Publications by authors named "Mahmoud B Alhassan"

12 Publications

  • Page 1 of 1

Effect of glycemic control and dyslipidemia on plasma vascular endothelial growth factor and pigment epithelium-derived factor in diabetic retinopathy patients in Northern Nigeria.

Int J Health Sci (Qassim) 2020 Nov-Dec;14(6):4-12

Department of Medical Laboratory Sciences, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria.

Objectives: The disruption of the reciprocal regulation between vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) has been associated with the pathogenesis of diabetic retinopathy (DR). This study assessed the levels of VEGF, PEDF, indices of glycemia, and lipid profile in diabetic patients with retinopathy.

Methods: One hundred fifty participants comprised 50 type 2 diabetic patients with DR, 50 without DR and 50 non-diabetic normotensive controls, aged 30-80 years, were randomly recruited for this case-control study. The study was carried out from November 2017 to December 2018. VEGF, PEDF, glycated hemoglobin (HbA1c), fasting plasma glucose, and lipid profile were determined using standard methods. Blood pressures (BP) and anthropometric indices were measured. Chi-squared test of independence, analysis of variance, and Pearson's correlation were used to analyze data. Statistical significance was set at < 0.05 and 95% confidence interval.

Results: Both diabetic groups had significantly higher ( = 0.001) systolic and diastolic BP, VEGF, PEDF, HbA1c, fasting plasma glucose, triglycerides, total, high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C) levels and significantly lower ( = 0.005) VEGF/PEDF than the controls. However, the diabetics with retinopathy had significantly higher ( = 0.001) HDL-C, LDL-C, VEGF, and PEDF levels compared to the diabetics without retinopathy. There were no significant differences ( > 0.05) in the levels of VEGF, PEDF, and VEGF/PEDF in both groups of diabetics that had good glycemic control and poor glycemic control. There was also no significant difference ( > 0.05) in the levels of VEGF and PEDF between the dyslipidemic and non-dyslipidemic subjects in both diabetic groups.

Conclusion: DR is associated with higher levels of VEGF and PEDF while good glycemic control and dyslipidemia seem not to have a profound effect on VEGF and PEDF levels in diabetics with or without DR. Higher PEDF levels are associated with higher atherogenic risk in the diabetics with retinopathy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644452PMC
November 2020

Association of Genetic Variants With Primary Open-Angle Glaucoma Among Individuals With African Ancestry.

JAMA 2019 11;322(17):1682-1691

Clayton Eye Care Center Management Inc, Marrow, Georgia.

Importance: Primary open-angle glaucoma presents with increased prevalence and a higher degree of clinical severity in populations of African ancestry compared with European or Asian ancestry. Despite this, individuals of African ancestry remain understudied in genomic research for blinding disorders.

Objectives: To perform a genome-wide association study (GWAS) of African ancestry populations and evaluate potential mechanisms of pathogenesis for loci associated with primary open-angle glaucoma.

Design, Settings, And Participants: A 2-stage GWAS with a discovery data set of 2320 individuals with primary open-angle glaucoma and 2121 control individuals without primary open-angle glaucoma. The validation stage included an additional 6937 affected individuals and 14 917 unaffected individuals using multicenter clinic- and population-based participant recruitment approaches. Study participants were recruited from Ghana, Nigeria, South Africa, the United States, Tanzania, Britain, Cameroon, Saudi Arabia, Brazil, the Democratic Republic of the Congo, Morocco, Peru, and Mali from 2003 to 2018. Individuals with primary open-angle glaucoma had open iridocorneal angles and displayed glaucomatous optic neuropathy with visual field defects. Elevated intraocular pressure was not included in the case definition. Control individuals had no elevated intraocular pressure and no signs of glaucoma.

Exposures: Genetic variants associated with primary open-angle glaucoma.

Main Outcomes And Measures: Presence of primary open-angle glaucoma. Genome-wide significance was defined as P < 5 × 10-8 in the discovery stage and in the meta-analysis of combined discovery and validation data.

Results: A total of 2320 individuals with primary open-angle glaucoma (mean [interquartile range] age, 64.6 [56-74] years; 1055 [45.5%] women) and 2121 individuals without primary open-angle glaucoma (mean [interquartile range] age, 63.4 [55-71] years; 1025 [48.3%] women) were included in the discovery GWAS. The GWAS discovery meta-analysis demonstrated association of variants at amyloid-β A4 precursor protein-binding family B member 2 (APBB2; chromosome 4, rs59892895T>C) with primary open-angle glaucoma (odds ratio [OR], 1.32 [95% CI, 1.20-1.46]; P = 2 × 10-8). The association was validated in an analysis of an additional 6937 affected individuals and 14 917 unaffected individuals (OR, 1.15 [95% CI, 1.09-1.21]; P < .001). Each copy of the rs59892895*C risk allele was associated with increased risk of primary open-angle glaucoma when all data were included in a meta-analysis (OR, 1.19 [95% CI, 1.14-1.25]; P = 4 × 10-13). The rs59892895*C risk allele was present at appreciable frequency only in African ancestry populations. In contrast, the rs59892895*C risk allele had a frequency of less than 0.1% in individuals of European or Asian ancestry.

Conclusions And Relevance: In this genome-wide association study, variants at the APBB2 locus demonstrated differential association with primary open-angle glaucoma by ancestry. If validated in additional populations this finding may have implications for risk assessment and therapeutic strategies.
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http://dx.doi.org/10.1001/jama.2019.16161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6865235PMC
November 2019

Visual function and vision-related quality of life in presbyopic adult population of Northwestern Nigeria.

Niger Med J 2015 Sep-Oct;56(5):317-22

Department of Ophthalmology, Zamfara State Eye Care Programme, King Fahad IBN Abdul-Azeez Women and Children Hospital, Gusau, Zamfara State, Nigeria.

Purpose: To determine the impact of uncorrected presbyopia on vision-related quality of life (QoL) and visual function (VF) among adults 40 years and older in Bungudu local government area (LGA) of Zamfara State, Nigeria.

Materials And Methods: A population-based cross-sectional study in Bungudu LGA of Zamfara State Nigeria was conducted in 2012. Six-hundred and fifty persons at least 40 years of age were examined using a two-stage cluster random sampling-based on probability proportional to size. Presbyopia was defined as the inability to read N8 at 40 cm in an indoor illumination using LogMAR E-chart. Demographic information comprising of age, sex, occupation, and educational level among others was obtained from a pilot tested VF-14 and modified vision-related QoL questionnaire by trained interviewer.

Results: Out Of the 650 subjects enumerated 635 were examined given a response rate of 97.7%. The mean age of participants was 53.59 years (95% confidence interval:52.75%-54.43%). The crude prevalence of presbyopia was 30.4%, (95% CI: 26.8%-34.1%). The mean VF score of persons with presbyopia was 85.09, (95% CI: 83.09%-87.09%) and being female was strongly associated with high VF scores (P = 0.003). The VFs most impaired were the ability to read, write, use mobile phones, and thread needles. The higher the degree of presbyopia the lower the mean VF score (P = 0.00).

Conclusion: Uncorrected presbyopia is associated with functional visual impairment and reduce QoL especially in the ability to read, write, and usage of mobile cell phones among adults 40 years and older in Bungudu District.
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http://dx.doi.org/10.4103/0300-1652.170379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698845PMC
January 2016

Prevalence of presbyopia and spectacle correction coverage in a rural population of North West Nigeria.

Clin Ophthalmol 2015 30;9:1195-201. Epub 2015 Jun 30.

Department of Vitreoretina, National Eye Centre, Kaduna, Nigeria.

Purpose: To determine the prevalence of presbyopia, and near vision spectacle coverage in a rural population of Northwestern Nigeria.

Study Design: Cross sectional prevalence study.

Subjects And Methods: Six hundred and fifty people of at least 40 years of age, in 13 clusters (50 per cluster) were examined using a multi-stage random sampling with probability proportional to size. The survey was conducted from April 7 to 28, 2012 at Bungudu Local Government Area of Zamfara State, Nigeria. Presbyopia was defined as the inability to read N8 at 40 cm. Presbyopic Spectacle Correction Coverage (PSCC) was calculated, and information on barriers to using near vision spectacles identified.

Results: The crude prevalence of presbyopia was 30.4%, 95% CI: (26.8%-34.1%). The prevalence was significantly higher in females (P=0.0005) and individuals with at least secondary education (P=0.022). The age specific prevalence of presbyopia was three times (63.5%) more among those aged 70 years and above, as compared to those within 40-49 years age group (19.3%). The met need was 0.2%, the unmet need 30.2%, and a PSCC of 0.7%. The major barriers reported as reasons for not obtaining near vision spectacles were unawareness and lack of felt need.

Conclusion: The prevalence of presbyopia in Bungudu is relatively low compared to other reports with major risk factors being increasing age, female sex and attainment of higher education. The presbyopic spectacles correction coverage is very low with high unmet need thus there is a need to create awareness, and provide affordable and accessible optical services in the affected population.
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http://dx.doi.org/10.2147/OPTH.S81194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494630PMC
July 2015

Peribulbar versus retrobulbar anaesthesia for cataract surgery.

Cochrane Database Syst Rev 2015 Jul 2(7):CD004083. Epub 2015 Jul 2.

Clinical Ophthalmology, The National Eye Centre, Western Bye Pass, Nnamdi Azikiwe Way, Kaduna, Kaduna State, Nigeria, PMP 2267.

Background: Cataract is a major cause of blindness worldwide. Unless medically contraindicated, cataract surgery is usually performed under local (regional) anaesthesia. Local anaesthesia involves the blockage of a nerve subserving a given part of the body. It involves infiltration of the area around the nerve with local anaesthetic. The two main approaches in the eye are retrobulbar and peribulbar. There is debate over whether the peribulbar approach provides more effective, safer anaesthesia for cataract surgery than retrobulbar block.

Objectives: The objective of this review was to assess the effects of peribulbar anaesthesia (PB) compared to retrobulbar anaesthesia (RB) on pain scores, ocular akinesia, patient acceptability and ocular and systemic complications.

Search Methods: In the previous version of our review, we searched the databases until December 2007. In this updated version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (March 2015); MEDLINE (1960 to March 2015); and EMBASE (1980 to March 2015).

Selection Criteria: We included randomized controlled clinical trials comparing peribulbar anaesthesia and retrobulbar anaesthesia for cataract surgery.

Data Collection And Analysis: Two authors independently assessed trial quality and extracted data. We contacted trial authors for additional information, study methodology and missing data. We carried out a descriptive narrative of results as the included studies used varied methods for reporting the outcomes. We performed a subgroup analysis for globe akinesia.

Main Results: We included six trials involving 1438 participants. Three of the six trials had adequate sequence generation while all the trials had unclear allocation concealment There was no evidence of any difference in pain perception during surgery with either retrobulbar or peribulbar anaesthesia. Both were largely effective. There was no evidence of any difference in complete akinesia or the need for further injections of local anaesthetic. Conjunctival chemosis was more common after peribulbar block (relative risk (RR) 2.11, 95% confidence interval (CI) 1.46 to 3.05) and lid haematoma was more common after retrobulbar block (RR 0.36, 95% CI 0.15 to 0.88). Retrobulbar haemorrhage was uncommon and occurred only once, in a patient who had a retrobulbar block.

Authors' Conclusions: There is little to choose between peribulbar and retrobulbar block in terms of anaesthesia and akinesia during surgery measuring acceptability to patients, need for additional injections and development of severe complications. Severe local or systemic complications were rare for both types of block.
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http://dx.doi.org/10.1002/14651858.CD004083.pub3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7175781PMC
July 2015

Face washing promotion for preventing active trachoma.

Cochrane Database Syst Rev 2015 Feb 20(2):CD003659. Epub 2015 Feb 20.

Hode Internal Medicine, 120 South Park Drive, Suite F, Brownwood, Texas, USA, 76801.

Background: Trachoma remains a major cause of avoidable blindness among underprivileged populations in many developing countries. It is estimated that about 146 million people have active trachoma and nearly six million people are blind due to complications associated with repeat infections.

Objectives: The objective of this review was to assess the effects of face washing promotion for the prevention of active trachoma in endemic communities.

Search Methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2015, Issue 1), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2015), EMBASE (January 1980 to January 2015), PubMed (January 1948 to January 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to January 2015), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (accessed 10 January 2014), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 26 January 2015.To identify further relevant trials we checked the reference lists of the included trials. Also, we used the Science Citation Index to search for references to publications that cited the trials included in the review. We contacted investigators and experts in the field to identify additional trials.

Selection Criteria: We included randomized controlled trials (RCTs) or quasi-RCTs that compared face washing with no treatment or face washing combined with antibiotics against antibiotics alone. Trial participants were residents of endemic trachoma communities.

Data Collection And Analysis: Two review authors independently extracted data and assessed trial quality. We contacted trial authors for additional information when needed. Two trials met our inclusion criteria; but we did not conduct meta-analysis due to methodological heterogeneity.

Main Results: We included two cluster-RCTs, which provided data from 2447 participants. Both trials were conducted in areas endemic to trachoma: Northern Australia and Tanzania. The follow-up period was three months in one trial and 12 months in the other; both trials had about 90% participant follow-up at final visit. Overall the quality of the evidence is uncertain due to the trials not reporting many design methods and the differences in outcomes reported between trials.Face washing combined with topical tetracycline was compared with topical tetracycline alone in three pairs of villages in one trial. The trial found that face washing combined with topical tetracycline reduced 'severe' active trachoma compared with topical tetracycline alone at 12 months (adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) 0.40 to 0.97); however, the trial did not find any important difference between the intervention and control villages in reducing other types of active trachoma (adjusted OR 0.81, 95% CI 0.42 to 1.59). Intervention villages had a higher prevalence of clean faces than the control villages among children with severe trachoma (adjusted OR 0.35, 95% CI 0.21 to 0.59) and any trachoma (adjusted OR 0.58, 95% CI 0.47 to 0.72) at 12 months follow-up. The second trial compared eye washing to no treatment or to topical tetracycline alone or to a combination of eye washing and tetracycline drops in children with follicular trachoma. At three months, the trial found no evidence of benefit of eye washing alone or in combination with tetracycline eye drops in reducing follicular trachoma amongst children with follicular trachoma (risk ratio (RR) 1.03, 95% CI 0.96 to 1.11; one trial, 1143 participants).

Authors' Conclusions: There is evidence from one trial that face washing combined with topical tetracycline may be effective in reducing severe active trachoma and in increasing the prevalence of clean faces at one year follow-up. Current evidence is inconclusive as to the effectiveness of face washing alone or in combination with topical tetracycline in reducing active or severe trachoma.
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http://dx.doi.org/10.1002/14651858.CD003659.pub4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441394PMC
February 2015

Pediatric cataract surgery in National Eye Centre Kaduna, Nigeria: outcome and challenges.

Middle East Afr J Ophthalmol 2015 Jan-Mar;22(1):92-6

Department of Pediatric, National Eye Centre, Kaduna, Nigeria.

Purpose: To assess the outcomes of congenital/developmental cataract from a tertiary eye care hospital in Northwest Nigeria.

Materials And Methods: A retrospective chart review was performed of all patients diagnosed with congenital or developmental cataract who underwent surgery from January 2008 to December 2009. Data were collected on patient demographics, preoperative characteristics, intraoperative complications, and postoperative outcomes as well as complications.

Results: A total of 181 eyes of 102 patients underwent surgery. There were 95 (52.5%) right eyes. There were 64 (62.7%) males. The mean age of the patients was 6.88 ± 7.97 years. Fifty-four (51.3%) patients were below 3 years old. Most (62%) patients had congenital cataract with a history of onset within the first year of life [39 (62.9%) patients]. Amblyopia, nystagmus, and strabismus were the most frequent ocular comorbidities accounting for 50.3%, 36.5%, and 35.4% of eyes respectively. The majority (84.3%) of the patients had surgery within 6 months of presentation. All patients underwent manual small incision cataract surgery (MSICS). Seventy-nine (77.5%) patients underwent simultaneous bilateral surgery. Intraocular lens implantation was performed in 83.4% eyes. The most common early and late postoperative complication was, posterior capsular opacity which occurred in 65 eyes of 43 children. In these cases, moderate visual acuity was predominant visual outcome.

Conclusion: Treatment of pediatric cataract in our setting is complicated by demographic factors which results in late presentation and consequently, late treatment of children. Short-term visual outcome is fair. Data on long term postoperative outcomes could not be acquired due to poor follow-up.
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http://dx.doi.org/10.4103/0974-9233.148356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302484PMC
April 2015

Interventions for Mooren's ulcer.

Cochrane Database Syst Rev 2014 Jan 22(1):CD006131. Epub 2014 Jan 22.

Clinical Ophthalmology, The National Eye Centre, Western Bye Pass, Nnamdi Azikiwe Way, Kaduna, Kaduna State, Nigeria, PMP 2267.

Background: Mooren's ulcer is a chronic, painful peripheral ulcer of the cornea. Its cause is unknown but it can or will lead to loss of vision if untreated. Severe pain is common in patients with Mooren's ulcer and the eye(s) may be intensely reddened, inflamed and photophobic, with tearing. The disease is rare in the northern hemisphere but more common in southern and central Africa, China and the Indian subcontinent. There are a number of treatments used such as anti-inflammatory drugs (steroidal and non-steroidal), cytotoxic drugs (topical and systemic), conjunctivectomy and cornea debridement (superficial keratectomy). There is no evidence to show which is the most effective amongst these treatment modalities.

Objectives: The aim of this systematic review is to assess the effectiveness of the various interventions (medical and surgical) for Mooren's ulcer.

Search Methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2013), EMBASE (January 1980 to June 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 4 June 2013.

Selection Criteria: We planned to include randomised controlled trials (RCTs) or discuss any prospective non-RCTs in the absence of any RCTs. The trials included would be of people of any age or gender diagnosed with Mooren's ulcer and all interventions (medical and surgical) would be considered.

Data Collection And Analysis: Two authors screened the search results independently; we found no studies that met our inclusion criteria.

Main Results: As we found no studies that met our inclusion criteria, we highlighted important considerations for conducting RCTs in the future in this area.

Authors' Conclusions: We found no evidence in the form of RCTs to assess the treatment effect for the various interventions for Mooren's ulcer. High quality RCTs that compare medical or surgical interventions across different demographics are needed. Such studies should make use of various outcome measures, (i.e. healed versus not healed, percentage of area healed, speed of healing etc.) as well as ensuring high quality randomisation and data analysis, as highlighted in this review .
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http://dx.doi.org/10.1002/14651858.CD006131.pub3DOI Listing
January 2014

Face washing promotion for preventing active trachoma.

Cochrane Database Syst Rev 2012 Apr 18(4):CD003659. Epub 2012 Apr 18.

Phoebe Inpatient Medicine Specialists, Phoebe Putney Memorial Hospital, Albany, Georgia, USA.

Background: Trachoma remains a major cause of avoidable blindness among underprivileged populations in many developing countries. It is estimated that about 146 million people have active trachoma and nearly six million people are blind due to complications associated with repeat infections.

Objectives: The objective of this review was to assess the effects of face washing on the prevalence of active trachoma in endemic communities.

Search Methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 8), MEDLINE (January 1950 to September 2011), EMBASE (January 1980 to September 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to September 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 2 September 2011. We checked the reference list of the included trials to identify further relevant trials. We used the Science Citation Index to search for references that cite the studies that are included in the review. We also contacted investigators and experts in the field to identify additional trials.

Selection Criteria: We included randomized or quasi-randomized controlled trials, comparing face washing with no treatment or face washing combined with antibiotics against antibiotics alone. Participants in the trials were people normally resident in endemic trachoma communities.

Data Collection And Analysis: Two review authors independently extracted data and assessed trial quality. Study authors were contacted for additional information. Two clinically heterogeneous trials are included, therefore a meta-analysis was considered inappropriate.

Main Results: This review included two trials with data from a total of 2560 participants. Face washing combined with topical tetracycline was compared to topical tetracycline alone in three pairs of villages in one trial. The trial found a statistically significant effect for face washing combined with topical tetracycline in reducing 'severe' active trachoma compared to topical tetracycline alone. No statistically significant difference was observed between the intervention and control villages in reducing ('non-severe') active trachoma. The prevalence of clean faces was higher in the intervention villages than the control villages and this was statistically significant. Another trial compared eye washing to no treatment or to topical tetracycline alone or to a combination of eye washing and tetracycline drops in children with follicular trachoma. The trial found no statistically significant benefit of eye washing alone or in combination with tetracycline eye drops in reducing follicular trachoma amongst children with follicular trachoma.

Authors' Conclusions: There is some evidence that face washing combined with topical tetracycline can be effective in reducing severe trachoma and in increasing the prevalence of clean faces. Current evidence does not however support a beneficial effect of face washing alone or in combination with topical tetracycline in reducing active trachoma.
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http://dx.doi.org/10.1002/14651858.CD003659.pub3DOI Listing
April 2012

Environmental sanitary interventions for preventing active trachoma.

Cochrane Database Syst Rev 2012 Feb 15(2):CD004003. Epub 2012 Feb 15.

Prevention of Blindness Union, Riyadh, Saudi Arabia.

Background: Trachoma is a major cause of avoidable blindness. It is responsible for about six million blind people worldwide, mostly in the poor communities of developing countries. One of the major strategies advocated for the control of the disease is the application of various environmental sanitary measures to such communities.

Objectives: To assess the evidence for the effectiveness of environmental sanitary measures on the prevalence of active trachoma in endemic areas.

Search Methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 9), MEDLINE (January 1950 to September 2011), EMBASE (January 1980 to September 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to September 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 23 September 2011. We checked the reference list of included trials and the Science Citation Index. We also contacted agencies, experts and researchers in trachoma control.

Selection Criteria: We included randomised and quasi-randomised controlled trials comparing any form of environmental hygiene measures with no measure. These hygiene measures included fly control, provision of water and health education. Participants in the trials were people normally resident in the trachoma endemic areas.

Data Collection And Analysis: Two authors independently extracted data and assessed the quality of the included trials. Study authors were contacted for additional information. Six trials met the inclusion criteria but we did not conduct meta-analysis due to heterogeneity of the studies.

Main Results: We included six studies with a total of 12,294 participants from 79 communities. Two studies that assessed insecticide spray as a fly control measure found that trachoma is reduced by at least 55% to 61% with this measure compared to no intervention. However, another study did not find insecticide spray to be effective in reducing trachoma. One study found that another fly control measure, latrine provision, reduced trachoma by 29.5% compared to no intervention; this was, however, not statistically significantly different and findings have not been confirmed by a more recent study. Another study revealed that health education reduced the incidence of trachoma. These findings were not confirmed by a second study, however, which found that a modest health education programme with modest water supply did not reduce trachoma. However, all the studies have some methodological concerns.

Authors' Conclusions: There is some evidence from two trials that insecticides are effective in reducing trachoma, however, this effect was not demonstrated in another trial that used insecticides. Two trials on latrine provision as a fly control measure have not demonstrated significant trachoma reduction. Health education had shown significant reduction of trachoma in one study but another study did not demonstrate similar findings. Generally there is a dearth of data to determine the effectiveness of all aspects of environmental sanitation in the control of trachoma.
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http://dx.doi.org/10.1002/14651858.CD004003.pub4DOI Listing
February 2012

Interventions for Mooren's ulcer.

Cochrane Database Syst Rev 2011 Jun 15(6):CD006131. Epub 2011 Jun 15.

Clinical Ophthalmology, The National Eye Centre, Western Bye Pass, Nnamdi Azikiwe Way, Kaduna, Kaduna State, Nigeria, PMP 2267.

Background: Mooren's ulcer is a chronic, painful peripheral ulcer of the cornea. Its cause is unknown but it can or will lead to loss of vision if untreated. Severe pain is common in patients with Mooren's ulcer and the eye(s) may be intensely reddened, inflamed and photophobic, with tearing. The disease is rare in the northern hemisphere but more common in southern and central Africa, China and the Indian subcontinent. There are a number of treatments used such as anti-inflammatory drugs (steroidal and non-steroidal), cytotoxic drugs (topical and systemic), conjunctivectomy and cornea debridement (superficial keratectomy). There is no evidence to show which is the most effective amongst these treatment modalities.

Objectives: The aim of this systematic review is to assess the effectiveness of the various interventions (medical and surgical) for Mooren's ulcer.

Search Strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 4), MEDLINE (January 1950 to April 2011), EMBASE (January 1980 to April 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS), (January 1982 to April 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrial.gov). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 16 April 2011.

Selection Criteria: We planned to include randomised controlled trials (RCTs) or discuss any prospective non-RCTs in the absence of any RCTs. The trials included would be of people of any age or gender diagnosed with Mooren's ulcer and all interventions (medical and surgical) would be considered.

Data Collection And Analysis: Two authors screened the search results independently; we found no studies that met our inclusion criteria.

Main Results: As we found no studies that met our inclusion criteria, we highlighted important considerations for conducting RCTs in the future in this area.

Authors' Conclusions: We found no evidence in the form of RCTs to assess the treatment effect for the various interventions for Mooren's ulcer. High quality RCTs that compare medical or surgical interventions across different demographics are needed. Such studies should make use of various outcome measures, (i.e. healed versus not healed, percentage of area healed, speed of healing etc.) as well as ensuring high quality randomisation and data analysis, as highlighted in this review .
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http://dx.doi.org/10.1002/14651858.CD006131.pub2DOI Listing
June 2011

Long-term complications of extracapsular cataract extraction with posterior chamber intraocular lens implantation, in Nigeria.

Int Ophthalmol 2004 Jan;25(1):27-31

Department of Clinical Ophthalmology, The National Eye Centre Western Bypass, PMB 2267, Kaduna, Nigeria.

Aim: To identify the long-term complications of extracapsular cataract extraction with posterior chamber intraocular lens implantation surgery, in the National Eye Centre, Kaduna, Nigeria.

Methods: The study is a retrospective review of patients that have had extracapsular cataract extraction with posterior chamber intraocular lens implantation, in the National Eye Centre, Kaduna, Nigeria from January 1996 to December 1999. The medical records of all patients that satisfy these criteria were retrieved. Information collected included age, sex, eye operated upon, intra-operative complications, pre-operative visual acuity and last follow-up, and long-term post-operative complications.

Result: Medical records of only 66 patients (71 eyes) that maintained a minimum follow-up of at least one year were retrievable. No major intra-operative complications were recorded. Only one eye had posterior capsule rent. Ninety percent of the operated eyes had vision of 6/60 or better one year post-operative. The overall visual outcome (WHO criteria) was borderline. Of the corrected eyes, the consultants have a statistically significantly better outcome than residents. The following post-operative complications were recorded in 25 (35.2%) eyes: pseudophakic bullous keratopathy (11.3%); posterior capsular opacification (7.0%); persistent inflammation (7.0%); secondary glaucoma (2.8%); pupil distortion (5.6%); and ocular hypotony (1.4%).

Conclusion: ECCE + PC-IOL microsurgery is associated with long-term complications like PBK (Pseudophakic bullous keratopathy) and PCO (Posterior capsular opacification). Their management creates new demands in our country. This study is limited by the small number of eyes eligible for review at least one year after surgery.
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http://dx.doi.org/10.1023/b:inte.0000018526.45216.31DOI Listing
January 2004
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