Purpose To describe the indications, visual acuity outcomes and graft survival after penetrating keratoplasty in Addis Ababa, Ethiopia. Methods The medical records of patients who had penetrating keratoplasty (PKP) at Menelik II Hospital between September 2000 and September 2013 were retrospectively reviewed. The pre-specified outcomes were graft survival, visual acuity, and complication rates. Results A total of 321 patients underwent penetrating keratoplasty during the study period and were included in the analysis. The indications for surgery were trachoma or leukoma in 141 (44%), keratoconus (KCN) in 45 (14%), corneal dystrophy in 46 (14%), pseudophakic or aphakic bullous keratopathy in 28 (9%), trauma in 27 (8%), prior graft failure in 18 (6%), active ulcer, burn or perforation 9 (3%), and other 7 (2%). Graft survival was 80% overall at 2 years but varied considerably depending on indication for surgery. Uncorrected visual acuity improved from baseline mean logMAR 2.09 (SD 0.67) to mean logMAR of 1.53 (SD 1.03) at 2 years. A number of factors affected visual acuity outcomes. Patients were not routinely refracted, and only 18% (N = 60) of patients had access to corrective spectacles or contact lenses post-operatively. Complication rates were high with infectious keratitis being the most common. Conclusions Penetrating keratoplasty 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.
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PurposeThe 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.MethodsThis 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.ResultsLight 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.ConclusionsMicrosporidial 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.
Purpose To assess the sustainability of the Type I Boston Keratoprosthesis in the developing world and report 18‐month follow‐up data on the International Boston Keratoprosthesis Study Group pilot project in Ethiopian. Methods Through an international collaboration between the Massachusetts Eye and Ear Infirmary, USA and the Menelick II Hospital, Ethiopia, six pre‐selected patients underwent surgery with th Type I Boston Keratoprosthesis (KPro). Patient inclusion criteria included hospital access, multiple graft failure, or binocular blindness. An International Protocol was developed to standardize evaluation and follow‐up. To reduce costs, the patient’s own cornea was used as a carrier for the KPro when possible instead of a donor cornea. Follow‐up reports were transmitted electronically to all physicians involved. Results Six Ethiopian patients received a Boston KPro under local anesthesia without complications. In two patients, their own cornea was used as a carrier for the KPro. All patients had improved visual acuity from a baseline vision of hand motions. Postoperative vision ranged from CF at 5m to 20/40. All patients were able to self‐administer their ophthalmic medications and five of six patients reported greater independence in ADLs. There were no infections, or compliance issues. Conclusion Early results indicate that the Boston KPro may be an option in the developing world. KPro complication rates were no different from developed countries. The use of the patient’s own cornea was not associated with a poor outcome. It remains unclear as to whether KPro may be superior to PK in this setting. Careful patient selection, standardized protocol implementation, and meticulous post‐operative follow‐up are necessary for long‐term sustainability.
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