Ocular Diseases in HIV-positive Patients in a Tertiary Hospital in Nigeria

Aims:To determine the pattern of ocular disorders in HIV-positive patients in a tertiary ospital in Nigeria.Study Design:A cross-sectional hospital based study on confirmed HIV positive adult patients attending the HIV clinic in University of Port Harcourt Teaching Hospital.Duration of Study:November and December 2011. Methodology:Consecutive patients within the inclusion criteria were recruited until the required sample size was met. The visual acuity was tested using the Snellen’s chart and the illiterate E-chart. Ocular examination of the adnexial and anterior segments were done using a pen torch and a slit lamp biomicroscope. Fundoscopy was done using a direct and indirect ophthalmoscope as well as with a 90D lens. Other information such as CD4 count and HIV serotype were retrieved from the patient’s case notes. The data was analysed using EPI-info version 7.0. Statistical methods such as the frequency and chi-square were used to test the significance of association.Level of significance was drawn at P<0.05.Results: A total of 411 patients were enrolled in this study. The age range was between 18-69 years with a mean age of 36.9 years. There was a female preponderance with a male to female ratio of 1:2. Ocular disorders were seen in 37.1% of patients studied. The commonest manifestation was the ocular adnexial manifestation and conjunctival microvasculopathy ranked highest (15.6%) in this group. Herpes zoster ophthalmicus was seen in 5 (1.2%) patients, presumed squamous cell carcinoma in 12(2.9%) and Kaposi sarcoma in 3(0.7%). Chorioretinitis was found in 12(2.9%), retinal microvasculopathy in 19(4.6%) and maculopathy in 15(3.6%). There was no case of CMV retinitis. Conclusion: Ocular findings seen in HIV-positive patients were mostly adnexial and occurred in 37% of the study population

Prevalence of ocular findings in a sample of Egyptian patients with psoriasis

Background: Psoriasis is a common disorder worldwide. The prevalence of psoriasis in Egypt, an African country with a Caucasian population, ranges 0.19–3%. Despite this relatively high prevalence of psoriasis, there are no epidemiologic data regarding the burden of associated eye affection. Determining the magnitude of the problem could help in offering better integrated health services. Aim: The purpose of this study was to evaluate eye involvement in a sample of Egyptian psoriatic patients. Patients and Methods: This case-control study included 100 patients with psoriasis and 100 age and sex matched healthy controls. Psoriasis extent and severity was graded by psoriasis area and severity index (PASI). Complete ophthalmological examination and tests for dry eye were performed to all subjects. Results: The mean age of the psoriasis group was 50.7 ± 14.3 years. Thirty eight percent of the cases were females. The mean duration of psoriasis was 10.1 ± 7.5 years. Psoriasis patients had more conjunctival injection (n = 40, P = 0.035), more pinguecula (n = 38, P = 0.048) than controls. Ocular surface disease index (OSDI), tear breakup time (TBUT), Schirmer I, and Rose Bengal staining showed statistically significant positive results in the psoriasis group. Conclusion: This is the first report on the prevalence of eye comorbidities in Egyptian psoriatic patients. Dry eyes were more common with psoriasis, particularly the erythrodermic type. Other ocular findings were not statistically significantly different except for conjunctival injection and pinguecula.

Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection / Achados oftalmológicos em lactentes com microcefalia e infecção presumida pelo vírus Zika

ABSTRACT Purpose: In 2015, a twenty-fold increase in the prevalence of microcephaly in Brazil was reported, and the Ministry of Health associated this abnormal prevalence with the maternal-fetal Zika virus (ZIKV) transmission. Methods: We assessed the ophthalmological findings of ten mothers and their infants that had been clinically diagnosed with ZIKV-related microcephaly and presented ocular abnormalities, born from May to December 2015. Results: Seven mothers (70.0%) referred symptoms during pregnancy (malaise, rash and arthralgia), of which six (85.7%) were in the first trimester. At the time of exam, no ophthalmological abnormalities were identified in the mothers and they did not report ocular symptoms during pregnancy. Serology was negative in all infants for Toxoplasmosis, Rubella, Cytomegalovirus, Syphilis and Human Immunodeficiency Viruses. Ocular findings included macular alterations (gross pigment mottling and/or chorioretinal atrophy) in fifteen eyes (75.0%), and optic nerve abnormalities (hypoplasia with double-ring sign, pallor, and/or increased cup-to-disk ratio) in nine eyes (45.0%). Conclusions: Patients presented normal anterior segment and important macular and optic nerve abnormalities. Further studies will assess the visual significance of these alterations.

RESUMO Introdução: No ano de 2015, foi identificado no Brasil um aumento da prevalência de microcefalia em vinte vezes. Esta malformação foi associada pelo Ministério da Saúde à transmissão vertical do Zika vírus (ZIKV). Método: Investigamos dez lactentes com diagnóstico clínico presumido de microcefalia relacionada à ZIKV, que apresentavam anormalidades oculares, nascidos entre maio e dezembro de 2015. Resultados: Sete mães (70,0%) relataram sintomas (mal-estar, rash e artralgia) durante a gestação, sendo seis (85,7%) no primeiro trimestre. No dia da avaliação nenhuma alteração ocular foi identificada nas mães e elas não relataram sintomas oculares durante a gestação. Sorologia foi negativa para toxoplasmose, rubéola, citomegalovírus, sífilis e vírus da imunodeficiência adquirida (HIV) em todos os lactentes. Os achados oculares incluíram alterações maculares (depósito pigmentar grosseiro e/ou atrofia coriorretiniana) em 15 olhos (75,0%) e alterações do nervo óptico (hipoplasia do disco com sinal do duplo anel, palidez e/ou aumento da escavação papilar) em nove olhos (45,0%). Conclusões: Os pacientes apresentaram segmento anterior normal e importantes e anormalidades maculares e do nervo óptico. Estudos futuros vão avaliar a importância destas alterações visuais.

Prevalence of eye disease in Brazilian patients with psoriatic arthritis

OBJECTIVES: The aim of this study was to report the type and frequency of ocular manifestations in Brazilian psoriatic arthritis patients. METHODS: We conducted a cross-sectional study in a Brazilian tertiary hospital. The test group included 40 patients who had psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis. A control group of 40 individuals was matched for age and gender. All of the patients underwent ophthalmic evaluation, which included best-corrected visual acuity, slit lamp and fundus examinations, and dry eye diagnostic tests (Schirmer I, tear breakup time and rose bengal). Demographic parameters were also evaluated. RESULTS: The mean age of the patients was 53.9±13.1 years; the mean disease duration was 8±10.5 years. Most of the patients were women (60%), and the majority had polyarticular disease (57.5%). Several ocular abnormalities were found, including punctate keratitis, pinguecula, blepharitis, pterygium, cataract, glaucoma, uveitis, and retinal microvascular abnormalities. There were no significant differences in the rates of these abnormalities compared with the control group, however. The Keratoconjunctivitis sicca and dry eye diagnostic tests were more often positive in the patients with psoriatic arthritis than in the control group. CONCLUSIONS: In this study, keratoconjunctivitis sicca was the most common ocular finding related to psoriatic arthritis. Therefore, we recommend early ophthalmologic evaluations for all psoriatic arthritis patients who complain of eye symptoms.

Ocular findings in patients with systemic sclerosis

OBJECTIVE: To evaluate the frequency and characteristics of ocular manifestations in outpatients with systemic sclerosis. METHODS: In this cross-sectional study, 45 patients with systemic sclerosis were enrolled. Data regarding demographics, disease duration and subtype, age at diagnosis, nailfold capillaroscopic pattern and autoantibody profile were collected, and a full ophthalmic examination was conducted. Parametric (Student's t-test) and nonparametric (Mann-Whitney U test) tests were used to compare continuous variables. Fisher's exact test was used to compare categorical data. P values < 0.05 were considered significant. RESULTS: Twenty-three subjects (51.1 percent) had eyelid skin changes; 22 (48.9 percent) had keratoconjunctivitis sicca, 19 (42.2 percent) had cataracts, 13 (28.9 percent) had retinal microvascular abnormalities and 6 (13.3 percent) had glaucoma. Eyelid skin changes were more frequent in patients with the diffuse subtype of systemic sclerosis and were associated with a younger age and an earlier age at diagnosis. Cataracts were presumed to be age-related and secondary to corticosteroid treatment. There was no association between demographic, clinical or serological data and keratoconjunctivitis sicca. The retinal microvascular abnormalities were indistinguishable from those related to systemic hypertension and were associated with an older age and a severe capillaroscopic pattern. CONCLUSIONS: Eyelid skin abnormalities and keratoconjunctivitis sicca were the most common ocular findings related to systemic sclerosis. Some demographic and clinical data were associated with some ophthalmic features and not with others, showing that the ocular manifestations of systemic sclerosis are characterized by heterogeneity and reflect the differences in the implicated pathophysiological mechanisms.

Ophthalmologic Evaluation in Pediatric Developmental Delay

PURPOSE: To evaluate the ocular results and refractive errors in children with developmental delay and to determine the significance of ophthalmologic screening in children. METHODS: The present study was conducted with children who visited the development delay clinic of National Health Insurance Corporation Ilsan hospital in Goyang, Korea. Primary evaluation included external eye examination, pupil reflex, and ocular movement test with focal light, and secondary evaluation included slit-lamp examination, fundus examination, cycloplegic refraction, and lacrimal drainage test if necessary. RESULTS: Out of 89 subjects included in the study, 61.8% had ocular abnormalities other than refractive errors, and the two most common results included strabismus and epiblepharon, with occurrence rates of 24.7% and 22.5%, respectively. Among the 60 subjects who underwent cycloplegic refraction, 56.6% had refractive errors, with astigmatism (30%) being the most common. Among the 24 subjects who received treatment, four underwent surgical treatment and 20 started wearing glasses. CONCLUSIONS: The present study revealed a high prevalence of ophthalmologic abnormalities in pediatric developmental delay patients, indicating that systemic and comprehensive ophthalmic examination is necessary for these patients.

Ocular Findings in Children with Down's Syndrome

In order to identify the characteristic ocular findings in Down's syndrome(DS), 123 Korean children with DS prospectively underwent ocular examination, including visual acuity assessment, slit-lamp biomicroscopy, ocular motility, cycloplegic refraction, and ophthalmoscopy. The ocular findings in decreasing prevalence were the following:upward slanting of the palpebral fissure(78 patients, 63%), epicanthus(75 patients, 61%), epiblepharon(66 patients, 54%), astigmatism(38 patients, 31%), hyperopia(35 patients, 28%), myopia(31 patients, 25%), strabismus(31 patients, 25%, 18 esotropia and 13 exotropia), nystagmus(27 patients, 22%), nasolacrimal duct obstruction(21 patients, 17%), blepharoconjunctivitis(20 patients, 16%), retinal abnormalities(18 patients, 15%), cataract(4 patients, 13%), and glaucoma(1 patient, 0.8%). Brushfield spots and keratoconus were not found. The ocular findings in Korean children with DS are characterized as an unreported, high incidence of epiblepharon, the highest rate of exotropia as reported, and no cases of Brushfield spots. The difference in the incidence of these ocular abnormalities according to race and age should be considered in every patient with DS.