Presentation of children with advanced retinoblastoma for treatment in Ghana: the caretakers' perspectives

BACKGROUND

Retinoblastoma, the commonest childhood malignant intraocular tumour, is diagnosed late, with less than 50% survival in developing countries, including Ghana.

OBJECTIVES

To determine, from caretakers' perspective, contributing factors to late presentation of children with retinoblastoma.

METHODS

A cross-sectional study involving questionnaire administration to consenting caretakers of consecutive children diagnosed with advanced retinoblastoma at the Eye Unit, Korle-Bu Teaching Hospital, Accra, Ghana, from September 2008-June 2011. Clinical diagnosis was confirmed by CT scan or ultrasonography. Ethical approval was granted by University of Ghana Medical School.

RESULTS

Forty caretakers aged 22-58 years (mean = 32.8 ± 7.8yrs) were interviewed. Twenty-four (60%) were females, 36(90%) were parents. Thirty-two (80%) had at least primary level of education. Initial symptoms noticed by caretakers were: white spot 35(87.5%), redness 3(7.5%), proptosis 1(2.5%) and squint 1(2.5%). Thirty-five caretakers (87.5%) sought prior treatment between 1-24 months (median=1month) and 7(37%) beyond 3months, mainly from health/eye centres 34(85%). Six caretakers (15.4%) knew their children had cancer, 11(27.5%) had heard about retinoblastoma, but only 2(5.0%) knew treatment existed. Thirty-two caretakers (80%) would accept enucleation with prosthesis and 17(42.5%) without it. Cost: 8(20% respondents) and lack of awareness of prognosis of retinoblastoma 12(30% respondents) were stated as important factors though they did not prove significant. Caretakers' level of education, occupation and gender had no significant association with knowledge about retinoblastoma, awareness of treatment or cure, acceptance of enucleation with or without prosthesis, nor awareness of prognosis without treatment, p>0.05.

CONCLUSION

Low awareness of the cause, treatment and prognosis of retinoblastoma exists among caretakers of children with advanced retinoblastoma. This may contribute to the late stage of the disease presentation.

Epidemiology and recurrence rate of pterygium post excision in Ghanaians

OBJECTIVES

To determine the epidemiology and recurrence rate of pterygium after excision using bare sclera technique.

DESIGN

Prospective non-comparative study.

SETTING

Ophthalmology unit, Korle-Bu Teaching Hospital, Accra, Ghana.

METHODS

The study involved 60 consecutive patients with primary apterygial from July 1998 to December 2000 who had bare sclera excision after informed consent. They were post-operatively followed up for 30-months.

RESULTS

Thirty-five patients (58%) were females. The patients' ages ranged from 17-75 years, mean (±12.6). Overall recurrence was 22(37%). The main complications encountered include were granuloma 20 %(n=12), restriction in medial rectus muscle motility 2(3%), persistent vascularisation at excision site 2(3%) and adherence leucoma with uveitis 1(2%). No significant association was found between recurrence and pterygium morphology, calcification, allergy and occupation (indoor or outdoor).

CONCLUSION

The recurrence rate after pterygium excision using bare sclera technique in Ghanaians is high (37%).

Dermis-fat grafts and enucleation in Ghanaian children: 5 years' experience

BACKGROUND

Enucleation in young children often results in retarded orbital growth ipsilaterally. The need for an implant that will naturally grow with the child, like Dermis-fat Graft (DFG), for managing the anophthalmia has been of interest over the years.

OBJECTIVE

To evaluate the use of DFG as an implant for volume replacement post-enucleation.

STUDY DESIGN

A prospective non-comparative case series involving 18 consecutive children who had DFG either primarily or secondarily in conjunction with enucleation for intraocular pathologies, from December 2007 to September 2012, at the ophthalmology unit, Korle-Bu. Data from patients who had a minimum of three months follow up(FUP) were analysed.

OUTCOME MEASURES

Complete covering of DFG with healthy conjunctiva, increase in volume of DFG, and presence or absence of complications.

RESULTS

Fifteen patients were analysed, aged nine months to ten years (mean (SD), 3.7±2.7years). Eight (53.3%) were females. Thirteen (86.7%) DFGs were secondary and 2(13.3%) primary. Indications for enucleation were intraocular retinoblastoma (n=10, 66.7%), unexplained retinal detachment mimicking retinoblastoma (n=3,20.0%), anterior staphyloma (n=1,6.7%) and medulloepithelioma (n=1,6.7%). Fourteen (93.3%) patients showed increase in volume of DFG. Time for Conjunctival reepithelialisation of the dermal surface was four to fourteen weeks (mean/median=5.5/4.0). Complications encountered were infection (n=1,6.7%), infection with necrosis (n=1,6.7%), melanosis /keratinization (n=2, 13.3%) and cysts(n=2,13.3%). The patients were followed up for 3 to 54 months (mean/median 20.13 /16.00).

CONCLUSION

DFG for management of post-enucleation anophthalmia in Ghanaian children showed 93.3% success.

Prevalence of congenital eye anomalies in a paediatric clinic in Ghana

There is little information about the epidemiology of congenital eye anomalies in Ghana. We retrospectively reviewed the clinical records of 485 admissions to the paediatric eye centre of the Korle-Bu Teaching Hospital, Ghana (2004-2009) and 263 were diagnosed with at least one anomaly. Visual acuity was quantitatively assessed in 209 patients and 130 had some visual impairment; 49 with bilateral and 64 with unilateral blindness. The most frequent congenital anomaly overall was cataract (n = 44). In infants, cataract was the most frequent finding (28/121). Toddlers most frequently presented with retinoblastoma (10/65). Glaucoma was the most frequent anomaly in preschool (9/39) and school (10/38) children. We conclude that avoidable causes of childhood blindness caused most congenital eye anomalies. Intensification of community-based health promotion and preventive eye care, early detection and provision of adequate resources for effective therapy could reverse these trends.

Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population

PURPOSE

To evaluate the surgical outcome of combined trabeculotomy-trabeculectomy in Ghanaian children with primary congenital glaucoma.

MATERIALS AND METHODS

A retrospective case series involving 19 eyes of 12 consecutive children with primary congenital glaucoma who had primary trabeculotomy-trabeculectomy from 12 August 2004 to 30 June 2008, at the Korle-Bu Teaching Hospital, Ghana. Main outcome measures were preoperative and postoperative intraocular pressures, corneal diameter, corneal clarity, bleb characteristics, duration of follow-up, surgical success, and complications.

RESULTS

A total of 19 eyes of 12 patients met the inclusion criteria. Six of the patients were males. Mean age at diagnosis was 4.4 (range 2-8) months. Mean age at surgery was 5.9 months (range 3-16). Eight (67%) infants had bilateral disease. Mean duration of follow-up was 13.1 (range 5-38) months. The preoperative mean horizontal corneal diameter was 13.4 ± 1.1(range 12-16) mm. Complete success (intraocular pressure <21 mm Hg) was obtained in 15 (79%) eyes. The probability of success was 94.4, 83.3, 66.7, 44.4, 38.9, 33.3, and 13.3% at 3, 6, 9, 12, 15, 18, and 21 months, respectively (Kaplan-Meier analysis). All eyes had corneal oedema preoperatively. Seventeen eyes (90%) had clear cornea at their last follow-up. Mean preoperative and postoperative intraocular pressures were 30.3 ± 8.8 and 18.1 ± 6.8 mm Hg respectively (P<0.001, t-test). Twelve (63%) eyes had well-functioning blebs at the last follow-up. One eye (5%) developed seclusio pupillae and cataract postoperatively.

CONCLUSION

The overall success for combined trabeculotomy-trabeculectomy in Ghanaian children with primary congenital glaucoma was 79%. The probability of success reduced from more than 66% in the first 9 months postoperatively to below 45% after that.