FACULTY OF CLINICAL SCIENCES
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Item Retinopathy of prematurity in a tertiary facility: an initial report of a screening programme(Paediatric Association of Nigeria, 2020) Olusanya, B. A.; Oluleye, T. S.; Tongo, O. O.; Ugalahi, M. O.; Babalola, Y. O.; Ayede, A. I.; Baiyeroju, A. M.Retinopathy of prematurity (ROP) screening in Nigeria is at a nascent stage and at the moment there are no National guidelines for ROP screening in Nigeria. Thus it is desirable for screening programs to report findings amongst screened preterm infants in order to facilitate the development of national ROP screening criteria and guidelines. The aim of this report is to describe the frequency, severity and risk factors for retinopathy of prematurity (ROP) among preterm and very low-birth-weight babies screened within the first year of initiating an ROP screening program at a Nigerian tertiary facility. Methods: A cross-sectional study of infants born at less than 34 weeks gestational age; or with birth weight less than 1500g between May 2016 and May 2017. ROP screening examinations were performed by ophthalmologists with the use of an indirect ophthalmoscope, after pupillary dilation, in collaboration with the neonatology team. Information on gestational age at birth, birth weight, oxygen therapy and presence of other risk factors were recorded and analyzed. Results: A total of 74 infants were screened during the period. There were 36 (48.6%) males. Mean gestational age at birth was 29.6 (±2.35) weeks. Mean birth weight was 1.26 (±0.27) kg with a range of 800 to 1950g. ROP was detected in 9 (12.2%) infants. Two (22.2%) of these had Threshold ROP. There was no significant difference between the mean birth weight and mean gestational age of the infants who had ROP compared to those without ROP. The two infants with Threshold ROP were treated with intravitreal Bevazicumab and had regression of ROP. Conclusion: Retinopathy of prematurity was diagnosed in at risk infants in this facility. There is, therefore, a need to establish ROP screening programs in all neonatal units across the country. In addition, established programs need to evaluate their screening criteria with a view towards developing country-specific screening guidelines.Item Refractive amblyopia among children in Ibadan: the need for amblyopia screening programmes(2015) Olusanya, B. A.; Ugalahi, M. O.; Okoli, C. E.; Baiyeroju, A. M.Background: The prevalence and burden of amblyopia in developing countries is probably underestimated, and little is known about the pattern of amblyopia in West Africa. Aim: To determine the relative frequency and types of amblyopia among children with refractive errors seen in the eye clinic of a tertiary hospital over a 2 year period. Methods: A cross-sectional study conducted at the eye clinic of the University College Hospital, Ibadan, Nigeria between January 2012 and December 2013. Case notes of children with refractive errors seen during this period were retrieved and information including socio-demographic data, presenting visual acuity and visual acuity with correction were recorded. Amblyopia was defined as best corrected visual acuity worse than 6/9 or a difference of >2 Snellen chart lines between both eyes in the absence of any ocular pathology that could explain the visual impairment. Results: A total of 250 eligible patients who had refractive errors were included in the study. Visual acuity was corrected to 6/9 or better in 224 (89.6%) children while 26(10.4%) of them had amblyopia. Among the 26 children with amblyopia, 21 (80.8%) children had amblyopia in both eyes and majority (65.4%) had isoamctropic amblyopia. Of the 47 amblyopic eyes, 36 (76.6%) eyes had moderate amblyopia while 11 (23.4%) eyes had severe amblyopia. Conclusion'. There is a high relative frequency of amblyopia in this study and we recommend preschool eye examinations for all children to ensure early detection and management of amblyopia, thereby reducing the burden of amblyopia in our populace.Item Paediatric ophthalmology(2015) Baiyeroju, A. M.; Ademola-Popoola, D. S.Item Delays in uptake of surgery for childhood cataract at a child eye health tertiary facility in sub-Saharan Africa(SAGE Publishing, 2019) Ugalahi, M. O.; Olusanya, B. A.; Fagbemi, O. O.; Baiyeroju, A. M.Background: Timely uptake of surgery is vital in the control of childhood blindness due to cataract. The aim of this study is to determine the uptake of surgery as well as the frequency and reasons for rescheduling of surgery for childhood cataract in a tertiary hospital in southwest Nigeria. Methods: A retrospective study of children with childhood cataract seen at the Paediatric Ophthalmology unit of the University College Hospital, Ibadan between 2011 and 2015. Demographic and clinical information was retrieved from case records. Caregivers of children who did not have surgery were contacted by telephone to elicit reasons why surgery was not done. Results: A total of 164 children were included in the study; 90 (54.9%) were male. The median age at presentation was 4 years with a range of 2–180 months. A total of 64 (39.0%) children had unilateral cataract. All patients were scheduled for surgery, but 123 (75%) underwent surgery. Surgery was rescheduled in 42 (34.1%) of those who had surgery. Reasons for rescheduling included financial constraints, illness, delay in paediatrician evaluation to ascertain fitness for anaesthesia and strike actions by health workers in the hospital. Conclusion: Three quarters of the children had surgery, though it had been rescheduled, at least once, in about onethird of them. Delayed uptake of surgery was mainly due to inability to afford treatment and strike actions. The need for improved coverage of health insurance especially for the paediatric age group in developing countries cannot be overemphasized. This is because good vision is an integral part of child development.Item Congenital aniridia: clinical profile of children seen at the University College Hospital, Ibadan, South-West Nigeria(SAGE Publishing, 2021) Ugalahi, M. O.; Ibukun, F. A.; Olusanya, B. A.; Baiyeroju, A. M.Purpose: To describe the clinical features of patients younger than 16 years with aniridia presenting to the Paediatric Ophthalmology unit of the Eye Clinic, University College Hospital, Ibadan, Nigeria. Methods: The is a retrospective review of children with aniridia seen between May 2015 and April 2019 at the Paediatric Ophthalmology unit of the Eye Clinic, University College Hospital in Ibadan. Data on demographic characteristics, presenting complaints, ocular and systemic examination findings, and interventions were collected and descriptively summarised. Results: A total of 28 eyes of 14 patients were studied. The mean age was 6.37 ± 4.98 years. Seven (50%) patients were male. Aniridia was diagnosed in first-degree relatives of nine patients. The most common complaint at presentation was poor vision in 11 (78.6%) patients. Objective visual acuity assessment was obtained in 22 (78.6%) eyes. Presenting visual acuity was worse than 20/60 in all 22 eyes and worse than 20/400 in 8 (36.4%) eyes. Refraction was performed in 17 (60.7%) eyes and revealed a mean spherical equivalent of −3.93 ± 5.99 diopters. Twenty (71.4%) eyes had corneal opacities, and lenticular opacities were seen in 15 (62.5%) of 24 eyes. Mean intraocular pressure (IOP) at presentation was 21.62 ± 10.4 mmHg; 12 (41.4%) eyes had elevated IOP at presentation. Ten (35.7%) eyes had cataract surgery and six (21.4%) eyes had glaucoma surgery. Conclusion: Familial aniridia was common in this study, and most of the patients presented with moderate to severe visual impairment. The common ocular associations were refractive error, cataract, corneal opacity and glaucoma.Item Common forms of strabismus in a tertiary eye clinic in Southwest Nigeria(Wolters Kluwer - Medknow, 2019-12) Olusanya, B. A.; Ugalahi, M. O.; Ayeni, O.; Fawole, O. I.; Baiyeroju, A. M.Background: Strabismus occurs worldwide and is associated with undesirable psychosocial impact and negative social prejudice. However, there is a dearth of information on the different subtypes of strabismus in Nigerian patients. The aim of this study is to describe the common forms of strabismus among patients of an eye clinic in southwestern Nigeria. Methods: We retrospectively reviewed all new patients seen at the eye clinic of our hospital between January 1999 and December 2008. Patients with a diagnosis of strabismus were identified from the clinic registers and their case records were reviewed. Information on age, gender, cause, and type of squint as well as associated ocular/systemic disease was retrieved from the case records. Results: A total of 240 patients had strabismus, giving a relative frequency of 1.2%. Mean age of patients with strabismus was 19.8 (±19.7) years while male-to-female ratio was 0.98:1. Esotropia (53.8%) was more common than exotropia (44.2%). The mean age of patients with esotropia was 12.8 years compared with 27.9 years for patients with exotropia (P < 0.001). Sensory strabismus was the most common form of strabismus, occurring in 83 (34.5%) patients, while accommodative esotropia was found in only 5.8% patients. Conclusion: The relative frequency of strabismus in this study is fairly similar to other reports from Nigeria and Africa. Secondary strabismus was quite common whereas primary forms of strabismus such as accommodative esotropia appear to occur less frequently among our patients in comparison to Caucasian populations.Item Bilateral congenital anophthalmia: a report of two cases and a case for increased anomaly ultrasound scans coverage in pregnancy in Nigeria(Nigerian Association of Resident Doctors (NARD), 2022-02) Onebunne, E. O.; Ugalahi, M. O.; Olusanya, B. A.; Baiyeroju, A. M.This is a report of two cases of patients with bilateral congenital anophthalmos who presented to a tertiary hospital, in Ibadan Southwest Nigeria, with the aim of highlighting the need for increased implementation of fetal anomaly scans coverage during pregnancy in Nigeria. Information on patients’ sociodemographic data, clinical features, and management are described. Both patients presented because of the inability of the parents to view the globes after delivery. Ophthalmic examination and ocular ultrasonography confirmed bilateral absence of the eyeballs in both patients and the parents were counseled on the anomaly including its treatment and prognosis.Item Age at detection and age at presentation of childhood cataract at a tertiary facility in Ibadan, Southwest Nigeria(2020) Olusanya, B. A.; Ugalahi, M. O.; Adeyemo, A. O.; Baiyeroju, A. M.Background: To describe factors which influence the age at detection and age at presentation of patients with childhood cataract at a tertiary eye care facility in Southwest Nigeria. Methods: A retrospective review of children who presented with cataract between 2011 and 2015. Case notes were reviewed and data on age at detection and presentation as well as other clinical information was collected and analyzed using Stata 12 statistical software. Results: A total of 164 cases were reviewed, 52.4% of them were boys. Median age at presentation was 48 months while the median age at detection was 13.5 months. Seventy-four (45.1%) children had congenital cataract, 31.1% had developmental cataract, and 21.3% had traumatic cataract. The child’s mother detected the cataract in 116 (70.7%) of the patients. Median age at presentation for patients with congenital cataract was 18 months and 84 months for developmental cataract. The median age at presentation for congenital cataracts that were noticed by the mother was 17 months compared with 72 months for those noticed by other caregivers (p = 0.0085). The median age at presentation for developmental cataracts that were noticed by the mother was 72 months compared with 114 months for those noticed by other caregivers (p = 0.0065). Gender of the child did not significantly influence the age at detection or presentation. The source of referral and the location of domicile did not significantly affect the time interval between detection of the cataract and presentation to hospital. Conclusion: The average age of children presenting with cataracts in our setting is older than in high income countries. Detection of the cataract by the mother increases the likelihood of early presentation; thus, focused maternal education may promote earlier detection and presentation. Keywords: Childhood, Cataract surgery, Access, Nigeria, Sub-Saharan AfricaItem Spare the rod or spoil the eye? corporal punishment- related eye injuries among children presenting to tertiary hospital in South West Nigeria(2018-06) Monye, H. I.; Ugalahi, M. O.; Olusanya, B. A.; Baiyeroju, A. M.Objective: To determine the burden of corporal punishment in the aetiology of ocular injuries among children, to inform evidence-based advocacy measures to curb this trend. Methodology: This study was a retrospective review of cases of punishment-related ocular injuries among children aged 16 years and less who presented to the Eye Emergency of the University College Hospital, Ibadan, between 2010 and 2016. Data on proportion of paediatric ocular trauma due to corporal punishment, patient demography, circumstance surrounding, and nature of injury, management and visual outcome were descriptively summarised. Results: There were 109 cases of paediatric eye injuries during the study period of which 18(16.5%) were due to corporal punishment. The mean age was 10.3 years (SD 2.7). Males comprised 61.1 % (11) of cases. Place of injury was at school in 10 (55.6%) and at home in 8 (44.4%) cases. All injuries were unilateral. Sixteen (88.9%) of these injuries were of the closed globe type and management was conservative in 15 (83.3%) children. Twelve (66.7%) children had visual acuity less than 3/60 at presentation while 8 (44.4%) had 6/18 or better vision as at time of last follow up. Conclusion: Punishment-related eye injuries are important in the aetiology of paediatric ocular trauma in our locality especially as relates to poor visual outcome. There is therefore the need for targeted sensitization of parents, care givers and teachers, as well as creation of awareness of alternative methods to corporal punishment and legislation in order to effectively tackle this problem.Item Simultaneous versus sequential surgery for bilateral congenital cataracts in a resource-limited setting(2018) Ugalahi, M. O.; Olusanya, B. A.; Monye, H. I.; Baiyeroju, A. M.Background: To compare simultaneous surgery with sequential surgery for the treatment of bilateral congenital cataracts in children younger than three years at a tertiary hospital in a resource-limited setting in order to facilitate informed decision making by parents and healthcare providers. Methods: A retrospective review of medical records of children below three years who had bilateral surgery for congenital cataracts between 2010 and 2016 at the paediatric ophthalmology unit of a university teaching hospital in Nigeria. Data on demographic characteristics, type of surgery, delays in care, time interval between surgery and optical rehabilitation, direct cost of care, systemic associations and surgical complications were retrieved, descriptively summarized and compared for both groups. Results: There were 40 eligible patients, 25 (62.5%) of which were males. Age at presentation ranged from 4-128 weeks with a median of 28 weeks. Twenty-four (60%) patients had simultaneous bilateral cataract surgery. Patients who underwent sequential cataract surgery had higher direct costs and accumulated hospital stay, and were more likely to experience delays in accessing second procedures as well as post-operative optical rehabilitation. No anesthetic or other serious ocular complications such as endophthalmitis were noted in either group. Conclusion: Although there were similarly low complication rates in both groups, we observed higher direct costs of care, longer duration of hospital stay, as well as longer intervals before second surgeries and visual rehabilitation in the sequential group. Therefore, simultaneous cataract surgeries may be the preferable option in resource-limited settings like ours, where health care financing is mainly through out-of-pocket expenses.