Ophthalmology
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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 Trabeculectomy for congenital glaucoma in University College Hospital, Ibadan: a 7 year review of cases(Wolters Kluwer - Medknow, 2015-12) Olusanya, B. A.; Ugalahi, M. O.; Malomo, M. O.; Baiyeroju, A.Introduction: Congenital glaucoma is an uncommon ocular condition affecting about 1/15,000 live births. About two third of cases are bilateral with a higher prevalence in males. The definitive treatment requires surgery which could be trabeculectomy, trabeculotomy, goniotomy, drainage tubes or a combination of trabeculotomy and trabeculectomy. Aim: To determine the outcome of trabeculectomy in patients with congenital glaucoma seen at the University College Hospital Ibadan between 2007 and 2013. Methods: The medical records of all patients with congenital glaucoma seen between the years 2007 and 2013 were retrieved. Inclusion criteria were patients who had trabeculectomy with or without anti-metabolites within this period. The main outcome measures assessed were postoperative intraocular pressure (IOP) and corneal clarity. Data was analyzed with the statistical Package for Social Sciences version 21. Results: Thirty-four eyes of 18 patients were reviewed out of which 16 patients had bilateral trabeculectomy while two had unilateral trabeculectomy. The mean preoperative IOP was 26.31 mmHg while the mean IOP in the immediate postoperative period, at 3 months after surgery and at last follow-up visit were 13.31 mmHg, 12.78 mmHg and 15.89 mmHg respectively. IOP was <21 mmHg in 81.82% of the eyes as at last clinic visit. All eyes had cloudy corneas preoperatively while 38.24% had minimal residual corneal opacity (Haab’s striae) as at last follow-up visit. Conclusion: In the absence of equipment for other surgical options, trabeculectomy is an effective surgical approach in the management of congenital glaucoma in the short term.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 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 Traitement d’urgence : ophtalmie dunouveau-né(2019) Olusanya, B.; Baiyeroju, A.Item 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.Item Ophthalmic congenital anomalies: spectrum and systemic associations in a Nigerian tertiary hospital(2017) Olusanya, B. A.; Ayede, A. I.; Adeleye, A. O.; Olusanya, A. A.; Lawal, T. A.; Baiyeroju, A. M.; Ogunkunle, O. O.; Joel-Medewase, V. I.; Adebayo, B. E.; Akinrinoye, O. O.; Ashubu, O. F.; Omokhodion, S. I.Background: To document the pattern of ophthalmic congenital anomalies and their associated systemic anomalies in Nigeria’s foremost university teaching hospital. Methods: Retrospective cross-sectional study conducted at the University College Hospital, Ibadan from January 2009 to December 2013. Clinic and ward registers of various departments and units in the hospital were reviewed to identify children with any structural abnormality, present at birth, which involved the eye and/or its adnexae. Results: Two hundred and forty eight children with 259 ophthalmic congenital anomalies were studied. The median age was 1.2 years with an interquartile range of 4.6 years. The male to female ratio was 1.27:1. Congenital cataract was found in 109 (44%) patients; 40 (15.4%) children had congenital glaucoma, and whole globe anomalies were observed in 18 (6.9%) children. Eighteen (7.9%) children had a family history of congenital anomalies. Associated systemic congenital anomalies were seen in 32 (12.9%) patients with the most common being cardiovascular anomalies in 13 (5.2%) patients. Children who had congenital cataracts were more likely to have multiple associated systemic anomalies (p<0.005). All the children who had associated cardiovascular anomalies had congenital cataracts (p= 0.001). Conclusion: The commonest ophthalmic congenital anomaly presenting for tertiary care in Ibadan is congenital cataract. Cardiovascular anomalies are the commonest systemic association of ophthalmic congenital anomalies. There is an urgent need for the establishment of a registry for congenital anomalies with effective screening and active surveillance within the Nigerian health system.Item Ophthalmic congenital anomalies: spectrum and systemic associations in a Nigerian tertiary hospital(2017) Olusanya, B. A.; Ayede, A. I.; Adeleye, A. O.; Olusanya, A. A.; Lawal, T. A.; Baiyeroju, A. M.; Ogunkunle, O. O.; Joel-Medewase, V. I.; Adebayo, B. E.; Akinrinoye, O. O.; Ashubu, O. F.; Omokhodion, S. I.Background: To document the pattern of ophthalmic congenital anomalies and their associated systemic anomalies in Nigeria’s foremost university teaching hospital. Methods: Retrospective cross-sectional study conducted at the University College Hospital, Ibadan from January 2009 to December 2013. Clinic and ward registers of various departments and units in the hospital were reviewed to identify children with any structural abnormality, present at birth, which involved the eye and/or its adnexae. Results: Two hundred and forty eight children with 259 ophthalmic congenital anomalies were studied. The median age was 1.2 years with an interquartile range of 4.6 years. The male to female ratio was 1.27:1. Congenital cataract was found in 109 (44%) patients; 40 (15.4%) children had congenital glaucoma, and whole globe anomalies were observed in 18 (6.9%) children. Eighteen (7.9%) children had a family history of congenital anomalies. Associated systemic congenital anomalies were seen in 32 (12.9%) patients with the most common being cardiovascular anomalies in 13 (5.2%) patients. Children who had congenital cataracts were more likely to have multiple associated systemic anomalies (p<0.005). All the children who had associated cardiovascular anomalies had congenital cataracts (p= 0.001). Conclusion: The commonest ophthalmic congenital anomaly presenting for tertiary care in Ibadan is congenital cataract. Cardiovascular anomalies are the commonest systemic association of ophthalmic congenital anomalies. There is an urgent need for the establishment of a registry for congenital anomalies with effective screening and active surveillance within the Nigerian health system.