Title: Clinico-pathological and survival profiles of orbito-ocular tumors in Enugu Nigeria. Is there an emerging trend?

BACKGROUND: Orbito-ocular tumors are rare, but they cause significant morbidity and mortality. There are reported variations in their pattern of presentation and frequency of occurrence. OBJECTIVE: To evaluate the occurrence, clinico-pathologic spectrum, and patterns of orbito-ocular neoplasms as well as the treatment and outcome profiles. METHODS: A 5-year retrospective analysis of consecutive patients treated for orbito-ocular tumors. We evaluated patterns of occurrence, clinic-pathological concordance, and outcome of treatment. Associations were evaluated with chi square and confidence interval. Data analysis was performed using SPSS for windows version 23 and inferences were judged using the 95% level of significance. RESULTS: Among 100 patients with orbito-ocular masses, 62 were histologically confirmed. The female to male ratio (F:M) was 1.0. Their ages ranged from 7 months to 93 years, mean = 33.4 ± 2.7 years. There was an age variation among tumor types. Patients with squamous cell carcinoma (SCC) had a mean age of 46.4 years, while for retinoblastoma the mean age was 3.09 years. All patients with retinoblastoma had proven macroscopic orbital extension. SCC was the most common tumor type (n = 19), however, among children, retinoblastoma (n = 11) was more common. Melanocytic nevus, sebaceous gland carcinoma, and adenocarcinoma of lacrimal gland (n = 6, n = 5, n = 5), respectively, among other tumors were treated. Concordance between clinical and histopathological diagnoses was obtained among 30 (48.3%) cases. 1-year and 3-year survival for retinoblastoma was 90% and 72.9%, respectively, and 78.9% and 68.4% for SCC. CONCLUSION: SCC is currently the most common orbito-ocular tumor in our setting.

Refractive Error and Visual Impairment Among School Children: Result of a South-Eastern Nigerian Regional Survey.

PURPOSE: To determine the prevalence refractive errors and causes of visual impairment in school children in the south-eastern region of Nigeria. METHODS: School-based cross-sectional samples of children 5 to 15 of age in both urban and rural areas were profiled through cluster sampling. The main outcome measures were presenting, uncorrected, and best-corrected visual acuity using the Refractive Error in School-age Children (RESC) protocol. RESULTS: A total of 5723 children were examined during the study period comprising 2686 (46.9%) males and 3037 (53.1%) females; (M:F ratio 0.9:1) and aged 10.49±2.74SD of mean (range, 5 to 15 years). The age group 12 to <13 accounted for the highest 776 (13.6%) number of the study participants. The uncorrected visual acuity (VA) of <20/40 (6/12) was seen in 188 (3.4%) of the study participants while the presenting and best-corrected visual acuity of <20/40 (6/12) were noted in 182 (3.4%) children and 14 (0.2%) children, respectively. Refractive error was the principal cause of visual impairment. CONCLUSION: Prevalence of refractive error is low. Myopia is the principal cause of refractive error occurring more in females and in urban schools. The main cause of visual impairment is refractive error, and most children that need spectacle correction did not have them. Program to identify children with refractive error in addition to providing free or affordable optical services remains the key to preventing visual impairment from refractive error particularly in resource-poor settings.

Vision Screening in Infants Attending Immunization Clinics in a Developing Country.

Background: Vision screening in infants is an important part of the medical care of children as some eye abnormalities, if not treated in the first few months or years of life, can lead to irreversible vision loss. Objective: The objective of this cross-sectional, descriptive study was to identify ocular anomalies among infants attending immunization clinics in Nigeria and refer promptly and appropriately. Methodology: Infants were screened across 6 immunization clinics. Screening activities included relevant ocular history, vision assessment, external ocular examination, ocular motility, Hirschberg's test, pupil examination, and the red reflex test. Infants with abnormal findings were referred for comprehensive eye examination. Result: Of the 142 infants who underwent vision screening, 29 were referred. These referrals were either as a result of ocular abnormalities (n = 22) or presence of risk factors from history (n = 7). The prevalence of ocular abnormalities was 15.5% and neonatal conjunctivitis (38%), was the commonest ocular abnormality found. Others were bacterial conjunctivitis (14%), nasolacrimal duct obstruction (14%), strabismus (14%), capillary hemangiomas (10%), iris nevi (5%), and vernal keratoconjunctivitis (5%). Of the 7 infants referred based on history alone, 6 (85.7%) had a history of prematurity. Conclusion: Conjunctivitis, strabismus, congenital nasolacrimal duct obstruction, and capillary hemangioma are some of the prevalent disorders seen in infants at immunization clinics in Nigeria. Babies at risk of retinopathy of prematurity (preterm birth and oxygen therapy) can be identified. Immunization clinics can serve as good points of vision screening for infants in developing countries to facilitate prompt referral and treatment.

Relationship between corneal biomechanical properties among pregnant women in a tertiary hospital in Nigeria.

OBJECTIVE: In Nigeria, many pregnant women as well as health-care providers are unaware of the effect of pregnancy on the eye. The present study investigated the changes in central corneal thickness (CCT), corneal sensitivity (CS), and intraocular pressure (IOP) among pregnant women in a tertiary hospital in Nigeria and the relationship between them. MATERIALS AND METHODS: A prospective longitudinal study was used. One hundred and thirty-four pregnant women attending the Obstetric Clinic of the University of Nigeria Teaching Hospital, Enugu, were consecutively recruited in their second trimester for the study. Changes in CCT, CS, and IOP were monitored at the second and third trimesters and 6-week postpartum. Data obtained were analyzed using Statistical Package for the Social Sciences version 20. The effect of duration of pregnancy on these variables was determined using simple linear regression and further analysis was done using Bonferroni's post hoc test. RESULTS: The women were aged 18-48 years, with a mean age of 30.81(±5.49) years and majority of them (61.2%) were multigravida. The duration of pregnancy varied inversely and significantly with CS (P < 0.05) and IOP (P < 0.000) with the least values recorded in the third trimester, while it varied directly and also significantly with CCT (P < 0.000) with the highest value obtained in the third trimester. A negative correlation that was significant only in third trimester was found between CCT and IOP (P < 0.02) and CS (P < 0.03). CONCLUSION: There was a progressive increase in CCT with a corresponding decrease in CS and IOP across the trimesters of pregnancy, but these changes reversed 6-week postpartum.

Public's knowledge of the differences between ophthalmologists and optometrists: a critical issue in eye care service utilisation.

AIM: To assess the public's knowledge of the differences between ophthalmologists and optometrists and identify the factors associated with knowledge. METHODS: The study was a population-based random survey of adults aged 18 years or older conducted in Enugu, south eastern Nigeria, between March and June, 2011. Data on respondents' socio-demographics, clinical profile, and knowledge of the differences between ophthalmologists and optometrists were collected using a 28-item questionnaire. Data were analysed using descriptive and analytical statistics. Values of P<0.05 were considered statistically significant. RESULTS: The respondents (n=394) comprised 198 males and 196 females (sex ratio=1.01:1), aged 18-70 (30.9±10.8) years. The majority of respondents were single (57.4%), possessed secondary education (96.9%), employed (65.2%) and had no health insurance (77.4%). Their clinical profile showed previous eye exam 54.1%, spectacle wear 41.6% and contact lens wear 5.6%. In the multivariate analysis, participants' good knowledge of the differences between ophthalmologists and optometrists was significantly associated with educational status (OR: 0.32, 95% CI: 0.23-0.44, P<0.0001, ß=-0.988), employment status (OR: 1.8, 95% CI: 1.45-2.25, P<0.0001, ß=0.124) and previous eye examination (OR: 1.63, 95% CI: 1.29-2.07, P<0.0001, ß=0.549). CONCLUSION: Participants' socio-demographic and clinical characteristics are important predictors of good knowledge. The findings may have implications for all stakeholders in eye care delivery. There is need for knowledge enhancement, by the government and eye care providers, through population-based eye health literacy campaigns.

Comparisons of the Tono-Pen® and Goldmann Applanation Tonometer in the Measurement of Intraocular Pressure of Primary Open Angle Glaucoma Patients in a Hospital Population in Southwest Nigeria.

OBJECTIVE: The aim of this study was to compare intraocular pressure (IOP) measured with the Tono-Pen® to that measured using the Goldmann applanation tonometer (GAT) in patients with primary open angle glaucoma attending a glaucoma clinic. SUBJECTS AND METHODS: A comparative clinic-based observational study was conducted involving 75 patients (39 men and 36 women) attending a glaucoma clinic in Southwest Nigeria. A pretested structured questionnaire was used to collect sociodemographic data. The Tono-Pen and the GAT were used to measure the IOP in each patient. Central corneal thickness (CCT) was measured with an ultrasonic pachymeter, and the corrected GAT value was calculated for each patient. The Tono-Pen readings were compared with the uncorrected and corrected GAT readings. Descriptive and comparative analyses were performed. Values for p < 0.05 were considered statistically significant. RESULTS: The mean age of the participants was 60.39 ± 16.71 years. The mean IOP using the Tono-Pen was 21.1 ± 6.8 mm Hg versus the mean uncorrected GAT value of 17.1 ± 6.9 mm Hg and the corrected GAT value of 18.9 ± 7.5 mm Hg. The mean CCT was 510.5 ± 29.6 µm. The mean differences between the Tono-Pen reading and uncorrected and corrected GAT readings were 3.9 ± 2.6 and 2.1 ± 3.5 mm Hg, respectively. Gender (Tono-Pen vs. GAT; p = 0.981 vs. 0.437) and corneal thickness (p = 0.057) did not significantly affect the IOP value. Of the 75 patients, 68 (90.7%) preferred the Tono-Pen to the GAT. CONCLUSION: In this study, the Tono-Pen gave a higher value for IOP than the uncorrected and corrected GAT values. Gender and corneal thickness did not significantly affect the measurements. Most patients found the Tono-Pen more acceptable than the GAT.

Awareness and Utilization of Welders' Personal Protective Eye Devices and Associated Factors: Findings and Lessons From a Nigerian Population.

This study assessed commercial welders' awareness and utilization of personal protective eye devices (PPEDs), and their associations, in Enugu, Nigeria, between January and March, 2011. The participants included 343 males, age 33.9 years±10.0 SD years. The participants reported high awareness of welding-associated ocular hazards (99.4%) and PPEDs (75.2%-98.3%), but low PPED possession and utilization rates. Cost and "presumed lack of utility" were the leading barriers to PPED possession; non-utilization was mainly attributed to "user inconvenience" and "presumed lack of protective benefit." PPED utilization was significantly associated with lower educational status (p=.030) and electric welding (p<.0001). The underlying causes are amenable to preventive occupational eye health education, enhanced ergonomics and affordability of PPEDs, and legislative enforcement of their use.

Causes and emerging trends of childhood blindness: findings from schools for the blind in Southeast Nigeria.

AIM: To ascertain the causes severe visual impairment and blindness (SVI/BL) in schools for the blind in southeast Nigeria and to evaluate temporal trends. METHODS: All children who developed blindness at <15 years of age in all the three schools for the blind in southeast Nigeria were examined. All the data were recorded on a WHO/Prevention of Blindness (WHO/PBL) form entered into a Microsoft Access database and transferred to STATA V.12.1 for analysis. To estimate temporal trends in causes of blindness, older (>15 years) children were compared with younger (≤15 years) children. RESULTS: 124 children were identified with SVI/BL. The most common anatomical site of blindness was the lens (33.9%). Overall, avoidable blindness accounted for 73.4% of all blindness. Exploring trends in SVI/BL between children ≤15 years of age and those >15 years old, this study shows a reduction in avoidable blindness but an increase in cortical visual impairment in the younger age group. CONCLUSIONS: The results from this study show a statistically significant decrease in avoidable blindness in children ≤15 years old. Corneal blindness appears to be decreasing but cortical visual impairment seems to be emerging in the younger age group. Appropriate strategies for the prevention of avoidable childhood blindness in Nigeria need to be developed and implemented.

Knowledge and attitudes regarding eye donation and corneal transplant: medical versus nonmedical university students in a developing country in Africa.

OBJECTIVES: We sought to assess the knowledge and attitudes of medical and nonmedical University students regarding eye donation and corneal transplant. MATERIALS AND METHODS: The study was a comparative, questionnaire-based, cross-sectional survey of fourth-year medical and environmental science students at the University of Nigeria conducted in October 2012. Participants' demographics, knowledge, and attitudes on eye donation and corneal transplant were analyzed using descriptive and comparative statistics. Values for P less than .05 were considered statistically significant. RESULTS: The participants (107 medical students, 75 environmental science students) were 117 men and 65 women aged 22.3 ± 2.2 years (range, 18-32 y). There were no significant intergroup differences regarding awareness of eye donation (OR 1.71; 95% CI: 0.92-3.17; P = .0924) and willingness to donate their own (OR 0.76; 95% CI: 0.33-1.76; P = .5260) or their relatives ' eyes (OR 0.76; 95% CI: 0.29-1.98; P = .6274). Significantly more medical students than environmental science students knew that donation consent is given by the donor while alive (OR 2.93; 95% CI: 1.56-5.4; P = .0005) and had good knowledge of donor eye preservation (OR 2.43; 95% CI: 1.27-4.68; P = .007). CONCLUSIONS: Among medical and nonmedical undergraduate students, there are crucial deficits in knowledge and attitudes on eye donation and corneal transplant. Tailored donation awareness campaigns and introduction of undergraduate course work on eye donation may reverse the trend.

Pediatric ocular injuries in a resource-deficient rural mission eye hospital in southeastern Nigeria.

INTRODUCTION: Pediatric ocular trauma is a significant worldwide problem of public health importance being a leading cause of non-congenital unilateral blindness. This study evaluated the proportion, type and causes of ocular injuries among children in a rural hospital of Nigeria. METHODS: Children (<16 years) presenting with ocular trauma at the Eye clinic of the Presbyterian Joint Hospital, Ohaozara, Ebonyi state, Nigeria, between November 2011 and May 2012 were studied. Participant's socio-demographics, type of trauma, cause of trauma, and occupation of parents were collected and analysed. RESULTS: The Proportion of ocular injuries was 26.4%. Injuries were more common among males (P=.041) and children from lower social class (P=.026). Injuries occurred more frequently during farm work (59.4%) and play (21.9%). The most common causes of injury were stick (34.4%) and stones (21.8%). CONCLUSION: The proportion of ocular injuries among children at the rural hospital is high. Most causes are preventable.

Ten-year rural experience of surgical eye removal in a primary care center south-eastern Nigeria.

INTRODUCTION: Surgical removal of the eye usually reflects the pattern of severe ocular diseases and the level of development and socio-cultural dynamics in each specific setting. In Nigeria there have been several reports of causes of surgical eye removal in urban tertiary eye-care centers. This study determined the pattern of surgical eye removal in a rural primary eye-care facility (hospital) in South-eastern Nigeria. METHODS: A retrospective chart review was performed for all patients who had surgical removal of the eye between January 2002 and January 2012 at the eye unit of the Presbyterian Joint Hospital, Ohaozara, Ebonyi State, South-eastern Nigeria. Data collected included age, sex, diagnosis and the eye affected. The diagnosis was further categorized into degenerative lesions, infections, trauma and neoplasm. The statistical package for social sciences was used for data analysis. RESULTS: Two hundred and twenty-six eyes from 226 patients were surgically removed within the study period from 52.2% (n = 118) males and 47.8% (n = 108) females (ratio: 1.1:1; p = 0.5). The mean age of the cohort was 47.6 ± 20.2 years (range 2-82). Children aged 0-10 years were 8.4% while those over 60 years comprised 23.4% of the study population. The three most common causes of surgical removal of the eye were severe eye infections 60.6% (n = 137), degenerative eye diseases (staphyloma) 13.3% (n= 30) and severe eye injury 11.5% (n = 26). Retinoblastoma 6.2% (n = 14) was the commonest tumour type seen. CONCLUSION: The most common cause of surgical eye removal was severe ocular infections followed by degenerative eye diseases. More males than females had their eyes surgically removed. Over half of those who had their eyes removed were aged 51 to over 60 years. The commonest cause of eye removal among children was retinoblastoma. These causes are largely preventable and avoidable. With intensive eye health education and the provision of adequate eye-care facilities this trend can be reversed.

Prevalence of Human Immunodeficiency Virus Seropositivity among Eye Surgical Patients at a Rural Eye Care Facility in South-Eastern Nigeria.

PURPOSE: To determine the prevalence of human immunodeficiency infection among patients who underwent surgery at a rural eye care facility in southeastern Nigeria. MATERIALS AND METHODS: A retrospective chart review was performed for all patients who had undergone surgery and a pre-operative Human Immunodeficiency Virus (HIV) test, between August 2008 and July 2009 at the Eye unit of the Presbyterian Joint Hospital, Ohaozara, Ebonyi State, Nigeria. Data were analyzed for age, sex, type of surgery and HIV status. Frequency, percentage and 95% confidence intervals (CI) were calculated with univariate analysis and the parametric method. RESULTS: A total of 380 cases were reviewed comprised of 228 males and 152 females (M:F= 1.5:1).The mean age of the cohort is 56 years (range, 4 years to 91 years). Fourteen patients (3.7%; 95% confidence interval 1.8 - 5.6) were HIV positive. CONCLUSION: A high HIV sero-prevalence was reported in our study. Infection-control precautionary measures are indicated to minimize risk of HIV transmission to ophthalmic surgeons and allied health-workers.