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Year : 2015  |  Volume : 7  |  Issue : 2  |  Page : 41-44

Indications for destructive eye surgeries in Sokoto, North Western Nigeria

Department of Surgery, Ophthalmology Unit, Usmanu Danfodiyo University, Sokoto, Nigeria

Date of Web Publication12-Nov-2015

Correspondence Address:
Adamu Dantani Muhammad
Department of Surgery, Ophthalmology Unit, Usmanu Danfodiyo University, Sokoto
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1858-540X.169399

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Objective: To determine the clinical indications for destructive eye surgeries (DES) in Sokoto, North-Western Nigeria. Materials and Methods: A retrospective hospital-based study involving the review of the medical records of all patients that had DES in Usmanu Danfodiyo University Teaching Hospital and Specialist Hospital, Sokoto from January 2010 to December 2014. The age, sex, occupation, indications for surgery, and type of surgery done were recorded. Results: A total of 41 patients had DES during the study period. The mean age of the patients was 34.4 ± 17.7 years. The most frequent indication for DES was malignant neoplasms 41.4% (n = 17) followed by ocular infections 24.4% (n = 10) and trauma 24.4% (n = 10). Evisceration (n = 22) was the most common DES procedure. Conclusion: There is a need for educating the population on the dangers of late presentation, and since trauma and intraocular infections are largely preventable, public health education on safety measures is advocated.

Keywords: Enucleation, evisceration, exenteration, neoplasm

How to cite this article:
Muhammad AD, Muhammad N. Indications for destructive eye surgeries in Sokoto, North Western Nigeria. Sudanese J Ophthalmol 2015;7:41-4

How to cite this URL:
Muhammad AD, Muhammad N. Indications for destructive eye surgeries in Sokoto, North Western Nigeria. Sudanese J Ophthalmol [serial online] 2015 [cited 2023 Jan 31];7:41-4. Available from: https://www.sjopthal.net/text.asp?2015/7/2/41/169399

  Introduction Top

Destructive eye surgeries (DES) include exenteration, enucleation, and evisceration. Exenteration is the removal of the orbital contents, including the eyeball. Enucleation is the removal of the eyeball with preservation of other orbital contents while evisceration is the removal of the contents of the eyeball, with the sclera and optic nerve left behind. [1],[2] The decision to perform DES is usually distressing to all concerned; the patients, their relatives, and the Ophthalmologist; and is taken as a last resort. The main aim of DES is to improve the quality of life of the patient, unlike cataract surgery where visual restoration is the main goal.

The indications for these surgeries varies from place to place and is especially different between developing and developed countries. [3] In the former, infections and trauma are the main causes while, in the latter, orbito-ocular tumors constitute the bulk of the indications. [4],[5] There is some evidence of a decline in these destructive surgeries [6],[7] probably due to improvement in diagnostics and therapeutics resulting in more globe preservation.

The Ophthalmology Departments of the Usmanu Danfodiyo University Teaching Hospital and Specialist Hospital, Sokoto are both located in the Sokoto metropolis and provide all levels of eye care services for the neighboring communities of Zamfara, Kebbi, and Niger states, including Niger Republic. This study aims to determine the indications for DES in Sokoto so that appropriate intervention strategies may be formulated to help in reducing DES.

  Materials and methods Top

A retrospective review of all patients who underwent evisceration, exenteration or enucleation in the two hospitals (a federal teaching hospital and a state specialist hospital) from January 2010 to December 2014 (5-year period) was undertaken. The case files of patients of all ages that had undergone DES within this period were retrieved. Information collected included patients demographic data, visual acuity at diagnosis, the eye affected, indication for DES, and the type of surgery performed. Indication for DES was categorized into five groups broadly: Trauma, neoplasms, infections, degeneration and others. Data were entered into Microsoft Excel (Microsoft Corporation) and then exported and analyzed using SPSS version 16.0 (SPSS Inc., 2006, Chicago, Illinois, USA). Descriptive statistics was used to summarize the characteristics of the subjects. Chi-square test was used to test for significance among groups. A P < 0.05 was considered as statistically significant. Ethical approval was obtained from the Ethics and Research Committee of Usmanu Danfodiyo University Teaching Hospital.

  Results Top

Over the 5-year study period, a total of 5,354 patients were operated in the two hospitals. DES were performed in 41 (0.76%) patients. There were 30 (73.2%) males and 11 (26.8%) females in the study. The age range was from 1 to 63 years with a mean age of 34.4 years (standard deviation = 17.7). All patients in the study were having a visual acuity of no light perception in the affected eye at the time of presentation. Children (0-10 years) constituted 29.2% (n = 12). The occupation of the adult subjects was farming in 24.4% (n = 10), artisanship in 14.6% (n = 6), housewives in 19.5% (n = 8), and civil service in 12.2% (n = 5).

[Table 1] shows the indications for DES with their frequencies. The most common indication for DES is neoplasms contributing 41.4% followed by trauma (24.4%).
Table 1: Indications for destructive eye surgeries

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The most common age group to undergo DES is the first decade of life (0-10 years) with 29.3% during the fifth decade (51-60 years) closely follows with 21.9%. [Table 2] describes the frequency distribution of indications by age group.
Table 2: Frequency distribution of indications by age

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[Figure 1] shows the types of surgeries done, their indications and frequencies. The most frequent type of surgery performed was evisceration (n = 22) while exenteration (n = 16) was second in frequency.
Figure 1: Type of surgery, indications and frequency

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  Discussion Top

DES represented 0.76%% of all surgeries in the two hospitals studied over the 5 years study period. This is lower than what was reported in other studies. [3],[8],[9] This could be related possibly to the higher number of surgeries performed in the other studies. There was a male preponderance found in our study (73.2%) and this is similar to what was reported in other studies. [9],[10],[11] This could be explained by the outdoor, often risky, activities of this gender. The mean age of our patients was 34.4 years. This is similar to what was reported in the literature. [1],[5],[10] However, Eballé et al. [3] in Cameroon reported a higher mean age and Bodunde et al. [12] in Sagamu, Nigeria reported a lower mean age in their studies. The most affected age group was 0-10 years (29.3%) in our study compares to reports from Nigeria, [10],[13] Cameroon, [3] and China. [14]

All the patients were blind in the affected eye before surgery in this study, and this is comparable to findings from other studies. [15],[16] Usually, DES are performed to save the patient's life or to enhance their quality of lives. It is advisable that all conservative approaches are taken to preserve the globe/orbit before performing DES. In our setting, patients usually present with advanced diseases with often poor prognosis for vision or sometimes even life.

Neoplasms were the most common indication (41.4%) for DES in this study and a high proportion was among the <5 years presenting with retinoblastoma. This may be due to a relatively high prevalence of retinoblastoma among the Hausa-Fulani population that live in this zone. The practice of consanguineous marriage among the tribe may contribute to this high prevalence as explained by some studies. [17],[18] Additionally, the availability of a pediatric ophthalmologist may have led to more pediatric patients with tumors being referred to the hospitals. In our setting, most patients usually present late with fungating orbital mass. Globally, the indications for DES were reported to be malignant neoplasms, trauma, and infections [17],[19],[20] - with infections being the least common indication in the developed countries and also the need for DES been less in that part of the world. [21] In Nigeria, there have been varied reports on most common indications for DES; Monsudi et al. [10] and Ibanga et al. [11] reporting intraocular infections as most frequent while Bodunde et al. [12] and Mpyet et al. [22] reported trauma and Chinda et al. [23] reported malignant tumors as most frequent indications for DES.

In our study, there was no patient with a painful blind eye that required DES. This may be due to this category of patients responding very well to medical management. Other studies also reported very few painful blind eyes requiring DES. [10],[23] The most common procedure performed for DES was evisceration. This is similar to what was reported in most other studies. [3],[10],[11],[12] However, a study in Manchester [21] found an increasing frequency of exenteration but this was mainly due to basal cell carcinoma.

  Conclusion Top

Malignant neoplasms were the commonest indications for DES in our study. There is a need for public health education to create awareness and promote early presentation in neoplasia and ocular infections, and safety measures to prevent trauma that are largely preventable.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Iliff CE, Iliff WJ, Iliff NT. Oculoplastic Surgery. Philadelphia, PA: WB Saunders Co.; 1979. p. 203-22.  Back to cited text no. 2
Eballé AO, Dohvoma VA, Koki G, Oumarou A, Bella AL, Mvogo CE. Indications for destructive eye surgeries at the Yaounde Gynaeco-Obstetric and Paediatric Hospital. Clin Ophthalmol 2011;5:561-5.  Back to cited text no. 3
Shapiro A, Monselise MB. Destructive ophthalmic procedures, a comparison between a developed and a developing country. Albrecht Von Graefes Arch Klin Exp Ophthalmol 1978;207:271-3.  Back to cited text no. 4
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Saeed MU, Chang BY, Khandwala M, Shivane AG, Chakrabarty A. Twenty year review of histopathological findings in enucleated/eviscerated eyes. J Clin Pathol 2006;59:153-5.  Back to cited text no. 6
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Kagmeni G, Noche CD, Nguefack-Tsague G, Wiedemann P. Indications for surgical removal of the eye in rural areas in cameroon. Ophthalmol Eye Dis 2014;6:27-30.  Back to cited text no. 8
Pandey PR. A profile of destructive surgery in Nepal Eye Hospital. Kathmandu Univ Med J (KUMJ) 2006;4:65-9.  Back to cited text no. 9
Monsudi KF, Ayanniyi AA, Balarabe AH. Indications for destructive ocular surgeries in Nigeria. Nepal J Ophthalmol 2013;5:24-7.  Back to cited text no. 10
Ibanga A, Asana U, Nkanga D, Duke R, Etim B, Oworu O. Indications for eye removal in southern Nigeria. Int Ophthalmol 2013;33:355-60.  Back to cited text no. 11
Bodunde O, Ajibode H, Awodein O. Destructive eye surgeries in Sagamu. Niger Med Pract 2006;48:47-9.  Back to cited text no. 12
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Ducasse A, Segal A, Favre F, Burette A. The mutilating surgery of the eye. Its frequency and its indications. A 5 years study at Reims CHR. Bull Soc Ophtalmol Fr 1990;90:113-5.  Back to cited text no. 15
Limbu B, Saiju R, Ruit S. A retrospective study on the causes for evisceration at Tilganga Eye Centre. Kathmandu Univ Med J (KUMJ) 2009;7:115-9.  Back to cited text no. 16
Bahakim HM, el-Idrissy IM. Epidemiological observations of consanguinity and retinoblastoma in Arabia. A retrospective study. Trop Geogr Med 1989;41:361-4.  Back to cited text no. 17
Bittles A. Consanguinity and its relevance to clinical genetics. Clin Genet 2001;60:89-98.  Back to cited text no. 18
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Nwosu SN. Destructive ophthalmic surgical procedures in Onitsha, Nigeria. Niger Postgrad Med J 2005;12:53-6.  Back to cited text no. 20
Rahman I, Cook AE, Leatherbarrow B. Orbital exenteration: A 13 year Manchester experience. Br J Ophthalmol 2005;89: 1335-40.  Back to cited text no. 21
Mpyet C, Wade P, Ramyil A. Indications for surgical removal of the eye in adults: A five-year review. Niger J Med 2008;17:107-9.  Back to cited text no. 22
Chinda D, Abah ER, Rafindadi AL, Samaila E. Changing trend in the causes of destructive eye surgery at Guinness Ophthalmic Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. Ann Niger Med 2010;4:62.  Back to cited text no. 23


  [Figure 1]

  [Table 1], [Table 2]

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