Browsing by Subject "Ophthalmology"

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    A survey of the attitude towards research and research education among South African Ophthalmology trainees
    (2020) du Toit, Linett; du Toit, Nagib
    Background Completing a research dissertation or Master of Medicine (MMed) degree during ophthalmology specialist training has now become compulsory in order to qualify as an ophthalmologist in South Africa. At a national level there is currently no co-ordinated effort to standardize research training and resources for trainees. Objectives The primary objective was to determine if South African ophthalmology trainees were interested in doing research. Secondary objectives were to determine: whether they felt that their current research training was adequate; whether a national web-based research support system would be desirable; and whether such a support platform would stimulate involvement in further research once training was completed. Methods A questionnaire was designed and anonymously completed by the trainees in each training unit in South Africa. Categorical responses were summarized using crude and weighted means with 95% confidence intervals (CI). Free text responses were analyzed thematically using an inductive approach. Results Out of 81 trainees (registrars) in South Africa at the time of the survey, 64 fully completed the questionnaire - a response rate of 79%. Seventy-two percent (95% CI 57% to 87%) of the trainees reported that they were interested in doing research. Only 28% (95% CI 18% to 41%) of respondents felt that their current research training was adequate. Ninety five percent (95% CI 86% to 99%) of trainees advocate a web-based support platform would be beneficial an eighty six percent (95% CI 74% to 93%) reported such would motivate them to continue to do research once their training was complete. The themes from the qualitative data were in keeping with the quantitative results and identified variation between training institutions in terms of available research resources, supervision and allocated time to perform research. Conclusion The trainee ophthalmologists in South Africa are interested in performing research. They feel that their current research training programs are inadequate. There is a strong need for nationally standardised research guidance to eliminate the current variation between training institutions. Guidance on dedicated time allocation to complete the research component of training should be provided by regulatory bodies. A proposed web-based support system may be a good option to standardize selected available research resources and provide equal access to all trainees nationally as well as to supplement research output during and after specialist training. Further research should address the reported lack of supervision and elucidate additional barriers to performing research in South Africa.
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    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).
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    Evisceration and sympathetic ophthalmia : is there a risk ?
    (2006) Du Toit, Nagib; Murray, A D N
    Includes bibliographical references (leaves 35-37).
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    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.
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    Impact of systematic capacity building on cataract surgical service development in 25 hospitals
    (2017) Judson, Katherine; Courtright, Paul; Ravilla, Thulsiraj; Khanna, Rohit; Bassett, Ken
    BACKGROUND: This study measured the effectiveness and cost of a capacity building intervention in 25 eye hospitals in South Asia, East Africa and Latin America over 4 years. The intervention involved eye care non-governmental organizations or high-performing eye hospitals acting as "mentors" to underperforming eye hospitals- "mentees" in 10 countries. Intervention activities included systematic planning and support for training and key equipment purchases as well as hospital-specific mentoring which focused on strengthening leadership, increasing the volume and equity of community outreach, improving surgical quality and volume, strengthening organizational and financial management and streamlining operational processes. METHODS: This is a before and after observational study of the impact of this multi-dimensional process on hospital and individual productivity and financial sustainability after 4 years. Mentee hospitals reported data monthly using a standardized template. Key indicators included cataract surgery volume, cataract operations per surgeon, the proportion of direct paying cataract surgical patients, intervention program costs per additional surgery and cost per mentor. RESULTS: By the end of the study period, the hospitals experienced a 69% average increase (range: -63% to 690%) in cataract surgical volume over baseline with 12 hospitals showing increases over 100%. Twenty-three hospitals experienced a 59% average increase in the number of cataract surgeries per surgeon with 10 hospitals showing increases over 100%. The proportion of paying patients increased in 8 of the 14 hospitals reporting this data. The average mentoring cost per additional surgery for these 25 hospitals was $5.39. An average of $36,489.99 was spent per mentor per year to support their work with mentees. CONCLUSIONS: The intervention resulted in proportionally similar increases in cataract surgical volume and productivity across diverse settings in three distinct geographic regions. Its wide applicability and moderate cost make it an attractive means to rapidly and substantially increase eye care services to meet VISION2020 goals.
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    Is the Adams D-15 colour vision test a sensitive screening tool for ethambutol- and linezolid-induced optic neuropathy? A retrospective case series
    (2021) Van der Merwe, Pieter Jacobus Stephanus; Tinley, Christopher
    Background: Ethambutol hydrochloride and linezolid are commonly used anti-tuberculous agents. Both agents can cause potentially blinding toxic optic neuropathy. Currently there is no low-cost, sensitive screening tool to detect early toxicity before permanent vision loss has occurred. Purpose: To evaluate the ability of the Adams D-15 colour vision test to detect early ethambutol- and linezolid-induced optic neuropathy. Methods: This was a retrospective case series of 15 patients who were screened for ethambutol- and linezolid-induced toxic optic neuropathy. At screening and follow-up visits, a detailed clinical history was taken, a standard of care examination performed and a battery of side-room investigations conducted, including: Farnsworth Munsell D15 (FM D15) and Adams D15 colour vision tests, retinal nerve fiber layer optical coherence tomography (RNFL-OCT) and a Humphrey visual field 24-2 (HVF 24-2). According to the results of these tests, the patients were classified into 3 groups: “No toxicity”, “Uncertain toxicity” or “Confirmed toxicity”. Results: Six patients were classified as “No toxicity”, 3 were “Uncertain toxicity” and 6 were classified as “Confirmed toxicity”. The Adams D15 showed a sensitivity of 100% for detecting a toxic optic neuropathy. Conclusion: The Adams D15 is a sensitive screening tool for the detection of early ethambutol- and linezolid-induced optic neuropathy.
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    Outcomes of corneal crosslinking for the treatment of keratoconus at a tertiary South African hospital
    (2022) Kriek, Jozef; du Toit, Nagib
    Objectives. To describe and analyse the effectiveness of using accelerated epithelium-off corneal crosslinking (A-CXL), in a cohort of patients with progressive keratoconus (KC), presenting to Groote Schuur Hospital, South Africa. Methods. A retrospective review of patients who underwent A-CXL, using 6.4 mW/cm2 ultraviolet-A irradiation for 15 min, for progressive KC between 1 May 2017 and 1 June 2018. All patients completed 6 months minimum follow-up (Mean 9months, range 6-15). The diagnosis of keratoconus was based on corneal tomography and its clinical signs. Keratometry values and visual acuities were measured to ascertain if there was improvement in acuity or corneal curvature at 6 months post-procedure. Results. Nineteen eyes of 17 patients were included. The group consisted of 6 (32%) males and 13 (68%) females, with a mean age of 22.17 years (SD = 5.8). Zero eyes showed mild keratoconus, 8(42%) showed moderate keratoconus and 11(58%) showed severe keratoconus. At 6 months follow-up, results revealed that UCDVA improved from logMAR 0.96 to 0.83 (p = 0.068) and BCVA improved from logMAR 0.40 to 0.34 (p = 0.073). The mean UCDVA and BCVA Snellen line gain was 0.43 and 0.94. Overall the change in UCDVA and BCVA trended towards being statistically significant. The median Kmax value decreased from 57.7D to 55.9D. The mean Kmax value decreased from 59.46D to 58.85D (p = 0.137). The mean Kmean anterior increased from 50.26D to 50.86D (p = 0.139), the mean Kmean posterior from -7.48D to -7.67D (p = 0.026). There was a statistically significant change in Kmean post, but not so for Kmean ant and Kmax. Both severity groups showed a decrease in thinnest point corneal pachymetry from mean 445 micrometer(μm) to mean 422 μm (Moderate: p = 0.009; Severe: p = 0.003). KC progression was stopped or stabilised in 13 eyes (68%); 6 eyes (32%) showed progression. No complications were found. Conclusions. Our results show the effectiveness of 15-minute A-CXL (irradiance of 6.4 mW/cm2) in maintaining both corneal stability and visual acuity in our patient population at 6 months follow-up. In future, a larger study with prolonged follow-up would be required to elucidate this finding.
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    Outcomes of uveitic cataract surgery in a cohort of South African children
    (2023) Kennedy, Clare; Tinley, Christopher; Steffen Jonel
    BACKGROUND: Cataract formation is a common and potentially blinding complication of paediatric uveitis. Surgical management approach remains a point of controversy. The purpose of this study was to determine the peri- and postoperative outcomes of uveitic cataract surgery in a cohort of South African children. METHODS: Retrospective case-series of paediatric patients with uveitis who underwent cataract surgery between 01/01/2010 to 31/12/2020. The main outcome measures were postoperative best corrected visual acuity (BCVA), intra- and postoperative complications, and immunosuppressive requirements. RESULTS: The study included 18 eyes from 14 patients. Fifteen eyes underwent a pars plana vitrectomy, lensectomy with capsulectomy and were left aphakic. Three eyes had an anterior approach lensectomy with insertion of a posterior chamber intraocular lens (PCIOL). All eyes had improvement in BCVA, with a mean gain of 5 lines. BCVA equal to or better than 6/12 was achieved in 68.8% of eyes with 62.5% seeing 6/9 or 6/6. The most common post operative complication was cystoid macular oedema (CMO). Of the 3 eyes that had PCIOLs inserted, 2 required removal.