OpenUCT :: Browsing by Department "Division of Ophthalmology"

Browsing by Department "Division of Ophthalmology"

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Open Access
Adjunctive use of intravitreal dexamethasone in presumed bacterial endophthalmitis
(2009) Albrecht, Eric; Cook, C
Includes abstract. Includes bibliographical references (leaves 33-36).
Open Access
Audit of cataract surgery at Groote Schuur Hospital
(2009) Motala, Mahommed Ismail; Cook, Colin; Meyer, Landon
To report on the visual outcomes and complications of cataract surgery done at a South African training hospital. Literature review and retrospective observational study of all patients undergoing cataract surgery on the cataract surgery project lists during 2006. Follow-up occurred till last discharge visit. Primary outcome: Uncorrected visual acuity at the last visit of 6/6 - 6/18 visual acuity was achieved in 73.56% of the phacoemlusifaction group and in 65.77% of the scleral tunnel extracapsular cataract extraction group. (p=0.103). Secondary outcomes: Intraoperative complications were noted in 7.34% in the phacoemulsification group and in 12.87% of the scleral tunnel extracapsular cataract extraction group. (p=0.031). The posterior capsule rupture rate was 3.94% in the phacoemulsification group and 7.6% in the scleral tunnel extracapsular cataract extraction group. (p=0.066).
Open Access
Awareness of diabetic retinopathy among diabetics in the Cape Town Metropole
(2014) Joubert, Francois; Cockburn, Nicole
Objective: To investigate the awareness of diabetic retinopathy (DR) among diabetics in the Cape Town Metropole by assessing: - Whether diabetics know that diabetes can affect their eyes. - Whether the awareness of DR differs according to subtype of diabetes, place of treatment (private versus public sector), level of education and socio-economic status. - Knowledge of systemic risk factors for developing DR. - Knowledge of treatment of DR. A population-based cross-sectional study was conducted as part of the Rapid Assessment of Avoidable Blindness (RAAB) survey undertaken in 2010
Open Access
Barriers to cataract surgery in Africa: a systematic review
(2016) Aboobaker, Shaheer; Courtright, Paul
Background: Cataract remains the leading cause of blindness in Africa. We sought to review the available literature relating to barriers to cataract surgery in Africa. Methods: A review of the literature was undertaken using PubMed and Google Scholar using the search terms "barriers, cataract, Africa, cataract surgery, cataract surgical coverage (CSC), and Rapid Assessment of Avoidable Blindness (RAAB)". The review covered the period 1999-2014. Results: In RAABs, barriers related to awareness and access were more commonly reported than acceptance, while non -RAAB studies reported cost as the most commonly reported barrier. The few qualitative studies tended to report community and family dynamics with regard to barriers to cataract surgery. CSC was reported as lower in females in 88.2% of the studies. Conclusion: Studies of barriers to cataract surgery give variable responses. This may be due to the study context but also may be due to the type of data collection. It is likely that qualitative data will give a deeper understanding of the complex social, family, community, financial and gender issues relating to barriers to uptake of cataract surgery in Africa.
Open Access
Cataract surgery and non-attendance: RCT to determine the effect of a SMS reminder system and financial impact in a developing country
(2017) Malherbe, Lodewicus Francois; Cook, Colin
AIMS: Missed cataract surgical appointments are an important cause of inefficiency, with delays in appropriate treatment, loss of continuity of care, and wasted resources. This study was conducted to determine if an SMS reminder system will reduce the failure to attend (FTA) rate by our patients who are booked for cataract surgery. METHODS: A randomised controlled trial was conducted at Groote Schuur Hospital between June 2015 and June 2016. Eligible patients were randomised into one of two study groups: either the "NO reminder control group "or the "SMS reminder intervention group". Patients in the SMS reminder group were entered into a secure web platform from which the automated SMS reminder system dispatched an SMS reminder one month, four days and one day pre-operatively between 10am and 12am. The message contained the following: "Dear "Mr/Mrs name", this is to confirm your cataract surgery at Groote Schuur Hospital, booked for "date". Please phone 021 404 3541 if any queries." RESULTS: 234 patients were enrolled into this study, and 15 patients were excluded. Of the remaining 219 patients, 111 were randomised into the NO reminder group (control) and 108 into the SMS reminder group (intervention). SMS reminders reduced the FTA rate by 52.6% from 11.7% to 5.6% (p=0.11). Transport problems were identified as the most common reason for non-attendance. CONCLUSION: An SMS reminder system aids in the reduction of non-attendance for booked cataract surgery. With an estimated cost of only 54 cents for three SMS reminders, this affordable intervention results in an improved efficiency of clinical service delivery.
Open Access
Clinical profile, causes, and outcomes of optic neuritis at Groote Schuur Hospital
(2016) Mustak, Sayeed-Hamzah; Cook, Colin
Objective: To determine the clinical profile, causes and response to corticosteroid therapy in patients admitted and treated for optic neuritis at a tertiary hospital in Cape Town, South Africa. Methods: A retrospective case review was conducted of 117 patients admitted to Groote Schuur Hospital and treated for optic neuritis between January 2002 and December 2012. Inclusion criteria were based on clinical findings of acute optic nerve dysfunction with or without optic disc swelling. Demographic information, clinical presentation, course of illness, investigations performed and visual outcomes at discharge and at three month follow up were collected. Data analysis was performed using STATA version 10.0. Results: 60 of 117 patients (51%) had an identifiable secondary cause for optic neuritis. Of the 57 patients with idiopathic optic neuritis only 14 had features of "typical optic neuritis" associated with demyelinating disease. HIV and syphilis accounted for 62% of secondary causes of optic neuritis. Presenting visual acuity of hand movements (HM) or worse and absence of pain with extra ocular movement were associated with poorer final visual outcomes in the idiopathic optic neuritis group. Conclusion: Optic neuritis in our patients, as elsewhere in Africa,tends to be atypical in presentation, with a high proportion of patients having an identifiable, most commonly infectious, cause.These patients thus require more extensive investigation in order to identify possible causes which may influence management. In settings with a high HIV prevalence, HIV and syphilis testing should form part of the routine first line investigations for patients with optic neuritis.Secondary optic neuritis and idiopathic atypical optic neuritis carry a poorer prognosis than typical demyelinating optic neuritis.
Open Access
Co-Infection in HIV positive patients with retinitis: A case series of dual positive intraocular fluid polymerase chain reaction
(2020) Hayes, Morgan; Steffen, Jonel
Objective To report 10 cases of dual-positive intraocular fluid PCR results in infectious retinitis where both pathogens may be clinically relevant. Methods A retrospective observational case series including 10 patients with infectious retinitis who demonstrated more than 1 positive result on PCR testing over a 10-year period at a single referral centre. Results Of 619 patients who underwent intraocular fluid PCR testing for infectious retinitis, we identified 10 patients (1.62%) where 2 organisms were isolated. All 10 patients were HIV positive with profound immunosuppression (mean CD4 count 67cells/mm3) and extensive retinitis. CMV was identified in all 10 cases whilst the additional pathogen was VZV in 6 cases, Toxoplasma gondii in 3 cases and HSV in 1 case. Conclusions PCR analysis of ocular fluids is important in this clinical scenario since more than one pathogen may be present and clinically relevant. Clinicians should be aware of this rare phenomenon to ensure that, when it does occur, consideration be given to adjusting treatment to cover both organisms.
Open Access
Comparison of the optyse lens free ophthalmoscope with the conventional direct ophthalmoscope
(2009) Van Velden, Johannes Stephanus; Cook, C
Includes abstract. Includes bibliographical references (leaves 42-45). Library also has copy on CD-ROM.
Open Access
Construct validity testing of a low cost vitreoretinal surgical simulator
(2020) van Der Westhuizen, Dean; Rice, James
Objective: To test the construct validity of a low cost, low fidelity vitreoretinal surgical simulator Design: Construct validity study. Six microsurgical dexterity tasks, performed on a low cost vitreoretinal surgical simulator, were graded using a scoring rubric designed to assess microsurgical dexterity. Tasks one and two were dominant hand exercises, tasks three-five required bimanual dexterity and task six assessed visualization through a retinal viewing system The scores of a novice group (Ophthalmology residents who had never performed a pars planar vitrectomy) were compared to an expert group (Vitreoretinal surgeons who had performed in excess of 20 pars planar vitrectomies). Scores were graded via video recordings of the tasks, by blinded independent graders using a scoring rubric. Participants: The novice group of surgeons included 8 ophthalmology residents training at the Groote Schuur hospital department of Ophthalmology. The expert group of surgeons included 5 vitreoretinal surgeons working at the Groote Schuur hospital department of Ophthalmology, and 2 vitreoretinal surgeons working in the private sector in Cape Town, South Africa. Results: Expert surgeons performed significantly better( P=< 0.05) than the novice surgeons across all six microsurgical dexterity tasks. Greater differences were seen in bimanual tasks(tasks three-five) and in task six that was designed specifically to assess the surgeon's ability to ensure good visualisation through a retinal viewing system. Conclusions: The microsurgical dexterity tasks performed on This low cost, low-fidelity vitreoretinal surgical simulator can distinguish between novice and expert retinal surgeons demonstrating significant construct validity. Its use can be encouraged in the training of novice vitreoretinal surgeons.
Open Access
Corneal donations in South Africa: a 15-year review
(2018) York, Nicholas; Tinley, Christopher
Background: Corneal pathology is one of the leading causes of preventible blindness in South Africa. A corneal transplant procedure can restore, or significantly improve vision in most of these patients. In current South African clinical practice however, there is a gross shortage of corneal tissue available to ophthalmologists to perform these procedures. There is little published data on corneal donations in South Africa describing the magnitude of the current problem. Objectives: To describe trends in the number of corneal donors per year, the number of corneal transplants performed each year, the origin of corneal donors, the allocation of corneas to the public or private sector and the demographics of corneal donors in South Africa. Methods: A retrospective review of all corneal donations made to South African eye banks during a 15-year study period from 1 January 2002 to 31 December 2016. Results: A progressive year-on-year decline in corneal donors was found over the study period, from 565 donors per year in 2002 to 89 donors in 2016. As a direct result, there has been an 85.5% decrease in the number of corneal transplants performed per year using locally donated corneas, from 1049 in 2002 to 152 in 2016. 48.8% of donors originated from mortuaries, 39% from private hospitals and 12.2% from government hospitals. Donors originating from mortuaries showed the most significant declines over the 15 year period, decreasing by 94.8%. 79.3% of donated corneas were allocated to the private sector while 21.7% were allocated to the public sector. Demographic data showed that 69.1% of donors were male, while 30.9% were female. 77.2% were white, 14.0% coloured, 6.3% black and 2.5% Indian/Asian. Age of donors demonstrated a bimodal peak, at 25 and 55 years. Conclusion: The number of corneal donations in South Africa has markedly declined, causing the burden of corneal disease requiring corneal transplantation to continually rise. This study describes the magnitude and trends of the current problem in South Africa. The demographic data has identified certain low donor rate groups within the South African population, where there are possible cultural and other objections to corneal donation. These should serve as a major focus of future research and initiatives aimed at reversing the current trends.
Open Access
Corneal epithelial debridement for the treatment of painful bullous keratopathy: A pilot study
(2018) McClunan, Daemon; Du Toit, N
Purpose: The aim of the study was to evaluate the outcomes of corneal manual epithelial debridement (MED) for the treatment of painful bullous keratopathy (BK). Methods: In a prospective interventional case series, 15 eyes of 15 consecutive patients presenting with painful BK of varying aetiology underwent MED. Patients were followed up at 10 days, 1 month, 2 months, 3 months and 6 months post procedure. Outcome parameters evaluated include numeric rating pain score (NRS), visual acuity (VA), corneal transparency and size of corneal bullae. Results: The mean NRS was significantly decreased from its baseline value of 7.2 +- 1.7 at all follow-up visits (p < 0.02). Mean VA and corneal transparency remained stable for the duration of the study. In most patients the average size of corneal bullae was initially reduced, but returned to baseline by the end of the study. Conclusion: MED reduces mean pain scores and temporarily reduces the size of corneal bullae in BK. MED may be considered as a simple, low cost alternative for reducing pain in patients awaiting corneal transplant. Further studies are required to evaluate MED for the treatment of BK and compare outcomes against other palliative treatment options.
Open Access
Cytomegalovirus retinitis at Groote Schuur Hospital : clinical management and outcomes
(2015) Lapere, Steven; Rice, James
Objectives 1. To review the clinical presentation, management and outcomes of patients who were diagnosed and treated for cytomegalovirus (CMV) retinitis at Groote Schuur Hospital over a 10 year period 2. To review and compare the treatment protocols of thirteen public hospital centres in South Africa that treat patients for CMV retinitis Design & method This is a retrospective cohort study. A record review of 141 eyes in 91 patients diagnosed with and treated for CMV retinitis between 2003 and 2013 was performed. Additionally, a standard questionnaire was sent to thirteen public hospitals in South Africa that treat patients for CMV retinitis to determine current treatment protocols. At Groote Schuur Hospital, all cases of suspected CMV retinitis undergo a vitreous biopsy for polymerase chain reaction (PCR) confirmation. Treatment consists of weekly intravitreal ganciclovir injections until clinical resolution has taken place. Patients not on highly active anti-retroviral treatment (HAART) are referred for initiation of treatment. Ganciclovir treatment is continued until immune reconstitution has taken place.
Open Access
Diagnostic and clinical value of routine polymerase chain reaction analysis of intraocular fluid specimens in the diagnosis of suspected infectious posterior uveitis
(2013) Scheepers, Marius
Open Access
Duane's retraction syndrome in a cohort of South African children a 20 year clinic based review
(2019) Steyn, Anna; Tinley, Christopher
OBJECTIVES: To describe the clinical features of Duane’s retraction syndrome in a cohort of South African children and analyse subtypes for ethnic differences. METHODS: Retrospective case series of 120 patients seen in the period from 1997 to 2017 at the Red Cross War Memorial Children’s Hospital. RESULTS: Of the 120 patients, Type 1 was present in 76 (64%) of cases, with Type 2 in 27 (23%) and Type 3 in 16 (13%).Type 2 was most common in black children (54%), while Type 1 predominated in mixed race (68%) and white children (94%). A female predominance was seen in white children (69%) and mixed race children (59%), while there was a male predominance amongst black children (62.5%) Left involvement was the most common (44%), followed by right (41%) and bilateral involvement (14%).The average age of presentation was 2,85 years. A positive family history of squints or Duane’s was present in 6 (0,5%). Congenital systemic abnormalities were present in 12 (1%) and congenital ocular abnormalities in 2 (0.4%). Squint in primary position was present in 57 (46%), of which 39% had esotropia and 61% exotropia. Squint was more common in black children (71%) than in mixed race (39.4%) and white children (41%). An abnormal head position was present in 59 (50%) and was most common in Type 2 (67%). Up and downshoots were seen in 58 (48.3%). Ametropia was found in 94 (79%), and of these 88 (93,6%) were hyperopic and 6 (6.4%) myopic. Amblyopia was present in 15 (12.5%). Surgery was performed in 41(34%). CONCLUSION: This study is the first to provide robust data on the profile of paediatric DRS in the 3 main South African ethnic groups, and shows clear ethnic differences in DRS. In black patients, males are more often affected, the proportion with Type 2 DRS is more frequent, and surgery is required more often. Further population-based studies on the epidemiology of DRS in children are needed to clarify the role of race as a potential risk factor.
Open Access
Eviscerated corneas as tissue source for ex vivo expansion of limbal epithelial cells on platelet-rich plasma gels
(2016) Heydenrych, Leonard Goussárd; Du Toit, D F
Purpose/Aim of the study: To assess if corneal epithelium can be cultured ex-vivo from corneas eviscerated due to irretrievable trauma, according to a cell culture method which made use of autologous platelet-rich plasma (A-PRP) as culture substrate. To compare corneal epithelium cultured ex vivo from corneas eviscerated following trauma using A-PRP combined with DMEM (Dulbecco's modified Eagles medium), versus DMEM alone. Materials and Methods: This was a laboratory case controlled study of human corneal cells cultured in a mixture of A-PRP and DMEM, versus DMEM alone from 6 eviscerated corneas. A hundred explants were created of which fifty explants were plated on A-PRP-gel construct combined with DMEM and fifty controls were placed in serum free DMEM alone. Donor patients received systemic antibiotics prior to evisceration. Results: Confluent epithelium in mono-layers could be cultured when donor limbal biopsies were placed in a mixture of A-PRP culture medium and DMEM. No growth were observed when corneas were placed in serum-free DMEM medium only (p<0.05). No bacterial infection was observed in cultures. Conclusions: This study demonstrated that autologous platelet rich plasma is a viable and effective alternative to bovine serum for the ex-vivo expansion of limbal epithelial cells. It also shows that eviscerated corneas are a viable source of donor tissue for this purpose in South Africa where access to tissue banks is limited.
Open Access
Evisceration and sympathetic ophthalmia : is there a risk ?
(2006) Du Toit, Nagib; Murray, A D N
Includes bibliographical references (leaves 35-37).
Open Access
The eye in systemic disease
(South African Academy of Family Physicians, 2014) Lenake, M; Du Toit, N
The eye is a unique organ which is often involved in systemic disease. Patients with systemic disease may first present with eye pathology, and patients with known systemic illnesses may need to have their eyes specifically checked for ocular complications. It is thus useful for the physician to be familiar with the ocular manifestations of common systemic diseases at primary care level. Diseases like diabetes, herpes zoster ophthalmicus and thyroid ophthalmopathy often involve the eyes, and if the eye signs are not identified early, the visual consequences can be devastating. Diabetic retinopathy is an important cause of blindness in this country. These, as well as common ocular manifestations of human immunodeficiency virus/acquired immune deficiency syndrome, syphilis, some dermatological conditions and the ocular side-effects of certain drugs, are discussed in this article. It is important for the primary care physician to be familiar with the spectrum of ocular involvement in systemic diseases since appropriate intervention and referral can be sight saving for the patient.
Open Access
The gradual loss of vision
(South African Academy of Family Physicians, 2013) Du Toit, N
Gradual loss of vision is a clinical problem that is encountered fairly regularly in most primary healthcare settings. Patients present with chronic, slowly progressive and generally painless visual loss. The reduction in vision is usually bilateral, though frequently asymmetrical, and occurs over weeks to years. A goal-directed assessment of the patient presenting with gradual loss of vision is required. A history of the type of visual loss, e.g. central or peripheral, and whether it is worse for near vision or distance vision, is helpful. The examination should focus on visual acuity, confrontation visual field testing, pupil testing for the presence of an afferent pupil defect and assessment of the red reflex and fundoscopy. The more common conditions that cause gradual loss of vision can be divided into two groups based on the reversibility of the visual loss. Cataracts, refractive error, corneal blindness and early diabetic macular oedema are generally reversible. Optic atrophy, glaucoma, retinal degeneration and age-related macular degeneration usually cause permanent loss of vision. Most of these conditions are briefly discussed in this article. This has been performed at a level that is suitable to primary care.
Open Access
Health System Analysis of Diabetes and Diabetic Retinopathy Services in Nigeria – The Case of Akwa Ibom State
(2018) Samuel, Stephen Maduabuchi; Geneau, Robert; Mpyet, Caleb
This research project, undertaken for a MPH dissertation investigated and analysed the situation of diabetes and diabetic retinopathy services and management systems in four (4) government hospitals in Akwa Ibom State Nigeria using the World Health Organisation (WHO) Tool for the Assessment of Diabetic Retinopathy and Diabetes Management Systems (TADDS). Part A is the research protocol, which explains the background and the key components of this research study. This is a cross sectional descriptive case study involving primary data collection. We conducted the case study using the WHO TADDS to survey health personnel involved in the management of diabetes mellitus (DM) and diabetic retinopathy (DR) in four (4) government hospitals in Akwa Ibom State. Concurrently, semi-structured interviews were conducted with key informants to investigate and analyse the situation of DM and DR services in Akwa Ibom State in Nigeria. Part B is a structured literature review of published articles, online reports, and summaries related to DR. It covers the review of scientific evidence (clinical overview) about the aetiology and prevention of DR and the known risk factors; the review of epidemiological evidence on DM and DR globally and in sub-Saharan Africa (SSA); and the review of the evidence on effectiveness and cost-effectiveness of public health and health system interventions for the prevention and management of DR. Part C is the journal-ready manuscript. In this part, the format of the journal Ophthalmic Epidemiology was used to present the research project and its main findings. Part D contains all the relevant appendices used during the research project.
Open Access
How does the practice of evisceration for open globe injuries at Groote Schuur Hospital conform to international standards
(2017) Zondi, Junaid; Du Toit, Nagib
Background: Penetrating trauma can have devastating visual consequences and is often challenging to manage effectively, especially in the setting of severe trauma. The decision to perform a primary repair or a primary evisceration following an open globe injury can be a difficult one. Removal of an eye is not only traumatic but produces grief, anxiety and depression. It can result in a poor quality of life of the affected patients, and thus must be justified before it is performed. Before a primary evisceration can be considered, certain criteria need to be fulfilled. The affected eye must have acuity of no perception of light. A total afferent pupillary defect must be present. There must be prolapsed uvea and/or retina in the wound. Wounds should be longer than 20mm, or extend posterior to the equator of the globe. The fellow eye should be normal and the patient must be able to give informed consent. The primary evisceration rete at Groote Schuur Hospital appears to be higher than in other centers. If we do conform to the required criteria, then we are justified in performing primary eviscerations, but if we do not conform, then we need to improve our adherence in order to meet the required standards and improve our management. Purpose: a. To determine if the above criteria for primary evisceration are met in those undergoing primary eviscerations at Groote Schuur Hospital, and at which point(s) we strayed from the guidelines. b. To determine the rate of primary and secondary eviscerations following ocular trauma. c. To evaluate the visual outcomes, at 3 months, of patients who present with no perception of light vision and total afferent pupillary defect who meet some of the criteria for primary evisceration, but primary evisceration is not performed. Methods: A retrospective case series study was performed to identify all patients who were admitted to the ophthalmology ward at Groote Schuur Hospital following an open globe injury. The records of all patients who underwent primary evisceration were analyzed to evaluate whether or not the criteria were met and to determine the rates of primary and secondary evisceration at GSH. Results: There was a total of 249 open globe injuries admitted during the designated two year period. Of these, 212 (85.14%) were males and 37 (14.86%) were females. The number of patients undergoing primary evisceration was 61 (24.5%) and the number of patients undergoing primary repair was 175 (70.3%) and thirteen (5.2%) had other procedures. Of the 61 patients who underwent primary evisceration, 10 patients had missing data and were thus excluded. Therefore, out of 51 patients in whom the required data was available, a total of 37 (72.55%) patients met ALL the criteria required for a primary evisceration to be performed. A total of 11 (21.56%) patients did not meet the visual acuity criterion of no perception of light (10 were perception of light and 1 was hand movements vision). A total of 9 (17.6%) patients were documented to not have a total relative afferent pupillary defect. All patients had prolapsed uvea in the wound. Three patients (5.8%) had an "abnormally" seeing or poorly seeing fellow eye. Five (9.8%) were not documented as irreparable. The informed consent criterion was fulfilled in all patients. Secondary eviscerations accounted for 4.6% of surgeries done for open globe trauma. Of the patients that were eligible for primary evisceration, but instead had primary repair, the majority (77.7%) remained NPL and 88.8% had phthisis bulbi at 3 months. Conclusion: The majority of our evisceration cases met all the criteria for a primary evisceration. The two criteria which we did not fully adhere to were the visual acuity of no light perception and the presence of a total relative afferent pupillary defect. Visual acuity testing in the trauma setting is challenging, but we should improve on the accuracy of our testing of these two entities, and clearer documentation of all the criteria in our open globe injury cases especially if undergoing a primary evisceration. A few patients had an abnormally seeing fellow eye and still underwent PE due to the injured eye being irreparable. Our primary evisceration rate reflects our resource- limited setting and the severity of our ocular trauma cases. The poor visual acuity and poor outcome in the form of phthisis bulbi at three months in those who did not have a primary evisceration despite poor acuity appears to support our rationale for performing primary eviscerations in those with poor prognoses, given our resourcelimited setting.