Retinopathy of prematurity and associated factors in Lagos, Nigeria.

BACKGROUND: Screening and early treatment of retinopathy of prematurity (ROP) is important to reduce visual impairment in at risk infants. AIM: To determine the frequency and risk factors associated with ROP in preterm infants in Lagos University Teaching Hospital. METHODS: This was a prospective cohort study of preterm infants with gestational age (GA) less than 32 weeks and birthweight 1500 g or less conducted from November 2011 to May 2014. The infants' eyes were examined using an indirect ophthalmoscope at 4-6 weeks of life or at 34 weeks post-conceptual age. Examinations were repeated weekly until regression or progression to a high risk pre-threshold disease. Staging was according to the revised International Classification for ROP and treatment criteria were as defined by the Early Treatment for ROP study. The GA, birth weight (BW), use of oxygen, presence of respiratory distress syndrome and other risk factors were recorded and tested for significance. RESULTS: Twelve (15%) of the 80 infants examined had any ROP and six (7.5%) had treatable ROP. The mean (SD) GA and BW for infants with ROP were both lower than for those without ROP; 28.2 (1.7) weeks vs 29.1 (1.6) weeks and 1124 (212) g vs 1251 (274) g for GA and BW, respectively. Risk factors such as supplemental oxygen, sepsis, respiratory distress and anaemia were not significantly associated with ROP. CONCLUSION: The frequency of ROP and treatable ROP was high; it is therefore recommended that routine care of preterm infants should include screening for ROP and that affordable treatment facilities should be provided in public hospitals.

A ten year review of diabetic retinopathy at the Guinness Eye Centre, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos.

BACKGROUND: Diabetic retinopathy is an important complication of diabetes mellitus, which may lead to blindness. OBJECTIVE: The study is to analyze posterior segment lesions in Diabetes Mellitus patients seen in Guinness Eye Centre, Lagos University Teaching Hospital in relation to the number, duration and severity. METHODS: All the case files of Diabetes Mellitus patients seen during the period of study were retrieved and data extracted from them were analyzed. Such information included age, sex, duration of Diabetic Retinopathy and its severity. RESULTS: A total of 84 case files were reviewed. There were 47 males and 37 females with a male to female ratio of 1.3:1. No diabetic patient was seen in the age group 30 years and below. Fifty-five (65%) patients who presented themselves did so very late. Of the 35 patients found to have diabetic retinopathy at presentation, 16 had the disease bilaterally. The most common form of Diabetic Retinopathy was clinically significant macula oedema. The study shows that a high proportion of the patients (41.6%) had Diabetic Retinopathy. CONCLUSIONS: Patients with DM should be referred early for eye examinations. Physicians Residents should be made to rotate through eye Departments for a period of at least 2 weeks so they can learn fundoscopy. Diabetic patients should be educated on the eye complications that may arise from their condition. Regular eye screening with fundus camera and laser therapy should be part of the routine management of Diabetics in Nigeria as is done in advanced countries.

Pattern of conjunctival masses seen at Guinness Eye Centre Luth Idi-Araba.

BACKGROUND: Conjunctival masses are growth on the surface of the outer eye; which may represent benign or malignant transformations. OBJECTIVE: To determine the pattern of presentation of conjunctival masses at the Guinness Eye Centre (GEC), Lagos University Teaching Hospital (LUTH) Idi-Araba over a 13 year period (Jan 1995-Dec 2007). METHOD: A retrospective review of the clinical notes of all patients that presented to GEC with conjunctival masses during the study period was carried out. The bio-data, clinical features, stage, laterality and associated features of the masses were noted. The diagnosis, treatment and complications of treatment were also recorded. RESULTS: Case notes of 612 eyes of 393 patients were included in the study. There were 219 (55.7%) males, 174 (44.3%) females with ages ranging from 4-85 years with a male to female ratio of 1.26: 1. Three hundred and eighty-eight patients (98.7%) presented as elective cases to the outpatient department while 5 (1.3%) presented as emergencies on account of associated ocular inflammation. There were 220 (56%) bilateral masses while 44% were uniocular. Pterygium was the leading conjunctival mass affecting 548 eyes (89.5%) of 329 patients. Pingueculae occurred in 53 eyes (8.7%), conjunctival cysts in 5 (0.8%) eyes, neoplastic growths in 3 (0.5%) eyes, conjunctival granulomas in 2 (0.3%) eyes and limbal teratoma in 1 (0.2%) eye. Most of these patients defaulted from surgery as only 141 eyes (23%) of 121 patients had surgery. Post-operative complications occurred in 33 eyes (5.4%) of 30 patients. The commonest postoperative complication was pterygium recurrence which occurred in 18 eyes of 15 patients. CONCLUSION: Pterygium was the commonest conjunctival mass and preventive strategies need to be advocated. Prevention of recurrence remains a challenge in the management of pterygium as recurrence after surgical excision occurred in 13.2% of eyes. Our study however did not confirm outdoor occupations as a risk factor for pterygium.

Aetiology of vitreous haemorrhage in Guinness Eye Centre, Lagos University Teaching Hospital over a two year period (June 2007-May 2009).

BACKGROUND: The Vitreous Humour is the transparent biological gel which fills the posterior 5/6th of the eyeball. Extravasations of blood into this delicate tissue may cause visual loss. OBJECTIVE: The study was to determine the causes and pattern of vitreous haemorrhage in Guinness eye centre, Lagos University Teaching Hospital. METHODS: Retrospective consecutive case series of all patients with Vitreous haemorrhage over a 2 year period (June 2007 - May 2009) RESULTS: A total of 5137 new patient were seen at Guinness eye centre during the study period. 13 of them had vitreous heamorrhage giving an incidence of 0.25%. 12 of the patients were males. The mean age was 41 year. The age range was from 14years to 69 years. Majority of the patients (69%) presented within 4 weeks of drop in vision. Vitreous heamorrhage was caused by trauma in 46% of the patients and proliferative sickle cell retinopathy in 30% of the patients. All the patients with vitreous haemorrhage due to proliferative sickle cell retinopathy had the Hb genotype SC. CONCLUSION: Trauma and proliferative sickle cell retinopathy were found to be important causes of vitreous heamorrhage in this case series.