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Click to read: Nigerian Journal of Ophthalmology 2008; 16(1)



Herpetic Eye Disease in a Public Eye Hospital in Nigeria
Sebastian NN Nwosu and Akunne I Apakama
Department of Ophthalmology, Nnamdi Azikiwe University, Nnewi Campus

ABSTRACT
Objective: To determine the aetiology, pattern and complications of herpetic eye disease seen at the Guinness Eye Centre,Onitsha, Nigeria
Materials and Methods: The case files of all patients with herpetic eye disease who presented at the centre between January 1998 and December 2003 were reviewed. Information on age, sex, aetiological diagnosis, visual acuity,ocular complications and HIV status were abstracted into a standard proforma and analyzed.
Results: Sixty-two patients (64 eyes) – 35 male and 27 female – were seen. Age range was 14 months to 80 years. Thirtyone (50%) patients (32 eyes) had herpes simplex keratitis, 30 had cytomegalovirus retinitis. Twenty-nine patients were HIV positive. Fifty per cent of the affected eyes had low vision.Common ocular complications were: corneal opacity (20 patients); herpetic neuralgia (9 patients); uveitis (8 patients);and superimposed bacterial infections (6 patients).
Conclusions: Herpetic eye disease is an important cause of ocular morbidity. Herpes zoster and cytomegalovirus infections, especially in young people, should raise the  suspicion of coexisting HIV infection. Corneal scarring is the most common complication of the disease and requires keratoplasty to restore vision.
Key words: herpetic eye disease, Onitsha, Nigeria

Intermediate Term (3-6 Years Post Surgery) Outcome of Keratoprosthesis in 5 Nigerian Eyes
Joseph Momodu Waziri-Erameh MB, BS, FMC (Oph)1; Afekhide Ernest Omoti MB,BS, FMC
(Oph) FWACS, FICS1; Chinyere Nnenne Pedro-Egbe MBBS, FMC (Oph)2
1Department of Ophthalmology, University of Benin Teaching Hospital. PMB 1111, Benin City, Nigeria
2Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

ABSTRACT
Objective: The aim of this study is to report on the intermediate (3-6 years post surgery) outcome of keratoprosthesis implant surgery in Nigerian eyes.
Methods: This is a descriptive study of 5 eyes of 5 consecutive Nigerian patients that had keratoprosthesis at University of Benin Teaching Hospital and DDS Eye Surgery, Benin City, between February 1994 and May 1995. The 5 eyes were followed up for 3-6 years. The visual acuity and observed complications were monitored in each eye.
Results: All the patients in this study were male, with an age range 30 to 76 years and a mean age of 42 years. Preoperatively,one eye had corneal decompensation following cataract extraction, while the other 4 eyes had scarred and vascularized cornea from various causes; all 5 eyes had light perception (LP) vision pre-operation. Post-operatively, the 5 eyes had VA ranging from 6/60 to NLP, after a variable follow-up period of 3-6 years. Complications included development of tough vascularized retroprosthetic membrane (4 eyes) and infective endophthalmitis in one eye.
Conclusion: The intermediate-term outcome of keratoprosthesis surgery in Nigerian eyes shows that it is unsuitable, largely because of the problem of retroprosthetic membrane.
Key words: keratoprosthesis, retroprosthetic membrane, cornea.

 Surgical Indications for Eye Removal in Enugu, South EasternNigeria
BI Eze FMCOphth, FWACS, FICS; FC Maduka-Okafor FMCOphth, FICS; OI Okoye FMCOphth, FICS; O Okoye MBBS
Department of Ophthalmology, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria

ABSTRACT
Objective: To determine the surgical indications for removal of the eye in Enugu in south eastern Nigeria.
Method: Retrospective case series review.
Results: At the University of Nigeria Teaching Hospital Enugu,between 1st January 1994 and 31st December 2003, 106 eyes of 106 patients, comprising 71 (67.0%) males and 35 (33.0%)
females, aged 6-72 years (mean 31.8), were removed by evisceration (59; 55.7%), enucleation (35; 33.0%), and exenteration (12; 11.3%). Severe open globe injury (49;46.2%), infection (29; 27.4%), malignant tumour (15; 14.2%) and blind painful eye (14; 13.2%) were the indications for eye removal. Eye removal was more frequent in males (67.0%), among farmers (21.7%), and among the 21-40 year age group (41.5%). Patients who had their eyes removed constituted 0.42% of new outpatients, 4.63% of inpatients and 7.83% of patients who had eye operations during the study period.
Conclusion: The indications for eye removal were mainly for preventable/curable causes. There is, therefore, a need to improve promotive, preventive and curative eye care delivery to reverse this trend.
Key words: eye, removal, indications, Enugu, Nigeria.

Transpupillary Thermotherapy for Classic Subfoveal Choroidal Neovascularization: A case report
AO Hassan FRCS, FRCOphth, FWACS; O Oderinlo FRCS, DRCOphth; O Okonkwo, FRCS,DRCOphth;
FO Oluyadi FWACS, FMCOphth; AO Ogunro, FWACS, FMCOphth; SA Oke, DO WACS, MSc
Eye Foundation Hospital, 27 Isaac John Street, Ikeja GRA, Lagos

ABSTRACT
Aim: To report a case of successful treatment of a classic subfoveal choroidal neovascularization with a transpupillary thermotherapy protocol.
Case Report: A 67-year old pensioner presented with a six month history of reduced vision in both eyes. He had been previously diagnosed with primary open angle glaucoma.After anterior and posterior segment examination and fundus fluorescein angiography were done, a diagnosis of a classic subfoveal choroidal neovascularization secondary to exudative age-related macular degeneration OS with bilateral cataracts and primary open angle glaucoma OU was made.Complete resolution of the choroidal neovascular membrane was achieved with transpupillary thermotherapy.
Key words: transpupillary thermotherapy, age-related macular degeneration, subfoveal choroidal neovasularization, fundus fluorescein angiography.

Retrobulbar versus Subconjunctival Anaesthesia for Cataract Surgery – Experience in Nigeria
Joseph Momodu Waziri-Erameh MB, BS FMC(OPH,) FWACS, FICS;1 R Valentina Okeigbemen MBBS, FMCOph;1 Ireju Onyinye Chukwuka MBBS, FMC(OPH);2 Sydney Ejimadu MBBS,AFMC(OPH)2
1Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Nigeria,
2Department of Ophthalmology,University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

ABSTRACT.
Aim: To test the efficacy of subconjunctival anaesthesia (SCA) for cataract surgery against the established retrobulbar anaesthesia (RBA).
Methods: This was a prospective study of 73 adults (44 males, 29 females) selected for cataract surgery and intraocular lens (IOL) implants under local anaesthesia. Their ages ranged from 24 years to 73 years. Thirty-seven (37) eyes had subconjunctival anaesthesia while 37 had retrobulbar  anaesthesia for the cataract surgery and intraocular lens implant. The anaesthetic used was 2% lignocaine. An agreed marking scheme was formulated to assess the benefits of the anaesthesia and akinesia produced by the both methods. The anaesthesia (both methods) for all the patients was administered by one ophthalmologist and the assessment was done by the ophthalmologist and an assisting ophthalmologist.The results were collated and analysed according to the type of anaesthesia; any complications related to anaesthesia were noted.
Results: Both SCA and RBA were satisfactory for cataract surgery. The RBA was observed to give better akinesia and less photophobia than the SCA during cataract surgery. There were no significant anaesthesia-related complications in either SCA or RBA.
Conclusion: Subconjunctival anaesthesia is not as good as retrobulbar anaesthesia for cataract surgery in Nigeria because of observed less akinesia and more photophobia. There may be a need to give verbal instructions to the patients which they may not understand.
Key words: subconjunctival, retrobulbar, akinesia,anaesthesia, photophobia.

Combined Cataract and Glaucoma Surgery: An assessment of 68eyes in an eye hospital in Lagos, Nigeria.
AO Hassan FRCS, FRCOphth; AS Harriman, DO, MRCOphth; OO Oluyadi, FWACS; AO Ogunro, FWACS; OG Okonkwo DRCOphth, FRCS; OO Oderinlo FRCS; OO Oke DO WACS.
Eye Foundation Hospital, 27 Isaac John Street, Ikeja, Lagos

ABSTRACT.
Objective: To assess the best corrected visual acuity and average intraocular pressure at 6 months and one (1) year in patients with cataracts in glaucoma that had combined trabeculectomy and cataract surgery with lens implantation.
Methods: A retrospective review of the case notes of patients who underwent combined glaucoma and cataract surgery with lens implantation in a private eye centre, The Eye Foundation Hospital, was carried out, using the following parameters:age, pre-operative intraocular pressure (IOP), post-operative intraocular pressure preoperative and postoperative visual acuity, the number of preoperative antiglaucoma medications,and the number of postoperative antiglaucoma medications atone (1) year or more.
Results: 68 eyes of 67 patients were assessed during the study.Thirty-one (44.93%) had preoperative visual acuity (VA) of light perception (LP) -6/60 (very poor). At 6 months post operatively, 50 patients were followed up, 40% (n=20) had a visual acuity of 6/12-6/5 (very good). At one year, 37 patients followed up, of those, 48.65% (n=18) maintained a visual acuity of 6/12-6/5(very good). Mean preoperative intraocular pressure was 18.96 ± 7.38mmHg. At 6 months,mean IOP was 11.77± 3.61mmHg; one (1) year postoperatively IOP was 13.93 ± 3.21mmHg. There was a statistically significant improvement in VA (p<0.05) and intraocular pressure (p = 0.05).
Conclusion: Combined trabeculectomy and cataract surgery should be considered as a good operative choice in elderly patients who present with significant cataracts in glaucoma and who require two or more antiglaucoma drugs to maintain a normal intraocular pressure. Though a more difficult operation than either procedure alone, good results can be achieved in experienced hands with significant improvement in VA (p<0.05) and Intraocular pressure(p=0.05).
Key words: combined cataract / glaucoma surgery,intraocular pressure, visual acuity

Bilateral Spontaneous Hyphaema in Juvenile Xanthogranuloma:A case report and literature review
AO Adio FWACS, FMCophth; B Fiebai FMCophth; GI Nathaniel, MBBS
Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State

SUMMARY
Background: A four-month-old Nigerian male was presented with spontaneous hyphaema in both eyes initially thought to be due to trauma or possibly non accidental injury. There was associated secondary glaucoma and skin lesions typical of juvenile xanthogranuloma. This condition, to the best of our knowledge, has not yet been reported in Nigeria.
Case report: There was redness in the right eye with no associated tearing or photophobia. On examination, there was visually directed reaching in both eyes, with central, steady and maintained fixation, corneal haze and 15% hyphaema. The left eye, which appeared normal, later also developed 10% hyphaema, upon which an impression of juvenile xanthogranuloma was entertained. Laboratory investigations,including a clotting profile, were all within normal limits.Examination under anaesthesia showed progressively increasing buphthalmos and vitreous haemorrhage in the left eye with high intraocular pressure and large cup disc ratios.Histology showed irregularly disposed spindle-shaped cells in the dermis that were intimately associated with small capillaries containing red blood cells. Occasional tuton-like giant cells were seen with hyperkeratosis and papillomatosis of the epidermis which is consistent with juvenile xanthogranuloma.
Conclusion: Ocular complications provide the primary concern in this condition and could eventually lead to blindness.Therefore, a high index of suspicion is the key to the prevention of blindness.
Key words: juvenile xanthogranuloma, hyphaema, glaucoma.

Gathering Baseline Data for a Rural Cataract Surgical OutreachService in Igabi District, Nigeria
M Mansur Rabiu MSc, CEH, FWACS, FMCOph; CP Ozemela, DI Apiafi
National Eye Centre, Kaduna, Nigeria.

ABSTRACT.
Background: In an effort to plan for effective community-based cataract surgical services in Igabi district of northern Nigeria, the National Eye Centre, Kaduna (a tertiary eye hospital) conducted a population-based cross sectional survey in the district. The survey was conducted in order to generate baseline data on cataract blindness in the district.
Methods: A total of 2044 people out of 2400 eligible people were examined. The study population was chosen by two-stage cluster random sampling. In the first sampling stage, 30 clusters/wards were randomly chosen, while in the final stage, 80 people who were 40 years and over were selected in each ward. Each of the selected persons had visual acuity recorded for both eyes. Those with vision less than 3/60 in the better eye were assessed for cataract. People with cataract were asked why they had not sought medical attention.
Results: A blindness prevalence of 4.1% (95% CI 3.2%-5.0%) was found among the sampled population. Cataract was responsible for 52.3% of the blindness. Thus, the prevalence of cataractblindness was found to be 2.2% (95% CI 1.6%-2.8%). The cataract surgical coverage (people) was 12.8% and the couching coverage (people) was 10.3%. The main barrier to seeking cataract surgery was the inability to afford the cost of service (61.5%).
Conclusion: Districts with a high burden of cataract blindness should be provided with free or highly subsidized cataract outreach programmes with effective publicity and high quality surgery.
Key words: cataract blindness, Igabi, Nigeria

 

Click to read: Nigerian Journal of Ophthalmology 2008; 16(1)

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