Cs Ejimadu

Incidence and risk factors for retinal vein occlusion at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

OBJECTIVE The objective of the following study is to determine the incidence of retinal vein occlusion (RVO) and identify the risk factors in RVO in patients presenting to a tertiary hospital in Rivers State. MATERIALS AND METHODS The medical records of consecutive patients with RVO who presented to the retina clinic of the eye Department of University of Port Harcourt Teaching Hospital over a 5 year period were retrieved. Information extracted from the data included the demographic data of patients, presenting visual acuity, history of systemic and ocular disease, blood pressure and intraocular pressure. Data was analyzed using the Statistical Package for Social Sciences 20.0. (IBM Corporation and its licensors 1989,2011). RESULTS Out of the 364 patients seen at the retina clinic during this period, 27 (7.4%) had RVO. Seven patients had bilateral disease. The incidence of RVO in the retinal clinic was 7.4%. Systemic hypertension, diabetes mellitus, hyperlipidemia and glaucoma were the main risk factors recorded in our patients. Central retinal vein occlusion (CRVO) 20 (74%) was more predominant than branch retinal vein occlusion (BRVO) 7 (26%). 21 eyes of patients with CRVO had visual acuities of < 3/60, while 7 eyes of patients with BRVO had visual acuities less than 3/60. Vitreous hemorrhage 10 (52.6%) was the most common complication encountered. All cases of non-perfused vein occlusion 4 (14.8%) were seen in patients who had CRVO. CONCLUSION The incidence of RVO in our hospital is high. RVO is a significant cause of visual impairment, with CRVO being more common. Identifying associated risk factors and treating these could help reduce the incidence of RVO.

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.

Amblyopia in black children: as seen in University of Port Harcourt Teaching Hospital, Nigeria.

Background: Amblyopia is a common cause of visual impairment in children with uncorrected refractive errors, so screening and treatment should be carried out as early as possible to prevent permanent visual loss. Objective: To determine the prevalence of amblyopia among individuals less than 18years with refractive errors presenting to the Ophthalmology clinic of the University of Port Harcourt Teaching Hospital (UPTH). Methods: Children with refractive errors presenting at UPTH over a period of 2 years were studied. Their bio-data and relevant medical and ocular history were obtained. Their visual acuity was measured and standard ophthalmic examination was done for the anterior segment with a pen torch and slit lamp bio-microscope. The posterior segment was examined with Welch Allen direct ophthalmoscope. All the children in the study were refracted using the appropriate techniques. Result: A total of 306 children with refractive errors were studied, out of which 110 (36%) were Original Research Article Ejimadu and Paul; BJMMR, 5(6): 814-818, 2015; Article no.BJMMR.2015.086 815 males and 196 (64%) were females. Of these children, 204 (66.7%) had astigmatism, 68 (22.2%) had Myopia, 23(7.5%) had hypermetropia and 11(3.6%) had inconclusive refraction. Two hundred and seventy eight (90.8%) of these children with refractive errors had optimal correction by refraction while 17(5.6%) had developed amblyopia. All the children who had amblyopia were between 13 and 18years; five (29.5%) were males while twelve (70.5%) were females which is statistically significant (p=0.00001). Conclusion: The prevalence of amblyopia among children with refractive error is high and therefore early screening and intervention is important to prevent permanent visual loss.

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.

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.