|Year : 2010 | Volume
| Issue : 2 | Page : 62-65
Changing trend in the causes of destructive eye surgery at Guinness Ophthalmic Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria
D Chinda, ER Abah, AL Rafindadi, E Samaila
Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria
|Date of Web Publication||24-Mar-2011|
E R Abah
Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Shika-Zaria
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background : With improvement in preventive medicine and advancement in the management of otherwise morbid eye conditions, the reasons for destructive eye surgeries have changed overtime.
Objectives : This study aims at determining the current indications for destructive eye surgeries and compares these to the findings of a similar study done in the same unit two decades earlier.
Materials and Methods : It is a retrospective study of 278 cases of destructive eye operations performed at the Guinness Ophthalmic Unit of Ahmadu Bello University Teaching Hospital Kaduna from January 1991 to December 2000.
Results : They were 152 eviscerations, 67 enucleations, and 59 exenterations. Tumors were responsible for the majority of destructive eye operations in the unit (31%). This was followed closely by endophthalmitis/panophthalmitis (30%). Others were trauma (23%), corneal disease (8%) and painful blind eyes (7%).
Conclusion : They were noticeable changes in the indications for destructive eye operations especially for some infective and nutritional causes which are largely preventable.
Keywords: Changing trend, enucleation, evisceration, exenteration
|How to cite this article:|
Chinda D, Abah E R, Rafindadi A L, Samaila E. Changing trend in the causes of destructive eye surgery at Guinness Ophthalmic Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. Ann Nigerian Med 2010;4:62-5
|How to cite this URL:|
Chinda D, Abah E R, Rafindadi A L, Samaila E. Changing trend in the causes of destructive eye surgery at Guinness Ophthalmic Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. Ann Nigerian Med [serial online] 2010 [cited 2020 Aug 12];4:62-5. Available from: http://www.anmjournal.com/text.asp?2010/4/2/62/78275
| Introduction|| |
The decision to remove an eyeball is distressing to the ophthalmologist, the patient and relations. Therefore, it is usually carried out as a life-saving procedure or for other strong indications as outlined below.
The common destructive ophthalmic surgeries and their indications are as follows:
1. Evisceration: It is the removal of the contents of the eyeball, leaving the sclera coat, extraocular muscles, optic nerve and other orbital contents intact.
- Ruptured globe
- Anterior staphyloma
- Painful blind eye
- Pthisis bulbi/cosmetic
2. Enucleation: This is the removal of the eyeball, leaving the extraocular muscles and other orbital content intact. The optic nerve is usually removed as much as possible to obtain tumor free margin. Indications: , Intraocular tumors, e.g. retinoblastoma and melanomas.
3. Exenteration: It is the removal of the eyeball, other orbital contents, adnexae, periorbita and even part of the bony orbit if indicated.
It is a radical procedure reserved for the treatment of potentially life-threatening malignancies. 
- Squamous cell carcinoma and Kaposi sarcoma of the conjunctiva.
- Uveal melanomas
- Retinoblastoma with extraocular spread
- Orbital rhabdomyosarcoma
- Nasopharyngeal and maxillary sinus carcinomas with orbital spread
- Advanced eyelid neoplasms, e.g. basal and squamous cell carcinomas
Guinness Ophthalmic Unit was established in 1967 at the Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Kaduna. It is situated in the Savannah Belt of Nigeria and provides all levels of ophthalmic care to communities north of rivers Niger and Benue. Patients are referred in large numbers from other parts of the country as well.
For these reasons, various types of end-stage ocular diseases present to the unit and those with life-threatening diseases or other strong indications for destructive surgeries eventually have one.
Destructive eye operations were studied in this ophthalmic unit about two decades ago.  This has formed a basis for comparison with the current study; more so, that a lot of socioeconomic changes have occurred since then.
Similar studies done in other parts of the country up to the early 90s show that infections, trauma and tumors are the major indications for destructive eye surgeries. ,
Similarly, in other developing countries like the Gambia, infection was top on the list of the indications for destructive operations. Staphyloma, trauma and tumors were also quite remarkable. 
In developed countries, tumors and painful blind eyes were more common at that time. ,
This study is designed to evaluate the trend of the indications for destructive eye surgeries in our setting.
| Materials and Methods|| |
A retrospective study of 278 cases requiring evisceration, enucleation or exenteration between January 1991 and December 2000 was conducted.
The patients' hospital records, including those of the theater, were retrieved and analyzed. This was with particular reference to the type of operation performed and the indications for them. The age and sex distribution of the patients was also evaluated in that respect. The patients with missing relevant details were excluded from the study.
| Results|| |
The results are given in [Table 1],[Table 2],[Table 3].
A total of 278 destructive eye surgeries were performed within the period under review. There were 171 males and 107 females with a M:F ratio 1.6:1.0.
One hundred and fifty-two (54.7%) patients had evisceration, 67 (24.1%) had enucleation and 59 (21.2%) had exenteration.
[Table 2] shows the frequency distribution of the various causes of destructive operations by age. This highlights that the most common indication for destructive surgery in children is malignant tumors. Endophthalmitis seems to be more prominent in early childhood and the elderly. Trauma was the major cause in the age range of 11-30 years, while corneal disease was more in the 0-10 and 11-20 years age range.
| Discussion|| |
Malignant tumors were responsible for majority (31%) of destructive eye operations in this study. The high prevalence of retinoblastoma among Hausa-Fulani population, who live in and around the referral unit, appears to be responsible. The practice of consanguineous marriage is high among them. This may be contributory to the high prevalence of retinoblastoma , as reflected in the high rate of destructive operation in the age range of 1-10 years (33.4%). In our setting, the patients usually present late with fungating orbital tumors.
Twenty years earlier, malignant tumors were only responsible for 4.4% of destructive eye operations in the same setting as ours. Change in lifestyle/westernization  and other socioeconomic factors including improvement in literacy level and awareness may be responsible for the rise of 14.2%.
A study in Manchester  also recorded an increasing frequency of exenteration, but majority were as a result of basal cell carcinoma.
Two decades earlier, endophthalmitis was responsible for only 8% of destructive operations in the same setting. The high percentage of endophthalmitis (30%) especially at the extremes of age may relate to the use of traditional eye medications and the poor socioeconomic status of the people in the area of study. The high rate in the elderly appears to be a reflection of postoperative infection related to increased rate of conventional cataract operations and couching, since it is a ripe age for cataract. In the developed world, endophthalmitis is now rare. 
Trauma was responsible for 23% of destructive eye surgeries in this study. In Irrua,  it was found to be responsible for 35.7%. This may be related to occupational variation in both the settings. Twenty years earlier, it was found to be 26.5% in our setting. There is no remarkable change from our current finding. The slight change may be due to use of safety precautions such as seat belts and helmets as well as protective goggles by workers at risk.
The decline in the percentage of corneal disease responsible for destructive eye operation (27.4%) is interesting. It may be due to the effectiveness of preventive medicine such as the Expanded Programme on Immunization (EPI), which includes measles vaccination. This, in addition to mass distribution of vitamin A at grassroot level, remarkably reduced corneal disease due to vitamin A deficiency and measles keratopathy. In Ghana,  corneal disease is no longer a significant reason for destructive eye operations. Rather, it is endophthalmitis/panophthalmitis and trauma that are largely responsible.
Painful blind eyes were fewer (7%) and are usually due to absolute/neovascular glaucoma unresponsive to medical treatment. The use of retrobulbar injection and cyclodestructive procedures has reduced the need for destructive eye surgery in their patients. Painful blind eye was also responsible for 7% of destructive eye surgeries at Illorin.  This finding is the same as ours.
Phthisis bulbi was responsible for only 1% as the cause of destructive eye operations. Two decades earlier, it was responsible for 2.2% in our setting. Most of them follow ocular injuries not severe enough for evisceration at presentation.
Worldwide, ,,, the indications for destructive eye disease were found to be due to malignant tumors, infections and trauma, with much less infection as an indication in developed countries. The frequency of the need to remove an eye is far less in the developed countries. 
In conclusion, this study has shown a remarkable decline in corneal disease as an indication for destructive operations, but infection and trauma, which are largely preventable, are still high. Neoplasms still present late. There is need for mass health education to create awareness, encourage early presentations and promote the use of protective eye wears and other safety measures including supervision of children during play and school discipline.
| References|| |
|1.||Amoni SS. Causes of Enucleation in Kaduna, Nigeria. Ann Ophthalmol 1980;12:343-9. |
|2.||Chaudhry IA, Alkuraya HS, Shamsi FA, Elzardi E, Riley FC. Current indications and resultant complications of eviscerations. Ophthmic Epidermiol 2007;14:93-7. |
|3.||Madan PU, Muthiah S, John PW. Managing corneal disease: Focus suppurative keratitis. CEH J 2009;22:39-41. |
|4.||Obuchowska I, Mariak Z, Sherkawey N. Clinical Indications for enucleation: A review of literature. Lin Oczna 2005;107:159-62. |
|5.||Allen ML, Blomquist PH, Itani KM. Enucleation and eviceration: A review of the indications and demographics. Invest Opthalmol Vis Sci 2003;44:787. |
|6.||Rahman I, Cook AE, Leatherbarrow B. Orbital extenteration: 13 years Manchester experience. Br J Ophthalmol 2005;89:1335-40. |
|7.||Gunalp I, Kaan G, Kudret D. Orbital extenteration: A review of 429 cases. Int Ophthalmol 1996;19:177-84. |
|8.||Majekodunmi S. Causes of enucleation of the eye at Lagos University Teaching Hospital: A study of 100 eyes. West Afr J Med 1989;8:288-91. |
|9.||Baiyeroju-Agbeja AM, Ajibade HA. Causes of removal of the eye in Ibadan. Nigerian J Surg 1996; 3:33-40. |
|10.||Dawodu OA, Hannah BF. Enucleation and Eviceration in the Gambia. Nigerian J Ophthalmol 2000;8:29-33. |
|11.||Shield C.L, Shields JA, De Potter P, Singh AD. Problems with hydroxyapatite orbital implant, experience with 250 consecutive cases. Br J Opthalmol 1994;78:706 |
|12.||Batten KL. Causes of enucleation seen in Jerusalem. Br J Opthalmol 1997;55:174-6. |
|13.||Bahakim HM, El-Idrissy IM. Epidemiological observations of consanguinity and retinoblastoma in Arabia: A retrospective study. Trop Geogr Med 1989;41:361-4. |
|14.||Bittles AH. Consanguinity and its relevance to clinical genetics. Clin Genet 2001;60:89-98. |
|15.||Ahmedin J, Melissa M, Carol D, Elizabeth M. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 2010;19:1893-907. |
|16.||Nwosu SN. Destructive ophthalmic surgical procedures in Onitsha, Nigeria. Nig Postgrad Med J 2005;12:53-6. |
|17.||Enock ME, Omoti AE, Fuh UC, Alikah AA. Indications for surgical removal of the eye in Irrua, Nigeria. Nigerian J Ophthalmol 2008;16:16-9. |
|18.||Gyabi ME, Amoaku WM, Adjuik M. Causes of destructive eye procedures in North-Eastern Ghana. Ghana Med J 2009;43:122-6. |
|19.||Ayanniyi AA. Emotional, psychosocial and economic aspects of anophthalmos and artificial eye use. Int J Ophthalmol Visual Sci 2009;7:1. |
[Table 1], [Table 2], [Table 3]