Faculty of Ophthalmology

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FACTORS CONTRIBUTING TO LATE PRESENTATION OF PATIENTS WITH STRABISMUS TO THE KOMFO ANOKYE TEACHING HOSPITAL, GHANA
(AMANKWAA-FREMPONG DOREEN, 2020-11-26) AMANKWAA-FREMPONG, DOREEN
Introduction Strabismus is an ophthalmic condition that refers to the misalignment of the eyes. It is a common eye problem in both children and adults resulting in reduced visual acuity, abnormal binocular vision and low self-esteem. Anecdotally, most patients with strabismus present late to the Eye Clinic at the Komfo Anokye Teaching Hospital (KATH). Factors contributing to this late presentation have not been studied. This study sought to determine the factors contributing to late presentation of patients with strabismus at KATH. Methods This was a hospital-based cross-sectional study of factors contributing to late presentation of patients with strabismus at KATH. Patients with strabismus who met the inclusion criteria were examined after informed consent and assent. Socio-demographic characteristics of the patients such as age, sex, place of residence, education, etc., were recorded using a structured questionnaire. Clinical findings (age at onset of strabismus, age at presentation, deviating eye, type of deviation, etc.) were documented on the questionnaire. Data collected was analysed using SPSS Version 20 and presented using descriptive and inferential statistics. Chi-square test, odds ratios and 95 % confidence intervals were computed. P-values less than 0.05 were considered statistically significant. Results A total of 330 (males-180, 54.5 % and females-150 (45.5 %) patients were recruited into this study. The mean age at onset and presentation of strabismus were 4.0±1.2 years and 10.1±9.4 years. Age of patient, education of patient, having no relative with strabismus, monthly income level of family and having no knowledge about strabismus were associated with late presentation of patients with strabismus (p-values = 0.002, 0.001, 0.025, 0.001 and 0.001 vi respectively). There was no association between type of strabismus, type of deviation, presenting visual acuity, angle of deviation and late presentation of patients with strabismus (p-values = 0.423, 0.196, 0.446 and 0.624). Children were 0.1 times less likely to present late compared to adults [OR = 0.1; CI = (0.01-0.8); p-value = 0.032]. Participants with lower education were 1.6 times more likely to present late with strabismus compared to those having higher education [OR = 1.6; CI = (1.1-2.3); p-value = 0.006]. Beneficiaries of National Health Insurance Scheme (NHIS) were 0.4 times less likely to present late compared with non-beneficiaries of NHIS [OR= 0.4; CI = (0.2 -0.9); p-value = 0.037]. Patients with no knowledge about strabismus were 2.9 times more likely to present late compared with those who have knowledge about strabismus [OR= 2.9; CI = (1.5 -5.8); p-value = 0.002]. Patients who have no relatives with strabismus 2 times more likely to present late compared with those having relatives with strabismus [OR= 2.0; CI = (1.0 -4.3); p-value = 0.042]. Conclusions Age, education of patient, having no relative with strabismus, monthly income level of family and having no knowledge about strabismus were associated with late presentation of strabismus. Being an adult, having a lower level of education, not having NHIS and knowledge about strabismus, not having relatives with strabismus could predict late presentation of patients with strabismus.
EFFECTS OF STEROID EYE DROPS ON INTRAOCULAR PRESSURE IN PATIENTS POST CATARACT SURGERY AND ASSOCIATED RISK FACTORS AT A TERTIARY FACILITY AND ITS OUTREACH CENTRE
(MENSA-BONSU, AKOSUA BADU, 2022-06-14) MENSA-BONSU, AKOSUA BADU
Introduction Topical corticosteroids are routinely used after cataract surgery to decrease inflammation, relieve pain, and improve visual outcomes. However, they are known to have significant side effects, whether topically or systemically administered. Not much is known about the incidence of Steroid-Induced Ocular Hypertension (SiOH) in adult Ghanaians undergoing cataract surgery. Considering the immense negative impact visual impairment has on the quality of life of those affected, it is imperative to know the incidence of SiOH in the Ghanaian population. This would help in outlining preventive measures for potential ocular complications among patients undergoing cataract surgery. General Aim To determine the effect of steroid eye drops on intraocular pressure in patients post-cataract surgery and its associated risk factors. Methods This is a prospective cohort study of the effect of steroid eyedrops in patients post-cataract surgery at Korle Bu Teaching Hospital and Emmanuel Eye Centre. Patients undergoing cataract surgery were recruited into the study after informed consent. Demographic information, history and findings from ocular examinations were documented using a structured questionnaire. Baseline intraocular pressures were recorded. Post-operative intraocular pressures were measured on day one, weeks one, five and thirteen after surgery. Continuous numerical data were summarized as mean and Standard deviation (SD) and categorical data as percentages (%). Mean change in intraocular pressure from baseline was computed. Risk factors for SiOH were analysed using a Binary Logistic Regression Model and presented as Odds ratios and 95% Confidence Intervals. Kaplan-Meier survival function was used in calculating the average time (days) to develop SiOH among study participants. P-values less than 0.05 were considered statistically significant. Results A total of 124 patients participated in this study with a mean age of 66.1±13.6 years. Majority 75 (60.0 %) of the study participants were females. The overall mean pre-operative intra ocular pressure (IOP)in the study eyes was 17.8±4.4 mmHg with a 5.3% increase in IOP from baseline which was not statistically significant (p = 0.061). The incidence of SiOH in the study was 29% on post-operative day one and reduced to 1.6% at 13 weeks. In a univariate and multivariate analysis, there were no risk factors associated with the development of SiOH . A sub analysis of the ocular responses however picked up age as a risk factor for responding to the use of topical steroids. Participants aged 70 years and above were more likely to respond to the use of topical steroids after cataract surgery though this did not translate to a significant likelihood of developing SiOH in this cohort of patients undergoing cataract surgery. From Kaplan-Meier analysis, the overall mean time (days) to develop SiOH among the study participants was 55.3 days (95% CI= 47.3 – 63.3 days). Conclusion SiOH post-cataract surgery is a common complication in this study cohort with an incidence of 36.3 %; most of which (29%) occurred within the first month post-operation. There were no risk factors associated with the development of SiOH in this study. Patients undergoing cataract surgery should have their IOP monitored closely during their early postoperative visits to prevent ocular complications associated with prolonged raised IOP.
DETERMINATION OF NORMATIVE VALUES FOR CENTRAL CORNEAL THICKNESS IN GHANAIAN CHILDREN IN THE ABLEKUMA SOUTH SUB-METROPOLITAN AREA
(BEYUO, VERA MAWUSIME, 2022-06-14) BEYUO, VERA MAWUSIME
Background The thickness of the cornea has importance in ocular health. Several studies including the work done by the Ocular Hypertension Treatment Study (OHTS) have demonstrated the significance of Central Corneal Thickness (CCT) measurements in the accurate assessment of intraocular pressure (IOP), accurate diagnosis and prognosis of glaucoma. The variation of CCT with age, gender and race have also been confirmed in studies. CCT has been shown to increase gradually with age in children stabilizing after the age of 10 years and has been shown to be thinner in African/Americans compared to whites. In the adult population, CCT values have been shown to affect the accurate diagnosis and management of glaucoma resulting in the need for assessment of the normal CCT values for any given population. The racial and ethnic variation in CCT values does not support extrapolation of normal population values from one geographic location to the other. In Ghana, data on normal CCT values in children is lacking, resulting in assessment of intraocular pressure based on reference values from populations with potentially different CCT values. It is therefore imperative that CCT values be assessed in healthy Ghanaian children to determine normal values for our population. This will provide baseline data for assessment of deviations from the mean values in the Ghanaian population in future studies to better correlate CCT with IOP values in Ghana. Aim The overall aim of this study was to measure the CCT in healthy Ghanaian children and determine the normal values of defined age-groups. Materials and methods A prospective cross-sectional study was conducted to measure the CCT of 420 children (840 eyes) aged 6 to 15 years. Informed written consent was obtained from parents/ guardians and assent obtained from children aged 8 years and above. An interviewer-administered questionnaire was used to obtain demographic data followed by an anterior and posterior ocular exam. One drop of 0.5% amethocaine was instilled in the eye 1 minute prior to measurement after which a hand-held pachymeter was used to take 3 measurements from the central 3mm of the cornea of the eye. Data handling and statistical analysis plan Statistically significant differences were assessed with the independent t-test for differences in continuous variables such as CCT, analysis of variance (ANOVA) for differences between groups such as age and gender and linear regression for differences in trends. Statistical significance was set at a p value of less than 0.05. Results: The overall mean CCT was 538.8 ± 27 µm (420 children, 840 eyes) and among children aged 6-8 years was 541.4±24.9 µm., for children aged 8-10 years 534.9±25.8 µm and those 10-15 years 538.3±28.6 µm. ANOVA (Analysis of variance with the F statistics) with the Post Hoc tests showed no significant difference in mean CCT among the age groups for both eyes. There was found to be a weak negative correlation between CCT and age. Thus, CCT decreased with age. Though CCT was higher in males, the difference was not statistically significant. Our study also demonstrated that there was a weak positive correlation between CCT and IOP. CCT was higher in hyperopes compared to emmetropes and thinnest in myopes and the difference was statistically significant. Conclusion: CCT in healthy Ghanaian children was found to be 538.8 ± 27 µm and did not vary significantly among age groups or sex. Results of this study provide baseline data for larger national studies that could ultimately lead to the development of national reference ranges for CCT values in the Ghanaian paediatric population. Secondary benefits of this study include improvement in the diagnosis, prognostic prediction, and management of glaucoma in children.
OCULAR BIOMETRIC PARAMETERS AND THEIR RELATIONSHIP WITH AGE, GENDER, REFRACTION AND BODY MASS INDEX IN HEALTHY GHANAIAN CHILDREN.
(BOSOMPEM ABIGAIL NYARKO, 2024-04-30) BOSOMPEM, ABIGAIL NYARKO
Background Ocular biometry involves measurement of axial length, keratometry-value (K-value), anterior chamber depth, lens thickness, and vitreous chamber depth. These biometric values are of importance in clinical decision making in paediatric cataract surgeries, diagnoses of myopia, paediatric laser surgeries and others. Currently, values used in our clinical setting are based on research from other parts of the world. This is due to the dearth of normative data for ocular biometric values for the Ghanaian paediatric population. Published data on paediatric ocular biometry exist abundantly for other populations, however, there is a dearth of published data on this topic in sub-Saharan Africa. This necessitates the need to establish the normative ocular biometric value in the Ghanaian population to optimise our clinical decisions. Aim The study was carried out to determine ocular biometric parameters and their relationship with age, gender, refraction, and body mass index(BMI) in normal Ghanaian school children in the Ablekuma South sub-Municipality. Materials and methods This was a prospective cross-sectional study which measured the ocular biometric values, refraction, and BMI of Ghanaian school children aged 6 to 15 years in the Ablekuma South sub-Municipality.. Informed written consent was obtained from parents/ guardians and assent obtained from children aged 8 years and above. Children with normal eye exam and no history of known eye disease were included in the study. An interviewer-administered pre-designed questionnaire was used to record demographic data such as age, sex, ethnic origin, data on ocular biometric measurements (axial length, anterior chamber depth, lens thickness, vitreous chamber depth,keratometry-value, and cornea radius), and outcome of cycloplegic refraction. Data handling and statistical analysis The data was analysed with SPSS version 25. Descriptive statistics were performed for demographic and ocular biometric parameters and results presented with appropriate charts and and tables. Relationship between ocular biometric parameters and demographic and anthropometric factors were assessed with the independent t-test for differences in continuous variables, analysis of variance (ANOVA) for differences between groups such as age and gender and linear regression for differences in trends. Statistical significance was set at a p- value of less than 0.05. Results Data on 352 children were analysed (704 eyes). They were aged 6 to 15 years, with 55% being female and 45% being male. They had a mean axial length of 22.73±0.75mm, anterior chamber depth of 3.28±0.29mm, lens thickness of 3.65±0.27mm, vitreous chamber depth of 19.44±0.70mm, cornea radius of 7.79±0.28mm and K-value of 43.39±1.56D. Axial length was 22.99±0.78mm in males and 22.51±0.69mm in females; anterior chamber depth was 3.34±0.32mm in males and 3.34±0.21mm in females; vitreous chamber depth was 19.66±0.78mm in males and 19.27±0.58mm on females; and cornea radius was 7.85±0.32mm in males and 7.74±0.20mm in females. K-value was 43.65±1.61D in females compared to 43.06±1.38D in males. Axial length (p=0.001, F=9.366), anterior chamber depth (p=0.001, F=6.447) and vitreous chamber depth (p=0.001, F=5.937) increased with increasing age. Cornea radius (p=0.644, F=0.556) and lens thickness (p=0.379, F=1.030) did not increase significantly with increasing age. Axial length (p=0.001, r=0.281), anterior chamber depth (p=0.001, r=0.228) and vitreous chamber depth (p=0.029, CI=0.01-0.11) had a significant positive relationship with BMI. Axial length (p=0.007, CI=0.00-0.20), anterior chamber depth (p=0.004, CI=0.00-0.20) were significantly related to hyperopia. while myopia and emmetropia had significant relationships with axial length, anterior chamber depth and vitreous chamber depth Conclusion Ocular biometric parameters increased with age, higher in males compared to females. There was a positive relationship between ocular biometry and BMI. Ocular biometry positively correlated with myopia and negatively correlated with hyperopia. Results from this study were similar to that from other studies conducted in sub-Saharan Africa. The findings could support future large population-based study on ocular biometric parameters in the paediatric population to help in the diagnosis and management of serious eye diseases.

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