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Kiage, D, Irfan N, Gichuhi S, Karim D, Nyenze E.  2013.  The Muranga Teleophthalmology Study: Comparison of Virtual (Teleglaucoma) with in-Person Clinical Assessment to Diagnose Glaucoma. Middle East Journal of Ophthalmology. 20(2):150-7. Abstract

Purpose: While the effectiveness of teleophthalmology is generally accepted, its ability to
diagnose glaucomatous eye disease remains relatively unknown. This study aimed to compare
a web-based teleophthalmology assessment with clinical slit lamp examination to screen for
glaucoma among diabetics in a rural African district.

Materials and Methods: Three hundred and nine diabetic patients underwent both the clinical
slit lamp examination by a comprehensive ophthalmologist and teleglaucoma (TG) assessment
by a glaucoma subspecialist. Both assessments were compared for any focal glaucoma damage;
for TG, the quality of photographs was assessed, and vertical cup-to-disk ratio (VCDR) was
calculated in a semi-automated manner. In patients with VCDR > 0.7, the diagnostic precision
of the Frequency Doubling Technology (FDT) C-20 screening program was assessed.
Results: Of 309 TG assessment photos, 74 (24%) were deemed unreadable due to media
opacities, patient cooperation, and unsatisfactory photographic technique. While the
identification of individual optic nerve factors showed either fair or moderate agreement, the
ability to diagnose glaucoma based on the overall assessment showed moderate agreement
(Kappa [κ] statistic 0.55% and 95% confidence interval [CI]: 0.48-0.62). The use of FDT to
detect glaucoma in the presence of disc damage (VCDR > 0.7) showed substantial agreement
(κ statistic of 0.84 and 95% CI 0.79-0.90). A positive TG diagnosis of glaucoma carried a 77.5%
positive predictive value, and a negative TG diagnosis carried an 82.2% negative predicative
value relative to the clinical slit lamp examination.

Conclusion: There was moderate agreement between the ability to diagnose glaucoma using
TG relative to clinical slit lamp examination. Poor quality photographs can severely limit the
ability of TG assessment to diagnose optic nerve damage and glaucoma. Although further
work and validation is needed, the TG approach provides a novel, and promising method to
diagnose glaucoma, a major cause of ocular morbidity throughout the world.

Key words: Glaucoma, Optic Neuropathy, Slit Lamp Examination, Teleglaucoma,


Nyenze, E, Ojuma M.  2012.  ORBITAL COLD ABSCESSES WITH ASSOCIATED PANSINUSITIS AND BONE INVOLVEMENT. East African Journal of Ophthalmolgy. 16(1):48-49. Abstract

Orbital involvement in tuberculosis is rare even in areas where TB is endemic.1 Orbital TB is classified into five forms; classical periostitis, orbital soft tissue tuberculoma or cold abscess with no bone destruction, orbital TB with bone destruction, orbital TB spread from para-nasal sinuses and tuberculous dacryoadenitis2,3,4,5. We present a 17 year old patient who presented with a third recurrence of orbital and forehead abscesses. On orbital CT-scan, the patient had pan-sinusitis, right orbital and frontal abscesses, bilateral proptosis and frontal bone destruction. Initially the diagnosis of orbital TB was based on a good response to antituberculosis medications and it was later confirmed by histology showing caseating TB granulomas.

Nyenze, E, Ilako D, Kimani K.  2012.  OUTCOME OF DAY-CARE SURGERY FOR AGE-RELATED CATARACTS, GARISSA GENERAL HOSPITAL, KENYA. East African Journal of Ophthalmology. 16(1):12-17d.: Nyenze E, Ilako D, Kimani K Abstract

Objective: To determine the outcome of surgeries for age related cataracts at Garissa Provincial General Hospital for the last four months of the year 2008.
Design: Retrospective record review
Setting: Eye clinic, Garissa Provincial General Hospital
Methods: Records for 182 surgeries for age related cataracts were retrieved and analysed retrospectively.
Results: A total of 182 surgeries were reviewed, 81 (44.5%) were for male patients and 101 (55.5%) were for female patients. The average age for the patients undergoing the cataract surgeries was 67 years( SD 11.2). All operated eyes had a vision of 6/60 or worse before surgery. Fifty four patients (29.4%) were blind before surgery and 56 operated eyes (30.8%) had significant ocular co-morbidity. One month after surgery, 124 eyes (68%) were reviewed and 87eyes (70.2%) had a good outcome, 24(19.4%) moderate and 13(10.5%) poor outcome after refraction/pinhole. Causes of poor outcome included ocular co-morbidity (7 eyes), surgical complications (4 eyes) and post-operative complications (2 eyes). The visual recovery rate for the blind patients was 81%. The eyes with good vision one month after surgery increased from 74 (59.7%) to 87(70.2%) after refraction underscoring the need for routine biometry.
Conclusion: The outcome was below the WHO recommendation of at least 90% of operated eyes attaining good best corrected vision after surgery.
Recommendation: Patient selection, good management of surgical complications and proper biometry are needed to improve on the outcome of cataract surgery at Garissa Hospital


NYENZE, DREMMANUELMUINDI.  2007.  KAP of traditional healers on treatment of eye diseases in Kitui district of Kenya. East African Journal of Ophthalmology. : Nyenze E, Ilako D, Kimani K Abstract
12.00 Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} ABSTRACT Objective: To establish the prevailing eye practices among traditional healers in Kitui district and establish whether these healers are able to identify ocular emergencies and refer in good time. Design: Community based qualitative survey Setting: Kitui district, Eastern Kenya Subjects: A total of 87 healers from 3 divisions of Kitui district were interviewed. Results: Seventy six (87.4%) said that they treat at least one of the eye conditions presented to them. Instillation of plant extracts into the conjuctival sac was the most preferred treatment modality and was practiced by 46(52.9%) healers for cataracts, 48(55.2%) for ocular injuries and 21(24.1%) for allergic conjunctivitis. The most commonly performed surgical procedures included rubbing the underside of the upper lid with a specifi c leaf for allergic conjunctivitis with papillary reaction performed by 43 (49.4%) healers; piercing chalazia with a thorn or needle by 11(12.6%) healers and making small incisions and applying herbs for ocular swelling by 4(4.6%) healers. The most preferred treatment for chemical injury was breast milk from any breast feeding mother practiced by 29 (33.3%) healers. Small extra ocular foreign bodies are removed by introducing seed from a specifi c plant in to the conjuctival sac by 51(58.6%) healers. Some healers mix traditional medicine with exorcism and rituals especially for squint as practiced by 14(16%) healers and ocular tumors by 9(10.3%) healers. The conditions the healers said they would refer included ocular tumors reported by 48(55.5%) healers, cataracts by 34(52.9%) healers, ocular injury by 30(34.5%) healers and squint by 21(24.1%) healers. Conclusion: Majority of the healers interviewed treat patients who present to them with eye diseases. Most did not refer emergencies like ocular injuries.

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