NIGERIAN JOURNAL OF OPHTHALMOLOGY

Volume 13, No. 1 June 2005

Articles

Pattern of Intraocular Pressure in Lagos ............................................................................ 1

AO Onakoya and HL Alimi

Relevance of Routine Preoperative Laboratory Tests before Cataract and Glaucoma Surgery in a Nigerian Hospital............................................................................................................................... 4

DS Ademola-Popoola and AA Ayanniyi

Paranasal Sinusitis in the Aetiology of Orbital Cellulitis..................................................... 8

J Ubah, OGB Nwaorgu and O Ogunleye

Patients= Perception of the Quality of Eye Care at the University College

Hospital, Ibadan ............................................................................................................... 11

FJ Awobem, CO Bekibele and AM Baiyeroju

Pattern of Presentation Seen in Sickle Cell Retinopathy Patients at Eye

Foundation Hospital, Lagos, Nigeria................................................................................ 17

AO Hassan, O Oderinlo, O Okonkwo, FO Oluyadi, AO Ogunro, and SA Oke

Conjunctivitis as Seen in Ile-Ife ......................................................................................... 21

BO Adegbehingbe, AO Onipede

Three Siblings with Peters= Anomaly: Problems of management in Nigeria ................... 27

E Samaila and CA Olali

Cephalic Tetanus: Case report of a rare complication of orbito-ocular

injury in a Nigerian ........................................................................................................... 32

OA Ogun, AO Ashaye and SO Ola

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Published in Nigeria by the

Ophthalmological Society of Nigeria

PATTERN OF INTRAOCULAR PRESSURE IN LAGOS

^*AO ONAKOYA

HL ALIMI

Guinness Eye Centre, Department of Surgery, College of Medicine and Lagos University Teaching Hospital, Idi Araba, Lagos

SUMMARY

Objective: To study the pattern of normal intraocular pressure (IOP) in Lagos, Nigeria.

Study Design: Prospective non-randomized uncontrolled hospital-based study.

Methodology: Consecutive new patients coming into three different eye clinics between June and August 2001 had their IOP measured by applanation. The demographic characteristics and laterality of the IOP measured were documented. Excluded were: patients with glaucoma, ocular trauma, ocular surgery, ocular inflammation, retinal/choroidal detachment, family history of glaucoma, myopia; patients on corticosteroid or antiglaucoma therapy; patients who had had an anaesthetic administered; and patients with systemic diseases such as hypertension, diabetes and thyroid disease.

Statistical testing of significance was done using the student t-test, and level of significance was taken to be p<0.05. Data analysis was done using the EPI INFO 2002 software.

Results: A total of 500 patients aged 10B84 years were included. Patients in the seventh decade constituted the majority (25.2%). More than 25% of all patients were <40 years. The mean age was 49.3 years " 14.2. The male to female ratio was 1.1:1. IOP range was 8-23mmHg. Mean IOP for all patients was 14.95mmHg " 2.55. The mean IOP in the male patients was 14.87mmHg and for the female 15.11mmHg. This difference was not statistically-significant (p>0.05). Fellow eye IOP difference was 1.79mmHg in males and 1.70mmHg in females, which was not statistically significant (p>0.1). Mean IOP was 14.81mmHg for the right eye and 15.41mmHg for the left, and was not statistically significant (p>0.055). IOP increased with age from 13.85mmHg in the second decade to 16.21mmHg in the ninth decade.

Conclusion: The IOP range and mean IOP values are similar to those from other studies. IOP generally increased with age, tending to drop slightly after the seventh decade in males but rising steadily in females. The sex of the patient and laterality of IOP did not have a significant effect on IOP.

RELEVANCE OF ROUTINE PREOPERATIVE LABORATORY TESTS BEFORE CATARACT AND GLAUCOMA SURGERY IN A NIGERIAN TEACHING HOSPITAL

^*DS ADEMOLA-POPOOLA, FMCOphth, FWACS

Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara State

P. O. Box 4718, Ilorin, Kwara State, Nigeria ! e-mail: dupsyp@yahoo.com

AA AYANNIYI, MBBS (Snr Registrar)

Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara State

SUMMARY

Objective: To investigate the outcome and the relevance of routine laboratory tests, i.e., full blood count (FBC), packed cell volume (PCV), haemoglobin (Hb), and fasting blood sugar (FBS) before cataract and glaucoma surgery.

Materials and Methods: A retrospective review of records of all patients who had cataract/glaucoma surgery at University of Ilorin Teaching Hospital (UITH) over a one and a half year period (October 2002 - March 2004) was carried out. Data assessed include age, sex, type of surgery done, laboratory tests done and the results.

Results: The records of 250 patients who were operated on at the University of Ilorin Teaching Hospital (UITH) during the period under study were reviewed. The age range was between 1 and 90 years, with a mean age of 56.54 years SD"19. The male to female ratio was 1.2:1. The majority of the patients (94.0%) had normal (2-6mmol/L) fasting blood sugar, while 6.0% had high FBS (> 6mmol/L). The mean FBS was 3.49 SD"1.87. Out of the 186 patients whose PCV records were available for review, 178 (71.2%) had normal PCV <30% and 4.3% had low PCV of < 30%. The mean PCV was 28.12 SD"17.1.

Conclusion: Routine laboratory tests before cataract and glaucoma surgery are not advised since a significant number of the patients had normal FBC and FBS. Therefore, indiscriminate preoperative routine testing should be avoided while more attention should be paid to history and clinical examination, the specific procedure being performed and the type of anaesthesia to be used.

PARANASAL SINUSITIS IN THE AETIOLOGY OF ORBITAL CELLULITIS

^*J UBAH

Ladoke Akintola University of Technology, Teaching Hospital, Osogbo

e-mail: ubahj2002@yahoo.com

OGB NWAORGU

O OGUNLEYE

University College Hospital, Ibadan

SUMMARY

Aim: The purpose of this study was to assess the prevalence of paranasal sinusitis as a cause of orbital cellulitis and to identify the commonest sinus(es) involved in our setting.

Methods: A retrospective review of the case notes of 47 patients with orbital cellulitis admitted into the ophthalmic ward of the University College Hospital, Ibadan within a ten-year period (1988-1987) was done.

Results: Sinusitis (34.2%) was the most common cause of orbital cellulitis with the maxillary sinus being the most involved (38%). Patients in the second decade of life had the highest prevalence of 56%. More cases were seen during the dry season C November to February.

Conclusion: Paranasal sinusitis is probably the most frequent cause of orbital cellulitis with the maxillary sinus being the most involved.

PATIENTS= PERCEPTION OF THE QUALITY OF EYE CARE AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN

FJ AWOBEM MBBS (Registrar)

^*CO BEKIBELE MBBS, FWACS, FMCOphth

e-mail: cobekibele@comui.edu.ng

AM BAIYEROJU MBBS, FWACS, FRCOphth

e-mail: baiyeroju@yahoo.com

Department of Ophthalmology, University College Hospital, College of Medicine, University of Ibadan, Ibadan, Nigeria

SUMMARY

Objective: To determine patients= perceptions about the quality of care and possible factors that may prevent adequate utilization of services at the study centre and therefore make recommendations for improvement in service utilization.

Materials and methods: A cross sectional survey of patients from the Eye Clinic and Eye Ward of the University College Hospital, Ibadan, was carried out using a standardized questionnaire between May and June 2001.

Results: A total of fifty respondents were interviewed: 33 (66%) were male, while 17 (34%) were female. Their ages ranged from less than 10 years to more than 80 years, with a mean age of 46.5 years. The majority of the patients (78%) lived within Ibadan, while 22% lived outside Ibadan. Over half of the respondents (56%) were gainfully employed. Others included retirees (20%) and students (20%).

Thirty-eight of the respondents (88%) experienced some obstacles before and/or on presentation at the hospital. Notable obstacles to the optimal use of facilities include: frequent strikes embarked on by hospital workers (66% of respondents), long wait before seeing the eye doctor as reported by 36% of respondents; high cost of services 8%, fear of the outcome of surgery reported by 12% of those who had surgery; and the unfriendly attitude of some staff. Recommendations by respondents for improving the quality of health service delivery include: provision of more equipment in the eye clinic (68%) and the employment of more eye doctors (64%). Other suggestions include reduction in the cost of surgery and other services (12%), and the need for records staff and nurses to be more humane and show understanding to patients, especially those from out of town (4%).

PATTERN OF PRESENTATIONS SEEN IN SICKLE CELL RETINOPATHY PATIENTS AT EYE FOUNDATION HOSPITAL LAGOS, NIGERIA

A O HASSAN FRCS, FRCOph, FWACS

^*O ODERINLO FRCSEd, DRCOphth

O OKONKWO FRCSEd, DRCOphth

FO OLUYADI FWACS

AO OGUNRO FWACS

SA OKE DO (WACS)

Eye Foundation Hospital, 27B Isaac John Street, Ikeja GRA, Lagos

ABSTRACT

Objective: To describe the pattern of presentation of sickle cell retinopathy patients who presented at the Eye Foundation Hospital Lagos, Nigeria between January 2002 and March 2003.

Materials and Methods: The medical records of 27 patients who presented at the Eye Foundation Hospital with retinal changes due to sickle cell disease within a 15-month period were reviewed retrospectively.

Results: A total of 27 patients were evaluated, 67% were male while 33% were female. The mean age at presentation was 36.18 years with female patients tending to present earlier than male patients.

The most common complaint at presentation was a sudden drop in vision seen in 63% of the patients evaluated. The dominant genotype among the patients was SC with 81.5%; 7.4% were SS and 11.1% were AS.

The duration from onset of symptoms to presentation was evaluated. The median duration at presentation was greater than 12 weeks after onset of symptoms; 85% of patients presenting had proliferative retinal changes.

Proliferative sickle retinopathy (PSR) changes were classified according to Goldberg=s classification of 1971. Stage 4 PSR was the most common stage seen, occurring in 48% of patients.

Conclusion: Sickle cell retinopathy patients seen at the Eye Foundation Hospital generally presented after 12 weeks of onset of sudden drop in vision. They were mostly in the SC genotype group and mostly had stage 4 proliferative retinopathy according to Goldberg=s classification.

CONJUNCTIVITIS AS SEEN IN ILE-IFE

^*BO ADEGBEHINGBE MBBCH, DO (Ir.), MSc Ophth. (UK), FWACS, FMCOphth

Ophthalmology Unit, Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife

e-mail: berniceola2003@yahoo.co.uk $ Tel: 234-0803-7218094

AO ONIPEDE² MBCHB, FWACP

Department of Medical Microbiology and Parasitology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife

SUMMARY

Objective: To survey the clinical pattern of conjunctivitis with the aim of identifying the etiologic agents of bacterial conjunctivitis and their antimicrobial sensitivity pattern.

Method: Patients with clinical features of conjunctivitis form the cohort of this study. A retrospective study of 3,872 patients seen at the eye clinic of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, between January 1997 and December 2000 was undertaken. Of these, 689 patients (17.8%) had conjunctivitis. Those diagnosed as having infective conjunctivitis had conjunctival swabs taken for microscopy, culture and sensitivity tests, and were investigated by standard microbiological methods.

Results: Out of a total of 3,872 new patients seen over a 3-year period, 689 (17.8%) presented with conjunctivitis. Of these, allergic conjunctivitis was the most common type, seen in 580 patients (84.2%), followed by acute bacterial conjunctivitis in 98 patients (14.2%), while conjunctivitis secondary to physical trauma and toxic etiologies were seen in 8 (1.2%) and 3 (0.4%) patients respectively. Thirty-three patients (33.6%) with infective (acute bacterial) conjunctivitis had laboratory confirmed positive culture results. Thirteen patients (13.3%) developed complications such as corneal ulceration 9 (9.2%) and perforation 4 (4.1%) before they presented at the hospital. Most of the bacterial isolates were sensitive to third generation cephalosporin, especially ciprofloxacin (89.8%-97.8% sensitivity).

Conclusion: Conjunctivitis due to allergy and infective causes is a major cause of ocular morbidity. The high sensitivity of the isolates to ciprofloxacin (89.8-97.8%), chloramphenicol (68.9%), and gentamicin (84.9%), supports the appropriateness of using these drugs as first line drugs in the management of bacterial conjunctivitis. Corneal ulceration (9.2%) and perforation (4.1%) are major causes of ocular morbidity and blindness (6.1%), among patients with conjunctivitis as seen in Ile-Ife. There is a need for public eye health education and early referral of all cases of eye infections to an eye specialist to prevent blinding complications.

THREE SIBLINGS WITH PETERS= ANOMALY:

Problems of Management in Nigeria

E SAMAILA, MBBS (ABU); DORCP (DUBLIN); FRCS(GLASGOW); FRCOPHTH (LONDON); FWACS

CA OLALI MBBS; FRCS (Ed)

Department of Ophthalmology, (Guinness Eye Clinic), Ahmadu Bello University Teaching Hospital, P.M.B. 2016, Kaduna, Nigeria

SUMMARY

The cases of three children with Peters= anomaly are presented. The children are products of a consanguineous marriage. The clinical features and peculiar problems of managing these patients in a developing country are discussed. With the advent of keratoplasty, some cases, if operated early achieve good vision though the problem of concomitant glaucoma remains a drawback. In Nigeria, and indeed in most developing countries of sub-Saharan Africa, corneal transplantation is still in the embryonic stage.

CEPHALIC TETANUS: Case Report of a Rare

Complication of Orbito-ocular Injury in a Nigerian

^*OA OGUN, M.B.; B.S. (Ib.)

AO ASHAYE, M.B.; B.S. (Ib.) FWACS, FMPCOphth

Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan Nigeria

SO OLA, M.B.; B.S. (Ib.) FWACP

Department of Medicine, College of Medicine, University of Ibadan, Ibadan Nigeria

SUMMARY

Objectives:

$ To highlight the risk of cephalic tetanus resulting from penetrating orbital injury.

$ To alert ophthalmologists to the importance of ensuring adequate anti-tetanus prophylaxis in all cases of ophthalmic and in particular orbital trauma most especially where foreign body retention is involved or is likely.

Methodology: A case of cephalic tetanus in a 24-year old Nigerian motor mechanic; presenting with torticollis, trismus, facial and neck muscle spasms and multiple cranial nerve palsies affecting the III^rd, IV^th, V^th and VII^thcranial nerves is reported. This followed a penetrating injury to the left orbit with a retained metallic foreign body. The patient=s anti-tetanus immunization status was not known prior to the injury. The patient developed symptoms of cephalic tetanus some days after receiving the anti-tetanus serum intramuscularly. He was treated vigorously with anti-tetanus serum, intravenous diazepam and fluids, intravenous metronidazole and other parenteral broad-spectrum antibiotics. He was also actively immunized with tetanus toxoid injections.

Results: He made a slow but remarkable recovery after about five weeks (38 days) with minimal neurological deficit.