Antibiotic Susceptibility Pattern and Bacterial Spectrum Among Patients with External Eye Infections at Menelik II Referral Hospital in Addis Ababa, Ethiopia.

Background: Eye infections can cause loss or impairment of visual function and can lead to severe impairment. Bacteria are the most common pathogens that affect the structure of the eye. As a result, quick identification of the causative agents and testing of their medication susceptibility are essential for effective treatment of eye infections. This study was intended for determining the extent of bacterial isolates from external eye infections (EEIs) and their susceptibility to antibiotics. Methods: A facility-based cross-sectional study was conducted among patients attending Menelik II Referral Hospital. The study comprised patients who had EEIs verified. EEI samples were collected using sterile methods. Bacterial isolates were identified using gram stain, colony morphology, and biochemical tests. The Kirby-Bauer disk diffusion technique was used to conduct a drug susceptibility test. Results: Totally, 323 participants were recruited for this study and 184 bacterial isolates were obtained from 175 (54.5%) participants. The main clinical diagnosis was blepharitis 122 (37.8%), followed by conjunctivitis 73 (22.6%) and keratitis 57 (17.6%). The gram-positive isolates were 171 (92.9%). CoNS with a frequency of 76 (41.3%) was the most common bacterial isolates, followed by S. aureus 67 (36.4%), Viridans streptococcus 16 (8.7%), and Klebsiella species 6(3.3%). Gram-positive isolates were sensitive to tobramycin, gentamicin, chloramphenicol, vancomycin, and ceftriaxone. In contrast, 94.0% of these gram-positive isolates showed resistance to penicillin. Multidrug resistance (MDR) was observed in both gram-positive and negative bacteria at rates of 123 (72%) and 12 (92.1%), respectively. The overall MDR rate among the isolates was 135 (73.4%). Conclusion: In this study, blepharitis was the major EEI, followed by conjunctivitis. The predominant bacterial species isolated from EEIs were CoNS, followed by S. aureus. More than half of the isolates were drug-resistant, with a large number being multidrug-resistant, highlighting the necessity for continued and coordinated surveillance to hunt for infections that are known to be resistant.

Predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy at Suhul Hospital, Tigrai, Northern Ethiopia: a retrospective follow-up study.

BACKGROUND: Ethiopia is striving to achieve a goal of "zero human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS)-related deaths." However, little has been documented on the factors that hamper the progress towards achieving this goal. Therefore, the ultimate aim of this study was to determine predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy (ART). METHODS: A retrospective follow-up study was employed on all adult HIV/AIDS patients who started ART between January 1 and December 30, 2010, at Suhul Hospital, Tigrai Region, Northern Ethiopia. Data were collected by trained fourth-year Public Health students using a checklist. Finally, the collected data were entered into SPSS version 16. Then after, Kaplan-Meier curves were used to estimate survival probability, the log-rank test was used for comparing the survival status, and Cox proportional hazards model were applied to determine predictors of mortality. RESULTS: The median follow-up period was 51 months (ranging between 1 and 60 months, inter-quartile range (IQR) = 14 months). At the end of follow-up, 37 (12.5%) patients were dead. The majority of these cumulative deaths, 19 (51.4%) and 29 (78.4%), occurred within 3 and 4 years of ART initiation respectively. Consuming alcohol (adjusted hazard ratio (AHR) = 2.23, 95% CI = 1.15, 4.32), low body weight (AHR = 2.38, 95% CI = 1.03, 5.54), presence of opportunistic infections (AHR = 2.18, 95% CI = 1.09, 4.37), advanced WHO clinical stage (AHR = 2.75, 95% CI = 1.36, 5.58), and not receiving isoniazid prophylactic therapy (AHR = 3.00, 95% CI = 1.33, 6.74) were found to be independent predictors of mortality. CONCLUSION: The overall mortality was very high. Baseline alcohol consumption, low body weight, advanced WHO clinical stage, the presence of opportunistic infections, and not receiving isoniazid prophylactic therapy were predictors of mortality. Strengthening behavioral and nutritional counseling with close clinical follow-up shall be given much more emphasis in the ART care and support program.

Penetrating Keratoplasty at a Tertiary Referral Center in Ethiopia: Indications and Outcomes.

PURPOSE: To describe the indications, visual acuity outcomes, and graft survival after penetrating keratoplasty (PKP) in Addis Ababa, Ethiopia. METHODS: The medical records of patients who underwent PKP at Menelik II Hospital between September 2000 and September 2013 were retrospectively reviewed. The prespecified outcomes were graft survival, visual acuity, and complication rates. RESULTS: A total of 321 patients underwent PKP during the study period and were included in the analysis. Indications for surgery were trachoma or leukoma in 141 (44%), keratoconus in 45 (14%), corneal dystrophy in 46 (14%), pseudophakic or aphakic bullous keratopathy in 28 (9%), trauma in 27 (8%), previous graft failure in 18 (6%), active ulcer, burn, or perforation in 9 (3%), and others in 7 (2%). The graft survival rate was 80% overall at 2 years but varied considerably depending on the indication for surgery. Uncorrected visual acuity improved from baseline mean logarithm of the minimum angle of resolution 2.09 (SD 0.67) to mean logarithm of the minimum angle of resolution of 1.53 (SD 1.03) at 2 years. A number of factors affected the visual acuity outcomes. Patients were not routinely refracted, and only 18% (N = 60) of patients had access to corrective spectacles or contact lenses postoperatively. Complication rates were high with infectious keratitis being the most common. CONCLUSIONS: PKP is becoming a viable treatment for corneal opacity in developing countries. However, the high burden of disease and lack of corrective lenses remain significant obstacles to overcome.

Life with anotner cornea: impact of corneal transplantation and eye banking in Ethiopia.

PURPOSE: Although clinical success of corneal transplantation is encouraging, its impact on the lives of beneficiaries is overlooked. We tried to understand how visually impaired people perceive the effect of a recently introduced corneal transplantation and eye banking service. METHODS: In-depth interviews were conducted among 20 patients with corneal visual impairment. All had transplantation surgery at Minilik II Hospital, mostly with corneas harvested and processed by Eye Bank of Ethiopia. The qualitative data focused on their experiences regarding changes in quality of life, visual outcome, and attitude toward corneal donation. Data were analyzed using the thematic framework approach. RESULTS: Before the transplantation, patients suffered from disability and low self-esteem but remained hopeful. After the transplantation, they felt satisfied with whatever visual gain they got and described the process as 'a miracle'. They believed their life had somewhat changed for the better as they became independent and capable again. They also felt extremely grateful to donors and became advocates for corneal donation. CONCLUSION: The availability of a corneal harvesting and transplantation service is making positive impacts on the lives of visually impaired individuals in Ethiopia. However, the extent of this service should be widened to have a significant effect on the magnitude of corneal blindness across the country.

Diagnosis and treatment of microsporidial keratoconjunctivitis: literature review and case series.

PURPOSE: The purpose of this study is to describe the clinical characteristics, microscopic findings, and treatment response to albendazole of microsporidial keratoconjunctivitis among immunocompromised individuals with HIV/AIDS. METHODS: This is a retrospective case series. Diagnosis of microsporidial keratoconjunctivitis was confirmed by subspecialist examination and conjunctival swabs examined by light microscopy. HIV infection was documented, and absolute CD4+ T cell count was determined. Patients were treated with albendazole and followed for clinical response. RESULTS: Light microscopy from the conjunctival swabs demonstrated myriad small, round to oval microsporidial organisms that stained positively with modified acid-fast methods. Two of the patients initially not taking highly active antiretroviral therapy (HAART) and presenting with an absolute CD4+ T cell count less than 100 cells/µL had a more severe form of keratoconjunctivitis than the third patient (receiving HAART, with a CD4+ T cell count of 259 cells/µL). All patients were started or continued on HAART. Two of the patients responded to oral albendazole, with resolution of symptoms and signs. The third patient did not initially respond, perhaps because of an immune recovery inflammatory syndrome, but subsequently had temporary improvement with albendazole. CONCLUSIONS: Microsporidial keratoconjunctivitis is a rare ocular complication of HIV/AIDS. Light microscopic evaluation of conjunctival swabs may be a useful minimally invasive first step toward diagnosis of microsporidial keratoconjunctivis in settings where electron microscopy is not available. Based on the limited available information, albendazole often is effective for this condition, and is widely available in developing countries at low cost.

The outcome of corneal transplantation versus indications in a tertiary eye care center in Ethiopia.

BACKGROUND: The outcome of PKP depends on several factors, mainly on its indications. Understanding the causes of graft failure may help to reduce the risk of failure. This study was designed to analyze and compare the long term outcomes of PKP for the different indications in our set up. OBJECTIVE: To assess the graft survival and visual outcome of full thickness corneal transplantation with respect to its indications at a tertiary eye care center in Ethiopia. METHODS: A retrospective analysis was done on all patients who underwent full thickness corneal transplantation at Menilik II hospital during a 5 year period from January 1st, 2001 to December 30. 2006. RESULTS: 111 cases completed their two years of follow-up at the time of study. The most common indication for penetrating keratoplasty (PKP) was post-inflammatory corneal opacity in 54/111 (48.6%) followed by keratoconus in 25 (22.5%) cases. The over all graft survival rate at two years was 76.6%. Keratoconus having the most favorable survival rate of 92%, to be followed by corneal dystrophy, (81.8%). Pre-operative corneal vascularization and anterior adherent leukoma corneas (AALK) have been shown to be significantly associated with higher risk of graft failure (p < 0.05). CONCLUSION: These results show that PKP has a very good outcome for keratoconus and corneal dystrophies. Corneal vascularization and AALK is associated with higher incidence of graft failure. Preoperative patient selection and ensuring conmpliance is shown to be essential.

Audit of exracapsular cataract extraction with posterior chamber intraocular lens implantation in a tertiary eye care center in Ethiopia.

A retrospective audit of records of 370 eyes of 315 patients for whom extracapsular cataract extraction with posterior chamber intraocular lens implantation (ECCE-PC IOL) was performed between 1998 and 1999 was made to determine postoperative visual outcome and complications. One hundred and ninety three patients were males and one hundred and seventy seven were females making a male to female ratio of 1:0.9. At two months postoperatively 82 (30.4%) of eyes had uncorrected visual acuity of 6/18 or better; while 176 (53.7%) of eyes attained an uncorrected visual acuity between 6/18 and 6/60, and 31 (11.5%) had visual acuity between 3/60 and 6/60. 340 of 358 (94.9%) had a preoperative visual acuity of < 3/60. As a result of the surgery, the percentage of blind eyes dropped from 94.9% to 4.4%. The commonest intra operative and early postoperative complications encountered were posterior capsular tear with vitreous loss (5.7%) and striate keratopathy (11.1%) respectively. Posterior capsular opacity was documented in 17 (4.6%) eyes as a late postoperative complication. Routine biometry, to calculate Intra ocular Lens (IOL) power was not done and this was the major limitation of the study. In conclusion, the study increases awareness of cataract surgery outcomes and provides a feedback to achieve better results both in terms of quality and quantity in cataract surgery. Further study with biometric measurement is recommended.

Outcome of corneal transplantation.

Corneal transplantation is a sight restoring surgery done for corneal blindness. The purpose of this retrospective preliminary study is to analyze the outcome of 54 corneal transplantations (for 32 females and 22 males) done in the Department of Ophthalmology between September 1998 and June 2002. The mean follow-up period was 13 months. Hundred percent (6/6) of the keratoconus (KC) and 85.4% of the nonkeratoconus grafts survived at a mean duration of 7.1 months and 16 months respectively. Seven of the 54 grafts (13%) have failed. The causes of graft failure were graft rejction in 4 and bacterial keratitis in 3 cases. Fifty of the 54 cases (92.6%) had a preoperative visual acuity of < 3/60. As a result of the transplantation, the percentage of blind eyes dropped from 92.6% to 21%. The data in this study confirms that corneal transplantation is a reasonably successful procedure in restoring sight for seleted cases of corneal blindness in Ethiopia.