The Journal of Ophthalmology of Eastern, Central and Southern Africa <p>The Journal of Ophthalmology of Eastern, Central and Southern Africa (JOECSA) is the official Journal of the College of Ophthalmology of Eastern, Central and Southern Africa (COECSA) with a subscribed membership of about 500. <em>JOECSA</em> is an open access journal, published in English in hard and soft copy formats and is dedicated to all aspects of ophthalmology and community eye health.</p> <p>This peer-reviewed scientific journal publishes research papers contributing towards new knowledge in eye care, prevention of blindness and poverty eradication efforts relevant to Eastern, Central and Southern Africa. JOECSA’s broad objective is to produce a high quality, regular, self-sustaining, peer reviewed ophthalmic journal which will increase local and international visibility and citation of ophthalmic research from the Eastern and central African Region.</p> <p><em>JOECSA</em> is a fully open access journal, providing authors with a distinctive new online submission and interactive review service on its recently improved portal:</p> <p><a href=""></a></p> College of Ophthalmology of Eastern, Central and Southern Africa en-US The Journal of Ophthalmology of Eastern, Central and Southern Africa Time to tumour detection in familial retinoblastoma patients: a retrospective study <p>Background: Screening in familial retinoblastoma through regular fundus examination and molecular genetic<br>testing, is recommended to improve prognosis in terms of vision, globe sparing and save life. At The Hospital for<br>Sick Children (SickKids) fundus screening and genetic testing is done in all patients with familial retinoblastoma,<br>while in Kenya there is no formalized screening protocol and genetic testing is not readily available.<br>Objectives: To determine the mean time to first tumour detection, tumour characteristics and outcome in<br>familial retinoblastoma patients seen at SickKids, Toronto, Canada and Kenyatta National Hospital (KNH),<br>Nairobi, Kenya.<br>Design: Retrospective descriptive study.<br>Subjects: Familial retinoblastoma patients at SickKids from July 1, 1993 to September 30, 2013, for KNH,<br>upto when all the medical files could be retrieved. Data collected included patient demographics, disease<br>characteristics, treatment course and outcomes.<br>Results: A total of 32 patients were reviewed; 20 (63%) were from SickKids and 12 (37%) from KNH. SickKids<br>patients were all bilateral (20/20, 100%), compared to 7/12 (58%) of KNH. The mean time to detection of first<br>tumour was 3.8 months from birth for SickKids and 25 months for KNH. Tumours were diagnosed at birth<br>in 13/40 (33%) of eyes at SickKids while none at KNH. At SickKids most eyes were IIRC Group A (17/34, 43%)<br>or Group B (15/34, 38%). None of the patients had extraocular disease. At KNH, affected eyes were at more<br>advanced stage: IIRC Group D (8/24, 33%) and E (4/24, 17%) with 4/24 (17% eyes) having extraocular disease. All<br>patients were treated using focal therapy at SickKids, (96% had laser photocoagulation). Only 2 (5%) patients<br>had enucleation, while at KNH, all patients had enucleation, (unilateral or bilateral); with half of them receiving<br>additional chemotherapy. At SickKids, 75% of salvaged eyes had vision between 20/20 and 20/60, with 8%<br>having vision less than 20/200. In two eyes (5%) vision was assessed as central, steady and maintained. At KNH,<br>62.5% of the salvaged eyes had vision reported as fixing and following light, two eyes (25%) had vision better<br>than 20/80. In one eye (12.5%), vision was perception of light.<br>Conclusion: Early diagnosis and better outcomes were observed at SickKids familial retinoblastoma compared<br>to KNH.<br>Recommendation: Develop a screening protocol at KNH for familial retinoblastoma through fundus examination<br>and genetic counseling and testing.</p> Njambi L Dimaras H Gallie BL Kimani K Copyright (c) 2020 Njambi L, Dimaras H, Gallie BL, Kimani K 2020-07-29 2020-07-29 24 1 Factors associated with poor presenting vision among patients with microbial keratitis In Uganda <p>Objective: To determine factors associated with poor presenting vision among patients with microbial keratitis<br>in Uganda.<br>Design: Retrospective audit study.<br>Methods: This was a study of patients presenting with microbial keratitis at the two main eye units in Southern<br>Uganda in the year 2015. Information on time to presentation, treatment history, use of traditional eye medicine,<br>trauma and presenting final visual acuity was collected. Factors associated with a poor presenting vision in a<br>regression model were analysed.<br>Results: There were 273 cases during the year 2015. The median presentation time was 7 days from onset<br>(IQR 2-21, total range 0-366 days). Trauma was reported in 59/88 (67%) patients and 69/162 (43%) reported<br>using traditional eye medicine. Visual acuity was reported in only 216/273 cases at presention. Visual acuity at<br>presentation of less than 6/60 (severe visual impairment) was strongly associated with the use of traditional eye<br>medicine (OR 5.13, 95%CI 2.17–12.1, p=0.001) and distance from the eye hospital (OR 1.02, 95% CI 1.01-1.03,<br>p=0.002).<br>Conclusion: This audit highlighted the role of use of traditional eye medicine and long distance from the eye<br>hospital in contributing to poor presentation among patients with microbial keratitis in Uganda.</p> Arunga S Atto G Ayebazibwe B Onyango J Macleod D Hu VH Burton MJ Copyright (c) 2020 Arunga S, Atto G, Ayebazibwe B, Onyango J, Macleod D, Hu VH, Burton MJ 2020-07-29 2020-07-29 24 1 Prognosis of paralysis of cranial nerves III, IV and VI at Menelik II Hospital <p>Objective: Cases of cranial nerve 3, 4 and 6 palsies were analyzed regarding ultimate spontaneous recovery<br>with objective criteria.<br>Design: A longitudinal cohort study.<br>Methods: Patients presenting or referred as ocular nerve palsies to our center was done. History including age,<br>sex, history of trauma, and vascular risk factors was noted. Detailed clinical evaluation including ophthalmological<br>and neurological examination to diagnose the type of palsy was done. With an objective measurement patients<br>were followed for spontaneous recovery.<br>Results: A total of 112 cases were reviewed. The sixth cranial nerve was affected most frequently (n=60, 53.6%<br>of cases) followed by third cranial nerve (n=39, 34.8%), combined cranial nerves palsy (n=11, 9.8%) and fourth<br>cranial nerve (n=2, 1.8 %). Head trauma (n=48, 42.9%) was the most common aetiology. Recovery was evaluated<br>with reduction of deviation angle noted for 65 (58%) patients 6 months after the first presentation. Thirty four<br>(52.3%) patients showed partial recovery and 31 (47.7%) showed complete recovery. In binary logistic analysis,<br>vascular causes were found to be only significant factor associated with complete recovery (P=0.000).<br>Conclusion: Of the three studied nerves, the VI cranial nerve was the most commonly affected. Head trauma<br>was the main cause of the cranial nerve paralysis. With objective criteria based on deviation angle, overall<br>spontaneous recovery rate from the III, IV, and VI nerve palsy was 52.3%. Patients who had presumed vascular<br>disorders had a high chance of recovery.</p> Sadik T Sherief Copyright (c) 2020 Sadik T Sherief 2020-07-29 2020-07-29 24 1 Malignant ocular and adnexal neoplasms in Gulu Regional Referral Hospital. An analysis of histopathology reports of patients seen in the eye clinic over a 13 year period <p>Background: Primary or secondary ocular and adnexal tumours are a common presentation in the eye clinic.<br>Management sometimes requires surgical intervention and histopathological analysis to confirm diagnosis<br>and plan definitive treatment. All the specimens submitted for histopathological examination during the study<br>period were reviewed and all the malignant lesions analysed and presented in this study.<br>Objectives: To establish the type and pattern of malignant ocular and adnexal neoplasms amongst patients<br>seen in Gulu Regional Referral Hospital Eye Department over a 13 year period (2006 to 2018).<br>Materials and Methods: In this retrospective study, histology reports of biopsies / tissues taken from<br>patients during the period January 2006 and November 2018 were analyzed. All surgeries were done by the<br>ophthalmologists and histopathology analysis by pathologists at Mulago National Referral Hospital / Makerere<br>University, College of Health Sciences, Department of Pathology. The study variable included age, sex, type of<br>operation, site of tumour and histological diagnosis. The operation notes in the theatre record book and case<br>notes of the in-patients were reviewed.<br>Results: A total of 436 histology reports were received; 133 (30.5%) from 128 patients were confirmed as<br>malignant neoplasms: 73 (55%) were females and 60 (45%) males. Childhood cancers (0-15 years) accounted<br>for 30.8%. About half (49%) of the patients were aged 26-50 years. The type of tumours identified were:<br>Squamous Cell Carcinoma of Conjunctiva (SCCC) 79 (59.4%), Retinoblastomas 29 (21.8%), Burkitt’s lymphoma 7<br>(5.3%), Rhabdomyosarcoma 7 (5.3%), Kaposi’s Sarcoma (KS) 4 (3%), Non-Hodgkin’s Lymphomas (NHL) 3 (2.3%),<br>Malignant Melanoma 2 (1.5%), Lacrimal Gland Adenocarcinoma 1 (0.8%), and Nasopharyngeal carcinoma (NPC)<br>1 (0.8%). The intraocular and extra ocular tumours accounted for 22.6% and 77.4% respectively with 97.7% of<br>intraocular tumours being retinoblastoma and 76.7% of the extra ocular cancers SCCC. The anatomical sources<br>of tissues included conjunctiva 75 (56.4%), Eye Ball 38 (28.6%), Orbital contents 18 (13.5%) and Lids 2 (1.5%). Of<br>the 133 cases 34 (26%) cases were HIV positive with the majority having SCCC, KS and NHL. Over the 13 years<br>there has been a gradual decline in the incidence of HIV related eye cancers.<br>Conclusion: The most common cancers were from the conjunctiva (56.4%) and eyeball (28.6%). Retinoblastoma<br>was the commonest intraocular and childhood malignant tumour while SCCC the commonest extra ocular<br>cancer with 80% observed in those aged 20-54 years besides both cancers accounting for 80% of all the cancers<br>seen. There is a general decline in the trend of particularly HIV related eye cancers which can be attributed to<br>the changing treatment protocol of HIV/AIDS.</p> Watmon B Copyright (c) 2020 Watmon B 2020-07-29 2020-07-29 24 1 From research to scaling-up programs: case study of Peek school eye health program in Trans-Nzoia county, Kenya <p>There are barriers to accessing eye health services by children especially in Low and Middle-Income Countries<br>(LMIC), where the prevalence of visual impairment is highest. We report the process of scaling up the Peek<br>school screening program that was initially tested in a randomized clinical trial in Trans-Nzoia county, Kenya.<br>The initial steps involved forming an advisory group that possessed expertise in technical, technological,<br>managerial, and program management. The team used the PRIME framework to develop a theory of change<br>on how the intervention would work at scale-up. The team led the project implementation through the three<br>phases of the PRIME framework (formative, implementation and scale up phases).<br>In this study we report on this process and influencing factors. We conclude that it is feasible to translate<br>research to scaled-up programs in LMICs. Important tools in this process include stakeholder mapping and<br>engagement. The Peek school screening model is acceptable and effective in screening for visual impairment<br>in this population.</p> Rono HK Mwangi N Mwangi A Wanjala E Khachesanga J Gichangi M Bunywera C Bastawrous A Burton MJ Copyright (c) 2020 Rono HK, Mwangi N, Mwangi A, Wanjala E, Khachesanga J, Gichangi M, Bunywera C, Bastawrous A, Burton MJ 2020-07-29 2020-07-29 24 1 Rhino-orbital fungal infection mimicking orbital malignancy – is traditional herbal preparation a predisposing factor?: Report of two cases <p>Background: Chronic inflammatory reactions may present clinically as a neoplastic lesion. In both<br>immunocompromised and immunocompetent patients with orbital pathology, fungal infection should be<br>considered when the presenting features are unusual or patient is not responding to standard therapy. The<br>prognosis for sight and even life may be dire if not managed properly.<br>Case presentations: We report two cases of fungal infections with clinical characteristics similar to orbital<br>malignancy. Both patients reported the use of plant based herbal medication as eye, ear and/or nose drops for<br>minor ailments. The first case was a 32-year old female who presented with a two-year history of superior-medial<br>painless orbital swelling associated with proptosis. The second case was a 36-year old man who presented<br>with a one-year history of painless inferior-medial orbital mass. Head and orbit CT scans with contrast showed<br>features consistent with an orbital malignancy in both patients. Incisional biopsy reported fungal infection and<br>fungal staining revealed hyphae in both patients. Determining the specific fungal agent was a challenge as<br>the specimens were solid masses and paraffin-embedded blocks were prepared, unlike a wet mount in which<br>septated or non-septated hyphae could aid in this differentiation. Immunohistochemistry was not done due to<br>limited resources.<br>Conclusion: Rhino-orbito-cerebral fungal infection can present with features masquerading an orbital<br>malignancy or orbital inflammatory disease. Traditional herbal preparations for common ailments of the eye,<br>ear and nose may be a predisposing factor. Debulking surgery and oral antifungals may be considered in the<br>management of rhino-orbital fungal infection in a resource poor setting.</p> Bonsaana GB Muonir Der E Akorli E Copyright (c) 2020 Bonsaana GB, Muonir Der E, Akorli E 2020-07-29 2020-07-29 24 1 Bilateral eyelid Kaposi’s sarcoma: a case report <p>Kaposi’s Sarcoma (KS) is a generalized angio-sarcoma caused by the Human Herpes Virus type 8 (HHV-8).<br>Infection by the Human Immunodeficiency Virus (HIV) has been shown to predispose to the development of<br>KS. The commonest location of KS lesions include the skin of the lower limbs, hard palate and gastrointestinal<br>system, lymph nodes and lungs. The occurrence of KS on the eye is considered rare. We report a case of a 45 year<br>old HIV positive female patient who presented with bilateral eyelid KS as the first manifestation of systemic KS.<br>Excisional biopsies were done on both eyelids. The histology showed fascicles of spindle cells and extravasation<br>of red blood cells. A histological diagnosis of bilateral eyelid KS was made.</p> Saiko M Agrippa FM Rudo MM Copyright (c) 2020 Saiko M, Agrippa FM, Rudo MM 2020-07-29 2020-07-29 24 1 Strengthening eye health research output in the region <p>In this issue of the journal, we are pleased to announce<br>an exciting three-year partnership with ‘Eye’ Journal<br>team of the Royal College of Ophthalmologists<br>(RCOphth). This partnership is part of the VISION<br>2020 COECSA-RCOphth LINK partnership that has<br>been in existence for the last 10 years and has led<br>to development and strengthening of the COECSA<br>fellowship exam and examiner training, curriculum<br>development, ‘train the trainers’ and online CPD.</p> Arunga S Nyenze EM Wambiya V Onyango J Copyright (c) 2020 Arunga S, Nyenze EM, Wambiya V, Onyango J 2020-07-29 2020-07-29 24 1