PROF. KOLLMAN MARTIN

BACKGROUND: Biometry has the potential to improve refractive outcomes of cataract surgery in developing countries. However, the procedure is difficult to carry out in remote areas. PATIENTS AND METHODS: The feasibility of automated biometry using portable devices was assessed in an eye camp in a remote Kenyan community and reasons for failure were documented. PC-IOLs in the range of 17-27 dioptres (dpt) were implanted and a model was created to predict spherical refractive error if a standard 22 dpt lens had been used. RESULTS: In 104 out of 131 eyes (80%) biometry was possible. Failure to obtain K-readings in eyes with coexisting corneal pathology was the main limiting factor. The calculated mean IOL strength to achieve emmetropia was 21.56 dpt with a SD=1.96 (min: 14.78 dpt, max: 27.24 dpt). If 22dpt lenses had been implanted around 20% would have had an error of more than 2 dpt and 7% an error of more than 3 dpt. CONCLUSION: Biometry is a challenging procedure in remote areas where comorbidities are common. However, without biometry and implantation of different IOL powers poor refractive outcome can be expected in around 20% of patients.

{ BACKGROUND: Estimates of intraocular pressure (IOP) are influenced directly by the central corneal thickness (CCT). We assume and apply a single value for CCT (520 mum) in applanation tonometry estimates, although there is compelling evidence that CCT varies between individuals. OBJECTIVE: To determine the influence of CCT and other factors on IOP among Ethiopians. METHODS: A cross sectional study was conducted among 300 sampled individuals from June to July 2006. The CCT was measured using OcuScan(R) RxP Ophthalmic Ultrasound and readings of IOP were made with Goldmann applanation tonometer. The data was analyzed using SPSS version 12 and S-Plus 2000 of statistical packages. RESULTS: Out of 300 individuals, 184 (61.3%) were males. The mean age was 42.57 years (SD+/-16.71), mean IOP 13.39 mm Hg (SD+/-2.81), and mean CCT 518.68 mum (SD+/-32.92). There was statistically significant relationship between CCT and IOP (r=0.199, P<0.001) and a borderline statistically significant detectable change of CCT with age (r=0.012

Objective: To establish ocular fi ndings in Kenyan children with HIV/AIDS. Design: Hospital-based cross sectional study . Setting: Mbagathi District Hospital (Nairobi) MSF-Belgium HIV clinic support center and paediatric ward. Subjects: HIV infected children. Results: A total of 208 HIV infected children were examined. The overall prevalence of ocular fi ndings was 67.3% (140 patients). 113 patients (54.3%) of the patients were on ARV therapy. The most common finding was adnexal lesions observed in 40.9% of the patients, followed by posterior segment findings in 31.3%. Conjunctival microvasculopathy (30 patients,14.4%), allergic conjunctivitis (27 patients, 13.0%) and molluscum contagiosum 12 patients, 5.8%) were the main adnexal findings. Five cases (2.4%) of infectious conjunctivitis, 4 cases (1.9%) of herpes zoster ophthalmicus (HZO) and conjunctival growth were also recorded. Keratoconjunctivitis (6 patients, 2.9%), anterior uveitis (6 patients, 2.9%), and corneal ulcer (3 patients, 1.4%) were the main anterior segment findings. Peripheral retinal perivasculitis (28 patients, 13.5%) was the commonest posterior segment finding, followed by cotton wool spots (18 patients, 8.7%) and presumed retinal pigment epitheliopathy (18 patients, 8.7%) . Two cases of white retinal infiltrate associated with frosted branch vasculitis and 2 cases of focal retinal haemorrhages were also observed. Tuberculosis was the major systemic finding (93 patients, 44.7%). This study found that ocular findings are directly related to the duration of exposure to HIV infection (age), to the severity of clinical state of the disease (WHO clinical staging)and to the severity of immune suppression (CD4 count). Conclusion: The results of this study suggest a high prevalence of ocular findings in Kenyan children with HIV/AIDS. Retinal perivasculitis was the commonest retinal finding observed. Further studies are needed to investigate the unusual fi ndings of retinal pigment epitheliopathy observed in this study.

Objective: To establish ocular fi ndings in Kenyan children with HIV/AIDS. Design: Hospital-based cross sectional study . Setting: Mbagathi District Hospital (Nairobi) MSF-Belgium HIV clinic support center and paediatric ward. Subjects: HIV infected children. Results: A total of 208 HIV infected children were examined. The overall prevalence of ocular fi ndings was 67.3% (140 patients). 113 patients (54.3%) of the patients were on ARV therapy. The most common finding was adnexal lesions observed in 40.9% of the patients, followed by posterior segment findings in 31.3%. Conjunctival microvasculopathy (30 patients,14.4%), allergic conjunctivitis (27 patients, 13.0%) and molluscum contagiosum 12 patients, 5.8%) were the main adnexal findings. Five cases (2.4%) of infectious conjunctivitis, 4 cases (1.9%) of herpes zoster ophthalmicus (HZO) and conjunctival growth were also recorded. Keratoconjunctivitis (6 patients, 2.9%), anterior uveitis (6 patients, 2.9%), and corneal ulcer (3 patients, 1.4%) were the main anterior segment findings. Peripheral retinal perivasculitis (28 patients, 13.5%) was the commonest posterior segment finding, followed by cotton wool spots (18 patients, 8.7%) and presumed retinal pigment epitheliopathy (18 patients, 8.7%) . Two cases of white retinal infiltrate associated with frosted branch vasculitis and 2 cases of focal retinal haemorrhages were also observed. Tuberculosis was the major systemic finding (93 patients, 44.7%). This study found that ocular findings are directly related to the duration of exposure to HIV infection (age), to the severity of clinical state of the disease (WHO clinical staging)and to the severity of immune suppression (CD4 count). Conclusion: The results of this study suggest a high prevalence of ocular findings in Kenyan children with HIV/AIDS. Retinal perivasculitis was the commonest retinal finding observed. Further studies are needed to investigate the unusual fi ndings of retinal pigment epitheliopathy observed in this study.

OBJECTIVE: To estimate the prevalence and pattern of conjuctival squamous cell carcinoma (CSCC) in patients with HIV infection. DESIGN: A hospital based cross sectional study. SETTING: Kenyatta National Hospital (KNH) and Kikuyu Eye Unit (KEU) during the period November 2003 and May 2004. SUBJECTS: Four hundred and nine HIV positive patients. RESULTS: Four hundred and nine HIV positive patients aged 25 to 53 years were screened. Male to Female ratio was 1:1. One hundred and three had conjunctival growths. Thirty two had histologically proven conjunctiva squamous cell carcinoma (CSCC). Estimated prevalence of CSCC among HIV positive patients was 7.8%. The average duration of growth of the conjunctival masses was 21.8 months. The average size of the lesions at the time of presentation was 6.6 mm. Twenty two (68.8%) patients had primary CSCC, while ten (31.2%) had recurrent lesions. The pattern of the histopathology results was: fifteen (46.9%) patients had poorly differentiated squamous cell carcinoma; nine (28%) had moderately differentiated squamous cell carcinoma; five patients (15.6%) had CIN; two patients (6.3%) had dysplasia and one patient (3.1%) had a well differentiated squamous cell carcinoma. CONCLUSIONS: Prevalence of CSCC in HIV/AIDS patients was 7.8%. Patients present late with advanced lesions. Recurrence rates from previous surgery are high. The often uncharacteristic complaints and findings on presentation complicate the clinical diagnosis. Active search for early manifestations of CSCC in HIV / AIDS patients, complete surgical excision and close follow up is necessary. Alternative treatment methods and techniques like the topical use of antimetabolites should be explored further.

OBJECTIVE: To estimate the prevalence and pattern of conjuctival squamous cell carcinoma (CSCC) in patients with HIV infection. DESIGN: A hospital based cross sectional study. SETTING: Kenyatta National Hospital (KNH) and Kikuyu Eye Unit (KEU) during the period November 2003 and May 2004. SUBJECTS: Four hundred and nine HIV positive patients. RESULTS: Four hundred and nine HIV positive patients aged 25 to 53 years were screened. Male to Female ratio was 1:1. One hundred and three had conjunctival growths. Thirty two had histologically proven conjunctiva squamous cell carcinoma (CSCC). Estimated prevalence of CSCC among HIV positive patients was 7.8%. The average duration of growth of the conjunctival masses was 21.8 months. The average size of the lesions at the time of presentation was 6.6 mm. Twenty two (68.8%) patients had primary CSCC, while ten (31.2%) had recurrent lesions. The pattern of the histopathology results was: fifteen (46.9%) patients had poorly differentiated squamous cell carcinoma; nine (28%) had moderately differentiated squamous cell carcinoma; five patients (15.6%) had CIN; two patients (6.3%) had dysplasia and one patient (3.1%) had a well differentiated squamous cell carcinoma. CONCLUSIONS: Prevalence of CSCC in HIV/AIDS patients was 7.8%. Patients present late with advanced lesions. Recurrence rates from previous surgery are high. The often uncharacteristic complaints and findings on presentation complicate the clinical diagnosis. Active search for early manifestations of CSCC in HIV / AIDS patients, complete surgical excision and close follow up is necessary. Alternative treatment methods and techniques like the topical use of antimetabolites should be explored further.

OBJECTIVE: To estimate the prevalence and pattern of conjuctival squamous cell carcinoma (CSCC) in patients with HIV infection. DESIGN: A hospital based cross sectional study. SETTING: Kenyatta National Hospital (KNH) and Kikuyu Eye Unit (KEU) during the period November 2003 and May 2004. SUBJECTS: Four hundred and nine HIV positive patients. RESULTS: Four hundred and nine HIV positive patients aged 25 to 53 years were screened. Male to Female ratio was 1:1. One hundred and three had conjunctival growths. Thirty two had histologically proven conjunctiva squamous cell carcinoma (CSCC). Estimated prevalence of CSCC among HIV positive patients was 7.8%. The average duration of growth of the conjunctival masses was 21.8 months. The average size of the lesions at the time of presentation was 6.6 mm. Twenty two (68.8%) patients had primary CSCC, while ten (31.2%) had recurrent lesions. The pattern of the histopathology results was: fifteen (46.9%) patients had poorly differentiated squamous cell carcinoma; nine (28%) had moderately differentiated squamous cell carcinoma; five patients (15.6%) had CIN; two patients (6.3%) had dysplasia and one patient (3.1%) had a well differentiated squamous cell carcinoma. CONCLUSIONS: Prevalence of CSCC in HIV/AIDS patients was 7.8%. Patients present late with advanced lesions. Recurrence rates from previous surgery are high. The often uncharacteristic complaints and findings on presentation complicate the clinical diagnosis. Active search for early manifestations of CSCC in HIV / AIDS patients, complete surgical excision and close follow up is necessary. Alternative treatment methods and techniques like the topical use of antimetabolites should be explored further.