Clinico-cytological analysis of conjunctiva and ocular surface symptoms of patients on topical anti-glaucoma medications attending Lagos University Teaching Hospital, Lagos, Nigeria: A case-control study.

Background: The long-term use of topical anti-glaucoma medications is often associated with ocular surface toxicity that can affect the patient's drug compliance and quality of life. This study assessed the effect of these medications, using cytological changes of the conjunctiva and ocular surface symptoms. Materials and Methods: This was a clinic-based, case-control study that was conducted at the Lagos University Teaching Hospital that compared glaucoma patients on topical medications with age-sex-matched controls. The controls were non-glaucoma patients, who were not on any topical ocular medications at least 6 months prior to the study. The Ocular Surface Disease Index (OSDI) questionnaire was used to assess ocular surface symptoms. Schirmer's I test, tear film break-up time (TBUT) test and corneal fluorescein staining of the ocular surface were used for ocular surface disease (OSD) assessment and conjunctival impression cytology (CIC) for histological assessment and grading. Results: Six hundred and ninety-six eyes of 348 respondents, 174 cases and 174 controls, were assessed for OSD. The mean ages of the case and control groups were 56.3 ± 12.9 years and 55.5 ± 13.2 years, respectively, with no statistical difference (P = 0.589). All ocular parameters assessed were significantly abnormal in the case group compared to the control group. The use of topical anti-glaucoma medications was significantly associated with abnormal TBUT (P < 0.001), Schirmer's test (P < 0.001), ocular surface staining (P < 0.001), CIC (P < 0.001) and OSDI scores (P = 0.001). A significant association was seen between abnormal TBUT and the number of medications (P = 0.044, odds ratio [OR] =0.79, 95% confidence interval [CI]: 0.44-1.14), between abnormal ocular surface staining and duration of anti-glaucoma medications usage (P = 0.0104, OR = 1.2, 95% CI: 1.04-1.43) and between abnormal CIC and the duration of anti-glaucoma medications (P = 0.0007, OR = 0.7, 95% CI: 0.59-0.86). Conclusion: The study demonstrates that prolonged use of topical anti-glaucoma medications may be associated with damage to the ocular surface structures.

Presentation and Management of Orbito-Ocular Malignancies in a Tertiary Institution in Southwest Nigeria.

Purpose: The aim of this study was to review the management of orbito-ocular malignancies in the Departments of Radiotherapy and Ophthalmology, Lagos University Teaching Hospital, between January 1997 and December 2011 in comparison to previous and recent studies globally. Materials and Methods: This was a retrospective study of orbito-ocular malignancies seen at the Departments of Radiotherapy and Ophthalmology, Lagos University Teaching Hospital from 1997 to 2011. Case files and treatment cards were retrieved through the Medical Records department and the information required was extracted with the aid of a data extraction form. Results: A total of 98 cases with histologically confirmed orbito-ocular malignancies seen during the 15-year study period were analysed. Retinoblastoma (51 [52.0%]) was the most common orbito-ocular malignancies seen in children, whereas squamous cell carcinoma of the conjunctiva (25 [25.5%]) was the most common in adults. Seventeen (17%) patients had a combination of radiotherapy, surgery, and chemotherapy. Thirty (33%) had enucleation, whereas 33 (36%) had exenteration. Thirty-six patients had chemotherapy, whereas 44 patients benefited from radiotherapy, and radical treatment was offered to 24 patients. Total radical treatment dose was 35-65 Gy in 20-35 fractions over 4-7 weeks. Most of the patients (84 [85.7%]) were lost to follow up. Five (5.1%) died from disease progression and four (4.1%) are still alive and on regular follow-up. Conclusion: This study showed that the use of multimodality treatment was implemented but did not improve survival because the majority of patients presented late. The need for a collaborative effort in early detection and prompt referral for treatment of cancer cases cannot be overemphasised.

A Study of the Prevalence and Pattern of Sickle Cell Retinopathy among Eye Clinic Attendees in a Nigerian Tertiary Hospital.

Background: Sickle Cell Disease (SCD) is the first and the most common group of haemoglobinopathies in the world. It affects virtually all body systems including the eyes. Proliferative Sickle cell Retinopathy (PSR) is a cause of visual loss in the working age group which has an impact on the economy and quality of life. This study aimed to describe the pattern of presentation of Sickle Cell Retinopathy (SCR)to improve understanding of the disease presentation. Methodology: The ophthalmic surgical records of patients diagnosed with sickle cell disease at the retinal unit, department of Ophthalmology at the Lagos University Teaching Hospital between the year 2011-2020 were reviewed retrospectively. Results: A total of 64 patients (108 eyes) records were reviewed in this study. The Prevalenceof sickle cell retinopathy was 5.4% of all retina cases within the study period. Age ranged from 10-70 years; the mean age was 36.28 years ± 13.66. There were 25 females and 39 males (F:M= 1:1.6). SCR was most common in patients with HbSC 40 (62.5%). Common presenting symptoms were loss of vision34 (53.1%) and floaters 34 (53.1%). Goldberg stage III 26 (20.3%) and stage IV 27 (21.1%) were the most common stages of proliferative disease at presentation. A significant association was seen between Haemoglobin genotype SC and the occurrence of sickle cell retinopathy with 90% of the patients with Haemoglobin genotype SC having had PSR. The majority of the patients25 (39.1%) had no treatment, and 13 (20.3%) had laser photocoagulation only. Conclusion: Sickle cell retinopathy is not uncommon in Nigeria and many patients only present in tertiary health facilities when they have severe symptoms such as loss of vision. This may be attributed to the late diagnosis and referral. Routine screening is recommended to ensure early detection and treatment to prevent avoidable blindness.

Ocular manifestations of leukaemia: A teaching hospital experience.

BACKGROUND: Knowledge of the ophthalmic manifestations of leukaemia is important not only because of the frequency with which changes are seen but because the eye often reflects the disease state of the illness, and once identified, prompt referral, early treatment can be instigated, blindness can be averted and a life may be saved. These manifestations are often overlooked because of the underestimation of the magnitude of the ocular sequelae which may be blinding. AIM: This study aims to describe the ophthalmic findings in adult leukaemic patients at two teaching hospitals in Lagos, Nigeria. PATIENTS AND METHODS: This was a clinic-based, comparison multicentre study conducted at Lagos University Teaching Hospital and Lagos State University Teaching Hospital over a 9-month period of May 2012-January 2013. The cases were newly diagnosed leukaemic patients (acute and chronic) from the haematology clinics. Controls were escorts of apparently normal patients. Detailed ocular examination was carried out after written informed consent was obtained. Analysis was done using SPSS 17. RESULTS: A total of 160 eyes in 80 individuals examined comprised forty cases and forty controls. The results of the cases were compared with the age- and sex-matched controls. Leukaemic-related ophthalmic manifestations were present in 56 eyes (70.0%) of the cases studied. Findings in cases were periorbital oedema in 8 eyes (10%), subconjunctival haemorrhage in four eyes (5%), intraretinal haemorrhage as found in 25 eyes (31.3%), retinal venous tortuosity in 21 eyes (26.3%), Roth spots in 19 eyes (23.8%) and retinal infiltrates in 17 eyes (21.3%). CONCLUSION: Ophthalmic disorders occur in adult patients living with leukaemia. Prompt initial and periodic ophthalmic evaluation is recommended in all leukaemic patients.

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

Normal corneal endothelial cell density in Nigerians.

AIM: The aim of the study was to describe the corneal endothelial cell density of adults at the MeCure Eye Center and to determine the relationship between age, sex, and corneal endothelial cell density. METHODS: This study was a retrospective study looking at those records of individuals who had undergone specular microscopy or corneal endothelial cell count measurement at the MeCure Eye Center. RESULTS: The endothelial cell characteristics of 359 healthy eyes of 201 volunteers were studied. The mean corneal endothelial cell density (MCD) was 2,610.26±371.87 cells/mm(2) (range, 1,484-3,571 cells/mm(2)). The MCD decreased from 2,860.70 cells/mm(2) in the 20-30-year age group to 2,493.06 cells/mm(2) in the >70-year age group, and there was a statistically significant relationship between age and MCD with a P-value of <0.001. There was no statistically significant correlation between sex and corneal endothelial cell density (P=0.45). CONCLUSION: This study shows that endothelial cell density in Nigerian eyes is less than that reported in the Japanese, American, and Chinese eyes, and is comparable to that seen in Indian and Malaysian eyes.