Knowledge and practice of primary eye care among primary healthcare workers in northern Nigeria.

OBJECTIVE: To assess knowledge and practice of primary eye care among primary healthcare workers known as community health extension workers in Funtua district of Nigeria. METHODS: Cross-sectional mixed method study among health workers employed in government-owned primary healthcare facilities. Quantitative data were obtained using self-administered questionnaires and checklists, while qualitative data by modified Delphi technique, role plays and observation. A score of 1 was given for each correct answer, while a total score of ≥60% was considered 'good'. RESULTS: Eighty three of 88 health workers participated (94%) in the questionnaire survey; while 16 of them were selected for the qualitative survey. Good scores regarding the knowledge of common eye diseases were obtained by 68.7%, but only 26.4% of them could identify their most important features. Participants could undertake 3 of 5 steps in visual acuity testing. Skills in recognising common eye diseases and their management were weak; while practice was often not according to the guidelines. CONCLUSION: Community health extension workers displayed good knowledge of common eye diseases. Areas of weakness are recognition and interpretation of eye signs, and practice rarely follows the guidelines. Preventive medicine was neglected; community health extension workers require practical retraining and supervision to achieve integration of primary eye care into primary healthcare services.

Peribulbar versus retrobulbar anaesthesia for cataract surgery.

BACKGROUND: Cataract is a major cause of blindness worldwide. Unless medically contraindicated, cataract surgery is usually performed under local (regional) anaesthesia. Local anaesthesia involves the blockage of a nerve subserving a given part of the body by infiltration of the area around the nerve with local anaesthetic. The two main approaches in the eye are retrobulbar and peribulbar. There is debate over whether the peribulbar approach provides more effective and safer anaesthesia for cataract surgery than retrobulbar block. OBJECTIVES: The objective of this review was to assess the effects of peribulbar anaesthesia (PB) compared to retrobulbar anaesthesia (RB) on pain scores, ocular akinesia, patient acceptability and ocular and systemic complications. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 4); MEDLINE (1960 to December 2007); and EMBASE (1980 to December 2007). SELECTION CRITERIA: We included randomized controlled clinical trials comparing peribulbar anaesthesia and retrobulbar anaesthesia for cataract surgery. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted trial authors for additional information, study methodology and missing data. We carried out a descriptive narrative of results as the methods used by the included stories for reporting the outcomes varied. We performed a subgroup analysis for globe akinesia. MAIN RESULTS: We included six trials involving 1438 participants. Two of the six trials had a low risk of bias; the remaining four had a moderate risk of bias. There was no evidence of any difference in pain perception during surgery with either retrobulbar or peribulbar anaesthesia. Both were largely effective. There was no evidence of any difference in complete akinesia or the need for further injections of local anaesthetic. Conjunctival chemosis was more common after peribulbar block (relative risk (RR) 2.11, 95% confidence Interval (CI) 1.46 to 3.05) and lid haematoma was more common after retrobulbar block (RR 0.36, 95% CI 0.15 to 0.88). Retrobulbar haemorrhage was uncommon and occurred only once, in a patient who had a retrobulbar block. AUTHORS' CONCLUSIONS: There is little to choose between peribulbar and retrobulbar block in terms of anaesthesia and akinesia during surgery in terms of acceptability to patients, need for additional injections and development of severe complications. Severe local or systemic complications were rare in PB and RB.

Outcome of scleral buckling for primary rhegmatogenous retinal detachment in Nigeria.

BACKGROUND: The goal was to review the visual and anatomical outcome of scleral buckling for primary rhegmatogenous retinal detachment at a tertiary eye care center in Nigeria between January 1994 and December 2000. MATERIAL/METHODS: This was a retrospective, descriptive case series of all eyes that had undergone scleral buckling over a 7-year study period. Data collected from the case notes included duration of symptoms, visual acuity at presentation and 3 and 6 months post-op, clinical presentation of the detachments, risk factors for retinal detachment, the surgical procedure done, anatomical outcome at discharge and at 3 and 6 months post-op, and intra-op and post-op complications. RESULTS: Ninety-eight eyes of 98 patients underwent scleral buckling for primary rhegmatogenous retinal detachment during the study period. The mean age was 42 years. The male-to-female ratio was 3.7:1. The mean duration of symptoms was 29.7 weeks. Seventy-six eyes (77.6%) had subtotal to total retinal detachment, with 91 (92.9%) eyes having macular detachment. The surgical technique was cryotherapy, sub-retinal fluid drainage, and explant. At 3 months post-op, 40/54 (74.1%) eyes had successful anatomical outcome. Only 52% (21/40) of these eyes had the best corrected visual acuity of 6/60 or better at 3 months post-op. CONCLUSIONS: In Nigeria, and possibly many developing countries, efforts should be made towards early diagnosis and treatment of retinal detachments with adequate expertise and facilities.