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2016

E, NYENZE.  2016.  EXPERIENCE OF AN OCULOPLASTIC SPECIALIST IN AFRICA, 1 OCTOBER 2016. GERMANY OPHTHALMOLOGICAL SOCIETY CONFRENCE 2016 (DOG2016. , BERLIN GERMANY
E, NYENZE, J MUSTAPHA.  2016.  Lid reconstruction after tumour excision in a patient with seborrhoiec keratosis: A case report. JOECSA. 20(1):40-44. Abstractlid_sebarrhoiec.pdfWehttp://coecsa.org/ojs-2.4.2/index.php/JOECSA/article/view/138bsite

comABSTRACTSeborrhoiec Keratosis (SK) is one of the most common benign neoplasia of the eyelids, usually affecting elderly females. Typically, the lesions start as discrete, tan-dark brown, flat lesions starting on the face and progressing to other sun-exposed areas. The natural progression is generally an increase in size, thickness and pigmentation of these lesions. A variant of SK, Dermatosis Papulosa Nigra (DPN), has been described in black people, characterized by an earlier and more severe manifestation with multiple, profuse lesions. The diagnosis is clinical, although histopathological examination may be sought to confirm the diagnosis. These lesions are benign and usually only removed for cosmetic reasons. However, in some patients, concern or discomfort may warrant removal. Cryosurgery, electrodesiccation, curettage or shave excision are all effective methods of management. When eyelid lesions are excised, the resulting anterior lamellar defect can be repaired by primary closure, local skin flaps or Full-Thickness Skin Grafts (FTSG). We report a 60 year old female patient who presented with DPN and thick pigmented lesions on the eyelids of both eyes, causing mechanical ptosis, left lower lid ectropion and interfering with vision. She was successfully managed with excision and lid reconstruction for both eyes.Keywords: Seborrhoiec keratosis, Dermatosis papulosa nigra, Eyelid tumours, Eyelid reconstruction, Eyelid excisional biopsy, Glabellar flap INTRODUCTIONSeborrhoeic Keratosis (SK) is one of the most common benign neoplasia of the eyelids1. It usually affects elderly people, with a female preponderance and some cases of reported family history2. The exact cause is unknown and has been linked to sunlight exposure3. Typically, lesions are small, discrete and tan-brown flat macules, most frequently on the face and trunk4. With time, these lesions exhibit increase in size, thickness and level of pigmentation5. As they grow, the lesions become papules with the characteristic verrucous “stuck-on” appearance4. A variant of seborrhoiec keratosis, Dermatosis Papulosa Nigra (DPN) has been described in black people2. This variant manifests earlier, with multiple and profuse lesions which are larger, thicker and exhibit a more chronic and worsening course than classic SK. SK lesions are benign and do not usually require removal5. However, many patients present to dermatologists due to concern about possible skin malignancy when there is growth or increased pigmentation of the lesions6. Reasons for removal include cosmetic reasons, discomfort, itchiness or documented growth in the lesions. The diagnosis is clinical in majority of cases. However, especially if lesions are going to be removed, histopathological confirmation of the diagnosis may be sought. Histology of lesions is characterized by hyperkeratosis, papillomatosis, acanthosis with intraepithelial horn or pseudohorn cysts3. There are several options for

2015

  2015.  Common Orbital Tumors and Approach to Management, 28 August 2014. COECSA 3RD ANNUAL CONFERENCE. , ENASHIPAI HOTEL AND SPA, NAIVASHAoverview_of_orbital_tumors_and_aproach_to_their.pdf
  2015.  Primary synovial cell sarcoma of the socket: Case report. Journal of Ophthalmology of Eastern Central and Southern Africa. 19(1):39-42. Abstract

Abstract

We report the first case of primary synovial cell sarcoma of the socket and the seventh of the globe and orbit in literature. Synovial cell sarcomas are relatively common intermediate to high grade malignant soft tissue tumours often with an initial indolent course and may present as a masquerade syndrome as in this case where a 12 year old female initially presented with a unilateral cataract of the right eye and cataract surgery was done with a posterior capsular intraocular lens implant. The patient was seen about 5 years later with endophthalmitis
and anterior staphyloma for which evisceration was done. Seven months later the patient presented yet again with a mass in the right socket. Debulking surgery was done following an incisional biopsy for histopathology which showed a biphasic synovial cell sarcoma. Bcl-2 was positive on immunohistochemistry confirming the diagnosis. The patient was treated with chemotherapy followed by radiotherapy and has been healthy with no evidence of recurrence and is on regular follow up.
Key words: Synovial, Sarcoma, Socket, Masquerade syndrome, Immunohistochemistry

b.  2015.  Review of ocular trauma in Tamale Teaching Hospital, Tamale, Ghana. Journal of Ophthalmology of Eastern Central and Southern Africa. 19(2):75-82. Abstractvol19_no_2.pdf

Abstract

Objective: To establish the epidemiologic characteristics, referral pattern, interventions, visual outcomes and complications resulting in visual impairment/blindness among ocular trauma patients in Tamale Teaching Hospital (TTH) Eye Clinic, Tamale, Ghana.
Materials and Methods: This was a retrospective hospital-based case series in which all new patients of all ages with various eye conditions from 1st January to 31st December 2010 were reviewed from the outpatient/inpatient record books and the sex and age recorded. The files/ folders of patients with ocular trauma were selected and retrieved. The epidemiological characteristics, referral pattern, interventions, visual outcomes and complications resulting in visual impairment/blindness among ocular trauma patients were analysed.
Results: A total of 2,027 records of new patients with various eye conditions were retrieved. Three hundred and sixty one (377 eyes) new ocular trauma patients’ files/ folders were analyzed. The Male: Female ratio was 1:1.1 (p=0.09) for all new patients with various eye conditions whilst it was 1.8:1 (p<0.01) for new ocular trauma patients. Ocular trauma patients were younger than general patients with 20 – 29 years age group having most new patients (27.4%) compared with the over 49 years age group for other new cases (23.4%). Approximately 68.4% of the ocular trauma patients were seen at TTH without a referral. Conjunctival lesions were the commonest finding affecting 124(32.9%) of the ocular trauma patients. The majority of patients 88.1% sustained closed globe trauma, 8.3% had adnexal trauma whilst 3.6% had open globe trauma. The commonest intervention rendered was medical treatment alone to 64.4% of the patients. By the WHO classification, majority 67.4% of traumatized eyes had normal vision, 13.9% were visually impaired and 18.7% were blind. Thus, 110 (32.6%) were visually impaired/ blind in the traumatized eye. The commonest complications resulting in visual impairment/ blindness were corneal opacities/ scars in 33(30.0%) cases.
Conclusion: Majority of ocular trauma patients presented with minor injuries which healed without complications. However, ocular trauma was a major cause of monocular blindness and visual impairment. Ocular trauma also tended to affect a younger age group and especially males compared to other eye diseases.
Key words: Ocular trauma, Epidemiology, Referral pattern, Intervention, Visual outcome, Complication

2014

EM, N.  2014.  Research and Publications in ECSA Region, 22 November 2014. The 2nd Colllege Of E Ophthalmologistsof Eastern, Southeren and Central Africa COECSA confere. , Livingstone, Zambiaresearch_and_publication_in_ecsa_region.pptx
EM, N.  2014.  Management of Orbital Retinoblastoma; Kenyatta National Hospital experience, 20 November 2014. The 2nd Colllege Of E Ophthalmologistsof Eastern, Southeren and Central Africa COECSA confere. , Livingstone, Zambia Abstractorbital_retinoblastoma_2.ppt

Approximately 30-40% of retinoblastoma patients Sub-Saharan Africa have orbital disease at presentation. This presents the ophthalmologist with several challenges among them if to do a primary excentaration or not, if to aim at cure or palliation and which adjuvant therapy to give. At Kenyatta National Hospital, Protocol based management of retinoblastoma developed by the Kenya National Retinoblastoma society has been used to manage these cases with promising success in terms of survival and cosmesis. All retinoblastoma cases with orbital disease are evaluated for distant metastases and if free, then aim to cure treatment started with Chemoreduction. After the proptosis reduces, enucleation with primary orbital implant is done. Chemotherapy is then continued to a total of six courses then radiotherapy upto 40 Grays.

Li Qun He, Njambi L, MNMHDKMEM.  2014.  Developing Clinical Cancer Genetics. Public Health Genomics. (DOI: 10.1159/000363645) Abstract

Abstract
Background/Aims: Clinical cancer genetics is an integral part
of cancer control and management, yet its development as an
essential medical service has been hindered in many low-andmiddle-
income countries. We report our experiences in developing
a clinical cancer genetics service for retinoblastoma in
Kenya. Methods: A genetics task force was created from within
the membership of the existing Kenyan National Retinoblastoma
Strategy group. The task force engaged in multiple inperson
and telephone discussions, delineating experiences,
opinions and suggestions for an evidence-based, culturally
sensitive retinoblastoma genetics service. Discussions were recorded
and thematically categorized to develop a strategy for
the design and implementation of a national retinoblastoma
clinical genetics service. Results: Discussion among the retinoblastoma genetics task force supported the development of a
comprehensive genetics service that rests on 3 pillars: (1) patient
and family counseling, (2) community involvement, and
(3) medical education. Conclusions: A coordinated national
retinoblastoma genetics task force led to the creation of a
unique and relevant approach to delivering comprehensive
and accurate genetic care to Kenyan retinoblastoma patients.
The task force aims to stimulate innovative approaches in cancer
genetics research, education and knowledge translation,
taking advantage of unique opportunities offered in the African
context

Key Words
Africa • Cancer • Clinical genetics • Genetic counseling •
Genetic testing • Retinoblastoma

2013

Nyenze E, Muchai M, IBDM.  2013.  A CASE OF RETROBULBAR HAEMORRHAGE IN A NEWLY DIAGNOSED CASE OF HAEMOPHILIA. Journal of ophthalmology. 17(2):77-80. Abstract

Abstract.
Haemophilia is a congenital disorder of coagulation. It presents with numerous and varied systemic manifestations depending on the severity of coagulation factor deficiency. There are also ocular manifestations ranging from simple subconjunctival haemorrhage to more debilitating complications like retinal, vitreous and retrobulbar haemorrhage which are potentially blinding.
We present this case due to the unique presentation of haemophilia for the first time to a medical institution with ocular manifestations that progressed to complicate with eventual loss of vision in the affected eye.

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. Abstracthttp://www.meajo.org

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,
Teleophthalmology

2012

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

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

2007

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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