Addressing Unmet Surgical Needs in an Underserved Nigerian Community: Report of a 'Town and Gown' Initiative

BACKGROUND

Access to quality and timely care prevents unnecessary deaths and morbidity from potentially curable surgical diseases. This study describes the magnitude of unmet surgical needs in a Nigerian community and describes the experiences garnered during a surgical outreach organized by a tertiary institution in an underserved community.

METHODS

This is a descriptive study highlighting details of a surgical outreach to a community in south-Western part of Nigeria. The project was based on a collaboration between a University Teaching Hospital (gown) and the community (town). Details of the patients' demographic and disease characteristics as well as barriers to seeking medical care were obtained. The operational workflow, treatment offered, and outcomes are highlighted. Results are presented as descriptive statistics.

RESULTS

Over a two-day period, 83 out of 3,056 patients who were screened had surgically treatable conditions (2.7%), predominantly hernias (37, 46.6%), goitres (13, 15.7%) and soft tissue swellings (9, 10.8%). The majority were adults (56, 67.5%) while 27 (32.5%) were in the paediatric age group. The mean duration of symptoms was 8.64 months ± 9.5 months. About half of the patients (46.9%) had never visited a medical facility on account of their index illnesses. Lack of funds was cited by many patients as the main reason for having not presented at a hospital. Sixty-three surgical operations were performed with no peri-operative adverse events.

CONCLUSION

Lack of financial access was the major barrier to surgical care in the sampled community. Moving from 'gown to town' helped address a significant proportion of the unmet needs over a relatively short period. Tertiary hospitals can provide surgical oversight to communities within their jurisdiction using this approach.

Trends in Eye Removal Surgeries at a Tertiary Care Hospital Over Three Decades

PURPOSE

To determine the trends in eye removal surgeries at a tertiary hospital in Nigeria over 26 years.

METHODS

A retrospective comparative review of clinical records of all patients who had eye removal surgery at a tertiary hospital in Ile-Ife, Nigeria, between 2014 and 2019 was done. Patients' demographic and clinical data, including indication for eye removal and type of surgery were analysed and compared with two earlier studies at the same hospital between 1994 and 2013.

RESULTS

There was an average of 14.3 surgeries per year between 2014 and 2019. Patients' ages ranged from 2 to 102 years, M:F was 1.5:1, the commonest indication for eye removal was infection (n=30, 34.9%), and the most common surgery was evisceration (n=70, 81.4%). Studies from 1994 to 2003 and 2005 to 2013, reported an average of 9.2 and 10 surgeries per year; ages ranging from 4 days to 88 years and 3 months to 88 years; with a M:F of 2.1:1 and 3.4:1 respectively. In both studies, the commonest indication for eye removal was trauma (43.4% and 43.8% respectively) and the most common surgery was enucleation (57.6% and 55% respectively). Trend data showed a progressive increase in eye infections (12% vs 15% vs 34.9%) and eviscerations (19.6% vs 31.2% vs 81.4%) over time.

CONCLUSION

There was a change in trend towards an increase in eviscerations and infective indications for eye removal at the hospital over three decades. Prompt and optimal treatment of orbito-ocular infections is recommended to reduce the incidence of eye removal surgeries.

Epidemiology and Management of Oculoplastic Disorders at a Tertiary Hospital: A 4-Year Review

PURPOSE

To describe the epidemiology and management of oculoplastic disorders at a tertiary hospital in Nigeria.

METHODS

This was a retrospective review of patients with oculoplastic disorders at the Department of Ophthalmology, Obafemi Awolowo University Teaching Hospitals Complex, IleIfe, Nigeria from January 2013 to December 2016. The general ophthalmology service records were reviewed to identify patients with oculoplastic disorders. Data retrieved from patient records included date of initial visit, age at presentation, gender, oculoplastic diagnosis and aetiology, modality of treatment given, and indications for patient referrals.

RESULTS

There were 563 (7.4%) patients with oculoplastic disorders, out of 7,575 ophthalmology department patients. They had 573 oculoplastic disorders in all. There were 281 (49.9%) males and 282 (50.1%) females. The median age at presentation was 28 years (range, 1 day to 100 years). Eyelid laceration (n=68; 11.9%) and chalazion (n=63; 11%) were the commonest disorders. Trauma (n=125; 21.8%) was the commonest aetiology, followed by inflammatory (n=121; 21.1%) and infective (n=108; 18.8%) causes. There were 162 (28.3%) surgical interventions; eyelid repair (n=67; 41.4%) was the commonest, followed by evisceration (n=25; 15.4%), and excisional biopsy (n=25; 15.4%). No patient had ptosis or lacrimal surgery. Orbital disorders (n=21; 42.9%) were the commonest indication for a referral elsewhere.

CONCLUSION

Eyelid laceration was the commonest oculoplastic disorder, trauma was the commonest aetiology, and eyelid repair was the commonest oculoplastic surgery done. Further training in oculoplastics with emphasis on ptosis, lacrimal and orbital surgery, as well as the provision of equipment needed for optimal oculoplastic service delivery are recommended.

Distribution of phthisis bulbi and status of fellow eyes at a tertiary eye-care centre in Nigeria: a ten-year review

BACKGROUND

Phthisis bulbi is an irreversible cause of visual loss with insufficient evidence about its aetiology and status of patients' fellow eyes.

OBJECTIVES

To identify the distribution of patients with phthisis bulbi and determine the status of their fellow eyes at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

METHODS

We analysed data retrospectively retrieved from medical records of patients diagnosed with phthisis bulbi at initial clinic visit from January 2008 to December 2017. Information abstracted included biodata, laterality of phthisical eye, duration and aetiology of phthisis bulbi, visual acuity, and morbidities present in fellow eyes.

RESULTS

Seventy-nine patients presented with unilateral phthisis bulbi. The mean age was 51±21.2 years and forty (50.6%) were males. The commonest aetiologies of phthisis bulbi were trauma 37 (46.8%), infection 17 (21.5%) and uveitis/inflammation 11 (13.9%). Seventy (88.6%) patients had morbidities in their fellow eye such as glaucoma 26 (32.9%), refractive errors 23 (29.1%) and cataract 22 (27.9%). Forty (50.6%) patients were either visually impaired or blind in their fellow eye (p=0.001).

CONCLUSION

The commonest cause of phthisis bulbi was trauma. Approximately nine out of ten patients had ocular morbidities in their fellow eye. A thorough follow-up of patients with phthisis bulbi is recommended.

Axial length/corneal radius of curvature ratio and refractive status in an adult Nigerian population

AIM/BACKGROUND

Associations between axial length (AL) to corneal radius of curvature (CR) ratio and refractive status in a healthy Nigerian adult population were studied.

MATERIALS AND METHODS

Healthy students and members of staff of Obafemi Awolowo Teaching Hospitals Complex, Ile-Ife, South West Nigeria, free of obvious ocular diseases except possible refractive errors were recruited. Consecutive consenting volunteers were recruited by simple random sampling and a proportionate sample of each population based on its representative fraction in the hospital community was recruited. The study was conducted between June and August 2011. Noncycloplegic objective refraction was done and spherical equivalent refraction (SER) of the right eyes was used for calculation. The AL, CR, and keratometric readings were measured with the IOL Master. The AL/CR ratio was calculated. The data were analyzed with statistical software package STATA 13.

RESULTS

Three hundred and fifty volunteers aged 18-60 years were studied. The mean ± standard deviation of AL/CR and SER were 3.04 ± 0.10 and -0.38 ± 1.42D, respectively. AL in myopia was significantly higher than in emmetropia and hypermetropia. There were no significant differences between CR in the refraction groups. Myopes had significantly higher AL/CR than nonmyopes. On controlling for age and gender, 1 mm increase in AL increased SER by -0.77D (95% confidence interval [CI] -0.91--0.64D) while a unit increase in AL/CR increased SER by -8.89D (95% CI -10.00--7.78D). Whereas AL accounts for 39% of variability in SER (P < 0.001), AL/CR accounts for 51% of the variability observed in SER (P < 0.001).

CONCLUSION

This study has further confirmed that the AL remains a strong determinant of refraction, but a derived factor AL/CR accounts for more variation in final refractive status than AL in isolation.

B-mode sonographic evaluation of optic nerve sheath diameter and lens thickness in Nigerian adults with glaucoma

Objective

This study was done to investigate the effect(s) of glaucoma on the ocular optic nerve sheath diameter and lens thickness using B-mode ultrasonography.

Materials and methods

One hundred and twenty study participants were recruited; 60 subjects with glaucoma and 60 age- and sex-matched controls without glaucoma. The optic nerve sheath diameter and lens thickness of both eyes were measured using a linear high frequency transducer with frequency of 6.5–12MHz.

Results

The mean optic nerve sheath diameter of the glaucomatous eyes (3.57 ± 0.19mm and 3.59 ± 0.33mm on the right and left, respectively) were significantly thinner than that of controls (4.23 ± 0.34 mm and 4.26 ± 0.30 mm on the right and left, respectively; p < 0.001). There is increased mean lens thickness in the glaucomatous eyes (4.15 ± 0.43mm and 4.18 ± 0.46mm on the right and left, respectively) than in the controls (4.01 ± 0.56mm and 3.99 ± 0.45mm on the right and left, respectively) with a statistically significant difference seen in the left eye (p = 0.024).

Conclusion

B-mode ultrasound is a reliable tool of assessing the nerve sheath diameter and lens thickness in glaucoma. Optic nerve sheath diameter is reduced in glaucoma

Visual impairment and blindness in type 2 diabetics: Ife-Ijesa diabetic retinopathy study

Diabetes and blindness are important health issues globally; we determined the prevalence of blindness, diabetic retinopathy, and other eye diseases in Nigerian-type 2 diabetics. A prospective, cross-sectional study was conducted on consenting type 2 diabetic patients who had scheduled comprehensive eye examination including dilated funduscopy with +78DS. Visual status was graded using the WHO criteria. Approval from Institutional Ethics Committee was obtained. Primary outcome measures were the prevalence and causes of blindness as well as prevalence of diabetic retinopathy. Secondary outcome measures were the presence of other eye diseases. Data were analyzed using SPSS version 13. Two hundred and sixty-six eyes of 133 type 2 diabetic patients aged 22-89 years were studied; 69 (51.9 %) were males while 64 (48.1 %) were females. Five (3.8 %) patients were blind while 27 (20.3 %) were visually impaired. Cataract was the leading cause of blindness (60 %) and visual impairment was found in 59.3 %. Diabetic retinopathy was present in 37 (27.8 %) diabetic patients of which 5 (3.8 %) were proliferative. Diabetic macular edema was present in 31 (23.3 %) patients. Severe visual impairment and blindness were commoner in those with diabetic retinopathy. Refractive error 67 (25.2 %), cataract 63 (23.7 %), and chronic glaucoma 44 (16.5 %) were the most prevalent non-diabetic retinopathy eye diseases. High prevalence of blindness, diabetic retinopathy, and other diseases are seen in type 2 diabetics. Health education, early diagnosis as well as treatment of diabetic retinopathy and other diseases will largely alleviate these ocular morbidities.

Prevalence and pattern of eye disorders among commercial motorcycle riders in Ile-Ife, Osun state

AIMS AND OBJECTIVES

To describe the prevalence and pattern of eye disorders existing among commercial motorcycle riders (CMRs) in Ile-Ife, Osun State. Materials, Subjects and Methods: A total of 1626 registered CMRs operated in 40 registered motorcycle assembly units in Ile-Ife. Using a multi- staged random sampling technique, a total of 322 riders were randomly selected from 10 units. Equal number of 322 was selected from the sample space as control. Structured questionnaires were administered and ocular examination carried out.

RESULTS

SA total of 312 (96.9%) CMRs had normal vision (better than 6/18) in the better eye. The observed prevalence of subnormal visual acuity (<6/18-3/60) was 3.1% (10 CMRs) while prevalence of monocular vision was 2.8% (9 riders). Cataract and glaucoma were the major causes of visual impairment and blindness. The common ocular conditions seen were presbyopia (11.8%), allergic conjunctivitis (11.5%), glaucoma suspect (8.1%), pterygium (4.7%), pingueculum (4.0%), uncorrected refractive error (3.7%) and cataract (2.8%). It was also observed that the longer the years of riding experience of these riders, the higher the occurrence of pterygium with a significant statistical impact of p value of 0.009. Presbyopia was also the commonest disorder amongst the control group (11.2%).

CONCLUSION

Presbyopia was the most common finding from the study while the commonest anterior segment disorder was pterygium which was an occupation- related ocular disorder. Causes of blindness seen were avoidable.

Causes of blindness in a special education school

BACKGROUND

Blind children and young adults have to overcome a lifetime of emotional, social and economic difficulties. They employ non-vision dependent methods for education.

OBJECTIVE

To assess the causes of blindness in a special school in southwestern Nigeria to aid the development of efficient blindness prevention programmes.

METHODS

A cross-sectional survey of the Ekiti State Special Education School, Nigeria was conducted in May-June 2008 after approval from the Ministry of Education. All students in the blind section were examined for visual acuity, pen-torch eye examination and dilated fundoscopy in addition to taking biodata and history.

RESULTS

Thirty blind students with mean age of 18±7.3 years and male: female ratio of 1.7:1 were examined. Blindness resulted commonly from cataract eight (26.7%), glaucoma six (20%) retinitis pigmentosa four (16.7%) and posttraumatic phthysis bulbi two (6.7%). Blindness was avoidable in 18 (61%) of cases. Glaucoma blindness was associated with redness, pain, lacrimation and photophobia in 15 (50%) and hyphaema in 16.7% of students; none of these students were on any medication at the time of study.

CONCLUSION

The causes of blindness in rehabilitation school for the blind are largely avoidable and glaucoma-blind pupils face additional painful eye related morbidity during rehabilitation. While preventive measures and early intervention are needful against childhood cataract and glaucoma, regular ophthalmic consultations and medications are needed especially for glaucoma blind pupils.

Efficacy of Garcinia kola 0.5% Aqueous Eye Drops in Patients with Primary Open-Angle Glaucoma or Ocular Hypertension

Purpose:

To evaluate the intraocular pressure (IOP) lowering efficacy of Garcinia kola 0.5% aqueous solution eye drops in patients with newly diagnosed primary open-angle glaucoma or ocular hypertension (POAG/OH).

Materials and Methods:

A randomized, double-masked, multicenter, active-controlled prospective study. Patients who met the inclusion criteria were randomly assigned in equal numbers to receive Timolol 0.5% eye drops as a control medication (A = Group 1 eyes) or Garcinia kola 0.5% eye drops as the study medication (B = Group 2 eyes). All drops were instilled at 6 am and 6 pm daily. Goldman applanation tonometry was performed at 9 am, 12 pm and 3 pm at baseline, week-6, week-12 and week-24 visits. Voluntary and actively elicited reports of adverse events were documented. The mean change in IOP over 24 weeks was the primary outcome measure. Both groups were compared for statistically significant differences at all visits. A P < 0.05 was considered statistically significant.

Results:

A total of 178 patients were randomly assigned to G. kola and Timolol groups. At baseline there were no differences in mean IOP between groups, based on age, sex, or diagnosis. At the end of the study period (24^th week), the mean (± SD) reduction in IOP was 12.93 ± 2.3 mmHg (47.8% ± 0.8% reduction) in G. Kola group and 13.09 ± 2.8 mm Hg (48.2% ± 1.03% reduction) in the Timolol group (P > 0.05). Adverse events were mild in nature with no statistically significant differences between groups (P > 0.05).

Conclusions:

Garcinia kola ophthalmic solution significantly reduces IOP as compared to baseline. The IOP lowering effect of both treatments was equivalent.

Ophthalmic admissions in a tertiary hospital in Nigeria

BACKGROUND

Hospitalization for eye care is required for different reasons. The pattern of admissions into the ophthalmic wards of a sub-urban tertiary hospital was studied.

METHODOLOGY

Records of patients admitted into the Ophthalmology wards of the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife from January 2004 to December 2007 were reviewed and the age, sex, duration of admission and diagnosis recorded. Data was analyzed with SPSS version 13 and statistical significance inferred at P<0.05.

RESULTS

Of the 523 patients admitted, 60.2% were males while 39.8% were females (P<0.0001); the male preponderance becomes less prominent with increasing age (P=0.001). The duration of admission ranged between 2 and 24 days with a mean of 2.86+/- 1.95 days and 63% were admitted for 3 days. The main indications for admission were cataract (58.3%), ocular trauma (14.3%) and glaucoma (13.4%). Eye injuries were more common among children and young adults while cataract and glaucoma were the leading indications in the middle aged and elderly.

CONCLUSION

Cataract, trauma and glaucoma were the leading indications for ophthalmic hospitalization. Human and infrastructural development of the ophthalmology unit should lay emphasis on the more prevalent needs to enhance effective and efficient management of these diseases.

Confocal scanning laser tomography of the optic nerve head of glaucoma patients: inter-correlation of disc parameters

OBJECTIVE

To evaluate the scanning laser tomography characteristics of the optic nerve head in patients with primary open angle (POAG) glaucoma using the Heidelberg retina tomography (HRT II).

DESIGN

A clinic-based retrospective study.

PARTICIPANTS

A total of 84 eyes of 42 POAG patients with good quality HRT II Images were studied at Charles Nicolle Hospital University department of Ophthalmology out-patient clinic, Tunis.

METHODS

Characteristics of optic disc pattern of glaucoma patients were documented using the HRT II. Association of disc area with the other HRT parameters and inter-eye difference in the HRT parameters were assessed using simple and multiple regression analysis. MAIN OUT-COME MEASURES: Disc area, cup area, rim area, cup-to-disc area ratio, cup volume, rim volume, mean cup depth, maximum cup depth and mean retinal nerve fibre layer thickness.

RESULTS

Twenty-seven males and 15 females were studied. The mean age of glaucoma patients was 48.9±2.7 years. The mean disc area, cup area, cup-to-disc area ratio and rim area were 2.19±0.46 (range, 1.23 - 3.16mm2), 0.95±0.94 (range 0.08 - 2.15), 0.42±0.21(range 0.004-0.92), 1.25± 0.46 (range 0.18-2.64) respectively. Disc area was positively correlated to the cup area (p=0.001), rim area (p=0.001), cup to disc area ratio (p=0.03), and mean cup depth (p=0.02).The glaucoma diagnosis score was strongly correlated with the rim area (p< 0.001), cup area (p< 0.001), mean cup depth (p< 0.001) and cup disc area ratio (p< 0.001). Absolute inter eye parameter between the two eyes were positively correlated with disc area (p< 0.05).

CONCLUSIONS

There was a significant correlation of the parameters between the two eyes and between the disc area and some other HRT parameters.

Assessment of human and material resources available for primary eye-care delivery in rural communities of southwestern Nigeria

Integration of primary eye-care (PEC) into the existing primary healthcare (PHC) system is efficient in reaching rural communities. Baseline assessment of human and material resources for primary eye-care delivery in a rural local government area of southwestern Nigeria with projected population of 126,625 was conducted. Data on number and cadre of all PHC facilities and health-workers were collected. All facilities were visited and materials required for basic PEC inspected. Forty-one (42.3%) community health extension workers, 42 (43.3%) health assistants, 3 (3.1%) community officers of health and 11 (11.2%) registered nurses administered PHC in 27 health facilities. No worker had training in PEC and none of the centres had all the materials for basic PEC delivery. Although procurement of materials and training of health-workers in basic PEC delivery is required, the healthcare facilities and workers currently available are adequate to commence integration of PEC into the PHC system.

Knowledge, attitudes, and self care practices associated with glaucoma among hospital workers in Ile-Ife, Osun State, Nigeria

This study was carried out to determine the level of correct knowledge about glaucoma and attitudes towards blindness prevention and treatment, and how these factors influence self care practices among teaching hospital workers. A random sample of the workers at Obafemi Awolowo University Teaching Hospital in Nigeria was interviewed. All respondents were asked the year of their last visit within the past one year to an eye care practitioner. A total of 205 members of staff were interviewed; 85 (41.5%) were males and 120 (58.5%) females. Female sex (P=0.003), medical profession (P=0.007), ophthalmic specialty (P=0.0001), secondary or tertiary education (P=0.001), and recent visit to an eye practitioner (P=0.012) were significant predictors of knowledge of glaucoma as a blinding disease. Younger people believed blindness prevention and treatment were the highest priorities compared with other diseases. Those who work in the ophthalmic unit and those who had relatives who had been blind from glaucoma also considered blindness treatment to be the highest priority compared with other diseases. People with a relative that had previous diagnosis of glaucoma (P=0.0001), older people (P=0.003), females (P=0.001), and people with correct knowledge of common eye diseases (P=0.0005) were significantly more likely to be under eye care. No interaction was found between knowledge and positive attitudes to self care practices. In conclusion, this study shows that there is a gap in the knowledge and understanding of glaucoma among Nigerian hospital workers, especially among the non-medical staff. There is therefore a need for eye health promotion activities targeting all workers at primary healthcare facilities.

Central nervous system stimulants: effect on visual functions and occurrence of road traffic accidents

OBJECTIVE

To determine the influence of the use of central nervous system (CNS) stimulants on visual functions and occurrence of road traffic accidents (RTA) amongst commercial drivers.

DESIGN

A cross-sectional study in which two hundred and fifteen consecutive drivers were interviewed and their eyes examined.

SETTINGS

Ife Central Local Government Area (LGA) of Osun State, Nigeria.

MATERIALS AND METHODS

Out of the estimated 270 commercial drivers registered in the four major parks of the LGA, 215 consecutive drivers participated in the survey Questionnaires were administered by face-to-face interview and the drivers' eyes examined by the authors.

RESULTS

The prevalence of visual impairment (visual acuity < 6/18) in the better eye without correction was 3.3%, and there was a significant association between uncorrected visual acuity impairment in the better eye and RTA (p = 0.0152). The prevalence of refractive error was 8.4%, but none of these drivers wear corrective glasses. Alcohol consumption is common (57.7%) amongst the drivers, and there was a significant association between alcohol consumption and RTA (p = 0.00124). There was also a significant association between the use of CNS stimulants (kolanut, marijuana and cigarette) and RTA (p = 0.005).

CONCLUSION

It was therefore concluded that visual impairment in the better eye, alcohol consumption and the use of other CNS affecting substances contribute to the occurrence of RTA among the drivers.

Intra-operative 5-FU in Glaucoma Surgery: A Nigerian Teaching Hospital Experience

Background:

5-Fluorouracil (5-FU) is an anti-metabolite used as an adjunct during the initial stages of a trabeculectomy to prevent excessive post-operative scarring and thus reduce the risk of failure.

Objectives:

To assess the effects of intra-operative 5-FU in trabeculectomy in Nigerians.

Methods:

Trabeculectomy with an intra-operative sponge soaked with 5-FU was performed in 49 eyes of 34 patients. The reduction in intra-ocular pressure (IOP), Visual acuity changes and complications were noted.

Results:

The mean presenting and preoperative IOP was 35.6+/-12.5mmHg and 25.5+/-6.6mmHg respectively. The mean post-operative IOP was 10.0+/- 5.2mmHg on the second post-operative day and 16.5+/7.3mmHg at 3 months. Post-operative complications included ocular hypotony in 4 (25 percent), shallowing of anterior chamber in 3 (18.8 percent), hyphema and cystic bleb in 2 (12.5 percent) each. None had bleb failure. 5 FU appears to reduce the relative risk of failure of trabeculectomy in those undergoing surgery for the first time (relative risk 0.29, 95 percent confidence interval 0.16 to 0.53).

Conclusions:

The use of 5-FU during trabeculectomy is associated with significant benefit in terms of intraocular pressure lowering beyond 3 months postoperatively. The results of surgery in Nigerian patients compare well with other reported series.

Neglected massive intracerebral abscess: an unusual cause of bilateral visual loss

BACKGROUND

Bilateral visual loss following chronically raised intracranial pressure is not uncommon especially in developing countries. However, this calls for concern when the cause of the raised intracranial pressure is neglected pyogenic cerebral abscess.

CASE SUMMARY

A sixteen year old male student presented to our unit with eight months history of recurrent headache associated with early morning vomiting. He developed bilateral visual loss a month prior to presentation. He had sought treatment at several herbal homes and orthodox hospitals before presentation. His cranial computed tomographic scan (CT) showed a massive peripheral contrast enhancing lesion in the frontal lobes with gross midline shift and other evidence of mass effect. He subsequently had craniotomy and excision of the mass. Intraoperative and laboratory findings confirmed the lesions to be abscess. He had ciprofloxacin and metronidazole for four weeks. He had uneventful postoperative period though his visual loss has persisted. He is being followed up in the clinic.

CONCLUSION

This patient illustrates that untreated frontal lobe abscess could cause bilateral visual loss from chronically elevated intracranial pressure (ICP). Even though this should be rare in contemporary neurosurgical practice, ignorance and poverty which are rife in developing countries will be important contributory factors. Physicians working in developing countries should be aware of the symptomatology of cerebral abscess and raised ICP. They should encourage patients to do cranial CT when the features are suggestive of space occupying lesions.

Blindness from bilateral bullous retinal detachment: tragedy of a Nigerian family

OBJECTIVE

To present a scourge of blindness possibly due to an inherited condition causing retinal detachment in 3 siblings

METHODS

In February 2004, three siblings from a monogamous family from Ipetu-Ijesha in Osun state, Nigerian presented to the author consecutively with history of visual impairment/ blindness. A detailed history and comprehensive ocular examination was conducted on each of them. Information obtained included patients demographic, family history of blindness, eye diseases and other medical conditions. Visual acuity assessment, slit lamp examination, direct and indirect ophthalmoscopy, intra-ocular pressure measurement, visual field test and systemic evaluation were conducted on each of the patients.

RESULTS

Two males and a female patient from the same parents who were systemically healthy are reported. Their ages were 67 years, 58 years and 52 years respectively. Each presented with bilaterally poor vision ranging from 6/36 to no light perception, intra-ocular pressure ranging between 6 and 18mmHg and bilateral grayish white bullous retinal detachment.

CONCLUSION

The mode of inheritance in these patients was most probably autosomal dominant or X-linked recessive. Ignorance and poverty causing failure to seek prompt specialize eye care were responsible for blindness in these siblings.

Prevalence of blindness and visual impairment in Atakunmosa West Local Government area of southwestern Nigeria

Blindness survey remains a useful tool for eye care needs assessment. A cross sectional survey of Atakunmosa West Local Government Area, a rural community of southwest Nigeria with no form of eye care facility was carried out. The objective of this study was to define areas of eye care need and develop programme for elimination of avoidable blindness in the region. Multistage cluster sampling technique selected 1248 respondents across all the eleven health districts. Respondents had visual acuity and ocular examination. Blindness was defined as presenting visual acuity (pva) of < 3/60 in the better eye and visual impairment as pva of < 6/18 in the better eye. Out of the 1,248 respondents screened, 14 (1.1%) were blind and 78 (6.3%) were visually impaired. There was an increasing risk of blindness and visual impairment with age; occurring more commonly after 60 years of age. The prevalence of blindness and visual impairment were higher in females although not statistically significant (P = 0.70; 0.46 respectively). Blindness was caused mainly by cataract (57.2%), glaucoma (14.3%) and congenital childhood blindness (14.3%). Cataract (57.7%), glaucoma (16.7%) and uncorrected refractive error (15.4%) were the leading causes of visual impairment. Blindness was avoidable in 85.7% of cases. Qualitative and subsidised cataract surgical and refractive services are needed urgently in this region and therefore, the incorporation of eye health care into the existing primary health care system may ensure programme sustainability.

Ocular health status of rural dwellers in south-western Nigeria

OBJECTIVE

To determine the prevalence and causes of ocular morbidity, visual impairment and blindness, and suggest strategies for blindness prevention in a rural population.

DESIGN

A population-based cross-sectional study.

SETTING

Imesi-Ile, in Obokun local government area of Osun State, Nigeria.

METHODS

All participants had preliminary interview and screening consisting of vision assessment using an illiterate E-chart and anterior segment hand light examination at their houses. Those who had signs and symptoms of ocular disease were offered comprehensive eye examination at the base hospital, including visual acuity using illiterate E-chart and refraction, slit-lamp biomicroscopy, gonioscopy, applanation tonometry and dilated fundus examination as necessary.

RESULTS

Of the 2201 patients examined, 298 (13.5%) had signs and symptoms of ocular disease. This consisted of 153 male (51.3%) and 145 (48.7%) female patients. Their ages ranged between 8 and 92 years, with a peak age range of 41-70 years (45.6%). Most of them had never seen an eye care specialist for appropriate ophthalmic care. The common eye problems encountered were cataract (48.0%), glaucoma (21.1%), allergic conjunctivitis (16.4%), refractive errors (12.4%), age-related macular degeneration (0.7%) and corneal opacities (0.7%). Thirty-two eyes of 27 persons (1.2%) (22 monocular and 5 binocular) were blind by the World Health Organisation definition. Cataract was the leading cause of blindness (44.4%), followed by glaucoma (33.3%), macular degeneration (7.4%), corneal opacity (7.4%), optic atrophy (3.7%) and phthisis bulbi (3.7%).

CONCLUSION

A significant proportion (13.5%) of people in this community had ocular diseases which require treatment. The role of primary eye care health workers in a rural community as Imesi-Ile cannot be overemphasised.

Blindness and visual impairment among the elderly in Ife-Ijesha zone of Osun State, Nigeria

BACKGROUND

To provide information on the prevalence of visual impairment, blindness and the leading causes of visual changes among the elderly in Ife-Ijesha zone of Osun state in Nigeria.

DESIGN

A cross-sectional descriptive community based study.

METHODS

All people aged 60 years or older were gathered at various centres in Ife-Ijesha zone of Osun State, Nigeria. They were all screened for various medical problems including eye ailments and blindness according to World Health Organisation (WHO) definition. Information was retrieved and clinical examination conducted by the ophthalmologist in the team. Data collected were analyzed using descriptive statistical methods.

RESULTS

Out of the 681 elderly who presented for medical check up, 445 had eye problems. A few 25 (5.6%) were bilaterally blind while 202 (45.4%) were visually impaired according to the WHO definition of blindness and visual impairment. Blindness was twice as common in men as in women and the difference was statistically significant (P=0.0001). Cataract (42.3%), glaucoma (32.4%) and uncorrected aphakia (9.9%) were the leading causes of blindness in 69 eyes while 80% of visual impairment was due to cataract alone.

CONCLUSIONS

The prevalence of blindness and visual impairment in this study population is high. These findings in a community where most of the elderly are fast losing traditionally accorded attention due to civilization and urban movement call for a great concern.

Burkitt's lymphoma of the head and neck region in a Nigerian tertiary hospital

BACKGROUND

Burkitt's lymphoma is endemic in Nigeria; it forms about 39% of all childhood cancers. In recent times more of these cases are being seen presenting first to the Ear Nose and Throat clinic.

OBJECTIVE

This study is designed to look at the pattern of presentation of head and Neck Burkitt's lymphoma at a Nigerian Tertiary hospital and to evaluate current treatment modality.

DESIGN

It is a retrospective study of all confirmed Burkitt's lymphoma of the head and neck region seen at the Obafemi Awolowo University Teaching Hospital Ile Ife (OAUTHC) between 1986 and 2002.

PATIENTS AND METHODS

The medical records of all the patients with the histopathologically confirmed Burkitt's lymphoma over a 17-year period (1986-2002) were evaluated. The proportion of the tumor affecting the Head and neck region were noted. The data extracted were entered into a questionnaire and analysis of data was done using the SPSS 10.0 software.

RESULTS

A total of 196 cases of Burkitt's lymphoma were seen over the period out of which 140 (71.4%) were in the head and neck region. There was a male preponderance with the incidence of 72% and 28% in females. The peak age incidence was found to be within the first decade of life. The most common sites that were affected are; the jaw (65.9%), nasal and paranasal sinuses (12.2). Majority of the patients presented with advanced disease. Combination Chemotherapy comprising Cyclophosphamide, Oncovin, Methotrexate and Prednisolone (COMP) was the mainstay of management. The treatment outcome was only favorable in 36.6%. Default rate was (11.7%) while the mortality rate was (12.6%). Relapse\recurrence was found in (5.1%) of cases. Frank drug resistance was found in (2.6%). Blindness was found to be a major morbidity associated with this disease. Septicemia and severe anemia were found to be the major causes of mortality. Some complications of treatment were noted.

DISCUSSION

The importance of the findings in this work was discussed in line with the existing literature.

CONCLUSION

Head and neck remain the mostly affected parts in Burkitt's lymphoma in this environment. Presentation with advanced disease is the bane. This partly explains high morbidity and mortality in affected children.

Isolated bilateral upper lid coloboma--a case report

BACKGROUND

Congenital upper lid colobomas may be associated with ocular and systemic anomalies. This paper reports an isolated bilateral upper lid coloboma.

METHOD

A report of a case of bilateral upper lid coloboma with discussion of relevant literature.

RESULTS

A 5-month old healthy baby girl presented with isolated bilateral upper lid coloboma. The coloboma was as large as two thirds of each upper lid with symblepharon. She had no other associated congenital anomalies reported by various workers. The upper lid defect in each eye was repaired in two stages. She had a flap from the lower lid using the lid switch technique and flap separation 2 weeks after the first surgery, in a combined surgery by a plastic surgeon and ophthalmologists. A good functional and cosmetic result was achieved from the treatment. The patient was discharged five days after the second surgery.

CONCLUSION

This case shows that lid coloboma could be an isolated problem in a child. Early and appropriate surgical intervention is necessary for good visual and functional outcome.

Case report: intraocular cysticercosis

A case of intravitreal cysticercosis causing left uniocular cataract and eventual left visual loss in a healthy female Nigerian is presented. The diagnosis of cysticercus celulosae was not made until the patient had left cataract extraction done. The cysticercus larva found its way into the anterior chamber and this stimulated severe ocular inflammation. The use of antihelminthic and systemic steroid caused amelioration of the patient's ocular inflammation and symptoms. The review of literature on ocular involvement and the management of cysticercosis are discussed.