Neurophthalmic manifestations of giant sellar tumors in adults: Relationship between endocrine status and visual acuity profile pre and postsurgical treatment: A prospective cohort study.

OBJECTIVE: To evaluate the relationship between visual acuity (VA) and endocrine status among patients with giant sellar tumors pre and postsurgical treatment. METHODS: A 7-year single institution prospective cohort study of patients with giant sellar tumors treated by pterional transylvian microsurgical resection. Patients were evaluated and followed-up by a collaborative team of ophthalmologists and neurosurgeons. RESULTS: Sellar tumors represent 25% of our brain tumors cases (n = 257). Giant sellar tumors were 61 (23.7%) cases. Pituitary adenomas occurred in 40 patients and in 24 of these, the tumor was a functional adenoma. The age range was 16 to 75 years with a mean of 43.7 ± 3.3 years. Visual impairment (n = 60), headache (n = 55), and endocrinopathy (24) were among the common manifestations. VA and visual field defects were experienced by 59 and 39 patients, respectively. For both eyes, endocrine active tumors presented with poorer preoperative VA profile using mean logMAR VA [(χ2 = 10.3, P = 0.002 OD) and (χ2 = 8.9, P = 0.003 OS)]. Postoperatively, the mean logMAR VA profiles of endocrine active tumors showed a significantly better response when compared to endocrine inactive tumors in both eyes [(χ2 = 5.53, P = 0.029 OD) and (χ2 = 6.77, P = 0.037 OS)]. CONCLUSION: Visual acuity defects are almost invariable in patients with giant sellar tumor and may be associated with an endocrine profile. Surgical resection with normalization of hormone status is rewarded with VA improvement.

Challenges and outcome of cranial neuroendoscopic surgery in a resource constrained developing African country.

BACKGROUND: Cranial neuroendoscopy has been safely applied to the surgical treatment of different lesions of the brain in our center since its introduction in September 2009. This article summarizes our experience with neuroendoscopy, highlighting the salient challenges and outcome. METHODS: A single institution, retrospective analysis of prospectively acquired cases over a 2.5-year period (September 2010 to February 2013). Challenges experienced during the course of patient care as well as complications and outcomes were recorded and analyzed using SPSS (SPSS Inc. Chicago IL, USA) version 17. Tests of statistical significance were set at 95% level. RESULTS: Of the 291 cranial procedures performed during the study period, 37 (12.7%) were neuroendoscopic interventions. Patients were between the ages of 0.25 years and 25 years with a mean of 5.7 ± 1.5 years (95% confidence interval (CI)). Aqueductal stenosis was the most common indication for endoscopic intervention in 22 (59.5%) patients. Endoscopic third ventriculostomy was the most commonly performed neuroendoscopic procedure in 21 patients (56.7%). Major challenges experienced were patient dependent in 28 ± 1.0 patients (95% CL), learning curve related in 21 ± 0.4 patients, and poor endoscopy support infrastructure in 15 ± 0.5 patients. Complications were significantly more common in the first 6 months of neuroendoscopy (χ2= 7.57, df = 1, P< 0.05). Overall, 30 (81.1%) patients in our study experienced a positive outcome. The permanent morbidity and mortality rates in our series were 2.7% and 8.5%, respectively. CONCLUSION: Highlighted are the myriad obstacles which interface the successful set up of neuroendoscopy service especially in resource-constrained settings. Endoscopic procedures become safer with experience and complications reduce significantly after a steep learning curve.

Topical-intracameral anesthesia in manual small incision cataract surgery: A pilot study in a Tertiary Eye Care Center in Africa.

BACKGROUND: Cataract remains a leading cause of blindness worldwide. Manual small incision cataract surgery (MSICS) is currently practiced as the technique of choice in Sub-Saharan Africa to reduce the backlog of cataract blindness. Optimal pain control during surgery remains a challenge to cataract surgeons. AIM: To evaluate the efficacy and safety profile of the use of aqueous topical/intracameral anesthesia in MSICS. MATERIALS AND METHODS: In this hospital-based case series, consecutive patients presenting at the eye clinic with operable cataract and willing to have surgery were enrolled. Baseline sociodemographics (age, sex, and occupation), type of cataract by morphology, pain perception, and surgeons experience were recorded. Descriptive and comparative statistical analyses were performed. A P < 0.05 was considered statistically significant. RESULTS: The surgeries were performed on 30 eyes of 16 (53.3%) males, and 14 (46.7%) females (sex ratio, 1:0.9) who were aged 60.3 ± 16.32 standard deviation (SD) (95% confidence interval [CI] of mean; 53.94-66.13) (range; 20-98 years). Using the visual analog scale, the mean pain score was 2.7 SD ± 2.215 (1.87-3.53 95% CI). There was no correlation between degree of pain perception and gender (P = 0.806) or age (P = 0.388). Patient's cooperation was excellent in 22 (73.3%) of patients. Intraoperative complications occurred in 3 (10%) of patients. CONCLUSION: The mean pain score in this study is low. There is no correlation between perception of pain with gender or age. Surgeons experience is excellent in most of the cases. This method of anesthesia in MSCIS is adequate for patient's comfort and safe cataract surgery.

Neonatal head injury unrelated to birth trauma in South-East Nigeria.

BACKGROUND: Neonatal head trauma resulting from causes other than birth trauma has rarely been the focus of many a research theme in the literature. AIM/OBJECTIVE: To highlight the occurrence of non-birth trauma related neonatal head injury, and evaluate the causes and outcome of treatment. METHODS: A 3 year retrospective review of neonatal patients with head injury from two tertiary hospitals in South-East Nigeria between July 2009 and June 2012 (n-37). Data was collected from patients' birth and medical records. Data was analyzed using the SPSS version 15. RESULT: Among the one hundred and seventy-six cases (11.78)% pediatric head injury cases seen, thirty seven (2.48)% occurred in neonatal patients. The most common cause of head injury was fall 22 cases [59.5%]. Children of mothers with low educational qualification were more likely to sustain falls 22 cases (59.5%). Road traffic accident (n = 15) was associated with more severe injuries and poorer outcome. Operative treatment was associated with increased mortality (two of three cases). The mortality rate in our series is 8.10%. CONCLUSION: Reduction of neonatal head trauma could be achieved through improved maternal education.

Orbito-ocular neoplasms in Enugu, South-Eastern, Nigeria.

BACKGROUND: Orbito-ocular neoplasms are important causes of ophthalmic morbidity and mortality. Various reports have shown that they occur more commonly among Africans than Caucasians. In this era of HIV pandemic, an increase in the frequency of AIDS-related orbito-ocular neoplasms has also been reported. OBJECTIVE: This study was carried out to determine the pattern of orbito-ocular tumours in Enugu, South-Eastern Nigeria and to compare it with the findings from earlier studies in the same area, other parts of Nigeria and other countries. METHODS: In a retrospective, non-comparative case series study the records of all the cases of orbito-ocular neoplasms seen in the Histopathology departments of the two tertiary multidisciplinary hospitals with major eye clinics in Enugu (ParkLane Specialist and University of Nigeria Teaching Hospitals) between January 2001 and August 2005 were analysed for types of tumours, frequency of occurrence, sex and age of patients. RESULTS: A total of 43 cases were analysed. There were 17 males and 26 females (M: F-l:1.4). Retinoblastoma was the most commonly occurring neoplasm accounting for 25.6% of all the tumours; followed by squamous cell carcinoma of the conjunctiva which was seen in 5 (11.6%) of cases. Squamous papilloma and Burkitt's lymphoma each accounting for 9.3% of the tumours in the series were the third most commonly occurring ones. CONCLUSION: In spite of the limitations of the study our findings suggest that the spectrum of orbito-ocular neoplasms has generally remained the same in Enugu, South-Eastern Nigeria as well as in other parts of the country.