African Journals Online
Nigerian Journal of Ophthalmology

Volume 11, No. 1, June 2003
ABSTRACTS

The Ophthalmologist: Life and Sight Preservation from the Cradle to the Grave

Fifth Faculty of Ophthalmology Lecture National Postgraduate Medical College of Nigeria
Friday, 16 August 2002
J Osa Ayanru FRCP(Ed), FWACS, FMC Oph.

It is a singular honour to be requested to deliver the Fifth Annual Faculty Lecture of the Nigeria National Postgraduate Medical College in Ophthalmology. As a foundation fellow of the College (1970) and past Faculty chairman, it gives me pleasure to observe the growth of the Faculty.

We pay tribute here to the many who laboured to ensure that we have a Faculty in the College and whose interest in its development has remained unshaken. But some are no more. May their souls rest in perfect peace.

As a professor in a university, often sooner rather than later, you will be called upon to deliver an ‘inaugural lecture’ in which you will concentrate on the highlights of your contribution up to that point in the time or developments in your discipline. I presented my inaugural lecture nineteen years ago in 1983, and it was primarily beamed at the university community.

TODAY the purpose of this lecture for the Postgraduate Medical College is different. It is partly to explain to ‘Town and Gown’ what Ophthalmology entails but primarily to raise funds to ensure the steady growth of the Faculty. It behoves us therefore to provide a menu which will accommodate different tastes – hosts and guests alike.

To ensure we have an even playing field (cricketers use this term, politicians too), my subject is centred round what the public wants to know.

Not infrequently during or after a social gathering or sometimes outside a supermarket, an acquaintance will walk up and remark.

“I don’t see clearly. Suffer from headaches a lot. Could these be from my eyes? Do I need to wear or change my glasses?“

Needless to say I cannot answer such enquiries on the spot. Both suggestions from my acquaintance may be right. They could equally be wrong. Unfortunately, in my experience, before I can make an input a third question is sometimes asked.

“What is the difference between an ophthalmologist and an optometrist”?

I hope at least one enquirer is here today, while I try to answer these questions.

OE Babalola FWACS, FMCOphthal
IB Babalola (Bsc)
Babalola OE, Rachel Eye Center, PO Box 4108, Garki, Abuja
M Esuga (MBBS)
P Kato Yohana (RN, Diploma in Ophthalmic Nursing)
A Ibeagbulam (DO)

SUMMARY

Objectives:

To describe an eye care outreach programme in the Federal Capital Territory (FCT) and the findings therefrom.

Main Outcome Measures: Causes of blindness and ocular morbidity, prevalence of blindness.

Methods: The programme was sponsored largely by the Bartimaeus Trust. Eighteen communities with a total population of 1083, all within two hours or less of commuting distance to the city of Abuja, were included in the outreach programme. The communities were a mixture of urban, semi-urban and rural. The subjects were volunteers who responded to electronic, poster and other forms of publicity for free eye examinations.

Findings: The programme was well received by the communities. The major causes of ocular morbidity were refractory errors (40.4%), allergic/vernal conjunctivitis (18%), pterygium (7.2%) and cataracts (3.0%). Prevalence of blindness was 2.7% among the examined population. The main causes of blindness were cataracts (37%), aphakia mainly from couching (18.5%), glaucoma (14.8%), and pathological myopia (14.8%).

Conclusions: Outreach programmes are useful for the social marketing of eye care services, and to identify major eye problems within a given catchment area. Cataracts are still a major problem within the FCT and more needs to be done to reduce the backlog. The rarity of onchocerciasis is remarkable but is probably attributable to recent population influx.

Cortical Blindness in Children in Enugu, Nigeria

EN Onwasigwe FMCOphthal

Ophthalmology Department, University of Nigeria Teaching Hospital, Enugu

SUMMARY

Objective

To analyse cortical blindness in Nigerian children.

Methods: The study covered a 5-year period with a minimum of 2 years follow-up. Diagnosis was made principally in blind eyes that were ophthalmoscopically normal.

Results: A total of 18 patients were selected with an upper limit of 16 years of age. Half of the patients studied presented by the 10^th month of life. The mean age was 18.1 months. Meningitis with convulsion accounted for most of the cases (72.2%). Sixteen (88.9%) of the patients had visual return, with 10 (55.6%) occurring within the first 6 months.

Conclusion: Though the prognosis has been observed to be satisfactory, the need to create awareness amongst the populace on the need for early presentation at the hospital in order to avert cortical blindness as a complication from meningitis is important

CM Chuka-Okosa,M.Sc. (CEH); FWACS^_

HB Faal,DCEH; FRCS

SUMMARY

Objectives:      

To determine the existing glaucoma services at the three levels of eye care in The Gambia

To highlight the problems with these services

Methodology:  Through observation, oral interviews examination of The Gambia’s documented eye care plan, data on personnel and their role, diagnostic equipment, treatment and follow-up at the three levels of eye care were critically analysed.

Results:  Gonioscopy, perimetry and the surgical treatment of glaucoma are only performed at the tertiary centre where the ophthalmologists are based. The pro-blems with the existing glaucoma services in The Gambia ranged from lack of a structured programme to lack of regular ophthalmologists with an interest in glaucoma, as well as a limited supply and variety of antiglaucoma therapy.

Conclusion: Preventive measures to reduce blindness from glaucoma in The Gambia are not part of the public health programme at present

Presumed Chloroquine Retinopathy in Ibadan

BGK Ajayi MBBS, FMCOphth, FWACS, MHS (Johns Hopkins)

Ojulowo Eye Clinic, Ibadan

CO BekibeleMBBS, FMCOphth, FWACS

Department of Ophthalmology, University College Hospital, Ibadan

SUMMARY

Objective: To review patients with clinical features of chloroquine retinopathy seen during the study period with the view of identifying the trend and creating public awareness for behavioural change.

Methods: A retrospective review of case notes of patients seen between 1996 and 2002.

Results: 19 patients with features of presumed chloro-quine retinopathy were reviewed: 5 women and 14 (73.7%) men. The age range is: 36-69 years, mean 50.7 years. Approximately 63% were civil servants, health care workers and teachers. Duration of chloroquine use ranged from six months to ten years, with a mean of 4.1 years. Total cumulative dose ranged from 10 gm to 312 gm, with a mean of 108 gm. Best corrected visual acuity of subjects ranged from 6/5-CF, mean 6/18.

Conclusion: The majority of people using large amounts of chloroquine over long periods are educated, middle-aged males, whose loss of vision would have far reaching effects on their families. There is, therefore, a need to create public awareness of the danger of long-term chloroquine use.  A follow up national survey would be desirable to determine the actual magnitude of the problem

Diabetic Eye Disease in Enugu South-Eastern Nigeria – A Preliminary Report

NO Magulike FRCS, Consultant Ophthalmic Surgeon/Senior Lecturer

Department of Ophthalmology, UNTH, Enugu           

CM Chuka-Okosa FWACS, Consultant Ophthalmic Surgeon/Senior Lecturer

JM Oli FRCP, Consultant Physician/Professor

SUMMARY

Objectives: 

To determine the pattern of ocular complications seen among patients being managed in a diabetic clinic.

Methods: Patients were randomly selected from the diabetic clinic of UNTH Enugu and examined over a 3 year-period between 1997 and 2000. The procedures carried out on each patient comprised: blood pressure check with patient standing; assessment of visual acuity; slit-lamp and torchlight examination of the anterior segment; tonometry using the Perkin’s handheld applanation tonometer; and fundoscopy using the directive ophthalmoscope.

Results: Out of the 149 patients examined, 3 (2.0%) were blind and 23 (15.4%) had visual impairment. Nineteen patients (12.75%) had diabetic retinopathy; 33 (22.1%) had cataracts; and 7 (4.7%) glaucoma. Nine (47.3%) of those with diabetic retinopathy were found to be hypertensive, four of which had maculopathy.

Conclusion: From this preliminary report, it is obvious that diabetic eye disease is also an important public health problem in southeastern Nigeria. Health education, screening for early detection, and prompt treatment of ocular complications will reduce visual loss in the patients

Does Niprisan^ฎ Retard the Evolution of Sickle Cell Retinopathy?

OE Babalola

Rachel Eye Center, PO Box 4108, Garki Abuja, Nigeria,  [email protected] 

C Wambebe

S Cousens  

SUMMARY

Objective:

To investigate the efficacy of Niprisan^®, an antisickling agent, in the management of sickle cell retinopathy.

Methods: The study was designed as a phase IIb double-blind, placebo-controlled crossover trial. Eighty-eight patients aged between 5 and 36 years (mean 15.3 years) were randomized into 2 treatment groups. One group received Niprisan® at a dose of 12mg/kg per os per day and the other group a placebo in a similarly encapsulated form, for an initial period of six months. After a crossover without interval washout, the treatment was continued for a further six months. Ocular signs, including jaundice and corkscrew/comma sign in the anterior segment, and signs of non-proliferative, pre-proliferative and proliferative retinopathy in the posterior segment, were assessed with a view to identifying deteriorations within these parameters.

Results: A within-person analysis provided no evidence that Niprisan® reduced the risk of anterior segment deterioration (odds ratio = 0.91; 95% c.i. 0.35, 2.36; p=1.00). Thirteen individuals contributed to the posterior segment analysis, 3 of whom experienced deterioration whilst receiving Niprisan® (odds ratio = 0.30, 95% c.i. 0.05-1.17; p=0.09;  Mcnemar chi2 = 3.17, p=0.05).

Conclusion: This study provides evidence that Niprisan® may reduce substantially the risk of posterior segment deterioration.

M Adu-Darko FRCS (Edin) FRCOphth, FWACS,

Department of Eye, Ear, Nose and Throat, School of Medical Sciences, Knust, Kumasi, Ghana

Background

Complications from infective corneal conditions are an important cause of blindness in adults and children. The eyelids play a major role in the pathogenesis of staphyloma and the perforation of descemetoceles. Tarsorrhaphy could, therefore, be beneficial in treating serious complications from infective corneal conditions.

Method: The case records of 46 patients (47 eyes) who were treated by tarsorrhaphy were analyzed in terms of demography, bacteriological studies and pre- and post-surgical intervention visual acuity.

Result: The best pre-surgical intervention vision ‘hand movement’ improved to 6/60 or better while the worst result was cosmetically amenable phthisis bulbi.

Conclusion: Tarsorrhaphy restored some useful vision in otherwise hopeless cases of infective corneal conditions.