Distribution of ocular perfusion pressure and its relationship with intraocular pressure in patients with primary open angle glaucoma in Enugu, South East, Nigeria.

Background: Ocular perfusion pressure (OPP) has been suggested as a possible risk factor for the development and progression of primary open angle glaucoma (POAG). Aim: To determine the distribution of OPP and its relationship with intraocular pressure (IOP) in Nigerian patients with POAG. Patients and Methods: : A descriptive and comparative survey was adopted. A total of 120 subjects, 60 newly diagnosed POAG and 60 non-glaucomatous (NG) subjects, aged 40 years and above, who attended the ophthalmic clinic of University of Nigeria Teaching Hospital Enugu were recruited over a six-month period in 2019. All the subjects had ocular examination, blood pressure and IOP measurements. Statistical package for social sciences software version 25 was used for data analysis. Chi-square test, independent samples t-test, and Mann-Whitney U test were used for comparison while Pearson correlation and simple linear regression were used to ascertain the relationship. A P value of <0.05 was considered significant. Result: The mean age of the participants was 57.9 + 11.9 years. The mean OPP was found to be significantly lower in the POAG subjects (Right eye, R = 43.6 ± 12.6, Left eye, L = 41.9 ± 13.3) mmHg compared with the NG group (R = 53.9 ± 10.9, L = 53.7 ± 10.9) mmHg (p < 0.001 for both eyes). A significant inverse relationship was observed between OPP and IOP in POAG subjects (p < 0.001), while there was none in NG subjects. Conclusion: OPP was lower in POAG subjects than in NG subjects. The observed relationship suggests that reduced OPP may play a role in the development of POAG.

Spectacle design preferences among school children in Enugu State, Nigeria.

BACKGROUND: Uncorrected refractive error has profound effects on children's educational and social development and spectacles are cost-effective in correcting this. However, the cosmetic appearance of spectacles may affect compliance to prescribed spectacles. AIMS: This study explored spectacle design preferences of school children in Enugu State, Nigeria and any associated sociodemographic factors. A cross-sectional study among children aged 5-15 years from schools in Enugu state, Nigeria. PATIENTS AND METHODS: The children independently selected from sets of spectacle frames, indicating their preferences on the basis of spectacle frame color, material, shape and size of the lens portion, design of the earpiece portions. Simple descriptive analysis was performed. Frequency tables were generated. Pearson's Chi-square test was used to test associations between categorical variables. Odds ratios were used to measure the strength of the associations where P < 0.05. Tests of significance were set at the 95% level. RESULTS: A total of 1,167 children (45.6% male and 54.4% female) were seen. Majority of the children preferred red colored spectacle frames 467 (40%), plastic frames 723 (62%), rectangular shaped lens-pieces (55.2%), and frames with a straight earpiece 987 (84.6%). There is a strong association between gender and choice of spectacle colour (P < 0.01), gender and lens size preference (P < 0.05), and between school location and shapes of spectacle earpiece (P < 0.01). CONCLUSIONS: Spectacle preferences exist among the study population and some demographic factors are associated with these preferences which should be considered in any childhood refractive error services.

Prevalence of refractive errors and visual impairment in school children in Enugu South-East Nigeria.

AIMS: To determine the prevalence of refractive errors and causes of visual impairment in school children in Enugu State, South-eastern Nigeria. METHODS: A descriptive cross-sectional, school-based survey in children aged 5-15 years from selected primary and junior secondary schools (public and private) in both urban and rural communities of Enugu State was carried out. Ocular examinations were performed on them according to the Refractive Error in School-age Children (RESC) protocol. RESULTS: A total of 1167 children were examined. The mean age (standard deviation) was 10.58 ± 3.0 years. Females were 653 (54.4%) of the study population. The uncorrected, presenting and best-corrected visual acuity of ≤20/40 (6/12) in the better eye of the children in this study were 3.6%. 3.5% and 0.4%. Among the children that had visual impairment, refractive error accounted for 33.3% of reduced vision while the overall prevalence of refractive error was 2.1%. Prevalence of myopia was 1.9% and hyperopia, 0.1%. The most prevalent astigmatism was ≤0.75 dioptre cylinder. CONCLUSION: The prevalence of refractive error in this study is low, with myopia being more common. Despite the low prevalence of refractive error, school vision screening is still important for African children as it serves as an opportunity to identify other ocular morbidities among the children.

Evaluation of content and cost of traditional eye medication in a resource-poor country - Implications for eye care practice and policy.

BACKGROUND: Cataract, glaucoma, and conjunctivitis are common causes of ocular morbidity in Nigeria. A major obstacle in reducing the burden of ocular morbidity in rural areas is access to eye care services. Up to 80% of the population in developing countries use traditional medications for their primary healthcare needs because they are accessible, available, and affordable. The aim of this study is to evaluate the content and cost of commercialized traditional medications used in the treatment of common eye conditions in Nigeria. PATIENTS AND METHODS: All the registered traditional healers (THs) at an International Trade Fair in Enugu who treated eye problems were identified. Data on their location and scope of their practice were collected by the researchers. Proxy patients consulted THs in the trade fair with simulated cataract, glaucoma, and bacterial conjunctivitis, and treatment was sought. Medication for the treatment of the simulated disorders was paid for and procured. The mode of administration and the cost of the drugs were recorded by proxy patients. Each medication was labeled with a code and sent to the laboratories of the National Agency for Drug Administration and Control for analysis. Data were entered into a database on Microsoft Access and transferred to STATA V12.1 (StataCorp) for analysis. RESULTS: Cataract was treated by 87.5% of all the traditional eye healers interviewed. A total of 32 samples were collected and analyzed. These comprised mainly oral (53.1%) and topical traditional medications (43.8%). The pH of the topical samples ranged from 3.5 to 10, while the mean microbiological load per topical solution was 3.3 × 104 cfu/mL ± 0.96. The cost of treatment of cataract ranged from 4 to 70 USD. CONCLUSION: The content of the majority of the samples of traditional eye medications in this study had high extremes of pH and/or had a high microbial content. The practice of THs should be regulated.

Audit of ophthalmology discharge summaries in a Nigerian Teaching Hospital.

BACKGROUND: Discharge summaries are important components of hospital-care transitions in ensuring continuity of care. AIM: We assessed the adequacy and accuracy of discharge summaries written by junior doctors. METHODS: An instrument, adapted largely from the current hospital discharge summary template and recommendations regarding content from the Joint Commission International, was used to study 420 discharge summaries written in 2012 from the ophthalmology service of a Rural Teaching Hospital in Nigeria. The simple descriptive analysis was done with Statistical Package for the Social Science version 17. RESULTS: Completeness of entries was relatively high in many traditional areas (biodata of patient, admission/discharge dates, name of supervising consultant, principal diagnosis, surgical procedures done, follow-up instructions, and condition on discharge) of the summaries. The portion of the paper-based template titled "summary" of the admission was most problematic; with information on medication changes and result of tests missing in 368/420 (87.6%) and 334/420 (79.5%), respectively. CONCLUSION: Educational intervention for doctors in training with the provision of oversight and feedback by their supervisors is required. Standardized discharge summary templates recognizing the peculiarities of specialized patient groups are recommended. Transition to electronic discharge summary system is imperative.

Patients' satisfaction with eye care services in a Nigerian teaching hospital.

BACKGROUND: Understanding the patients' perception of services received is essential as the parameters important to the patient may be quite different from that to the eye health provider. AIM: This study aims to evaluate patients' satisfaction with the care received from the pioneer teaching hospital in south-eastern Nigeria and use it to audit services. MATERIALS AND METHODS: This was a descriptive cross-sectional study. An interviewer-administered questionnaire was administered to 307 consecutive consenting patients seen at the eye clinic of the University of Nigeria Teaching Hospital Enugu in April 2013. The questionnaire asked questions regarding satisfaction with the time spent in the clinic, attitude of various categories of staff, physical facilities, cleanliness of the clinic and willingness to come again to the clinic or recommend it to others. RESULTS: The respondents were more satisfied with the attitude of the doctors and nurses than that of revenue and medical records clerks (P = 0.001). Most patients, 288 (93.8%) expressed satisfaction with the overall cleanliness of the eye clinic; 220 (71.7%) and 288 (93.8%) were not satisfied with the toilet facilities and cost of services, respectively. Only 140 (45.6%) participants will recommend the hospital to others strongly, 145 (47.2%) will do so hesitantly. CONCLUSION: Majority of the patients were satisfied with the services received. The major dissatisfaction points were cost of services and inadequate toilet facilities.

Refractive errors in children with autism in a developing country.

BACKGROUND: In a resource-limited country visual problems of mentally challenged individuals are often neglected. AIM: The present study aims to study refractive errors in children diagnosed with autism in a developing country. MATERIALS AND METHODS: Ophthalmic examination was carried out on children diagnosed with autism attending a school for the mentally challenged in Enugu, Nigeria between December 2009 and May 2010. Visual acuity was assessed using Lea symbols. Anterior and posterior segments were examined. Cycloplegic refraction was performed. Data was entered on the protocol prepared for the study and analyzed using Statistical Package for the Social Sciences version 17 (Chicago IL, USA). RESULTS: A total of 21 children with autism were enrolled in the school; 18 of whom were examined giving coverage of 85.7%. The age range was 5-15 years, with a mean of 10.28 years (standard deviation ± 3.20). There were 13 boys and 5 girls. One child had bilateral temporal pallor of the disc and one had bilateral maculopathy with diffuse chorioretinal atrophy. Refraction revealed 4 children (22.2%) had astigmatism and 2 children (11.1%) had hypermetropia. CONCLUSION: Significant refractive error mainly astigmatism was noted in the children with autism. Identifying refractive errors in these children early and providing appropriate corrective lenses may help optimize their visual functioning and impact their activities of daily life in a positive way.

Evaluation of complications of extracapsular cataract extraction performed by trainees

Background: Cataract extraction is the most common intraocular surgery taught to residents. Aim: This study aims to review the complications of trainee-performed extracapsular cataract extraction (ECCE) so as to identify the steps in which the trainee can benefit from closer supervision and practice. Subjects and Methods: This was a descriptive retrospective study of complications in the initial 150 ECCE with intraocular lens implant performed by two Ophthalmologists; from the University of Nigeria Teaching Hospital; Enugu; who visited a high volume training center. Both the intraoperative and early post-operative complications were studied. Data entry and analysis were performed descriptively using the Statiscal Package for the Social Sciences; SPSS version 15.0 (Chicago; IL; USA). Results: The age range of the patients was 40-95 years. The intraoperative complications included capsular flaps 12/161 (7.5); posterior capsule rent; 10/161 (6.2) and vitreous loss; 8/161 (5.0). Corneal complications (striate keratopathy; superior corneal edema; generalized corneal edema and corneal folds) ranked highest in post-operative complications accounting for 34 (56/164). Conclusions: Performance of adequate and proper anterior capsulotomy; minimal handling of the cornea and avoidance of posterior capsular rent are some of the challenges of the trainee in mastering ECCE. Stepwise supervised training can help a trainee master these steps while keeping the complications at acceptably low levels

Oxyphil cell adenoma in a Nigerian: case report and review of the literature.

Oncocytomas of the lacrimal gland are rare tumors. We report the first documented case in Nigeria. This was an interventional case report. A complete ophthalmologic and systemic examination with available pertinent investigations was done, followed by a modified exentheration and histopathologic examination. A 60-year-old Nigerian housewife was evaluated for a slow-growing, right upper lid mass associated with visual lesion in the ipsilateral eye. Plain skull x-rays revealed a soft tissue in the right eye orbit without any bony extension. A modified exentheration was done. Histopathology showed sheets of oxyphil cells in the lacrimal gland. Although rare, more cases of oncocytomas may exist than are reported in the literature.

Structured extracapsular cataract extraction-intraocular lens microsurgical training: report of a trainee's experience.

AIM: The aim was to report the experience an ophthalmologist gained in a structured intraocular lens (IOL) microsurgery training program for the information and benefit of colleagues in ophthalmology training institutions. MATERIALS AND METHODS: An ophthalmologist was trained in extracapsular cataract extraction (ECCE)-IOL implant in Aravind Eye Hospital (AEH), Madurai, for a period of 8 weeks. Details of patients operated on, procedures observed, and conferences attended were prospectively recorded in a log book. RESULTS: Training was available in conventional ECCE with posterior chamber IOL (ECCE-PCIOL), small incision sutureless cataract surgery, and phacoemulsification. During the period, this trainee observed a total of 1527 cataract extractions, administered 528 retrobulbar and 1047 facial blocks, and also operated on 75 patients. The trainee gained experience and confidence to perform high-quality, low-cost cataract surgery. CONCLUSION: Hands-on experience and competence in quality ECCE-IOL implant microsurgery can be acquired in a short period of time in a high-volume cataract center. Trainees can also be exposed to other techniques of cataract surgery. Ophthalmology training centers with diminishing surgical training opportunities can also benefit from this structured training in a high-volume cataract center like Aravind Eye Hospital.

Testicular cancer: Management challenges in an African developing country.

BACKGROUND: Advances in oncology have greatly improved the prognosis of testicular cancer. In developing countries, however, the outcome is still poor. PATIENTS AND METHODS: Twenty-four patients managed for testicular cancer at two centres (University of Nigeria Teaching Hospital, Enugu, Nigeria, and JAMA Urological Clinic, Enugu) between April 1984 and March 2003 were prospectively studied. Histopathological data were obtained in all cases. RESULTS: Peak age incidence was 20 - 29 years. Testicular swelling was the principal complaint in 23 patients. The mean interval between onset of symptoms and presentation was 5.3 months. Two patients (8.3%) presented with stage 1 disease, 7 (29.2%) with stage 2, 7 (29.2%) with stage 3, and 8 (33.3%) with stage 4. Seventy-five per cent of tumours were right-sided, and 25% were left-sided. Treatment consisted of radical orchidectomy in all patients and cisplatin-based chemotherapy and radiotherapy in some patients. One patient with a tumour in an intra-abdominal testis underwent laparotomy. The most common histological types were seminoma and embryonal carcinoma. A fifth of the patients died, while half were lost to follow-up. The mean follow-up period was 9 months. CONCLUSION: Morbidity and mortality of testicular cancer is high in developing countries. Late presentation, poverty, paucity of resources and the high cost of newer imaging modalities and treatment are major challenges to management. Better health funding and education regarding testicular self-examination is essential.

Visual loss in a school for the blind in Nigeria.

BACKGROUND: There are an estimated 1.4 million blind children worldwide, it has been observed that almost 90% of the so-called blind population (children inclusive) do not have total loss of visual function, but retain a degree of usable residual vision. The study aims to determined the sites and causes of visual loss in the students of a school for the blind in Nigeria, and also the proportion of those students who could benefit from low vision devices. METHODS: Forty-five students of the school were examined using the standard World Health Organization/Prevention of blindness examination record for childhood blindness. Refraction and assessment for low vision devices were conducted, where necessary. RESULTS: Glaucoma/buphthalmos (22.2%) and corneal lesions (20%) were the major causes of vision loss. Six students (13.3%) benefited from spectacles and/or low vision devices. CONCLUSION: Glaucoma/buphthalmos is assuming great significance in this study population, though most of the causes of vision loss are avoidable (77.7%). There is need for low vision service in the schools for the blind in South East Nigeria.

Management of primary congenital glaucoma by trabeculectomy in Nigeria.

AIM: To review the management of congenital glaucoma, bearing in mind the limited facilities available in developing countries. METHODS: The medical records of children aged < or = 3 years with primary congenital glaucoma seen at two teaching hospitals and one private eye hospital in Enugu, Nigeria over a 5-year period were reviewed retrospectively. All the children underwent trabeculectomy without use of anti-metabolites. RESULTS: Fifty-seven eyes of 32 patients (5 unilateral, 26 bilateral) were reviewed. Pre-operatively, 63.2% of the eyes had a corneal diameter of 12-15 mm. After surgery, the number with corneal haziness decreased from 25 (43.8%) to 15 (26.4%) (p=0.05). The mean (SD) pre-operative intra-ocular pressure (IOP) was 28.3 (7.5) mmHg and the mean post-operative IOP was 17 (5.6) mmHg (p=0.001). CONCLUSIONS: When facilities for other treatment modalities are not available, primary trabeculectomy without the use of anti-metabolites can be employed to manage primary congenital glaucoma.

A study on some physical attributes of Naeini sheep wool for textile industry.

In order to evaluate some physical and qualitative characteristics of Naeini sheep wool for using in textile industry, herds from 6 different regions of Isfahan province were chosen. Staple length from 3 different body parts (shoulder, side and britch) was measured prior to shearing. Wool samples were taken from a 100 cm2 surface on the mid-side of the Animals. Then the samples were transferred to the Laboratory of Animal Sciences for evaluations of some quality characteristics and to the Fiber Physics Laboratory for measuring tenacity, breaking strength and elongation at break of fibers. The means and standard deviations of staple length were estimated (10.8 +/- 2.36), (9.71 +/- 3.14) and (10.99 +/- 2.49) cm for shoulder, side and britch parts, respectively. The total average staple length of Naeini sheep (10.5 cm) is suitable for using in textile industry. Wool fibers of Naeini sheep have desirable tenacity and breaking strength (1.22 cN/dtex and 13.76 centi-Newton) to resist against mechanical tensions of the spinning step. However, Naeini sheep wool fibers have an adequate, but not a desirable % elongation at break (28.6%). Based on the fiber diameter mean of Naeini sheep and its variation (28.51 +/- 4.33 microm) the fleece grade of Naeini sheep was predicted 54's, which is an intermediate grade. However, by conducting breeding programs toward enhancing fleece grade, Naeini sheep wool will be simply applicable in textile industry.

Sildenafil citrate (Viagra) for the treatment of erectile dysfunction in Nigerian men.

Fifty-eight Nigerian outpatients with documented erectile dysfunction (ED) received open-label sildenafil citrate (Viagra) for 8 weeks. The 50-mg starting dose could be adjusted to 100 or 25 mg based on response and tolerability. The International Index of Erectile Function (IIEF) Questionnaire, a global efficacy question, and intercourse data recorded in a patient event log were used to assess efficacy. Frequency of penetration and maintained erection were both significantly enhanced (P<0.0001); 95% of patients reported improved erections and 81% of all attempts at intercourse were successful. Orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction also improved significantly (P&<0.0001). The most frequent adverse events (all-cause) were headache (17%) and myalgia (3%); only one patient discontinued treatment because of headache, which was considered unrelated to sildenafil. Oral sildenafil significantly improved erectile function and was well tolerated in this trial of Nigerian men suffering from ED. Our results are consistent with reports from other countries.

One-stage urethroplasty for strictures: Nigerian experience.

PURPOSE: To analyze the effects on voiding and complications of one-stage urethroplasty for urethral stricture. METHODS: All patients who underwent one-stage urethroplasty for stricture in two health institutions in Enugu, Nigeria, between January 1989 and December 1998, were included. The age of the patient, duration of symptoms and the cause of the stricture were noted. Retrograde urethrogram and, when necessary, micturating cystourethogram was done. Urethroplasty was either by substitution using pedicled penile skin flap or by end-to-end anastomosis. Patients were followed up monthly for 1 year during which the patient's ability to urinate satisfactorily was assessed and any complications were noted. One hundred and forty-four (144) men, aged between 11 and 76 years (mean 36.3 +/- 11.2 years), were studied. These included 121 cases who had rapidly recurring strictures after internal urethrotomy or dilatation and 23 cases of complete stricture. Etiology of the stricture included external trauma (43.8%), postinflammatory (36.1%) and iatrogenic (post-catheterization; 20.1%). Ninety-one (63.2%) strictures were in the anterior urethra, 47 (32.6%) in the posterior urethra and six (4.2%) bulbomembranous. The mean length of the strictures was 3.1 +/- 1.4 cm. RESULTS: Anastomotic urethroplasty was performed in 98 (68.1%) patients and substitution in 46 (31.9%). Hospital stay was between 12 and 14 days, except in those who developed complications. Normal voiding was achieved in 124 (86.1%) patients. Urethral fistula was encountered in five (3.5%) patients and recurrent stricture in 15 (10.4%). There was no mortality. CONCLUSIONS: One-stage urethroplasty affords an excellent cost-effective means of reconstruction of the urethra in patients with stricture of various etiologies. In our environment in particular, it avoids the fulminating infection often encountered after the first stage of a two-staged operation.

Priapism in adult Nigerians.

OBJECTIVES: To review the presentation and treatment of adult Nigerians with priapism. PATIENTS AND METHODS: Thirty-five men (mean age 35 years, range 20-54) were seen over a 12-year period. All patients underwent an immediate modified or conventional cavernospongiosus shunt and were assessed at 2, 6 and 12 weeks after discharge for erection, orgasm and fibrosis of corpora cavernosa. RESULTS: Ten patients initially presented to traditional healers and 13 presented early to qualified medical practitioners, and were managed conservatively. As a result, 21 of the 35 patients presented to the author's hospital 6-10 days after the onset of erection. Many did not realise that priapism was abnormal, or had no money to attend hospital. After surgical treatment detumescence was obtained in all patients and maintained. At 12 weeks, 14 patients had normal erections, 13 reduced erections and eight no erections. A local aphrodisiac was identified as the commonest predisposing factor, followed by sickle-cell disease. CONCLUSION: This study shows clearly that even if a patient with priapism presents late, vigorous treatment in the form of an adequate shunt should be undertaken as soon as possible, as this is the only chance the patient has to regain potency.

Renal cell carcinoma in Enugu, Nigeria.

Over a period of ten years (July 1988 to June 1998) all the patients seen at two health institutions in Enugu metropolis, with histologically diagnosed renal cell carcinoma, were studied to elucidate the pattern of presentation, management and response to treatment. Seventy four (74) such patients were seen during the study period. Fifty two (70.3%) were males while 22 (29.7%) were females. The ages of the patients ranged between 17 years and 72 years with a mean of 44 years. The commonest features at presentation were weight loss (100%) raised ESR (94.6%), haematuria (86.5%), anaemia (66.2%) and upper quadrant mass (64.9%). No bilateral case was encountered. Thirty two patients (43.2%) presented with the clinical triad of haematuria, loin pain and renal mass. Seven patients (9.5%) were HIV positive. Fifty nine patients (79.7%) presented with stages 3 and 4 disease and the outcome was poor. Those that presented with stages 1 and 2 tumour had good prognosis. Early diagnosis of the tumour is important in order to give the patients a high chance of survival.

Ureteric injuries in Enugu, Nigeria.

OBJECTIVE: To study the aetiology, mode of presentation and treatment outcome of ureteric injuries in Enugu. DESIGN: A prospective study carried out between January 1986 and December 1997. SETTING: Three busy health institutions in Enugu, Nigeria, namely, University of Nigeria Teaching Hospital, Mother of Christ Specialist Hospital and JAMA Urological Clinic. SUBJECTS: All patients presenting with ureteric injuries during the study period. INTERVENTIONS: Exploration and reconstruction of the injured ureter. MAIN OUTCOME MEASURES: Intravenous urography three months post operatively. RESULTS: One hundred and forty-eight patients were treated, out of which fifteen had bilateral injuries. All the injuries except one, occurred during operations for various abdominal and pelvic conditions. Fifteen males (10.1%) and 133 females (89.9%) were involved. Gynaecological operations accounted for majority of cases (87.8%). The type of injury was either transection or ligation. The left ureter was injured more than the right (52.1% and 47.9%, respectively). In 71 patients (48.0%), there was a fistula between the injured ureter and the vagina, presenting clinically with urinary incontinence. In 39 patients (26.4%), the injuries were discovered at surgery while the rest presented after the offending surgery. Ureteroneocystostomy, end-to-end ureteric anastomosis, and ileal interposition were the reconstructive methods adopted. All the renal units were salvaged and all the patients survived the procedures, however, post-operative IVU in four patients showed ureteric reflux. CONCLUSION: Open gynaecological operations are still the leading cause of ureteric injuries in Nigeria.