The Effect of Music on Operative Anxiety markers in patients undergoing Cataract Surgery: Adual centre cross-sectional comparative study

OBJECTIVE

To determine the effect of intraoperative music on various markers of anxiety among adult patients undergoing small incision cataract surgery.

METHODS

This was a hospital-based, age-sex matched, comparative cross-sectional study of consenting 144 adult participants aged 46 years and above with operable, age-related cataracts undergoing small incision cataract surgery under local anaesthesia in two ophthalmic centres. All participants were allotted into two equal groups consisting of 72 participants in the experimental group (exposed to music of their choice) and 72 participants in the control group (no music exposure). Blood pressure, pulse rate and salivary cortisol assay levels were measured. Data obtained were analyzed using statistical package for social sciences (IBM SPSS version 23.0).

RESULTS

One hundred and forty-four participants with total male-to-female ratio of 1:2.1 were studied. Gender ratio was 1:2.3 and 1:2.0 and the median age (Q1-Q3) of 65.00 (55.5-71.5) years and 65.50 (56.5-72.0) years for music and non-music groups respectively. Participants in the music group showed a statistically significant reduction in systolic blood pressure, diastolic blood pressure and pulse rate (p < 0.05) except at baseline. The mean value salivary cortisol level showed a statistically significant decrease in both groups from baseline for music (23.91ng/ml) and nonmusic (19.12ng/ml) group (p<0.001) respectively. Similarly, participants in the music group showed a statistically significant reduction of Spielberger State anxiety score after music intervention compared to control (p<0.001).

CONCLUSIONS

This study demonstrated the effectiveness of music in decreasing anxiety indicators during cataract surgery with markers like salivary cortisol assay, pulse rate, systolic and diastolic blood pressure.

Visual impairment and ocular morbidities among schoolchildren in Southwest, Nigeria

AIM

The purpose of this study was to determine the prevalence of visual impairment and ocular morbidities among primary and secondary schoolchildren aged 5 years to <l6 years in Ifo, Ifo Local Government Area in Ogun State, Nigeria.

MATERIALS AND METHODS

The study was a population-based descriptive cross-sectional study conducted among schoolchildren aged 5 years to <16 years old attending primary and secondary schools in Ifo, Ifo Local Government Area of Ogun State. Multistage sampling technique was used for the study. After enumeration and questionnaire administration, the visual acuities of all respondents were measured, followed by examination of the anterior and posterior segment structures of the eyes of the children.

RESULTS

A total of 1308 schoolchildren (574 males and 734 females) participated in the study with a mean age of 12.03 years (standard deviation = ±2.572 years). Eighty-seven (6.7%) children had visual impairment and 224 (17.1%) children had ocular morbidities. Of the 87 children with visual impairment, 61 (70.1%) had mild impairment, 19 (21.8%) had moderate impairment and 7 (8.0%) had severe impairment. The common ocular morbidities identified were refractive error 39.7%, high/asymmetrical vertical cup-to-disc ratio (suggestive of glaucomatous optic neuropathy) 33.5%, allergic conjunctivitis 19.2%, corneal opacity 2.7% and lenticular opacity 2.2%. Ocular morbidities identified among children with severe visual impairment were refractive error 5 (71.4%), allergic conjunctivitis and corneal opacity 1 (14.3%) each.

CONCLUSION

The study concluded that with the prevalence of 6.7% of visual impairment and 17.1% of ocular morbidity, it will be beneficial to establish a sustainable school eye health services in schools in Ifo.

Retinopathy of prematurity and associated factors in Lagos, Nigeria

BACKGROUND

Screening and early treatment of retinopathy of prematurity (ROP) is important to reduce visual impairment in at risk infants.

AIM

To determine the frequency and risk factors associated with ROP in preterm infants in Lagos University Teaching Hospital.

METHODS

This was a prospective cohort study of preterm infants with gestational age (GA) less than 32 weeks and birthweight 1500 g or less conducted from November 2011 to May 2014. The infants' eyes were examined using an indirect ophthalmoscope at 4-6 weeks of life or at 34 weeks post-conceptual age. Examinations were repeated weekly until regression or progression to a high risk pre-threshold disease. Staging was according to the revised International Classification for ROP and treatment criteria were as defined by the Early Treatment for ROP study. The GA, birth weight (BW), use of oxygen, presence of respiratory distress syndrome and other risk factors were recorded and tested for significance.

RESULTS

Twelve (15%) of the 80 infants examined had any ROP and six (7.5%) had treatable ROP. The mean (SD) GA and BW for infants with ROP were both lower than for those without ROP; 28.2 (1.7) weeks vs 29.1 (1.6) weeks and 1124 (212) g vs 1251 (274) g for GA and BW, respectively. Risk factors such as supplemental oxygen, sepsis, respiratory distress and anaemia were not significantly associated with ROP.

CONCLUSION

The frequency of ROP and treatable ROP was high; it is therefore recommended that routine care of preterm infants should include screening for ROP and that affordable treatment facilities should be provided in public hospitals.

The Pattern of Uveitis In An African Tertiary Eye Care Centre

OBJECTIVE

To determine the pattern of presentation of uveitis at the Guinness Eye Centre of the Lagos University Teaching Hospital, Lagos, Nigeria.

MATERIALS AND METHODS

The case files of all patients with the diagnosis of uveitis who presented at the center from January 2006 to December 2010 were reviewed. Data on age, sex, ethnicity, symptoms, duration of symptoms before presentation, eye affected, anatomical type of uveitis and clinical type of uveitis were extracted onto a form for analysis.

RESULTS

A total of 68 cases of uveitis were reviewed. There were 38(60.3%) males and 25 (39.7%) females. The range was from 12 to 90 years. The peak incidence occurred within the age range 21-40 years inclusive. Anterior uveitis and posterior uveitis occurred in 34(54.0%) and 17(27%) patients respectively. While reduction in vision was reported as a symptom by 54(85.7%) patients, only 41(65.1%) patients presented within 4 weeks of onset of symptoms.

CONCLUSION

Anterior uveitis was the most common clinical type in this study. The highest incidence of uveitis occurred in the third and fourth decades of life.

A ten year review of diabetic retinopathy at the Guinness Eye Centre, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos

BACKGROUND

Diabetic retinopathy is an important complication of diabetes mellitus, which may lead to blindness.

OBJECTIVE

The study is to analyze posterior segment lesions in Diabetes Mellitus patients seen in Guinness Eye Centre, Lagos University Teaching Hospital in relation to the number, duration and severity.

METHODS

All the case files of Diabetes Mellitus patients seen during the period of study were retrieved and data extracted from them were analyzed. Such information included age, sex, duration of Diabetic Retinopathy and its severity.

RESULTS

A total of 84 case files were reviewed. There were 47 males and 37 females with a male to female ratio of 1.3:1. No diabetic patient was seen in the age group 30 years and below. Fifty-five (65%) patients who presented themselves did so very late. Of the 35 patients found to have diabetic retinopathy at presentation, 16 had the disease bilaterally. The most common form of Diabetic Retinopathy was clinically significant macula oedema. The study shows that a high proportion of the patients (41.6%) had Diabetic Retinopathy.

CONCLUSIONS

Patients with DM should be referred early for eye examinations. Physicians Residents should be made to rotate through eye Departments for a period of at least 2 weeks so they can learn fundoscopy. Diabetic patients should be educated on the eye complications that may arise from their condition. Regular eye screening with fundus camera and laser therapy should be part of the routine management of Diabetics in Nigeria as is done in advanced countries.

Ocular findings in acquired immunodeficiency syndrome patients in Lagos, Nigeria

BACKGROUND

There is paucity of studies on the prevalence and pattern of ocular complication in HIV patients in developing countries where 90% of all HIV sufferers live. Most studies were carried out in industrialized countries and are not representative of the spectrum of ocular complication of HIV and it's prevalence in developing countries.

OBJECTIVE

To determine the prevalence of ocular disorders in adult (> 15 years ) AIDS patients at PEPFAR clinic in Lagos, Nigeria.

MATERIAL AND METHODS

All consecutive adult Seropositive HIV/AIDS patients of PEPFAR Clinic at the Lagos University Teaching Hospital between February 1st-March 15th 2008 were enrolled into the study Cross sectional and non randomized, convenient study was used. Biodata and medical history were recorded on interviewer administered questionnaire. Participants were examined according to standard protocol comprising visual acuity, intraocular pressure, anterior segment examination with slit lamp biomicroscopy, dilated fundoscopy and fundus photograph where necessary. PCV, CD4+ count, viral load at diagnosis, stage of HIV disease were extracted from patients' records. Details of drug were regimen also recorded. Data analysis was performed with EPI-lnfo 6.04 version; Chi square and student t test used to describe statistical association.

RESULTS

A total of 400 patients were studied. Male:female ratio was 1.7 and mean age was 40 years (S.D. + 9.12). Ocular disorders seen in 78.5% of patients; HIV related ocular disorders occurred in 45 (11.3) patients. Conjunctival microvasculopathy 166 patients (41.5%), pingueculum in 114 (28.5%), pterygium in 76 (19.0%), refractive error in 93 (23.3%), cataract in 12 (3.0%), and 22 (5.5%) Glaucoma suspects. HIV retinopathy and allergic eye disease in one patient each (0.3%). Presumed Cytomegalovirus retinitis 7 (1.8%), 14 (3.5%) Toxoplasmosis, 8 (2.0%) HZO, and 15 (3.8%) Presumed Squamous cell carcinoma. Eighty six (21.5%) of the patients had no abnormality. 91.4% of eyes examined had visual acuity with best correction of > 6/18. CD4+ in 79.3% of the patients was > 200 cells/ul and < 5% had counts < 50 cells with an overall mean of 406 cell/ul. 375 (93.8%) patients were on Highly Active Antiretroviral therapy (HAART), and 25 (6.2%) were not.

CONCLUSION

Study revealed low prevalence of HIV related ocular disorders. This could be due to few patients at low level of immunosuppresion where the infections occur.

Pattern of conjunctival masses seen at Guinness Eye Centre Luth Idi-Araba

BACKGROUND

Conjunctival masses are growth on the surface of the outer eye; which may represent benign or malignant transformations.

OBJECTIVE

To determine the pattern of presentation of conjunctival masses at the Guinness Eye Centre (GEC), Lagos University Teaching Hospital (LUTH) Idi-Araba over a 13 year period (Jan 1995-Dec 2007).

METHOD

A retrospective review of the clinical notes of all patients that presented to GEC with conjunctival masses during the study period was carried out. The bio-data, clinical features, stage, laterality and associated features of the masses were noted. The diagnosis, treatment and complications of treatment were also recorded.

RESULTS

Case notes of 612 eyes of 393 patients were included in the study. There were 219 (55.7%) males, 174 (44.3%) females with ages ranging from 4-85 years with a male to female ratio of 1.26: 1. Three hundred and eighty-eight patients (98.7%) presented as elective cases to the outpatient department while 5 (1.3%) presented as emergencies on account of associated ocular inflammation. There were 220 (56%) bilateral masses while 44% were uniocular. Pterygium was the leading conjunctival mass affecting 548 eyes (89.5%) of 329 patients. Pingueculae occurred in 53 eyes (8.7%), conjunctival cysts in 5 (0.8%) eyes, neoplastic growths in 3 (0.5%) eyes, conjunctival granulomas in 2 (0.3%) eyes and limbal teratoma in 1 (0.2%) eye. Most of these patients defaulted from surgery as only 141 eyes (23%) of 121 patients had surgery. Post-operative complications occurred in 33 eyes (5.4%) of 30 patients. The commonest postoperative complication was pterygium recurrence which occurred in 18 eyes of 15 patients.

CONCLUSION

Pterygium was the commonest conjunctival mass and preventive strategies need to be advocated. Prevention of recurrence remains a challenge in the management of pterygium as recurrence after surgical excision occurred in 13.2% of eyes. Our study however did not confirm outdoor occupations as a risk factor for pterygium.

Hydrocephalus and the eyes: a teaching hospital experience

BACKGROUND

The eye developes from prosencephalon, the primitive forebrain and hence share similar embryonic origin with brain. This gives insight into primary or secondary involvement of eyes in intra-cranial pathology.

OBJECTIVE

The study was done to describe ocular findings in hydrocephalus patients and effect of intervention on the complications.

METHODS

Forty one consecutive hydrocephalus patients were examined pre and post ventriculo-peritoneal shunts. Comprehensive ocular examinations included dilated fundoscopy in all cases.

RESULTS

A total of 41 patients were examined with the age range of between 4 hours to 108 months and a mean age of 21 months. Onset of the hydrocephalus varies from 4hours to 108 months, with a mean of 4.1 weeks. Twenty two patients (51.2%) presented after 2 months of onset of hydrocephalus. Most common presenting complaint was enlarged head seeing in 29 patients (70.7%).

CONCLUSION

A total of 12 (30%) out of 41 patients with hydrocephalus had optic atrophy. Another 10 patients had sun-setting phenomenon, 3 of these sun-setting phenomena resolved a week after ventriculo-peritoneal shunts. The ocular morbidity is high among hydrocephalus patients.

Aetiology of vitreous haemorrhage in Guinness Eye Centre, Lagos University Teaching Hospital over a two year period (June 2007-May 2009)

BACKGROUND

The Vitreous Humour is the transparent biological gel which fills the posterior 5/6th of the eyeball. Extravasations of blood into this delicate tissue may cause visual loss.

OBJECTIVE

The study was to determine the causes and pattern of vitreous haemorrhage in Guinness eye centre, Lagos University Teaching Hospital.

METHODS

Retrospective consecutive case series of all patients with Vitreous haemorrhage over a 2 year period (June 2007 - May 2009)

RESULTS

A total of 5137 new patient were seen at Guinness eye centre during the study period. 13 of them had vitreous heamorrhage giving an incidence of 0.25%. 12 of the patients were males. The mean age was 41 year. The age range was from 14years to 69 years. Majority of the patients (69%) presented within 4 weeks of drop in vision. Vitreous heamorrhage was caused by trauma in 46% of the patients and proliferative sickle cell retinopathy in 30% of the patients. All the patients with vitreous haemorrhage due to proliferative sickle cell retinopathy had the Hb genotype SC.

CONCLUSION

Trauma and proliferative sickle cell retinopathy were found to be important causes of vitreous heamorrhage in this case series.

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.

Intraocular pressure changes in a Nigerian population--effects of tracheal tube and laryngeal mask airway insertion and removal

OBJECTIVES

Laryngoscopy and tracheal intubation lead to acute elevation in intraocular pressure (IOP); the ocular hypertensive response. The Laryngeal mask airway prevents sudden surges in IOP. We compared IOP changes to the insertion and removal of the Laryngeal mask airway (LMA) and the endotracheal tube (ETT).

PATIENTS AND METHODS

Seventy ASA I and II patients aged 18 to 60 years at the Lagos University Teaching Hospital between January and December 2003 were randomly allocated to receive either an LMA or ETT for airway management. Anaesthesia was induced with propofol and atracurium. Intraocular pressure was measured by applanation tonometry post induction (baseline) and prior to removal (pre-extubation), after insertion or removal (0 minute), at 1,2,3,5 and 10 minutes after insertion or removal.

RESULTS

Insertion of the airway device caused an immediate rise in IOP of 4.6% in the LMA group (from 13.1 +/- 2.4 to 13.7 +/- 2.4 mmHg) and 49.2 in the ETT group (from 12.0 +/- 2.5 to 17.9 +/- 4.0 mmHg) (p<0.001). Removal of the airway device caused an immediate rise in IOP of 14.6 in the LMA group (from 11.26 +/- 2.4 to 12.9 +/-2.4 mmHg) and 50.3 in the ETT group (from 11.37 +/- 2.0 to 17.1 +/- 3.3 mmHg) (p<0.001). IOP thereafter declined towards baseline in both groups. Cardiovascular responses accompanied IOP changes. The mean insertion time was 39.8 +/- 9.1 seconds (ETT) vs 31.5 +/- 4.4 seconds (LMA). (p<0.001) Cough (17.1) and mild laryngeal spasm (2.9) occurred in the ETT group only following removal.

CONCLUSION

The LMA produced better IOP stability following its insertion and removal compared to the tracheal tube.

Vernal keratoconjunctivitis at Guinness Eye Centre, Luth (a five year study)

INTRODUCTION

Vernal keratoconjunctivitis (VKC) (Spring Catarrh) is a chronic, seasonally exacerbated bilateral external allergic ocular inflammation which causes a lot of ocular discomfort to children and young adults and, in severe or poorly managed cases, can even lead to blindness.

OBJECTIVES

To determine age/sex distribution, seasonal pattern, and frequency of clinical features.

METHODOLOGY

A review of medical records of patients who presented with VKC between January 2001 - December 2006.

RESULTS

A total of 148 patients' records were reviewed. There was male preponderance with a Male to Female ratio of 1.27:1, and higher frequency in patients less than 10 yrs was observed. A trimodal peak pattern (January-February, April-July and September-October) was seen. Itching was the most common symptom and brownish conjunctival discolouration, the most common sign.

CONCLUSION

This study is in agreement with previous findings of male preponderance and the tendency for the condition to affect children and young adults. It also detected an increase in number of cases in periods of seasonal changes from dry to wet. The necessity of patients' being assessed by an ophthalmologist was highlighted as several patients had been treated with antibiotics solely, which is insufficient for control of the condition.

Orbito-ocular lesions in Lagos

OBJECTIVE

we present a 10year retrospective clinicopathologic study of 135 cases of orbito-ocular lesions. The aim is to document pattern of orbito-ocular lesions, with their site, age and sex distribution.

MATERIALS AND METHODS

The materials consisted of slides, paraffin embedded tissue blocks and histology request forms of all orbito-ocular samples received at the Morbid Anatomy Department of Lagos University Teaching Hospital Idi-Araba Lagos between 1994 and 2003.

RESULTS

A total of 135 samples from 75(56%) males and 60(44%) females were analysed. The conjunctival, intraocular, orbital and eye lid lesions accounted for 27(20.1%), 75(55.5%), 18(13.4%) and 15(11%) cases respectively. The ages ranged from 20 days to 79 years with a mean age of 35 years. Sixty nine cases (51.1%) of all orbito-ocular lesions were seen in children of age 15 years and below. Squamous cell carcinoma was the commonest malignant conjunctival lesion (4 out of the 5 cases) occurring in adults with a mean age of 45 years. Retinoblastoma accounted for 46(85%) of all orbito-ocular malignancies with the peak in the 1-5year age group accounting for 37(80 %). Panophthalmitis, endophthalmitis and phthisis bulbi were common non neoplastic lesions requiring enucleation. Pseudotumour and rhabdomyosarcoma accounted for 5(27.8 %) and 4(22.2 %) cases respectively of all orbital lesions.

CONCLUSION

Retinoblastoma remains the commonest ocular malignancy while rhabdomyosarcoma was the commonest orbital malignancy with both occurring in childhood. Inflammatory lesions unfortunately are important orbito-ocular lesions requiring surgery in our environment.

Pattern of ocular emergencies seen at L.U.T.H. over a period of 1 year

AIM

To determine the commonest type of ocular emergencies seen at L.U.T.H. over a period of one year.

METHODOLOGY

Data of all consecutive patients seen as emergencies within the designated period was taken. These included age, sex, symptoms, signs, agents of injury, duration and the complications.

RESULTS

A total of 304 patients were seen. 207 (68.0%) of them were males, while 97 (32.0%) of them were females giving a ratio of 2.1:1. Out of the total number, 159 (52.3%) had non-injurious emergencies. Of the 145 (47.7%) injurious emergencies, blunt trauma was the commonest with 77 patients (25.3%). Penetrating trauma was next in frequency with 37 patients (12.2%) as compared to blunt injury with 77 patients. Foreign body injuries were seen in 18 patients (5.9%), followed by chemical injuries which constituted the least with 13 patients (4.3%).

CONCLUSION

Majority of the ocular emergencies seen were due to non-injurious type, while blunt trauma was the commonest of the injurious type.

RECOMMENDATION

Health education and awareness creation should be intensified on the various causes of the ocular emergencies, more importantly on the non-injurious causes to prevent the resultant ocular morbidity.

Polymorphism of the endothelial nitric oxide synthase gene is associated with diabetic retinopathy in a cohort of West Africans

PURPOSE

In addition to chronic hyperglycemia, there is increasing evidence that genetic factors may be important in the development of diabetes retinopathy (DR). Specifically, polymorphisms of the endothelial nitric oxide synthase gene (eNOS) have been reported to be associated with multiple health conditions including DR, hypertension, nephropathy, and cardiovascular diseases in several ethnic groups. However, there is a paucity of similar data in African Americans and other African populations. To address this issue, we investigated the potential association between polymorphisms of the eNOS gene and diabetes-related phenotypes in 384 persons with type 2 diabetes and 191 controls from two West African countries (Ghana and Nigeria).

METHODS

We genotyped the deletion/insertion (4a/b) and the G894T polymorphisms of eNOS gene in a total of 575 persons.

RESULTS

The b/b genotype of the polymorphism was associated with a 2.4 fold increased risk of DR (95% CI 1.39-4.09). In contrast, we did not observe any association between the genotypes or alleles of G894T polymorphism with DR, hypertension, or nephropathy.

CONCLUSIONS

We observed a significant association between the 4a/b polymorphism of the eNOS and DR in our West African cohort.

Ophthalmological complications of nasal, paranasal sinus diseases and head and neck tumours

BACKGROUND

The proximity of the eye to the nose, paranasal sinuses and skull base makes it vulnerable to be involved in the diseases of this area.

OBJECTIVE

To document the presenting diagnosis and ophthalmologic complications of nasal, paranasal sinus diseases and head/neck and skull base tumours.

DESIGN

A prospective descriptive study.

SETTING

Ophthalmology and otolaryngology units at Lagos University Teaching Hospital, Nigeria.

SUBJECTS

Two hundred and twenty nine patients were reviewed between July 2003 and July 2005.

RESULTS

Out of a total study population of two hundred and twenty nine patients, 88.2% patients presented primarily in the Otolaryngology unit. Otolaryngological diagnosis were as follows, sinusitis 170 (74.2%), nasal polyposis 27 (11.8%), nasopharyngeal carcinoma 23 (10%) and others were maxillary carcinoma six (2.3%), nasoethmoidal carcinoma two (0.9%) and frontoethmoidal mucocoele 0.4%. Ear, Nose and Throat (E.N.T) related ophthalmological complications was seen in 18 (7.9%) which included proptosis, proptosis /restrictive myopathy, visual loss, and enophthalmos while 39.3% had non ear, nose and throat related ophthalmological diseases.

CONCLUSION

Ophthalmological complications of paranasal sinus diseases and head/neck tumours is still a significant health problem. Sinusitis though increasing in prevalence has resulted in less ophthalmological complications partly due to predominant allergic type with less complications and also to the availability and access to antibiotics and anti allergic drugs.

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.

Conjunctival melanoma in a 55 year old male Nigerian: a case report

BACKGROUND

Conjunctival melanoma is a rare occurrence in the Negroid race.

PURPOSE

To report a case of a 55 year old security man with right conjunctival melanoma.

METHOD

A 55 old man was operated on to remove a pigmented right bulbar conjuctival growth. The specimen was submitted to Lagos University Teaching Hospital Lagos and Harold Wood Hospital England for histopathologic examination and confirmation.

RESULTS

Surgery was successful and histopathologic and immunohistochemical studies confirmed a diagnosis of a nodular malignant melanoma.

CONCLUSION

The need for the provision of definitive investigative tool (immunohistochemical studies) to facilitate definitive diagnosis and management of such cases in some recognised centres in Nigeria cannot be overemphasised.

Genomewide scan and fine mapping of quantitative trait loci for intraocular pressure on 5q and 14q in West Africans

PURPOSE

High intraocular pressure (IOP) is a major risk factor for glaucoma, one of the leading causes of blindness worldwide. Because it has been demonstrated that African populations are at increased risk for glaucoma, the authors investigated the genetic basis of IOP in a sample of West Africans with type 2 diabetes (T2D) from Ghana and Nigeria.

METHODS

Genomewide linkage analysis was conducted for loci linked to IOP (measured by applanation tonometry) in 244 affected sibling pairs with T2D using 372 autosomal short-tandem repeat markers at an average spacing of 9 cM.

RESULTS

Multipoint variance components linkage analyses revealed suggestive linkage on chromosome 5 (5q22) with a logarithm of odds (LOD) score of 2.50 (nominal P = 0.0003; empiric P = 0.0004) and on chromosome 14 (14q22) with an LOD score of 2.95 (nominal P = 0.0001; empiric P = 0.0003). Fine mapping at a marker density of 2 cM in the 5q region confirmed the linkage signal, with an increase in peak LOD score to 4.91.

CONCLUSIONS

The strong signal on chromosome 5 lies in the region in which a novel gene, WDR36, in the GLC1G locus was recently identified as causative for adult-onset primary open-angle glaucoma and provides additional evidence that chromosome 5 contains susceptibility loci for glaucoma in multiple human populations. The evidence provided in this study is particularly important given the evolutionary history of these West African populations and the recent ancestral relationship to African Americans-a population with one of the highest rates of diabetes and associated complications (including glaucoma) in the world.

Clinical trial of diclofenac sodium (Naclof) eye drops on Nigerians

Twenty-eight eyes of 26 age-matched patients who had planned extracapsular cataract extraction with or without intraocular lens implantation were enrolled into a double blind randomised actively controlled study of 2 groups. Each group of 14 eyes was assigned to receive 0.1% diclofenac sodium (Naclof) eye drops or 1% prednisolone acetate eye suspension. The patients received either 0.1% Diclofenac sodium eye drops or 1.0% prednisolone acetate eye suspension four times a day as their post operative anti-inflammatory medication for a period of four weeks. No significant difference was noticed in the subjective assessment of pain and conjunctival injection in the 28 days follow-up period except day 1 in the diclofenac sodium group (0.05> p >0.01). Other measured objective variables of inflammation such as anterior chamber cells and flare showed no significant difference from the 3rd-28th postoperative days (0.05< p > 0.20). The result demonstrated that 0.1% diclofenac sodium eye drops was as effective as 1% prednisolone acetate eye suspension in the control of postoperative inflammation after cataract surgery, and could serve as a viable alternative to topical steroids in Nigerians who are steroid responders.

Ocular findings in sickle cell disease patients in Lagos

Sickle cell disease has varied manifestations in all systems of the body, ocular manifestations can be severe and sudden blindness may result amidst other complications. The study aims at determining the ocular findings in patients with sickle cell anaemia (HbSS) and sickle cell haemoglobin C disease (HbSC). 99 subjects were recruited into the study carried out at the Lagos University Teaching Hospital over a 2 year period. A structured interview questionnaire was administered and physical examination was carried out at the Medical Out Patients' Sickle Cell Clinics. Subsequently in the (Guinness) Eye centre, examination for ocular manifestations was carried out using Snellen's chart, Slit light microscopy, direct and indirect ophthalmoscopy under mydriasis (with Gutt Tropicamide 1% , epinephrine 10% ) as well as tonometry and gonioscopy. The age of the 99 (51 males, 48 females) patients ranged from 13 to 43 years with a mean +/-SD of 20.42 +/- 6.13. There were 88 (88.9% ) SS and 11 (11.1% ) SC patients. The male to female ratio was 1.1: 1. Normal vision was present in 95 (96% ) of the patients [86 (97.8% ) SS and 9 (81.8% ) SC] while 4 (4.0% ) of the patients [2 (2.2% ) SS and 2 (18.2% ) SC] had impaired vision. Of the complaints, blurred vision was found in 12 (13.6% ) SS and one (9.0% ) SC patients. Itching of the eyes was found in 15 (17.0% ) SS and 3 (27.3% ) SC patients. Icterus was found in 50 (50.5% ), conjunctival signs were found in 49 (49.5% ), retinal vascular tortuosity was in 12 (12 .10% ), peripheral retinal degeneration was in 5 (5% ), iridescent spots was in 3 (3% ) and optic atrophy in 2 (2% ) patients. The tortuosity of major fundus vessels were graded into 4 according to Hook and Cooper's criteria 87 (87.9% ) of the patients were in grade 0. The conjunctival vessels anomalies were classified into 5 grades (criteria of Sergeant). 37 (37.5% ) were in grade 0, 35 (35.3% ) in grade 1, 8 (8.1% ) in grade 2, 7 (7.1% ) in grade 3 and 12 (12.1% ) in grade 4. Conjunctival abnormalities occur commonly while proliferative retinopathy and optic atrophy were uncommon in sickle cell disease patients in Lagos. Further studies are required with a larger number of subjects to investigate the low incidence of proliferative retinopathy and optic atrophy in Lagos.

Assessment of educational services available to blind and low vision school children in Lagos, Nigeria

A descriptive study to assess the educational services available to children attending the Pacelli School for the Blind in Lagos, Nigeria. A standardised methodology was used with structured and semi-structured questionnaires. Observations were also made in some areas. Of the 26 children aged 10-15 years who were identified as having low vision, 15 (57.7%) of them had significant improvement in distance and near vision after refraction while one third (31%) had improvement in their reading with low power magnifying lenses. All except 4 (25%) teachers were well educated but none seemed to have appreciable knowledge about the teaching of low vision children as all these children were taught Braille like their blind peers. While educational facilities available were reasonably adequate for blind children, no visual aids were available for low vision children. It is recommended that appropriate educational facilities, optical and non-optical devices should also be provided particularly for low vision children to enable them achieve their optimal potential in life.

Causes of low vision and blindness in children in a blind school in Lagos, Nigeria

A descriptive study to determine the causes of low vision and blindness in children attending the Pacelli School for the Blind in Lagos State, Nigeria. A standardised methodology was used with structured and semi-structured questioinaires. Twenty-six children aged below 16 years who were identified as having low vision and blindness were examined to determine the causes of the low vision and blindness. The anatomical sites of diseases leading to low vision and blindness in these children were retina (30.8%), lens (23.1%), glaucoma (19.2%), cornea (11.5%) and optic nerve (7.7%). Aetiologically, 38.5% of low vision was due to hereditary factors, 23.1% intra-uterine, 15.4% others and unknown in 23%. Retinal dystrophy was the most common cause of low vision and blindness, while congenital cataract and glaucoma were the major causes of avoidable blindness. Very few cases of corneal scar (Measles/Vitamin A deficiency) were seen. The causes of low vision appeared to be different from those of blindness as hereditary and intra-uterine factors were mainly responsible for low vision. It is recommended that these children be identified early, through low vision care programmes and those with avoidable causes treated accordingly.

Ocular trauma in Lagos

104 patients were treated for ocular trauma in Lagos from January, to December, 1986. These were cases that needed admissions and surgery. All of them were seen as emergencies. Minor injuries that were treated as day cases were not included in this study. There is need for recording all cases at the eye clinic level for accurate statistics. Traditional healers, environmental and social factors vary the causes and final visual results. Suggestions are made to improve on these set backs.