) months, p=0.005] and lag time [13(6-20) months, p=0.274] were low in the survived group. Bilateral Retinoblastoma (20.8%,p=0.002), brain metastasis (22.6%,p<0.001), IRSS IV (18.9%,p=0.01) and relapse (34%,p<0.001) occurred more among the patients that died. The overall survival (OS) was 22(11.77-32.23) months with 1-year OS of 63%. Treatment with only chemotherapy [HR 4.76(95%CI:1.726-13.128)], incomplete chemotherapy [HR 5.61(95%CI:1.271-24.741)], relapse [HR 5.98(95%CI:1.376-25.983)] and eye surgery after 3 chemotherapy cycles [HR 8.22(95%CI:1.087-62.239)] were predictors of mortality. Conclusion: Early presentation of retinoblastoma especially of advanced and bilateral disease may lead to improved survival if chemotherapy and eye surgery are appropriately performed. Routine screening and immediate referral of retinoblastoma particularly in rural areas are recommended.

Quality of life and depression among patients with high myopia in Nigeria: a cross sectional study.

AIM: To evaluate the quality of life (QOL) and level of depression among participants with high myopia in Nigeria and the demographic factors associated with these outcomes. METHODS: This cross-sectional study was conducted on 100 adult participants with high myopia (defined as refractive error ≤-5.00 D or worse, and uncorrected visual acuity worse than 6/18 in the better seeing eye) attending ophthalmology centres in Nigeria from 2 October 2021 to 30 August 2022. The means and standard deviations were calculated for each of the four domains of World Health Organization Quality of life scale (WHOQOL-BREF) using the transformed scores. The Beck Depression Inventory (BDI) scale was used to assess the level of depression. RESULTS: The highest and the lowest mean scores of WHOQOL-BREF domains were found for the psychological and physical health domains (mean percentage scores were 67.0 [95% confidence intervals (CI) 64.1-68.9] and 55.3 (95%CI 51.8-58.8, P<0.001), respectively. One-way analysis of variance (ANOVA) revealed significant differences in physical health with educational status (higher among those with tertiary education: mean difference 0.9, 95%CI -0.2-2.1; P=0.049), differences in psychological health with working status (higher among those who were working 1.2, 95%CI 0.3-2.1; P=0.012). Also, the result showed a statistically significant association between environmental health and marital status (higher among non-married: 1.7, 95%CI -0.9-2.3; P=0.012) while overall health was associated with place of residence (higher in urban areas: 2.3, 95%CI 1.2-3.5; P=0.024). For depression, one in every nine participants reported major depressive symptom, mostly younger people (aged 16-29 vs 30-49y: 17.0% vs 0, P=0.019), and slightly more women than men (14.3% vs 0, P=0.064). There were significant negative correlations between the depression scores and psychological health (r=-0.48, P<0.001), physical health (r=-0.29, P=0.002), social and relationship (r=-0.49, P<0.001), environmental (r=-0.48, P<0.001) and overall health (r=-0.49, P<0.001). CONCLUSION: People with high myopia have a relatively moderate QOL, but poor physical health, particularly the younger age group, and women who are more likely to experience clinically relevant depression. Eye care professionals should consider possible referrals for counselling for people with high myopia.

Prevalence and systemic associations of retinal vascular occlusions in Sub-Saharan Africa.

Background: Retinal vascular occlusions are a common cause of visual impairment. Studies on retinal vascular occlusions in sub-Saharan Africa (SSA) have primarily been retrospective and on retinal vein occlusion (RVO) only. The aim of this study, therefore, was to determine the prevalence and pattern of retinal vascular occlusions and their systemic associations in SSA. Materials and Methods: This was a hospital-based, cross-sectional study involving all new patients presenting at the general ophthalmic and specialty retina clinics in four hospitals in Nigeria over a 1 year period. All the patients underwent a comprehensive eye examination. The demographic and clinical data of patients with retinal vascular occlusions were entered into an excel sheet and analyzed using the Statistical Package for the Social Sciences (SPSS) software version 22.0. Statistical significance was indicated by P < 0.05. Results: A total of 8614 new patients were seen, and a diagnosis of retinal vascular occlusion was made in 90 eyes of 81 patients giving a disease prevalence of 0.9%. Eighty-one eyes of 72 (88.9%) patients had RVO, while 9 eyes of 9 (11.1%) patients had retinal artery occlusion (RAO). The mean age of patients with RVO and RAO was 59.5 years and 52.4 years, respectively. Increasing age, hypertension, and diabetes were the significant associations with retinal vascular occlusion with P < 0.0001. Conclusion: Retinal vascular occlusions are an increasing cause of retinal disease in SSA and tend to occur at an earlier age. They are associated with hypertension, diabetes, and increasing age. Further studies will, however, be required to establish the demographic and clinical profile of patients with RAO in the region.

Résumé Contexte: Les occlusions vasculaires rétiniennes sont une cause fréquente de la déficience visuelle. Les études sur les occlusions vasculaires rétiniennes en Afrique subsaharienne (SSA) ont été principalement rétrospectives et uniquemment sur l'occlusion veineuse rétinienne (RVO). Le but de cette étude était donc de determiner la prévalence et le schéma des occlusions vasculaires rétiniennes et leurs associations systémiques en Afrique subsaharienne. Matériels et méthodes: Il s'agissait d'une étude transversale hospitalière portant sur tous les nouveaux patients se présentant aux cliniques d'ophtalmologie générale et de rétine spécialisée dans quatre hôpitaux au Nigéria sur une période d'un an. Tous les patients ont subi un examen ophtalmologique complet. Les données démographiques et cliniques des patients avec des occlusions vasculaires rétiniennes ont été saisies dans une feuille excel et elles ont été analysées à l'aide du paquet statistique pour les sciences sociales (SPSS) logiciel version 22.0. La signification statistique était indiquée par P < 0,05. Résultats: Au total, 8614 nouveaux patients ont été vus et un diagnostic d'une occlusion vasculaire rétinienne a été réalisée dans 90 yeux de 81 patients donnant une prévalence de la maladie de 0,9 %. Quatre-vingt-un yeux de 72 (88,9 %) patients avaient RVO, tandis que 9 yeux de 9 (11,1%) patients avaient une occlusion de l'artère rétinienne (RAO). L'âge moyen des patients avec RVO et RAO était de 59,5 ans et 52,4 ans, respectivement. L'augmentation de l'âge, l'hypertension et le diabète étaient les associations significatives avec l'occlusion vasculaire rétinienne avec P < 0,0001. Conclusion: Les occlusions vasculaires rétiniennes sont une cause croissante de maladie rétinienne en Afrique subsaharienne et elles ont tendance à survenir à un âge plus précoce. Elles sont associées à l'hypertension, au diabète et à l'âge. D'autres études seront cependant nécessaires pour établir la démographie et le profil clinique des patients atteints de RAO dans la région. Mots-clés: Diabète, hypertension, occlusion artérielle rétinienne, occlusion veineuse rétinienne.

Tractional Retinal Detachment: Prevalence and Causes in Nigerians.

Aim: To determine the causes of tractional retinal detachment (TRD) in Nigerians. Materials and Methods: A prospective, multicentre study evaluating eyes diagnosed to have TRD. History, clinical examination (including visual acuity, intraocular pressure measurement, anterior segment examination and dilated fundoscopy) and systemic evaluation (including previous diagnosis of diabetes, hypertension, sickle-cell disease and others) were performed in TRD eyes out of a cohort of retinal detachment eyes. Results: The prevalence of TRD of the 237 patients diagnosed with RD within a one-year study period was 25.7% (61 patients). Eighty eyes were diagnosed with TRD. Thirty-eight eyes of nineteen patients (31%) were bilateral, and 42 (69%) were unilateral. There were 38 male patients (62.3%) and 23 female patients (37.7%). The mean age was 52.3 ± 12.7 years (11-69 years). 88.5% of all TRD patients had an associated systemic disease, diabetes being the most common disease in 88.8% of them. Proliferative diabetic retinopathy was the most common cause of TRD (77.5%) and the most common cause of bilateral TRD. Both trauma and proliferative sickle-cell retinopathy occurred in 3.8% of the eyes. 68.8% of TRD eyes were blind at the presentation. However, the causes of TRD did not show any significant association with blindness (P = 0.819). Conclusion: Proliferative diabetic retinopathy poses a significant threat to vision, being the most common cause of TRD. Early detection and treatment of proliferative retinopathy in diabetes and sickle-cell disease, and trauma prevention will significantly reduce the burden of blindness due to TRD.

Exudative Retinal Detachment in Nigerians: Demographics and Causes.

Background: Exudative retinal detachment (ERD) is a rare type of retinal detachment (RD), and information on its causes and presentation in Nigerians and Black Africans is scarce. Aim: To report the prevalence, vision at presentation, and causes of ERD in a cohort of RD patients. Materials and Methods: A prospective, multicentre, hospital-based study. We examined consecutive eyes diagnosed with ERD in ophthalmic patients seen within 1 year in four ophthalmic hospitals in Nigeria. The patients had a complete eye examination, including visual acuity, intraocular pressure measurement, slit lamp examination of the anterior segment, dilated fundus examination, and other ancillary investigations. Statistical analysis was done using SPSS version 22.0. Results: Nine out of 237 patients were diagnosed with ERD, giving a hospital-based prevalence of 3.8% of RDs. The mean age of patients was 45.8 ± 21.6 years (6 months-80 years), male:female = 2:1. ERD was bilateral in one patient and unilateral in eight patients. There was no gender association (P = 0.84), but systemic disease was associated with a risk of ERD (P = 0.001). Five out of 9 (55.6%) patients had an associated systemic disease. The systemic diseases include two patients (40%) who had chronic renal failure, two patients (40%) who had systemic hypertension, and one patient (10%) who had lung cancer. Other ocular causes of ERD include post endophthalmitis, coats disease, and age-related macular degeneration in one eye each. 80 % of eyes were blind at presentation. Conclusion: ERD is a rare form of RD in Nigerians and is associated with systemic diseases. There are inflammatory, neoplastic, vascular, and degenerative causes of ERD. At presentation, most eyes are blind. Early presentation will be beneficial in salvaging vision. Also, awareness of the occurrence and causes of ERD should be created amongst eye care practitioners.

Prevalence and systemic associations of retinal vascular occlusions in Sub­Saharan Africa

Background: Retinal vascular occlusions are a common cause of visual impairment. Studies on retinal vascular occlusions in sub Saharan Africa (SSA) have primarily been retrospective and on retinal vein occlusion (RVO) only. The aim of this study, therefore, was to determine the prevalence and pattern of retinal vascular occlusions and their systemic associations in SSA. Materials and Methods: This was a hospital based, cross sectional study involving all new patients presenting at the general ophthalmic and specialty retina clinics in four hospitals in Nigeria over a 1 year period. All the patients underwent a comprehensive eye examination. The demographic and clinical data of patients with retinal vascular occlusions were entered into an excel sheet and analyzed using the Statistical Package for the Social Sciences (SPSS) software version 22.0. Statistical significance was indicated by P < 0.05. Results: A total of 8614 new patients were seen, and a diagnosis of retinal vascular occlusion was made in 90 eyes of 81 patients giving a disease prevalence of 0.9%. Eighty one eyes of 72 (88.9%) patients had RVO, while 9 eyes of 9 (11.1%) patients had retinal artery occlusion (RAO). The mean age of patients with RVO and RAO was 59.5 years and 52.4 years, respectively. Increasing age, hypertension, and diabetes were the significant associations with retinal vascular occlusion with P < 0.0001. Conclusion: Retinal vascular occlusions are an increasing cause of retinal disease in SSA and tend to occur at an earlier age. They are associated with hypertension, diabetes, and increasing age. Further studies will, however, be required to establish the demographic and clinical profile of patients with RAO in the region

Burden and Presentation of Age-Related Macular Degeneration among Nigerians.

PURPOSE: Age-related macular degeneration (AMD) is a leading cause of visual impairment worldwide, and its prevalence may also be on the increase in Nigeria. The purpose of this study is to ascertain the burden and pattern of presentation of AMD in a developing country. METHODS: We conducted a multicenter, prospective study from January to December 2018. Biodata and history of systemic disease were obtained from consecutive patients presenting at four collaborating retina clinics and diagnosed with a retina disease after dilated fundus examination and ocular investigations such as fundus photography, fluorescein angiography, and optical coherence tomography. All eyes diagnosed to have wet and dry AMD were used for the study analysis. RESULTS: Out of 8614 patients, 156 eyes of 78 patients were diagnosed with AMD. The hospital-based prevalence for AMD was 0.91%. The mean age at presentation was 67.9 ± 9.2 years, ranging from 44 to 95 years. A majority (75.6%) of patients were between 60 and 79 years, 53.8% were females. Thirty-two eyes (20.5%) had wet AMD, while 124 eyes (79.5%) had dry AMD. Sixty-one eyes (39.1%) had moderate visual impairment (<6/18-6/60); 58 eyes (37.2%) had normal vision (6/18 and better); while 27 eyes (17.3%) were blind, and ten eyes (6.4%) had severe visual impairment. CONCLUSION: AMD contributes to the burden of visual impairment and blindness in the elderly Nigerian. In Nigeria, AMD occurs more in females and most common between the ages of 60 and 79. Dry AMD is four times more common than wet AMD. About 24% of eyes have severe visual impairment or blindness, while about a third each have a moderate visual impairment and normal vision. Increasing awareness of AMD among the at-risk population will be beneficial in achieving early diagnosis and treatment.

Retinopathy of Prematurity in the University of Calabar Teaching Hospital, Calabar, Nigeria: An Early Report of a Screening Service.

Background: Retinopathy of prematurity (ROP) is an important cause of childhood blindness worldwide. This blindness is avoidable through regular screening of preterm infants and prompt intervention for those with the condition. Aims/Objectives: This study aimed to determine the pattern of presentation of ROP and the risk factors for its development among preterm infants in the Neonatal Unit of the University of Calabar Teaching Hospital, Calabar, Nigeria. Design of Study: This study is a prospective, longitudinal study. Settings: The study was carried out in the Special Care Baby Unit, Sick Baby Unit, and Neonatal Clinic of the Department of Paediatrics and Child Health, University of Calabar Teaching Hospital, Calabar, Nigeria. Materials and Methods: All preterm infants whose mothers had given informed consent to participate were enrolled. Ocular examination was performed by a trained ophthalmologist. ROP was staged and documented using the revised version of the International Classification of ROP. Data were entered into a questionnaire and analysed using IBM SPSS version 22. Results: Of the 53 neonates recruited into the study, ROP was detected in 11 (21%) neonates, of which 9 (82%) had stage 1 disease, 2 (18%) had stage 2, and none had stage 3. ROP was more common in females, 7 (63.6%), than their male counterparts 4 (36.4%). ROP was higher among those with gestational age (GA) ≤30 weeks [9 (81.8%)] when compared with those with GA >30 weeks [2 (18.2%)] (P = 0.016). Other risk factors for ROP assessed by this study were found not to be significantly associated with the occurrence of ROP. Conclusion: ROP was present in 21% of the neonates, and the majority had stage 1 disease. This finding emphasizes the need for screening of all preterm neonates for ROP in order to forestall avoidable blindness which could result from this condition.

Profile, Visual Presentation and Burden of Retinal Diseases Seen in Ophthalmic Clinics in Sub-Saharan Africa.

PURPOSE: To determine the burden of retinal diseases and the degree of visual impairment associated with each disease, amongst Nigerians. PATIENTS AND METHODS: This was a hospital-based multicenter, prospective, cross-sectional, non-comparative study conducted from January to December 2018. Data was obtained from consecutive patients with a retinal diagnosis presenting at the general ophthalmic and specialty retina clinics in four hospitals (three public, and one private teaching eye department) in Nigeria. Biodata, visual acuity and refraction, intraocular pressure, findings on dilated retinal examination, diagnosis and systemic diseases were noted. Degree of monocular and bilateral visual loss associated with each diagnosed retinal disease was summarized and p value was calculated using chi-square test. P < 0.05 was considered significant. RESULTS: Eight hundred seventy-six of 8614 patients had a retinal diagnosis; establishing a hospital-based retinal disease prevalence of 9.8%. Male:female ratio was 1.1:1. The mean age of study patients was 49.97 (standard deviation 17.64 years). Mean symptom duration was 21.63 months (standard deviation 41.94). The mean intraocular pressure was 13.87 mmHg. Forty-three different retinal diseases were diagnosed. The most common was retinal complications of diabetes, i.e., diabetic retinopathy (DR) alone, diabetic macular edema (DME) alone and a combination of DR and DME, which accounted for 13.7%, 5.6% and 9.3%, respectively (contributed 28.6% of the entire diagnosis). This was followed by retinal detachment (RD), in 219 eyes (15.4%), dry age-related macular degeneration (AMD) in 124 eyes (8.7%). Nearly half of the eyes were blind or severely visually impaired. Blindness occurred in 34.1% of eyes; severe visual impairment in 8.2% of eyes and 29.7% had normal vision. There were 469 patients who had systemic diseases. The common systemic diseases were hypertension in 169 patients (19.3% of the total number of patients), hypertension and diabetes in 156 patients (18%), and diabetes alone in 98 patients (11.1%). Sickle cell disease was present in 1.5%. CONCLUSION: There is need to invest in infrastructure, local training and development of systems for early detection and treatment of several retinal diseases in sub-Saharan Africa; DR and DME having the largest burden. Collaborative physician care and management of hypertension and diabetes could significantly reduce the burden of DR and DME.

Indications for eye removal in southern Nigeria.

To determine the trend in frequency and clinical indications of surgical removal of eyes in a tertiary eye centre in Calabar, Nigeria. This is a 10-year retrospective review of patients who underwent surgical removal of eyes in a tertiary centre. The clinical records were reviewed (between Jan 2001 and Dec 2010) for demographic data, type of surgery, and clinical indications. A total of 137 eyes were surgically removed within the study period. Of these 46 were children (<16 years). There were 85 males and 52 females giving a M:F ratio of 1.6:1. Clinical indications for surgical eye removal include infective causes (32.1 %; perforated corneal ulcers, endophthalmitis, panophthalmitis), trauma (21.2 %), tumours (21.2 %), anterior staphyloma (13.1 %), and painful blind eyes (9.5 %). Phthisis bulbi, expulsive haemorrhage and aphakic bullous keratopathy accounted for the remaining 2.8 %. The eyes were removed by evisceration (63.5 %), enucleation (29.9 %) and modified exenteration (6.6 %). The commonest indication for eye removal in children was tumour (retinoblastoma). Eye removal in southern Nigeria is often due to infective causes (panophthalmitis and endophthalmitis), perforated corneal ulcer, mechanical trauma (blunt or open globe injury from gunshots or direct trauma), chemical burns, tumours, persistently painful blind eye and anterior staphyloma. Other indications for eye removal were phthisis bulbi, expulsive haemorrhage and aphakic bullous keratopathy.

Views of West African surgeons on how well their educational and professional backgrounds may have prepared them for health leadership roles.

BACKGROUND: Because of the appalling health indices in West Africa, Physicians there need to be at the forefront of the organizational challenge in managing and improving health systems. AIM: To collate the views of West African surgeons on how well their educational and professional backgrounds may have prepared them for leadership and managerial roles in health care, and draw appropriate policy implications. MATERIAL AND METHODS: Filled structured questionnaires from 110 surgeons that were attending an annual conference were analyzed. The respondents' bio data, professional, educational, health administrative backgrounds were probed. Their views on justifications for physicians' involvement in health managerial roles, probable influence of some physicians' characteristic traits and professional attributes on health leadership roles, and suggestions for improvement were also collated. RESULTS: 71.8% of the respondents had held or were then holding health-related administrative posts; 90% had attended different varieties of management courses; 95.4% identified physicians as the inherent leaders of the health care team; but only 28.4% adjudged their health management role "strongly important" (28.4%) among their multi-faceted roles; and they largely agreed that some stated professional and characteristic traits of physicians tend to make them poor leaders and managers. CONCLUSIONS: Our findings suggest that the preparations that the respondents got from their formal and professional education for leadership and managerial roles in health care were not optimal. We recommend for a paradigm shift for physicians on health leadership issue which is to be facilitated by a well-focused short time duration health management course for all physicians, particularly specialists.