Outcome of Combined Trabeculotomy-Trabeculectomy in Eyes of Nigerian Children with Primary Congenital Glaucoma.

PURPOSE: To report the outcome of combined trabeculotomy-trabeculectomy among children with primary congenital glaucoma at a child eye health tertiary facility in southwest Nigeria. METHODS: A retrospective review of children who underwent combined trabeculotomy-trabeculectomy (CTT) surgery on account of primary congenital glaucoma between 2016 and 2020 at the University College Hospital, Ibadan, Nigeria. All surgeries were performed by paediatric ophthalmologists. The main outcome measures were postoperative intraocular pressure, corneal clarity, and complications. RESULTS: A total of 21 eyes of 13 patients were included. Ten (76.9%) of the patients were males and 8 (61.5%) had bilateral disease. The mean age at presentation was 4.8 (± 3.6) months, while the mean age at surgery was 8.1 (± 5.9) months. The average waiting time between noticing symptoms and presenting to the clinic was 3.2 (±4.9) months. The mean horizontal corneal diameter was 13.2 (± 1.4) mm, while the mean pre-operative intraocular pressure (IOP) was 25.7 (± 8.6) mmHg. The surgical success (IOP<21 mmHg) rates at 3, 6, and 12 months were 86.7%, 64.3%, and 92.9% respectively. The Kaplan-Meier estimates of the probability that IOP remained below 21 mmHg up till 3, 6, and 12 months were 74%, 53%, and 53% respectively. Postoperatively, 85.7% of the eyes had complete resolution of corneal oedema. One eye had an intraoperative complication of vitreous loss. The post-operative clinic follow-up rate reduced to 52.4% by 1 year. CONCLUSION: Combined trabeculotomy-trabeculectomy is a relatively safe procedure that is associated with favorable success in Nigerian children with primary congenital glaucoma.

OBJECTIF: Présenter le résultat de la combinaison de la trabeculotomie et la trabeculectomie chez les enfants atteints de glaucome congénital primitif dans un hôpital tertiaire du sud-ouest du Nigéria. METHODES: Une revue rétrospective des enfants qui avaient subi une combinaison de trabeculotomie et trabeculectomie pour le traitement de glaucome congénital primitif entre 2016 et 2020 à l'University College Hospital,Ibadan, Nigeria. Toutes les chirurgies avaient été effectuées par des ophtalmologistes pédiatres. Les principaux résultats étaient la pression intraoculaire postopératoire, la clarté cornéenne et les complications. RESULTATS: Au total 21 yeux de 13 patients étaient étudiés. Dix (76,9%) patients étaient des garçons et 8 (61,5%) avaient une atteinte bilatérale. La moyenne d'age à la présentation était de 4,8 (± 3,6) mois, tandis que la moyenne d'age au moment de la chirurgie était de 8,1 (± 5,9) mois. Le temps d'attente moyen entre l'observation des symptômes et la présentation à la consultation était de 3,2 (± 4,9) mois. Le diamètre cornéen horizontal moyen était de 13,2 (± 1,4) mm, tandis que la pression intraoculaire (PIO) préopératoire moyen était de 25,7 (± 8,6) mmHg. Les taux de succès chirurgical (PIO <21 mmHg) à 3, 6 et 12 mois étaient respectivement de 86,7%, 64,3% et 92,9% . Les estimations de Kaplan-Meier de la probabilité que la PIO restait en dessous de 21 mmHg jusqu'à 3, 6 et 12 mois était respectivement 74%, 53% et 53%. Après l'opération, 85,7% des yeux avaient une résolution complète de l'œdème cornéen. Un œil avait une complication peropératoire de perte de vitré. Le taux de visites médicales en postopératoire était réduit à 52,4% en 1 an. CONCLUSION: La combinaison de la trabeculotomie et de la trabeculectomie est une procedure chirurgicale relativement sûre associée à un succès favorable chez les enfants Nigérians atteints de glaucome congénital primitif. Mots clés: Glaucome congenital, Trabeculotomie et Trabeculectomie, Résultat chirurgical, Pression intraoculaire.

NON-TRAUMATIC ECTOPIA LENTIS IN A PAEDIATRIC OPHTHALMOLOGY PRACTICE, IBADAN, NIGERIA.

Background: Non-traumatic ectopia lentis is a rare ocular disorder usually associated with syndromes like Marfans's syndrome, Weil-Marchesani and Homocystinuria. Ectopia lentis can lead to profound visual loss from refractive errors, glaucoma as well as retinal detachment if left unattended. Aim: The aim of this study was to describe the clinical profile of patients with non-traumatic ectopia lentis in a paediatric ophthalmology clinic in Ibadan, Nigeria. Methods: The clinical records of children ≤16 years diagnosed with non- traumatic ectopia lentis at the Paediatric Ophthalmology Clinic, University College Hospital Ibadan, from May 1, 2015 to Dec 31, 2019 were retrospectively reviewed. Information on demography, family history, visual acuity (VA), mean refractive error (spherical equivalent), and management was retrieved. Results: Clinical records of 25 patients were reviewed. The mean age was 8.9 (±3.41) years with a range of 2-15 years. Sixteen (64%) patients were males. All the patients had bilateral involvement. A positive family history of ectopia lentis was elicited in 6 (24%) patients. Thirteen (52%) patients had a Marfanoid habitus and superior displacement of the lens was observed in 26 (52%) eyes. The presenting visual acuity was <6/60 in 22 (44%) eyes. The spherical equivalent of the refractive errors ranged from -20.00DS to +13.25DS. Twenty (40%) eyes underwent surgery within the period of the study and the best corrected postoperative visual acuity improved by 2 or more lines in 12 (60%) of operated eyes. Conclusion: Severe visual morbidity was common in this cohort of patients with ectopia lentis in our practice. Treatment provided some improvement in vision which highlights the need to encourage early presentation for care. Detailed family history is important as a few of the patients were diagnosed following acceptance of our invitation to siblings for ophthalmic evaluation.

Delays in uptake of surgery for childhood cataract at a child eye health tertiary facility in sub-Saharan Africa.

BACKGROUND: Timely uptake of surgery is vital in the control of childhood blindness due to cataract. The aim of this study is to determine the uptake of surgery as well as the frequency and reasons for rescheduling of surgery for childhood cataract in a tertiary hospital in southwest Nigeria. METHODS: A retrospective study of children with childhood cataract seen at the Paediatric Ophthalmology unit of the University College Hospital, Ibadan between 2011 and 2015. Demographic and clinical information was retrieved from case records. Caregivers of children who did not have surgery were contacted by telephone to elicit reasons why surgery was not done. RESULTS: A total of 164 children were included in the study; 90 (54.9%) were male. The median age at presentation was 4 years with a range of 2-180 months. A total of 64 (39.0%) children had unilateral cataract. All patients were scheduled for surgery, but 123 (75%) underwent surgery. Surgery was rescheduled in 42 (34.1%) of those who had surgery. Reasons for rescheduling included financial constraints, illness, delay in paediatrician evaluation to ascertain fitness for anaesthesia and strike actions by health workers in the hospital. CONCLUSION: Three quarters of the children had surgery, though it had been rescheduled, at least once, in about one-third of them. Delayed uptake of surgery was mainly due to inability to afford treatment and strike actions. The need for improved coverage of health insurance especially for the paediatric age group in developing countries cannot be overemphasized. This is because good vision is an integral part of child development.

REFRACTIVE ERRORS AMONG CHILDREN ATTENDING A TERTIARY EYE FACILITY IN IBADAN, NIGERIA: HIGHLIGHTING THE NEED FOR SCHOOL EYE HEALTH PROGRAMS.

BACKGROUND: It is estimated that 19 million children aged below 15 years are visually impaired globally. Twelve million of these are due to uncorrected refractive errors. The aim of this study was to describe the pattern of refractive errors seen in children attending the eye clinic of the University College Hospital, Ibadan, Nigeria. METHODS: A descriptive retrospective study of children with refractive errors seen between January 2011 and December 2012 was conducted. Information on the age, sex, type of refractive error, degree of error (spherical equivalent), presenting complaint, previous spectacle use and return for follow-up visit were retrieved and analyzed using SPSS version 20. RESULTS: Three hundred and sixty-six children diagnosed with refractive errors accounted for 34.6% of all children seen. Of these, 267 (73%) records were successfully retrieved. The mean age was 10.58 (± 3.14) years, with 156 (58.5%) aged between 11 and 15 years. The male to female ratio was 1:2. The commonest refractive error was myopia, found in 124 (23.2%) of 534 eyes followed by simple myopic astigmatism and compound myopic astigmatism found in 117 (21.9%) and 111 (20.8%) eyes respectively. Majority, 229 (85.8%) had never worn spectacles previously and only 80(30%) children returned for a follow up visit. CONCLUSION: Refractive errors constitute a common diagnosis among children seen in our tertiary eye facility. Late presentation and poor follow up among our patients are a cause for concern. Public enlightenment, health education and school eye programs are recommended to reverse this trend.

Refractive Amblyopia among children in Ibadan: the need for amblyopia screening programmes.

BACKGROUND: The prevalence and burden of amblyopia in developing countries is probably underestimated, and little is known about the pattern of amblyopia in West Africa. AIM: To determine the relative frequency and types of amblyopia among children with refractive errors seen in the eye clinic of a tertiary hospital over a 2 year period. METHODS: A cross-sectional study conducted at the eye clinic of the University College Hospital, Ibadan, Nigeria between January 2012 and December 2013. Case notes of children with refractive errors seen during this period were retrieved and information including socio-demographic data, presenting visual acuity and visual acuity with correction were recorded. Amblyopia was defined as best corrected visual acuity worse than 6/9 or a difference of ≥ 2 Snellen chart lines between both eyes in the absence of any ocular pathology that could explain the visual impairment. RESULTS: A total of 250 eligible patients who had refractive errors were included in the study. Visual acuity was corrected to 6/9 or better in 224 (89.6%) children while 26 (10.4%) of them had amblyopia. Among the 26 children with amblyopia, 21 (80.8%) children had amblyopia in both eyes and majority (65.4%) had iso-ametropic amblyopia. Of the 47 amblyopic eyes, 36 (76.6%) eyes had moderate amblyopia while 11 (23.4%) eyes had severe amblyopia. CONCLUSION: There is a high relative frequency of amblyopia in this study and we recommend preschool eye examinations for all children to ensure early detection and management of amblyopia, thereby reducing the burden of amblyopia in our populace.

Risk factors for pterygium recurrence after surgical excision with combined conjunctival autograft (CAG) and intraoperative antimetabolite use.

BACKGROUND: To identify the determinants of recurrence following primary pterygium excision combined with conjunctival autograft (CAG) and intraoperative use of Mitomycin C (MMC) or 5-Fluorouracil (5-FU). METHODS: A randomized controlled clinical trial comparing 5-FU (50 mg/ml) plus CAG versus MMC (0.01%) plus CAG in preventing recurrence of primary pterygium following excision. RESULTS: A total of 80 eyes of 80 subjects were studied, with 46 eyes in the 5-FU group and 34 eyes in the MMC group. The mean age was 50.7 +/- 13.1 years with a male: female ratio of 0.95:1. Mean follow up period was 35.2 +/- 29.1 weeks. The overall recurrence rate was 10%, with a rate of 8.7% in the 5-FU group and 11.8% in the MMC group. The mean age of the patients who had a recurrence was 38.1 +/- 13.3 years compared to 52.1 +/- 12.4 years in those without a recurrence (p = 0.003). The median size of the pterygium in patients who had a recurrence was 3.2mm, while the median size in patients who did not have a recurrence was 3.0mm (p = 0.8). Five (12.8%) males had a recurrence compared to three (7.3%) females (p = 0.48); while 10.5% of fleshy pterygia recurred compared to none (0%) of the non-fleshy pterygia (p = 1.00). CONCLUSION: Younger age remains a risk factor for recurrence when both CAG and antimetabolites are combined in the treatment of pterygium, while the effect of gender, size and morphology of the pterygium may be diminished by such combination.

Outcome of trabeculectomy with 5-fluorouracil using releasable suture technique in a Nigerian Tertiary Hospital.

BACKGROUND: Trabeculectomy has undergone a series of modifications in recent times most of which are aimed at improving the efficacy of the procedure while reducing complications. The use of releasable sutures is one of such modifications. OBJECTIVE: To assess the efficacy and complications associated with the use of releasable sutures and 5-Fluorouracil(5-FU) in trabeculectomy among indigenous African patients with primary open angle glaucoma. METHODS: This was a chart review of 22 eyes of 17 patients diagnosed with primary open angle glaucoma. All the eyes included in the review had trabeculectomy with 5-Fluorouracil using releasable suture technique with postoperative clinic follow- up visit for a minimum period of 72 weeks. Information sought included patient's demographics, preoperative antiglaucoma medications, pre- and post- operative intraocular pressure, and associated complications. RESULTS: There were 17(13 M, 4 F) patients with 22 eye surgeries. Their mean age was 49.8 ± 9.3 years. The mean preoperative intraocular pressure was 27.7 ± 5.9 mmHg. The intraocular pressure on the first post-operative day was 10.6 ± 11.1 mmHg. The mean pressure before the removal of the releasable suture was 14.1 ± 10.8 mmHg and after removal was 6.0 ± 7.2 mmHg, (p > 0.0001). The mean intraocular pressure at 72 weeks of follow up was 16.9 ±5.6 mmHg. A qualified success rate of 81.8% was achieved in terms of intraocular pressure control. There were two eyes complicated by blebitis and an eye complicated by malignant glaucoma. CONCLUSION: The use of releasable suture in trabeculectomy helped in maintaining the intraocular pressure at a lower level in the early postoperative period and in reducing postoperative shallowing of the anterior chamber. The procedure appears to be associated with some sight- threatening complications such as endophthalmitis.

Demographic and clinical profile of patients with juvenile onset open angle glaucoma in southwestern Nigeria.

BACKGROUND: This was a non-comparative, retrospective review of patients diagnosed with juvenile open angle glaucoma (JOAG) in the eye clinic of a tertiary hospital in southwestern Nigeria. OBJECTIVE: To document the demographic characteristics, clinical features and treatment outcome of the patients diagnosed with JOAG. MATERIALS AND METHODS: Data were extracted from the clinical record of patients diagnosed with JOAG in the eye clinic of the University College Hospital, Ibadan, Nigeria, between January 2001 and December 2005. Such data included the basic demographic data, the clinical characteristic of the patients and the outcome of their treatment. RESULTS: Twenty-nine patients were reviewed, which represents 3.4% of all newly diagnosed glaucoma patients seen in the out-patient section of the eye clinic of the University College Hospital, Ibadan, over the period reviewed. Eight (27.6%) patients were aged 20 years and below. The mean age was 25.1 ± SD 6.0 years. Eighteen (62.1%) had visual acuity of 6/18 or worse in the better eye at the time of presentation. The mean intraocular pressure (IOP) of the patients at presentation was 32.3 ± SD 15.2 mmHg. Eight (27.6%) patients defaulted within 6 months of presentation. The mean IOP for the 21 patients who were followed up on treatment for a mean period of 9.6 months was 17.0 ± SD 6.0 mmHg. CONCLUSION: Most patients with JOAG in this review presented with advanced form of the disease. Early detection through parent-driven school eye health program and community-based case detection could help in reducing the scourge arising from JOAG among our population.

Case control study of dry eye and related ocular surface abnormalities in Ibadan, Nigeria.

BACKGROUND: Tear instability is associated with symptoms of ocular discomfort and irritation. Many patients with dry eyes remain untreated due to improper diagnoses. OBJECTIVE: To identify symptoms and surface abnormalities associated with dry eyes. MATERIALS AND METHODS: One hundred and fifty-six eyes of 78 subjects attending the Eye Clinic of the University College Hospital Ibadan were screened for dry eyes/tear instability using rose Bengal stain (graded 0-9), tear break-up time (TBUT), Schirmer's 1 tests, tear meniscus height and a standardised symptoms questionnaire. Grades 4-9 rose Bengal staining were considered as positive dry eye and were compared with grades 0-3 staining eyes as negative controls. RESULTS: Mean tear meniscus height, Schirmer's test and TBUT were lower among cases than their corresponding control eyes. The difference between the mean Schirmer's test values of cases and their controls were statistically significant (P = 0.00 for right eyes and P = 0.002 for left eyes). Rose Bengal grades were inversely correlated with the mean Schirmer's values (Pearson correlation -0.429, P = 0.05 for right eyes and -0.335, P = 0.03 for left eyes) and TBUT (Pearson correlation -0.316, P = 0.05 for right eyes and -0.212, P = 0.06 for left eyes). About 95.8% of the cases were symptomatic, as opposed to 70.4% of the controls (P = 0.01, Fisher's exact test) and 95.8% of dry right eyes compared to 61.1% of their controls had ocular surface abnormalities (P = 0.001), while 89.5% of dry left eyes compared to 62.7% of controls had surface abnormalities (P = 0.07). CONCLUSION: A close relationship exists between ocular irritation symptoms, surface abnormalities and functional evidence of tear instability. Such patients should be treated empirically or screened for dry eyes.

Pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft.

BACKGROUND: The use of conjunctiva autograft, adjunct antimetabolite therapy has been shown to be effective in preventing pterygium recurrence. OBJECTIVE: To compare 5 fluorouracil (5-FU) to conjunctival autograft in the treatment of large, fleshy pterygium. METHODS: A randomised controlled prospective study of outcome of pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft. Thirty-five eyes with large pterygium treated with bare sclera conjunctival excision plus 5-FU were compared with 33 eyes treated with excision and conjunctival autograft alone. RESULTS: Post-operative pterygium recurrence was observed in four (11.4%) eyes treated with 5-FU and 4 (12.1%) eyes treated with conjunctiva autograft (P>0.05). The post-operative complications included, granuloma formation 11.4% for 5-FU and 3.0% for autograft and conjunctival discharge 5.7% for 5-FU group only. CONCLUSION: 5-FU is marginally superior to conjunctival autograft in the prevention of pterygium recurrence but neither gives a more desirable single digit recurrence rate. Randomised studies combining both conjunctival autograft and 5-FU in pterygium treatment is advocated to further explore their effect.

Prevalence of refractive error and attitude to spectacle use among drivers of public institutions in Ibadan, Nigeria.

BACKGROUND: High rate of motor vehicle accidents' have been associated with poor vision. Studies on drivers from elsewhere other than health institutions have found abnormal visual acuities. The aim of this study is to determine prevalence of refractive errors and the attitude to spectacle wear among drivers of public institutions studied. METHODS: A cross sectional population study of all 99 motor vehicle drivers from the College of Medicine, University of Ibadan and University College Hospital (UCH) Ibadan between December 2003 and January 2004. RESULTS: The ninety-nine motor vehicle drivers in the study comprised of 67 (67.7%) from the College of Medicine, and 32 (32.3%) from the UCH. All were males, aged 38 to 60 years, mean 50.1 +/- (SD= 4.8 years). Proportion of drivers with refractive errors was 16.7% (95% CI, 16.6-16.8) but only 56.3% of these wear glasses while driving (others did not including 3 out 4 who were bilaterally visually impaired without glasses). Relative frequency of RTA among drivers was 16.2%, the risk was marginally higher among drivers with refractive error (OR 1.2, 95% CI: 0.4-3.7). The commonest refractive error was simple hypermetropia present in 15 eyes. Hypermetropia was associated with increasing age of drivers (p<0.05). Majority (97.7%) of the drivers were presbyopic but only 32 (32.3%) were current wearers of spectacles. CONCLUSION: Refractive errors were present in 16.7% of drivers studied. But 43.8% of these (3 out 4 of whom were bilaterally visually impaired without glasses) do not wear corrective lenses while driving. There is need for periodic visual screening exercise and eye health education on drivers.

Hunter syndrome: case report and review of literature.

Hunter syndrome is one of the mucopolysaccharidosis, which are a rare group of genetic diseases. It is due to a deficiency in the enzyme Iduronate 2-sulphatase. This in turn leads to the accumulation of glycosaminoglycans, dermatan and heparan sulphate. The intra and extracellular accumulation of this substances lead to multisystemic organ abnormality. We present a patient with Hunter syndrome who presented with involvement of the skin, cardiovascular system, the eyes and musculoskeletal system. We have also included a literature review. As far as we know, it is the first case reported in a Nigerian.

5-fluorouracil vs. beta-irradiation in the prevention of pterygium recurrence.

The aim of this study was to compare 5-fluorouracil (5-FU) with beta-irradiation in the prevention of pterygium recurrence. A retrospective non-randomised review of cases of fleshy pterygium treated with bare scleral excision and adjuvant 5-FU were compared with similar morphologically appearing pterygia, matched for age and sex, treated with bare scleral excision and adjuvant beta-irradiation. All surgeries were carried out at the university college hospital and Ojulowo eye hospital, Ibadan, Nigeria. Twenty-seven eyes of 24 patients who had pterygium excision with adjuvant treatment with 5-FU were compared with 31 eyes of 24 patients who were treated with excision and beta-irradiation. The mean age for the 5-FU group was 46.1 years while that for the beta-irradiation group was 46.9 years. Both sexes were equally represented, 12 males and 12 females. There were seven (25.9%) initial recurrences in the 5-FU group but four of these became atrophic, and therefore, cosmetically acceptable leaving three eyes (11%) with unacceptable recurrent pterygia. The beta-irradiation group, however, had seven (22.5) initial recurrence but five of these became atrophic and fell short of the cornea, leaving two (6.5%) with clinically unacceptable recurrence. The difference was, however, not statistically significant (Zc = 0.74 and p > 0.1). The associated complications were mostly mild in both groups and included cornea opacity of 10 (37%) complications, conjunctivitis of three (11%) complications, sclera granuloma of three (11%) complications and conjunctiva necrosis of one (3.7%) complication for the 5-FU group, and while the beta-irradiation group had corneal opacity of one (3.7%) complication and conjunctivitis of three (11%) complications. The non-statistical significance of a lower-pterigium recurrence rate with use of beta-irradiation for the treatment of fleshy pterygium compared with 5-FU may have been partly due to the small number of patients studied. A randomised-controlled study using a larger sample size is therefore proposed. However, the fact that over half of those with initial recurrence in the 5-FU group became atrophic (and therefore cosmetically acceptable) over time as well as less cost implication in the purchase of 5-FU relative to Strontium-90 association with few and mild complications makes it a desirable adjuvant therapy in depressed economies. However, beta-irradiation still has a place when cost issue is not an inhibiting factor in view of its clinically superior outcome.

Blepharoptosis in Ibadan, Nigeria.

OBJECTIVE: To look into the cases of blepharoptosis in our environment as well as find out the causes and effects of the ptosis. DESIGN: Prospective clinic study and prospective cluster sampling method of school children. SETTING: University College Hospital, Ibadan and 3 schools in Ibadan, Nigeria. SUBJECT: Over a 5 year period, all patients who presented with blepharoptosis at the University College Hospital were recruited for the study. During the same period, a school survey was also done to find out the prevalence of blepharoptosis among school children. RESULTS: Twenty five cases of blepharoptosis were found during the 5 year period. Fifty two percent of the patients were found to be less than 16 years of age while only 8% were over 50 years of age. There was a 1:1 male to female ratio with majority of them (68%) having only one eye affected. The most common cause of blepharoptosis was found to be congenital, accounting for 56% of the patients. The prevalence in the school survey was found to be 1.2% higher than the incidence of 0.5% found in the eye clinic. CONCLUSION: Blepharoptosis is not an uncommon ocular problem. A detailed assessment of the cause, amount of ptosis and levator functions helps to determine the most appropriate surgical technique which would give the best functional and cosmetic result.

Visual outcome of pressurised bottled drinks related eye injuries in Ibadan.

Records of 15 patients presenting with pressurised bottled drinks related eye injuries between January 1996 and 2001 were reviewed to identify factors contributing to accidental eye injuries from pressurised bottled drinks, reason for poor outcome and to make recommendations. In all, 16 eyes of 15 patients were studied out of which 7 were males (M:F, ratio 1:1.1). Age range, 3 years-49 years, mean 23.6 years. The majority of those affected were students 46.7%, and traders 26.7%. The commonest activity leading to injury was explosion during the process of arranging the bottles or crates of drinks (43.8%) and accidental fall of bottle from hand or height (37.5%). Drinks implicated include, Coca-cola 50%, beer 25%, others (Fanta, Legend stout, Mirinda, Grape juice) 25%. Complications arising from the injury included, hyphema 43.8%, vitreous haemorrhage 12.5%, and retinal detachment 12.5%. The globes were retained in 12 (75%) cases, 3 defaulted and one eye became phthisical. The final visual acuity was 6/18 or better in 25%, between 6/24 and 6/60 in 12.5% and less than 6/60 in 31.3%. The final visual acuities of three patients who were lost to follow up were unknown. Reason for poor visual outcome include severity of injury with resultant serious complications, and delay with instituting surgical treatment. Eye injuries resulting from exploding bottled drinks are potentially very serious and therefore best prevented. It is recommended that conversion of bottled drinks to canned or plastic containers be considered by the manufacturers. Greater care should be taken with the handling of bottled drinks by the sellers, factory workers and consumers. High risk occupations such as bottled drink sellers and factory workers may need to wear protective goggles during handling. Public health education on need to seek prompt and proper treatment as well as need for Government to institute the National health insurance scheme to cater for indigent patients.

The Ibadan glaucoma study.

To obtain epidemiological data on the prevalence and risk factors for open angle glaucoma in hospital workers of African origin, and investigate appropriate methods of a rapid, cost-effective screening procedure for glaucoma. A cross-sectional study of workers in the University College Hospital (UCH) Ibadan, using a structured questionnaire for data collection. The variables available for data analysis include workers demographic characteristics, visual acuity, pupil status, intraocular pressure, cup-disc ratio, central visual fields, family history of glaucoma, chronic diseases such as hypertension and diabetes. The data was analysed with EPI-INFO version 6.02 for simple analysis, while the SPSS package was used for multivariate analysis. A total of two thousand, one hundred and nine (2,109) UCH workers participated in the screening exercise for glaucoma. A high majority of the workers 1794 (85.1%) were negative to the diagnosis of glaucoma, while the remaining 315 (14.9%) were suspected to have glaucoma out of which 57 (2.7%) were confirmed as definite glaucoma cases. The prevalence of glaucoma among UCH workers was 27 per 1000, 95%, confidence interval = 20 per 1000, 35 per 1000. Factors associated with glaucoma were relative afferent pupillary defect, cup-disc ratio greater than 0.7, intraocular pressure, family history of glaucoma and the presence of chronic diseases such as diabetes. The left eye appears to have a higher probability of ocular problems compared with the right eye. The prevalence of glaucoma among hospital workers was 2.7% The cup-disc ratio appears to be a better diagnostic tool for glaucoma since it gives the best positive predictive value (with a cut-off point of 0.7) than all other variables.

A comparison of visual function scores in hydrocephalic infants with and without lumbosacral myelomeningocoele.

PURPOSE: The cerebrum is frequently malformed in children with myelomeningocoele. This anomaly renders them potentially susceptible to cerebral visual impairment. In these patients, hydrocephalus is an important and frequent complicating lesion which compromises intellectual function and may also cause cerebral visual impairment. In this study, we determined whether hydrocephalic patients with lumbar myelomeningocoele (HLM) are at a greater risk of visual impairment than hydrocephalic patients without this lesion (H). METHODS: In this prospective study, we assessed five parameters of visual function in 20 hydrocephalic children with lumbar myelomeningocoele and compared the total visual function scores (TVFS) obtained with those from hydrocephalic children without overt spinal dysraphism, but similar in age, sex and ventricular size. The parameters, which were assessed with the aid of a quantitative grading scale, were pupillary size and reaction, optic atrophy, visual fixation and tracking. RESULTS: The age and sex distributions of the patients in the two groups were similar. The anterior and posterior dimensions of the lateral ventricles were also similar. The mean (SD) of the TVFS were 24.25 (3.63) and 24.20 (3.47) respectively for the two groups (P = 0.90). CONCLUSIONS: The results suggest that, in hydrocephalic infants with lumbar myelomeningocoele, visual function is not further diminished by the associated dysraphism and that ventricular dilatation is the major determinant of visual impairment.