Relationship between ocular surface disease and patient's satisfaction among cataract surgical patients in Nigeria.

PURPOSE: To determine the effect of clinical and cytological features of ocular surface disease on patient's satisfaction following small incision cataract surgery at a tertiary eye care centre. METHOD: This is a prospective observational study of 70 consecutive consenting patients who underwent manual small incision cataract surgery(MSICS) at a tertiary eye care centre. All participants underwent ocular surface profile assessment using Schirmer I test (ST1), tear film break-up time (TBUT), conjunctival impression cytology (CIC) and ocular surface disease index (OSDI) at pre-operative visit, 1-week and 4-week post-operative visit. Patient's satisfaction with surgical outcome was evaluated at 6-week post-operative visit using a rating scale of 1 to 10. Data were analysed using IBM Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY USA). RESULTS: The mean age was 68 ± 9.4 years with a male/female ratio of 1:1.1. The mean OSDI score decreased significantly (p < 0.001) from 33.1 ± 8.4 pre-operatively to 20.8 ± 7.4 four weeks after surgery. The TBUT was 12 ± 4.1 s pre-operatively, but significantly reduced to 11.2 ± 3.9 s (p < 0.001) at 4-week post-operative period. At 6 weeks, patients with normal CIC reduced from 53 (75.8%) pre-operatively to 8 (11.4%) (p < 0.001, z = - 7.24). Fifty percent of patients with severe post-operative ocular surface disease reported dissatisfaction with their surgical outcome (p = 0.024). CONCLUSION: Manual small incision cataract surgery can significantly impair the ocular surface health profile of patients. The presence of ocular surface disease in patients pre-operatively can negatively impact their level of satisfaction with surgical outcome.

Relationship between intraocular pressure, anterior chamber depth and lens thickness in primary open-angle glaucoma patients.

INTRODUCTION: To investigate the relationship between intraocular pressure (IOP), anterior chamber depth (ACD) and lens thickness (LT) in primary open-angle glaucoma (POAG) patients and compare with age- and sex-matched controls. METHODS: A cross-sectional analytical study of 62 newly diagnosed POAG patients compared with 62 age- and sex-matched control subjects in a tertiary eye clinic. Socio-demographic data and ocular examinations were documented. IOP was measured using the Goldmann applanation tonometer. LT and ACD were measured using A-scan ultrasonography and the IOLMaster, respectively. Data were analyzed using SPSS version 19.0 and level of significance set at p value <0.05. RESULTS: In the glaucoma group and control groups, respectively, mean age was 60.3 ± 8.9 and 58.5 ± 8.1 years (p = 0.234), mean IOP was 28.27 ± 7.88 and 14.47 ± 2.60 mmHg (p < 0.001), mean ACD was 3.12 ± 0.27 and 3.15 ± 0.24 mm (p = 0.514), mean LT was 4.24 ± 0.46 and 4.23 ± 0.45 mm (p = 0.903), and mean ACD was shallower in females (p = 0.034) and (p = 0.001). In the glaucoma group, there was a positive correlation between IOP and ACD (r = 0.022, p = 0.864), but a negative correlation between IOP and LT (r = -0.04, p = 0.758) and ACD and LT (r = -0.058, p = 0.657). In the control group, there was a positive correlation between IOP and ACD (r = 0.141, p = 0.275), IOP and LT (r = 0.031, p = 0.811) and ACD and LT (r = 0.016, p = 0.901). CONCLUSION: ACD is shallower in females. There is no significant correlation between IOP and ACD or between IOP and LT in POAG as well as normal individuals.

The dynamics of COVID-19 outbreak in Nigeria: A sub-national analysis.

The African health crisis feared at the beginning of the COVID-19 pandemic has not materialized, and there is interest globally in understanding possible peculiarities in COVID-19 outbreak dynamics in the tropics and sub-tropics that have led to a much milder African outbreak than initial projections. Towards this, Susceptible-Infected-Recovered-Dead compartmental models were fitted to COVID-19 data from all Nigerian states in this study, from which four parameters were estimated per state. A density-based clustering method was used to identify states with similar outbreak dynamics, and the stage of the outbreak determined per state. Subsequently, outbreak dynamics were correlated with absolute humidity, temperature, population density and distance to the international passenger travel gateways in the country. The models revealed that while the outbreak is still increasing nationally, outbreaks in at least 12 states have peaked. A total of at least 519,672 confirmed cases were predicted by January 2021, with a worst case scenario of at least 14,785,457. Weak positive correlations were found between COVID-19 spread and absolute humidity (Pearson's Coefficient = 0.136, p < 0.05) and temperature (Pearson's Coefficient = 0.021, p < 0.05). While many studies have established links between temperature and humidity and COVID-19 spread, the correlation has most usually been negative where it exists. The findings in this study of possible positive correlation is in line with a number of previous studies showing such unexpected correlations in the tropics or subtropics. This highlights even more the importance of additional studies on COVID-19 dynamics in Africa.

Prevalence of ocular abnormalities in relation to sickle cell disease severity among children in South-western, Nigeria.

INTRODUCTION: Sickle cell disease (SCD) ranks high among genetic disorders worldwide. It is characterised by repeated vaso-occlusion with resultant end-organ damage. This process can occur in all vascular beds in the body, including ocular blood vessels and may cause irreversible blindness in advanced stages. Little is known of the relationship between the prevalence of ocular abnormalities among children with SCD and their disease severity. METHODS: A descriptive cross-sectional study was carried out at the Paediatric Haematology Clinics and the Eye Centre of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife. Children with SCD in steady state were recruited from the Haematology Clinics and examined for ocular abnormalities at the Eye Centre of the hospital. The subjects SCD severity grade was determined using a previously validated scoring system. RESULTS: One hundred and twenty (120) children aged 5 to 15 years were examined. Of these, 72 had one or more ocular abnormalities giving the prevalence of ocular abnormalities among them to be 60.0%. Though a higher proportion of children with moderate disease, 23 (65.7%) of 35, compared to those with mild disease, 49 (57.6%) of 85 had ocular abnormalities, this difference was not statistically significant, p = 0.412. CONCLUSION: Ocular abnormalities among Nigerian children with SCD are common even in steady-state, but not significantly associated with disease severity. Periodic screening for ocular abnormalities should thus be done on them irrespective of disease severity.

Strengthening retinopathy of prematurity screening and treatment services in Nigeria: a case study of activities, challenges and outcomes 2017-2020.

OBJECTIVES: Retinopathy of prematurity (ROP) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for ROP between 2017 and 2020 as well as the outcome of these activities in Nigeria. DESIGN: Descriptive case study. SETTING: Neonatal intensive care units in Nigeria. PARTICIPANTS: Staff providing services for ROP, and 723 preterm infants screened for ROP who fulfilled screening criteria (gestational age <34 weeks or birth weight ≤2000 g, or sickness criteria). METHODS AND ANALYSIS: A WhatsApp group was initiated for Nigerian ophthalmologists and neonatologists in 2018. Members participated in a range of capacity-building, national and international collaborative activities between 2017 and 2018. A national protocol for ROP was developed for Nigeria and adopted in 2018; 1 year screening outcome data were collected and analysed. In 2019, an esurvey was used to collect service data from WhatsApp group members for 2017-2018 and to assess challenges in service provision. RESULTS: In 2017 only six of the 84 public neonatal units in Nigeria provided ROP services; this number had increased to 20 by 2018. Of the 723 babies screened in 10 units over a year, 127 (17.6%) developed any ROP; and 29 (22.8%) developed type 1 ROP. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challenges included lack of equipment to regulate oxygen and to document and treat ROP, and lack of data systems. CONCLUSION: ROP screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and ROP treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential.

Intima-media thickness of the common carotid arteries as a marker of retinopathy and nephropathy in sickle cell disease.

PURPOSE: This study was conducted to test the hypothesis that the carotid intima-media thickness (CIMT) is higher in patients with sickle cell disease (SCD) than in the normal population, and to determine the relationships of the CIMT with central retinal artery (CRA) and renal artery Doppler indices. METHODS: Forty-four confirmed steady-state SCD patients aged 16 years and above were recruited consecutively. The Doppler velocimetric indices of their right renal artery and both CRAs were obtained. The CIMT was also measured on each side via B-mode ultrasonography. The subjects were categorized by age and sex. Mean and median values for each group were determined. The Spearman correlation test was used to quantify the relationships between CIMT and the Doppler parameters. RESULTS: The participants had a median age of 24.50 years (interquartile range, 12.50 to 36.50 years). Twenty-three were men (52.3%) and 21 were women (47.7%). The median CIMT was 0.70 mm (IQR, 0.50 to 0.90 mm). Significant correlations with the CIMT were found for the CRA peak systolic velocity (r=0.312, P=0.003), the renal artery resistivity index (RI) (r=0.284, P=0.007), and the renal artery pulsatility index (PI) (r=0.273, P=0.010). There was no significant relationship between the CIMT and the CRA end-diastolic velocity, CRA RI, or CRA PI. CONCLUSION: CIMT in SCD patients was higher than in the previously reported age groups of the reference populations. In addition, the CIMT was significantly correlated with the CRA peak systolic velocity, the renal artery RI, and the renal artery PI.

Clinical Signs and Intraocular Pressure Changes in Patients with Orbitozygomatic Complex Fractures.

OBJECTIVES: The study investigated the association between intraocular pressure changes and clinical ocular signs in 51 patients with orbitozygomatic complex fractures. Diplopia, chemosis, enophthalmos, subconjunctival haemorrhage, periorbital ecchymosis and extraocular muscles entrapment were assessed. STUDY DESIGN: Intraocular pressure was measured in mmHg at different time intervals with Perkins and Goldman tonometers; within first 3 days of injury (T1), 24 h post-elevation within 3-14 days of injury (T2), 1 month after initial treatment assessment (T3), 2 months after initial treatment assessment (T4), and 3 months after initial treatment assessment (T5). Intraocular pressure changes between T2/T1 and T3/T1 were analysed as change 1 and change 2, respectively, with paired t test. Significance was set at p < 0.05. RESULTS: Minimum intraocular pressure recorded in the affected eye was 5 mmHg at T1 and T2, while maximum intraocular pressure was 28 mmHg at T1. Mean intraocular pressure at T1 and T2 was 15.90 ± 4.73 mmHg and 16.80 ± 4.43 mmHg, respectively. All eye signs had completely resolved at T3 except enophthalmos, which persisted till T5. Statistical significant relationship exist between orbitozygomatic complex fracture and enophthalmos (T1: p = 0.04). subconjunctival haemorrhage (T2: p = 0.003), periorbital ecchymosis (T2: p = 0.005),and T3: p = 0.001). CONCLUSION: Chemosis, diplopia, enophthalmos, periorbital ecchymosis and subconjunctival haemorrhage showed positive contributory effect to intraocular pressure elevation in orbitozygomatic complex fracture.

The prospect of anatomy as a career choice among clinical year medical students in Nigeria.

BACKGROUND: Medical doctors are potential important source of anatomy teachers. The aim of this study was to determine the choice of anatomy as a career option among medical students in a Nigerian medical school METHOD: Descriptive survey of second- and third-year medical students using a self-administered questionnaire to asses age, sex, perception of anatomy as a subject, anatomy training experience and choice of anatomy as a career among respondents. Analysis was conducted using the SPSS and statistical significance inferred at P RESULTS: Three hundred and fifty three (85.3% response rate) who completely filled questionnaire were returned and analyzed of which 195 (55.2%) were males and 158(44.8%) were females. Their ages ranged between 18 and 37 years with a mean of 22.4 9.9 years. Although most students agreed that anatomy was an important subject in medical sciences 346 (98%), they had benefited from anatomy training in their clinical classes 320 (90.7%), and the knowledge of anatomy is useful in investigating patients with certain diseases 251 (71.1%), only 22 (6.2%) would choose anatomy as a career. Male students were more likely to choose anatomy as a career (P=0.026). Textbooks were the most common 334 (94.5%), while radiological means were the least 23 (6.5%) method employed in learning anatomy. CONCLUSION: Anatomy as a subject is perceived positively by clinical medical students, but the choice as a career option is low; attempt at increasing career interest is needful.

Relationship between Refraction, Anthropometrics, and Educational Status in a Nigerian Young Adult Population.

PURPOSE: The study aimed at determining the relationship between refraction and anthropometric measurements and the relationship between the level of education and refractive status in a Nigerian young adult population. MATERIALS AND METHODS: Healthy volunteers from the students and staff of a teaching hospital in South-Western Nigeria were studied. Demographic profiles including participants' highest educational status, parental educational level, and the age at first formal school enrollment were documented. The height and weight of the participants were measured. Noncycloplegic objective refraction was determined with autorefractor, and the spherical equivalent refraction (SER) of the right eye was used for analysis. SPSS 16 was used to explore the relationships between refraction, height, weight, and body mass index and the educational status of the participants. RESULTS: Two hundred and thirty-nine adults with a mean age of 28.4 ± 6.5 years comprising 116 males and 123 females were studied. The mean height, weight, body mass index, and right eye SER were 1.7 ± 0.1 m, 64.4 ± 12.2 kg, 23.6 ± 4.3 kg/m2, and -0.8 ± 1.4 D, respectively. Height was negatively correlated with the SER (R = -0.3, P < 0.01) in males but not in females. Refraction was not significantly related to weight or body mass index. Participants with higher levels of education were more likely to be myopic. Higher parental education and early formal school enrollment were significantly associated with myopia. CONCLUSION: This study demonstrated a significant positive relationship between height and myopia in male participants but not in females. Individual as well as parental higher levels of education have also shown a positive association with myopic tendency.

B-mode sonographic evaluation of optic nerve sheath diameter and lens thickness in Nigerian adults with glaucoma.

OBJECTIVE: This study was done to investigate the effect(s) of glaucoma on the ocular optic nerve sheath diameter and lens thickness using B-mode ultrasonography. MATERIALS AND METHODS: One hundred and twenty study participants were recruited; 60 subjects with glaucoma and 60 age- and sex-matched controls without glaucoma. The optic nerve sheath diameter and lens thickness of both eyes were measured using a linear high frequency transducer with frequency of 6.5-12MHz. RESULTS: The mean optic nerve sheath diameter of the glaucomatous eyes (3.57 ± 0.19mm and 3.59 ± 0.33mm on the right and left, respectively) were significantly thinner than that of controls (4.23 ± 0.34 mm and 4.26 ± 0.30 mm on the right and left, respectively; p < 0.001). There is increased mean lens thickness in the glaucomatous eyes (4.15 ± 0.43mm and 4.18 ± 0.46mm on the right and left, respectively) than in the controls (4.01 ± 0.56mm and 3.99 ± 0.45mm on the right and left, respectively) with a statistically significant difference seen in the left eye (p = 0.024). CONCLUSION: B-mode ultrasound is a reliable tool of assessing the nerve sheath diameter and lens thickness in glaucoma. Optic nerve sheath diameter is reduced in glaucoma.

Intraocular Pressure Changes With Positioning During Laparoscopy.

BACKGROUND AND OBJECTIVES: Pneumoperitoneum during laparoscopy can produce changes in intraocular pressure (IOP) that may be influenced by several factors. In this study, we investigated changes in IOP during laparoscopy with different positioning. METHODS: We recruited adult patients without eye disease scheduled to undergo laparoscopic operation requiring a reverse Trendelenburg tilt (rTr; group A; n = 20) or Trendelenburg tilt (Tr; Group B; n = 20). IOP was measured at 7 time points (T1-T7). All procedures were performed with standardized anaesthetic protocol. Mean arterial pressure (MAP), heart rate (HR), peak and plateau airway pressure, and end-tidal carbon dioxide (ETCO2) measurements were taken at each time point. RESULTS: Both groups were similar in age, sex, mean body mass index (BMI), duration of surgery, and preoperative IOP. A decrease in IOP was observed in both groups after induction of anaesthesia (T2), whereas induction of pneumoperitoneum produced a mild increase in IOP (T3) in both groups. The Trendelenburg tilt produced IOP elevations in 80% of patients compared to 45% after the reverse Trendelenburg tilt (P = .012). A significant IOP increase of 5 mm Hg or more was recorded in 3 (15%) patients in the Trendelenburg tilt group and in none in the reverse Trendelenburg group. At T7, IOP had returned to preoperative levels in all but 3 (15%) in the Trendelenburg and 1 (5%) in the reverse Trendelenburg group. Reversible changes were observed in the MAP, HR, ETCO2, and airway pressures in both groups. CONCLUSIONS: IOP changes induced by laparoscopy are realigned after evacuation of pneumoperitoneum. A Trendelenburg tilt however produced significant changes that may require careful patient monitoring during laparoscopic procedures.

Relationship between refraction, anthropometrics, and educational status in a Nigerian young adult population

BACKGROUND: Previous studies have shown a correlation between reading problems and binocular function, but few studies have assessed visual skills in dyslexic students, particularly in Iranian Farsi-language students. This study is aimed to determine some of the binocular functions of dyslexic children and compare it with a group of age, sex, and social class-matched control children. MATERIALS AND METHODS: We conducted a case­control study on 27 dyslexic children and 40 age, sex, and social class-matched control children (all between 7 and 13 years old) in grades one to six. This study was performed at three elementary schools in Tehran, Iran. Monocular and binocular near point of accommodation (NPA) were measured using the subjective push-up method, near point of convergence (NPC) was determined using the standard push-up technique, and stereoacuity was tested with the Titmus stereotypes in all of the children. RESULTS: Mean NPA of the right eye was 6.90 cm in dyslexic group and 5.98 cm in the control group (P = 0. 003). Mean NPA of the left eye in dyslexic children was 7.32 cm and in the control group was 6.23 cm (P = 0. 003). Mean binocular NPA was 6.66 cm in dyslexic and 6 cm in the control group (P = 0. 049). However, mean NPC (P = 0.33) and mean stereoacuity (P = 0.785) did not differ significantly between the dyslexic and control groups. CONCLUSION: Our findings showed a reduced monocular and binocular NPA in dyslexic children so that this function should be assessed by an optometric clinician in children with dyslexia

Awareness and utilization of protective eye device among welders in a southwestern Nigeria community.

OBJECTIVE: To determine the level of awareness and practice of use of protective eye devices among welders in Ile-Ife. METHODS: This is a cross-sectional descriptive study of 405 consenting welders. A pretested proforma was utilized to obtain information on sociodemographic characteristics, as well as awareness and use of protective eye device. RESULTS: The age of the respondents ranged from 16 to 80 years. The mean age was 39 ± 13 years. A large proportion (315, 78%) of the welders was aged between 21 and 50 years. The youngest group aged ≤ 20 years accounted for 15 (4%) of all welders, while the oldest group aged > 60 years accounted for 21 (5.2%). 402 were males (99.3%) and three were females (0.7%). Three hundred thirty-six (83%) of the welders had practiced for 6 years and above. There was a high level of awareness of protective eye devices among the welders (367, 90.6%), being higher among arc welders compared with gas welders (P < 0.001). Less than half (186, 45.9%) of the welders possessed protective eye devices. Of these, only 39 (9.6%) made use of the devices always. Some of the reasons for not using the protective eye devices include discomfort and poor visibility (56, 13.6%) and inadequate appreciation of the necessity to wear it (49, 12.1%). CONCLUSION: The findings of this study suggest that a significant proportion of welders in Ile-Ife were not utilizing protective eye device. Health education and awareness campaigns about the importance and benefits of utilizing protective eye devices are recommended.

Cataract surgical outcomes in diabetic patients: case control study.

PURPOSE: To determine the visual outcome of cataract surgery in diabetes mellitus with advanced cataract in a tertiary institution in Nigeria. DESIGN: A retrospective case control study conducted at the University College Hospital, Ibadan Nigeria. SUBJECTS: Twenty three consecutive patients with diabetes and 23 age and sex matched non-diabetic control patients who had extracapsular cataract extraction for advanced cataract between 2002-2005. MAIN OUTCOME: Mean post operative visual acuity and surgical complications. RESULTS: Twenty three patients with diabetes mellitus and 23 non diabetic controls were studied; mean duration of diabetes was 8.1 +/- 7.2 years. The mean post operative visual acuity in diabetics was 0.11+/-0.38, 0.33+/-0.57 and 0.38+/-0.49 at one week, two months and six months compared with 0.23+/-0.19, 0.46+/-0.37 and 0.48+/-0.31 in non diabetics. (p=0.207, 0.403 and 0.465 respectively). Improvement in preoperative visual acuity was noted in 84.2% and 90% in diabetics and non-diabetics respectively. Poor visual outcome in diabetics was mainly due to diabetic retinopathy, maculopathy or diabetes related surgical complications. CONCLUSION: Visual improvement was seen following surgery for advanced cataract in diabetics in this study population. Post operative monitoring for treatment of diabetic retinopathy may enhance visual outcome.