International Journal of Clinical and Experimental Ophthalmology ISSN: 2577-140X

Abstract

Aim: To evaluate the outcome of Trabeculectomy in advanced glaucoma in a hospital in Rivers State, Nigeria.

Methods: This was a non-randomized interventional study in which each patient served as its own control. Patients with advanced glaucoma and demonstrable field defects and Mean defect ≥-12 were included. The intervention employed was Trabeculectomy and IOP and visual acuity pre operative, as well as post op were collected and compared at pre- op, post -op day 1, one week, one month, 6 months. Data was analyzed using SPSS version 20.

Results: Thirteen (13) eyes from ten (10) patients with advanced glaucoma were involved in the study. Mean age of study population was 53±19.62 years. Mean of mean defect was -19.05±5.23dB while mean of vertical cup disc ratio (VCDR) was 0.88±0.04.

Mean of Pre- op Visual acuity (log MAR) was 0.46 and dropped to 0.72 first day post-op but improved over 6 months to 0.42. The mean of IOP pre-op was 24.15mmHg and dropped to 11.23mmHg (58.24%) over 6 months (p=0.001).

Conclusion: Trabeculectomy still remains the gold standard surgical treatment for glaucoma. In our study it resulted in a 58.24% drop in IOP over 6 months with mean visual acuity maintained at pre-op levels after 6 months follow up. It therefore is effective and safe surgical intervention in advanced glaucoma.

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Abstract

To determine the proportion of participants with elevated intraocular pressure and abnormal vertical cup disc ratio in a glaucoma screening event in a rural community in Nigeria.

Methods: 242 eyes of 121 participants at a one-day screening programme were examined. Visual acuity was accessed using Snellen literate and illiterate charts, followed by a pen torch examination of the anterior segment. The posterior segment was accessed using a direct ophthalmoscope (Welch Allyn, USA). All participants had intraocular accessed using Keeler non contact tonometer and those with significant media opacity preventing view of the posterior pole had cycloplegic examination after dilatation with 1%Tropicamide drops. Data generated was expressed as percentages and means.

Results: 121 participants (242 eyes) were examined. There were 42 males and 79 females giving a M:F ratio of 1:1.86. Age range of participants was 0-90years with a peak in the 5th decade. Mean age was 32 years. 79.3% of participants had normal visual acuity of 6/4 -6/18, while 9.5% had visual acuity worse than 6/60.

83% of eyes had intraocular pressure within normal level, <21mmHg, 12.4% within 21-30mmHg and 4.6% >30mmHg.

73.1% of eyes had Vertical Cup disc ratio (VCDR) <0.5, 10.7% had 0.5-0.7 and 6.6%>0.7. 9.6% of eyes could not be accessed due to media opacities.

Conclusion: 6.6% of participants had suspicious discs and 4.6% participants had intraocular pressures above 30mmHg. Opportunistic screening for glaucoma remains one of the important modes of case detection for glaucoma in the developing climes and should be encouraged as a way to address the scourge of this blinding disease.

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Clinical Image

A case of recurrent tuberculosis-related uveitis in a young female patient of North African origin.

Right eye: Slit-lamp photograph of broad-based posterior synechiae (formed by macrophage-laden iris tissue when brushing against and then adhering to, the anterior lens capsule) rendering the pupils irregular, clover- or, here, “Mickey Mouse”©-shaped. Cycloplegic agents can increase the pupillary circumference, displacing iris tissue further away from the crystalline lens to help reduce adhesions from forming that beget lens opacities as well as block aqueous humor flow.

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Editorial

Obesity is a chronic and metabolic disease with a high increasing prevalence worldwide. It has multifactorial pathogenesis including genetic and behavioral factors [1-5]. Overweight and obesity have been defined and classified by the World Health Organization (WHO) and the National Institutes of Health (NIH) [2,3].A person with a normal weight has Body Mass Index (BMI) of 18.5-24.9. A person with a BMI under 18.5 is called underweight. An adult having a BMI of 25-29.9 is overweight and pre-obese. Class 1 obesity is defined as a BMI between 30.00-34.99. Class 2 (Severe) Obesity is to have a BMI between 35.00-39.99. Morbid (Extreme, Class 3) obesity is to have a BMI over 40 [1-5]. Obesity is significantly associated with enhanced morbidity and mortality rates. It has also various economic, medical and psychological effects and causes health problems including many systemic diseases, economic costs and burdens, social and occupational stigmatization and discrimination and productivity loss [4-6]. Obesity carries the increased risk of development of many systemic and chronic diseases, including sleep apnea, depression, insulin resistance, Type 2 (adult-onset) diabetes, Gout and related arthritis, degenerative arthritis, hypertension, dyslipidemia, heart disease such as myocardial infarction, congestive heart failure, or coronary artery disease, polycystic ovary syndrome and reproductive disorders, Pickwickian syndrome (obesity, red face and hypoventilation), metabolic syndrome, non-alcoholic fatty liver disease, cholecystitis, cerebrovascular accident, colonic and renal cancer, rectal and prostatic cancer in males, and gallbladder, uterus and breast cancer in females [6-12].

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Abstract Read Full Article HTMLDOI: 10.29328/journal.ijceo.1001015 Cite this Article