Current concepts in the diagnosis of primary open angle glaucoma.

BACKGROUND: Primary open angle glaucoma is characterized by quantifiable parameters including the intraocular pressure, the aqueous outflow facility, and geometric measurements of the optic disc and visual defects. Despite this, diagnosis remains controversial. OBJECTIVE: To review the current concepts in the diagnosis of primary open angle glaucoma and adapt them to situations where high technology facilities are lacking. DATA SOURCE: Information was obtained from journals/medline, Hinari, the American Academy of Ophthalmology preferred practice pattern CD, and reputable textbooks using publications from 1972 to 2007. RESULTS: The Preferred Practice Pattern Committee of the American Academy of Ophthalmology recommends that the comprehensive initial glaucoma evaluation (history and physical examination) includes comprehensive adult eye evaluation with special attention to those factors that specifically bear on the diagnosis such as the optic disc, nerve fibre layer and visual field evaluation, open anterior chamber angles on gonioscopy and absence of secondary causes of glaucoma. Intraocular pressure is no longer relied onin the diagnosis of primary open angle glaucoma. Sequential evaluation of optic disc cup and size, neuroretinal rim size and shape, retinal nerve fiber layer, presence of peripapillary atrophy, and presence of retinal or optic disc haemorrhages enhance the ability to detect glaucomatous damages. CONCLUSION: A simple systematic approach in examination of the optic discs and visual field will improve accurate diagnosis of glaucoma.

Prevalence of Glaucoma Suspects and Pattern of Intra-Ocular Pressure (IOP) Distribution in Ahoada-East Local Government Area of Rivers State

Background: Glaucoma is the commonest cause of irreversible blindness in the world. Some glaucoma patients start out as glaucoma suspects for years. Aim: To determine the prevalence of glaucoma suspects and pattern of intra-ocular pressure distribution in glaucoma suspects. Methods: This survey was carried out in Ahoada-East local government area (LGA) of Rivers State. The study took place in 6 communities in the LGA. Multi-stage sampling technique was used to select the study sample which consisted of 960 persons drawn from the 6 communities. Ocular examination was carried out and consisted of visual acuity; basic eye examination and direct funduscopy. Subjects with pathologically cupped discs or cup/disc asymmetry of ? 0.2 had their intra-ocular pressures (IOP) measured. Data was recorded primarily on the WHO/PBL eye examination form and entered into Epi-Info version 6 for analysis. Results: A total of 34 subjects who had vertical cup/disc ratio 0.5 had their intra-ocular pressures measured. Of this; 23 were glaucoma suspects. There were 15 males (65.2) and 8 females (34.8) and those aged 40-79 years made up 69.6of the study sample. Most eyes (97.8) had normal intra-ocular pressures (10-21mmHg) while one had an IOP of 8 mmHg. Out of 866 subjects; 23 were glaucoma suspects giving a prevalence of 2.7. Conclusion: Since glaucoma is a leading cause of irreversible blindness in the world; the availability of data on glaucoma suspects; the type of glaucoma they have and the age groups most at risk would facilitate early diagnosis and follow up thus preventing unnecessary blindness from glaucoma

Ocular disorders in a petroleum industry in Nigeria.

OBJECTIVE: To determine the ocular disorders in the petroleum industry in Warri, Nigeria. METHODS: A clinic-based prospective study of the pattern of ocular disorders in workers of the Nigerian National Petroleum Corporation in Warri, Delta state of Nigeria was carried out over a 1-year period. Technical and non-technical workers were interviewed and examined using the Snellen's chart, pen-torch, direct ophthalmoscope, slit-lamp biomicroscope, Perkin's hand-held applanation tonometer, and the Kowa automatic visual field plotter where indicated. RESULTS: A total of 154 technical workers comprising 146 males (94.8%) and eight females (5.2%), and 116 non-technical workers comprising 90 males (77.6%) and 26 females (22.4%) were seen. There was no reported case of ocular trauma. Symptoms suggestive of ocular irritation were much more common in technical workers. Allergic conjunctivitis, pterygium, corneal abrasion, and foreign body on the cornea were significantly more common in technical workers P<0.0001. CONCLUSIONS: Exposure to irritant chemicals in the petroleum industry makes the technical workers more prone to allergic conjunctivitis, pterygium, corneal abrasion, and foreign body on the cornea. Protection goggles should be provided for all the technical workers.

Simplified and Safe Pterygium Surgery in Nigerians

Objective: To advocate a simplified and safe method of pterygium surgery to Ophthalmologists in Nigeria. Methods: After the routine standard preparation of the eyes for pterygium excision; 114 eyes that had the new procedure did not have the head of the pterygium shaved off the cornea with blade or knife in the usual standard manner; but was avulsed off the cornea unto the sclera . The cornea was then polished with the rough side of a broken ordinary razor blade. The pterygium was excised with a curved conjunctival scissors. Haemostasis and mitomycin C application were carried out in the usual standard manner. Results : All the 114 eyes that were operated using the new procedure had satisfactory cosmetic outcome of the pterygium excision and there was no complication encountered. Conclusion: The simplified method is both safe and effective for pterygium surgery

Presenting Visual Acuities in a New Eye Centre in Port Harcourt : Initial Report

Background: Visual acuity is a fundamental of an eye examination. It establishes in a quantitative way how well an eye can see. Apart from being a starting point in dealing with an eye; it is also a prognostic reference point and a medico-legal tool. Very few studies directly related to visual acuities are available as many authors concentrate on blindness and visual impairment. Aim: To document the presenting visual acuity of patients seen in a new Eye Centre in Port Harcourt over a 12 -month period. Methods: The visual acuities of the first 202 patients seen at a new private eye centre were obtained from case file records. The visual acuities were then analysed from 6/6 and better to No Light Perception. The visual acuities were further analysed into satisfactory vision; low vision; bilateral and uniocular blindness. Also analysed were age and sex distribution and a panoramic overview of the ocular problems of the patients. Results: Visual acuities 6/6 and better was seen in 32.2of the patients. In functional vision groupings 78.7had satisfactory vision; while 20.9had low vision. Bilateral blindness was found in 0.5and uniocular blindness in 0.9. Males were 54.0of the patients while 46.0were female. The age range 20-50 years accounted for 63.8of the patients. Conclusion: This study has documented the prevalence of satisfactory vision; low vision; bilateral and uniocular blindness in Port Harcourt and it will serve as a reference point in future visual acuity studies in the region

Non-Laser Management of Post-Extraction Opacification of the Posterior Capsule

The objective of this study is to describe an alternative procedure to laser for the management of posterior capsule opacifications after extra capsular cataract extraction and posterior chamber intraocular lens implantation. Thirty-one patients with posterior capsule opacification had non-laser secondary capsulotomy. The procedure was performed with the aid of a 25 G capsulotomy needle through the opening of the peripheral iridectomy after injection of visco elastic between the posterior capsule and the intraocular lens. There was improvement in the visual acuity of all the patients and there was no significant intraoperative or postoperative complications. The technique described provides an alternative to Nd: yag Laser capsulotomy particularly in centers that do not have yag laser facilities

Autologous whole Blood Patch in Repair of Leaking Filtering Bleds : Case Report on Initial Experience

Aim: To show the value of autologous whole blood patch in the management of leaking filtering blebs in Nigerian eyes.Methods: Two male patients who had trabeculectomy and adjunctive application of mitomycin C subsequently developed leaking blebs at the University of Benin Teaching Hospital; Benin City; Nigeria. A 27-gauge needle was used to inject 0.75- 1.0ml of whole blood under the conjunctival buttonhole.Result: The procedure succeeded in arresting the bleb leak but the trabeculectomy failed after 7 and 10 months respectively. Repeat trabeculectomy using another site remained successful after 2 years and 18 months respectively.Conclusion: Autologous whole blood patch is successful in sealing leaking blebs complications following trabeculectomy