A comparison of goldmann applanation tonometry and rebound tonometry measurements among patients attending a glaucoma clinic in Southwest Nigeria.

Background: The accurate measurement of intraocular pressure (IOP) is a fundamental basic examination in daily ophthalmic practice and is important in managing many ophthalmic diseases and conditions such as glaucoma, uveitis, and following trauma. Accurate measurement of IOP is particularly important in glaucoma because the intraocular pressure is the most important modifiable risk factor in its management. Aim: To compare intraocular pressure (IOP) measurements obtained with the Goldmann applanation (GAT) tonometer to intraocular pressure measurements obtained with the iCare rebound tonometer (RBT) and evaluate the suitability of the iCare tonometer for routine clinical use among adult patients attending a glaucoma clinic in Southwest, Nigeria. Patients and Methods: The study was a comparative cross-sectional study. A total of 132 eyes of 132 patients were recruited for the study. Three consecutive IOP measurements were obtained with each of the instruments by the same observer. A difference in IOP of ± 3 mmHg between the two instruments was considered clinically significant in this study. Results: The mean IOP measurement from GAT was 15.18 mmHg (±4.26 mmHg) and 16.32 mmHg (±4.48 mmHg) from RBT. The mean central cornea thickness was 520.66 µm (±33.34). Pearson's correlation (r = 0.84) revealed a strong statistically significant correlation between GAT and RBT measurements and paired student t-test revealed a statistically significant difference in the means of IOP obtained by the GAT and RBT. There was a tendency for RBT to yield higher IOP measurements. Conclusion: The intraocular pressure measurements obtained with iCare RBT and GAT though strongly correlated, showed statistically significant differences in the means. The impact of central cornea thickness on measurements obtained by GAT and RBT was statistically insignificant. The iCare rebound tonometer, cannot replace GAT for routine use in the glaucoma clinic.

Trends in glaucoma procedures and surgeries at the eye foundation hospital group, Nigeria.

AIMS: To review the trends in glaucoma procedural treatments from January 2009 to December 2017. METHODOLOGY: A retrospective search was carried out from the operating theater and laser room records of the Eye Foundation Hospitals in Lagos, Abuja, and Ijebu-Imushin. Consecutive glaucoma procedures for each year from January 2009 to December 2017 were recorded in the data sheet prepared for the study. Data were analyzed using SPSS version 25. RESULTS: From 2009 to 2017, trabeculectomy had been decreasing in frequency from 117 to 65 (44%), except for 2015. The frequency of use of glaucoma drainage device (GDD) has been steadily increasing from 1 in 2013 to 26 in 2017, but this is not statistically significant. The frequency of cataract extraction with trabeculectomy reduced drastically from 20 in 2009 to 3 (566%) in 2014. Bleb review (BR) increased from 2 in 2009 to 18 (800%) in 2015, however, it dropped to 6 in 2017 (66%). Among the laser procedures, transscleral cyclophotocoagulation (g-probe) is commonly done. It increased from 40 procedures in 2009 to 98 in 2014 (145%). There has been an increase in laser trabeculoplasty from 15 in 2009 to 44 in 2013 (193%). Laser iridotomy increased from 12 in 2009 to 26 in 2015 (116%). From 2009 to 2015, there was an increase in glaucoma procedures and surgeries - 206 to 325 (58%) but this declined by 27% from 2015 to 2017. CONCLUSION: Trabeculectomy is the most performed procedure at our centers. This is followed by g-probe and laser trabeculoplasty. The rate of trabeculectomy is on the decrease, while the rate of GDD is increasing. The laser procedures are also on the increase.

Refractive aim and visual outcome after phacoemulsification: A 2-year review from a Tertiary Private Eye Hospital in Sub-Saharan Africa.

AIM: To review the short-term visual outcome of phacoemulsification in adults with uncomplicated cataracts in Eye Foundation Hospital, Lagos, Nigeria. MATERIALS AND METHODS: A retrospective review of records of patients that had phacoemulsification between January 2012 and December 2013 in Eye Foundation Hospital, Lagos, Nigeria, was done. Preoperative visual acuity, refractive aim, intraoperative complications, postoperative unaided, and best-corrected visual acuity at 1 and 3 months were analyzed. Only eyes of adults that had phacoemulsification for uncomplicated cataracts were included in the study, all pediatric cataracts and eyes with ocular comorbidities were excluded. Common ocular comorbidities excluded were corneal opacity/corneal scar, glaucoma, uveitis, pseudo exfoliation syndrome, moderate and severe nonproliferative diabetic retinopathy, macula edema, proliferative diabetic retinopathy, eye trauma, age-related macular degeneration, previous corneal surgery, glaucoma surgery, and previous or simultaneous vitreoretinal surgery. RESULTS: A total of 157 eyes of 119 patients who met the inclusion criteria were analyzed. There were 60 (50.4%) females and 59 (49.6%) males, with age range from 31 to 91 years and a mean of 65.3 ± 11.10 years. Only eyes with available data were analyzed at 1 and 3 months postoperatively. In 112 eyes (85.7%), the refractive aim was met, 21 eyes (14.3%) did not meet their refractive aim, 20 eyes (12.7%) were excluded, the refractive aim could not be determined from the records as surgeons did not specify, and in 4 eyes, the required information was missing from the case files. An unaided visual acuity of 6/18 and better was achieved in 134 eyes (85.4%) at 1 month and 126 eyes (85.9%) at 3 months whereas best-corrected vision of 6/18 and better was achieved by 145 eyes (92.4%) at 1 month and 146 eyes (98.0%) at 3 months. CONCLUSION: Surgical outcomes after phacoemulsification are comparable with international benchmarks for good outcomes, with 85.4% of eyes achieving within 1 D of spherical equivalent of the refractive aim, 92.4% and 98.0% of eyes also achieving best-corrected visual acuities of 6/18 and better at 1 and 3 postoperative months, respectively. Unaided vision of 6/18 and better was also achieved in 85.4% and 85.9% at 1 and 3 postoperative months, respectively.

Incidence of postoperative eye infections in a private eye hospital in Lagos, Nigeria.

BACKGROUND: There is a dearth of information on postoperative eye infections in Nigeria and most hospitals do not have an infection control program in place. OBJECTIVE: This study was done to investigate the incidence of post-operative eye infections, their potential sources and the preparedness of the hospital to prevent such infections. METHODS: A microbiological survey of all eye surgical procedures between March 2004 and May 2005 was performed. Relevant samples were taken and cultured pre, intra and post operatively as required. Definitions of infections were based on the Centers for Disease Control (CDC) Criteria. In the eye clinic, and operation theatre, infection control procedures and practices were audited using a pre-designed questionnaire. RESULTS: There were 2 cases of post operative eye infections (with Haemophilus influenzae and Corynebacterium species) during the one year of survey of 339 performed surgeries. S. aureus, Coagulase negative staphylococcus (CNS), and Enterobacter spp were cultured from the aqueous humour, as well as pre and post operative conjunctivae swabs of three other patients. Eighty four (24.8%) other patients were colonized post operatively with CNS (32), S. aureus (28), Klebsiella pneumoniae (8), E. coli (5), Corynebacterium species (3), Pseudomonas aeruginosa (1) Proteus mirabilis (4), Enterobacter species alone (1) and in association with CNS on 2 occasions. Seventy eight percent of patients had contact with staff who consistently haboured Staphylococcus species in their nares. Four patients (0.11%) were exposed to surgeons whose hands were contaminated and one eye (0.003%) to contaminated antiseptic solution. Facilities for hand washing and protective clothing were adequate but staffs were observed to perform an inadequate hands scrubbing. Most items were heat sterilized. Cleaning facilities were adequate and the environment was clean. The choice of antiseptic was correct, but that of disinfectant was considered incorrect. The ophthalmic equipments except the eye occluder were appropriately disinfected. Staffs were not protected when handling linen. Infected linens were separated from soiled linens only in the theatre. They were not bagged, and were hand sluiced. The only type of waste that was properly handled was sharps. All waste types were stored together prior to final disposal away from the public. CONCLUSION: The incidence of post-operative infection was 1.69% and their sources were the patients' normal flora. Other potential sources of post-operative eye infections identified included nares of hospital staff, hands of surgeon and hospital disinfectants. Areas of deficiencies in infection control practices, which require proper infection control policies, include hand scrubbing practices, disinfection, linen management and waste handling.

Factors associated with psychoactive substance use among a sample of prison inmates in Ilesa, Nigeria.

OBJECTIVES: To determine the rates of psychoactive substance use before and during imprisonment among a sample of prisoners and the factors that are associated with current drug use among them. METHODS: All the inmates of Ilesa medium security prison, who gave informed consent to participate, were interviewed with a questionnaire detailing socio-demographic, drug-use and imprisonment-related information. RESULTS: Majority of the prisoners were young adults. The current (one month) use rates of the substances were: tobacco, 13.7%; hypnosedatives, 11.4%; alcohol, 10.7%; stimulants, 9.6%; cannabis, 7.0%; pethidine/morphine, 2.3%; inhalants, 2.3%; cocaine, 2.3%; heroin, 1.3% and LSD, 0.0%. These rates were just slightly lower than rates of use before imprisonment for hypnosedatives, stimulants, cannabis, pethidine/ morphine and inhalants. Majority of current users of cannabis (71.4%) and tobacco (68.3%) were engaged in 'heavy use' of these substances. Analyses of factors that were significantly associated with the five commonly used substances (tobacco, hypnosedatives, alcohol, stimulants and cannabis) indicated that current tobacco use was associated with unemployment before imprisonment, being a sentenced prisoner, previous mental disorder and previous arrest(s) for drug offense. Current hypnosedatives use was associated with being a sentenced prisoner, previous arrest(s) for drug offense and being held for a major offense. Current stimulants use was associated with unemployment, previous arrest(s) for drug offense, previous imprisonment and longer duration of imprisonment. Current cannabis use was associated with higher age groups and being a sentenced prisoner. Cannabis use was also associated with previous arrest(s) for drug offense, previous imprisonment and being held for a major offense, a pattern which suggests that cannabis use may be associated with criminality than the other substances. The observation on pethidire/morphine does not conform to previous observation of non-use by prisoners in Nigeria. CONCLUSION: The rates of drug use are lower than figures reported from samples in western countries but similar to previous reports from Nigeria. The present observation on pethidine suggests that injecting drugs may be an emerging behaviour among prisoners in Nigeria. The prevalence rates of the substances and the similarity in the prisoners' access to drug before and during imprisonment call for drug prevention and treatment programmes within the criminal justice system in Nigeria.

Psychological characteristics as correlates of emotional burden in incarcerated offenders in Nigeria.

OBJECTIVES: To evaluate the demographic and psychosocial characteristics of incarcerated offenders in a Nigerian prison and investigate their relationship with psychiatric morbidity. DESIGN: A cross-sectional study employing the 30 - item version of the General Health Questionnaire (GHQ-30) and the depression sub-scale of the Hospital Anxiety and Depression scale (HADS-Depression). SETTING: A medium security prison located in Ilesa, a semi-urban community in Southwestern Nigeria. SUBJECTS: Three hundred and three prison inmates. RESULTS: Out of the 352 inmates, 49 (13.9%) refused to participate in the study. There was a preponderance of male offenders (96.4%), and majority (59.3%) was awaiting trial. Thirteen inmates (4.3%) had been imprisoned before (i.e., before current imprisonment). Less than half (34%) reported enjoying good mental health in prison while 11 (3.7%) gave history of previous mental disorder before imprisonment. Majority reported the level of visitation and financial assistance by relatives and friends as poor. Also, majority reported prison accommodation and feeding as poor while less than a half of the sample were satisfied with the level of available health care. Majority of the inmates scored above the cut-off points on the measures of psychopathology. These were 87.8% and 85.3% on the GHQ - 30 and the HADS - Depression Sub-scale respectively. Significant relationship was observed between GHQ-30 'caseness' and awaiting trial status, and also with reporting current mental health; prison accommodation and prison feeding as poor. In addition, significant depressive symptoms were associated with being a Muslim or traditional religion worshipper; lower education; single, divorced or separated marital status, and appraisal of current mental health as poor. CONCLUSION: The results are largely similar to findings from the developed world. Improving living condition and provision of basic needs of the prisoners appear essential for the promotion of their mental health.

Types of Glaucoma and recent trends applied in treatment: Observations from a Glaucoma Training Workshop in the Gambia.

OBJECTIVES: To determine types of glaucoma seen and the recent trends applied in treatment, a retrospective non-comparative case-series study was conducted in the Eye Unit of the Royal Victoria Hospital, Banjul, The Gambia. METHODS: The records of the 88 patients(145 eyes) seen during the glaucoma training workshop(organised by Prof.James Standefer, a clinical ophthalmologist from Minneapolis, U.S.A.) which held between 3rd and 14th of September, 2001, were analysed for types of glaucoma and treatment given. All but one patient who was a baby underwent the following tests: visual acuity measurement using the illiterate E-Chart with multiple optotypes; tonometry using the Schiotz tonometer with the 5.5g weight; oblique flashlight test; Van Herrick's estimation of the angle depth; pupillary reactions to light; Slitlamp biomicroscopy; gonioscopy using the 4-mirror pressure gonioprism; fundoscopy using the +78D Volk lens and confrontational visual field analysis. RESULTS: 27 eyes did not have definite glaucoma. Out of the remaining 118 eyes, 65(55.08%) had POAG;17(14.41%)ACG out of which 8 were CACG and 2 acute ACG. 8 eyes had pseudoexfoliation of the lens capsule with or without glaucoma. In the frail and elderly, guttae Timoptol 0.5% was given once daily. 27 eyes had trabeculectomy; all were with releasable sutures and intraoperative application of 5-Fluorouracil. 3 eyes had laser trabeculoplasty and 5, diode laser transscleral cyclophotocoagulation. CONCLUSIONS: POAG was the commonest type of glaucoma seen. Pseudoexfoliation of the lens capsule with or without glaucoma and ACG are not very rare in The Gambia. In the frail and elderly, guttae Timoptol 0.5% was given once daily and none at all in painless glaucoma-blind eyes. Trabeculectomy with releasable sutures and intraoperative application of 5-FU has a very satisfactory pressure-lowering effect. KEYWORDS: glaucoma; treatment; the Gambia.