Indications for destructive eye surgeries among adults in a tertiary eye care center in North CENTRAL Nigeria.

BACKGROUND: Destructive eye surgery is a management option offered patients when further retention of the globe is likely to affect ocular and general health or jeopardize survival. Indications for this procedure vary and could reflect the pattern of severe or end stage ocular morbidities in a given environment. AIM: To assess the indications for destructive eye surgeries and to ascertain the proportion avoidable. SETTING: Jos University Teaching Hospital, Jos, Nigeria. METHODOLOGY: The ophthalmic surgical database of our facility was retrospectively reviewed to obtain information on patients who had destructive eye surgery from January 2008 - December 2015. These included demographics, clinical features, preoperative diagnosis, indication for surgery and type of destructive eye surgeries. The total number of ophthalmic surgeries within the study period was also computed. The data was entered into Epi Info statistical software, version3.4 (Epi InfoTM, Atlanta, Georgia,USA) and analyzed after validation by double entry. RESULTS: Eighty five destructive eye surgeries consisting of 2.5% of all surgical operations were performed on adults (aged ≥18years). There were 51(60%) males with a male: female ratio of 1.5:1 (p<0.005), mean age of 46.4 ± 19years. A sustained decline in the proportion of surgeries attributable to destructive eye surgeries was observed from the year 2012. A total of 75(88.2%) patients had evisceration, 3(3.5%) had enucleation and 7(8.2%) had exenteration. The main indications for destructive eye surgeries included trauma to the eyes in 39(45.9%), intractable infections in 32(37.6%), tumours in 7(8.2%) and painful blind eye in 3(3.5%); anterior staphyloma and phthisis bulbi each accounted for 2(2.4%). We observed that an adult male was four times more likely to lose an eye from trauma than a female (p<0.05). An individual was less likely to lose an eye to trauma with increasing age (p<0.05) but more likely to lose an eye to intractable infection with increasing age (p<0.001). CONCLUSION: There is a downtrend in the frequency of destructive eye surgeries in our center with males more likely to lose an eye to trauma and the elderly more likely to lose an eye to infection. Most of the indications for eye removal are avoidable.

AN AUDIT OF MINOR OPHTHALMIC SURGICAL INTERVENTIONS IN A TERTIARY EYE CARE FACILITY IN NORTHERN NIGERIA.

BACKGROUND: An estimated 285 million persons are visually impaired globally, and 39 million of them are blind. Majority of the blind population reside in developing countries. Over 60% of blindness is attributable to surgical causes of blindness. A surgical audit reveals areas of performance that require improvement. AIM: To assess the output and pattern of minor ophthalmic surgeries over a seven year period. METHOD: The minor ophthalmic surgical records of Jos University Teaching Hospital, Jos, Nigeria were retrospectively reviewed to obtain information on the patients'demographics, diagnosis, indication, type of surgery, type of anaesthesia administered, outcome of management, histology report and the rank of surgeon. The data obtained were analyzed using Epi Info Statistical version 3.4, Atlanta, Georgia USA. RESULTS: A total of 536 patients had minor ophthalmic operations at the Jos University Teaching Hospital between January 2008 and December 2014. There were 281(52.4%) males and 255(47.6%) females (χ(2)=9.4, p>0.1) with a mean age of 37.2 years (SD:24). Furthermore, 41(7.6%) patients had surgery in both eyes. The main anatomical sites of ocular morbidity were eyelid/lashes, conjunctiva and anterior segment observed in 237 (41.1%), 166(28.8%) and 94(16.3%) eyes respectively. Posterior segment lesions as indication for minor surgery was observed in 11(1.9%) eyes in the year 2013 and increased to 38(6.6%) eyes in 2014. Most (75%) minor surgical procedures were performed by resident doctors under supervision (χ(2)=13.7, p<0.05). A total of 584 procedures were performed comprising over 33 different types of minor surgeries. The main surgical procedures included pterygium excision in 104(17.8%) cases, eyelid repair in 74(12.7%) cases and incision and curettage for chalazion in 65(11.1%) cases (χ2=23.9, p<0.001). A recurrence rate of 31.6% and 6.1% was observed in eyes that had pterygium excision and incision and curretage for chalazion respectively; 83.8% of eyelids repaired had no postoperative sequelae while notching of the eyelid margin was observed in 9.4% of eyelids repaired. CONCLUSION: Minor ophthalmic surgeries constitute an important aspect of comprehensive eye care delivery with significant impact on control of blindness programmes. Most minor ophthalmic surgeries are performed on the ocular adnexa, hence the need for strengthening of the orbito-oculoplastic sub-specialty in the hospital.

Personal and environmental risk factors for active trachoma in children in Yobe state, north-eastern Nigeria.

OBJECTIVE: To determine the personal and environmental risk factors associated with trachoma in pre-school children in Yobe state, Nigeria. METHODS: Total of 639 children aged 1-5 from 27 villages were examined in their households for clinical signs of trachoma. Personal and environmental risk factors were independently determined by an observer while clinical examination was being performed. RESULTS: The prevalence of active trachoma was 35.7% (95% CI; 32.0-39.6) with prevalence of disease in boys being similar to girls. The highest prevalence was in children 2-3 years of age. The presence of flies on the face (OR 4.14; CI 2.72-6.29) and lack of a toilet in the compound (OR 2.11; CI 1.38-3.23) were independent risk factors for trachoma. CONCLUSION: The prevalence of trachoma is high. Provision and use of toilets, education on personal and environmental hygiene improvements need to be emphasized as part of the Surgery Antibiotics Facial cleanliness and Environmental improvement strategy.

Indications for surgical removal of the eye in adults: a five-year review.

BACKGROUND: To determine the indications and procedures used for removing the eye in adults in our environment. METHOD: A retrospective study of destructive ocular surgeries carried out between January 1999 and December 2003. Theatre and case records of adult patients that underwent surgical removal of the eye over a five-year period were reviewed. Clinical and histological diagnoses were obtained as well as type of surgery and personal data. Results were analysed using simple percentages. RESULTS: The most common indication for removing the eye in adults was due to trauma in 47 (45.6%) cases while evisceration was the most common surgery performed in 91 (88.3%) cases. Males were three times more likely to lose an eye than females. In 74.8% of cases, the loss of an eye was in young persons less than 50 years. CONCLUSION: The economically productive age group are more likely to lose an eye. The reason for the loss of an eye in most cases is largely avoidable. Lack of education on ways to prevent ocular injuries and improved access to eye care services requires urgent attention.

Outcome and benefits of small incision cataract surgery in Jos, Nigeria.

BACKGROUND: Cataract is the most common cause of blindness and cataract surgery is a common procedure. There is a need for a low cost, safe and effective form of cataract surgery for the developing world. This study reports the outcome of small incision cataract surgery in a developing country. METHODS: Eyes without coexisting ocular disease but with mature cataracts were operated upon. Small incision cataract surgery technique was used and patients were prospectively followed up. The procedure involved whole nucleus delivery through a sclerocorneal tunnel wound and insertion of a posterior chamber lens. Eyes examined at five days and six weeks after surgery are reported on for uncorrected visual acuity, complications of surgery and causes of poor outcome where applicable. RESULTS: Seventy-one eyes were included in this study. Uncorrected visual acuity at five days postop was good in 31 (43.7%) eyes and 49 (69.0%) eyes after six weeks of surgery. Six weeks postop, four (5.6%) eyes had poor outcome. The most common intraoperative complication was rupture of the posterior capsule while retinal lesions were the most common cause of poor visual outcome. CONCLUSION: Small incision cataract surgery offers faster visual recovery, is cost effective and has the prospects for increasing the uptake of cataract surgery in a developing country.

Cataract surgical coverage and barriers to uptake of cataract surgery in leprosy villages of north eastern Nigeria.

AIMS: To determine the coverage, outcome, and barriers to uptake of cataract surgery in leprosy villages of north eastern Nigeria. METHODS: People 30 years and above resident in eight leprosy villages were examined. Cataract blind people were questioned about the reasons they had not been treated. Subjects who had received an operation for cataract were examined to determine the outcome and, where applicable, the causes of poor outcome. RESULTS: 480 people were examined. Cataract was the commonest cause of blindness. The cataract surgical coverage (people) was 39.2% for orthodox surgery and 29.7% for couching. After surgery, visual acuity > or =3/60 had been restored to 82.1% of eyes that had had orthodox surgery, but only 58.6% of eyes that had been couched. Cost was the commonest reason given for not seeking treatment for cataract. CONCLUSIONS: Cataract is the major cause of blindness in this population but cataract surgical needs are currently not being met. There is a need for better collaboration between leprosy control and ophthalmic services, improved education of people affected by leprosy, a commitment to improving orthodox cataract surgery outcomes, and consideration of a possible role for traditional healers as sources of referral for orthodox surgical services.

Prevalence and causes of blindness and low vision in leprosy villages of north eastern Nigeria.

AIMS: To determine the prevalence and spectrum of ocular pathology, and the prevalence and causes of blindness and low vision in leprosy villages of north eastern Nigeria. METHODS: People affected by leprosy, aged 30 years and above, resident in eight leprosy villages were invited to participate. Ocular examination was undertaken of each consenting individual. RESULTS: 480 people were examined. 456 (48%) of 960 eyes had at least one ocular lesion, but only 37% of all lesions were leprosy related and potentially sight threatening. The prevalence of blindness (VA<3/60 with available correction) was 10.4%. An additional 7.5% of subjects were severely visually impaired (3/60< or =VA<6/60). Cataract was the commonest cause of blindness. Other major causes were non-trachomatous corneal opacity and trachoma. CONCLUSIONS: Blindness and low vision are highly prevalent among leprosy patients in this setting. Only a third of the burden of ocular pathology is related to the direct effects of leprosy. Efforts to reduce the backlog of cataract and trichiasis, to improve early detection and management of lagophthalmos, and to provide refractive services are urgently required.

Results of intra-operative 0.5mg/ml mitomycin C with 20mg depo steroid in the treatment of primary pterygium.

OBJECTIVE: The effectiveness of intra-operative mitomycin C on the recurrence rate of pterygium in patients undergoing primary pterygium excision was assessed. METHOD: 51 consecutive primary pterygia of 46 patients were excised between April and December 1998. 0.5 mg/ml mitomycin C was applied on bare sclera for one minute and 20 mg depot steroid injected subconjunctivally. Post operatively patients were placed on Gutt Dexamethasone 0.1% with antazoline and chloramphenicol 1.0%. RESULTS: Follow up ranged from four to 14 months. There was no recurrence of pterygium. Side effects of treatment included: delayed wound healing, avascularised sclera and pyogenic granuloma. CONCLUSION: This study suggests that intraoperative application of 0.5 mg/ml mitomyin C with 20 mg depot steroid following primary pterygium excision is effective and safe in preventing recurrence.

Enucleation for ritual practices.

Five cases of enucleation performed on seeing eyes are presented, highlighting the dangers this procedure poses to the patient. It also presents the problems this can pose to the development of ophthalmology.