Cn Pedro-Egbe

Screening for refractive error among primary school children in Bayelsa state, Nigeria

Introduction Vision screening study in primary school children has not been done in Bayelsa State. This study aims to screen for refractive error among primary school children in Bayelsa State and use the data to plan for school Eye Health Program. Methods A cross sectional study on screening for refractive error in school children was carried out in Yenagoa Local Government Area of Bayelsa State in June 2009. A multistage sampling technique was used to select the study population (pupils aged between 5-15 years). Visual acuity (VA) for each eye, was assessed outside the classroom at a distance of 6 meters. Those with VA ≤6/9 were presented with a pinhole and the test repeated. Funduscopy was done inside a poorly lit classroom. An improvement of the VA with pinhole was considered refractive error. Data was analyzed with EPI INFO version 6. Results A total of 1,242 school children consisting of 658 females and 584 males were examined.About 97.7% of pupils had normal VA (VA of 6/6) while 56 eyes had VAs ≤ 6/9. Of these 56 eyes, the visual acuity in 49 eyes (87.5%) improved with pinhole. Twenty seven pupils had refractive error, giving a prevalence of 2.2%. Refractive error involved both eyes in 22 pupils (81.5%) and the 8-10 years age range had the highest proportion (40.7%) of cases of refractive error followed by the 9-13 year-old age range (37%). Conclusion The prevalence of refractive error was 2.2% and most eyes (97.7%) had normal vision.

Visual outcome following optic neuritis: a 5-year review.

BACKGROUND Optic neuritis is a demyelinating inflammatory disease of the optic nerve that typically affects young adults especially females, and is usually associated with multiple sclerosis especially in Caucasians. The prognosis for visual recovery is usually good but with poor quality. OBJECTIVE The objective was to determine the level of improvement of vision after an attack of optic neuritis in Port Harcourt, Nigeria. DESIGN A retrospective hospital-based study was performed. SETTING Eye Clinic, University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria. DATA EXTRACTION Medical records of all cases of optic neuritis seen at the Eye Clinic of UPTH over a 5-year period (January 2006-December 2010) were retrieved and relevant data including age, sex, presenting symptom, and visual acuity (VA) were extracted. The VA at discharge 12 weeks later was noted. Our diagnosis of optic neuritis was based on the presence of low vision, dyschromatopsia, and peri-ocular pain. RESULTS Over 24,000 patients were seen during this period, and 27 cases were optic neuritis (0.1%). Of the 27 cases of optic neuritis, 20 cases were retro-bulbar neuritis (74.1%), while seven (25.9%) were papillitis. There were 16 females and 11 males giving a female to male ratio of 3:2. Most cases (75%) at presentation had VAs<6/24. By the 12 th week, most visual acuities (77.1%) had improved to 6/12 or better. CONCLUSION This study confirms widely documented evidence that there is improvement in visual acuity after an attack of optic neuritis. Even though the risk of developing multiple sclerosis following optic neuritis is said to be low in blacks, these patients should still be followed up for sometime especially as some may go on to develop other complications of demyelination.

Congenital upper lid eversion and severe chemosis in a new born

The purpose of this study is to report a case of bilateral congenital eversion of the upper eyelid in an 8 h- old male baby. JD is an 8 h-old male baby born by normal vaginal delivery after prolonged labor, to a 24-year-old primigravida. Pregnancy was said to be term but was complicated by pregnancy-induced hypertension. A midwife delivered the baby and it was by spontaneous vertex delivery. He was said to have cried immediately after birth, but shortly afterward parents noticed a reddish fleshy swelling over the eyes and this made it difficult for them to see the eyeballs. The reddish swelling steadily increased in size necessitating their prompt referral to our center. On examination, a full term baby was seen with complete eversion of both upper eyelids and marked conjunctival chemosis. Ocular examination revealed normal globes with healthy cornea and briskly reactive pupils. The child was admitted and started on 3-hourly chloramphenicol ointment, ciloxan eye drop (ciprofloxacin hydrochloride United States Pharmacopeia equivalent to ciprofloxacin 0.3% w/v) - 8 times daily and 5% hypertonic saline patch over the chemosed conjunctiva. The pediatrician was also invited to co-manage the patient. After 9-days of treatment, the conjunctival chemosis fully resolved and lids reverted back to normal position. At 4-week follow-up, the lids continued to maintain their normal position and child could now open eyelids spontaneously. Congenital upper eyelid eversion is a rare clinical entity even though it is said to be commoner in blacks. Knowledge of its complete resolution with conservative management will help in future management of such cases thereby preventing complications that may arise from poorly treated cases.

The relationship between vertical cup-disc ratio and body mass index in Port Harcourt, Nigeria

BACKGROUND Glaucoma is the leading cause of irreversible blindness in the world and risk factors to developing glaucoma must be determined early to prevent blindness from the disease. AIM To determine the relationship between vertical cup disc ratio (VCDR) and body mass index (BMI) in a population screened for glaucoma in Port Harcourt, Nigeria. MATERIALS AND METHOD This study was part of a one-day screening exercise for glaucoma at the University of Port Harcourt. Demographic data included age, sex, race and occupation. Height was measured with a wall-mounted tape and weight with a bathroom scale. Intraocular pressure was measured with Perkins applanation tonometer and funduscopy was with direct ophthalmoscope. BMI was calculated as weight in kilograms divided by the square of height in meters (Weight/Height2). RESULTS A total of 491 subjects were screened; consisting of 230 males (46.8%) and 261 females (53.2%). The mean age was 35±13.29 years. About 28%(n=141) of the participants were overweight while 17.7%(n=87) were obese. The mean BMI was 25.39 ± 4.82 kg/m 2 and the mean VCDR for both eyes was 0.38±0.13mmHgratios have no units. Most participants (n=864; 89.4%) had normal VCDR. Only 102 (10.6%) had cupped discs. There was no statistically significant relationship between BMI and VCDR (P= 0.947; R2 = 0.01). CONCLUSION Obesity was not associated with a larger VCDR.

Ocular problems among public service retirees in a Southern Nigerian Metropolitan City

Background: Advancing age is a recognized risk factor for blindness and visual impairment worldwide. More than 82% of all blind people are 50 years or older. This therefore places a huge public health and socioeconomic burden on the populace, often leading to social dependence. Aim: To determine the pattern, profile, and risk factors of eye diseases among retired public servants in Port Harcourt City, Nigeria. Materials and Methods: Participants were retired public servants who consented to ocular examinations at their pension pay points in Port Harcourt during the 2012 World Sight Day. Visual acuity, ocular examinations including fundoscopy and intraocular pressure measurements were recorded and subsequently analyzed using Statistical Package for Social Sciences version 20. Results: Five hundred and ninety-two persons were studied; 455 males and 137 females (F: M = 1:3.3). The Mean age was 68.7 ± 7.6 years (range: 56–97 years). Using World Health Organization/International Agency for Prevention of Blindness criteria for visual assessment 239 (40.4%) had good vision, 203 (34.3%) had moderate visual impairment, 48 (8.1%) had severe visual impairment, while 102 subjects (17.2%) were blind. Cataract was the leading cause of blindness 56 (54.9%), followed by glaucoma 18 (17.7%), uncorrected refractive error 19 (18.6%), and diabetic retinopathy 9 (8.8%).Conclusion: Visual impairment and blindness are common causes of ocular morbidity among retirees of public service in Port Harcourt. It is therefore advocated that special eye health care intervention by governments and nongovernmental agencies be extended to these groups of people.

Audit of visual outcome of cataract surgeries in a private eye hospital in Port Harcourt, Nigeria

Aim: The aim was to determine the quality of cataract surgeries in Port Harcourt, and ascertain the difference in the outcome, if any, between small incision cataract surgery (SICS) and extra capsular cataract extraction (ECCE). Materials and Methods: This is a retrospective study carried out in a Private Eye Hospital in Port Harcourt between August 2006 and November 2012. Case notes of 83 consecutive patients (92 eyes) who had either SICS OR ECCE with posterior chamber intraocular lens (PCIOL) were included in the study. Demographic data and data concerning ocular and systemic co-morbidities were retrieved from patients′ case notes. Best-corrected visual acuity was measured with Snellen′s chart preoperatively, and 6 weeks following surgery. The visual outcome was categorized, using the World Health Organization (WHO) recommendation, as good (>6/18), borderline (6/24-6/60), or poor (<6/60). Statistical software package Epi-info version 6.04d was used to analyze our data. Result: A total of 92 eyes of 83 patients who had cataract surgeries was included in the study. Sixty-seven eyes (73%) had ECCE + intraocular lens (IOL) while 25 eyes (27%) had SICS + IOL. At 6 weeks postoperative, 66.3% of cases had good visual outcome while about 9.8% of cases had a poor outcome. Conclusion: Since only 66.3% of cases had good visual outcome and 9.8% had poor outcome, cataract surgical outcome in Port Harcourt is below the acceptable WHO standards of >85% and <5% for good and poor outcomes respectively. Steps to improve good outcome will include proper postoperative hygiene of patients, good preoperative evaluation of all cases, and improvement in surgeons′ skills. Good visual outcome was associated more with ECCE (71.7% of 67 eyes) than SICS (52% of 25 eyes) probably due to inadequate experience of the surgeons in SICS. This difference was, however, not statistically significant.

A 3-year review of cranial nerve palsies from the University of Port Harcourt Teaching Hospital Eye Clinic, Nigeria

Purpose: To provide the types, frequency and clinical information on common cranial nerve palsies seen at the Eye Clinic at the University of Port Harcourt Teaching Hospital. Materials and Methods: A chart review was performed of patients who presented with cranial nerve palsy at the Eye Clinic over a 3-year period (January 2009-December 2011). Data were collected on age, sex, type of cranial nerve palsy, a history of systemic disease such as diabetes mellitus (DM), hypertension and cerebrovascular disease. Exclusion criteria included medical charts with incomplete data. Data was analyzed using Epi-info Version 6.04D. Statistical significance was indicated by P < 0.05. Results: Twenty-four patients had cranial nerve palsies. There were 11 males and 13 females with a mean age of 34.50 ± 18.41 years. Four patients (26.6%) had exotropia while three patients (20%) had esotropia. Complete ophthalmoplegia was noted in two patients (13.3%). The 3rd and 6th cranial nerves were affected in seven patients each (29.2%) and five patients (20.8%) had 7th cranial nerve palsy. Approximately 38% of patients with cranial nerve palsies had systemic disorders (16.7% systemic hypertension; 12.5% DM). The relationship between cranial nerve palsy and systemic disorder was statistically significant (P < 0.01). Conclusion: This is the first study in the literature on ocular cranial nerve palsies in Southern Nigeria. Third and sixth cranial nerve palsies were the most common cases to present to the University of Port Harcourt Teaching Hospital Eye Clinic. There was a statistically significant association to systemic disorders such as hypertension and DM and majority of cases with 6th cranial nerve palsy.

The relationship between body mass index and intra-ocular pressure in Port Harcourt Nigeria.

Background : There are conflicting reports regarding the relationship between body mass index (BMI) and intraocular pressure (IOP). There is a need to evaluate these contradicting findings in our environment. Aim: To examine the relationship between intraocular pressure and body mass index (BMI) in a population screened for glaucoma at the University of Port Harcourt, Nigeria Materials and Method: This study was part of a one -day screening exercise for glaucoma at the University of Port Harcourt. All subjects participated with willful consent. Demographic data included age, sex, race and occupation. Height was measured with a wall-mounted tape and weight with a bathroom scale. Intraocular pressure was measured with Perkins hand-held applanation tonometer and funduscopy was carried out with a direct ophthalmoscope. BMI was calculated as weight in kilograms divided by the square of height in meters (Weight/Height 2

Subjective Optic Disc Assessment and Single Measurement Intraocular Pressure to Screen a Cohort of Pensioners in Port Harcourt

Background: There is good evidence that screening can detect primary open-angle glaucoma (POAG) in adults and that early treatment of adults reduces the number of persons who develop visual field defects or those whose visual field defects progress.1 Aim: To screen and identify persons with glaucoma among pensioners in Port Harcourt. Materials and Method: The study was carried out among retirees in Rivers State. Verbal consent was obtained from the Treasury Department of the Rivers State Ministry of Finance and also from all individuals who participated in the study. Demographic data including age and sex were recorded in the WHO/PBL eye examination form. Ocular examination consisted of uncorrected VA measured with Snellen’s chart and then pin-hole presented when VA 21mmHg and VCDR >0.5 or VCDR = 0.8 with normal intraocular pressure. Results: A total of 176 subjects (351 eyes) were examined; 135(76.7%) male and 41(23.3%) female patients. The mean age of respondents was 62.33 (±±8.58) years. Of the 176 subjects examined, 14 had glaucoma (based on the defined criteria of VCDR > 0.5 and IOP above 21mmHg or VCDR = 0.8 with normal IOP) giving a relative frequency of 7.95%. Ten subjects had ocular hypertension. Conclusion: There is a need to screen at-risk people for glaucoma especially the aged. In doing this, sufferers will be identified early and appropriate treatment instituted to prevent visual loss. Key words: glaucoma screening, cohort, pensioners, Port Harcourt

Ocular injuries from exploding glass-bottled Coca-Cola® drinks in Port Harcourt, Nigeria.

Background: Eye injuries and subsequent loss of vision from the glass and caps of exploding pressurized bottled drinks have been well reported, and as a result most developed countries now use mainly plastic bottles. In Nigeria, however, most drinks are still sold in glass bottles and ocular injuries from this source are therefore not uncommon. Aim: To retrospectively analyze ocular injuries resulting from exploding glass-bottled Coca-Cola® and propose ways of eliminating such injuries in future. Setting: Eye Clinic, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Materials and methods: The medical records of all cases of ocular injury that presented at the Eye Clinic of the University of Port Harcourt Teaching Hospital over a 5-year period (January 2006 to December 2010) were retrieved and relevant data including age, sex, occupation, events surrounding bottle explosion, and type of ocular injury sustained were extracted. Results: A total of 426 cases of ocular injuries was seen during the period under review. There were 335 (78.6%) males and 91 (21.4%) females. Six patients had ocular injury from exploding glass-bottled Coca-Cola®, giving an incidence of 1.4%. The presenting visual acuities (VA) were light perception (2 cases), counting fingers (2 cases), and 1 VA of 6/24 and 1 VA of 6/12. There were 4 (66.7%) cases of corneoscleral laceration with uveal prolapse and 1 case of total hyphema. Conclusion: Because pressurized glass-bottles can explode with normal handling, legislation to ban the use of glass containers for bottling carbonated drinks will go a long way to reducing ocular morbidity from this source. Plastic bottles should be introduced as an alternative.