Trends in Eye Removal Surgeries at a Tertiary Care Hospital Over Three Decades.

PURPOSE: To determine the trends in eye removal surgeries at a tertiary hospital in Nigeria over 26 years. METHODS: A retrospective comparative review of clinical records of all patients who had eye removal surgery at a tertiary hospital in Ile-Ife, Nigeria, between 2014 and 2019 was done. Patients' demographic and clinical data, including indication for eye removal and type of surgery were analysed and compared with two earlier studies at the same hospital between 1994 and 2013. RESULTS: There was an average of 14.3 surgeries per year between 2014 and 2019. Patients' ages ranged from 2 to 102 years, M:F was 1.5:1, the commonest indication for eye removal was infection (n=30, 34.9%), and the most common surgery was evisceration (n=70, 81.4%). Studies from 1994 to 2003 and 2005 to 2013, reported an average of 9.2 and 10 surgeries per year; ages ranging from 4 days to 88 years and 3 months to 88 years; with a M:F of 2.1:1 and 3.4:1 respectively. In both studies, the commonest indication for eye removal was trauma (43.4% and 43.8% respectively) and the most common surgery was enucleation (57.6% and 55% respectively). Trend data showed a progressive increase in eye infections (12% vs 15% vs 34.9%) and eviscerations (19.6% vs 31.2% vs 81.4%) over time. CONCLUSION: There was a change in trend towards an increase in eviscerations and infective indications for eye removal at the hospital over three decades. Prompt and optimal treatment of orbito-ocular infections is recommended to reduce the incidence of eye removal surgeries.

BUT: Déterminer les tendances des chirurgies d'ablation de l'oeil dans un hôpital tertiaire du Nigeria sur une période de 26 ans. MÉTHODES: Un examen comparatif rétrospectif des dossiers cliniques de tous les patients ayant subi une chirurgie d'ablation de l'œil dans un hôpital tertiaire d'Ile-Ife, au Nigeria, entre 2014 et 2019, a été effectué. Les données démographiques et cliniques des patients, y compris l'indication de l'ablation de l'œil et le type de chirurgie, ont été analysées et comparées à deux études antérieures menées dans le même hôpital entre 1994 et 2013. RÉSULTATS: Il y avait une moyenne de 14,3 chirurgies par an entre 2014 et 2019. L'âge des patients allait de 2 à 102 ans, le rapport M:F était de 1,5:1, l'indication la plus courante pour l'ablation de l'œil était l'infection (n=30, 34,9%), et la chirurgie la plus fréquente était l'éviscération (n=70, 81,4%). Les études menées de 1994 à 2003 et de 2005 à 2013 ont fait état d'une moyenne de 9,2 et 10 interventions chirurgicales par an, d'âges allant de 4 jours à 88 ans et de 3 mois à 88 ans, et d'un rapport M:F de 2,1:1 et 3,4:1 respectivement. Dans les deux études, l'indication la plus courante pour l'ablation de l'œil était le traumatisme (43,4 % et 43,8 % respectivement) et la chirurgie la plus courante était l'énucléation (57,6 % et 55 % respectivement). Les données sur les tendances ont montré une augmentation progressive des infections oculaires (12 % vs 15 % vs 34,9 %) et des éviscérations (19,6 % vs 31,2 % vs 81,4 %) au fil du temps. CONCLUSION: On constate un changement de tendance vers une augmentation des éviscérations et des indications infectieuses pour l'ablation des yeux à l'hôpital sur trois décennies. Un traitement rapide et optimal des infections orbitooculaires est recommandé pour réduire l'incidence des chirurgies d'ablation des yeux. Mots clés: Anesthésie, énucléation, éviscération, exentération, implant orbitaire, tendances.

Epidemiology and Management of Oculoplastic Disorders at a Tertiary Hospital: A 4-Year Review.

PURPOSE: To describe the epidemiology and management of oculoplastic disorders at a tertiary hospital in Nigeria. METHODS: This was a retrospective review of patients with oculoplastic disorders at the Department of Ophthalmology, Obafemi Awolowo University Teaching Hospitals Complex, IleIfe, Nigeria from January 2013 to December 2016. The general ophthalmology service records were reviewed to identify patients with oculoplastic disorders. Data retrieved from patient records included date of initial visit, age at presentation, gender, oculoplastic diagnosis and aetiology, modality of treatment given, and indications for patient referrals. RESULTS: There were 563 (7.4%) patients with oculoplastic disorders, out of 7,575 ophthalmology department patients. They had 573 oculoplastic disorders in all. There were 281 (49.9%) males and 282 (50.1%) females. The median age at presentation was 28 years (range, 1 day to 100 years). Eyelid laceration (n=68; 11.9%) and chalazion (n=63; 11%) were the commonest disorders. Trauma (n=125; 21.8%) was the commonest aetiology, followed by inflammatory (n=121; 21.1%) and infective (n=108; 18.8%) causes. There were 162 (28.3%) surgical interventions; eyelid repair (n=67; 41.4%) was the commonest, followed by evisceration (n=25; 15.4%), and excisional biopsy (n=25; 15.4%). No patient had ptosis or lacrimal surgery. Orbital disorders (n=21; 42.9%) were the commonest indication for a referral elsewhere. CONCLUSION: Eyelid laceration was the commonest oculoplastic disorder, trauma was the commonest aetiology, and eyelid repair was the commonest oculoplastic surgery done. Further training in oculoplastics with emphasis on ptosis, lacrimal and orbital surgery, as well as the provision of equipment needed for optimal oculoplastic service delivery are recommended.

OBJECTIF: Décrire l'épidémiologie et la gestion des troubles oculoplastiques dans un hôpital tertiaire du Nigeria. MÉTHODES: Il s'agissait d'un examen rétrospectif des patients atteints de troubles oculoplastiques au département d'ophtalmologie, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, de janvier 2013 à décembre 2016. Les dossiers du service d'ophtalmologie générale ont été examinés afin d'identifier les patients souffrant de troubles oculoplastiques. Les données extraites des dossiers des patients comprenaient la date de la première visite, l'âge au moment de la présentation, le sexe, le diagnostic oculoplastique et l'étiologie, la modalité du traitement administré et les indications pour le renvoi des patients. RÉSULTATS: 563 (7,4 %) des 7 575 patients du service d'ophtalmologie présentaient des troubles oculoplastiques. Ils présentaient 573 troubles oculoplastiques au total. Il y avait 281 (49,9%) hommes et 282 (50,1%) femmes. L'âge médian à la présentation était de 28 ans (intervalle de 1 jour à 100 ans). Paupière (n=68 ; 11,9%) et le chalazion (n=63 ; 11%) étaient les troubles les plus courants. Le traumatisme (n=125 ; 21,8%) était l'étiologie la plus fréquente, suivie par les causes inflammatoires (n=121 ; 21,1%) et infectieuses (n=108 ; 18,8%). Il y a eu 162 (28,8 %) interventions chirurgicales ; la réparation de la paupière (n=67 ; 41,4 %) était la plus courante, suivie de l'éviscération (n=25 ; 15,4%) et de la biopsie excisionnelle (n=25 ; 15,4%). Aucun patient n'a subi de ptose ou de chirurgie lacrymale. Les troubles orbitaux (n=21 ; 42,9%) étaient l'indication la plus fréquente d'un renvoi ailleurs. CONCLUSION: La lacération de la paupière était le trouble oculoplastique le plus courant, le traumatisme était l'étiologie la plus courante et la réparation de la paupière était la chirurgie oculoplastique la plus courante. Il est recommandé de poursuivre la formation en oculoplastie en mettant l'accent sur le ptosis, la chirurgie lacrymale et orbitale, ainsi que de fournir l'équipement nécessaire à une prestation optimale des services oculoplastiques. Mots clés: Troubles oculoplastiques, prévalence, chirurgie, traumatisme.

Chemopreventive and remediation effect of Adansonia digitata L. Baobab (Bombacaceae) stem bark extracts in mouse model malaria.

ETHNOPHARMACOLOGICAL RELEVANCE: Adansonia digitata L. Baobab (Bombacaceae) solvent extracts have been reported to possess medicinal properties and are currently been used traditionally for the treatment of malaria and several other diseases and infection; however few reports exist in literature that provides supportive scientific evidence in favour of its medicinal use. AIM OF THE STUDY: This study investigated the efficacy of Adansonia digitata stem bark extract in offering protection against experimental malaria and also examined its remediation effect when administered after established infection. MATERIALS AND METHODS: Weanling albino mice were used in the study. The mice were transfected intraperitonially with an inoculums size of 1× 107 of chloroquine susceptible strain of plasmodium berghei infected erythrocytes. Mechanisms of action of the extract were investigated by measuring the degree of tissue peroxidation and tissue antioxidant status. Severity of malaria was determined by measuring the serum C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and serum and tissue Alkaline phosphatase (ALP) activity. RESULTS: There was a significant increase in serum CRP, TNF-α concentrations and serum and tissue ALP activity in the control mice following Plasmodium berghei infection. All the treatment had effect on the growth of Plasmodium berghei parasites in mice. The extracts showed a significant dose dependent increase packed cell volume (PCV), percentage chemosupression/clearance and a significant decrease in percentage parasitemia at the two doses when administered after established infection. Methanolic extract (MEAD) at 400mg/kg exhibited the highest chemosupressive activity. The extract significantly reduced the degree of tissue peroxidation, increased the level of reduced glutathione (GSH), catalase and superoxide dismutase activity. Administration of the extract after established infection reduced serum CRP and TNF-α concentrations and serum and tissue ALP activity. CONCLUSION: Our study suggests that Adansonia digitata protects against Plasmodium berghei induced-malaria, and that administration of the extract after established infection reduced malaria progression.

Axial length/corneal radius of curvature ratio and refractive status in an adult Nigerian population.

AIM/BACKGROUND: Associations between axial length (AL) to corneal radius of curvature (CR) ratio and refractive status in a healthy Nigerian adult population were studied. MATERIALS AND METHODS: Healthy students and members of staff of Obafemi Awolowo Teaching Hospitals Complex, Ile-Ife, South West Nigeria, free of obvious ocular diseases except possible refractive errors were recruited. Consecutive consenting volunteers were recruited by simple random sampling and a proportionate sample of each population based on its representative fraction in the hospital community was recruited. The study was conducted between June and August 2011. Noncycloplegic objective refraction was done and spherical equivalent refraction (SER) of the right eyes was used for calculation. The AL, CR, and keratometric readings were measured with the IOL Master. The AL/CR ratio was calculated. The data were analyzed with statistical software package STATA 13. RESULTS: Three hundred and fifty volunteers aged 18-60 years were studied. The mean ± standard deviation of AL/CR and SER were 3.04 ± 0.10 and -0.38 ± 1.42D, respectively. AL in myopia was significantly higher than in emmetropia and hypermetropia. There were no significant differences between CR in the refraction groups. Myopes had significantly higher AL/CR than nonmyopes. On controlling for age and gender, 1 mm increase in AL increased SER by -0.77D (95% confidence interval [CI] -0.91--0.64D) while a unit increase in AL/CR increased SER by -8.89D (95% CI -10.00--7.78D). Whereas AL accounts for 39% of variability in SER (P < 0.001), AL/CR accounts for 51% of the variability observed in SER (P < 0.001). CONCLUSION: This study has further confirmed that the AL remains a strong determinant of refraction, but a derived factor AL/CR accounts for more variation in final refractive status than AL in isolation.

A CASE OF COMPOUND INTUSSUSCEPTIONS IN A NIGERIAN CHILD - A RARE FINDING IN A COMMON DISEASE.

Intussusception is the most common, non-congenital, cause of intestinal obstruction in infants. There are various patterns of intussusception seen in children with the most common being ileo-colic variety. Compound intussusception in which intussusception involves more than one non-adjacent segment is a rare finding in the literature and it can be associated with worse morbidity than typically occurs, especially in a region where delayed presentation is a major contributor to morbidity and mortality in the treatment of intestinal obstruction. We report the first documented case of double compound intussusception in an African child and reviewed relevant literature.

Visual impairment and blindness in type 2 diabetics: Ife-Ijesa diabetic retinopathy study.

Diabetes and blindness are important health issues globally; we determined the prevalence of blindness, diabetic retinopathy, and other eye diseases in Nigerian-type 2 diabetics. A prospective, cross-sectional study was conducted on consenting type 2 diabetic patients who had scheduled comprehensive eye examination including dilated funduscopy with +78DS. Visual status was graded using the WHO criteria. Approval from Institutional Ethics Committee was obtained. Primary outcome measures were the prevalence and causes of blindness as well as prevalence of diabetic retinopathy. Secondary outcome measures were the presence of other eye diseases. Data were analyzed using SPSS version 13. Two hundred and sixty-six eyes of 133 type 2 diabetic patients aged 22-89 years were studied; 69 (51.9 %) were males while 64 (48.1 %) were females. Five (3.8 %) patients were blind while 27 (20.3 %) were visually impaired. Cataract was the leading cause of blindness (60 %) and visual impairment was found in 59.3 %. Diabetic retinopathy was present in 37 (27.8 %) diabetic patients of which 5 (3.8 %) were proliferative. Diabetic macular edema was present in 31 (23.3 %) patients. Severe visual impairment and blindness were commoner in those with diabetic retinopathy. Refractive error 67 (25.2 %), cataract 63 (23.7 %), and chronic glaucoma 44 (16.5 %) were the most prevalent non-diabetic retinopathy eye diseases. High prevalence of blindness, diabetic retinopathy, and other diseases are seen in type 2 diabetics. Health education, early diagnosis as well as treatment of diabetic retinopathy and other diseases will largely alleviate these ocular morbidities.

Diagnostic accuracy of tru-cut biopsy of breast lumps at University College Hospital, Ibadan.

BACKGROUND: Tru-cut needle biopsies form an integral part of Triple assessment of breast cancer and include clinical assessment, mammography and core needle biopsy. No study has been done to evaluate the validity of the procedure in our environment. This study was done to evaluate the validity of core needle biopsies in our centre. METHOD: A retrospective study of patients with tru-cut needle biopsies of breast lumps and follow-up excisional biopsy or mastectomy done in the Department of Surgery, University College Hospital, Ibadan over a ten year period was done. Fifty one patients who fulfilled the inclusion criteria had their records obtained from the Department of Pathology. The diagnosis was classified into benign and malignant with the excisional biopsy or mastectomy diagnosis used as the gold standard. The sensitivity, specificity and accuracy were calculated and kappa was also done to evaluate the degree of agreement. RESULTS: A total of 51 cases were included in this study. The average age of the patients was 47 ± 13 years with a range from 19 to 81 years. Thirty of the biopsies (59%) had a definitive diagnosis of malignancy while twenty one (41%) were benign. The overall sensitivity, specificity and accuracy were 86%, 71% and 80.4% respectively. The specificity of malignant biopsies was 68% while benign was 35%. The level of agreement for malignant biopsies was higher than benign biopsies with a kappa of 0.39 for malignant diagnosis as against 0.29 for benign. CONCLUSION: Tru-cut needle biopsies have a comparable sensitivity and specificity to excisional biopsies. Diagnostic accuracy can be further enhanced with the adoption of image guided biopsies.

Prevalence and pattern of eye disorders among commercial motorcycle riders in Ile-Ife, Osun state.

AIMS AND OBJECTIVES: To describe the prevalence and pattern of eye disorders existing among commercial motorcycle riders (CMRs) in Ile-Ife, Osun State. Materials, Subjects and Methods: A total of 1626 registered CMRs operated in 40 registered motorcycle assembly units in Ile-Ife. Using a multi- staged random sampling technique, a total of 322 riders were randomly selected from 10 units. Equal number of 322 was selected from the sample space as control. Structured questionnaires were administered and ocular examination carried out. RESULTS: SA total of 312 (96.9%) CMRs had normal vision (better than 6/18) in the better eye. The observed prevalence of subnormal visual acuity (<6/18-3/60) was 3.1% (10 CMRs) while prevalence of monocular vision was 2.8% (9 riders). Cataract and glaucoma were the major causes of visual impairment and blindness. The common ocular conditions seen were presbyopia (11.8%), allergic conjunctivitis (11.5%), glaucoma suspect (8.1%), pterygium (4.7%), pingueculum (4.0%), uncorrected refractive error (3.7%) and cataract (2.8%). It was also observed that the longer the years of riding experience of these riders, the higher the occurrence of pterygium with a significant statistical impact of p value of 0.009. Presbyopia was also the commonest disorder amongst the control group (11.2%). CONCLUSION: Presbyopia was the most common finding from the study while the commonest anterior segment disorder was pterygium which was an occupation- related ocular disorder. Causes of blindness seen were avoidable.

ANAESTHESIA FOR OPHTHALMIC SURGICAL PROCEDURES.

BACKGROUND: Ophthalmic surgical procedures are performed under anaesthesia to enhance comfort and cooperation of patient. OBJECTIVE: To review factors influencing the choice of anaesthesia for ophthalmic surgical procedures. DESIGN: Restrospective descriptive study. SETTING: Eye unit of a tertiary hospital. SUBJECTS: All patients who had ophthalmic surgeries in the operating theatre from January 2002 to December 2009. RESULTS: Two hundred and ninety ophthalmic surgeries were carried out during the study period. Age range was 1-95 years and mean of 61.0 ± 1.9; most (55%) were elderly while 4.8% were children. One hundred and fourty seven (50.7%) were males, 143(49.3%) females; male:female of 1.03:1. Local anaesthesia was the more commonly (92.1%) employed while general anaesthesia was used in 23(7.9%) patients. General anaesthesia was used more frequently (71.4%) in children compared to other age groups; the mean age and standard error of means for patients who had general anaesthesia (27.2 /5.4 years) is smaller compared to 63.9/0.93 years for patients who had local anaesthesia (p < 0.0001). Regional anaesthesia was the most frequently used for all types of procedures except for eye wall repairs in which general anaesthesia was used for 71.4% of patients (p < 0.0001). General anaesthesia was indicated in seven (41.2%) of emergency ophthalmic surgical procedures as compared to 16 (5.9%) of elective ophthalmic procedures P < 0.0001. CONCLUSION: General anaesthesia was more commonly employed in children, eye wall repairs and emergency ophthalmic surgical procedures.

Bilateral orbital infarction and retinal detachment in a previously undiagnosed sickle cell hemoglobinopathy African child.

Bone infarction involving the orbit in sickle cell disease is not common. Bilateral orbital infarction in a previously undiagnosed sickle cell hemoglobinopathy has not been previously reported. In this report, we present a case of an 11-year-old previously undiagnosed sickle cell disease Nigerian girl with severe acute bilateral orbital infarction and retinal detachment to highlight that hemoglobinopathy induced orbital infarction should be considered in African children with acute onset proptosis with or without previous history of sickle cell hemoglobinopathy.

Causes of blindness in a special education school.

BACKGROUND: Blind children and young adults have to overcome a lifetime of emotional, social and economic difficulties. They employ non-vision dependent methods for education. OBJECTIVE: To assess the causes of blindness in a special school in southwestern Nigeria to aid the development of efficient blindness prevention programmes. METHODS: A cross-sectional survey of the Ekiti State Special Education School, Nigeria was conducted in May-June 2008 after approval from the Ministry of Education. All students in the blind section were examined for visual acuity, pen-torch eye examination and dilated fundoscopy in addition to taking biodata and history. RESULTS: Thirty blind students with mean age of 18±7.3 years and male: female ratio of 1.7:1 were examined. Blindness resulted commonly from cataract eight (26.7%), glaucoma six (20%) retinitis pigmentosa four (16.7%) and posttraumatic phthysis bulbi two (6.7%). Blindness was avoidable in 18 (61%) of cases. Glaucoma blindness was associated with redness, pain, lacrimation and photophobia in 15 (50%) and hyphaema in 16.7% of students; none of these students were on any medication at the time of study. CONCLUSION: The causes of blindness in rehabilitation school for the blind are largely avoidable and glaucoma-blind pupils face additional painful eye related morbidity during rehabilitation. While preventive measures and early intervention are needful against childhood cataract and glaucoma, regular ophthalmic consultations and medications are needed especially for glaucoma blind pupils.

Perception and attitude of people toward onchocerciasis (river blindness) in South Western Nigeria.

BACKGROUND: Onchocerciasis (river blindness) is a major cause of bilateral blindness with devastating socioeconomic consequences. Since Nigeria is the most heavily onchocerciasis endemic country in the world, the information on people's knowledge about this disease is significant. This could influence their response to current preventive measures of the African Programme for Onchocerciasis Control. AIM: This study was designed to estimate the level of knowledge and attitudes of rural/semi-urban communities in Ife North Local Government Area of Osun State toward onchocerciasis. MATERIALS AND METHODS: Cluster random sampling was used to select 500 adults for the study. Semi-structured questionnaires were administered to subjects. Data on knowledge of the local name, cause, mode of transmission, manifestation, severity, treatment, and prevention of onchocerciasis were collected and analysed. Statistical analysis included frequency distribution of the responses and a Chi-square test for comparison of variables with the P value for statistical significance set at 0.05. RESULTS: Onchocerciasis was well known by its local name among 458 (91.6%) of the respondents. Only seven (1.4%) knew that it affects both the eyes and skin. The cause was commonly attributed to impure blood by 114 (22.8%), whereas transmission was thought to be through fomites by 161 (32.2%). Only 12 (2.4%) respondents attributed the disease to blackfly bites. The level of education and the association of onchocerciasis with a river were significantly associated (P = 0.001). Subcutaneous nodules were felt to contain water (85.4%), baby worms (3.2%), and fat (0.6%). There was a negative attitude toward sufferers of the disease. CONCLUSION: Adequate information transfer in simple local dialect by trained personnel to the communities at risk of onchocerciasis is essential for better uptake of all aspects of the onchocerciasis control programme.

Ophthalmic admissions in a tertiary hospital in Nigeria.

BACKGROUND: Hospitalization for eye care is required for different reasons. The pattern of admissions into the ophthalmic wards of a sub-urban tertiary hospital was studied. METHODOLOGY: Records of patients admitted into the Ophthalmology wards of the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife from January 2004 to December 2007 were reviewed and the age, sex, duration of admission and diagnosis recorded. Data was analyzed with SPSS version 13 and statistical significance inferred at P<0.05. RESULTS: Of the 523 patients admitted, 60.2% were males while 39.8% were females (P<0.0001); the male preponderance becomes less prominent with increasing age (P=0.001). The duration of admission ranged between 2 and 24 days with a mean of 2.86+/- 1.95 days and 63% were admitted for 3 days. The main indications for admission were cataract (58.3%), ocular trauma (14.3%) and glaucoma (13.4%). Eye injuries were more common among children and young adults while cataract and glaucoma were the leading indications in the middle aged and elderly. CONCLUSION: Cataract, trauma and glaucoma were the leading indications for ophthalmic hospitalization. Human and infrastructural development of the ophthalmology unit should lay emphasis on the more prevalent needs to enhance effective and efficient management of these diseases.

Primary malignant bone tumours in Ibadan, Nigeria: an update.

Bone tumours are relatively rare compared to tumours of other sites. The frequency of primary malignant bone tumours is low in our environment, as was observed in an earlier study. The aim of this study is to update the information available on the pattern of primary malignant bone tumours at the University College Hospital (UCH), Ibadan, Nigeria. The medical records of 49 patients with malignant bone tumours documented in the Cancer Registry of UCH, Ibadan between January 2001 and September 2007 were reviewed retrospectively. The results were then added to those of the previous study published in 2002. This brought the number of cases of primary malignant bone tumours to 163 from January 1977 to September 2007. Primary malignant bone tumours represented 0.53% of the 30462 cases of cancer seen in the hospital in the period studied. The male female ratio was 1.5:1. About 44% of the tumours occurred among patients less than 20 years of age. Osteogenic sarcoma was the commonest malignant bone tumour. Important changes recorded in the seven years since the last review from this centre include; a rise in the prevalence rate of primary malignant bone tumours (49 new cases in the last seven years as compared to 114 cases over 23 years), the male-female ratio of Osteogenic sarcoma showed a decline (1.5:1 as compared to 1.6:1), and there was an increase in the prevalence of primary malignant bone tumours in the 0-9 years and > 60 years age groups. The significance of these findings will need to be determined by further studies.

Central nervous system stimulants: effect on visual functions and occurrence of road traffic accidents.

OBJECTIVE: To determine the influence of the use of central nervous system (CNS) stimulants on visual functions and occurrence of road traffic accidents (RTA) amongst commercial drivers. DESIGN: A cross-sectional study in which two hundred and fifteen consecutive drivers were interviewed and their eyes examined. SETTINGS: Ife Central Local Government Area (LGA) of Osun State, Nigeria. MATERIALS AND METHODS: Out of the estimated 270 commercial drivers registered in the four major parks of the LGA, 215 consecutive drivers participated in the survey Questionnaires were administered by face-to-face interview and the drivers' eyes examined by the authors. RESULTS: The prevalence of visual impairment (visual acuity < 6/18) in the better eye without correction was 3.3%, and there was a significant association between uncorrected visual acuity impairment in the better eye and RTA (p = 0.0152). The prevalence of refractive error was 8.4%, but none of these drivers wear corrective glasses. Alcohol consumption is common (57.7%) amongst the drivers, and there was a significant association between alcohol consumption and RTA (p = 0.00124). There was also a significant association between the use of CNS stimulants (kolanut, marijuana and cigarette) and RTA (p = 0.005). CONCLUSION: It was therefore concluded that visual impairment in the better eye, alcohol consumption and the use of other CNS affecting substances contribute to the occurrence of RTA among the drivers.

Chemopreventive and remediation effect of Hydrocotyl bonariensis Comm. Ex Lam (Apiaceae) leave extract in galactose-induced cataract.

ETHNOPHARMACOLOGICAL RELEVANCE: Hydrocotyl bonariensis Comm. Ex Lam (Apiaceae) is being widely used in Western Nigeria in treating various symptoms of ophthalmic diseases; however scientific data in support of this medicinal use have not been reported. AIM OF THE STUDY: This study, investigated the efficacy of Hydrocotyl bonariensis leave extract in offering protection against experimental cataract and also examined its remediation effect when administered after cataract onset. MATERIALS AND METHODS: Weanling albino rats fed with 30% galactose diet were used in the study. Mechanisms of action of the extract were investigated by measuring the degree of lens peroxidation, lens antioxidant status and lens protein concentration. Severity of cataract was determined by measuring the cataract index. RESULTS: The extract at 500 mg kg(-1) reduced cataract index significantly and also reduced cataract progression when administered after cataract onset. Administration of this dosage also significantly reduced the degree of lens peroxidation, increased the level of reduced glutathione (GSH) and the lens catalase and superoxide dismutase activity. The extract also prevents protein insolubilization. Administration of the extract at 1000 mg kg(-1) reduced cataract index and lens peroxidation but did not increase the antioxidant status significantly. Administration of the extract after cataract onset reduced cataract index, moderately increased percentage soluble protein above the value prior to the arrest of hypergalactosemia but did not increase the antioxidant status. CONCLUSION: Our study suggests that Hydrocotyl bonariensis protects against galactose-induced cataract, and that administration of the extract after cataract onset reduced cataract progression but did not reverse cataractogenesis.

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.

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.

Ocular manifestations of Burkitt's lymphoma: experience in Ile-Ife south western Nigeria.

BACKGROUND: Burkitt's lymphoma is the most common childhood tumour in subSaharan Africa that typically affects the jaws and abdomen. Ocular involvement with blindness has been documented in some studies. OBJECTIVE: This was to evaluate the role of Burkitt's lymphoma (BL) as a cause of blindness in Nigerian children. METHODS: Cases of BL seen in the hospital between 1986 and 2003 were studied retrospectively. Some of the patients with orbital disease at presentation underwent ultrasonographic examination of the eyes. RESULTS: Forty-three (16.5%) of the 260 patients seen presented with orbital tumours; 29 (67.4 %) of the 43 patients had full ophthalmic examination. The patients studied comprised 22 males and 7 females with a M: F ratio of 3:1, and median(age range) of 7(3-15) years. Orbital tumours occurred concurrently with jaw masses on the same side in 19(65.5 %) of 29 patients; the eye diseases were unilateral in 23 (79.3%) and bilateral in six (20.7%) of the cases. Proptosis was the ocular presentation in 27(93%) of patients and it was associated with conjunctival injection in nine, chemosis in 11 and exposure keratopathy in five. Fourteen (48.3%) patients had associated blindness; 12 (85.7%) remained blind in the affected eye(s) and one regained vision to 6/36 after chemotherapy. The patients underwent Cyclophosphamide-Oncovin-Methotrexate (COM) regimen with intrathecal therapy. Eight (27.6%) patients had concomitant CNS disease; these included cases of 6th and 7th nerve palsies, one case of intra-cerebral extension of tumour and another case of total ophthalmoplegia. CONCLUSION: Burkitt's lymphoma is an important cause of childhood blindness in Nigeria and the orbital disease ismainly extra ocular.

Visual functions of commercial drivers in relation to road accidents in Nigeria.

OBJECTIVE: To determine the effects of the visual functions on the occurrence of road traffic accidents (RTA) amongst commercial drivers in Ife central local government area (LGA) of Osun state of Nigeria. DESIGN: A cross-sectional study. SETTINGS: Four major motor parks located at Ife Central LGA. MATERIALS AND METHODS: Of the estimated 270 commercial drivers in the four major parks of the LGA, 215 consecutive drivers were interviewed and had their eyes examined. Structured questionnaires were administered by an ophthalmologist. RESULTS: The prevalence of visual impairment (visual acuity < 6/18) in the better eye without correction was 3.3% ± 2.4 and there was a significant association between uncorrected visual acuity impairment in the better eye and RTA (P = 0.0152). Refractive error was seen in 8.4% of the drivers, but none of these wear corrective glasses. Visual field defect, abnormal stereopsis and color vision impairment did not have any significant association with RTA. CONCLUSION: Poor visual acuity is strongly associated with RTA amongst Nigerian commercial drivers as opposed to visual field defect, abnormal color vision and stereopsis. A significant proportion of visual impairment was due to uncorrected refractive errors.