Prevalence and Aetiology of Visual Impairment and Blindness in Persons with HIV/AIDS on Highly Active Anti-Retroviral Therapy in Benin City, Nigeria.

BACKGROUND: The use of Highly Active Anti-Retroviral Therapy (HAART) has revolutionized the course and pattern of eye diseases in persons with HIV/AIDS which ultimately affects the visual status. OBJECTIVE: To determine the prevalence and etiology of visual impairment and blindness in people with HIV/AIDS on HAART in Benin City, Nigeria. METHODOLOGY: This was a descriptive hospital-based study on all HIV/AIDS patients on HAART in the United States President's Emergency Plan for AIDS Relief (PEPFAR) clinics of University of Benin Teaching Hospital seen from July to August 2018 and Central Hospital, Benin City in October 2019. Demographic data and other relevant questions related to the disease were obtained from participants and recorded in an interviewer administered questionnaire. Participants were examined and ocular findings recorded. The IBM SPSS software version 21 was used for data analysis and level of significance set at p<0.05. RESULTS: There were 451 persons comprising 104 (23.1%) males and 347 (76.9%) females. More participants, 176(39%) were within the age group 41-50 years, with a mean age of 46.6± 10.78 years, and age range of 14-75 years. Visual impairment was present in 105 (23.3%), blindness in 10 (2.2%) and 336(74.5%) had normal visual acuity. Refractive error was the most common cause of mild 34 (29.6%) and moderate 23(20%) visual impairment. Cataract 4(3.5%) was the predominant cause of blindness. There was no case of severe visual impairment recorded. CONCLUSION: The major causes of visual impairment and blindness in persons with HIV are not HIV-related diseases which may be an indication of improved management protocols.

CONTEXTE: L'utilisation de la thérapie antirétrovirale hautement active (HAART) a révolutionné le cours et le modèle des maladies oculaires chez les personnes atteintes du VIH/SIDA, ce qui affecte finalement l'état visuel. OBJECTIF: Déterminer la prévalence et l'étiologie de la déficience visuelle et de la cécité chez les personnes atteintes du VIH/SIDA sous HAART à Benin City, au Nigeria. MÉTHODOLOGIE: Il s'agissait d'une étude descriptive en milieu hospitalier sur tous les patients atteints du VIH/sida sous HAART dans les cliniques du Plan d'urgence du président des États-Unis pour la lutte contre le sida (PEPFAR) de l'hôpital universitaire de Benin vu de juillet à août 2018 et de l'hôpital central de Benin City en octobre 2019. Les données démographiques et d'autres questions pertinentes liées à la maladie ont été obtenues des participants et enregistrées dans un questionnaire administré par un enquêteur. Les participants ont été examinés et les résultats oculaires enregistrés. Le logiciel IBM SPSS version 21 a été utilisé pour l'analyse des données et le niveau de signification fixé à p<0,05. RÉSULTATS: 451 personnes ont été recensées, dont 104 (23,1%) hommes et 347 (76,9%) femmes. La plupart des participants, 176 (39%) étaient dans la tranche d'âge 41-50 ans, avec un âge moyen de 46,6± 10,78 ans, et une fourchette d'âge de 14-75 ans. La déficience visuelle était présente chez 105 (23,3%), la cécité chez 10 (2,2%) et 336 (74,5%) avaient une acuité visuelle normale. L'erreur de réfraction était la cause la plus fréquente de déficience visuelle légère (34, 29,6%) et modérée (23, 20 %). La cataracte, 4 (3,5 %), était la cause prédominante de cécité. Aucun cas de déficience visuelle grave n'a été enregistré. CONCLUSION: Les principales causes de déficience visuelle et de cécité chez les personnes séropositives ne sont pas des maladies liées au VIH, ce qui peut indiquer une amélioration des protocoles de prise en charge. Mots clés: Déficience Visuelle, Cécité, VIH/SIDA, HAART.

Evaluation of Ophthalmology Inpatients Consultation in a Nigerian Tertiary Eye Care Centre.

BACKGROUND: Ophthalmology consultations are more thorough on outpatient basis, but inpatient evaluation cannot be over looked especially in terms of care of patients admitted in other specialties. OBJECTIVES: This is to assess the profile of inpatient consultation and eye problems evaluated and managed by the ophthalmology department of the University of Benin Teaching Hospital, Benin City, Nigeria. METHODS: All consecutive inpatients who had ophthalmic consultations requested for by various departments in the hospital between July 2018 and June 2019. RESULTS: A total of 227 inpatient consultations with 217 diagnoses were seen. Most of the patients were between the ages of 20-39 years. The highest number of consults (50.7%) were received from the medical wards. The most common reasons for ophthalmic inpatient consultations were reduction in vision (26.7%), eye pain (19.9%) and ocular screening which was ocular examination for patients with raised intracranial pressure, hypertension, diabetes and glaucoma (15.4%). Based on subspecialties, anterior segment and cornea unit received the highest number of consults (41.9%) while retina/ uveitis received the highest (58.7%) number of screening consultation. CONCLUSION: Inpatient consultations is very useful to the patient and managing physician. Although a better knowledge in the identification of common ophthalmic conditions can help to reduce the number of inpatient consults from other medical specialties.

DETERMINANTS OF THE USE OF TRADITIONAL EYE MEDICATION IN A SEMI-URBAN COMMUNITY IN SOUTHERN NIGERIA.

BACKGROUND: The use of traditional eye medication is still practised in some communities in Nigeria. AIM: To assess the determinants of the use of traditional eye medication (TEM) by adults in Ekiadolor community. METHOD: A descriptive cross-sectional study on the determinants of the use of traditional eye medication among adults was done between the months of September and November 2011 in Ekiadolor community in Edo state, Nigeria. RESULTS: Out of the 430 participants in this study, 57.2% were females and 42.8% males. Majority of the respondents (92.1%) knew about TEM. The prevalence of the use of TEM was 48.7%. Affordability (21.8%) was the main reason for the use of TEM. The male gender, persons of low socio economic class and people that lacked formal education were more likely to use TEM (p=0.001). CONCLUSION: The determinants of the use of traditional eye medication in this community are affordability, low socio economic status and lack of formal education. Formal education is of great importance, as this will go a long way in addressing the issues directly relating to the use of traditional eye medication in our communities.

Visual Impairment among Commercial Motorcyclists

Background: Normal vision is a universal requirement for safe riding of motorcycles. This study aims to determine the prevalence of visual impairment among commercial motorcyclists in Benin City; Nigeria. Method: This is a prospective cross sectional study carried out in Oredo Local Government Area (LGA) of Benin City. Each motorcycle park was taken as a cluster; and all motorcyclists in that park had structured questionnaires administered to them. One hundred and forty three commercial male motorcyclists in eleven motorcycle parks in Oredo LGA were subsequently examined with Snellen's chart or illiterate E chart as applicable. The main outcome measures eligibility for driver's licence on account of vision test as required by the Federal Road Safety Corps of Nigeria. Results: Ninety eight point six percent (98.6) of those examined had acceptable driving vision requirement according to Federal Road Safety Corps. One point four percent (1.4) had subnormal visual acuity; while 5.3had refractive errors. Ocular pathologies were found in 11.5of the eyes examined. Conclusion: Most commercial motorcyclists may pass the Federal Road Safety Corps. However Colour vision and visual field testing may give a more reliable result

Reducing the Barriers to the Uptake of Cataract Surgical Services in a Tertiary Hospital

Background: Cataract is a major cause of avoidable blindness and is responsible for about 50of global blindness.Objective: To determine the effect of reducing barriers to the uptake of cataract surgical services at the University of Benin Teaching Hospital; Benin City; Nigeria.Study Design and Methods: A comparative retrospective study of the number of cataract surgeries performed from January 2005 to December 2008 was carried out. A joint partnership between the Ophthalmology Department; the hospital management and a non-profit; non-governmental organization (NGO) was established to tackle the barriers of awareness; access and high cost of surgery to the uptake of cataract surgery from January 2005. The Ophthalmology Department and hospital management agreed to perform cataract surgeries free for all cataract patients while the NGO provided all the consumables required. The number of cataract surgeries performed was obtained from the theatre records and the data obtained analysed for the number of surgeries done per year.Results: The total number of cataract surgeries performed as seventy five (75); one hundred and twenty nine (129); one hundred and six (106) and three hundred and eighty-three (383) for the years 2005; 2006; 2007 and 2008; respectively showing a significant increase in the year 2008. Poor awareness; the bureaucracy of the referral system and high cost of surgery were identified as barriers to the uptake of cataract surgical services at the University of Benin Teaching Hospital. Publicity through the mass media; direct presentation of patients to the eye clinic for screening and providing cataract services free to all patients were methods used to overcome these barriers. Conclusion: Cataract surgical output can be increased by concerted effort and joint partnership among stakeholders in the eye care sector by recognising and reducing the barriers to the uptake of cataract surgical services

Prevalence of human immunodeficiency virus in ophthalmic surgical patients.

AIM: The aim of this study was to determine the incidence of human immunodeficiency virus in one hundred and sixteen (116) ophthalmic patients who had surgery over a two year period (July 2003 to June 2005) in the Department ofOphthalmology of the University ofBenin Teaching Hospital, Benin City. MATERIALS AND METHODS: A two year prospective study was carried out on 116 ophthalmic patients who had surgery between July 2003 and June 2005, A total of 116 patients were screened for HIV 1 & 2. An informed consent was obtained from all the patients. Patients who did not give their consent were excluded from the study. RESULTS: The total number of patients screened was one hundred and sixteen (116).There were 61 males and 55 females The age range was lyear to 78years with a mean age of 46 +/- 22.2 years (SD). The highest number of patients, 25 was found in the age group 61-70 years, comprising 21.6 of the total number of patients, followed by 24 patients in the 51 60 years age group. Three (3) patients comprising 2.6% were HIV positive. There were 2 females aged 25 and 50 years and a male aged 42years. The 25 year old female presented with squamous cell carcinoma of the conjunctiva, while the 57 year old woman had panophthalmitis. The male patient had herpes zoster ophthalmicus. He developed corneal opacities as complications of herpes zoster and had a peripheral iridectomy done to improve his vision. CONCLUSION: Although the HIV seropositivity rate of 2.6% is low, there is a need to do routine testing for HIV seropositivity in ophthalmic surgical patients who are billed for surgery as it gives them an opportunity to know their HIV status, thus enabling them to take appropriate preventive or treatment measures where necessary. HIV screening should be mandatory for high risk patients such as those with panophthalmitis, herpes zoster and squamous cell carcinoma of the conjunctiva that are markers for HIV.

Ocular melanoma presenting as a case of panophthalmitis in a 78-year-old Nigerian woman (masquerade syndrome): an uncommon finding in Benin City, Nigeria.

Theodore states that the term 'masquerade syndrome' first appeared in the ophthalmic literature in 1967 to describe a conjunctival carcinoma that presented as chronic conjunctivitis. Since then, the masquerade syndrome label has been applied to a group of disorders that mimic ocular inflammatory disease. Although some benign conditions can be considered masquerade syndromes, most often the term refers to malignant entities. Tsai and O'Brien also report that ocular oncology, the subspecialty that concerns itself with ocular and orbital malignancies, is by nature a field of uncommon disorders. A discussion of the masquerade syndrome therefore becomes a study in uncommon presentations of uncommon diseases. Nevertheless, the subject deserves wide attention because, in many cases, the diseases that masquerade are not only vision-threatening but potentially fatal. Significant morbidity and mortality can be averted by early recognition and diagnosis of the masquerade. In this article, we present a case of a 78-year-old Nigerian woman who had an ocular melanoma that presented as a panophthalmitis, a rare case of masquerade syndrome in our environment.

Prevalence of pterygium and pingueculum among motorcyclists in Nigeria.

OBJECTIVES: To find out the prevalence of pingueculum and pterygium among commercial motorcyclists in Benin City, Nigeria and to note any associated or risk factors. DESIGN: A prospective, cross sectional, case control study. SETTING: A local Government Area (Oredo) and University of Benin Teaching Hospital, Benin City, Nigeria. SUBJECTS: One hundred and forty four commercial male motorcyclists in motorcycle parks in the local Government area and a control group of 114 male indoor workers. MAIN OUTCOME MEASURES: Presence of pterygium or pingueculum. RESULTS: One hundred and forty four male motorcyclists formed the subjects of this study. The age range was 18 to 65 years with a mean age of 34.9 +/- 8.0 years. The total number of motorcyclists with pingueculum was 37 with 26 bilateral cases, 63 eyes were involved. The prevalence rate was 25.7%. Pterygium was present in 18 patients including 12 bilateral cases making a total of 30 eyes. The prevalence rate was 12.5% The total number of indoor workers with pingueculum was 24 and it was present in 46 eyes. The prevalence rate was 21.05%. Pterygium was present in 12 eyes of nine persons in the control group and the prevalence rate was 7.9%. There was no association between the duration of work as a commercial motor cyclist and the presence of a pterygium or a pingueculum. The usage of a hat/cap was found to have a protective effect as motorcyclists who do not wear hats are more likely to develop pingueculum than those who wear them. The use of glasses and hats together was found to be protective against the development of pingueculum and pterygium in this study. CONCLUSION: The prevalence rate of 12.5% of pterygium and 25.7% of pingueculum in commercial motorcyclists in this study is quite high when compared with that of the controls. The wearing of face caps/hats was found to have a protective effect. They should be educated about the importance of wearing protective goggles and caps/brimmed hats.

Retinitis pigmentosa in Benin, Nigeria.

OBJECTIVES: To determine the mode of presentation and degree of visual impairment of retinitis pigmentosa in Nigerians. DESIGN: A prospective, non-comparative study. SETTING: University of Benin Teaching Hospital, Benin City, Nigeria. SUBJECTS: Thirty Nigerian patients with a diagnosis of retinitis pigmentosa who presented at the Eye Clinic of the Ophthalmology Department of the University of Benin, Teaching Hospital, Benin City, Nigeria over a three year period (July 1997-June 2000) were included in the study. The clinical features and mode of presentation were noted. The examination included visual acuity, slit lamp examination and fundoscopy. MAIN OUTCOME MEASURES: Presenting symptoms and signs, visual acuity. RESULTS: The degree of visual impairment and clinical features in thirty Nigerians with retinitis pigmentosa seen at the University of Benin Teaching Hospital, Benin City, Nigeria were studied. There were twenty males and ten females. The age range was 14 to 71 years (mean 36.7 years +/- 14.8 years). Fifteen patients (50%) had visual acuity of less than 3/60 while only seven (23.3%) had visual acuity of 6/12 or better. The commonest mode of presentation was poor vision in 90% of the patients followed by night blindness in 56.7%. Others were headaches, flashes of light and floaters. CONCLUSION: The degree of visual loss in Nigerians with retinitis pigmentosa is severe and may be related to the long duration of the disease and age of the patients at presentation. Health education of the public and patients about the need for early presentation to hospital and the use of vitamin A and carbonic anhydrase inhibitors are recommended.

Solar retinopathy in Benin City, Nigeria.

The case reports of three patients who were seen at the University of Benin Teaching Hospital Benin City with a diagnosis of solar maculopathy are presented. There was good visual recovery in two of the patients. This report shows the effect on the retina of direct sun gazing. The need to use protective filters is emphasized.

Ultrasonic diagnosis of orbito-ocular diseases in Benin City, Nigeria.

The use of ultrasound in the evaluation of eye disease is a recent development in Benin City, Nigeria. This study was carried out to find out the usefulness of ocular ultrasound in the diagnosis and management of eye diseases in Benin City. A total of thirty nine patients who had B scan ultrasound examination of their eyes over a one year period (March 1999 February 2000 ) are included in the study. There were twenty five males and fourteen females. The most common diagnosis was retinal detachment in twenty one patients. Other conditions detected by ultrasound examination were vitreous haemorrhage, intraocular foreign bodies, mucocoele, orbital tumours and trauma. There was a 92.3% correlation between the clinical diagnosis and B scan ultrasound diagnosis. B scan ultrasound examination is a safe, non invasive, inexpensive, atraumatic and accurate means of evaluating the eye. Its use is strongly recommended in Nigeria.

Chemical injuries to the eye in Benin City, Nigeria.

Chemical injury to the eye is still an important cause of blindness and serious complications in Benin City, Nigeria. Twelve patients were seen with chemical injury to the eye over a five year period. They were all male patients. Ten were assault cases and two were accidental cases. The most common injurious agent was ammonia. Complications seen were corneal opacification in ten patients, symblepharon in nine patients, entropion, ectropion, cataract and staphyloma developed in some of the patients. There were four cases of bilateral blindness and six cases of unilateral blindness. Late presentation to hospital and failure to initiate adequate first aid treatment were contributing factors to the poor outcome. Health education of the public about the importance of prompt, prolonged irrigation of the chemically injured eye and early presentation to the hospital is advised.

Congenital anophthalmos in Benin city, Nigeria.

Clinical Anophthalmos is a very rare condition and this is illustrated in Benin City, Nigeria where the two cases described are the only cases that have been seen at the University of Benin Teaching Hospital over a period of twenty years. The two cases were unilateral anophthalmos. The first case is a case of primary anophthalmos while the second case is the consecutive or degenerative type of anophthalmos.