The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries

Background

Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival.

Methods

We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models.

Findings

The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope).

Interpretation

This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.

Funding

Queen Elizabeth Diamond Jubilee Trust.

Ocular surface squamous neoplasia at a tertiary eye facility, Southwestern Nigeria: a 10-year review

BACKGROUND

Ocular surface squamous neoplasia (OSSN) is a low-grade malignancy arising from the squamous epithelium of the ocular surface AIM: To describe the clinical presentation, histological diagnoses, treatment, and outcome of treatment in patients with OSSN managed at a tertiary health facility.

METHODS

Medical records of all patients with OSSN managed using a standardized treatment protocol over a 10-year period were reviewed.

RESULTS

Eighty-six patients comprising 44 (51.2%) males and mean age of 48.2 ± 15.8 years were studied. The most common presentation was a fleshy growth in the eye in all patients, and 43 (50.0%) patients tested positive to human immunodeficiency virus. The right eye was affected in 44 (51.2%) patients with no bilateral tumors, and the medial limbus was involved in 28 (32.6%) patients. Morphologically, 40 (46.5%) patients had gelatinous growth, 24 (27.9%) patients were in T_is category while 30 (34.9%) patients were in T₄ category. Twenty-eight (32.6%) patients received complete course of adjuvant topical mitomycin C (0.04%) while nine (10.5%) patients completed adjuvant systemic chemotherapy and external beam radiation. Overall, 61 (70.9%) patients had no tumor recurrence, seven (8.1%) patients had recurrent tumor, while the status of 18 (20.9%) patients was not known.

CONCLUSION

OSSN occurs more commonly in younger age group in our studied population and is strongly associated with HIV seropositivity. Intraoperative cryotherapy in patients with carcinoma in situ and intraoperative cryotherapy with adjuvant topical mitomycin C in those with invasive SCC that is limited to the ocular surface are associated with low tumor recurrence.

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND

The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe.

METHODS

A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries.

RESULTS

Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease.

CONCLUSIONS

Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral.

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance

Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.

Objectives

To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis.

Design, Setting, and Participants

A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017.

Main Outcomes and Measures

Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis.

Results

The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]).

Conclusions and Relevance

This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

Epithelial lacrimal gland tumours in Nigeria: Clinicopathological features and treatment

Background:

Epithelial lacrimal gland tumours are uncommon orbital tumours and are not widely reported among African populations.

Objective:

This study aimed to describe the clinicopathological features, treatment, and outcomes of epithelial lacrimal gland tumours in Nigeria.

Design:

Retrospective case series.

Setting:

Ocular Oncology Unit, Ophthalmology Department and Pathology Department of University College Hospital, Ibadan, Nigeria.

Materials and Methods:

A review of the medical records of all patients with histopathological diagnoses of epithelial lacrimal gland tumours managed at a tertiary health facility, southwestern Nigeria over 11.5 years was carried out.

Results:

Eighteen patients with equal numbers of men and women, and mean age at presentation of 42.2 ± 15.7 years (median 42 years, range 17–70 years) were managed. All patients presented with orbital swelling and had nonaxial proptosis with palpable firm to hard mass in the superotemporal quadrant of the orbit. The mean duration of symptoms was 42.2 ± 38.6 months (median 24 months, range 3–120 months). Visual acuity was <3/60 at presentation in eight (44.4%) of the affected eyes. Thirteen (72.2%) patients underwent orbitotomy and tumour excision, while five (27.8%) patients had orbital exenteration, and two of whom (11.1%) had combined orbital exenteration and craniotomy. Histopathological examination of the specimens revealed pleomorphic adenoma in nine (50.0%) patients, low-grade mucoepidermoid carcinoma in three (16.7%) patients, high-grade mucoepidermoid carcinoma in two (11.1%) patients, adenoid cystic carcinoma in three (16.7%) patients, and adenocarcinoma “not otherwise specified” in one (5.6%) patient. Mortality was reported in four (44.4%) of nine patients with malignant tumours, while no mortality was noted in the patients with benign pleomorphic adenoma. The mean follow-up period for the patients was 28.9 months (median, 4.5 months; range, 2–140 months).

Conclusion:

The main presenting symptom of epithelial lacrimal gland tumours in our patients was an orbital mass and the most common clinical finding, in addition to the orbital mass, was nonaxial proptosis. The tumours were equally divided into benign and malignant lesions in our studied population. Pleomorphic adenoma was the only benign tumour while mucoepidermoid carcinoma was the commonest malignant lesion. Orbital exenteration was performed in a high proportion of our patients and high mortality was noted among patients with malignant tumours.

Relationship between dry eye and glycosylated haemoglobin among diabetics in Ibadan, Nigeria

Introduction

dry eye is a fairly common ocular surface disorder which significantly affects the quality of life of patients. This study aimed to determine the prevalence, and relationship between dry eye and glycosylated haemoglobin (HbA1c) among patients with diabetes mellitus.

Methods

this was a descriptive hospital-based study conducted among patients diagnosed with diabetes mellitus and attending the Diabetic Clinic at a tertiary health facility in Ibadan, south-western Nigeria. Dry eye was assessed using the standardized Ocular Surface Disease Index Questionnaire administered to the eligible respondents on dry eye symptoms. Detailed ocular examination including the tear break-up time (TBUT) and Schirmer I test were carried out and a recent glycosylated haemoglobin value was also obtained.

Results

one hundred and eighty-nine Type 2 diabetic patients were studied, with 68.8% female and a mean age of 60.2 ± 10.3 years. The frequency of dry eye among patients was 21.7% (95% CI, 15.8-27.6). The most commonly reported symptoms of dry eye were “feeling of gritty sensation” (78%, 95% CI, 65.4-90.7) and “blurred vision” (73.2%, 95% CI, 59.6-86.7) while “discomfort in windy areas” (61%, 95% CI, 46.0-75.9) was the most common environmental trigger. No statistically significant correlation was noted between dry eye and HbA1c (r = 0.086, p= 0.239), and age (r = 0.096, p = 0.1)

Conclusion

dry eye is fairly common among patients with diabetes mellitus with most frequent symptoms being gritty sensation and blurred vision. No significant correlation was noted between dry eye and glycosylated haemoglobin (HbA1c).

Ocular surface squamous neoplasia in Ibadan, Nigeria

Introduction: Squamous cell carcinoma is the most common malignancy of the conjunctiva worldwide. Ocular surface squamous neoplasia (OSSN) describes the spectrum of ocular surface intraepithelial neoplasia, pre-invasive and invasive squamous cell carcinoma.

Method: This nonrandomized study aims to describe the epidemiology, clinical features and evaluate the outcome of treatment in patients with histological diagnosis of OSSN managed at a single tertiary center in Ibadan, Nigeria.

Result: Twenty-five patients were managed within the study period with a mean age of 42 ± 15.3 years and male: female ratio of 1:1.5. All patients presented with growth and redness, and, visual impairment was observed in seven (28%) patients. Fifteen (60%) patients were seropositive for HIV infection and one patient (4%) had xeroderma pigmentosum. The right side was involved in 11 (44%) patients and there were no bilateral lesions. Morphologically, 18 (72%) lesions were gelatinous, six (24%) were leucoplakic while one (4%) was nodular. Twenty-two (88%) patients underwent surgical excision with alcohol kerato-epitheliectomy and cryotherapy, while three (12%) patients had lid sparing orbital exenteration. The three (12%) patients with intraepithelial neoplasm, and six (24%) who had SCC but with tumor-free margins received no adjuvant treatment post-operatively, while 13 (52%) with SCC and microscopic margin involvement were treated with four courses of 0.04% topical mitomycin C (MMC) and the three (12%) patients who had orbital exenteration were referred for radiotherapy. The average follow-up period was 12 months, no patient was lost to follow-up and none has had recurrence.

Conclusion: OSSN occurs in younger individuals, and is strongly associated with HIV infection in our environment. Early diagnosis and intervention can prevent severe ocular morbidity. Wide surgical excision with intra-operative cryotherapy and adjuvant treatment with topical MMC post-operatively seem to give good outcome in our patients.

Delleman-Oorthuys syndrome (oculocerebrocutaneous syndrome) in a Nigerian child: a case report

Background:

Delleman–Oorthuys syndrome, also known as oculocerebrocutaneous syndrome, is a rare congenital anomaly with ocular, cerebral and cutaneous manifestations. So far, only 40 cases have been described.

Clinical case:

A 3-year-old female Nigerian child with no identifiable left eyeball, multiple left-sided facial skin defects and delayed developmental milestones but otherwise uneventful medical and family history was evaluated at the Ophthalmology and Paediatric Neurosurgery in Ibadan, Nigeria. Besides the mentioned defects that were present since birth, brain imaging revealed several brain abnormalities including intracranial cysts. Global hyperreflexia and bilateral flexor plantar response were observed upon clinical examination. Left micro-ophthalmia and orbital mass were detected. A histological assessment of the orbital mass revealed it to be rudimentary ocular tissue. The diagnosis of Delleman–Oorthuys syndrome was made based on the clinico-radiological features. The patient underwent a left-sided posterior fossa cystoperitoneal shunt. The left orbital mass was enuclated and the patient is currently awaiting left eyelid reconstruction and an orbital implant and repair of the left alar nasi cleft.

Conclusion:

To our knowledge, this is the first published report of Delleman–Oorthuys syndrome in a female child of West African descent. Given the variable manifestations of Delleman–Oorthuys syndrome, and overlap with other syndromes, the Delleman–Oorthuys syndrome may be underreported. Neuroimaging of patients with cutaneous tags, orbital cysts and micro-ophthalmia could reveal more cases.

Delleman syndrome: A case report from West Africa - features and the challenges of management

Delleman syndrome is a rare congenital disorder. We report an 8-month old female with a history of a fleshy mass covering the left eye since birth. Examination revealed poor vision in the left eye, an upper lid coloboma and an epibulbar dermoid with a large area of alopecia and scalp hypoplasia involving the left frontoparietal region. Transfontanelle ultrasound scan did not reveal any intracranial cyst. Cranial computerised tomography subsequently revealed characteristic cerebral malformations of Delleman syndrome. This report demonstrates clinical and computed tomographic features of a case of Delleman syndrome with emphasis on the usefulness of transfontanelle ultrasonography in assessing for life-threatening intracerebral cysts or hydrocephalus, particularly in resource-limited settings, where neuroimaging is not readily available or affordable.

Hydatid cyst of the orbit in a young Nigerian female: a case report

Objective: To report an unusual case of orbital hydatid cyst successfully managed by surgical excision.Case report: A 33-year-old female presented with gradual protrusion of the left eye associated with poor vision, cosmetic embarrassment and watering. She had excision biopsy of an encapsulated cystic lesion with cheesy tissue and serous content. Orbital hydatid cyst due to echinococcosis was confirmed at histopathological examination of the excised tissue. She subsequently became pregnant hence, could not undergo post-operative antihelminthic treatment, but was managed conservatively with no recurrence after five years of regular follow-up.Conclusion: Orbital hydatid cyst should be considered as a differential in a young patient presenting with unilateral proptosisFunding: NoneKeywords: Echinococcosis, Hydatid cyst, Orbit, Nigerian, Proptosis

Hydatid cyst of the orbit in a young Nigerian female: a case report

OBJECTIVE

To report an unusual case of orbital hydatid cyst successfully managed by surgical excision.

CASE REPORT

A 33-year-old female presented with gradual protrusion of the left eye associated with poor vision, cosmetic embarrassment and watering. She had excision biopsy of an encapsulated cystic lesion with cheesy tissue and serous content. Orbital hydatid cyst due to echinococcosis was confirmed at histopathological examination of the excised tissue. She subsequently became pregnant hence, could not undergo post-operative antihelminthic treatment, but was managed conservatively with no recurrence after five years of regular follow-up.

CONCLUSION

Orbital hydatid cyst should be considered as a differential in a young patient presenting with unilateral proptosis.

FUNDING

None.

Prevalence of congenital colour vision deficiency among secondary school students in Ibadan, South-West Nigeria

AIM

The aim was to determine the prevalence and pattern of congenital colour vision deficiency among secondary school students in Ibadan, Nigeria.

SUBJECTS AND METHODS

A descriptive cross-sectional study was conducted among students from three public secondary schools through a multi-staged sampling method. Ocular examination including visual acuity assessment and colour vision test with the Ishihara plate was performed for all students. Further assessment with the Farnsworth-Munsell D-15 panel was performed for those who failed the Ishihara test.

RESULTS

One thousand six hundred and thirty-five students participated in the study. There were 769 (47.0%) males with mean age of 13.9 ± 1.9 years. The overall prevalence of congenital colour vision deficiency was 2.3% with prevalence of 3.8% and 0.9% in males and females, respectively, which was statistically significant (P = 0.00112), and equal proportion of deutans 11 (32.0%) and protans 12 (35.0%) ratio of 1:1.1.

CONCLUSION

The prevalence of congenital colour vision deficiency among public secondary school students in Ibadan is comparable to findings in other parts of the country.

Comparison of Peribulbar with Posterior Sub-Tenon's Anesthesia in Cataract Surgery Among Nigerians

Purpose:

To compare the akinetic and the analgesic effects of peribulbar and posterior sub-Tenon's anesthesia in patients undergoing cataract surgery.

Methods:

In a hospital-based randomized comparative interventional study, patients aged 50 years and above who underwent elective surgery for uncomplicated cataract were randomized to receive either peribulbar block or posterior sub-Tenon block. Pain during injection, surgery, and after surgery was assessed using numerical reporting scale (NRS). Limbal excursion was measured with a transparent meter rule.

Result:

A total of 152 eyes of 152 patients were studied. Peribulbar and sub-Tenon regional blocks provided comparable adequate akinesia (P = 0.06) and similar levels of analgesia (P = 0.10) during cataract surgery. Both techniques also provided similar levels of analgesia to the patient during injection and in the immediate postoperative period. Ninety-two percent of patients who had peribulbar and 97% of those who had sub-Tenon blocks reported either mild pain or no pain at all during surgery (P = 0.49). There was no report of severe pain in all patients during the stages of the surgery. Occurrence of chemosis and subconjunctival hemorrhage was more common in sub-Tenon than peribulbar anesthesia.

Conclusions:

This study shows that peribulbar and posterior sub-Tenon routes of administering anesthetic substances is comparable in providing adequate akinesia and analgesia for cataract surgery with minimal complications. Therefore, both techniques are effective and safe for cataract surgery among Nigerians.

Spindle cell hemangioma: Unusual presentation of an uncommon tumor

Spindle cell hemangioma (SCH) is an uncommon tumor that usually presents as subcutaneous or deep dermal nodule affecting the extremities and is typically <2 cm in size. A few cases have been reported in the head and neck region. To the best of the authors’ knowledge, there are no previous reports of SCH occurring in the orbit in the English literature. We, therefore, report the case of a large SCH involving the right orbit of a healthy 9-year-old Nigerian girl.

Orbito-Ocular Tumours in Ibadan, South-West Nigeria

AIM

The aim of this study was to review the cases of orbito-ocular tumors in a single tertiary health facility, and determine changes in pattern of presentation.

METHODS

Medical records of all patients with histologically confirmed orbito-ocular tumors between January 1992 and December 2011 in a tertiary center were reviewed. Patients' demographics, types of orbito-ocular tumor and their presentation were recorded.

RESULTS

Records of 205 patients were analyzed with a male to female ratio of 1.1:1 and median age of seven years. Retinoblastoma was the most common tumor followed by ocular surface squamous neoplasia. Squamous cell carcinoma was the most common eyelid tumor while rhabdomyosarcoma was the most common orbital tumor. No case of melanoma was seen during the period. More than two thirds of patients had lost vision at presentation due to delay in seeking appropriate medical attention Conclusion: There appears to be a reduction in the cases of orbito-ocular tumors in Ibadan, however, there is little variation in the pattern of presentation. Encouraging early presentation to the appropriate health facility may possibly reduce the morbidity in these patients.

Risk factors for pterygium recurrence after surgical excision with combined conjunctival autograft (CAG) and intraoperative antimetabolite use

BACKGROUND

To identify the determinants of recurrence following primary pterygium excision combined with conjunctival autograft (CAG) and intraoperative use of Mitomycin C (MMC) or 5-Fluorouracil (5-FU).

METHODS

A randomized controlled clinical trial comparing 5-FU (50 mg/ml) plus CAG versus MMC (0.01%) plus CAG in preventing recurrence of primary pterygium following excision.

RESULTS

A total of 80 eyes of 80 subjects were studied, with 46 eyes in the 5-FU group and 34 eyes in the MMC group. The mean age was 50.7 +/- 13.1 years with a male: female ratio of 0.95:1. Mean follow up period was 35.2 +/- 29.1 weeks. The overall recurrence rate was 10%, with a rate of 8.7% in the 5-FU group and 11.8% in the MMC group. The mean age of the patients who had a recurrence was 38.1 +/- 13.3 years compared to 52.1 +/- 12.4 years in those without a recurrence (p = 0.003). The median size of the pterygium in patients who had a recurrence was 3.2mm, while the median size in patients who did not have a recurrence was 3.0mm (p = 0.8). Five (12.8%) males had a recurrence compared to three (7.3%) females (p = 0.48); while 10.5% of fleshy pterygia recurred compared to none (0%) of the non-fleshy pterygia (p = 1.00).

CONCLUSION

Younger age remains a risk factor for recurrence when both CAG and antimetabolites are combined in the treatment of pterygium, while the effect of gender, size and morphology of the pterygium may be diminished by such combination.

Mooren'S ulcer in ibadan, southwest Nigeria

BACKGROUND

Mooren's ulcer has been described as an idiopathic, painful, relentless, peripheral, chronic ulcerative keratitis that progresses circumferentially and centrally, with an unusual geographical presentation and distribution.

AIM

To review the demographic and clinical characteristics of patients with Mooren's ulcer at University College Hospital, Ibadan, Nigeria over seven years, and, the outcome of treatment.

STUDY DESIGN

A retrospective case series.

METHODS

Medical records of all patients with Mooren's ulcer seen in the Eye Clinic, University College Hospital, Ibadan, South-west Nigeria between January 2007 and December 2013 were reviewed.

RESULTS

Thirty-one eyes of 23 patients, (18 males, overall mean age of all patients 30.9 ±16.6 years) were affected with Mooren's ulcer. The right eye was involved in nine (39.1%) patients while eight (34.8%) patients had bilateral lesions. Most common presenting symptoms were redness and pain, with an average of 6.8 clock hour-limbal involvement. All patients received topical and systemic steroids, while eight patients with severe disease, or poor response to treatment with steroids, received systemic methotrexate or cyclophosphamide. Surgical treatment with conjunctivectomy and cryotherapy was undertaken in 14 (60.9%) patients (21 eyes) who had a minimum follow-up period of eight weeks, while those presenting with perforation also had scleral patch graft or direct repair. The ulcer healed with varying degrees of corneal opacity in 18 (85.7%) of the 21 eyes, while the remaining three eyes developed descemetocele, anterior staphyloma or corneal perforation. Large proportion (76.2%) of eyes maintained their presenting acuity.

CONCLUSION

Mooren's ulcer remains an uncommon disease in Ibadan, South-west Nigeria, and the clinical presentation is as recorded in other parts of the West African sub-region. Systemic immunosuppression with methotrexate and scleral patch graft appear to give good outcome in patients presenting with severe ulceration and/or perforation.

Pattern of presentation and outcome of ophthalmic rhabdomyosarcoma in Ibadan

BACKGROUND

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma, and the commonest primary orbital malignancy in children. Studies on ophthalmic RMS are scanty in Nigeria, and other parts of Africa. This study thus describes the pattern of ophthalmic RMS in Ibadan and treatment outcome.

METHOD

A retrospective, non-comparative, consecutive, interventional analysis of patients with ophthalmic RMS in an ocular oncology unit of a teaching hospital over 20 years was carried out.

RESULTS

Records of 22 patients, 15 males and 7 females, aged 2 months to 50 years (Median 7 years, Range 5-13 years) were analyzed. All patients presented with visual loss, orbital swelling and proptosis. Histological examination revealed embryonal RMS in 16 (72.7%) patients, alveolar in three (13.6%), pleomorphic in two (9.1%) and "not otherwise stated" in one (4.5%). Treatment outcome was poor as only two (9.1%) patients remained tumour-free 12 and 36 months after diagnosis. Three (13.6%) patients died on admission, while two (9.1%) patients are presently undergoing treatment. Fifteen (68.2%) patients were lost to follow-up, financial constraint and perceived poor response to treatment being the main reasons for incomplete and inconsistent treatment regimen and resultant poor outcome.

CONCLUSION

Demography and morphology of ophthalmic RMS in Ibadan is comparable to other studies. However, treatment outcome remains poor, mainly due to late presentation, incomplete and inconsistent treatment. Strengthening the national health insurance scheme to cater for the indigent and increased public enlightenment on early presentation of cases may go a long way in improving the outcome in our patients.

Management of bilateral congenital upper eyelid eversion with severe chemosis

PURPOSE

To report a case of complete bilateral congenital upper eyelid eversion associated with severe chemosis in a newborn, and to describe a semi-invasive technique for its management.

CASE REPORT

The patient was a four-hour-old Nigerian neonate with bilateral congenital upper eyelid eversion with severe and progressive chemosis. Conservative management failed to resolve the condition. However, compression eyelid sutures resulted in prompt and satisfactory resolution.

CONCLUSION

Compression eyelid suturing is a semi-invasive technique for management of severe chemosis due to congenital upper lid eversion resulting in rapid and satisfactory resolution of the condition.

BILATERAL ORBITO-OCULAR GUNSHOT INJURY IN A NIGERIAN MALE: CASE REPORT AND REVIEW OF LITERATURE

Orbito-ocular injuries with retained intra-orbital foreign bodies affecting both orbits are uncommon in civilian practice. This case report aims to highlight an unusual presentation of bilateral orbito-ocularinjury with retained intra-orbital foreignbodies following accidental explosion of a locally fabricated dane gun. A 30-year-old male presented with a five day history of bilateral orbito-ocular injury sustained following an explosion of a dane gun he was fabricating. There was immediate loss of vision in both eyes, and initial treatment was sought at a nearby private general medical clinic. Visual acuity at presentation was no perception of light and light perception with inaccurate projection in the right and left eye respectively, and he had an open wound over the left cheek with retained intra-orbital foreign bodies on plain radiographs. He subsequently underwent wound exploration and closure with removal of the foreign bodies. Vision however remained poor and he was lost to follow-up after being referred for vitreo-retinal consultation. The attendant socio-economic impact on the individual and family following severe bilateral orbito-ocular injury could be enormous when it results in bilateral loss of vision in a young adult. Measures should thus be put in place to regulate the handling of firearms so as to possibly reduce the resultant morbidity from such injuries.

Etiology of visual impairment among ophthalmic patients at Federal Medical Center, Abeokuta, Nigeria

BACKGROUND

The Nigeria national blindness survey has documented region-specific prevalence and causes of visual impairment in the country. However, there is need for local studies to ascertain specific causes of visual impairment peculiar to each community, as this varies from one locality to another.

AIM

To determine the causes of blindness and low vision among patients presenting to the Eye Clinic, Federal Medical Center Abeokuta, Nigeria.

STUDY DESIGN

A retrospective study.

MATERIALS AND METHODS

Medical records of all patients seen at the Eye Clinic, Federal Medical Center, Abeokuta, Nigeria between January 2011 and December 2012 were reviewed.

RESULTS

Out of the 5,352 patients managed during the period, 474 (8.9%) were blind, 3,178 (59.4%) had low vision while 1,700 (31.7%) had "normal vision". The risk of visual impairment increased with age. The major causes of blindness were cataract (32.5%), glaucoma (20%) and age-related macular degeneration (12.8%), while the most common causes of low vision were uncorrected refractive errors (20.5%), cataract (17.6%) and glaucoma (14.8%).

CONCLUSION

Cataract, glaucoma and uncorrected refractive errors are the leading causes of visual impairment in Abeokuta, Nigeria. Public enlightenment coupled with prompt and effective management will reduce the burden of blindness in the country.

Giant deep orbital dermoid cyst presenting early in infancy in a Nigerian child: a case report and review of the literature

Introduction

Dermoid cysts are the most common orbital cystic lesions seen in children. While superficial orbital dermoid cysts present early in life, deep dermoid cysts remain clinically occult until adolescence or adulthood. We here present a case of a deep orbital dermoid cyst in a Nigerian child that became symptomatic early in infancy.

Case presentation

A female Nigerian infant of Yoruba ethnicity presented at three months of age with left non-axial proptosis and a hazy cornea. A superotemporal cystic orbital mass was seen on ultrasonography, and her parents were counseled for simple tumor excision. They however defaulted, only for their child to re-present two years later with gradually progressive proptosis, an enlarged orbit and keratinized ocular surface, necessitating orbital exenteration.

Conclusion

Deep orbital dermoid cysts may be symptomatic from birth. Late presentation may result in an irreversible loss of vision, as demonstrated in our case. The need for public enlightenment on early presentation and prompt management of such benign lesions is emphasized.

Orbital intravascular papillary endothelial hyperplasia in a Nigerian child: a case report and review of the literature

INTRODUCTION

Intravascular papillary endothelial hyperplasia is a reactive proliferative lesion of endothelial cells in blood vessels. It typically presents as a painless, reddish purple lesion in the sites affected. The orbit remains an uncommon site of affectation of this relatively common disease. It is noteworthy that this is the first reported case, to the best of our knowledge, of orbital intravascular papillary endothelial hyperplasia in a Nigerian child.

CASE PRESENTATION

The case reported here is an orbital intravascular papillary endothelial hyperplasia causing non-axial proptosis and loss of vision in a 14-year-old Nigerian boy. We describe the clinical and histological findings of intravascular papillary endothelial hyperplasia in the orbit of this 14-year-old boy. The key distinguishing features are discussed and relevant literature is reviewed.

CONCLUSION

Although unusual in presentation, intravascular papillary endothelial proliferation should be considered in the list of differentials of proptosis due to mass lesion in young Nigerians and, possibly, Africans.

Visual outcome of uveitic cataract in Ibadan

The aim of this study is to evaluate the factors responsible for poor visual outcome in patients who had surgery for cataract due to uveitis in our subpopulation. A nonrandomized retrospective chart review of 28 patients (28 eyes) diagnosed with uveitic cataract that had cataract surgery between June 2001 and May 2007 at the University College Hospital, Ibadan, Nigeria was carried out. All had extracapsular cataract extraction with or without IOL implantation. The outcome measure was post-operative best corrected visual acuity. Over 60% of our patients achieved final best corrected visual acuity (BCVA) of 6/18 or better. The major causes of poor vision were posterior capsule opacity (PCO) in 6 patients, cystoid macular oedema (CMO) in 2 patients and pre-existing chorioretinal scar in 1 patient. We conclude that post uveitic cataract surgery results in good visual outcome with few complications in Ibadan.

Pattern of pre-hospital consultation among ophthalmic patients seen in a tertiary hospital in South West Nigeria

This hospital based study aimed to seek information on the factors influencing non-doctor consultation practices in South West Nigeria. A high prevalence of such practices and the attendant public health significance have been reported in different regions of the world, yet studies related to this are generally lacking in this region. Semi-structured questionnaires were administered to 142 ophthalmic patients presenting newly to the out-patient unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria. Information were obtained on demographic data, health care facilities visited before presenting to the eye clinic, drugs prescribed, and reasons for consulting such facilities. The age of the participants ranged from 16 to 85 years with a mean of 44.79 years (SD 17.25 years). 32 (22.5%) of these had not used any pre-visit consultation. 110(77.5%) had consulted one form of health care provider or the other, with only 48 of them (43.6%) having consulted allopathic doctors. 62 (56.4%) had consulted alternative practitioners. Thus 43.7% of the patients practiced non-doctor consultation. The main reasons given for engaging in non-doctor consultation are 'problem not serious' (25.8%), 'no nearby hospital' (25.8%), and 'to save time' (21.0%). Non-doctor consultation practices are prevalent in South West Nigeria as in many other developing regions of the world. Ignorance and inadequate health care providers contribute a great deal to this. Increased public enlightenment, making health care services available and accessible to the populace and stricter government policies on drug dispensing will go a long way in reducing these practices.

Visual outcome of traumatic cataract surgery in Ibadan, Nigeria

OBJECTIVE

To review the visual outcome of traumatic cataracts operated at the University College Hospital, Ibadan with the view to making recommendations for improved outcome.

METHODS

All patients operated at the University College Hospital Ibadan, Nigeria between May 1999 and April 2004 with traumatic cataract were reviewed retrospectively to determine visual outcome and main causes of poor visual outcome <6/18, using a structured data entry form and information obtained from the operation register and case notes of patients

RESULTS

32 patients, age range 2 to 71 years, mean age 25.6 +/- SD 16.1 years were reviewed. 22 (68.8%) were males while 10 (31.2%) were females. Causes of traumatic cataract included wood/stick splinters in 7 (21.9%), cane/whiplash injury 6 (18.8%), and propelled missile injuries, 5 (15.6%). Less important cause of injuries were gun shot, road traffic accident and fist injuries. 11 (35.6%) of the patients had best corrected post operative visual acuity of >6/18, 10 (32.2%) <6/18-3/60, while 32.2% of the cases reviewed remained blind or had vision <3/60 in the affected eye. Cause of poor post operative visual acuity (less than 6/18) in 64.4% of the subjects included cornea opacity 12.5%, posterior capsule opacity 12.5%, retinal detachment 9.4%, and glaucoma 6.9%.

CONCLUSION

Useful vision can be restored in a proportion of traumatic cataracts through surgery, although sight-limiting complications, which may be related to the severity of the trauma or prolonged post op inflammation may be present, many are potentially treatable with further intervention. The need for adequate health education to prevent ocular injuries and preoperative diagnosis of associated posterior segment complications that may prevent optimal post-operative visual acuity is also noted.

The effect of timolol maleate on tear film break-up time in Nigerians

The aim of this study was to evaluate the effect of Timolol maleate on tear film break-up time in a Nigerian population. 192 eyes of 96 subjects were examined in a hospital based case-control study after being administered pre-coded questionnaires. The mean tear film break-up time was measured. There was significant difference (t = 10.164, P < 0.001) in the mean break-up time of cases (10.45 secs) and controls (30.18 secs). Half of the cases had some ocular discomfort with the instillation of Timolol maleate, a significant number of them having just been commenced on the medication (chi2 = 8.889, P = 0.003). Long-term instillation of Timolol maleate impairs tear film stability. The ocular discomfort experienced by patients on Timolol may contribute to poor drug compliance observed in patients on chronic drug therapy. Regular screening of patients on Timolol maleate for tear film instability and dry eyes is important and drug manufacturers should explore the possibility of incorporating artificial tears in Timolol maleate preparation.