Ds Ademola-Popoola

Retinoblastoma - a clinico - pathological study in Ilorin, Nigeria*

Retinoblastoma is the commonest childhood primary malignant intraocular neoplasm that is often characterized by spontaneous regression. They display photoreceptor differentiation. This study provides the clinical presentations and histological profiles of retinoblastoma in Ilorin, Kwara-State, in the North Central geo-political zone of Nigeria. A retrospective study of clinically and histologically verified retinoblastoma at the University of Ilorin Teaching Hospital, Ilorin, Kwara-State, Nigeria from January 1989 to December 2000 was undertaken. The clinical and histological features were analyzed using the patients case folder and surgical pathology records. There were 20 patients, 9 males and 11 females (M:F ratio 1: 1.2), age range from 5 (1/2) months to 6 years with 23 eyeball tumours histologically confirmed retinoblastoma during the study period. Proptosis with chemosis was the most common clinical presentation (84.6 %). Bilaterality was 15 % in this study. Enucleation and Exenteration combined with chemotherapy were offered to 15 (75 %) and 5 (25 %) patients respectively. A poorly differentiated type with extensive areas of tumour necrosis was the commonest histological pattern. Thirteen (65 %) of the patients died before completing the course of chemotherapy.

Ocular and visual complications of head injury

PurposeTo evaluate the pattern of ocular and visual complications of head injury.MethodA prospective study of 225 head-injured patients managed at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. For the purpose of extracting vaisual complications, a Neurosurgeon and an Ophthalmologist examined each patient and appropriate investigations were carried out. Patients with ocular morbidity were analysed for age, sex, cause of injury, admission Glasgow coma score, and associated injuries in addition to findings at ophthalmic and neurosurgical evaluations.ResultsTwo major types of ocular and visual complications were observed in 57 (25.3%) of 225 head-injured patients studied. Soft-tissue injury to the globe and adnexae included periorbital ecchymosis, subconjuctival haemorrhage, lid laceration, or rarely globe rupture in 29 patients. Neuro-ophthalmic ocular cranial nerve palsies occurred in 28 patients, while orbital fracture was encountered in two patients. Ocular injuries were multiple in 60% of cases. The patients, comprising 37 male and 20 female subjects, were aged 9 months to 57 years (mean=28 years). Traffic accident was the leading cause of head injuries (84.2%), while fall from height (7%), assault (7%), and gunshot (1.8%) were miscellaneous causes.ConclusionInjury to the globe and adnexae and ocular cranial nerve palsies constitute the most common oculovisual complications following head injury in our centre.

Psychological and social adjustment to blindness: Understanding from two groups of blind people in Ilorin, Nigeria

BACKGROUND Blindness can cause psychosocial distress leading to maladjustment if not mitigated. Maladjustment is a secondary burden that further reduces quality of life of the blind. Adjustment is often personalized and depends on nature and quality of prevailing psychosocial support and rehabilitation opportunities. This study was aimed at identifying the pattern of psychosocial adjustment in a group of relatively secluded and under-reached totally blind people in Ilorin, thus sensitizing eye doctors to psychosocial morbidity and care in the blind. MATERIALS AND METHODS A cross-sectional descriptive study using 20-item Self-Reporting Questionnaire (SRQ) and a pro forma designed by the authors to assess the psychosocial problems and risk factors in some blind people in Ilorin metropolis. RESULT The study revealed that most of the blind people were reasonably adjusted in key areas of social interaction, marriage, and family. Majority were considered to be poorly adjusted in the areas of education, vocational training, employment, and mobility. Many were also considered to be psychologically maladjusted based on the high rate of probable psychological disorder of 51%, as determined by SRQ. Factors identified as risk factors of probable psychological disorder were poor educational background and the presence of another medical disorder. CONCLUSION Most of the blind had no access to formal education or rehabilitation system, which may have contributed to their maladjustment in the domains identified. Although their prevailing psychosocial situation would have been better prevented yet, real opportunity still exists to help this group of people in the area of social and physical rehabilitation, meeting medical needs, preventive psychiatry, preventive ophthalmology, and community health. This will require the joint efforts of medical community, government and nongovernment organizations to provide the framework for delivery of these services directly to the communities.

Psychosocial characteristics of totally blind people in a Nigerian city

Purpose: To characterize the demographic and psychosocial problems of a group of blind people as a way of attracting more attention to and providing data that can improve the psychosocial care of the visually impaired. Materials and Method: A cross-sectional descriptive study of a population of totally blind people in Ilorin, Nigeria using a self-report questionnaire (SRQ). The questionnaire was verbally administered by the study personnel in the local language. Simple frequency tables were obtained and the Chi-square test was performed to determine significant differences between variables. P value <0.05 was considered statistically significant. Results: Sixty one blind patients consented to participate. Most participants were engaged in street begging for their livelihood. Most subjects desired a job change, signifying dissatisfaction with the present occupation. Up to 80% of the cohort was married and had spouses who were also blind in at least one eye. Approximately two-thirds had five or more children and majority lived with family members who were responsible for taking care of their personal hygiene, cooking and mobility. The majority developed blindness in childhood and 16% had a family history of blindness and 77% had never used conventional eye care, with corneal disease being the most frequent cause of blindness. Many feared that their children may also become blind. Thirty-one (51%) scored ≥5 on SRQ and were classified as probable cases of psychological disorder. Conclusion: Blindness in a majority of cases that started in childhood was probably preventable. Inaccessibility to or failure of the formal rehabilitation and social welfare systems may have caused this psychosocial dilemma. The high level of social and family interaction provides opportunity for organized preventive ophthalmology, community health care services and psychosocial care.

Comparison of ocular biometry measurements by applanation and immersion A-scan techniques.

Purpose The study compared ocular biometry values using applanation and immersion techniques to determine the most applicable method for our tertiary training centre where personnel with different levels of experience and expertise in biometry take measurements used in calculation of required intraocular lens before cataract surgery. Methods The study was a prospective cross-sectional comparative study of different techniques of ocular biometry from diagnostic equipment (biometry probe 10 MHz Sonomed® A-scan (PACSCAN 300A, USA). Measurement variables were obtained among children and adults undergoing cataract surgery. Scleral (Prager) shell was used for the immersion technique followed by the contact technique by the same examiner. Results The biometry values of 92 eyes of 92 adult were taken. Their ages ranged from 18 to 95 years with a mean of 64.7 (SD ± 12.9) years. There were 55 (59.8%) males and 37 (40.2%) females, with a male to female ratio of 1.5:1. Average axial length (22.0–24.4 mm) eyes were the most common eyes measured in 75 (81.5%) of the cases. The means of the axial lengths biometry values with immersion and contact technique were 23.66(±1.36) and 23.46 mm (±1.46); the axial length differences was 0.2 ± 0.26 mm (range 0.0–0.94 mm) and statistically significant (95% CI of the Difference 0.15 to 0.26, p = 0.000). The Standard deviation SD (mm) of Individual Eye Axial Length showed a mean of 0.03 ± 0.04 (0.0–0.3) mm for immersion and for contact technique 0.14 ± 0.12(0.0–0.6)mm. Conclusion There was a significant difference in ocular biometry measurement with the contact and immersion ultrasound techniques. The immersion technique had better repeatability, thus it is ideal in a training hospital setting in a typical in sub-Saharan Africa who have limited resources to employ a dedicated person to do biometry; and where the different operators of A-scan machines have different levels of experience and expertise.

Retinopathy of Prematurity (ROP) in a Developing Economy with Improving Health Care

PurposeThe purpose of this study is to highlight the changing pattern of retinopathy of prematurity (ROP) incidence with improvement in economy and health care in Africa, pointing out the challenges and recommendations for sustainable, cost-effective screening and management.Recent FindingsROP was initially thought to be rare in some parts of Africa. Recent findings have shown this not to be true. Studies done over 2011–2016 reported the presence of any ROP stage in 12–52% of screened babies with the prevalence of treatable ROP at 2.9–9.8%. ROP-trained ophthalmologists available to screen with binocular indirect ophthalmoscope and manage babies are few. Awareness of this blinding disease, disease screening, adequate follow-up, treatment issues, and physician competing duties are the major factors militating against effective ROP programs.SummaryCreating awareness and collaboration among stakeholders is urgently needed in most parts of Africa. Cost-effective, regional ROP screening program across several contiguous states using a telemedicine approach with widefield retinal imaging by middle-level personnel is strongly advocated to best address the growing problem of ROP in many parts of Africa.

Normal values of intraocular pressure in full-term Nigerian newborns

Purpose To determine the normative range of intraocular pressure (IOP) in full-term newborns and possible association with birth parameters during the first week of life. Methods This was an observational cross sectional study in which IOP was measured in 1000 eyes of 500 normal full-term newborns using the Perkins applanation tonometer under topical anesthesia. An average of three readings was taken as the IOP value. The relationship between IOP and birth parameters was analyzed. Results The male to female ratio was 1:1 with 254 (50.8%) male and 246 (49.2%) female babies. The (mean ± SD) value of IOP in the right eyes was 11.93 ± 1.80 mmHg, ranging between 9.00 and 16 mmHg. In the left eyes, the mean value of IOP was 11.84 ± 1.77 mmHg with a range of 8.00–15.00 mmHg. IOP in males (12.02 ± 1.84 mmHg) was not significantly different from that in females (11.89 ± 1.75 mmHg). There was no significant difference between right and left eyes (p = 0.42). The 95% range (mean ± 2 SD) was 15.53 mmHg for the right eye and 15.38 mmHg for the left. Correlational analysis showed that birth weight and gestational age were positively correlated with IOP. Conclusion This study provides useful normative data on IOP among Nigerian full-term newborns. Further studies on possible ethnic/geographic variations of IOP in children may be beneficial.