Buphthalmos: a Twelve-year Review at Ibadan

Abstract

Summary Objective: To review the presentation, management, follow-up and outcome of management of children presenting with buphthalmoś at the University College Hospital (UCH), Ibadan. Methods: This was a retrospective review of cases of buphthalmos seen at the UCH Ibadan, between 1991 and 2002. The case notes of patients seen in the-Eye Clinic during the period were reviewed. All children diagnosed with buphthalmos or congenital glaucoma were identified, and their case notes studied in greater details. Results: Twenty seven eyes in 15 children with buphthalmos were reviewed. This represented 0.1 percent of all new patients, and 0.6 percent of new paediatric cases seen within the study period. Their ages ranged between 22 days and nine years (mean, 25.5 months). Sixty percent were aged 18 months or less, 80 percent were boys and the disease was bilateral in 80 percent of cases. Only one (6.7 percent) patient presented with the classical triad of epiphora,.photophobia and blepharospasm, while four (26.7 percent) presented with both epiphora and photophobia. Two (13.3 percent) patients had associated cardiac abnormalities. Of the 27 buphthalmic eyes, 21 (77.8 percent) had trabeculectomy, with good intraocular pressure control (i.e. <21mmHg) after surgery in 14 eyes (66.7 percent). Of these, three (21.4 percent) required medication to achieve such control. The duration of follow-up from the time of initial presentation ranged between 2.5 months and 6.75 years (mean, 25.9 months). Six (40 percent) of the patients were followed up for more than a year, while 60 percent were lost to follow-up. Out of 10 eyes in which the visual acuity was objectively measured, two (20 percent) had good visual outcome (i.e. visual acuity 6/18 or better), while six had poor outcome due to complications associated with late presentation. Due to lack of appropriate facilities, visual acuity was not assessed objectively in 17 eyes. Conclusion: Buphthalmos is a rare disease in Ibadan and occurs predominantly in males. Majority of cases are bilateral. In this study, trabeculectomy achieved adequate pressure control in the majority of cases and as such, it appeared to be a good option in the management of buphthalmos in black patients. The main problems were late presentation and poor follow up. The public needs to be educated on making early use of available health services. There is also a need to introduce, equip and provide support for paediatric ophthalmology units.