African
Journals Online
Nigerian Journal of
Ophthalmology
Volume 8, No. 1, August, 2000
ISSN 0189-9171
ABSTRACTS
Diabetic
Retinopathy in Nnewi, Nigeria
Sebastian N.N. Nwosu
Consultant Ophthalmic Surgeon, Nnamdi Azikwe
University Teaching Hospital, Nnewi
SUMMARY
The objective of this paper is to determine the
incidence and pattern of diabetic retinopathy in a clinic population of
diabetics in Nnewi. All consecutive new patients seen at the Diabetic Eye
Clinic, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, between
March 1997 and September 1998 were examined. Examination methods include
interviewer-administered structured questionnaire, visual acuity test, external
eye examination, refraction, tonometry, gonioscopy, binocular indirect
ophthalmoscopy and slit lamp fundus examination with 78D non-contact lens. Data
on patients with diabetic retinopathy were analyzed and presented in this
report. 33 patients (61 eyes) out of 100 new patients had diabetic retinopathy.
Of the 33 patients, 14 did not know that diabetes could cause visual loss; 16
had not consulted any eye health worker. None had laser or vitreo-retinal
surgery. Six patients were bilaterally blind and another 6 had uniocular
blindness. Visual impairment in the better eyes was recorded in 12 patients.
All cases of bilateral blindness in this cohort were due to diabetic
retinopathy and its complication (neovascular glaucoma). The severity of
diabetic retinopathy is as follows: mild non-proliferative diabetic retinopathy
(NPDR) 23 eyes; moderate NPDR 20 eyes; severe NPDR 2 eyes and proliferative
diabetic retinopathy 16 eyes. Vitreous haemorrhage (4 eyes) and traction
retinal detachment (8 eyes) complicated proliferative diabetic retinopathy.
Concurrent diabetic maculopathy was found in 34 eyes viz: clinically significant
macular edema (CSME) 33 eyes; Non-CSME 1 eye. Diabetic retinopathy is not rare
in Nigerians. Diabetics should be educated on the ocular complications of the
disease. Since laser and vitreo-retinal surgery will reduce visual loss in the
patients, these facilities should be provided in eye hospitals in Nigeria.
KEY
WORDS: Diabetic retinopathy, incidence, visual loss, Nigeria.
Pattern and Outcome of Paediatric Ocular
Trauma – A 3 - Year Review at National Eye Centre, Kaduna
Fatima Kyari, Mahmoud B. Alhassan,
Adenike Abiose
Department of
Clinical Ophthalmology, National Eye Centre, P.M.B. 2267, Kaduna, Nigeria.
SUMMARY
Aims
and Objectives: To describe the pattern of paediatric ocular
trauma seen at the national Eye Centre, Kaduna, between January 1995 and December
1997; and the factors that affect the visual and ocular outcome.
Materials
and Methods: The medical records of all the children 15
years or younger, with ocular injuries presenting as emergencies within the
3-year period, were reviewed. Relevant information obtained formed the database
for analysis using Epi Info 6. Overall P
value for predictors of visual and ocular outcome was determined.
Results:
One hundred and thirty-seven children, 13.4% of all
paediatric attendance, presented with ocular injuries. The male to female ratio
was 2:1. Only 22% of the patients presented on the day of injury. Fifty-three
(38.7%) had penetrating injury, while 45 (32.9%) had contusion injury. About
half occurred while at play and a quarter occurred as home accidents. Eighty
patients (58.4%) needed hospital admission, 29 (21.2%) were treated on
outpatient basis and 28 (20.4%) were lost before treatment was commenced.
Sixty-five percent of the admitted patients stayed longer than seven days in
the hospital. Seventy-one eyes (67.6%) were blind at presentation while 62%
(39) of those tested at last hospital visit remained blind. Good final visual
acuity (VA) was related to good initial VA and non-penetrating injury. Poor
final VA was related to poor initial VA, injury to multiple ocular structures
and penetrating injury. Poor ocular outcome (evisceration and phthisis) was
related to penetrating injury, injury to multiple ocular structures and
evidence of infection at time of presentation.
Conclusions: Ocular trauma in children is a common cause of hospital attendance.
They often result in severe visual deficit and there is need for adult
supervision of children at play and control measures to prevent them. There is
need to encourage early presentation and shielding of injured eyes.
KEY
WORDS: Eye injury; childhood; outcome; avoidable;
management.
Cataract
Intervention Surgery: A Community Approach
R.E. Umeh, Onwasigwe
E.N., Ozoh G.A., Onwasigwe C.N., Okoye O.I., Umeh O.C.
Dept. of
Ophthalmology, College of Medicine, University of Nigeria, Enugu Campus, Enugu.
SUMMARY
We present a report of an on-going British
Council Prevention of Blindness – sponsored Cataract Surgical Outreach in Inyi
– a rural community in Oji River Local Government Area of Enugu State, Nigeria.
The important of Community Women’s group in the mobilization of patients and
the community is documented. The eye care providers from the University of
Nigeria Teaching Hospital, Enugu, which carried out the study, consisted of
consultant Ophthalmologist, ophthalmic resident doctors, nurses and auxiliary
staff. Of the 35 patients recruited over a two-month period, 17 males and 18
females, with age range from 51-80 years, mean age 57.8 years. Most patients
(88.6%) had age-related cataract. All 35 patients had intra-capsular cataract
extraction using a cryoprobe, under local anaesthesia. Three patients (8.6%)
had post-operative complications, which are, residual soft lens matter, uveal
prolapsed and up-drawn pupil. There was no case of post-operative infection. Rehabilitation
was done with spectacles. The benefits of successful cataract operation and
restoration of adequate vision as an effective motivator in overcoming
patient’s reluctance and socio-cultural barriers for surgery is highlighted.
KEY
WORDS: Primary eye care, cataract
backlog, cataract surgical outreach, community women’s group and motivators.
Trabeculectomy With Intraoperative
5-Fluorouracil In Enugu, South-Eastern Nigeria: A Pilot study
C.M. Ekwerekwu and
U.F Ezepue
Department of Ophthalmology, U.N.T.H., Enugu.
SUMMARY
AIM: To determine the outcome of 5 FU applied
at time of trabeculectomy in Nigerian patients with open-angle glaucoma who had
primarily received medical therapy. Patients were 13 adult Nigerian seen
consecutively in the Glaucoma Clinic between September 1996 and November 1997.
All had open-angle glaucoma and had primarily been treated with topical
anti-glaucoma therapy. None required a combined surgical procedure and they
were on their topical anti-glaucoma therapy except Pilocarpine until the day of
surgery. Each patient was followed up for at least 3 months. The surgical
technique was similar to Cairns: Just prior to raising the sclera for 5 minutes
with or without apposition of the conjunctival flap over the swab. This was
followed by copious irrigation with normal saline and then raising of the
limbal based partial-thickness sclera flap. With at least a 3-month
postoperative follow-up 10 out of 14 eyes had a final intraocular pressure of
<18.5mmHg. 4 required additional subconjunctival 5-FU. The final visual
acuity remained unchanged in 10 eyes while 3 recorded a worsening of visual
acuity of more than 2 snellen lines due to progression of cataract. The
postoperative complications included bleb breakdown and leakage, early and late
bleb fibrosis, choroidal detachment and chronic hypotony. Neither
endophthalmitis nor extinction phenomenon was recorded in our study.
Trabeculectomy with intra-operative application of 5-FU is relatively safe and
effective but a larger study with a longer follow-up is required to determine
the long-term success rate nd complications of this technique.
KEY
WORDS: 5-Fluorouracil, Nigeria, open-angle
glaucoma, trabeculetomy.
Enucleation
and Evisceration in the Gambia
Dawodu O.A., Hannah
B. Faal
Ophthalmology
Department, University of Benin Teaching Hospital, P.M.B. 1111, Benin City.
SUMMARY
The
decision to remove an eyeball is usually a difficult one for both surgeon and
patient. From the surgeon’s position, it is an acceptance of total defeat at
any efforts that may have been made to salvage the vision or the eyeball. For
the patient, the loss is enormous since any form of artificial replacement of
the organ is usually functionless, (vision wise). At best an improved cosmetic
appearance is all that is achieved. This study highlights those factors that
cumulate in the removal of the eyeball either by enucleation or by
evisceration. The commonest is endophthalmitis/panophthalmitis which was
responsible for 51% of cases. This was followed by staphyloma which make up
24.7%. Other causes include orbital/ocular tumours 8.1%, trauma 5.8%, painful
blind eye 5.8%, and phthisis 4.5%. Over 75% of enucleated/eviscerated eyes were
due to preventable or treatable causes most important of which is infection
which is the underlying factor in cases of endophthalmitis/panophthalmitis and
staphyloma. Health Education to improved awareness as well as improvement in
the socio-economic conditions of the general populace will go a long way in
reversing this trend.
Blepharokeratoconjunctivitis
A.I. Okeke, And G. Schumann
Department of Ophthalmology, Abia State University
Teaching Hospital, Abia, Nigeria.
SUMMARY
The
microbes isolated in 110 in and out patients ages 1-80 years and who had
blepharokeratoconjunctivitis and their sensitivity to antibiotics and
chemotherapeutics were presented. Sixty samples (54.5%) showed bacterial, while
7 samples (6.3%) showed fungal involvement. In 6 samples (5.5%), bacteria and
Fungus coexisted. Majority of bacterial pathogens were sensitive to common
antibiotics while some commonly available antibiotics were not effective on a
reasonable number of germs (tables 5 & 6). Pseudomonas aeruginosa showed
the highest resistance to available antibiotics while penicillin group of
antibiotics had no effect on gram negative pathogens (table 6). Staphylococcus
aureus considered the most common cause of ocular infection was isolated in 5
(4.5%) samples, while staphylococcus epidermidis considered non pathogenic was
isolated in 16 (14.5%) cases. Fusarium Spp, found in 3 (2.7%) cases was blamed
for one hypopion keratitis and one endophthalmitis. Despite the use of such
antibiotics and chemotherapeutics like chloramphenicol, erythromycin,
tetracycline, and sulfacetamide to which the pathogens were sensitive, blepharokeratoconjuctivitis
persisted. The problem of induced pathogenicity, the difficulty in reaching
infection reservoirs with antibiotics, the often inadequate dosage of
antimicrobes as well as geographical and environmental influences were
discussed.
KEY WORDS: Blepharokeratoconjunctivitis, microbes,
pathogenicity Abia/Imo states Nigeria.
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