Assessment of glaucoma awareness, uptake, and satisfaction with a free, targeted glaucoma screening program Southwest in Nigeria.

Background: Glaucoma is a global public eye health concern, being the number one cause of irreversible blindness. Aim: It is commoner, has an earlier onset, and is more aggressive in people of African descent. Awareness creation and screening activities have been identified as key components of the glaucoma care pathway. Subjects and Methods: This was a cross-sectional, descriptive study with analysis. The screening took place at the eye clinic, University College Hospital, Ibadan. Participants comprised all consenting adults aged 40 years and above who presented following a prescheduled telephone appointment during the 2021 World Glaucoma Week (WGW) activities. The main outcome variables were the awareness of glaucoma, and the uptake of and satisfaction with the free screening program. The associations between participants' prior awareness of glaucoma and their socio-demographic and clinical features were explored using the Chi-squared test. A P value of <0.05 was considered significant. Results: A total of 94 (47%) participants presented for the screening out of the 200 people who scheduled an appointment through the telephone appointment booking system. Forty-nine (52.1%) were males, and the mean (SD) age of participants was 55 years (10.9) with a range of 40-80 years. Fifty-eight (61.7%) participants had heard of glaucoma before the 2021 WGW awareness programs and 75.9% (44) gained some new knowledge from the programs. Newly diagnosed glaucoma was 9.6% (n = 9) of which seven (77.8%) had advanced glaucoma (CDR ≥0.9) in at least one eye. One hundred percent of the participants reported that they would recommend the screening to others. Conclusion: Targeted eye screening can help with the early detection of glaucoma. Patient satisfaction should be at the fore of eye health services to improve uptake.

POSTERIOR UVEAL EFFUSION POST TRABECULECTOMY IN UNILATERAL INFANTILE GLAUCOMA: A CASE REPORT AND MANAGEMENT CHALLENGES.

Choroidal effusion is an abnormal collection of fluid within the suprachoroidal potential space. It is a common complication following glaucoma filtering surgeries such as trabeculectomy. It is a clinical diagnosis that sometimes goes undetected or unreported, except when symptomatic. Reported incident rates is 7.9 - 18.8% for serous effusions and 0.7 - 3% for haemorrhagic effusions. This report aims to highlight a case of choroidal effusion after trabeculectomy and its management challenges. CASE REPORT: A seven year old boy presented to our facility with history of cloudy appearance of the right eye of five years duration. He was diagnosed with right infantile glaucoma. Intraocular pressures (IOP) were 44mmHg and 18mmHg right and left eyes respectively. Patient subsequently had right trabeculectomy. He developed hypotony at post-operative day two and a right choroidal effusion was noticed at post-operative day four. As a result of this, he initially had a right anterior chamber reformation with ocular viscoelastic on day seven. Later, a compression suture over the bleb and sclerostomy was performed 11 days post initial surgery. Choroidal effusion progressively regressed post-operatively and completely resolved at day five post-sclerostomy and effusion drainage. CONCLUSION: Choroidal effusion is a common complication after trabeculectomy in which conservative management results in resolution. However, when conservative management fails, surgical intervention should not be delayed to maximize good outcome.

Acute angle closure following hemodialysis in a 34-year-old Nigerian female.

Studies have reported that intraocular pressure (IOP) might change markedly during hemodialysis. We report the case of a 34-year-old Nigerian female with a 3-year history of chronic kidney disease secondary to chronic glomerulonephritis who presented with acute symptomatic elevation of IOPs following hemodialysis. She had no ocular complaints immediately before undergoing hemodialysis. She presented with a history of pain, redness, and mild blurring of vision in the left eye about 15 min after hemodialysis. Examination revealed circumciliary injection, shallow anterior chambers, and closed angles on gonioscopy in both the eyes. She was treated with pilocarpine (4%) four times daily and dorzolamide/timolol (2%/0.5%) twice daily combination eye drops with subsequent relief of symptoms and IOP reduction from an initial 48 and 74 mmHg to 10 and 12 mmHg for the right and left eyes, respectively. This case highlights the need for sensitization and awareness among renal physicians and ophthalmologists of the possibility of extremely high IOP during or immediately following hemodialysis. It also emphasizes the importance of gonioscopy and treatment of at-risk patients with narrow angles before hemodialysis.

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.