Trends in Eye Removal Surgeries at a Tertiary Care Hospital Over Three Decades.

PURPOSE: To determine the trends in eye removal surgeries at a tertiary hospital in Nigeria over 26 years. METHODS: A retrospective comparative review of clinical records of all patients who had eye removal surgery at a tertiary hospital in Ile-Ife, Nigeria, between 2014 and 2019 was done. Patients' demographic and clinical data, including indication for eye removal and type of surgery were analysed and compared with two earlier studies at the same hospital between 1994 and 2013. RESULTS: There was an average of 14.3 surgeries per year between 2014 and 2019. Patients' ages ranged from 2 to 102 years, M:F was 1.5:1, the commonest indication for eye removal was infection (n=30, 34.9%), and the most common surgery was evisceration (n=70, 81.4%). Studies from 1994 to 2003 and 2005 to 2013, reported an average of 9.2 and 10 surgeries per year; ages ranging from 4 days to 88 years and 3 months to 88 years; with a M:F of 2.1:1 and 3.4:1 respectively. In both studies, the commonest indication for eye removal was trauma (43.4% and 43.8% respectively) and the most common surgery was enucleation (57.6% and 55% respectively). Trend data showed a progressive increase in eye infections (12% vs 15% vs 34.9%) and eviscerations (19.6% vs 31.2% vs 81.4%) over time. CONCLUSION: There was a change in trend towards an increase in eviscerations and infective indications for eye removal at the hospital over three decades. Prompt and optimal treatment of orbito-ocular infections is recommended to reduce the incidence of eye removal surgeries.

BUT: Déterminer les tendances des chirurgies d'ablation de l'oeil dans un hôpital tertiaire du Nigeria sur une période de 26 ans. MÉTHODES: Un examen comparatif rétrospectif des dossiers cliniques de tous les patients ayant subi une chirurgie d'ablation de l'œil dans un hôpital tertiaire d'Ile-Ife, au Nigeria, entre 2014 et 2019, a été effectué. Les données démographiques et cliniques des patients, y compris l'indication de l'ablation de l'œil et le type de chirurgie, ont été analysées et comparées à deux études antérieures menées dans le même hôpital entre 1994 et 2013. RÉSULTATS: Il y avait une moyenne de 14,3 chirurgies par an entre 2014 et 2019. L'âge des patients allait de 2 à 102 ans, le rapport M:F était de 1,5:1, l'indication la plus courante pour l'ablation de l'œil était l'infection (n=30, 34,9%), et la chirurgie la plus fréquente était l'éviscération (n=70, 81,4%). Les études menées de 1994 à 2003 et de 2005 à 2013 ont fait état d'une moyenne de 9,2 et 10 interventions chirurgicales par an, d'âges allant de 4 jours à 88 ans et de 3 mois à 88 ans, et d'un rapport M:F de 2,1:1 et 3,4:1 respectivement. Dans les deux études, l'indication la plus courante pour l'ablation de l'œil était le traumatisme (43,4 % et 43,8 % respectivement) et la chirurgie la plus courante était l'énucléation (57,6 % et 55 % respectivement). Les données sur les tendances ont montré une augmentation progressive des infections oculaires (12 % vs 15 % vs 34,9 %) et des éviscérations (19,6 % vs 31,2 % vs 81,4 %) au fil du temps. CONCLUSION: On constate un changement de tendance vers une augmentation des éviscérations et des indications infectieuses pour l'ablation des yeux à l'hôpital sur trois décennies. Un traitement rapide et optimal des infections orbitooculaires est recommandé pour réduire l'incidence des chirurgies d'ablation des yeux. Mots clés: Anesthésie, énucléation, éviscération, exentération, implant orbitaire, tendances.

Epidemiology and Management of Oculoplastic Disorders at a Tertiary Hospital: A 4-Year Review.

PURPOSE: To describe the epidemiology and management of oculoplastic disorders at a tertiary hospital in Nigeria. METHODS: This was a retrospective review of patients with oculoplastic disorders at the Department of Ophthalmology, Obafemi Awolowo University Teaching Hospitals Complex, IleIfe, Nigeria from January 2013 to December 2016. The general ophthalmology service records were reviewed to identify patients with oculoplastic disorders. Data retrieved from patient records included date of initial visit, age at presentation, gender, oculoplastic diagnosis and aetiology, modality of treatment given, and indications for patient referrals. RESULTS: There were 563 (7.4%) patients with oculoplastic disorders, out of 7,575 ophthalmology department patients. They had 573 oculoplastic disorders in all. There were 281 (49.9%) males and 282 (50.1%) females. The median age at presentation was 28 years (range, 1 day to 100 years). Eyelid laceration (n=68; 11.9%) and chalazion (n=63; 11%) were the commonest disorders. Trauma (n=125; 21.8%) was the commonest aetiology, followed by inflammatory (n=121; 21.1%) and infective (n=108; 18.8%) causes. There were 162 (28.3%) surgical interventions; eyelid repair (n=67; 41.4%) was the commonest, followed by evisceration (n=25; 15.4%), and excisional biopsy (n=25; 15.4%). No patient had ptosis or lacrimal surgery. Orbital disorders (n=21; 42.9%) were the commonest indication for a referral elsewhere. CONCLUSION: Eyelid laceration was the commonest oculoplastic disorder, trauma was the commonest aetiology, and eyelid repair was the commonest oculoplastic surgery done. Further training in oculoplastics with emphasis on ptosis, lacrimal and orbital surgery, as well as the provision of equipment needed for optimal oculoplastic service delivery are recommended.

OBJECTIF: Décrire l'épidémiologie et la gestion des troubles oculoplastiques dans un hôpital tertiaire du Nigeria. MÉTHODES: Il s'agissait d'un examen rétrospectif des patients atteints de troubles oculoplastiques au département d'ophtalmologie, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, de janvier 2013 à décembre 2016. Les dossiers du service d'ophtalmologie générale ont été examinés afin d'identifier les patients souffrant de troubles oculoplastiques. Les données extraites des dossiers des patients comprenaient la date de la première visite, l'âge au moment de la présentation, le sexe, le diagnostic oculoplastique et l'étiologie, la modalité du traitement administré et les indications pour le renvoi des patients. RÉSULTATS: 563 (7,4 %) des 7 575 patients du service d'ophtalmologie présentaient des troubles oculoplastiques. Ils présentaient 573 troubles oculoplastiques au total. Il y avait 281 (49,9%) hommes et 282 (50,1%) femmes. L'âge médian à la présentation était de 28 ans (intervalle de 1 jour à 100 ans). Paupière (n=68 ; 11,9%) et le chalazion (n=63 ; 11%) étaient les troubles les plus courants. Le traumatisme (n=125 ; 21,8%) était l'étiologie la plus fréquente, suivie par les causes inflammatoires (n=121 ; 21,1%) et infectieuses (n=108 ; 18,8%). Il y a eu 162 (28,8 %) interventions chirurgicales ; la réparation de la paupière (n=67 ; 41,4 %) était la plus courante, suivie de l'éviscération (n=25 ; 15,4%) et de la biopsie excisionnelle (n=25 ; 15,4%). Aucun patient n'a subi de ptose ou de chirurgie lacrymale. Les troubles orbitaux (n=21 ; 42,9%) étaient l'indication la plus fréquente d'un renvoi ailleurs. CONCLUSION: La lacération de la paupière était le trouble oculoplastique le plus courant, le traumatisme était l'étiologie la plus courante et la réparation de la paupière était la chirurgie oculoplastique la plus courante. Il est recommandé de poursuivre la formation en oculoplastie en mettant l'accent sur le ptosis, la chirurgie lacrymale et orbitale, ainsi que de fournir l'équipement nécessaire à une prestation optimale des services oculoplastiques. Mots clés: Troubles oculoplastiques, prévalence, chirurgie, traumatisme.

Axial length/corneal radius of curvature ratio and refractive status in an adult Nigerian population.

AIM/BACKGROUND: Associations between axial length (AL) to corneal radius of curvature (CR) ratio and refractive status in a healthy Nigerian adult population were studied. MATERIALS AND METHODS: Healthy students and members of staff of Obafemi Awolowo Teaching Hospitals Complex, Ile-Ife, South West Nigeria, free of obvious ocular diseases except possible refractive errors were recruited. Consecutive consenting volunteers were recruited by simple random sampling and a proportionate sample of each population based on its representative fraction in the hospital community was recruited. The study was conducted between June and August 2011. Noncycloplegic objective refraction was done and spherical equivalent refraction (SER) of the right eyes was used for calculation. The AL, CR, and keratometric readings were measured with the IOL Master. The AL/CR ratio was calculated. The data were analyzed with statistical software package STATA 13. RESULTS: Three hundred and fifty volunteers aged 18-60 years were studied. The mean ± standard deviation of AL/CR and SER were 3.04 ± 0.10 and -0.38 ± 1.42D, respectively. AL in myopia was significantly higher than in emmetropia and hypermetropia. There were no significant differences between CR in the refraction groups. Myopes had significantly higher AL/CR than nonmyopes. On controlling for age and gender, 1 mm increase in AL increased SER by -0.77D (95% confidence interval [CI] -0.91--0.64D) while a unit increase in AL/CR increased SER by -8.89D (95% CI -10.00--7.78D). Whereas AL accounts for 39% of variability in SER (P < 0.001), AL/CR accounts for 51% of the variability observed in SER (P < 0.001). CONCLUSION: This study has further confirmed that the AL remains a strong determinant of refraction, but a derived factor AL/CR accounts for more variation in final refractive status than AL in isolation.

Benign prostate hyperplasia: average volume in southwestern Nigerians and correlation with anthropometrics.

OBJECTIVES: To determine the prevalent age of symptomatic benign prostate hyperplasia (BPH), the average BPH volume, and the association between BPH volumes and the age, and anthropometrics in our immediate black community. PATIENTS, MATERIALS AND METHOD: Selected patients with lower urinary tract symptoms (LUTS) due to BPH with tissue diagnosis, and adult men of similar age group with no irritative or obstructive LUTS were prospectively studied from July 2003 to June 2009. The age, height and weight were recorded, prostate volumes determined with ultrasound, body mass index (bmi) calculated, and correlations determined between the prostate volume and the age, and anthropometrics. RESULTS: 105 patients aged 43-88 yrs (mean=64.4, 8.88 SD) managed for BPH were studied with 93 asymptomatic men aged 43-80 yrs (mean=56.15, 9.89 SD). The mean (SD) prostate volume, height, weight and bmi were 83.8 (37.7) ml, 1.67 (0.07) m, 63.6 (9.32) kg and 22.8 (3.03) kg/m2, and 24.5 (9.2) ml, 1.69 (0.06) m, 68.9 (10.6) kg and 24.2 (3.44) kg/m2 respectively for symptomatic and asymptomatic groups. In the symptomatic group, BPH volume showed significant positive correlation with the age (p=0.030), but no correlation with the weight (p=0.550), height (p=0.375) and bmi (p=0.840). In the asymptomatic group, prostate volume also showed significant positive correlation with the age (p=0.041), but no correlation with the weight (p=0.434), height (p=0.394), and bmi (p=0.203). CONCLUSION: The prevalent age of symptomatic BPH in our community is 43- 88 years with 83.79 (37.66) ml mean (SD) volume in symptomatic patients and 24.45 (9.21) ml in asymptomatic men. BPH volume correlates with age but not with anthropometrics. Lack of correlation with BPH volume suggests that anthropometrics may not be risk factors for development of BPH in our community.

Benign prostate hyperplasia: average volume in southwestern Nigerians and correlation with anthropometrics.

AIMS AND OBJECTIVES: To determine the prevalent age of symptomatic benign prostate hyperplasia (BPH), the average BPH volume, and the association between BPH volumes and the age, and anthropometrics. PATIENTS, MATERIALS AND METHODS: Selected patients with lower urinary tract symptoms (LUTS) due to BPH with tissue diagnosis, and adult men of similar age group with no irritative or obstructive LUTS were prospectively studied from July 2003 to June 2009. The age, height and weight were recorded; prostate volumes determined with ultrasound, body mass index (BMI) calculated, and correlations determined between the prostate volume, the age and anthropometrics. RESULTS: One hundred and five patients aged 43-88years (mean=64.4, 8.88SD) managed for BPH were studied with 93 asymptomatic men aged 43-80years (mean=56.15, 9.89SD). The mean (SD) prostate volume, height, weight and BMI were 83.8(37.7) ml, 1.67(0.07) m, 63.6(9.32) kg and 22.8(3.03) kg/m2, and 24.5(9.2) ml, 1.69(0.06) m, 68.9(10.6) kg and 24.2(3.44) kg/m2 respectively for symptomatic and asymptomatic groups. In the symptomatic group, BPH volume showed significant positive correlation with the age (p=0.030), but no correlation with the weight (p=0.550), height (p=0.375) and BMI (p=0.840). In the asymptomatic group, prostate volume also showed significant positive correlation with the age (p=0.041), but no correlation with the weight (p=0.434), height (p= 0.394), and BMI (p=0.203). CONCLUSION: The prevalent age of symptomatic BPH in our community is 43-88years with 83.79(37.66) ml mean (SD) volume in symptomatic patients and 24.45(9.21) ml in asymptomatic men. BPH volume correlates with age but not with anthropometrics. Lack of correlation with BPH volume suggests that anthropometrics may not be risk factors for development of BPH.

New onset neuromyelitis optica in a young Nigerian woman with possible antiphospholipid syndrome: a case report.

INTRODUCTION: Devic's neuromyelitis optica is an inflammatory demyelinating disease that targets the optic nerves and spinal cord. It has a worldwide distribution and distinctive features that distinguish it from multiple sclerosis. There has been no previous report of neuromyelitis optica from our practice environment, and we are not aware of any case associated with antiphospholipid syndrome in an African person. CASE PRESENTATION: We report the case of a 28-year-old Nigerian woman who presented with neck pain, paroxysmal tonic spasms, a positive Lhermitte's sign and spastic quadriplegia. She later developed bilateral optic neuritis and had clinical and biochemical features of antiphospholipid syndrome. Her initial magnetic resonance imaging showed a central linear hyperintense focus in the intramedullary portion of C2 to C4. Repeat magnetic resonance imaging after treatment revealed resolution of the signal intensity noticed earlier. CONCLUSION: Neuromyelitis optica should be considered in the differential diagnoses of acute myelopathy in Africans. We also highlight the unusual association with antiphospholipid syndrome. Physicians should screen such patients for autoimmune disorders.