Vitreous Hemorrhage, Aetiology and Visual Outcome of Vitrectomy in a Black African Population.

BACKGROUND: Information on the causes and outcome of treatment of vitreous hemorrhage (VH) in sub-Saharan Africa is limited. OBJECTIVES: To determine the causes and postoperative vision after vitrectomy for VH. DESIGN: A retrospective review of records from consecutive eyes, with VH greater than one-month duration, who had vitrectomy and adjunctive treatment in a retina unit in Nigeria. METHODS: We assessed the change between preoperative and postoperative visual acuity, bio data, cause of VH, duration of follow up, and additional treatment. Data was analyzed using SPSS statistical package 17.0 to determine the significance of the change in visual acuity for each cause of VH. A p value <0.05 was considered statistically significant. RESULTS: Of the 221 eyes of 219 patients, the common causes of VH were trauma 43 eyes, (19.7%), proliferative diabetic retinopathy, 37 eyes (17.0%) and proliferative sickle cell retinopathy, 30 eyes (13.8%). There was no association between cause and the presenting preoperative visual acuity. There was a statistically significant association between cause of VH and postoperative visual outcome. Postoperative visual improvement was significant for branch retinal vein occlusion, central retinal vein occlusion, proliferative diabetic retinopathy with VH only, proliferative sickle cell retinopathy, and trauma with VH only, p value = 0.000, 0.002, 0.001, 0.039, and 0.000 respectively. Postoperative visual change was not significant in age-related macular degeneration and polypoidal choroidal vasculopathy (p value = 0.155, 0.428 respectively). CONCLUSION: Significant improvements in visual acuity can be achieved with active treatment of VH in the majority of cases in Nigeria. This information is useful for discussions on prognosis and agrees with previous studies.

CONTEXTE: Les informations sur les causes et les résultats du traitement de l'hémorragie vitréenne (HV) en Afrique subsaharienne sont limitées. OBJECTIFS: Déterminer les causes et la vision postopératoire après une vitrectomie pour une HV. CONCEPTION: Une revue rétrospective des dossiers d'yeux consécutifs, avec une HV de plus d'un mois, qui ont subi une vitrectomie et un traitement d'appoint dans une unité de rétine au Nigeria. MÉTHODES: Nous avons évalué la variation entre l'acuité visuelle préopératoire et postopératoire, les données biologiques, la cause de l'HV, la durée du suivi et le traitement complémentaire. Les données ont été analysées à l'aide du progiciel statistique SPSS 17.0 afin de déterminer la signification du changement d'acuité visuelle pour chaque cause de HV. Une valeur p <0,05 a été considérée comme statistiquement significative. RÉSULTATS: Sur les 221 yeux de 219 patients, les causes les plus fréquentes de l'HV étaient les suivantes : traumatisme, 43 yeux (19,7%), rétinopathie diabétique proliférante, 37 yeux (17,0 %) et rétinopathie drépanocytaire proliférante, 30 yeux (13,8 %). Il n'y avait pas d'association entre la cause et l'acuité visuelle préopératoire. Il y avait une association statistiquement significative entre la cause de l'HV et le résultat visuel postopératoire. L'amélioration visuelle postopératoire était significative pour l'occlusion de la veine rétinienne de branche, l'occlusion de la veine rétinienne centrale, la rétinopathie diabétique proliférante avec HV uniquement, la rétinopathie drépanocytaire proliférante et le traumatisme avec HV uniquement, valeur p = 0,000, 0,002, 0,001, 0,039 et 0,000 respectivement. Le changement visuel postopératoire n'était pas significatif dans la dégénérescence maculaire liée à l'âge et la vasculopathie choroïdienne polypoïde (valeur p = 0,155,0,428 respectivement). CONCLUSION: Des améliorations significatives de l'acuité visuelle peuvent être obtenues avec un traitement actif de l'HV dans la majorité des cas au Nigeria. Cette information est utile pour les discussions sur le pronostic et concorde avec les études précédentes. Mots clés: Rétinopathie diabétique, traumatisme oculaire, rétinopathie diabétique proliférante, rétinopathie drépanocytaire, Afrique subsaharienne, hémorragie vitrée, vitrectomie, acuité visuelle.

Leaves and stems of Capparis erythrocarpos, more sustainable than roots, show antiarthritic effects.

ETHNOPHARMACOLOGICAL RELEVANCE: Capparis erythrocarpos is a medicinal plant used widely in many parts of Africa for the management of pain and inflammatory conditions such as rheumatoid arthritis. Its wide range of use, popularity and high value, make C. erythrocarpos containing products a target for economically driven adulteration. This is made worse, by the use of roots, which are unsustainable plant parts. In addition, the mechanism of anti-inflammation is not clearly understood. AIM OF THE STUDY: Therefore, this study comparatively evaluated the anti-arthritic and analgesic effects of the leaves, stems and roots of C. erythrocarpos, while elucidating the mechanism of anti-inflammation. MATERIALS AND METHODS: Using the complete Freund's adjuvant arthritis model, the antiathritic effects were evaluated. The analgesic effects were determined by measuring responses to Von Frey filament number 9. Effects of C. erythrocarpos extracts on the levels of Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-α) were determined using ELISA. Haematological and serum biochemical assays were also carried out. RESULTS: The leaf, stem and root extracts significantly reduced paw volumes with ED50 values (mg/kg) of 182.5, 181.5 and 36.4 respectively. The leaf extract at a dose of 100 mg/kg showed substantial analgesic activity with a decrease in the percentage response to Von Frey filament 9. However, there was no significant difference in activities of the leaf, stem and root extracts. Results from ELISA assays show that lower doses of the stem extracts reduce levels of IL-6. Lower doses of all extracts also reduce TNF-α levels. Haematological analysis showed extracts reversed elevated WBC and platelet levels. Toxicity evaluation with kidney and liver function tests indicated no significant differences between the treatment and control groups. CONCLUSIONS: The leaves and stems, just as the roots, have antiarthritic and analgesic effects and can be used as more sustainable alternatives to the roots. This will support the continuous growth of the industry that has developed around C. erythrocarpos.

Bilateral simultaneous macular infarction with spontaneous visual recovery in genotype ss hemoglobinopathy patient.

To report the rare and dramatic event of bilateral macular infarction in a sickle cell hemoglobinopathy (SS genotype) patient, resulting in bilateral severe reduction in visual acuity. Without any intervention, the patient's vision gradually improved over the follow-up period. Central visual field defects however persisted. A 21-year-old male Nigerian, presented with a 1-week history of bilateral sudden painless loss of vision. His symptom was associated with fever, feeling of heaviness in the chest and head, and a dizzy spell. Visual acuity was reduced to 20/200 in both eyes and near acuity was; right eye: N24, left eye: N36. Funduscopy showed a pale, milky white, thickened retinal patch superotemporal to the fovea in both eyes. Fluorescein Angiograph: revealed features consistent with occlusion of the parafoveal terminal arterioles in both eyes. Although he did not receive any ocular treatment, and exchange blood transfusion was not done, he regained near-normal visual acuity in both eyes over a 17-month follow-up period, central visual field defects persisted in both eyes. Visual recovery in this patient demonstrates that macular function could improve over time following macular ischemia, without any treatment. Patients and caring physicians should be aware of this possibility.

Presentation of glaucoma in the greater Accra metropolitan area of Ghana.

BACKGROUND: This study addresses the prevalence and clinical presentation of patients with primary open angle glaucoma (POAG) in the greater Accra metropolitan area. METHODS: This is a retrospective case series of 455 patients (813 eyes) at the Emmanuel Eye Clinic. Patients were diagnosed from May 2008 to Nov 2011. The definition of POAG conformed to the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. Information collected included basic demographic data, distribution of glaucoma subtypes, measured intraocular pressure (IOP), best corrected visual acuity (BCVA) and optic disc measurements. RESULTS: Nearly 24% presented blind in at least one eye. The average age was 56.7 +/-16.7 years and the average IOP was 33.9 mmHg +/- 12.7 mmHg for right eyes and 33.5 mmHg +/-12.0 mmHg for left eyes. The mean vertical cup to disc ratio (vCDR) was 0.83 for right eyes versus 0.82 for left eyes. A total of 32 patients (53 eyes) were diagnosed with normal tension glaucoma (NTG). Statistically significant differences between the NTG and high tension groups included age (45.3 +/- 16.7 vs. 56.7 +/-16.7, p<0.001), mean IOP (19.1 mmHg +/- 4.5 mmHg vs. 33.7 +/- 12.4 mmHg, p<0.001) and mean vCDR (0.76 +/- 0.17 vs. 0.83 +/-0.10, p<0.01). Comparing age-matched NTG patients with high tension glaucoma patients showed no significant difference in vCDR. CONCLUSIONS: The clinical presentation of POAG at the Emmanuel Eye Center is characterized by elevated IOP and grossly advanced optic neuropathy. Significant differences between high tension glaucoma and NTG were identified.

The effect of medical therapy on IOP control in Ghana.

BACKGROUND: To investigate IOP control following twelve months of continuous medical therapy in Ghana. METHODS: This retrospective case series included 163 glaucoma patients diagnosed at a referral eye center between 1996 and 2006. Information collected included age, gender, IOP at presentation, six months and one year post treatment and types of anti-glaucoma medications prescribed. Optimal IOP control was defined according to results from the Advanced Glaucoma Intervention Study (AGIS), which demonstrated arrest of visual field progression in patients with IOP < 18 mmHg at all visitations: Level 1 (post-treatment IOP ≤ 21 mmHg); Level 2 (≤ 18 mmHg) and level 3 (≤ 16 mmHg). The principal outcome measure was the achievement of IOP <18 mmHg at six months and twelve month visitations. RESULTS: One hundred sixty three patients were analyzed. These included 68 males (41.7%) and 95 females (58.3%). The mean age was 57±16 (median 59 years; range 7 - 95 years). There was no significant difference in age (p=0.35) or mean IOP (p=0.08) between genders. The mean pre-treated IOP of 31.9±8.9 mmHg significantly decreased to 21.3±6.6 mmHg at 6 months (p=0.001), with 57.4% of eyes at Level 1 IOP control, 25.3% at Level 2 and 15.4% at Level 3 and decreased further at 12 months to 20.7±6.9 mmHg (p=0.48) with 69.7% of eyes at Level 1, 34.4% at Level 2, and 12.4% at Level 3. CONCLUSIONS: Current medical regimen is insufficient to reduce IOP to target levels as defined in the Advanced Glaucoma Intervention Study.

Presentation of Glaucoma in the Greater Accra Metropolitan Area of Ghana

Background: This study addresses the prevalence and clinical presentation of patients with primary open angle glaucoma (POAG) in the greater Accra metropolitan area. Methods: This is a retrospective case series of 455 patients (813 eyes) at the Emmanuel Eye Clinic. Patients were diagnosed from May 2008 to Nov 2011. The definition of POAG conformed to the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. Information collected included basic demographic data; distribution of glaucoma subtypes; measured intraocular pressure (IOP); best corrected visual acuity (BCVA) and optic disc measurements. Results: Nearly 24 presented blind in at least one eye. The average age was 56.7 +/-16.7 years and the average IOP was 33.9 mmHg +/- 12.7 mmHg for right eyes and 33.5 mmHg +/-12.0 mmHg for left eyes. The mean vertical cup to disc ratio (vCDR) was 0.83 for right eyes versus 0.82 for left eyes. A total of 32 patients (53 eyes) were diagnosed with normal tension glaucoma (NTG). Statistically significant differences between the NTG and high tension groups included age (45.3 +/- 16.7 vs. 56.7 +/-16.7; p0.001); mean IOP (19.1 mmHg +/- 4.5 mmHg vs. 33.7 +/- 12.4 mmHg; p0.001) and mean vCDR (0.76 +/- 0.17 vs. 0.83 +/- 0.10; p0.01). Comparing age-matched NTG patients with high tension glaucoma patients showed no significant difference in vCDR. Conclusions: The clinical presentation of POAG at the Emmanuel Eye Center is characterized by elevated IOP and grossly advanced optic neuropathy. Significant differences between high tension glaucoma and NTG were identified

The Effect of Medical Therapy on IOP Control in Ghana

Background: To investigate IOP control following twelve months of continuous medical therapy in Ghana. Methods: This retrospective case series included 163 glaucoma patients diagnosed at a referral eye center between 1996 and 2006. Information collected included age; gender; IOP at presentation; six months and one year post treatment and types of anti-glaucoma medications prescribed. Optimal IOP control was defined according to results from the Advanced Glaucoma Intervention Study (AGIS); which demonstrated arrest of visual field progression in patients with IOP 18 mmHg at all visitations: Level 1 (post-treatment IOP . 21 mmHg); Level 2 (. 18 mmHg) and level 3 (. 16 mmHg). The principal outcome measure was the achievement of IOP 18 mmHg at six months and twelve month visitations. Results: One hundred sixty three patients were analyzed. These included 68 males (41.7) and 95 females (58.3). The mean age was 57}16 (median 59 years; range 7 . 95 years). There was no significant difference in age (p

Central retinal artery occlusion following peribulbar anesthesia for pterygium excision.

Pterygium is a common ocular surface pathology in tropical environments. In the early stages, it may be managed medically with topical anti-inflammatory agents and ocular lubricants. However as the disease progresses, surgical excision becomes necessary and several anaesthetic methods may be used to assist this. We share our experience of a 30-year old woman who underwent uneventful pterygium excision using peribulbar lignocain injection with adrenaline. She developed sudden blindness due to central retinal artery occlusion with macular infarction. While peribulbar anaesthesia is generally safe, a remote risk of retinal vascular accident exists and its routine use should be done with caution. Where possible topical anaesthesia with or without intra-lesional injection be employed.

Causes and incidence of destructive eye procedures in north-eastern ghana.

OBJECTIVE: To determine the causes and incidence of destructive ophthalmic procedures as seen at a major reference eye centre in northern Ghana METHODS: Retrospective case series involving a review of surgical records of all evisceration and enucleation procedures done between January 2002 and December 2006 at the Bawku Hospital Eye Department. Information collected included basic demographic data, diagnosis, visual acuity at diagnosis and the eye affected. The aetiology responsible was determined from history, clinical examination and investigations as contained in the existing records. The primary clinical indications for evisceration were categorized into degenerative lesions, infections, trauma, neoplasms, and others. Statistical analysis was done using the Epi Info software. RESULTS: A total of 337 eyes of 336 patients made up of 217 (64.6%) males and 119 (35.4%) females were removed during the study period. Mean age was 36.4 with a range of 1-90 years. Children under 15 years constituted 25.1% of whom 9.3% were under 5 years. The elderly (>/=60 years) comprised 26.3%. The most common cause of destructive procedure was endophthalmitis /panophthalmitis (47.9%), ocular injuries (23.2%), degenerative lesions (8.9%) and neoplasms (5.1%). Regarding neoplasms, females were more likely to be enucleated while the reverse was so for traumas (p=0.04 and p=0.02, Chi(2) test, respectively). Compared to the total number of surgeries done each year the crude incidence was computed at 26.6% per 1000 cases per year. CONCLUSION: Most causes of destructive procedures in this part of Ghana are preventable and serious preventive strategies are needed to reverse this trend.

Barriers to Cataract Surgical Uptake in the Upper East Region of Ghana

Background: The Upper East Region has one of the highest cataract surgical rates in Ghana. Notwithstanding this; cataract blindness is still a major problem. Aim: To determine patient-related barriers to cataract services in the region and their resolution. Methods: Focus Group Discussion (FGD) and Indepth interviews were used to explore the opinions of 66 cataract patients resident in the region between July and August 2003. Purposeful sampling was used in selecting 24 patients in the hospital while a Snowball sampling method was employed on 42 respondents resident in the village communities Results: Average age of the respondents was 67.6 years with equal proportions of males and females (0.9:1). Twelve and fifteen percent of respondents respectively cited fear and lack of escort as barriers to service up-take while 8and 9pointed to sociocultural beliefs and the fact that they were able to cope satisfactorily with their disability. Only 1.5of respondents gave lack of awareness as a barrier with none citing geographical barrier as a problem. Cost of surgery; however; stood out clearly as a very significant barrier with 91of respondents attesting to it. Conclusion: It is concluded that further expansion of outreach services; coupled with a more intensive health education is needed to overcome these barriers

Epidemiology of Hospitalized Ocular Injuries in the Upper East Region of Ghana

Aim of Study: The Upper East is the poorest and most rural region in Ghana and ocular injuries are a major public health problem. This study aims at providing epidemio- logic data on the burden of this problem in order to facilitate the provision of integrated eye care and safety strategies for the prevention of such injuries in the region. Design: A retrospective case series. Methods: Computerized records of all eye injuries admitted to the clinic between January and December 2004 were retrieved and analyzed using the Epi-Info software. Injuries were classified using the Birmingham Eye Trauma Terminology while Snellen visual acuities were classified/ banded using the WHO categories of visual impairments. Results: Ninety six eyes of 96 patients were admitted over the study period. Seventy five percent of the patients were males and 82.3 below the age of 30 years. Half of the patients had to travel beyond 100 km to get ophthalmic assistance. Only one third of the cases reported within 24 hours while 21 reported after one week of their injuries. These delayed periods of reporting showed no statistically significant relationship with the distances travelled to the hospital (p=0.76; chi2 test); nor the eventual visual outcome achieved following treatment. Open-globe injuries were by far the most common (60/96) and were 4.7 times more likely (Chi squared test) to produce poor visual outcome (p=0.02 CL 1.75-12.63). Conclusion: Current eye care strategies do not adequately address the issue of eye injuries in the region. There is the need to provide integrated approach by incorporating primary eye care strategies into the existing primary health care system