Prevalence, Correction Coverage, Unmet Need and Impact on the Quality of Life of Presbyopia among Market Traders in Ibadan, Nigeria.

Presbyopia is an age-related condition that results from the gradual decline in accommodation leading to inability to focus at near distances. This study sought to determine the prevalence, correction coverage, unmet need and impact on the quality of life of presbyopia among Bodija market traders in Ibadan, Nigeria. A cross sectional study was conducted on 314 participants aged 35 years and older selected by a non-probability sampling method. Their near vision was tested and corrected to the nearest diopter. Presbyopia was defined as being able to read the N8 optotype at a distance of 40 cm after correction with plus lens of at least one diopter. The prevalence of presbyopia was 46.8% (95% CI: 41.20, 52.5). The prevalence was significantly higher in those aged 50 years or more (95% CI: 2.98, 7.77), in females (95% CI: 1.45, 3.64) and in individuals with no formal education (95%CI: 3.32, 10.91). The presbyopia correction coverage was 29.9% and unmet need was = 70.1%. The major barriers reported as reasons for not obtaining near vision spectacles were lack of money and spectacles not being a priority. Presbyopes reported more difficulty with near work (p<0.001). The prevalence of presbyopia in Bodija market is relatively low compared to other reports with major risk factors being increasing age, female gender and no formal education. Presbyopia correction coverage is low with high unmet need it is important to create awareness and provide affordable and accessible near vision spectacles for those in need.

5-Fluorouracil vs avastin as adjunct to conjunctival autograft in the surgical treatment of pterygium.

BACKGROUND: The use of adjunct antimetabolite therapy along with conjunctiva autograft has been shown to be effective in preventing pterygium recurrence. There has however been fewer reports on the effect of anti-vascular endothelial growth factor on pterygium recurrence. OBJECTIVE: To compare 5-fluorouracil with conjunctival autograft with bevacizumab (avastin) used along with autograft in the surgical treatment of pterygium. METHODS: A randomized controlled prospective study of outcome of pterygium treatment using 5-fluorouracil with conjunctiva autograft as adjuvant treatment compared avastin with conjunctiva autograft. RESULTS: A total of 70 eyes of 70 patients were recruited into the study with a mean age of 51.49 (±14.36) years. Thirty-five patients each were randomized into the 5-fluorouracil treatment group and into the avastin treatment group respectively. The mean follow-up was 18.35 months (18.44 for the 5-FU and 18.26 for the avastin group). Post operative, pterygium recurrence was observed in 1/27 (3.7%) eyes treated with 5-fluorouracil and 1/26 (3.9%) eyes of the avastin group. Both recurrences were observed at 1 year of follow-up and they were both female patients aged 46 and 52 years, respectively. CONCLUSIONS: Both 5-fluorouracil and avastin are comparably effective as adjunct to conjunctival autograft. However, cost, availability, and convenience are other considerations with use of avastin.

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.

Awareness and knowledge of glaucoma among workers in a Nigerian tertiary health care institution.

PURPOSE: The aim of this study reports the level of awareness and knowledge of glaucoma among selected health care personnel at a health institution in southwestern Nigeria. MATERIALS AND METHODS: Health personnel at the Federal Medical Centre, Owo, Nigeria, a tertiary health care institution were stratified into a clinical and an administrative directorate. One-hundred twenty participants were selected from each directorate by a random sampling technique. A structured questionnaire was used to collect sociodemographic data and data on the level of knowledge and awareness of glaucoma. Statistical analyses included the independent t-test and Pearson's chi-square test for categorical variables. Statistical significance was indicated by P < 0.05. RESULTS: From the target population of 240 participants, 216 (98 males; 118 females) completed the questionnaire. The mean age of the participants was 35.07 ± 07 years. A total of 148 (68.6%) participants had heard of glaucoma comprising all participants from the clinical directorate and 28 participants from the administrative directorate. There was no statistically significant difference between the clinical and administrative directorates about the knowledge of the aspect of vision that is first affected by glaucoma, the painless nature of glaucoma among most Africans and the irreversible nature of glaucoma-related blindness (P > 0.05, all comparisons). CONCLUSION: There is the need to update the knowledge base of these workers if they are to be useful in propagating information of the irreversible blindness that could arise from delay in glaucoma diagnosis and treatment.

Squamous papillomas of the conjunctiva: a retrospective clinicopathological study.

BACKGROUND: There is very limited literature on squamous papillomas of the conjunctiva from Nigeria and sub-Saharan Africa. In an attempt to contribute to the literature on the subject, we studied the clinicopathological characteristics of patients histologically diagnosed with squamous papilloma of the conjunctiva in Ibadan, Nigeria. MATERIALS AND METHODS: Clinical and pathological records of patients with histological diagnosis of squamous papilloma of the conjunctiva made in the Department of Pathology, University College Hospital, Ibadan, between January 1985 and December 2004, were reviewed. RESULTS: There were totally 26 cases. Patients' ages ranged from 2 to 58 years with a mean age of 32 years. Male to female ratio was 1.4:1. Size of tumors ranged from 2 to 10 mm. Duration of presenting complaints was from 2 months to 10 years. The lesions in 10 cases were located in the medial canthus, at or close to the limbus in another 10 cases, and in the tarsal conjunctiva in a single case. Five cases had no documentation of location. Sixteen cases (61.5%) had multiple papillomas. Four cases had a history of chemical injury (alkaline based - hair relaxer in a single case, acid based - wet cell car battery fluid in two cases, and unknown chemical in a single case) preceding the lesion by at least 6 weeks. Fourteen cases had koilocytosis on histology suggestive of Human Papilloma Virus (HPV) etiology. HIV screening test was negative in the three patients who had the screening done. Preoperative clinical diagnosis was squamous papilloma in 16 cases, pterygium in 6 cases and squamous cell carcinoma in 2 cases. CONCLUSION: In the environment where we practice, conjunctival squamous papilloma occurs most commonly in the fourth decade of life. Only very few cases are submitted for histological diagnosis. HPV infection and chemical injury are the main etiology. We strongly advocate that all excisions of the conjunctiva, irrespective of the clinical impression, should be submitted routinely for histological assessment.

Barriers to cataract surgery of persons screened at camps in Ibadan, Nigeria.

PURPOSE: To determine barriers to uptake of cataract surgery by outreach patients at the University College Hospital, Ibadan and to make appropriate recommendations for improved cataract surgery uptake METHODS: Consenting cataract blind/visually impaired (presenting vision < 6/18) outreach patients identified from the outreach patient register of the University College Hospital, (UCH) Ibadan during a five months period (January to May 2009) were followed up for a visit in late June and July 2009. A semi-structured questionnaire schedule was used for data collection. People who did not use the services were administered a barriers questionnaire-schedule while those who accepted the services were administered a questionnaire schedule to elicit motivating factors for acceptance of services. Subjects were also examined using standard ophthalmic equipment (pen torch, ETDRS vision charts and ophthalmoscope) and information obtained recorded in a data entry form. RESULTS: A total of 186 subjects comprising 115 who had undergone cataract surgery and 71 who were yet to access cataract surgery services were followed up and included in the study. Reason for accessing surgery included awareness of quality service 63 (57.0%), was referred 32(29.0%) and pressure from family or friends 13(12.0%). Barriers to access included, untreated medical problems 21 (29.0%), not able to afford total (direct and indirect) cost of treatment 15 (21.0%), cataract not mature 10 (14.0%), not able to afford cost of surgery 9 (13.0%) and Dr's appointment 8 (11.0%). CONCLUSION: barriers to surgery uptake by outreach camp patients include cost of services, underlying medical problems and preferred doctors' practice. Adoption and scaling up of health insurance to cover those most in need as well as a change in preferred practice amongst eye care practitioners are possible areas for intervention.

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.

Visual outcome after cataract surgery at the university college hospital, ibadan.

AIM: The aim of this study was to determine the visual outcome of patients who had cataract surgery in the University College Hospital Ibadan. METHODOLOGY: This is an observational descriptive, longitudinal study of consecutive patients undergoing cataract surgery at the University College Hospital conducted between May and October 2007. A total of 184 patients who presented to the hospital and met the inclusion criteria were recruited into the study. Patients were examined preoperatively, 1st day postoperatively and 8th week postoperatively. RESULTS: The mean age was 66.5 years; and the male to female ratio was 1.2:1. Preoperatively, 137 patients (74.5%) were blind in the operated eye, while 39 patients (23.6%) were blind in both eyes at presentation. At 1st day postoperatively, 87 patients (47.3%) had pinhole visual acuity of 6/6-6/18. Best corrected vision after refraction eight weeks postoperatively showed that 127 patients out of 161 patients (78.8%) had good vision while 28 patients (17.4%) had borderline vision, and six patients (3.8%) had severe visual impairment after refraction. The number of bilaterally blind patients also reduced from 39 (23.6%) to one (0.6%). Uncorrected refractive error was the commonest cause of poor vision prior to refraction. Glaucoma was the commonest ocular co-morbidity accounting for poor vision in 9.1% of patients eight weeks after cataract surgery. CONCLUSION: This study demonstrates that good results can be obtained with cataract surgery and intraocular lens implantation in the developing world. More attention should be directed towards ensuring that successful outcomes are indeed being realized by continued monitoring of postoperative visual outcomes and prompt refraction for all patients.

Visual Outcome after Cataract Surgery at the University College Hospital; Ibadan

Aim: The aim of this study was to determine the visual outcome of patients who had cataract surgery in the University College Hospital Ibadan. Methodology: This is an observational descriptive; longitudinal study of consecutive patients undergoing cataract surgery at the University College Hospital conducted between May and October 2007. A total of 184 patients who presented to the hospital and met the inclusion criteria were recruited into the study. Patients were examined preoperatively; 1st day postoperatively and 8th week postoperatively. Results: The mean age was 66.5 years; and the male to female ratio was 1.2:1. Preoperatively; 137 patients (74.5) were blind in the operated eye; while 39 patients (23.6) were blind in both eyes at presentation. At 1st day postoperatively; 87 patients (47.3) had pinhole visual acuity of 6/6-6/18. Best corrected vision after refraction eight weeks postoperatively showed that 127 patients out of 161 patients (78.8) had good vision while 28 patients (17.4) had borderline vision; and six patients (3.8) had severe visual impairment after refraction. The number of bilaterally blind patients also reduced from 39 (23.6) to one (0.6). Uncorrected refractive error was the commonest cause of poor vision prior to refraction. Glaucoma was the commonest ocular co-morbidity accounting for poor vision in 9.1of patients eight weeks after cataract surgery. Conclusion: This study demonstrates that good results can be obtained with cataract surgery and intraocular lens implantation in the developing world. More attention should be directed towards ensuring that successful outcomes are indeed being realized by continued monitoring of postoperative visual outcomes and prompt refraction for all patients

Visual outcome of uveitic cataract in Ibadan.

The aim of this study is to evaluate the factors responsible for poor visual outcome in patients who had surgery for cataract due to uveitis in our subpopulation. A nonrandomized retrospective chart review of 28 patients (28 eyes) diagnosed with uveitic cataract that had cataract surgery between June 2001 and May 2007 at the University College Hospital, Ibadan, Nigeria was carried out. All had extracapsular cataract extraction with or without IOL implantation. The outcome measure was post-operative best corrected visual acuity. Over 60% of our patients achieved final best corrected visual acuity (BCVA) of 6/18 or better. The major causes of poor vision were posterior capsule opacity (PCO) in 6 patients, cystoid macular oedema (CMO) in 2 patients and pre-existing chorioretinal scar in 1 patient. We conclude that post uveitic cataract surgery results in good visual outcome with few complications in Ibadan.

Fall incidence in a population of elderly persons in Nigeria.

BACKGROUND: Falls are a common public health problem amongst the elderly in many communities. There is a need for information on the causes as well as the impact of this preventable risk on health among the elderly in sub-Saharan Africa. OBJECTIVE: To examine the prevalence and factors associated with falls among a population of elderly persons in Nigeria. METHODS: A multi-stage stratified sampling of households was implemented to select persons aged 65 years and older in the south-western and north-central parts of Nigeria (n = 2,096). Respondents were asked about the occurrence, number, and consequences of falls in the previous 12 months. They were also assessed for the presence of vision impairment, chronic pain and medical conditions. RESULTS: Falls were reported by 23% (n = 482) of the sample. Females (24.0%) were more likely than males (17.9%) to report falls. Respondents with chronic pain conditions, especially those with arthritis, and those with insomnia were at increased risk for falls. Among fallers, females were more likely than males to sustain injuries, including fractures (45.0 vs. 30.1%; p = 0.001). Persons with near vision impairment were less prone to serious falls with injuries than those with no visual impairment (p < 0.05). CONCLUSION: Falls are an important health problem among elderly Nigerians. A fall prevention program must have a particular focus on females, those with chronic pain conditions and those experiencing insomnia.

Visual impairment from age-related cataract among an indigenous African population.

AIM: To determine the magnitude of visual impairment (VI) resulting from lens opacity/cataract among a rural population in southwestern Nigeria. METHOD: A population-based cross-sectional survey using a multistage sampling method to select subjects >or=50 years. Participants with pinhole visual acuity of

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.

Eye health of professional drivers of a Nigerian University.

BACKGROUND: Safe driving and road traffic accident prevention could be attained through ensuring good condition of vehicles, the road as well as the physical and mental state of the driver among others Objectives: To determine the ocular health status of professional drivers of the University of Ibadan, Nigeria METHODS: A cross sectional survey of all drivers in the employment of the University of Ibadan, excluding the College of Medicine, was carried out between March and June 2002 at the University Medical Centre and the eye clinic of the University College Hospital, Ibadan. RESULTS: One hundred and ninety seven all male drivers were screened. Their ages ranged from 31 to 64 years (mean 48.3 +/-5.9yr). Less than satisfactory presenting (functional) binocular visual acuity (< 6/18) was found in 11(5.6%) of the drivers. With refraction no driver had binocular vision of <6/18, but three drivers each had corrected visual acuity in the worse eye of 6/12, 6/18 and 6/36 respectively. The commonest visual problems were presbyopia 100 (50.8%), and refractive errors 38 (19.3%). Other ocular pathologies included pterygium 11 (5.6%), optic atrophy 9 (5.0%), colour vision defects 7 (3.6%) cataract 2 (1.0%), age related macular degeneration 4 (2.0%), glaucoma 3 (1.5%) retinal scar 2 (1.0%), exotropia 1 (0.5%), and pingueculum 1 (0.5%), CONCLUSION: Periodic screening of driver population of any establishment is a worthwhile task that may help to identify potentially blinding or visually impairing conditions such as glaucoma and refractive-error which can be promptly treated.

Upper lid skin bacterial count of surgical eye patients in Ibadan, Nigeria.

Infective endophthalmitis can follow contamination from eyelid of surgical eye patients. Information about peri-ocular skin bacterial isolates and their determinants would help in planning appropriate interventions. This study aimed to determine the upper lid skin bacterial count and factors related to high counts if any, among surgical eye patients. A cross section of consenting new surgical eye patients seen at the Eye clinic of the University College Hospital Ibadan between May and July 2006 was studied. They were interviewed with a standard questionnaire, and swab of the upper eyelid skin taken. Specimens were Gram-stained, bacterial counts and culture were carried out using standard techniques. A total of 80 subjects were studied, age range 13 to 87 years (mean 57.8 +/- 15.8) years. Females were 42 (52.5%) while males were 38 (47.5%). Bacterial culture was obtained from 76 (95.0%) of those studied, with 24 (30.0%) having Staphylococcus aureus sensitive to gentamycin and amoxicillin + clavulanic acid combination while 52 (65.0%) had coagulase negative Staphylococcus. The mean bacterial count was 218 +/- 321 colony forming units (CFUs) per ml. Higher bacterial counts (> 50 CFUs per ml) were found amongst non-literates, patients older than 60 years of age, and male gender. Older age and male gender remained significantly associated with a high bacterial count using the logistic regression model (OR = 4.9, P = 0.03 and OR = 8.06, P = 0.005 respectively). The conclusion reached was that risk of having positive bacterial culture from the upper lid skin increases with older patient age and male sex of eye surgery patients. Adequate care should be taken to ensure proper skin preparation of elderly and male patients to prevent contamination of operation site.

Impact of self-reported visual impairment on quality of life in the Ibadan study of ageing.

BACKGROUND: Information is lacking on the impact of visual impairment on the quality of life of elderly Africans. This study aims to examine the impact of self-reported visual impairment on the quality life of an elderly Nigerian sample. RESULTS: Four hundred and fifty-three (22.3%) of the respondents reported impairment for distant vision, 377 (18.4%) reported near vision, and 312 (15.2) reported impairment for both far and near. Impairment of near vision had a significant impact on all domains of quality of life. Distant vision had less impact, with a significant decrement only in the domain of environment. After adjusting for the possible effects of age, sex, and co-occurring chronic physical illness, near-vision impairment accounted for 3.92% decrement in the overall quality of life of elderly persons. CONCLUSION: Impairment of vision is associated with significant decrement in diverse areas of quality of life in this elderly sample. Problems with near vision were nevertheless more likely than those of distant vision to affect quality of life.

Visual outcome of traumatic cataract surgery in Ibadan, Nigeria.

OBJECTIVE: To review the visual outcome of traumatic cataracts operated at the University College Hospital, Ibadan with the view to making recommendations for improved outcome. METHODS: All patients operated at the University College Hospital Ibadan, Nigeria between May 1999 and April 2004 with traumatic cataract were reviewed retrospectively to determine visual outcome and main causes of poor visual outcome <6/18, using a structured data entry form and information obtained from the operation register and case notes of patients RESULTS: 32 patients, age range 2 to 71 years, mean age 25.6 +/- SD 16.1 years were reviewed. 22 (68.8%) were males while 10 (31.2%) were females. Causes of traumatic cataract included wood/stick splinters in 7 (21.9%), cane/whiplash injury 6 (18.8%), and propelled missile injuries, 5 (15.6%). Less important cause of injuries were gun shot, road traffic accident and fist injuries. 11 (35.6%) of the patients had best corrected post operative visual acuity of >6/18, 10 (32.2%) <6/18-3/60, while 32.2% of the cases reviewed remained blind or had vision <3/60 in the affected eye. Cause of poor post operative visual acuity (less than 6/18) in 64.4% of the subjects included cornea opacity 12.5%, posterior capsule opacity 12.5%, retinal detachment 9.4%, and glaucoma 6.9%. CONCLUSION: Useful vision can be restored in a proportion of traumatic cataracts through surgery, although sight-limiting complications, which may be related to the severity of the trauma or prolonged post op inflammation may be present, many are potentially treatable with further intervention. The need for adequate health education to prevent ocular injuries and preoperative diagnosis of associated posterior segment complications that may prevent optimal post-operative visual acuity is also noted.

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.

Unexpectedly high prevalence of target-organ damage in newly diagnosed Nigerians with hypertension.

INTRODUCTION: Hypertension remains a formidable cardiovascular problem in the entire world. Untreated or poorly controlled hypertension predisposes to target-organ damage and is often followed by serious cardiovascular events. Knowledge of the type and distribution of endorgan damage in newly diagnosed hypertensive patients would help to determine the interventions or preventative measures needed in such patients. OBJECTIVE: To assess target-organ involvement in newly diagnosed, untreated hypertensive patients presenting at the University College Hospital, Ibadan, Nigeria. METHODS: Newly diagnosed hypertensive men and women were recruited consecutively into the study. Target-organ damage was assessed using electroctrocardiography, echocardiography, renal function assessment (including tests for albuminuria) and fundoscopy. RESULTS: A total of 68 subjects were recruited, but only 54 (79.4%), with a mean age of 59.1 ( +/- 12.4) years, completed the study. There were 29 ( +/- 53.7%) men, mean age 63.5 ( +/- 12.6) years, and 25 (46.3%) women, mean age 54.1 ( +/- 10.4) years. Fifty per cent of the subjects had no symptoms. Some form of albuminuria was found in about 40.7%. Seventy-one per cent (71%) had between grade 1 and 2 hypertensive retinopathy. Only six (11.1%) had glomerular filtration rate greater than 90 ml/min. Systolic function was impaired in three (5.6%) of the subjects. Diastolic dysfunction was present in 36 (66.7%) subjects. CONCLUSION: Target-organ damage already exists in newly diagnosed hypertensive subjects before presentation. We suggest early screening for cardiovascular risk factors and possibly a reduction in the criteria for the definition of hypertension in black Africans.