Bio

DR. GICHUHI STEPHEN

Areas Of Specialization

Evidence-based medicine especially its application to Anterior Segment diseases

Research Interests

  • Ocular surface squamous neoplasia

Publications


2010

Gichuhi S.  2010.  Partners in Prevention HSV/HIV Transmission Study Team. Acyclovir and transmission of HIV-1 from Persons infected with HIV-1 and HSV-2. . N Engl J Med. 2010 Feb 4;362(5):. Epub 2010 J. :427-39.: Elsevier AbstractWebsite

BACKGROUND: Most persons who are infected with human immunodeficiency virus type 1 (HIV-1) are also infected with herpes simplex virus type 2 (HSV-2), which is frequently reactivated and is associated with increased plasma and genital levels of HIV-1. Therapy to suppress HSV-2 reduces the frequency of reactivation of HSV-2 as well as HIV-1 levels, suggesting that suppression of HSV-2 may reduce the risk of transmission of HIV-1. METHODS: We conducted a randomized, placebo-controlled trial of suppressive therapy for HSV-2 (acyclovir at a dose of 400 mg orally twice daily) in couples in which only one of the partners was seropositive for HIV-1 (CD4 count, > or = 250 cells per cubic millimeter) and that partner was also infected with HSV-2 and was not taking antiretroviral therapy at the time of enrollment. The primary end point was transmission of HIV-1 to the partner who was not initially infected with HIV-1; linkage of transmissions was assessed by means of genetic sequencing of viruses. RESULTS: A total of 3408 couples were enrolled at 14 sites in Africa. Of the partners who were infected with HIV-1, 68% were women, and the baseline median CD4 count was 462 cells per cubic millimeter. Of 132 HIV-1 seroconversions that occurred after randomization (an incidence of 2.7 per 100 person-years), 84 were linked within couples by viral sequencing: 41 in the acyclovir group and 43 in the placebo group (hazard ratio with acyclovir, 0.92, 95% confidence interval [CI], 0.60 to 1.41; P=0.69). Suppression with acyclovir reduced the mean plasma concentration of HIV-1 by 0.25 log(10) copies per milliliter (95% CI, 0.22 to 0.29; P<0.001) and the occurrence of HSV-2-positive genital ulcers by 73% (risk ratio, 0.27; 95% CI, 0.20 to 0.36; P<0.001). A total of 92% of the partners infected with HIV-1 and 84% of the partners not infected with HIV-1 remained in the study for 24 months. The level of adherence to the dispensed study drug was 96%. No serious adverse events related to acyclovir were observed. CONCLUSIONS: Daily acyclovir therapy did not reduce the risk of transmission of HIV-1, despite a reduction in plasma HIV-1 RNA of 0.25 log(10) copies per milliliter and a 73% reduction in the occurrence of genital ulcers due to HSV-2. (ClinicalTrials.gov number, NCT00194519.) 2010 Massachusetts Medical Society

2009

Mingaine M, K G, Gichuhi S, J K.  2009.  Intraocular pressure changes in eyes receiving intravitreal acetonide in Kikuyu Eye Unit. . East African Journal of Ophthalmology. : Elsevier Abstract

Objective: To determine the magnitude and pattern of intraocular pressure (IOP) changes in eyes that received intravitreal triamcinolone acetonide (IVTA) in Kikuyu Eye Unit.
Study Design: Retrospective interventional case series.
Setting: Kikuyu Eye Unit.
Subjects: Seventy-two eyes (of 61 patients) injected between January 2007 and August 2008.
Methods: Data on intraocular pressure (IOP), diagnosis, additional procedures and treatment was collected using questionnaires and analysed using SPSS version 11.5. 
Results: The mean pre-injection IOP was 16.0 (SD 5.2) mmHg, which increased to 23.8 (SD 11.5) mmHg after IVTA injection (p<0.001). IOP started increasing significantly within 2 weeks (p=0.006). The median post-injection time before IOP peak was 4.6 weeks, and IOP remained high for 24 weeks after injection. Intraocular pressure increase of 5 mmHg or more was found in 39 (54.2%) eyes, while that of 10 mmHg or more was found in 22 (30.1%). Thirty-three eyes (45.8%) had maximum post-injection IOP beyond 21 mmHg. Twenty-two eyes (30.6%) received treatment for IOP elevation. Eyes with pre-injection IOP of more than 21 mmHg were associated with significantly higher IOP increases (p<0.001) and all received pressure-lowering medication. No associations were noticed between age, sex, other procedures, diagnosis and pattern of IOP change.
Conclusions: Intraocular increase was found to be a common complication of IVTA, and the increase occurred in the first six months.
 

Nderi, GJ, Gichuhi S, Kollman M, Matende I.  2009.  Outcome of glaucoma surgery at Mombasa Lighthouse for Christ Eye Center. East African Journal of Ophthalmology. : Elsevier Abstract

OBJECTIVES:
The main objective was to evaluate the outcome of glaucoma surgeries in a centre for eye care in Kenya.
 
DESIGN:
Retrospective case series.
 
SETTING:
The study was conducted at Mombasa Light House for Christ Eye Centre- Kenya.
 
SUBJECTS:
All patients diagnosed to have glaucoma and managed by surgery between 2004-2007.
 
MATERIALS AND METHODS:
Records from 2004 to 2007 were retrieved and data collected on the surgeries done using a structured questionnaire. 2008 was left for follow up to avail a one year minimum follow up time.
Analysis was done using SPSS version 13.
 
RESULTS:
265 operations were recorded in this period. 213 were retrieved and the outcomes analysed. There was good IOP control over the follow up period with a gradual rise post operation, though the pressures remained within normal. Most of the patients were controlled with no need for medications, or much less medication use.
 
The average intra-ocular pressure at two year follow up was 15.0mmHg against a baseline of 28.7mmHg (p< 0.001). 29 eyes (13.6%) required medication for intra-ocular pressure control. One type of medication was able to control the pressures post operatively. Surgery reduced topical antiglaucoma medication use by 72%.
 
 
CONCLUSION:
Intra-ocular pressure was well controlled surgically for the two year follow up.
 
RECOMENDATIONS:
Surgical intervention can be taken as a first option for glaucoma control in our set up, especially as most of our patients present late.

Kiage, DO, Damji FK, Gichuhi S, Gradin D.  2009.  Ahmed Glaucoma Valve Implant: Experience in East Africa.. Middle East African Journal of Ophthalmology. 16(3):157-161.: Elsevier AbstractWebsite

Purpose: To describe short term outcomes of Ahmed Glaucoma Valve [AGV] implantation in East African patients.Materials and Methods: In this multi-center retrospective case series we reviewed eyes of Black African patients with refractory glaucoma, treated consecutively with Ahmed Glaucoma Valve implantation, in two centers in Kenya between January 2006 and October 2007.Results: About 25 cases including 18 [72%] pediatric eyes and seven [28%] adult eyes were identified. Results have been presented with a median follow-up of two months with inter-quartile range [IQR] of one to 12 months. intraocular pressure [IOP] was reduced from a mean of 36.4 mmHg preoperatively to 16.7 mmHg and glaucoma medications were lowered from a mean of 1.32 before surgery to 0.2 after surgery. The success rate during short term follow-up was 79%. The mean visual acuity dropped slightly from 6/18 pre-operatively to 6/24. There was only one major complication of an extruded, infected valve in a child.Conclusions: The Ahmed Valve Implant is safe and effective in lowering IOP for the short term in pediatric and adult East African patients with refractory glaucoma. Further studies with more patients and longer term follow-up are needed in this population.Key words: Aqueous Rainage Devices, Glaucoma Surgery, Intraocular Pressure

Gichuhi, S, Bosire R, Mbori-Ngacha D, Gichuhi CM, Wamalwa D.  2009.  Risk factors for neonatal conjunctivitis in babies of HIV-1 infected mothers. Ophthalmic Epidemiology. 16(6):337-345.: Elsevier Abstract

PURPOSE:
To determine the prevalence and correlates of neonatal conjunctivitis in infants born to human immunodeficiency virus type 1 (HIV-1) infected mothers.

METHODS:
This was a nested case-control study within a perinatal HIV-1 cohort. HIV-1 seropositive mothers were enrolled during pregnancy and mother-infant pairs followed after delivery with assessment for neonatal conjunctivitis at 48 hours and up to 4 weeks after birth. Genital infections (chlamydia, gonorrhea, syphilis, trichomonas, bacterial vaginosis, and candida) were screened for at 32 weeks gestation. Mothers received treatment for genital infections diagnosed during pregnancy and short-course zidovudine. Newborns did not receive ocular prophylaxis at hospital deliveries. Multivariate logistic regression models were used to determine cofactors for neonatal conjunctivitis overall and stratified for infant HIV-1 status.

RESULTS:
Four hundred and fifty-two infants were assessed and 101 (22.3%) had neonatal conjunctivitis during the first month postpartum. In multivariate analyses using odds ratios (OR) and confidence intervals (CI), neonatal conjunctivitis was associated with neonatal sepsis (adjusted OR 21.95, 95% CI 1.76, 274.61), birth before arrival to hospital (adjusted OR 13.91, 95% CI 1.39, 138.78) and birth weight (median 3.4 versus 3.3 kilograms, p=0.016, OR 1.79, 95% CI 1.01, 3.15). Infant HIV-1 infection was not associated with conjunctivitis.

CONCLUSIONS:
Despite detection and treatment of genital infections during pregnancy, neonatal conjunctivitis was frequently diagnosed in infants born to HIV-1 infected mothers suggesting a need for increased vigilance and prophylaxis for conjunctivitis in these infants. Neonatal sepsis, birth before arrival to hospital, and higher birthweight are factors that may predict higher risk of neonatal conjunctivitis in this population.

2008

Do, DV.  2008.  Surgery for post-vitrectomy cataract. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006366.. : Elsevier AbstractWebsite

BACKGROUND: Cataract formation or acceleration can occur after intraocular
surgery, especially following vitrectomy, a surgical technique for removing the
vitreous used in the treatment of disorders that affect the posterior segment of
the eye. OBJECTIVES: The objective of this review was to evaluate benefits and
adverse outcomes of surgery for post-vitrectomy cataract with respect to visual
acuity, quality of life, and other outcomes. SEARCH STRATEGY: We searched the
Cochrane Controlled Trials Register (CENTRAL) (which contains the Cochrane Eyes
and Vision Group Trials Register) (The Cochrane Library, Issue 4, 2007), MEDLINE,
EMBASE, Latin America and Caribbean Health Sciences (LILACS) and the UK Clinical
Research Network Portfolio Database (UKCRN).The databases were last searched on
18 January 2008. We also searched www.clinicaltrials.gov,
www.controlled-trials.com, and www.actr.org.au in December 2007, in case
pertinent trials were registered and were nearing completion. SELECTION CRITERIA:
We planned to include randomized and quasi-randomized trials comparing cataract
surgery with no surgery in adult patients who developed cataract following
vitrectomy. DATA COLLECTION AND ANALYSIS: Two authors screened the search results
independently. No studies were eligible for inclusion in the review. MAIN
RESULTS: We found no randomized or quasi-randomized trials comparing cataract
surgery with no cataract surgery for patients developing cataracts following
vitrectomy surgery. AUTHORS' CONCLUSIONS: There is no evidence from randomized or
quasi-randomized controlled trials on which to base clinical recommendations for
surgery for post-vitrectomy cataract.

2007

STEPHEN, DRGICHUHI.  2007.  Interventions for squamous cell carcinoma of the conjunctiva in HIV-infected individuals. Cochrane Database Syst Rev. 2007 Apr 18; (2):CD005643. Review. PMID: 17443606 [PubMed - indexed for MEDLINE] Gichuhi S, Irlam JJ.. Cochrane Database Syst Rev. . 18(2):CD005643.: Elsevier AbstractWebsite

Johns Hopkins Bloomberg School of Public Health, Epidemiology, 615 North Wolfe Street, W5010, Baltimore, MD 21205, USA. sgichuhi@jhsph.edu BACKGROUND: Squamous cell carcinoma of the conjunctiva is a rare, slow-growing tumour of the eye, normally affecting elderly men around 70 years of age. In Africa, however, the disease is different. The incidence is rising rapidly, affecting young persons (around 35 years off age), and usually affecting women. It is more aggressive, with a mean history of three months at presentation. This pattern is related to the co-existence of the HIV/AIDS pandemic, high HPV exposure, and solar radiation in the region. Various interventions exist, but despite therapy, there is a high recurrence rate (up to 43%) and poor cosmetic results in late disease. This review was conducted to evaluate the interventions for treatment of conjunctival squamous cell carcinoma in HIV-infected individuals. OBJECTIVES: To evaluate the effect of interventions for treating squamous cell carcinoma of the conjunctiva in HIV-infected individuals on local control, recurrence, death, time to recurrence, and adverse events. SEARCH STRATEGY: Using a sensitive search strategy, we attempted to identify all relevant trials, regardless of language or publication status, from the following electronic databases; Medline/PubMed, CENTRAL, AIDSearch, EMBASE, LILACS, African Healthline, Cochrane HIV/AIDS Specialised Register, and the Cochrane Cancer Network Specialised Register. We searched the clinical trial register of the US National Institutes of Health, searched the international conference proceedings of AIDS and AIDS-related cancers, and contacted individual researchers, research organisations, and pharmaceutical companies that manufacture the drugs used as interventions. Searches were done between September 2005 and June 2006. SELECTION CRITERIA: Randomised controlled trials (RCTs) involving HIV-infected individuals with ocular surface squamous neoplasia. DATA COLLECTION AND ANALYSIS: We independently screened the results of the search to select potentially relevant studies and to retrieve the full articles. We independently applied the inclusion criteria to the potentially relevant studies. No studies were identified that fulfilled the selection criteria. MAIN RESULTS: No RCTs of interventions currently used against conjunctival squamous cell carcinoma in HIV-infected individuals were identified. AUTHORS' CONCLUSIONS: Implications for practice:Current clinical practice in treatment of squamous cell carcinoma of the conjunctiva rests on a weak evidence base of case series and case reports.Implications for research:Randomised controlled trials for treatment of this disease are needed in settings where it occurs most frequently. Preventive interventions also need to be identified. HIV/AIDS research has not focused on treatment of this tumour. PMID: 17443606 [PubMed - indexed for MEDLINE]

2005

Choksey, PV, Gichuhi S.  2005.  Diabetes and the eye.. Clinical care guidelines for diabetes in Kenya.. , Nairobi: Ministry of Health, Kenya Abstract

Johns Hopkins Bloomberg School of Public Health, Epidemiology, 615 North Wolfe Street, W5010, Baltimore, MD 21205, USA. sgichuhi@jhsph.edu BACKGROUND: Squamous cell carcinoma of the conjunctiva is a rare, slow-growing tumour of the eye, normally affecting elderly men around 70 years of age. In Africa, however, the disease is different. The incidence is rising rapidly, affecting young persons (around 35 years off age), and usually affecting women. It is more aggressive, with a mean history of three months at presentation. This pattern is related to the co-existence of the HIV/AIDS pandemic, high HPV exposure, and solar radiation in the region. Various interventions exist, but despite therapy, there is a high recurrence rate (up to 43%) and poor cosmetic results in late disease. This review was conducted to evaluate the interventions for treatment of conjunctival squamous cell carcinoma in HIV-infected individuals. OBJECTIVES: To evaluate the effect of interventions for treating squamous cell carcinoma of the conjunctiva in HIV-infected individuals on local control, recurrence, death, time to recurrence, and adverse events. SEARCH STRATEGY: Using a sensitive search strategy, we attempted to identify all relevant trials, regardless of language or publication status, from the following electronic databases; Medline/PubMed, CENTRAL, AIDSearch, EMBASE, LILACS, African Healthline, Cochrane HIV/AIDS Specialised Register, and the Cochrane Cancer Network Specialised Register. We searched the clinical trial register of the US National Institutes of Health, searched the international conference proceedings of AIDS and AIDS-related cancers, and contacted individual researchers, research organisations, and pharmaceutical companies that manufacture the drugs used as interventions. Searches were done between September 2005 and June 2006. SELECTION CRITERIA: Randomised controlled trials (RCTs) involving HIV-infected individuals with ocular surface squamous neoplasia. DATA COLLECTION AND ANALYSIS: We independently screened the results of the search to select potentially relevant studies and to retrieve the full articles. We independently applied the inclusion criteria to the potentially relevant studies. No studies were identified that fulfilled the selection criteria. MAIN RESULTS: No RCTs of interventions currently used against conjunctival squamous cell carcinoma in HIV-infected individuals were identified. AUTHORS' CONCLUSIONS: Implications for practice:Current clinical practice in treatment of squamous cell carcinoma of the conjunctiva rests on a weak evidence base of case series and case reports.Implications for research:Randomised controlled trials for treatment of this disease are needed in settings where it occurs most frequently. Preventive interventions also need to be identified. HIV/AIDS research has not focused on treatment of this tumour. PMID: 17443606 [PubMed - indexed for MEDLINE]

2003

Isenberg, L.  2003.  A double application approach to ophthalmia neonatorum prophylaxis.. Br J Ophthalmol. 2003 Dec;87(12):1449-52.. : Elsevier AbstractWebsite

{ Jules Stein Eye Institute, Department of Ophthalmology, Research and Education Institute at Harbor-UCLA Medical Center, Torrance, CA 90509, USA. isenberg@ucla.edu AIMS: To investigate if a second drop of 2.5% povidone-iodine ophthalmic solution placed within the first postnatal day would achieve better prophylaxis against ophthalmia neonatorum than a single drop applied at birth. METHODS: A masked, prospective, controlled trial was conducted over a 2 year period in a Kenyan hospital. Randomisation was achieved by alternating weeks of one or two eye drop application to both eyes. All 719 neonates received one drop of the povidone-iodine solution to both eyes at birth, while 317 received a second drop at hospital discharge or 24 (SD 4) hours after delivery, whichever was first. All infants developing conjunctivitis within a month after birth underwent microbiological analysis using Gram and Giemsa stains, direct fluorescent antibody assay for Chlamydia trachomatis, and culture. RESULTS: Of the neonates receiving the one eye drop application, 18.4% returned with a red eye with discharge, 4.0% had organisms found on the initial smear, and 8.2% had a positive culture. The corresponding proportions for the multidrop group were 24.3%, 4.7%, and 10.4%. Of those returning with an inflamed eye, there were no cases of Neisseria gonorrhoeae, 4.2% in the single dose group and 3.9% in the double dose group were positive for C trachomatis, and 5.4% and 6.5% respectively for Staphylococcus aureus. At discharge, the eyelid oedema score of the double dose group was mildly greater than the single dose group (1.4 (0.67) v 1.2 (0.73)

2002

STEPHEN, DRGICHUHI.  2002.  Does prospective monitoring improve cataract surgery outcomes in Africa? Br J Ophthalmol. 2002 May;86(5):543-7.. : Elsevier AbstractWebsite

Department of Epidemiology and International Eye Health, Institute of Ophthalmology, Bath Street, London EC1V 9EL, UK. dhyorston@enterprise.net AIMS: To determine if prospective monitoring influences cataract surgical outcomes in east Africa. METHODS: A prospective observational study of all routine extracapsular cataract extractions with posterior chamber lens implants carried out at Kikuyu Eye Unit, Kenya, between 1 January 1999 and 31 December 1999. RESULTS: Out of 1845 eligible eyes 1800 were included in the study. Two months' follow up was available in 67.2% of patients. The proportion achieving a good outcome increased steadily from 77.1% in the first quarter to 89.4% in the fourth quarter (chi(2) for trend, p<0.001). There was no change in the incidence of operative complications; however, the proportion of patients achieving a good visual outcome following vitreous loss increased from 47.2% in the first 6 months to 71.0% in the last 6 months (chi(2) p<0.05). Of the eyes with poor outcome (best corrected acuity <6/60 at 2 months) half were due to pre-existing eye diseases. The proportion of patients with known ocular comorbidity decreased from 10.2% in the first quarter to 5.9% in the fourth quarter (chi(2) for trend, p<0.05). Poor outcome was associated with age over 80 years, known diabetes, preoperative bilateral blindness, any ocular comorbidity, and intraoperative vitreous loss. CONCLUSIONS: This study demonstrates improvement in visual outcome results after cataract surgery over a 1 year period. Monitoring of outcomes appears to be associated with a change in surgeons' attitudes, leading to greater emphasis on appropriate case selection, better management of surgical complications, and improved visual outcomes. PMID: 11973251 [PubMed - indexed for MEDLINE] PMCID: PMC1771115

2000

Gichuhi, S, Kollmann KHM, Choksey PV.  2000.  The prevalence of primary open angle glaucoma in black diabetics East African Journal of Ophthalmology, Vol. 10, No. 1, Nairobi (2000), 2000. East Afr J Ophthal . 10(1):24-25.: Elsevier AbstractWebsite

Department of Epidemiology and International Eye Health, Institute of Ophthalmology, Bath Street, London EC1V 9EL, UK. dhyorston@enterprise.net AIMS: To determine if prospective monitoring influences cataract surgical outcomes in east Africa. METHODS: A prospective observational study of all routine extracapsular cataract extractions with posterior chamber lens implants carried out at Kikuyu Eye Unit, Kenya, between 1 January 1999 and 31 December 1999. RESULTS: Out of 1845 eligible eyes 1800 were included in the study. Two months' follow up was available in 67.2% of patients. The proportion achieving a good outcome increased steadily from 77.1% in the first quarter to 89.4% in the fourth quarter (chi(2) for trend, p<0.001). There was no change in the incidence of operative complications; however, the proportion of patients achieving a good visual outcome following vitreous loss increased from 47.2% in the first 6 months to 71.0% in the last 6 months (chi(2) p<0.05). Of the eyes with poor outcome (best corrected acuity <6/60 at 2 months) half were due to pre-existing eye diseases. The proportion of patients with known ocular comorbidity decreased from 10.2% in the first quarter to 5.9% in the fourth quarter (chi(2) for trend, p<0.05). Poor outcome was associated with age over 80 years, known diabetes, preoperative bilateral blindness, any ocular comorbidity, and intraoperative vitreous loss. CONCLUSIONS: This study demonstrates improvement in visual outcome results after cataract surgery over a 1 year period. Monitoring of outcomes appears to be associated with a change in surgeons' attitudes, leading to greater emphasis on appropriate case selection, better management of surgical complications, and improved visual outcomes. PMID: 11973251 [PubMed - indexed for MEDLINE] PMCID: PMC1771115

STEPHEN, DRGICHUHI.  2000.  Gichuhi S. A new millennium through new eyes; 15 corneal grafts in a day! EAJ Ophthalmol 2000; 10: 40.. (Letter to the Editor). EAJ Ophthalmol 2000; 10: 40. : Elsevier Abstract

Department of Epidemiology and International Eye Health, Institute of Ophthalmology, Bath Street, London EC1V 9EL, UK. dhyorston@enterprise.net AIMS: To determine if prospective monitoring influences cataract surgical outcomes in east Africa. METHODS: A prospective observational study of all routine extracapsular cataract extractions with posterior chamber lens implants carried out at Kikuyu Eye Unit, Kenya, between 1 January 1999 and 31 December 1999. RESULTS: Out of 1845 eligible eyes 1800 were included in the study. Two months' follow up was available in 67.2% of patients. The proportion achieving a good outcome increased steadily from 77.1% in the first quarter to 89.4% in the fourth quarter (chi(2) for trend, p<0.001). There was no change in the incidence of operative complications; however, the proportion of patients achieving a good visual outcome following vitreous loss increased from 47.2% in the first 6 months to 71.0% in the last 6 months (chi(2) p<0.05). Of the eyes with poor outcome (best corrected acuity <6/60 at 2 months) half were due to pre-existing eye diseases. The proportion of patients with known ocular comorbidity decreased from 10.2% in the first quarter to 5.9% in the fourth quarter (chi(2) for trend, p<0.05). Poor outcome was associated with age over 80 years, known diabetes, preoperative bilateral blindness, any ocular comorbidity, and intraoperative vitreous loss. CONCLUSIONS: This study demonstrates improvement in visual outcome results after cataract surgery over a 1 year period. Monitoring of outcomes appears to be associated with a change in surgeons' attitudes, leading to greater emphasis on appropriate case selection, better management of surgical complications, and improved visual outcomes. PMID: 11973251 [PubMed - indexed for MEDLINE] PMCID: PMC1771115

UoN Websites Search