Childhood traumatic cataract in Nigeria; a multicentre study: 2017-2021.

OBJECTIVE: To determine the frequency, demography, aetiology and mechanisms of ocular injuries associated with childhood traumatic cataract in Nigeria. METHODS: A retrospective multicentre study conducted across ten child eye health tertiary facilities in Nigeria between January 2017 and December 2021. Clinic records of all children aged 0-17 years who had been diagnosed with cataract at the various participating centres were reviewed. Information collected include: biodata, mechanism of injury; laterality, place of injury; object responsible; person responsible; duration before presentation and surgical intervention. RESULTS: A total of 636 out of 1656 children (38.4%) had traumatic cataracts during the study period. Their mean age was 109.4 ± 45.2 months with a male-to-female ratio of 2:1. Most injuries were unilateral, two (0.3%) children had bilateral involvement. Only 78 (15.3%) children presented within 4 weeks of the injury. Closed globe injuries were responsible for the traumatic cataract in 475 (74.7%) children, while open globe injuries were more likely to present within 24 h (P < 0.001). The commonest objects of injury were cane, sticks, plant, wood and play materials. Self-inflicted injuries occurred in about 82 (13%) children while 407 (64.0%) were caused by close relatives and contacts. The location where trauma occurred was home in 375 (59.8%) and school in 107 (16.8%) children. CONCLUSION: This multicentre study demonstrates that more than one-third of all childhood cataracts in Nigeria are trauma-related and majority are due to closed globe injuries. Public health interventions to reduce the occurrence of ocular trauma and to encourage early presentation after trauma are advocated.

Current pattern of ocular trauma as seen in tertiary institutions in south-eastern Nigeria.

BACKGROUND: Ocular trauma is a leading cause of monocular blindness worldwide and in developing countries, are not only more common but also more severe. Industrialization and urbanization may alter or modify prevalent aetiological factors and the presentation of ocular trauma. OBJECTIVE: To determine the current pattern of eye injuries in Teaching Hospitals in Enugu State. METHODS: This prospective cross-sectional descriptive study was carried out at the eye clinics and emergency units of two tertiary institutions in Enugu, Nigeria. Consecutive ocular trauma patients were enrolled over a 5-month period. On presentation, they underwent ocular examination including visual acuity (which was categorized according to the WHO classification of visual impairment and blindness}, anterior and posterior segment examinations. Injuries were grouped using the Birmingham Eye Trauma Terminology system. RESULTS: Within the study period, 2545 new patients presented to the hospitals where the study was conducted. A total of 89 patients presented with ocular trauma, giving an incidence of 3.5%. The male to female ratio was 1.3:1 and patients aged 10 to 19 years formed the majority (24%). Domestic accidents (22%) were the most common cause of ocular injuries while blunt objects (57%) were the most common agents. Closed globe injuries constituted 76% of all injuries. Forty-three per cent of patients presented within 24 h of injury. CONCLUSION: Ocular trauma is still prevalent in South-eastern Nigeria and there has indeed been a change in the pattern as well as the incidence. Assault and road traffic accidents have emerged as important causes of eye injuries. In addition, there has been an improvement in the health-seeking behaviour of people living in Enugu and this may reflect positively on the uptake of recommended preventive strategies.

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.

Glaucoma following childhood cataract surgery: the South India experience.

PURPOSE: To determine the characteristics and risk factors for the development of glaucoma after cataract surgery in children seen at a major referral tertiary eye centre in South India. METHODS: This is a retrospective review of the medical records of consecutive patients seen at the glaucoma/paediatric eye clinic of the centre, with a diagnosis of glaucoma secondary to aphakia/pseudophakia over a 5-year period. RESULTS: There were 21 eyes of 14 children that developed glaucoma and 23 eyes of 12 children were selected as control. The mean age (standard deviation SD) at the time of cataract surgery for the glaucoma group was 7.4 (± 10.1) months and 39.13 (± 41.2) months for the control. The mean follow-up (SD) period was 114.29 (± 61.9) months and 97.61 (± 43.5) months for the glaucoma and control, respectively. The mean duration from cataract surgery to onset of glaucoma was 81.19 (± 52.4) months (median 66 months, range 21-172 months). Multivariate analysis detected age at surgery younger than 12 months (OR 10.45, 95%CI 1.76-62.03, p = 0.010) and ocular anomalies mainly microcornea (OR 7.11, 95%CI 1.14-44.46, p = 0.036) as risk factors for development of glaucoma after paediatric cataract surgery. CONCLUSION: Glaucoma can develop several years after childhood cataract surgery. Surgery in the first year of life and microcornea are risk factors for the development of glaucoma post-surgery. Signs of glaucoma should specifically be looked for during follow-up visits.

Using Key Informant Method to Determine the Prevalence and Causes of Childhood Blindness in South-Eastern Nigeria.

PURPOSE: To determine the prevalence and causes of childhood blindness in an underserved community in south-eastern Nigeria using the key informant method. METHODS: This was a descriptive cross-sectional study. Key informants (KI) appointed by their respective communities received 1-day training on identification of blind children in their communities. Two weeks later, the research team visited the agreed sites within the community and examined the identified children. The World Health Organization eye examination record for blind children was used for data collection. Data entry and analysis were done with the Statistical Package for Social Sciences (SPSS) version 17.0. RESULTS: Fifteen blind or severely visually impaired children (age range 3 months to 15 years) were identified in this community; nine of these were brought by the KIs. The prevalence of childhood blindness/severe visual impairment (BL/SVI) was 0.12 per 1000 children. By anatomical classification, operable cataract in 6 (40.0%) was the leading cause of BL/SVI in the series; followed by optic nerve lesions (atrophy/hypoplasia) in 3 (20.0%). The etiology of BL/SVI is unknown for the majority of the children (66.7%). It was presumed hereditary in four children (26.7%). Sixty percent of the blindness was judged avoidable. Only three children (20.0%) were enrolled in the Special Education Centre for the Blind. CONCLUSION: The prevalence of childhood BL/SVI in our study population is low but over half of the blindness is avoidable. There may be a significant backlog of operable childhood cataract in south-eastern Nigeria. The KI method is a practical method for case finding of blind children in rural communities.

Prevalence, Awareness and Determinants of Diabetic Retinopathy in a Screening Centre in Nigeria.

There is a global rise in the prevalence of diabetes and this has led to a rise in the consequences of diabetes such as diabetic retinopathy (DR). The current study aims to determine the prevalence, awareness and determinants of DR among diabetics who attended a screening centre in Enugu, south-eastern Nigeria. A descriptive cross-sectional study was carried out among consenting diabetic patients who visited the centre. An interviewer-administered questionnaire was used to gather information on demographic details, the knowledge of the participants on effects of diabetes on the eye and previous care they had received for their eyes. Each participant underwent eye examination which included posterior segment examination with slit lamp biomicroscopy with +90DS lens after pupil dilation. A total of 80 eligible participants were examined. The prevalence of any DR among the participants was 32.1 % (95 % CI 20.6-43.5) whereas prevalence of proliferative diabetic retinopathy, PDR was 6.4 % and diabetic macular oedema, DME was 31.3 %. Age at onset of diabetes and duration of diabetes were the most determinant factors associated with DR (p = 0.039 and p = 0.000 respectively). Only ten (12.5 %) participants had undergone at least one specific eye examination to check for DR since they were diagnosed with diabetes. The major reason for not having had a prior screening is 'no one referred me for it' (31 participants, 44.3 %). DR is emerging as an important cause of blindness and severe visual impairment. Adequate screening programme and treatment protocol need to be set up for this population even in developing countries to prevent blindness.

Prevalence of presbyopia in a rural African community.

INTRODUCTION: When presbyopia (loss of accommodation of the crystalline lens with increasing age) sets in, doing near work becomes associated with headache and eye strain. Reading and writing become a challenge. Literacy levels may be low in rural communities; nevertheless some work other than reading, like sewing, sorting stone from grain and operating mobile phones, is done with dissatisfaction. This study aims to determine the prevalence of presbyopia, the unmet presbyopia need and the presbyopia correction coverage in a rural African community. METHODS: A population-based cross-sectional study was carried out in a rural population aged 35 years and greater, selected by cluster random sampling. Information was sought on biodata of the participants and they were subsequently examined. Distance visual acuity for each participant was determined. Anterior and posterior segments of the eyes were examined. Objective refraction with subjective refinement was done on all subjects with distant visual acuity less than 6/6. Near visual acuity was assessed at 40 cm with distant correction in place if required. Presbyopia was defined as inability to read N8 at 40 cm or requiring an addition of at least +1.00DS to improve near vision to at least N8. Questionnaires were administered to those identified as presbyopic on source of procurement of spectacles (if they had one) and on reasons for non-procurement of presbyopic spectacles. They were also asked to rate their difficulty with various listed near work. Data entry and analysis were done using Statistical Package for the Social Sciences v16.0 and Program for Epidemiologist v4.01 software. RESULTS: A total of 585 subjects (participation rate 81.1%) aged 35 years and greater were interviewed and examined. The prevalence of presbyopia was 63.4% (95% confidence interval (CI) 62.6-64.2%). There was increasing prevalence with increasing age. The met presbyopia need was 17.6%, unmet need was 45.8% and presbyopic correction coverage was 27.8%. The commonest reasons for not procuring presbyopic correction were 'not a priority' (21.5%) and 'cost' (21.2%). CONCLUSIONS: The prevalence of presbyopia in this rural African community is high. Many who need presbyopic correction do not have corrective spectacles.

Unmet visual needs of children with Down syndrome in an African population: implications for visual and cognitive development.

PURPOSE: To determine the magnitude and types of ocular disorders in children with Down syndrome in an African population and to assess to what extent these visual needs have been met.
 METHODS: This is a cross-sectional study of children with Down syndrome attending a school for the mentally challenged in Southeastern Nigeria. Visual acuity, ocular examination, and cycloplegic refraction were done on all cooperative participants. Information was sought from parents/caregivers to ascertain previous ocular treatment/spectacle usage. 
 RESULTS: A total of 30 children with Down syndrome aged 5-15 years were examined. Uncorrected refractive errors were detected in 76.4% of them. Other lesions included mongoloid slant (53.5%), strabismus (33.3%), ptosis (33.3%), nystagmus (13.3%), and cataract (3.3%). None of the children with refractive errors had ever worn spectacles.
 CONCLUSIONS: Refractive error is a common finding in this population. There is a high unmet visual need in these children. This may have implications for visual and cognitive development. Early screening for ocular disorders in Down syndrome is recommended to detect and treat them.

Challenges in the management of paediatric cataract in a developing country.

AIM: To review the management of cataract in children in a tertiary hospital in a developing country, and to highlight the challenges therein. METHODS: The hospital records of children aged 15 years or less that had cataract surgery at University of Nigeria Teaching Hospital, Enugu from 2005 to 2008 were reviewed retrospectively. Information was obtained on bio-data, pre- and post-operative visual acuity (VA), biometry, and type of surgery, use of intraocular lens (IOL) and presence of co-morbidity. SPSS was used for data entry and analysis. RESULTS: The hospital records of 21 children (26 eyes) were analyzed. There were 12 males (57.1%) and 9 females (42.9%). Pre-operative VA could not be assessed in 11 eyes (42.3%), 14 eyes (53.9%) had VA <3/60 and 1 eye (3.8%) had VA 6/60. Biometry was done in only 5 eyes (19.2%). All eyes had standard extracapsular cataract extraction without primary posterior capsulectomy; 12 eyes (46.2%) had posterior chamber intraocular lens (PC-IOL) implant while 13 eyes (50.0%) had no IOL. After 12 weeks of follow up, vision assessment was available in only 15 eyes. With best correction, VA of 6/18 or better was achieved in only 5 eyes (33.3%). CONCLUSION: Inadequate facilities and inadequate follow up after surgery are some of the challenges in managing paediatric cataract in the developing countries. If these challenges are not addressed, cataract will remain a major cause of childhood blindness and low vision in Africa for many years. There should be collaboration between Paediatric Ophthalmology Centres in industrialized and developing countries to enhance skill transfer. Governmental and International Non-governmental Organizations can go a long way to facilitate this exchange.

Corneal ulcers in a tertiary hospital in Africa.

PURPOSE: To study the clinical features of corneal ulcers in a tertiary hospital in Africa. METHODS: This is a retrospective review of the medical records of 82 consecutive corneal ulcer patients who presented to the eye clinic of Enugu State University of Science and Technology (ESUT) Teaching Hospital Parklane, Enugu, Nigeria, in 2008. Data entry and analysis was done using SPSS version 15.0. RESULTS: The 82 consecutive patients comprised 38 males (36.3%) and 44 females (53.7%). Fifty-five (71.4%) presented with visual acuity in the affected eye of less than 3/60. After treatment, the vision improved in 21 eyes (32.3% of the total), remained the same in 34 eyes (52.3%), and deteriorated in 4 eyes (6.2%); 6 eyes (9.2%) had to be eviscerated. Forty-three eyes (52.4%) had antecedent trauma: Only 5 patients (6.1%) presented to the hospital within 24 hours of trauma or onset of symptoms. Thirty-eight patients (47.6%) sought treatment from patent medicine dealers prior to coming to the hospital, while 16 (19.5%) admitted use of traditional eye medication. CONCLUSION: Trauma is a major risk factor for corneal ulcer in developing countries. Vision is often poor after treatment, making corneal ulcer a major cause of corneal blindness. Patients commonly seek help from the wrong source and only present to the hospital when these have failed.

Monitoring cataract surgical outcome in a Nigerian mission hospital.

AIM: To evaluate the visual outcome of cataract operations in a Nigerian mission hospital. METHODS: The computer system cataract surgery record forms were used to collect data on the first 100 consecutive cataract surgeries performed in January and part of February 2003 at a Nigerian mission hospital, Mercy Eye Centre, Abak. RESULTS: There were 54 males and 30 females (100 eyes). Sixteen patients had bilateral cataract. The mean age was 58.45 years (SD 13.58). Four patients were hypertensive, 3 diabetic, 2 both hypertensive and diabetic; and also 2 both hypertensive and asthmatic. Four patients had post-uveitic cataract, 3 traumatic cataract, 1 subluxated cataract not related to trauma and the rest had age-related cataract. One patient each had age-related macular degeneration and glaucoma. Only 42 patients (49 eyes) kept with their follow-up visits until 12 weeks post-operatively. Among these, pin hole or corrected visual acuity of 6/6-6/18 was achieved in 35.4%, <6/18-6/60 in 50%, and <6/60 in 14.6%. Almost half of those with poor outcome were attributed to inappropriate selection. CONCLUSION: The main cause of poor visual outcome in our centre is unsuspected co-morbidity. In spite of this, there is potential for good quality cataract surgery in Africa. As we pay more attention to appropriate patient selection we expect our outcome to improve. Provision of facilities for biometry would also be a great help in this direction.

An overview of management of pterygium in Nigeria / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To review the management of pterygium in Nigeria.METHODS: The medical records of patients who had pterygium excisions over a four year period (January 1999-December 2002) were reviewed. These patients were seen at University of Nigeria Teaching Hospital and Ebrans Clinic both in Enugu, Nigeria. The analysis of patients' bio-data, clinical presentation, surgical management and post-operative complications were carried out using EPI-INFO version 6.1. Three surgical techniques were employed: bare sclera procedure only (60 eyes); bare sclera with adjuvant 5-fluorouracil (42 eyes)and bare sclera with mitomycin-C, MMC, (22 eyes).RESULTS: One hundred and twenty-four eyes of 72 patients had pterygium excisions and were followed up for a least one year post-operatively. There were 41 males (56.9%) and 31 females (43.1%) giving a male to female rario of 1 :0.8. The mean age was 42.8 years while the range was 20-69 years. Recurrence was highest is stage Ⅲ (55.6%) and lowest in stage Ⅰ (22.2%). Concerning the 3surgical techniques, the recurrence rates were 65.0%, 52%and L3.6% respectively.CONCLUSION: In the management of pterygium in a developing country, early excision with use of intraoperative MMC is advocated. It is safe, affordable, technically easier and less invasive.