Knowledge and Practice of Fundoscopy among Medical Doctors in Port Harcourt, Nigeria

Background: Many clinical entities manifest early characteristic changes in the fundus of the eye. The value of fundoscopy cannot be overemphasized and every medical doctor is expected to be able to use the ophthalmoscope to detect common pathological changes. However, more often than not fundoscopy is seen as an exclusive specialized skill of the ophthalmologist. Aim: The aim of this study was to evaluate knowledge and practice of fundoscopy among the physicians present at the Ordinary General Meeting of the Nigerian Medical Association (Rivers State branch) held in Port Harcourt on 30th June 2014. Methods: A self administered questionnaire about their knowledge and practice of fundoscopy was administered to 125 medical doctors attending the Ordinary General Meeting of the Nigerian Medical Association (Rivers State branch) held in Port Harcourt on 30th June 2014. Questions asked tested the Knowledge and Practice of the physicians on matters related to fundoscopy. Participants’ knowledge and practice were graded as Good for scores of 75% and above, Fair for 50% - 74% score and Poor for scores less than 50%. Respondents’ demographic data, responses and corresponding scores were entered into computer software—Scientific Package for Social Sciences (SPSS) version 20 and subsequently analyzed. Results: The study participants were 125 physicians;86 males and 39 females (M:F = 2.2:1). Twenty-eight percent of the study participants had good knowledge of fundoscopy while only 15% had good practice. Seventy eight physicians representing 62.4% of the participants could correctly refer patients with the need for fundoscopy to an ophthalmologist, whereas 11 (8.8%) worked in facilities without basic instrument for fundoscopy (ophthalmoscope). Conclusion: Our study demonstrates that knowledge and practice of fundoscopy among medical practitioners in Port Harcourt is poor and far from ideal. Therefore, refresher courses emphasizing the acquisition of the skill in fundoscopy and the provision of ophthalmoscopes in our General Practitioners’ clinics are necessary.

Prevalence, Causes and Management of Neovascular Glaucoma: A 5-Year Review

Purpose: To determine the prevalence, identify the causes and outline the management options available at our center for the treatment of neovascular glaucoma. Setting: The study was carried out in the department of ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria. Methods: The case records of all patients who were managed in the department of ophthalmology from January 2013 to December 2017 for neovascular glaucoma were retrieved. Data collected included, age, sex, causes of neovascular glaucoma, presenting visual acuity, treatment options and outcomes, systemic and ocular comorbidities. Results were analysed using Statistical Package for Social Sciences (SPSS) 20.0 for Windows statistical software. Results: Thirty-two eyes (32) of twenty-eight patients were studied. The hospital prevalence of neovascular glaucoma was 0.3%. There were 4 cases of bilateral neovascular glaucoma (NVG). Retinal vein occlusion 17 (53%) was the commonest cause of NVG followed by proliferative diabetic retinopathy 13 (41%). Uveitis was seen in only 2 (6%) eyes. The commonest form of intervention used was a combination of medical therapy and anti VEGFs. Fifty percent (50%) of the study population had a lowering of their intraocular pressures within the normal limits post treatment and this was statistically significant (p = 0.000). However, only 10% had an improvement in their visual acuity after treatment. Conclusions: Neovascular glaucoma is a potential blinding condition with challenges in control of intraocular pressures and preservation of vision. Early detection and attention to aetiological factors with timely institution of the appropriate mode of treatment may help in preserving vision.

Prevalence of Dry Eye Disease in a Rural Niger Delta Community, Southern Nigeria

Background: Dry Eye Disease (DED) or Dry Eye Syndrome (DES) is the fast growing public health problem characterized by deficiency in the quantity and/or quality of tear film due to tear deficiency or excessive tear evaporation. It negatively affects the health and the quality of life of individuals. Although dry eye is a common eye disease world-wide, many people are undiagnosed and untreated especially in underdeveloped countries. Aim: To determine the prevalence of dry eye disease in Aluu community. Methods: The cross-sectional, population-based study from 16th to 18th June 2016. Participants were members and residents of the community who consented to ocular examinations. Ocular examinations including Schimer’s test were carried out. Data were entered into a spread sheet using statistical package for social sciences (SPSS) 16.0 statistical software and subsequently analysed. Results: Seven hundred and thirty persons (210 males and 520 females) participated in the study. The mean age was 34.2 ± 12.4 years. The prevalence of Dry Eye Disease in this study was 27.4%. Over 72% of the study population had normal Schimer’s test 95% CI [15.0 - 15.2], 18.4% had mild dry eye syndrome 95% CI [10.1 - 10.7], 6.8% had moderate dry eye syndrome test 95% CI [5.5 - 7.6] while 2.2% had severe dry eye syndrome test 95% CI [3.0 - 3.8]. Conclusion: The prevalence of dry eye disease in Aluu community is high. It is therefore, advocated special eye healthcare intervention by governments and non-governmental agencies be extended to this rural Niger Delta community.

Clinical Outcome of Intracameral Dexamethasone in Paediatric Cataract Surgery in a Nigerian Missionary Hospital

Paediatric cataract surgery is associated with several complications among which is high ocular inflammatory response. Conventionally immediate post-operative subconjunctival steroid with adjuvant systemic and frequent topical steroids have been used to control post-operative inflammation. Studies have reported the advantage of intracameral dexamethasone in decreasing postoperative inflammation. Aim: To evaluate the clinical outcome of intracameral dexamethasone in paediatric cataract surgery in Evangelical Church of West Africa (ECWA) Eye Hospital, Kano. Method: This was a prospective study of 694 paediatric cataract surgeries from January 2006 to December 2014. All the patients were given intracameral dexamethasone 0.4 mg (0.1 ml) immediately after surgery. Each patient had surgical intervention on one eye. Evaluation was done on first, third postoperative day, one week and four weeks later (follow up visits). Outcomes were measured on the fourth week post-operation. Examination of children was done with help of slit lamp for cells, flare or any other sign of inflammation. In case of non-cooperative children examination was done with microscope under sedation/general anaesthesia for fibrinous reaction, exudative membrane, posterior synechiae and red reflex. Results: There were total of 694 patients with age range of 0 to 11 years. Mean age of participants was 2.03 ± 2.5 years. The mean duration of cataract before presentation to the hospital was 5.7 ± 4.3 months with a range of 0 to 16 months. Post operative complications, likely to be associated with intracameral dexamethasone were corneal opacity (0.6%) and raised intraocular pressure (12.5%). In 31 patients (4.5%) there was no post operative complication. Conclusion: Intracameral injection of dexamethasone has a role in preventing immediate postoperative anterior uveitis in paediatric cataract but may not be without complication.