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.

Endophthalmitis: magnitude, treatment and visual outcome in northwest frontier province of Pakistan.

BACKGROUND: Many cases of post-operative and posttraumatic endophthalmitis are being managed at the Khyber Institute of Ophthalmic Medical Sciences, Peshawar in Pakistan but no study has been done to ascertain the magnitude of the disease and to also evaluate the visual outcome after management. METHODS: The case notes of 39 patients diagnosed with posttraumatic and postoperative endophthalmitis between May 2006 and April 2007 were analyzed and clinical characteristics obtained were documented and tabulated. RESULTS: During the study period, 2474 patients were admitted in both the male and female wards. Of these, 39 (1.6%) had endophthalmitis due to surgical and traumatic complications. In all, 6 (12.4%) patients had evisceration, while 21 (53.8%) patients who had topical antibiotics consisting of ofloxacin, 0.1% corticosteroids, fortified cetazoline and 1% atropine along with intravitreal antibiotics, a combination of 0.1 mg vancomycin and 0.4 mg amikacin, were discharged home with a visual acuity of counting fingers to light perception. CONCLUSION: Endophthalmitis is a serious ocular complication of open globe injury and intraocular surgery. The frequency in this center has been noted to be very high as compared to other places. Its management is very challenging and often leads to devastating structural and functional damage to the eye; causing severe frustration to both the patient and the attending physician. Efforts must be made to prevent the condition.

A review of 50 cases of aphakic detachment in Peshawar, North West Frontier Province of Pakistan.

BACKGROUND: This prospective study was conducted at Khyber Teaching Hospital Peshawar, North West Frontier Province (NWFP) of Pakistan over the period of 16 months. It was to assess the demographic pattern, mode of presentation, treatment modalities and postoperative result of aphakic retinal detachment. This study also compared the incidence of aphakic retinal detachment in intracapsular versus extracapsular cataract extraction as well as the duration between cataract surgery and retinal detachment. PATIENTS AND METHOD: A total of 50 patients were recruited in this prospective study. A Proforma was specially designed for this purpose. Detailed history with reference to age, sex, presenting complaints, spectacle wear, previous ocular surgery, duration of surgery/laser treatment, systemic and family history was taken. All patients had detailed ophthalmic examination, underwent conventional retinal reattachment surgery, and were followed up for 6 months. RESULTS: Of the total number studied, 86% of the patients were males; only 14% were females, with a mean age of 58 years. The overall anatomical success was achieved in 40 (80%) eyes. The visual acuity of 6/12 and better was achieved in 8 (16%) eyes. 20 (40%) eyes attained a vision of 6/18 to 6/36. 12 (24%) eyes had a vision between 6/60 to CF 3m. The vision could not be improved beyond CF 3m in 10 (20%) eyes. CONCLUSION: Vitreous loss during cataract surgery is the most common cause of aphakic retinal detachment. The risk is maximal in the first and second year. The overall anatomical attachment achieved through conventional retinal detachment surgery is 80%.

Mammalian cerebral cortical tissue responds to low-intensity visible light.

Low levels of visible light directed onto slices of rat cerebral cortical tissue enhanced net potassium-induced release of the neurotransmitter gamma-aminobutyric acid (GABA) from these brain slices. At higher light intensity, net potassium-induced release was suppressed. These effects were apparently not from increased temperature. The amount of light enhancing this neurotransmitter release is approximately equal to the amount of light that can penetrate the head and reach the brain at the intensities of sunlight; this was determined by measuring the light entering the rat head through fur, scalp, skull, and dura mater and considering several natural lighting conditions. These results suggest that ambient light may be sufficient to alter the release of transmitters from mammalian cerebral cortex in vivo.

Characterization of transmitter release as a response of vertebrate neural tissue to erythrosin B.

A rat cerebral cortical slice preparation was used to study the response of transmitter release to the application of the food dye, Erythrosin B, a tetraiodinated derivative of fluorescein. Erythrosin B (100 microM) stimulated net release of previously taken up [3H]norepinephrine and [3H]gamma-aminobutyric acid (GABA). The Erythrosin-induced release of GABA (the only transmitter studied) occurred in the absence of added Ca2+, and in the presence of tetrodotoxin (TTX). Ultrastructural analysis of the vesicle content of frog neuromuscular junctions treated with Erythrosin B revealed a diminution in the number of synaptic vesicles present in the nerve terminal. By using fluorescein and some halogen-substituted derivatives including Erythrosin B, it was found that incubation with the unhalogenated compound caused no net release, whereas incubation with the iodine-, chlorine- or bromine-substituted compound did cause release. It was also found that somewhat greater release induced by Erythrosin B (at 100 microM) occurred in the light than in the dark. That Erythrosin B inhibits the Na+,K+,Mg2+-ATPase was confirmed in this preparation; it did so in both light and dark. The discrepancy between release and Na+,K+,Mg2+-ATPase blockade in the dark suggests that release either occurs by some other mechanism than by Na+,K+,Mg2+-ATPase blockade, or that an additional light-dependent process contributes to the release. We conclude that Erythrosin B can presumably induce net release of transmitters generally, that release does not occur via the TTX-sensitive Na+ channel, that release via vesicles does occur, and that light somewhat enhances the release.

The effect of diamide on transmitter release and on synaptic vesicle population at vertebrate synapses.

Diamide, a sulfhydryl-oxidizing agent, has previously been shown to cause acetylcholine release in two preparations in the absence of added Ca2+. Similarities in action between diamide and alpha-latrotoxin, a component of black widow spider venom which causes transmitter release with no added Ca2+, and which seems to require a disulfide bond for its action, led us to study further the transmitter-releasing properties of diamide. In rat cerebral cortical slices we show that diamide, like alpha-latrotoxin, released all transmitters studied; GABA, acetylcholine, norepinephrine and dopamine. The response reached a peak after a delay (5-15 min), in contrast to the much faster release evoked by high K+ (within 3 min). Diamide-induced GABA release was found to occur equally well in the absence of added Ca2+, and was blocked when diamide was reduced prior to addition. Our ultrastructural studies of the frog neuromuscular junction showed that whereas alpha-latrotoxin caused the elimination of synaptic vesicles, diamide did not. Dithiothreitol, a disulfide-reducing agent, also caused GABA release, but this effect was Ca2+-dependent, blocked by high Mg2+, and occurred without delay. These observations comparing the 3 transmitter-releasing agents have further delineated the sulfhydryl/disulfide-group involvement in transmitter release and have demonstrated that dithiothreitol is operating at a different site from either alpha-latrotoxin or diamide.

A regional study of the molecular forms of acetylcholinesterase in the brain of developing and adult rats.

This study of the molecular forms of acetylcholinesterase in several rat brain regions using sucrose gradient centrifugation has revealed only two major forms throughout postnatal development: the 4S and 10S. In all regions studied (cerebral cortex, cerebellum, caudate nucleus, hippocampus, pons-medulla and superior colliculi), enzyme activity progresses from high 4S/low 10S activity at birth to the converse in the adult. The 10S, the major form in mature brain, is not proportionally greater at birth in areas which are phylogenetically older. Study of cerebral cortex and cerebellum at 1, 13, 19-20 postnatal days and in the adult shows a nonlinear shift from the 4S form to the 10S form with a decrease or leveling off of 10S (in specific activity and total amount) prior to attaining the high adult levels. We suggest a possible relation of our findings to certain histogenic events in the brain.