Long-term follow-up of phacotrabeculectomy surgery in Tanzania.

INTRODUCTION: The glaucomas often co-exist with cataract. We previously reported a large trial of anti-scarring treatment in combined phacotrabeculectomy surgery. Long-term outcomes in an African population are extremely rarely reported. We present here the outcomes in IOP, acuity, bleb morphology and patient perceptions at 3-5-years post surgery. METHODS: Tanzanian patients with glaucoma and visually significant cataract underwent combined phacotrabeculectomy surgery. In November 2015 an attempt was made to contact all participants in the study inviting them for a repeat examination. All who attended were given a detailed examination. A semi-structured interview in Swahili was administrated to determine patient experience and satisfaction with the surgery. RESULTS: Sixty-eight (23%) attended for repeat review in 2015. The mean time from original surgery was 4.5-years (range 2.3-6.6-years). Overall 53 (78%) had IOP < 21 mm Hg and 29 (43%) an IOP < 16 mm Hg at final follow-up. A flat bleb at 26 and 100 days was associated with failure by IOP criteria at 4.5-years post-operatively. A vascular bleb at those time points was not any more associated with late failure than a non-vascular bleb. A majority of patients were pleased with the surgery. The cost of surgery is high but it is a price patients were willing to pay. Nearly all patients (95%) would recommend the service to family and friends. DISCUSSION: Owing to the small proportion reviewed, our conclusions are severely limited. Phacotrabeculectomy worked well in a majority of the reviewed population long-term and is accepted by a majority of these patients as worthwhile.

Wide-Field En Face Swept-Source Optical Coherence Tomography Features of Extrafoveal Retinoschisis in Highly Myopic Eyes.

Purpose: To evaluate the features of extrafoveal retinoschisis (EFRS) in highly myopic eyes detected by swept-source optical coherence tomography (SS-OCT). Methods: In this retrospective case series, 89 eyes of 65 patients with high myopia and coexisting EFRS were included. The participants underwent a comprehensive ophthalmologic examination, including visual acuity, ocular biometry, refraction, and perimetry. Three-dimensional wide-field scans were obtained with SS-OCT, and en face images were reconstructed with custom software. En face OCT features of EFRS were determined by two ophthalmologists masked to clinical characteristics. The associations of EFRS subtypes with ocular biometry and other OCT changes were evaluated as well. Results: In wide-field SS-OCT scans, EFRS was classified into three different types, the inner limiting membrane (ILM) detachment and inner and outer EFRS, according to the specific layer of the splitting. All these three types were most frequently distributed in the inferotemporal quadrant (71.2% for ILM detachment, 59.5% for inner EFRS, and 75.0% for outer EFRS). Inner limiting membrane detachment and inner EFRS were often adjacent to peripapillary atrophy. Outer EFRS tends to coexist with inner EFRS, as we did not observe any case with standalone outer EFRS or with coexisting with ILM detachment. Eyes with all three types combined had the longest axial length (29.1 ± 1.26 mm, P = 0.003) and the greatest refractive error (-13.0 ± 2.86 diopters [D], P = 0.014). The incidence of retinal microfolds and breaks among subgroups was significantly different (P = 0.012 and 0.003, respectively). Staphyloma was associated with outer EFRS (30.6% with versus 7.6% without outer EFRS). Conclusions: Wide-field SS-OCT reveals the spatial distribution of retinoschisis outside the fovea, and associations with retinal vessels and other retinal landmark structures. Further observations on the longitudinal changes and functional damage would help lead to a better understanding of its mechanism and prognosis.

Rising trends of endogenous Klebsiella pneumoniae endophthalmitis in Australia.

BACKGROUND: Endogenous Klebsiella pneumoniae endophthalmitis (EKPE) is a well-known entity in South-East Asia. We demonstrate a range of differing clinical features and outcomes of EKPE, and highlight the increasing incidence of EKPE in major centres in Sydney and Melbourne, Australia. DESIGN: Retrospective observational case study and case series in the hospital setting. PARTICIPANTS: Four cases of EKPE. METHODS: EKPE cases from 2005 to 2015 were identified through established endophthalmitis databases as well as hospital-based microbiological searches. MAIN OUTCOME MEASURES: EKPE cases were confirmed with positive K. pneumoniae intraocular samples. RESULTS: Rising trends of EKPE were noted in major centres in Australia. Six eyes of four patients with EKPE from January 2011 to December 2015 are reported. The mean age was 49 years (range 43-58 years). Two patients had bilateral involvement. There were systemic symptoms up to 10 days prior to ocular symptoms. The source of sepsis in all cases was a hepatic abscess. Two patients had diabetes mellitus. Five eyes had hypopyon panuveitis on presentation. All eyes underwent vitrectomy. The patient with the most delayed presentation underwent enucleation following globe perforation. Final best corrected visual acuity (BCVA) in one patient with bilateral EKPE was light perception (LP) only. The other three eyes had BCVA in at least one eye of 6/24 or better. CONCLUSIONS: EKPE is an emerging condition in Australia. Although rare, EKPE is a sight-threatening and potentially life-threatening emergency that can initially present to ophthalmologists. One should suspect EKPE in septic patients with a B-scan showing a vitreous or retinal abscess.

Incidence and risk factors associated with retinal redetachment after silicone oil removal in the African population.

The purpose of this study was to investigate the incidence and risk factors associated with retinal redetachment after silicone oil (SO) removal in the African population. A retrospective cohort study was performed on patients undergoing SO removal over a period of 4 years. The risk factors assessed were (1) characteristics of the retinal detachments including type of retinal detachment, type, number and location of the retinal tears, and proliferative vitreoretinopathy (PVR) score, and (2) surgical factors including type of silicone oil used, use of laser prior to SO removal, and location of the laser (360° or around the tear only). SO was removed either through a pars plana approach or transpupillary approach and anterior limbal incision. Ninety-nine eyes met the inclusion criteria during the study period. Twelve patients (12 %) had retinal redetachment after SO removal. Factors associated with redetachment were a preexisting macular hole, PVR grade B or worse, and no intraoperative endolaser photocoagulation. The incidence of redetachment in African population is similar to that reported from developed countries and other advanced vitreoretinal centers. Redetachment occurred at higher rates in patients with preexisting macular holes and tears who did not receive intraoperative endolaser photocoagulation and patients with a severe grade of PVR.

Results and safety profile of trainee cataract surgeons in a community setting in East Africa.

PURPOSE: To evaluate the results and safety profile of assistant medical officer ophthalmologists (AMO-O) performing cataract surgery in the last stage of their surgical training, before their appointment to local communities. METHODS: We retrospectively analyzed the records of patients who underwent cataract surgery by AMO-Os at Dar es Salaam, Comprehensive Community Based Rehabilitation for Tanzania Disability Hospital between September 2008 and June 2011. Surgical options were either extracapsular cataract extraction (ECCE) or manual small incision cataract surgery (MSICS), both with polymethylmethacrylate intraocular lens implantation. RESULTS: Four hundred and fourteen patients were included in the study. Two hundred and twenty-five (54%) underwent ECCE and 189 had MSICS. Mean logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity (UCVA) improved from 2.4 ± 0.6 preoperatively to 1.3 ± 0.8 1 week postoperatively (t-test, P < 0.001) and to 1.1 ± 0.7 3 months postoperatively (t-test, P < 0.001). Mean logMAR best-corrected visual acuity (BCVA) was 0.7 ± 0.5 1 week postoperatively and 0.6 ± 0.5 3 months postoperatively. There was no significant difference in mean logMAR UCVA (P = 0.7) and BCVA (P = 0.7) postoperatively between ECCE and MSICS. 89.5% achieved BCVA better than 6/60 and 57.3% better than 6/18 with a follow-up of 3 months. Posterior capsule rupture and/or vitreous loss occurred in 34/414 patients (8.2%) and was more frequent (P = 0.047) in patients undergoing ECCE (10.2%) compared with MSICS (5.3%). CONCLUSION: AMO-O cataract surgeons at the end of their training offer significant improvement in the visual acuity of their patients. Continuous monitoring of outcomes will guide further improvements in surgical skills and minimize complications.

Does Myopia Affect Angle Closure Prevalence.

PURPOSE: To conduct a simulation study to estimate the prevalence of occludable angle (OA), a surrogate for primary angle closure glaucoma (PACG), with the increased rate of myopia in the Chinese population. METHODS: People with phakic eyes in Liwan Eye Study were included as the study sample. Anterior chamber depth (ACD) was measured before dilation by A-mode ultrasound and OA was evaluated with static gonioscopy. Random sampling was used to generate 50 cohorts with sample size of 200 for each of myopic rates 10%, 20%, 40%, 50%, and 135 for myopic rate 60%, according to the multinomial distribution. The mean ACD and OA rates of each cohort were calculated. Logistic function model of nonlinear least-squares estimation was used to predict the prevalence of OA. RESULTS: Data of the right eyes from 1160 subjects were qualified for analysis. The mean age was 64.2 ± 9.5 years, with 43% being male. The prevalence of myopia and OA was 32.5% (95% confidence interval [CI], 29.8%-35.3%) and 10.3% (95% CI, 8.7%-12.2%), respectively. The mean ACD in the sampling cohorts increased from 2.68 mm to 2.74 mm when the prevalence of myopia increased from 10% to 60%. The projected prevalence of OA in the cohorts with myopia prevalence of 10%, 20%, 40%, 50%, and 60% was 11.1% (95% CI, 10.5%-11.8%), 10.7% (95% CI, 10.1%-11.4%), 9.9% (95% CI, 9.3%-10.5%), 9.3% (95% CI, 8.8%-9.9%), and 9.6% (95% CI, 8.9-10.3%), respectively. CONCLUSIONS: The increasing prevalence of myopia has minimal impact on the prevalence of OA.