The Journal of Ophthalmology of Eastern, Central and Southern Africa

Malignant hypertensive retinopathy in a postnatal patient with pregnancy induced hypertension: Case report

Zungu TL, Mdala S, Gandiwa M, Mhango P, Kayange PC — Wed, 19 Apr 2023 00:00:00 -0400

Pregnancy Induced Hypertension (PIH) is one of the leading causes of maternal and perinatal mortality, especially in developing countries. Hypertensive retinopathy is a common condition in patients with PIH. Patients mostly present with mild hypertensive retinopathy changes such as arteriolar narrowing and arteriovenous nicking. Malignant hypertensive retinopathy is a rare finding in PIH patients. We present a case of a 32 year old postnatal woman with PIH who developed malignant hypertensive retinopathy in both eyes during post-partum period.

Indications for destructive eye surgery at Sekuru Kaguvi Eye Hospital, Zimbabwe

Mangombe S, Masanganise R — Wed, 19 Apr 2023 00:00:00 -0400

Background: Destructive Eye Surgery (DES) is a management option that is offered as a final resort where
keeping the globe risks jeopardizing life or the general health of an individual. The three destructive eye
operations are: evisceration, enucleation and exenteration in order of increasing aggressive nature of the
operation.

Objective: To find out the common indications for destructive eye surgeries (DES) at Sekuru Kaguvi Hospital
(SKH).

Methods: Patients who presented to Sekuru Kaguvi Hospital in the period January to March 2017 who ended
up having some form of DES were enrolled into the study. Data was collected on participant demography,
occupation, the affected eye, diagnosis and the subsequent DES done.

Results: A total of 37 eyes of 37 patients had DES done during the period January to March 2017. Generally
more males had DES done on them compared to females (73%). Percentages of the DES done were:
eviscerations 51.4%, enucleations 29.7% and exenterations 18.9%. The main indication for DES was trauma in
32.4%, followed by retinoblastoma in 21.6%, panophthalmitis in 21.6%, ocular surface squamous neoplasia
in 18.9%, staphyloma and painful blind eye in 5.4%. The commonest indication for the eviscerations was
a ruptured globe in 57.9%, the remainder being panophthalmitis. There was a total of 11 ruptured globes
requiring an evisceration and 10 (90.9%) were males. Globe ruptures attributed to assault were 71.2%. The
mean age for eviscerations was 39.21 years. Of the total enucleations done, 72.7% were children under 5
years (average age 2 years), the commonest indications being retinoblastoma in this group (87.5%). A total
of 7 exenterations were performed, the commonest indication being ocular surface squamous neoplasia in
85.7%. Males were at a higher chance of being exenterated than females (5:2). Most of the removed eyes had
no vision (no light perception in 73%, light perception in 18.9%, hand movement in 5.4% and 3/60 in 2.7%).

Conclusion: The main indication for DES was trauma followed by panophthalmitis and retinoblastoma.
The commonest indication for exenteration was OSSN which can be treated earlier before warranting eye
removal. There is thus need to address these preventable conditions and risks that can lead to eye removal.

Conjunctival malignant melanoma mimicking scleromalcia perforans: a case report

Mulatu DG, Adamu Y, Ayalew M — Wed, 19 Apr 2023 00:00:00 -0400

Malignant melanoma of the conjunctiva is a relatively infrequent neoplasm that can be associated with
significant morbidity and cause diagnostic difficulty to both the ophthalmologist and pathologist. We herein
describe a case of malignant conjunctival melanoma which clinically simulated scleromalcia perforance
causing sclerouveal staphyloma or huge conjunctival cyst. Being rare but potentially lethal tumour,
conjunctival melanoma should be included in the differential diagnosis of slowly growing conjunctival
masses or sclerouveal staphylomas for early detection and management.

Central corneal thickness and its relationship with IOP, visual fields and optic disc parameters among glaucoma patients attending the Eye Hospital at University Teaching Hospitals in Lusaka, Zambia

Wed, 19 Apr 2023 00:00:00 -0400

Background: Glaucoma is a heterogeneous group of optic neuropathies characterized by an acquired loss
of retinal ganglion cells, optic nerve atrophy and Visual Field Defects (VFD). Raised Intraocular Pressure (IOP)
is the only causal risk factor for glaucoma that can be therapeutically and surgically manipulated to change
the course of the disease process. Though Goldman Applanation Tonometry (GAT) is the “gold standard”
for IOP measurement, readings of IOP with GAT are believed to be influenced by Central Corneal Thickness
(CCT). The study evaluated the correlation of CCT and IOP with VFD parameters like Mean Deviation (MD),
Pattern Standard Deviation (PSD) and Cup-to-Disc Ratio (CDR) in Primary Open Angle Glaucoma (POAG)
patients.

Objective: To determine the relationship of central corneal thickness, intraocular pressure, visual fields and
optic disc parameters in Zambian primary open angle glaucoma patients.

Methods: A cross-sectional study was conducted in 2014 from January to September and all glaucoma
patients visiting the University Teaching Hospitals – Eye Hospital during the study period were included
if they consented to it and met the inclusion criteria. A total of 166 randomly selected newly diagnosed
glaucoma patients aged 18 years and above were recruited. The CCT was measured using Kacon Ophthalmic
Ultrasound system and IOP was measured by GAT. Analyses were carried out considering the level of
significance at 5%.

Results: One hundred and sixty-six newly diagnosed glaucoma patients aged 18 to 88 years were included
into the study. There were 85 (51.2%) males and 81 (48.8%) females with a mean age being 51.31 years. The
mean IOP was 23.60 (±10.40) mmHg. The mean CCT was 531.9 (±40.59). All the participants had primary
open angle glaucoma POAG. Thin CCT was significantly correlated with vertical CDR (r= - 0.023, and 0.011).
Thin CCT was also significantly associated with worsened MD of visual field (r= - 0.033 and p=0.023) and PSD
(r= - 0.027 and p=0.012).

Conclusions: The mean CCT of Zambian POAG patients is thinner as compared to other races. CCT was
positively correlated with IOP. Patients who had thicker CCT were more likely to have low IOP compared to
patients who had thinner CCT. In the POAG patients thinner CCT was associated with greater cup disc ratio
and Visual Field (VF) damages than those with a thicker CCT.

What is a good PhD program in ophthalmology?: Students’ perspective

Mwangi N, Rono H, Arunga S, Mdeme F — Wed, 19 Apr 2023 00:00:00 -0400

Access to doctoral studies is increasing and the impact of PhD programs is generally understood to be
positive. However, the lack of clarity about what a PhD entails can be a barrier to student entry into the
programs. During the pre-entry period, students need to consider the reasons for choosing to take PhD and
the value expected from it. In practice, this involves complex considerations related to personal, institutional,
logistical and PhD program characteristics. As such, prospective students would benefit from a reflection
on these factors in advance of registering for the PhD. Realising that there is a limited published literature
on what makes a PhD ‘good’, in this paper we explore the factors that contribute to students’ perception
of a good scholarly engagement. We use an interview format to report on some broad areas of relevant
consideration. We conclude that sustained student motivation, effective supervision, adequate facilities and
a supportive environment are pertinent for the learning that makes a PhD ‘good’.

Retinopathy of prematurity: Prevalence and risk factors among infants in rural Kenya

Sitati SM, Ojuma MS, de Alba CAG — Wed, 19 Apr 2023 00:00:00 -0400

Background: Retinopathy of Prematurity (ROP) is a potentially blinding eye disorder that is seen in premature
infants. Data is scanty on prevalence rates in Africa. This study was done to determine the prevalence and
risk factors for ROP in a rural hospital in Kenya.

Design: A prospective cohort study.

Methods: The study was carried out at the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu,
Kenya between March 2015 and April 2016 in the neonatal unit and outpatient eye clinic. Infants less than
32 weeks gestation and/or weighing less than 1500 grams at birth, plus those with an unstable clinical
course had a dilated fundoscopic examination starting at 28 days of life. Exam findings were recorded using
standard IC-ROP classification. Examinations were repeated every 1-2 weeks until mature vasculature in
zone III was confirmed. Infants were excluded if they died before the ROP outcome or if they did not show
up for the first outpatient exam.

Results: One hundred and thirty one neonates were included in the study, with a male to female ratio of
1:0.95 (64/67). Mean gestational age was 30.64 ± 3.6 weeks and mean birth weight was 1478 ± 414.08 grams.
Of these, 91 (69.5%) had been on oxygen, with a mean of 4.6 ± 5.9 days on oxygen. Four babies developed
ROP (a prevalence of 3.05%). Three (75%) had zone II, stage 1 ROP and one (25%) had zone II, stage 2 ROP;
all regressed without treatment. No infant developed vision-threatening ROP. Peri-natal risks identified
in this group included respiratory distress syndrome, prolonged oxygen administration, intra-ventricular
haemorrhage and seizures.

Conclusion: ROP prevalence was much lower than that reported in other studies, with all cases of ROP
regressing without treatment. The presence of ROP in this setting however, makes a case for screening in
hospitals in rural areas.

Primary open angle glaucoma as seen at the University Teaching Hospital, Lusaka, Zambia

Muma MKI, Bailey R, Michelo C — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To determine the prevalence of Primary Open-Angle Glaucoma (POAG) among patients attending
eye clinic at University Teaching Hospital (UTH).

Design: A cross sectional survey.

Methods: The POAG survey was carried out at the eye clinic of the University Teaching Hospital (UTH), Lusaka
from January to December 2013. The clients (n = 1,625) had a full ocular examination and their demographic
information (specifically age, sex, residence and ethnicity) was captured. The ocular examination included
visual acuity and intraocular pressure (IOP) among others. Multivariate logistic regression, stratified by age
group and gender, was used to determine the association between demographic factors and POAG.

Results: Of the 1,714 patients randomly sampled for the study, 89 (5.2%) declined to participate in the study;
hence the response rate of 94.8%. The ages ranged from 20 to 98 years, with a median age of 51 years (IQR
45, 59). The prevalence of POAG was 19.0% (95% CI, 14.6%, 23.8%), distributed as 5.7% (95% CI 3.2, 9.1) in
males and 13.3% (95% CI 11.7, 21.3) for females. Females were more likely to have POAG than males (72.9%
vs. 27.1%; OR 2.78, 95% CI 2.1, 5.8). Surprisingly, age groups younger than 40 years had higher proportion of
POAG compared to the older population (61.6% vs. 38.4%, P<0.001). The main determinants of POAG were
age, sex and Diabetic Retinopathy (DR). There was a significant negative correlation between POAG and HIV
infection (r2 = 0.0269; p<0.001).

Conclusion: The prevalence of POAG in this population of 19.0% was higher and certainly not comparable
to those in black populations in Barbados, St. Lucia, Nigeria, Ghana and South Africa. The striking finding
of this study was that 40.7% of all the identified POAG cases were below the age of 40 years. There was no
association between POAG and HIV infection

Outcomes of paediatric cataract surgery at Lighthouse for Christ Eye Centre - Mombasa, Kenya: A retrospective case series

Shiramba B, Mukiri M, Njambi L, Matende I — Wed, 19 Apr 2023 00:00:00 -0400

Background: Paediatric cataract is one of the main and treatable causes of childhood blindness and visual
impairment in developing countries, with varied outcome because of lack of properly equipped facilities,
late presentation and poor follow-up.

Objective. This study aimed to assess the outcome of non-traumatic cases of paediatric cataract surgically
managed at Lighthouse for Christ Eye Centre, Mombasa, Kenya.

Methods: This was a retrospective case series carried out from 1st January 2013 to 31st December 2014. Eyes
of children<16 years of age operated for non-traumatic cataract, were included. The clarity of the visual axis
and the Visual Acuity (VA) were the primary outcome measures. The types of surgery, the method of aphakic
correction and complication rates were also recorded.

Results: Most patients were males (male: female ratio of 2.5:1). Majority of patients were in the 1-5 year age
category (48.7%). Most patients were bilaterally affected (70.5%), with developmental cataract being the
most common in 67.7% of eyes. Majority of the surgeries done were lensectomy + anterior vitrectomy (AV)
+ intraocular lens (IOL) implantation. Foldable IOLs were the most commonly implanted, in 82 eyes (75.2%).
Twenty-four eyes were left aphakic (18%). The most common type of post-operative refractive correction
was spectacles (55.6%). Majority of eyes with post-operative VA recorded, fell in the good outcome category
as per World Health Organization (WHO) and Kilimanjaro Centre for Community Ophthalmology (KCCO)
guidelines, for each follow-up visit. More than 90% of eyes had a clear visual axis for each follow-up period.
At 12 weeks follow-up period, post-operative findings and complications were noted in approximately 40%
of eyes, the most common finding was amblyopia (8.8 %).

Conclusion: Lens washout, primary posterior capsulotomy, anterior vitrectomy and primary intra-ocular
lens implantation offers an effective method for correction of aphakia related to paediatric cataract surgery.
It also maintained a clear visual axis for up to 1 year post-operatively with a significant number (>90%)
remaining clear at each follow up visit. A majority of eyes (50%) had good visual outcome.
Recommendations: Strict follow up schedule is advised for consistent visual rehabilitation to further
improve the outcome.

Impairment of vision among commercial motorcyclists (Bodaboda riders) in Uganda

Wed, 19 Apr 2023 00:00:00 -0400

Background: To determine the prevalence and factors associated with impaired vision among commercial motorcyclists (bodaboda) riders in Uganda.

Objective: To determine the prevalence and factors associated with impaired vision among commercial motocyclists (bodaboda) riders in Uganda.Methods: This was a descriptive cross-sectional study done in Kawempe South division in Kampala district. Socio-demographic characteristics, relevant medical and riding history were recorded. All riders underwent a general medical examination and a detailed ocular examination which included vision, anterior and posterior segment assessment. A rider with impaired vision was defined as one whose presenting visual acuity was 6/12 or less in either eye.

Results: Seven hundred and twenty four male riders, aged between 17 to 56 years (mean 30.3 years, Standard deviation=7.2 years) were recruited. Thirty riders (4.1%, 95%CI: 2.7- 5.6) had impaired vision in either eye. Eight riders (1.1%) had visual impairment in both eyes. The ocular disorders associated with impaired vision included: refractive errors 12 (40%), uveitis 6 (20%) and anophthalmic socket 4 (13.3%), ptosis 2 (6.7%), amblyopia 2 (6.7%) corneal scar 2 (6.7%) and cataract 2 (6.7%).

Conclusion: A significant proportion of bodaboda riders in Kampala have impaired vision. The causes of impaired vision were ocular disorders that are treatable and reversible if diagnosed early.

Traumatic central retinal artery occlusion with optic neuropathy: a case report

Sonjoy KD, Situma PW, Kareko CW — Wed, 19 Apr 2023 00:00:00 -0400

Traumatic optic neuropathy with central retinal artery occlusion is rare. We report a case of an 11 year old male
patient who presented with poor vision in the left eye after blunt trauma to the forehead. The visual acuity was
light perception and he had relative afferent pupillary defect. Examination and investigations revealed optic
neuropathy with central retinal artery occlusion and patent cilioretinal artery. In spite of treatment with oral
prednisolone for 2 weeks the visual acuity remained light perception after 3 months of follow up. The right eye
was found to be normal. Traumatic central retinal artery occlusion is rare but should be ruled out in patients with
poor vision due to trauma to the head.

Profile of amblyopia at Sabatia Eye Hospital

Wanyonyi M, Njambi L, Kariuki M, Sitati S — Wed, 19 Apr 2023 00:00:00 -0400

Background: Amblyopia is a visual development disorder whose onset is in childhood. It becomes resistant
to treatment after the critical age of 7 – 8 years when the visual system is estimated to have matured. Early
diagnosis is vital to the prevention of visual impairment caused by amblyopia.
Objective: This study aims to determine the proportion and profile of amblyopia among children who presented
at the Sabatia Eye Hospital in 2014.

Methods: This was a quantitative, hospital-based, retrospective case series. All children aged below 16 years who
fit the amblyopia case definitions and were seen at Sabatia Eye Hospital between 1st January and 31st December
2014 were included in the study. The 2014 outpatient records were used to recruit the study population.

Results: A total of 268 patients (451 eyes) were recruited in the study from the 4,269 files assessed, giving a
proportion of 6.3%. Most patients [183 (68.28%)] had bilateral amblyopia. Refractive amblyopia (56.54%) was the
most common type and it was predominantly due to ametropia. Two thirds of children with refractive amblyopia
presented after the age of 8 years. The second most common type of amblyopia was combined (31.49%) followed
by sensory deprivation (9.31%) and strabismic (2.66%) amblyopia. Moderate amblyopia (58.47%) was more
common than deep amblyopia (41.53%) and was predominantly due to refractive errors.

Conclusion: Refractive amblyopia is the most common type of amblyopia and has a predominantly late

Prevalence of keratoconus in patients with allergic conjunctivitis attending Kenyatta National Hospital eye clinic

Mugho SN, Ilako D, Nyenze EM — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To determine the prevalence of keratoconus among patients with allergic conjunctivitis aged
between 8 and 30 years, attending Kenyatta National Hospital eye clinic.

Methods: A cross sectional study of patients on follow up for allergic conjunctivitis. They were examined on the
slit lamp, clinical signs of keratoconus were elicited, and then keratometry and corneal topography was done on
each of them. The social demographic and clinical data was captured in a questionnaire. Descriptive analysis of
the data was done to determine means, frequencies and proportions of the various variables. The relationship
between the demographic characteristics of the patients, the duration and severity of allergic conjunctivitis,
with keratoconus was assessed.

Results: Two hundred and forty six eyes of 123 patients were examined. Keratoconus prevalence was found to
be 10.6% by clinical diagnosis, 14.6% by keratometry and 30.9% by topography. Majority of those diagnosed
with keratoconus were aged 10 to 14 years (42.1%). The male: female ratio of those with keratoconus was 1.9:1,
and among them 34.2% had moderate allergic conjunctivitis, and 42.1% had severe allergic conjunctivitis, which
was statistically significant. Patients with allergy symptoms for more than 10 years formed the largest proportion
of those with keratoconus (42.1%).

Conclusion: The prevalence of keratoconus in patients with allergic conjunctivitis was found to be high and
the majority were male. Corneal topography diagnosed more patients with keratoconus, and therefore is highly
recommended as part of the follow up investigations for all patients with allergic conjunctivitis. This will ensure
early detection and management of the condition.

Outcomes of trabeculectomy among glaucoma patients in Uganda: A 4-year hospital based audit

Mbumba FB, Hirnschall N, Arunga S, Kwaga T, Onyango J, Rigal K — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To determine the outcomes of trabeculectomy surgery and predictors of post-operative Intra Ocular
Pressure (IOP) among glaucoma patients attending Ruharo Eye Centre.

Materials and Methods: In a clinical audit conducted from January to June 2016, we reviewed records of all
patients who had undergone trabeculectomy at Ruharo Eye Centre (REC), at least in one eye prior to recruitment.
We made phone calls to patients inviting them for a clinical examination. For the patients who turned up, we
recorded their Best Corrected Visual Acuity (BCVA), Visual Fields (VFs), Intra Ocular Pressure (IOP), Cup-Disc
Ratio (CDR), and any post-operative complications. We also asked patients about their general satisfaction with
both the operation and vision. We did a before and after comparison analysis on several outcome measures
using STATA v14. These included: visual acuity, intra ocular pressure, cup disc ratio and visual field. We defined
treatment success as a post-operative IOP reduction of 40% from baseline and analyzed for its predictors in a
multivariate regression model.

Results: Sixty-two eyes of 38 patients were included in this study. Median age was 66 years (range 24 to 91
years). Median observation time was 2.8 years (range 0.2-4.6 years). Overall treatment success rate was 95%.
Mean IOP pre-and post-operatively was 32 mmHg (95% CI 29.3-34.7) and 12.9 mmHg (11.7-14.2) respectively,
P=0.001; there was no significant worsening of visual acuity and visual field loss. Mean visual acuity Log MAR pre
and post-operatively was 0.58 (95% CI 0.48-0.68) and 0.65 (95% CI 0.52-0.78), P=0.21. Mean visual field defect
was 23.4 (95% CI 21.4-25.5) and 22.9 (95% CI 20-9-25.0), P=0.44.

Conclusion: Trabeculectomy in our setting seemed to have a good success rate and provided good IOP control,
preservation of vision and visual fields.

Outcomes of surgery for stage 4 and 5 retinopathy of prematurity in a developing country

Nazmun N, Situma PW, Sonjoy KD, Malek A — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To assess anatomical and visual outcomes plus complications of surgeries in patients with stage 4
and 5 retinopathy of prematurity in a tertiary eye care centre in Bangladesh.

Methods: Retrospective case series of all patients that underwent surgery for stage 4 and 5 retinopathy of
prematurity between January 2015 and January 2018 was carried out. Anatomic outcomes, qualitative visual
acuity as well as the complications were assessed.

Results: Thirty three eyes of 25 patients were recruited in the study (12 male and 13 female). Overall 22 (66.7%)
of the eyes had complete retinal re-attachment. The percentage for complete re-attachment for stage 4A, 4B,
and 5 were 89.5%, 66.7% and 12.5% respectively. Overall 19 eyes (57.6%) had ability to fix and follow objects. This
included 14 eyes (73.7%) in stage 4A, 4 eyes (66.7%) in stage 4B and 2 eyes (25.0%) in stage 5. The commonest
complications noted were cataracts (15.2%), vitreous haemorrhage (15.2%) and glaucoma (9.1%).

Conclusion: Anatomical outcomes of surgery for stage 4A retinopathy of prematurity are very encouraging
while those of stage 4B and 5 are poorer. Consequently, visual outcomes for stage 4A are also better than those
for stage 4B and 5.

Development of attributes relevant to satisfying ophthalmic care among health providers and adult patients at Harare Central Hospital, Zimbabwe: a mixed method study

Kawome MM, Shamu S, Masanganise R — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To develop attributes relevant to satisfying ophthalmic care among health providers and patients.
Design: Mixed-method study.

Settings: Harare Central Hospital Eye Unit, Zimbabwe.

Subjects: A convenience sample of 30 eligible adult patients who had come for eye care at the outpatients’
department and 18 health care providers.

Methods: This study was conducted as the first phase of a two-phase broader study. We held five focus groups
with patients and doctors separately and twelve in-depth key informant interviews with nurses. Participants
were asked to identify attributes of the care process they regarded as leading to satisfying eye care. We recorded
full details and used a tallying method to record frequencies. We then ranked and identified key attributes, with
the top three attributes regarded as the most important.

Results: The study developed nine attributes from health providers and seven attributes from health users.
The most important attributes for health providers were the availability of drugs, good staff attitude and the
availability of equipment. Patients prioritised good staff attitude, adequate information and the availability of
doctors. All the attributes mentioned by health users were mentioned by health providers but ranked differently.

Conclusion: Both clinical and nonclinical attributes of care were considered by health providers and health
users. Overall, attributes that were important to patients were linked to interpersonal relations (attitudes,
communication, availability of, and access to doctors). Health providers’ preferences were mostly clinical (drugs
and equipment). Acknowledging these differences in perspectives may help policymakers when designing
frameworks for quality health services.

Sensitivity and specificity of McMonnies Questionnaire in diagnosing dry eye syndrome among patients aged 40 years and above in Uganda

Atto G, Twinamasiko A, Arunga S — Tue, 18 Apr 2023 00:00:00 -0400

Objective: To evaluate the sensitivity and specificity of McMonnies Questionnaire (MQ) as a screening tool for
Dry Eye Syndrome (DES) among patients aged 40 years and above attending Ruharo Eye Centre (REC).

Design: This was a cross-sectional hospital-based study.

Methods: The study was conducted during the months of September to December 2017. Both males (76) and
females (91) who were aged 40 years and above using convenient sampling were included. All participants were
screened for DES using McMonnies Questionnaire after which assessment for the signs of DES using Schirmer
I, TBUT and Rose Bengal tests were done. We entered data into Excel and exported into Stata 13.0 for analysis.

Results: A total of 167 patients were enrolled, 91 (54.49%) were females. The female to male ratio was 1.2:1. The
median age of the patients was 63 years (IQR: 54-72, range: 40-94). The median Schirmer I, TBUT and MQ scores
were 14 mm (IQR: 5-22, range: 1-35), 6.67 seconds (IQR: 3.33-17, range: 1-34.33) and 12 (IQR: 9-17 range of 2-27).
The prevalence of DES was 68%. The sensitivity and specificity of McMonnies Questionnaire in diagnosing DES
were 81.6% (95% CI, 73.2 - 88.2) and 39.6% (95% CI, 26.5 - 54) respectively.

Conclusion: The McMonnies Questionnaire had a high sensitivity (81.3%)but low specificity (36.9%) in diagnosing
DES. Therefore, when such a test is negative, it is good for ruling out DES but not suitable for identifying
people at risk of the disease.

Glaucoma awareness in Sub Saharan Africa region: Review and strategies

Gessesse GW, Mulugeta A, Giorgis AT, Ayele FA — Wed, 19 Apr 2023 00:00:00 -0400

There is low level of awareness on glaucoma among the public in the region and there is a need for more research.
Raising glaucoma awareness has multiple impacts that ultimately contribute to early detection, management
and avoiding blindness due to the disease. There are various strategies for raising awareness on glaucoma and
the experience in Ethiopia has shown the importance of raising glaucoma awareness in terms of early detection
of disease, compliance to glaucoma management, acceptance of surgery, mobilizing stakeholders, and getting
due attention to glaucoma as a public health problem.

From strabismus to pseudo-strabismus and familial exudative vitreoretinopathy, a clinical journey of phenotypically identic twins with symmetric ocular features

Pathan AH, Niyonzima JC, Sazzad Iftekhar QS — Wed, 19 Apr 2023 00:00:00 -0400

Familial Exudative Vitreoretinopathy (FEVR) is a rare genetic condition and several genes have been identified.
Clinically, it can cause macular dragging and therefore pseudo-strabismus or exudative or tractional retinal
detachment leading to loss of vision in severe cases. Other symptoms including refractive error, cataract and
glaucoma have been documented. The main differential diagnosis remains retinopathy of prematurity. We
report two phenotypically identic twins that were seen in a lower level hospital and diagnosed with strabismus
presumed to be secondary to myopia. A multidisciplinary team including optometrist, paediatric and vitreoretinal
ophthalmologists re-examined the twins and found eccentric fixation and features of FEVR on fundoscopy
and angiography. There was a high chance that the twins would have been managed only with spectacles
missing the opportunity to be followed up for a more severe vitreoretinal proliferative disease. This case report
underlines the genetic basis of the disease with symmetrical and equally distributed myopia, macular dragging
and subsequent pseudo-strabismus and FEVR angiographic features. A multidisciplinary team-work was of
utmost importance. Beside refractive error correction, the twins also benefited from laser photocoagulation to
the avascular retinae to prevent further progress of the proliferative vitreoretinopathy. A good clinical history is
enough to rule out retinopathy of prematurity and focus on other causes of retinal fibrovascular membranes in
the pediatric population. The fluorescein angiography can be decisive in the clinical setting while genotyping is
essential for genetic counseling. Clinicians in low income countries may depend solely on a good clinical history
and examination but a high index of suspicion in presence of clinical features of FEVR is key.

Characteristics of babies referred to a tertiary eye hospital of Bangladesh for retinopathy of prematurity screening and management, a database analysis

Niyonzima JC, Nahar N, Chowdhury M, Kumar SD, Rahman M — Wed, 19 Apr 2023 00:00:00 -0400

Background: IspahaniIslamia Eye Institute and Hospital (IIEIH) is a not for profit hospital and a leading Retinopathy
of Prematurity (ROP) screening center in Bangladesh.

Objective: The study had an aim to analyze the characteristics of referred babies and identify possible bottlenecks
in the referral system.

Methods: Electronic records of babies referred to IIEIH for a period of three years (2016-2018) were analyzed
retrospectively. All the babies registered in the electronic file were screened by any of the three consultants with
a keen interest in ROP. Variables of interest were ROP stage, gestational age, birth weight, time to screening, referring
institution and treatment modalities (laser, Anti-VEGF, retina surgery or combination). Data was exported
to SPSS version 23 for Mac for descriptive and correlation analysis. A P-value of less than 0.05 was considered
statistically significant.

Results: Eight hundred and eighty seven babies with ROP stage 1 or above were registered over the 3 years
period, a large majority were referred mostly by neighbouring private institutions (75%), 60% of babies were
moderate pre-terms according to WHO classification, the mean birth weight was 1563±397.1 grams. ROP stage
2 was dominant (37%) and 61% of any stage ROP babies had at least one treatment modality. There was an obvious
delay in screening since only 55% of babies were screened within a period of less than 8 weeks. The younger
the gestational age and the lower the birth weight, the higher the risk of presenting with ROP with advanced
stage. (P-value<0.001).

Conclusions: The majority of babies with ROP came from private institutions and more than half of them needed
at least one treatment modality. The delay in screening was a key bottleneck and needs to be addressed. We
recommend more NICUS and more ROP services in public hospitals

Diabetic retinopathy screening program in Southwestern Uganda

Wed, 19 Apr 2023 00:00:00 -0400

Objectives: Between 2019 and 2045, the prevalence of Diabetes Mellitus (DM) will double; associated with
this, the burden of Diabetic Retinopathy (DR) is also expected to increase, especially in low-resourced settings.
To prevent avoidable visual impairment and blindness, early detection through screening and early treatment
are necessary. To enable access to these services, we developed the Lions Diabetic Retinopathy Project for
southwestern Uganda to serve the region including 17 Districts with eight million inhabitants.

Methods: A three-pronged strategy for mass screenings levering the existing general health system and
opportunistic screening of higher-risk population. Capacity building involved training a vitreoretinal surgeon
and allied eye care providers, installing critical infrastructure at the referral eye hospital, and acquiring equipment
for primary health centres.

Results: In 1.5 years, 60 DR screening camps were implemented; this led to screening of 9,991 high risk
individuals for DM and 5,730 DM patients for DR. We referred 1,218 individuals with DR for further management
at the referral eye hospital, but only 220 (18%) attended referral. The main barrier for not attending referral
was long travel distance and the associated direct and indirect costs. Human resources trained included 34
ophthalmic nurses, five midlevel providers, and one vitreoretinal surgeon. Major equipment acquired included
a vitrectomy system, an outreach vehicle, and non-mydriatic fundus cameras.

Conclusions: DR screening can be implemented in a resource-limited setting by integrating with the general
primary healthcare system. However, geographic barriers stymie delivery of therapeutic services and we need
to establish models to bring these services closer to areas with poorer access.

Concurrent retinoblastoma and morning glory disc anomaly in a 9 month old baby: a case report

Nyabuga B, Njambi L, Kimani K — Wed, 19 Apr 2023 00:00:00 -0400

Concurrent occurrence of retinoblastoma and other ocular anomalies is rare. Appearance of leukocoria in the
other eye usually signals bilateral disease although this is not always the case. This emphasises the need of
careful examination always. We present a case of retinoblastoma and morning glory disc anomaly in a baby.
Both conditions had leukocoria in each eye, which was noted at different stages of the clinical evaluation.
Although our patient did not have other associated features, this scenario requires distinct multi- disciplinary
approach for management of each of the conditions and any accompanying clinical disorders.

Argon laser for subhyaloid retinal haemorrhage: a case report

Kanji R, Ruvuma S, Kwaga T, Wiaffe G, Soliman A, Tuswingwire P, Arunga S — Wed, 19 Apr 2023 00:00:00 -0400

To present a case of severe pre-retinal haemorrhage that was treated with Argon laser posterior hyaloidotomy.
A 30-year-old female, non-diabetic and non-hypertensive patient presented with sudden painless loss of vision
in the left eye and no history of trauma. Her vision was counting fingers in that eye. Retinal imaging showed
severe pre-retinal haemorrhage over the macular area. Argon laser posterior hyaloidotomy was immediately
performed. Blood drained inferiorly into the vitreous cavity with clearance of the premacular area. Her vision
improved to 6/9 within 30 minutes. Neglect of early intervention for preretinal haemorrhage with the Argon
laser leads to complications such as vision loss and prolonged time for visual recovery. Argon laser hyaloidotomy
is a viable option for prompt vision recovery.

Factors associated with poor presenting vision among patients with microbial keratitis In Uganda

Arunga S, Atto G, Ayebazibwe B, Onyango J, Macleod D, Hu VH, Burton MJ — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To determine factors associated with poor presenting vision among patients with microbial keratitis
in Uganda.

Design: Retrospective audit study.

Methods: This was a study of patients presenting with microbial keratitis at the two main eye units in Southern
Uganda in the year 2015. Information on time to presentation, treatment history, use of traditional eye medicine,
trauma and presenting final visual acuity was collected. Factors associated with a poor presenting vision in a
regression model were analysed.

Results: There were 273 cases during the year 2015. The median presentation time was 7 days from onset
(IQR 2-21, total range 0-366 days). Trauma was reported in 59/88 (67%) patients and 69/162 (43%) reported
using traditional eye medicine. Visual acuity was reported in only 216/273 cases at presention. Visual acuity at
presentation of less than 6/60 (severe visual impairment) was strongly associated with the use of traditional eye
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,
p=0.002).

Conclusion: This audit highlighted the role of use of traditional eye medicine and long distance from the eye
hospital in contributing to poor presentation among patients with microbial keratitis in Uganda.

Bilateral eyelid Kaposi’s sarcoma: a case report

Saiko M, Agrippa FM, Rudo MM — Wed, 19 Apr 2023 00:00:00 -0400

Kaposi’s Sarcoma (KS) is a generalized angio-sarcoma caused by the Human Herpes Virus type 8 (HHV-8).
Infection by the Human Immunodeficiency Virus (HIV) has been shown to predispose to the development of
KS. The commonest location of KS lesions include the skin of the lower limbs, hard palate and gastrointestinal
system, lymph nodes and lungs. The occurrence of KS on the eye is considered rare. We report a case of a 45 year
old HIV positive female patient who presented with bilateral eyelid KS as the first manifestation of systemic KS.
Excisional biopsies were done on both eyelids. The histology showed fascicles of spindle cells and extravasation
of red blood cells. A histological diagnosis of bilateral eyelid KS was made.

Review of outcome of horizontal childhood strabismus surgery at Kenyatta National Hospital and Kikuyu Eye Unit

Fazal AF, Kimani K, Nyamori J, Mundia D — Wed, 19 Apr 2023 00:00:00 -0400

Background: With early management of strabismus, improved visual acuity and better cosmetic outcomes
can be achieved. Strabismus surgery aims to improve the cosmetic appearance of the eyes and eventually
reduce the negative psycho-social impact, possibly restore Binocular Single Vision (BSV) and centralize or
expand the field of BSV hence this study is of importance to determine whether we are achieving the aims
of surgery.

Objectives: The aim of this study was to determine the outcome of horizontal childhood strabismus surgery
at Kenyatta National Hospital (KNH) and Kikuyu Eye Unit (KEU).

Methods: A retrospective case series was carried out targeting children who underwent strabismus surgery.

Results: A total of 199 children (0 – 15 years) who had corrective strabismus surgery from June 2008 to June
2013, of whom 122/199 (61.3%) completed the 2-3 month follow-up. Forty one out of ninety (45.6%) cases
of esotropia and 19/32 (59.4%) cases of exotropia had a good outcome, while the poor outcome was 15/90
(16.7%) and 2/32 (6.3%), respectively. Bilateral medial rectus recession for esotropia had 12/34 (35.3%) good
outcome and 6/34 (17.6%) poor outcome, while recess-resect procedure for esotropia had 27/53 (50.9%)
good and 9/53 (17%) poor outcome. Bilateral lateral rectus recession for exotropia had 4/9 (44.4%) good and
1/9 (11.1%) poor outcome, while for recess-resect procedure for exotropia had 15/23 (65.2%) good and 1/23
(4.3%) poor outcome.

Conclusions: The most common type of paediatric strabismus was esotropia. Most common surgery
performed was a recess-resect procedure for all types of tropia. Surgical success rate was generally good.

Psychological experiences of adult patients with blindness secondary to glaucoma at Lions Sight First Eye Hospital in Blantyre, Malawi

Chilonga FS, Kayange PC, Manda CS, Zungu TL, Masulani-Mwale C — Wed, 19 Apr 2023 00:00:00 -0400

Background: Glaucoma is the second leading cause of blindness in the world. Blindness secondary to
glaucoma is irreversible, and thus people experience lifelong blindness once they develop blindness from
glaucoma. Currently, there is lack of literature regarding psychological experiences of patients living with
blindness secondary to glaucoma in Africa.

Objective: To explore psychological experiences of adult patients with blindness secondary to glaucoma.

Method: A hospital based qualitative study at a tertiary government eye hospital was done among adult
patients who presented with blindness secondary to glaucoma. Selection of participants was done by
purposive sampling and individual in-depth interviews were used to collect data among study participants
until data saturation. Data was analyzed using content analysis.

Results: Eight adult patients (7 men and 1 woman) with blindness secondary to glaucoma were interviewed.
Patients with glaucoma experienced psychological distress and depression due to unemployment, lack
of basic needs and worries related to unaccomplished family obligations. The patients felt restricted in
performing activities of daily living which consequently overburden their caregivers.

Conclusion: This study has shown that adult patients who are blind from glaucoma experience challenging
mental health problems. There is a need for integration of psychosocial care into the management of patients
with blindness secondary to glaucoma.

Solitary retinocytoma in a seven year old boy

Wanyonyi M, Njambi L, Kimani K, Gachago M, Njuguna M — Wed, 19 Apr 2023 00:00:00 -0400

Retinal astrocytoma is a rare benign tumour of astrocytes in the neurosensory retina. Detection usually occurs in childhood or adolescence. In this age group the diagnosis of solitary cases can be challenging as they may mimick retinoblastoma. However, there are cases that have been diagnosed in adulthood. In this case report, a seven year old boy presented with long standing history of leukocoria. The discussion highlights the management and distinguishing features with other causes of leukocoria.

Review of ocular trauma in Tamale Teaching Hospital, Tamale, Ghana

Bonsaana GB, Nyenze EM, Ilako DR, Wanye S — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To establish the epidemiologic characteristics, referral pattern, interventions, visual outcomes and complications resulting in visual impairment/blindness among ocular trauma patients in Tamale Teaching Hospital (TTH) Eye Clinic, Tamale, Ghana.

Materials and Methods: This was a retrospective hospital-based case series in which all new patients of all ages with various eye conditions from 1st January to 31st December 2010 were reviewed from the outpatient/inpatient record books and the sex and age recorded. The files/ folders of patients with ocular trauma were selected and retrieved. The epidemiological characteristics, referral pattern, interventions, visual outcomes and complications resulting in visual impairment/blindness among ocular trauma patients were analysed.

Results: A total of 2,027 records of new patients with various eye conditions were retrieved. Three hundred and sixty one (377 eyes) new ocular trauma patients’ files/ folders were analyzed. The Male: Female ratio was 1:1.1 (p=0.09) for all new patients with various eye conditions whilst it was 1.8:1 (p<0.01) for new ocular trauma patients. Ocular trauma patients were younger than general patients with 20 – 29 years age group having most new patients (27.4%) compared with the over 49 years age group for other new cases (23.4%). Approximately 68.4% of the ocular trauma patients were seen at TTH without a referral. Conjunctival lesions were the commonest finding affecting 124(32.9%) of the ocular trauma patients. The majority of patients 88.1% sustained closed globe trauma, 8.3% had adnexal trauma whilst 3.6% had open globe trauma. The commonest intervention rendered was medical treatment alone to 64.4% of the patients. By the WHO classification, majority 67.4% of traumatized eyes had normal vision, 13.9% were visually impaired and 18.7% were blind. Thus, 110 (32.6%) were visually impaired/ blind in the traumatized eye. The commonest complications resulting in visual impairment/ blindness were corneal opacities/ scars in 33(30.0%) cases.

Conclusion: Majority of ocular trauma patients presented with minor injuries which healed without complications. However, ocular trauma was a major cause of monocular blindness and visual impairment. Ocular trauma also tended to affect a younger age group and especially males compared to other eye diseases.

Refractive errors among school children in Addis Ababa, Ethiopia

Nebiyat K, Alemayehu W, Tigist SW — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To determine the prevalence of refractive errors among school children aged 6-18 years in the city of Addis Ababa, Ethiopia.

Methods: A cross sectional study of refractive errors examined 1800 students in four randomly selected elementary schools during March, 2014. Subjects were selected by multistage random sampling. The children were examined by a team of ophthalmic nurses, optometrists and an ophthalmologist who performed visual acuity testing, cycloplegic refraction and slit lamp examination. Visual impairment was defined as V/A < 6/12.

Results: A total of 1800 (695 boys and 1105 girls) students were included in the study with a response rate of 99.4%. Refractive errors in either eye were 71 (4.0%) (95% CI 3.9-4.0). Of these myopia < 1.oD was found to be higher 19 (26.7%) cases followed by astigmatism >+ − 1.5D in 12 (17%) cases. Being female and the presence of other eye diseases increases the odds of refractive error.

Conclusion and recommendation: The prevalence of refractive errors in school children is significant in Addis Ababa, highlighting the need for school screening and optical intervention programs.

Prevalence of dry eye syndrome in diabetic patients attending Kenyatta National Hospital, Kenya

Ogundo C, Ilako D, Maina J — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To determine prevalence and ocular findings of dry eye syndrome in adult diabetic patients at Kenyatta National Hospital (KNH) in Kenya.

Methods: A descriptive cross sectional study that was carried out among diabetic patients attending diabetic outpatient clinic and diabetic eye clinic at the KNH during October 2013-May 2014. All diabetic patients aged 18 years and over were requested to participate. Data on demographic profile, symptomatology, duration of diabetes and medication use of participants was documented. They were subsequently examined and underwent non-invasive tests to determine presence of dry eye syndrome (DES). Data collected was analyzed using the Statistical Package for Social Scientists (SPSS) version 21.0. Descriptive statistics such as frequencies, tables, mode, median and mean were used to summarize the data. Relationship between frequency, presence of dry eye syndrome and age, sex, duration of diabetes was assessed.

Results: Prevalence of DES was 49.8% (CI 0.001-0.568), was more common among females (M:F 1:2.2) and increased with age (p=0.001, peak age 56-65 years) and duration of diabetes (p=0.000454, peak duration after 15-19 years). There was significant association between DES and symptomatology (p<0.00001) , but not between DES and ocular signs (p=0.81) nor DES and TBUT (P=0.082) nor DES and Schirmer test (p=0.454).

Conclusion and recommendation: There is high prevalence of DES among diabetics. Greater emphasis should be placed on symptoms when making a diagnosis of DES.

Patients’ satisfaction with outreach eye care service provided in South West Ethiopia

Yeshigeta GB, Aemero AM, Tsedeke AA — Wed, 19 Apr 2023 00:00:00 -0400

Background: Nowadays, assessing patient satisfaction is an integral part of monitoring and evaluation of health service delivery and quality assurance. Patient satisfaction with the outreach based eye care service in Ethiopia has not been studied.

Objective: This study was conducted to determine the overall patient satisfaction and its factors and predictors in Southwest Ethiopia.

Methods: A cross-sectional study was conducted on 411 sampled ophthalmic patients who received eye care service during regular ophthalmic outreach programs of Jimma University from January-December, 2013. Overall patient satisfaction was measured using a validated patient satisfaction questionnaire (PSQ-18). The physical facility of the outreach sites were assessed by complementary questions. Mean satisfaction scores were calculated and compared among variables using ANOVA test. Multivariate analysis and linear regression models were tested and were considered significant if P<0.05.

Results: Majority, 402(97.8%) of the study subjects were satisfied and the overall mean satisfaction score of the study subjects was 4.7(SD±0.5) out of 5. This was statistically different among subgroups of age (P=0.000), education level (P=0.007) and occupation type (P=0.000) but not with sex (P=0.393), religion (P=0.059) and marital status (P=0.124). Age was the only independent factor for the overall satisfaction (P=0.007). Among components of patient satisfaction, the highest mean was in communication 4.63(SD±0.6) followed by technical quality of health care providers 4.60(SD±0.6). The interpersonal manner of health care providers had the lowest mean score 3.3(SD±1.6). Each of the components (technical quality, interpersonal manner, communication, financial aspect, time spent with care providers, accessibility and convenience, physical facility) were significantly associated with overall satisfaction (P<0.05). All these components except physical facility and financial aspect were significant linear predictors of overall satisfaction.

Conclusion: The overall patient satisfaction to the regular outreach eye care services was very high. Jimma University should therefore continue the program while improving on each domain of satisfaction measures with the focus on interpersonal manner and accessibility and convenience.

Ocular manifestations among HIV/AIDS patients; a case of Muhimbili National Hospital, Tanzania

Yusufali ME, Mafwiri MM, Sanyiwa AJ, Kisimbi SJ, Muhina C, Mosenene S, Sirili N — Wed, 19 Apr 2023 00:00:00 -0400

Objective: About 70-80% of HIV/AIDS patients develop an ocular complication at some point of their illness, at times causing blindness, ocular damage and even death. This study was conducted to determine the pattern of ocular manifestations of HIV/AIDS and their relationship to Highly-Active-Anti-Retroviral-Therapy and CD4+Tcells-count among HIV/AIDS patients at Muhimbili National Hospital.

Methods: Cross-sectional study among 296 systematically sampled HIV/AIDS patients. Data collection was by history taking, clinical examination, laboratory investigations and review of case notes. Analysis was aided by using SPSS version 17 software. Inferential statistics was performed and a p<0.05 was considered significant.

Results: Of the 296 patients, 165(56%) were females. About 153(51.7%) patients were using Highly-Active-Anti-Retroviral-Therapy, 164(55.4%) and 66(20.3%) had CD4+Tcells-counts of >350cells/μL and <200cell/mm3 respectively. Ocular manifestations affected 124/296 (41.9%) patients. The prevalence of ocular manifestations was significantly higher among those not on Highly-Active-Anti-Retroviral-Therapy (67.1% vs 18.3%, x2=66.79, p<0.01) and among patients with CD4+Tcells-count <200cells/μL (73.3% vs 29.9%, x2=34.1, p<0.05). The commonest manifestations among 592 eyes were optic atrophy 5.4(9.1%), cataract 25(4.2%), keratitis 23(3.8%), HIV-retinopathy 21(3.5%) and squamous cell carcinoma of the conjunctiva 16(2.7%).

Conclusion: Despite introduction of HAART, the prevalence of ocular manifestations in Dar-es-Salaam is still high. Further research on optic nerve disorders; awareness creation to inform patients, health personnel and the community; and to screen HIV patients for ocular manifestations are recommended.

Magnitude of delay in presentation and management of retinoblastoma patients at the Kenyatta National Hospital, Kenya

Makite I, Kimani K, Njuguna M — Wed, 19 Apr 2023 00:00:00 -0400

Background: Retinoblastoma is the commonest intraocular childhood malignancy in the world and is curable when detected early. Delay in presentation and management is seen as a major contributor affecting outcome.

Objective: To determine the magnitude of delay in the presentation and management of retinoblastoma patients at the Kenyatta National Hospital.

Methodology: A cross sectional hospital based study done from November 2012 to April 2014 at the Kenyatta National Hospital. Data was collected using a semi structured questionnaire from the parents/guardians of retinoblastoma patients who gave consent.

Results: Ninety-one parents/guardians of 64 patients participated. Sixty point nine percent took more than 5 months from onset of symptoms to presentation at the referral centre while 46.1% took more than 1 month from onset of symptoms to first visit to a health facility. Ten point nine percent of patients took more than 2 weeks before starting definitive management at the referral centre.

Conclusions: Majority of the patients presented late to the referral centre while most of the health care providers referred the patients early. Augmentation of public awareness on retinoblastoma would make the primary caregivers more aware of early symptoms of the disease.

Incidence of neonatal conjunctivitis at Mbarara Regional Referral Hospital, South Western Uganda

Ayebazibwe B, Twinamasko, A Waddell K — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To determine cumulative incidence of neonatal conjunctivitis (NC) in babies delivered at Mbarara Regional Referral Hospital (MRRH), establish the responsible microorganisms and their sensitivity to available antibiotics and determine factors associated with neonatal conjunctivitis among these babies.

Methods: A prospective cohort study where babies delivered at MRRH whose mothers stayed in Mbarara municipality were recruited within 24 hours after birth and weekly follow up was done until the occurrence of NC, or lost to follow up or administrative censoring at 28 days. Neonates who developed conjunctivitis had a conjunctival swab taken for microbiology.

Results: Out of 438 babies recruited, 45 (10.3%) were lost to follow up while 49 (11.2%, 95% CI 8.4 – 14.5) developed neonatal conjunctivitis by 28 days. Isolated pathogens were Staphylococcus aureus 23 (67.65%), Klebsiella pneumoniae 7 (20.59%), Neisseria gonorrhoeae 3 (8.82%) and Streptococcus pyogenes 1(2.94%). In 15 (30.6%) of 49 cultures done there was no growth. Isolates tested had only 18% sensitivity to tetracycline. However there was 100% sensitivity to gentamycin and oxacillin, while slightly lower sensitivity was achieved for ceftriaxone (76%), ciprofloxacin (68%) and chloramphenical (61%). Not receiving prophylaxis within 24 hours after birth [adjusted OR 4.85 CI (1.17 – 20.19)] and neonatal admission to Neonatal Intensive Care Unit (NICU) after delivery [adjusted OR 6.03 CI (1.09 – 33.32)] were independently associated with higher odds of developing NC.

Conclusions: The incidence of NC was unexpectedly high. Admission to NICU and lack of prophylaxis within 24 hours were risk factors for developing NC.

Key words: Neonatal, Conjunctivitis, Cohort, Incidence

A 5 year’s retrospective case series on the clinical profile and management of retinoblastoma at Maputo Central Hospital, Mozambique

Dimande LSA, Ilako D, Nyenze EM, Zambujo Y — Wed, 19 Apr 2023 00:00:00 -0400

Background: Retinoblastoma is the commonest intraocular malignancy in childhood. The national
epidemiological characteristics of retinoblastoma in Mozambique are not clearly known. Early diagnosis
and appropriate treatment leads to a favourable outcome while a delayed diagnosis and inappropriate
treatment can be fatal.

Objective: To determine the pattern of presentation and management of retinoblastoma patients at
Maputo Central Hospital during a 5 year period (1st January 2010 to 31st December 2014).
Methodology: The study was a retrospective case series carried out at Maputo Central Hospital
(Ophthalmology and Paediatric Oncology Services). Records of all retinoblastoma patients were retrieved
with the help of the specific file number. Demographic characteristics, clinical presentation, investigations
and management modalities of retinoblastoma patients were retrieved. Data was extracted and entered
into a structured questionnaire and analysed.

Results: A total of 57 patients from 7 different provinces of Mozambique had clinical, histological or both
clinical and histological diagnosis of retinoblastoma. The overall mean age at presentation was 30.5 months
(CI 24.65 - 36.05) (SD 21.5); 82.4% of cases had unilateral retinoblastoma while 12.3% of cases had bilateral
(mean age at presentation was 30.2 months and 26.4 months respectively). The female: male ratio was
1.2:1. The main presenting complaint was white reflex (62.5%) followed by eye swelling (50%), eye redness
(40%) and poor vision (32.5%) while the main clinical signs were leukocoria (55%) followed by proptosis
(50%) and eye redness (27.5%). Out of the 51 eyes who had surgery: 96% did not have documentation
of the choroid and 98% of the scleral, but 54.9% of the eyes had optic nerve involovement, 33.3% had
resection margin involvement and 31.4% had periocular tissue involvement. The main modalities of
management were enucleation (93.9%), chemotherapy (24.5%) and exenteration (18%). The eligible
patients for chemotherapy were 67.7% but only 35.3% of the patients received chemotherapy.

Conclusion: Many patients presented at older ages (with a mean age at presentation of 30.5 months) and
many presented late with advanced orbital disease. Majority of the patients had unilateral retinoblastoma.
Significant number of patients had optic nerve, resection margin and periocular tissue involvement noted
on histology. The main modalities of management were enucleation, exenteration and chemotherapy,
although there were no clear eligibility criteria for chemotherapy in retinoblastoma patients.

Knowledge, attitude and practice of eye diseases in children among paediatricians in Kenya

Wanyama SP, Marco S, Kariuki MM — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To assess knowledge, attitude and practice of childhood eye diseases among paediatricians working
in Kenya.

Methods: The study was carried out among paediatricians working in the various hospitals and clinics in Kenya.
A semi structured questionnaire was distributed to consenting paediatricians for completion. Dependent
variables were knowledge attitude and practice. Independent variables were age, sex, duration and type of
practice. The data was analyzed using STATA. Level of knowledge was grouped according to Bloom’s original
cut-off points into good (>80%), moderate (60-80%) and poor (< 60%).

Results: Out of the 125 paediatricians who responded, 69.6% had a level of knowledge classifiable as poor,
28.0% moderate and 2.4% good. The mean score of participants in this study was 58.20%. However participants
showed varied levels of knowledge in different subject matters. Sixty nine point six per cent of paediatricians carry
out eye examination in children, though this varied with each participant doing only the test they are familiar
with. Their referral of children with eye diseases to an ophthalmologist was found to be generally appropriate.
The attitudes of participants in the various subject areas raised were positive. Ninety nine point two per cent of
participants agreed that eye examination by paediatricians could help with early referral of retinoblastoma.

Conclusion: The participants had poor level of knowledge of childhood eye diseases. However their attitude and
practice was generally positive. Their knowledge could be boosted with regular continuous medical education
on eye diseases.

A randomized clinical trial comparing retrobulbar injection of absolute alcohol and chlorpromazine in managing painful blind eyes, Menelik II Hospital, Addis Ababa, Ethiopia

Tadesse T, Abeba TG, Damji K — Wed, 19 Apr 2023 00:00:00 -0400

Background: Many eye diseases may end up with a painful blind eye. Different management options
have been used to alleviate the pain and maintain the globe. Topical medications are frequently used as
conservative treatment. Retrobulbar injection of neurolytic agents like alcohol, chlorpromazine (CPZ) or
phenol are other medical options that can be considered.

Objectives: Comparing the efficacy and safety of retrobulbar absolute alcohol with chlorpromazine
injection in the treatment of painful blind eyes.

Methods: A double masked trial in which patients with painful blind eye, aged 18 years or above, were
randomized to receive either a retrobulbar injection of 2ml of absolute alcohol (96%) or 2ml of CPZ (25mg/
ml), both with 2ml of lidocaine (2%). Visual Analogue Scale (VAS) is used to objectively measure intensity
of pain and level of pain relief after the intervention.

Results: A total of 84 eyes of 84 patients were injected with either absolute alcohol (n=43) or CPZ (n=41).
Thirty nine from alcohol group and 35 participants from the CPZ group appeared for third month followup
evaluation. Sixth month response was also evaluated in 30 and 26 participants from alcohol and CPZ
groups, respectively. The mean and standard deviation in VAS pain reduction was 57.9 mm (±32.17) in
the alcohol group and 55.4 mm (±31.26) in the CPZ group (P value= 0.734). Based on the improvement in
pain intensity 30 patients (79.6%) from absolute alcohol group and 28 patients (80.0%) from CPZ group
had significant pain relief after the 3rd month of injection. Statistically significant mean IOP reduction was
noted in CPZ group compared to the alcohol group: mean IOP (in mm Hg) reduction at 3rd month was
13.0 vs 2.5 (P-value 0.009). Immediately after the injection complications like burning sensation (20 vs 8),
ptosis (2 vs 0) and retrobulbar haemorrhage (0 vs 2) were noticed in alcohol and CPZ group respectively.
Lid swelling, external ophthalmoplegia, ptosis, chemosis and skin necrosis were the type of complications
observed later on. All the immediate and subsequent complications had resolved spontaneously.

Conclusions and recommendation: Efficacy of pain reduction with retrobulbar injection of absolute
alcohol and chlorpromazine was comparable. The choice of retrobulbar injection between the two agents
also needs to consider availability and cost. Further study is required to evaluate long term efficacy and
safety.

Health education and awareness about diabetic retinopathy among patients attending diabetic clinics in tertiary and regional hospitals in Tanzania

Mafwiri MM, Mwakyusa N, Shilio B, Lutale JK — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To assess the level of diabetes education, diabetes eye-care delivery knowledge and awareness
about diabetic retinopathy among patients attending diabetes clinics in selected regional and tertiary
hospitals in Tanzania.

Materials and Methods: A cross-sectional study was conducted in 6 regional and all 4 zonal tertiary referral
hospitals in Tanzania. A semi-structured questionnaire was administered to about 413 systematically
sampled patients to explore their demographics, diabetes health education, awareness about diabetic
retinopathy and eye-care, and challenges encountered when accessing diabetic eye care services.

Results: A total of 413 patients were recruited. Seventy one (8.6%) patients were type-1, and 336 (81.3%)
type-2. Two hundred and fifty five (61.8%) had diabetes for 1-10 years. Three hundred and twenty two
(77.9%) had received diabetes education. Receiving diabetes education was significantly associated with
level of education (p<0.0001), residential region (p<0.0001) and occupational status (p<0.007). Nurses
and doctors were the leading providers of diabetes education reported by 243 (75.5%) and 196 (47.5%)
patients. Radio, television, brochures/posters, relatives and friends were the least mentioned sources
of diabetes education. Education messages delivered were diabetic diet (390, 94.4%); control of: blood
sugar (226, 54.7%), blood-pressure (49, 12%); eye-care (62, 15%), feet-care (62,15%) and 45 (11%) exercise.
Twenty four (5.8%) patients were aware about the need for yearly eye examination. One hundred and
twenty three (29.8%) had previous eye examination. Shortage of staff in facilities providing diabetes-care;
inadequate drugs and equipment for monitoring blood sugar were the main challenges.

Conclusions and recommendations: Although diabetes education is provided to most patients
attending diabetes clinics in Tanzania, patients have limited awareness about diabetic complications
in particular diabetic retinopathy including the need for yearly eye examination which would make
strategies to implement health promotion and prevention of diabetic retinopathy blindness difficulty.
Strategies to improve diabetes education are required.

The clinical presentation and outcome of Mooren’s ulcer at Ruharo Eye Centre, Southwestern Uganda; a hospital based retrospective study

Kavuma D, Arunga S — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To describe the clinical presentation, management, and treatment outcomes of Mooren’s ulcer
in Uganda.

Methods: We reviewed records of all patients diagnosed with Mooren’s ulcer at Ruharo Eye Centre
from January 2013 to December 2015. We collected data from fifty-two patient charts on demographic
characteristics, history and presenting complaints, eye affected, clinical presentation, modes of medical
and surgical treatment, and post treatment visual acuity.

Results: The median age was 24.5 years (IQR 16.5 years). The ratio of males to females was 8:1. Thirty two
(82.1%) patients presented with pain, 13 (33.3%) with redness, and 10 (25.7%) with tearing. Forty seven
(90.4%) patients had unilateral disease. Four (80%) of those with bilateral disease were aged 30 years and
above while one (20%) was below 30 years. Twenty nine (55.8%) of the patients received only medical
treatment and 23 (44.2%) received various forms of surgical management. Forty one (78.8%) still had
active ulceration on their last review date, 7 (13.5%) perforated after admission, 3 (5.8%) of the patients
were marked as healed on their last review date, and one (1.92%) was eviscerated. At the last follow up,
most patients ended with worse visual acuity (n=21, 40.4%) while 20 (38.5%) had no change and only 11
(21.2%) improved.

Conclusion: This primary study provided background information on presentation of Mooren’s ulcer in
Uganda; our data indicated that younger males were the most affected group; severe disease occurred in
older patients.

To what extent has Burundi achieved VISION 2020, “The Right to Sight” global initiative, targets for eye service delivery?

Niyonzima JC, Nyenze EM, Karimurio J, Kandeke L — Wed, 19 Apr 2023 00:00:00 -0400

Purpose: To assess the extent to which Vision 2020 eye care service delivery targets had been met in
Burundi by 2015.

Methods: This was a descriptive cross-sectional study targeting District, Regional, and National Hospitals
in Burundi. A questionnaire was used to collect data on number and distribution of different cadres of eye
personnel. The recommendations of Vision 2020 were used to benchmark human resources as meeting,
exceeding or not meeting targets. A separate questionnaire was used to capture the number of cataract
surgeries conducted in the country.

Results: In 2015, Burundi had 15 ophthalmologists (37.5% of the target), 33 ophthalmic clinical officers
(66.0% of the target) and 2 optometrists (5% of the target). The mean deficit for all cadres was 72.8%.
Eighty-percent of the ophthalmologists were based in Bujumbura. Four out of the 7 regions had no
ophthalmologist. Sixty-eight percent of eye care facilities belonged to the private sector. Seventy-five
percent of the facilities were in urban areas. The cataract surgical rate for the entire country was 138
surgeries per million populations per year.

Conclusions: Burundi had not met the targets for human resources by 2015. Cataract surgery was very
low. Most of the eye care personnel and services were concentrated in the capital Bujumbura.

Branch retinal vein occlusions: a review

Gachago MM, Kibata AG — Wed, 19 Apr 2023 00:00:00 -0400

Introduction: Branch Retinal Vein Occlusion (BRVO) is the second most common retinal vascular disease with a
prevalence of 0.8%. The Branch Vein Occlusion Study was the first trial to show efficacy of treatment of macular
oedema in BRVO with grid laser which was considered the gold standard for several years. Since then several
other studies have been done on various classes of drugs and surgery and there are great strides that have
been made in enhancing the visual and anatomical outcome. In this review article, we did a pubmed search of
publications done over the years on the natural history of BRVO as well as the treatment options. The studies
included clinical trials, systematic reviews and case reports.

Results: Currently anti-Vascular Endothelial Growth Factors (AntiVEGFs) appear to have the best outcomes in
terms of anatomical and visual recovery. Other therapies that have shown promise are the intravitreal steroids,
grid laser, antiVEGFs and steroids combined with lasers. Parsplana vitrectomy appears to be as efficacious as
antiVEGF but is very invasive and no good clinical trials have been done yet.

Conclusion: Great strides have been made in improving the outcome of BRVO especially the macular oedema if
prompt and correct treatment is administered to the patient.

Causes of severe visual impairement and blindness among children: a case of Mbarali District in Southern Tanzania

Mafwiri MM, Moshiro C, Mosenene S, Fakir A — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To determine the anatomical causes and diagnosis leading to severe visual impairment and blindness
and explore their relationship to demographic characteristics among children in Mbarali district, Southern
Tanzania.

Materials and methods: Key informants were trained on how to identify children with poor vision and other
ocular abnormalities. Key informants identified, listed and referred for examination children with poor vision,
white pupillary reflex, squint, and smaller and bigger than normal eyes. Children with a visual acuity of <6/60
in the better eye were recruited for the study. Cycloplegic refraction, anterior and posterior segment and ocular
alignment examination were performed to ascertain the cause of Severe Visual Impairment (SVI) or Blindness
(BL).

Results: Sixty six children had a visual acuity (VA) of <6/60. Seventy percent were 5 years or more. The mean age
was 9.18(±4.42) (SD =4.42) years. Thirty five (53%) were females. Forty eight (72.7%) had SVI (VA<6/60) while 18
(27.3%) were BL (VA<3/60). Lens related conditions (27.3%), uncorrected refractive error (15.2%) and corneal
related disorders (13.6%) were the commonest causes of SVI/BL. Majority of children with lens related conditions
(72.2%), uncorrected refractive error and congenital glaucoma (75%) were females, while all 6 children with
cortical blindness were males. Lens related and cortical blindness conditions were commoner among under-five
than among older children (6/20, 30% vs 12/46, 26%) and (4/20,20% vs 2/46, 4%). Un-operated cataract was the
leading diagnosis causing SVI/BL. Only 4 patients were operated for cataract. There was only one patient with
phthisis-bulbi related to keratomalasia.

Conclusion and Recommendations: Lens related conditions, specifically cataract was the leading cause of
SVI/BL. Recruitment of an eye-doctor at Mbarali District Hospital and establishment of tertiary eye services at
Mbeya Zonal Referral Hospital are recommended to enable identification, referral and comprehensive tertiary
management of children with eye conditions.

Haemorrhagic retinal arterial macroaneursym: a case report

Kayange PC, Gandiwa M, Manda CS — Wed, 19 Apr 2023 00:00:00 -0400

Retinal Arterial Macroaneurysms (RAMs) are acquired saccular or fusiform dilatations of the large branches of
retinal arteries, usually within the first three orders of bifurcation. RAMs are rare conditions and usually affect
hypertensive elderly women. In clinical practice, RAMs are frequently misdiagnosed as they masquerade
other retinal conditions. We present a case of haemorrhagic RAM which was initially misdiagnosed as vitreous
haemorrhages secondary to retinal vein occlusion or posterior vitreous detachment.

Pattern of posterior segment injuries after ocular trauma at the vitreoretinal unit at Kikuyu Eye Unit, Kenya

Nguyo GN, Jafferji S , Gachago M, Njuguna M — Wed, 19 Apr 2023 00:00:00 -0400

Background: Ocular trauma is a significant cause of monocular blindness worldwide. Eye injuries involving the
posterior segment have been a matter of concern particularly due to the related poor visual outcome. These injuries
require specialised intervention and follow up care to achieve best possible visual outcome.

Objective: This study aimed to give baseline information on pattern of posterior segment eye injuries in the East Africa
set up.

Design: Retrospective case series of eye injuries involving posterior segment treated at Kikuyu Eye Unit, a tertiary
referral eye hospital in Kenya between 1st January 2010 and 31st December 2014.
Results: One hundred and six eyes of 102 patients were reviewed, including 25 children. Seventy three patients (71.6%)
were male and majority were in the 31-40 years age group. The most known circumstance of injury was road traffic
accident in 9 (8.8%) patients. Metal was the most common agent causing these injuries in 15 (14.7%) eyes. Seventy nine
eyes (74.5%) had closed globe injuries. Retinal detachment and vitreous haemorrhage were the most common findings,
at 49 (46.2%) and 47 (44.3%) eyes respectively. Eighty nine eyes (84.0%) were blind at initial review with presenting
vision acuity <3/60.

Conclusion: Ocular injuries involving the posterior segment were most common in young males. Closed globe injuries
were the most common type of injuries (75%). Most eyes were blind at presentation indicating the severity of these
injuries and need for specialised intervention.

Prevalence and pattern of manifest strabismus in paediatric patients at CCBRT, Dar es Salaam, Tanzania

Njambi L, Rita O, Kazim D, Sonia V — Wed, 19 Apr 2023 00:00:00 -0400

Background: Awareness on the magnitude of strabismus burden is crucial in preventing development of
amblyopia, restore binocularity, aid in development of stereopsis and improve treatments outcomes.
Objective: To determine the prevalence, and pattern of strabismus presentation in paediatric patients at
Comprehensive Community Based Rehabilitation in Tanzania (CCBRT).

Design: Retrospective descriptive hospital based study.

Subjects: Children aged 16 years and below presenting with strabismus at CCBRT between January 1, 2014 and
June 30, 2014.

Methods: All strabismus coded files of patients below 16 years were identified from medical records. The data
collected included patients’ demographic data; age at onset of strabismus; visual acuity; characteristics of the
deviation; refractive status; binocular functions and amblyopia assessment; and relevant ocular and systemic
findings.

Results: The prevalence of strabismus was 5.9%. Males were 49.1% and females 50.9%. Family history was
present in 3.3% of the patients. Most of the patients (61.8%) were below five years; average 4.6 years. A third of
the patients (32.5%) presented within one year of onset of strabismus; average duration 25.7 months. Systemic
and ocular co morbidities were present in 17.9% and 46.2% of the patients respectively. About half (47.9%),
had normal vision. Esotropia was the commonest deviation ( 63.3%); exotropia, 24% and hypertopia 2.8% . In
76.9% the strabismus was unilateral and alternating in 22.6%. Most of the deviations (42.9%) were between
30-50 prism dioptres. Hyperopia was in 51.7%; myopia in 14.4% and astigmatism 11.6% of the eyes. Amblyopia
was noted in 25.9% of the patients. Binocular single vision assessment was done in 14.1%; 62.5% had a negative
result.

Conclusion: The prevalence of strabismus in this study was high at 5.9%. Esotropia was the commonest
deviation.

Prevalence of strabismus and the outcomes of its management among children attending Ruharo Eye Center, South Western Uganda

Ntizahuvye S, Onyango J — Wed, 19 Apr 2023 00:00:00 -0400

Background: Strabismus consists of any deviation of binocular alignment and is present in 2 to 4% of the
world’s child population. Strabismus can be both the cause and the effect of poor binocularity. When it appears
in the early years of life, strabismus may lead to states of sensorial adaptation such as retinoic correspondence
anomaly and amblyopia given that binocular single vision has a critical role in maintaining alignment. On the
other hand, if strabismus arises after binocular vision development, diplopia and image confusion appear, which
persist indefinitely or until motor alteration is corrected.

Aim: To determine prevalence of strabismus and outcomes of its management among children attending
Ruharo Eye Center, South western, Uganda from January 2014 to December 2015.

Methods: In this retrospective descriptive study, medical records of all strabismus patients aged below 16
years seen at Ruharo Eye Center, South western, Uganda from January 2014 to December 2015, were reviewed.
Information was collected on demographic characteristics, refractive errors, types of strabismus, management
and outcomes.

Results: A total of 8,665 children were seen at REC during the period from January 2014 to December 2015. Of
these, 125 children had strabismus thus a prevalence of 1.4%. There were 56 males (44%) and 69 females (55%)
with mean age of 14 years, from 4 months to 15 years. Twenty nine children (23.2%) had amblyopia and eighty
six children (68.8%) had refractive errors of more than 0.5 diopter. Patients with hypermetropia were 45 (36.0%),
myopia 38 (30.4%) and astigmatism 3(2.4%). Esotropia accounted for 80% and exotropia 20% and both were the
common types. In our study, the management of strabismus cases included: glasses (30), eye patching (30) and
surgery (34). Of the 34 patients operated, post-operative alignment was achieved in 25 cases (73.53%) and under
correction occurring in 17.65%.

Conclusion: The prevalence of paediatric strabismus at Ruharo Eye Center was 1.4%. The most common type of
paediatric strabismus in this study was esotropia. The surgical success rate was generally good.

Solar retinopathy: a case report

Onyango O, Nyenze EM — Wed, 19 Apr 2023 00:00:00 -0400

A young woman presented with a history of poor vision both eyes after staring at the sun for approximately 5
minutes during a religious pilgrimage. Her vision was 6/12 at presentation. Fundoscopy revealed bilateral yellow
spots on the macular. Optical Coherence Tomography (OCT) scans revealed bilateral Retinal Pigment Epithelium
(RPE) damage. The patient was managed conservatively with full recovery of vision in 8 months.

Developing a sustainable and scalable control programme for Retinopathy of Prematurity in Kenya: a health system perspective

Wed, 19 Apr 2023 00:00:00 -0400

Disease-control programmes have an important role to play in strengthening health systems to deliver the
interventions they recommend. In low and middle income countries, there is a shortfall in the coverage of
interventions for primary, secondary and tertiary interventions for the control of Retinopathy of Prematurity
(ROP)-related childhood blindness and visual impairment. We need strong health systems to ensure prevention,
timely diagnosis and access to effective care for ROP. If a health system strengthening approach is employed as
ROP interventions are being planned, health system issues that will affect implementation and outcomes can
be identified.

Diabetic retinopathy among patients with type 2 diabetes mellitus at Moi Teaching and Referral Hospital, Eldoret, Kenya

Musawa MS, Karoney MJ, Kwobah CM, Oduor C, Owino C — Wed, 19 Apr 2023 00:00:00 -0400

Background: Diabetic Retinopathy (DR) accounts for 5% of the 39 million causes of blindness occurring worldwide
and is estimated to contribute 3% of blindness in Kenya. Dyslipidemia, poor control of sugar, hypertension and
obesity increase the risk of DR in patients with diabetes. This study addresses the gap in information on the
magnitude of DR and its associated factors in patients with type 2 diabetes at Moi Teaching and Referral Hospital
(MTRH).

Objectives: To determine the prevalence and severity of DR and its associated factors in patients with type 2
diabetes mellitus.

Methods: This cross sectional study was conducted amongst patients with type 2 diabetes mellitus in MTRH.
Randomly selected participants underwent anthropometric, laboratory and visual acuity testing. Direct
ophthalmoscopy was used to assess DR and macula edema. Grading of DR was done using international clinical
diabetic retinopathy severity scale. A univariate and multivariate logistic regression model was used to assess
associations of the variables with DR.

Results: Of the 329 participants enrolled, 187 (57%) were female with a mean age of 56.8 (10.99) years. One
hundred and three (31%) had diabetic retinopathy and 39 (12%) had diabetic macula edema. Mild to moderate
non proliferative diabetic retinopathy was the most prevalent grade at 79 (25%). One hundred and eighty
four (56%) of participants had hypertension (133/80; IQR 120/70-150/89) mmHg and 158 (48%) had glycated
haemoglobin between 7-10%. The median for the other assessed factors were as follows: duration of diabetes
5 (9) years, total cholesterol 4.6 (1.3) mmol/l and low density lipoprotein 3.0 (1.5) mmol/l. Increase in duration of
diabetes by 5 years {OR 2.02(95% CI 1.11-3.69); p 0.02}, glycated haemoglobin > 6.5% {OR 2.13(95% CI 1.02-4.42);
p 0.04}, systolic hypertension >160 mmHg {OR 1.02(95% CI 1.01-1.03); p 0.01} were associated with increased
risk of diabetic retinopathy while male gender and body mass index did not. Only 15% of the participants in this
study reported having had previous eye check-up.

Conclusion: A third of patients with type 2 diabetes on follow up at MTRH have DR. Systolic hypertension,
increased duration of diabetes and high glycated haemoglobin were positively associated with increased risk of
developing DR

Editorial: Conference scientific committees-what do they do?

Nyawira M, Mukuria M, Bitok M — Wed, 19 Apr 2023 00:00:00 -0400

Editorial: Conference scientific committees-what do they do?

A toolkit for glaucoma management in Africa

JOECSA — Wed, 19 Apr 2023 00:00:00 -0400

Glaucoma is the leading cause of irreversible vision
impairment worldwide and the burden is largely in sub-
Saharan Africa (SSA) where about 4% of adults aged 40
years and above have the condition1. Clinic-based data
have increasingly shown younger adults presenting with
severe glaucoma.

Introducing the new JOECSA editorial board

JOECSA — Wed, 19 Apr 2023 00:00:00 -0400

In this issue, we are pleased to introduce the new
JOECSA editorial board. The board was selected
following an elaborate process that took over one year.
It included a call for expression of interest from the
wider COECSA community, training of the new board
and updating of the submission and review systems.

Strengthening eye health research output in the region

Arunga S, Nyenze EM, Wambiya V, Onyango J — Wed, 19 Apr 2023 00:00:00 -0400

In this issue of the journal, we are pleased to announce
an exciting three-year partnership with ‘Eye’ Journal
team of the Royal College of Ophthalmologists
(RCOphth). This partnership is part of the VISION
2020 COECSA-RCOphth LINK partnership that has
been in existence for the last 10 years and has led
to development and strengthening of the COECSA
fellowship exam and examiner training, curriculum
development, ‘train the trainers’ and online CPD.

Ophthalmology as a leader in innovation

Dr MM Gachago — Wed, 19 Apr 2023 00:00:00 -0400

Introduction: Never a dull day in Ophthalmology

It gives me great pleasure to write this article for I truly
believe that ophthalmology is one of the most exciting
branches of medicine as there is constant research
that leads to numerous innovations in technology,
pharmaceuticals and surgical techniques. However, for
one to fully appreciate this highly dynamic breed of
medicine one must have the innate desire to continuously
study, research, and learn new surgical techniques. Gone
are the days when we did our residency and coasted on
the knowledge obtained for the rest of our lives.
It gives me great pleasure to write this article for I truly
believe that ophthalmology is one of the most exciting
branches of medicine as there is constant research
that leads to numerous innovations in technology,
pharmaceuticals and surgical techniques. However, for
one to fully appreciate this highly dynamic breed of
medicine one must have the innate desire to continuously
study, research, and learn new surgical techniques. Gone
are the days when we did our residency and coasted on
the knowledge obtained for the rest of our lives.

National guidelines for screening and management of retinopathy of prematurity in Kenya: an overview of the recommendations

Sitati S, Mwangi N, Njambi L, Onyango O, Gachago M, Mundia D, Murila F — Wed, 19 Apr 2023 00:00:00 -0400

Retinopathy of Prematurity (ROP) is a challenge to neonatology and ophthalmology, as it causes blindness
before the age of six months of age. In low and middle income countries, it is an upcoming epidemic and
important cause of childhood blindness. Guidelines in many developing countries are lacking. The objective
of the national guidelines for screening and management of ROP in Kenya is to improve the access, quality
and coverage of prevention, screening, treatment and follow-up in ROP services. In this article, we provide
an overview of the guidelines to facilitate their implementation by those providing care in new born units
and eye care services.

Eye health in Kenya: 50 years on, what have we to show for it?

JOECSA — Wed, 19 Apr 2023 00:00:00 -0400

Eye health in Kenya: 50 years on, what have we to show for it?

Outcomes of conjunctival flap in severe microbial keratitis

Wed, 19 Apr 2023 00:00:00 -0400

Objectives: To describe the 3-month outcomes of conjunctival flap in managing severe Microbial Keratitis (MK).

Design: This was a prospective cohort study.
Setting: Patients were enrolled at two major eye hospitals in Mbarara, a major city in the Southwestern sub-region
of Uganda, over a one year period.

Subjects: Individuals of any age that met the case definition of severe microbial keratitis, in which perforation
occurred acutely or was impending.
Interventions: A complete Gunderson conjunctival flap was done in all suitable patients. Demographics, health
access, clinical, and microbiological data were recorded.
Main outcome measures: Statistical significance testing was done to assess predictors of evisceration at the
3-month follow-up time point.

Results: Among 57 patients (57 affected eyes), median age was 44 years (IQR 38, 60) and 47.4% were women.
Trauma was associated with 35.1% of cases. Median time to presentation was 23 days (IQR 12, 34). Etiology was
80.7% purely fungal pathogens, 10.5% mixed bacterial/fungal, and 8.8% undetermined. Mean infiltrate and epithelial
defect sizes were 7.2mm (SD 2.3) and 6.0mm (SD 2.5), respectively. Presenting visual acuity was <3/60 in
78% of eyes. At 3-months, 19 eyes (34.5%, 95%CI 23.5-48.2) had improved best-corrected visual acuity, though 9
eyes required evisceration (15.8%, 95%CI 8.3-28.0). There were no clinically or statistically significant predictors
for evisceration at 3 months.

Conclusions: Conjunctival flap is a reasonable rescue procedure, especially if therapeutic penetrating keratoplasty
is an eventually feasible option. However, there are considerable risks of vision loss or lack of improvement
and eventual need for evisceration.

Stand for action! Eye care and Sustainable Development Goals

JOECSA — Wed, 19 Apr 2023 00:00:00 -0400

Stand for action! Eye care and Sustainable Development Goals

The COECSA research repository

Arunga S, Bore M, Kavuma D, Nyatuga M — Wed, 19 Apr 2023 00:00:00 -0400

We would like to introduce to you the proposed College of Ophthalmology of Eastern, Central and Southern Africa (COECSA) Research Repository, a digital archive that will contain various research papers done in the Eastern, Central and Southern Africa (ECSA) region, with a particular focus on Masters’ theses.

Radio as an effective tool for community mobilisation for eye health programs, a case study of the Mbarara University of Science and Technology, Department of Ophthalmology outreach program to Ntungamo district, rural south-western Uganda

Arunga S, Twinamasiko A — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To determine the most effective method of mobilizing the rural community to uptake cataract
outreach services in Ntungamo district, south western Uganda.

Methods: This was a community based prospective survey conducted in Ntungamo district, rural south western
Uganda. Different methods were used to inform the local communities in the six sub regions in Ntungamo district
about an ongoing University outreach program. These included; local radio announcements, announcements
at places of worship, posters, word of mouth and referral from a previous outreach. One hundred and twenty
five respondents were randomly selected from a total of 600 people who turned up for the service and enrolled
into the study. Interviewer administered questionnnars were administered. The main interview question was
how respondents had received information about a cataract outreach service coming to their area. Results were
compiled and frequency tabulations were drawn.

Results: The respondents reported that they received the information through radio announcements (85.6%),
by word of mouth (10%), by posters (2%) and by referral from previous outreach (1%). The results were consistent
across all the six sub regions in Ntungamo district.

Conclusion: Radio announcements were the most effective method for mobilizing the community for uptake
of cataract outreach services.

Recommendation: Radio

Solar retinopathy following religious ritual ceremony: A case report from Blantyre, Malawi

Gandiwa M, Manda CS, Kayange PC — Wed, 19 Apr 2023 00:00:00 -0400

Solar retinopathy is a retinal damage as a result of direct or indirect exposure to the solar radiation. It usually
occurs following direct viewing of an eclipse without adequate protective devices. It may also occur following
prolonged gazing at the sun, during sun bathing, and in patients with psychiatric disorders such as schizophrenia
or drug intoxication.
We discuss the clinical presentation, diagnosis and treatment of a 26 year old woman who developed solar
retinopathy after prolonged gazing at the sun during a religious ritual.

Status of sub-specialization among practising ophthalmologists in Eastern Africa

Kariuki M, Kithuka P, Irungu D , Koome G — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To establish the status of sub-specialization among practicing ophthalmologists in the Eastern Africa
region.

Design: This was a cross-sectional study.

Method: An analysis of data obtained from 65 practising ophthalmologists from six universities/teaching
hospitals in three countries within Eastern Africa.

Results: About a third (32%) of the practising ophthalmologists had sub-specialized while the rest (68%) had
not sub-specialized. Glaucoma had the highest number of sub-specialists while neuro-ophthalmology, uveitis
and ophthalmic pathology/tumour had none. About two-thirds (65.9%) of ophthalmologists who had not
sub-specialized indicated willingness to specialize subject to availability of opportunity and funding. Vitroretinal
surgery and anterior segment being the most preferred sub-specialties. India was cited as the main subspecialization
destination due to availability of sufficient hands-on training opportunities. The main barriers
to sub-specialization cited were lack of sufficient funding and inadequate opportunities for sub-specialization.
Lack of support in terms of equipment was seen as a major post-training challenge.

Conclusion: Majority of practising ophthalmologists had not sub-specialized mainly due to lack of sufficient
opportunities and funding. Although glaucoma is the area with many sub-specialists, vitro-retinal surgery
and anterior segment are emerging as the main preferred specialty area among ophthalmologists who had
not sub-specialized. Consequently, sustainable and demand driven funding and training opportunities for subspecialization
needs to be provided as a mechanism of raising sub-specialization profiles within the regions.

Prevalence, risk factors and causes of visual impairment in patients with diabetes at Mbarara Regional Referral Hospital, South Western Uganda; A hospital based study

Seba EG, Arunga S, Bwonya BD, Twinamasiko A — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To determine the prevalence, causes and risk factors to visual impairment among patients with
diabetes at Mbarara Regional Referral Hospital (MRRH) as a baseline pilot for developing diabetic retinopathy
treatment services.

Design: This was a descriptive cross sectional hospital based study conducted for a period of six months.
Methods: In a cross-sectional study done at Mbarara Regional Referral Hospital, 318 patients with diabetes aged
18 years and above were enrolled. Their visual acuity was determined. Those that had visual acuity of below
6/18 underwent a detailed ocular exam including refraction and a dilated fundoscopy to determine the cause
of visual impairment.

Results: The prevalence of visual impairment was 28.6% without correction, and 17% with correction. Cataract
was the commonest cause of visual impairment (34.5%) followed by refractive error (20.8%), glaucoma (16.8%)
and diabetic retinopathy (12.5%). Age was the only significant risk factor to visual impairment in this population.

Conclusion: The proportion of visual impairment was high and cataract was the commonest cause of visual
impairment in this population.

Ocular surface disease among glaucoma patients in Ibadan, South-West Nigeria

Sarimiye TF, Fasina O, Ashaye A, Bekibele C, Olawoye O — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To study the frequency and severity of ocular surface disease among glaucoma patients attending
the Eye Clinic of the University College Hospital, Ibadan, Nigeria.

Methods: A hospital-based, cross sectional study was carried out at the Eye Clinic of the University College
Hospital, Ibadan. After a detailed ocular examination, each respondent completed an Ocular Surface Disease
Index (OSDI) questionnaire and performed central visual field assessment. Participants were analyzed for the
effect of anti-glaucoma topical medications (all BAK-preserved) and glaucoma severity on ocular surface disease.

Results: A total of 122 consecutive glaucoma patients were studied. Males accounted for 45.1%. Increasing daily
drops of anti-glaucoma medication was significantly associated with increasing side effects such as redness,
stinging and peppery sensations (p < 0.01). Eighty four patients representing 68.9% had some form of OSD using
the OSDI score. The OSDI scores and the number of patients with OSD significantly increased with increasing
glaucoma severity (p < 0.01).

Conclusion: Ocular surface disease was found to be associated with glaucoma severity and use of BAK-preserved
topical anti-glaucoma medications.
Key words: Benzalkonium chloride, Glaucoma, Ibadan, Ocular surface disease

Knowledge, attitude and practices among medical officers and diabetic patients regarding diabetic retinopathy in Ogun state of Nigeria

Bogunjoko TJ — Wed, 19 Apr 2023 00:00:00 -0400

Objective: To assess the knowledge, attitudes and practices regarding Diabetic Retinopathy (DR) among Medical
Officers (MO) and diabetic patients in Ogun State of Nigeria.

Design: This was a cross-sectional study.

Setting: Diabetic clinics based in three hospitals in Ogun state.

Methods: Medical officers in all the general hospitals were interviewed via telephone while one teaching hospital
and two state hospitals were randomly selected to conduct face-to-face interviews with diabetic patients. Data
obtained from these interviews was filled into a structured questionnaire.

Results: All the medical officers in the general hospitals were aware that DM affects the eyes while 43% believed
that diabetic patients need a monthly eye examination. About 36% examined the eyes of diabetic patients on
each visit. All medical officers would refer a diabetic with poor vision to an ophthalmologist. Majority (75%) of
the patients recruited were female. Fifty-one per cent of patients were not aware that diabetes affects the eyes
while only 35% had ever had a fundoscopy.

Conclusions: The medical officers in the general hospitals in the state are all aware that diabetes can cause DR
but don’t have eye clinics. Less than half of them (43%) screen for DR. Known diabetics are not having regular
eye examination.

First JOECSA online only publication

JOECSA — Wed, 19 Apr 2023 00:00:00 -0400

Welcome to the first JOESCA edition that is available
only on the online version.

Teams for better ophthalmology care

JOECSA — Wed, 19 Apr 2023 00:00:00 -0400

Teams for better ophthalmology care