Masters Degrees (Ophthalmology)

Permanent URI for this collectionhttps://hdl.handle.net/10413/8050

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Aphakic iris-claw (Artisan®/Verisyse) lens implantation in low-income African population.
(2007) Kruse, Carl-Heinz.; Linda, Visser.
Purpose: To test the viability of implanting the Artisan®/VerisyseTM lens in a low-income monocular aphakic African population with insufficient capsular support where contact lens wear is expensive and spectacle correction is not possible, by assessing the postoperative visual functions. To further assess whether adverse effects (e.g.: pigment dispersion with secondary glaucoma, prolonged uveitis) in patients with highly pigmented irises would be as low as with patients in European and American trials. Methods: A prospective, randomised, controlled clinical trial comparing outcomes in two groups of unilateral aphakic patients. The patients in the first group received an Artisan intra-ocular iris-claw lens as a secondary procedure while the second group remained aphakic (the current treatment status quo for public patients in KwaZulu-Natal province in South Africa). Follow-up was done for 1 year. Results: The study was terminated early due to ethical and statistical reasons. Nine treated and five control patients were included. Monocular uncorrected vision was significantly higher in the treatment group (P=0,012) and patient satisfaction was higher (p=0,002). Changes in other variables (intraocular pressure, angle pigmentation, change in cup-to-disc ratio, iris pigment changes and best spectacle corrected vision) were not significantly different between the two groups. Conclusion: The Artisan®/VerisyseTM lens is a feasible option for aphakic African patients with regard to visual outcome, safety and patient satisfaction. This form of refractive correction should be the standard for patients with no capsular support and where other options are too expensive or carry greater risk.
Bevacizumab in a treat-and-extend regimen for neovascular age related macular degeneration in a resource limited sector.
(2016) Le Roux, Etienne Philip.; Kruse, Carl-Heinz.
Abstract available in PDF file.
Corneal ulcers : culture isolates and antibiotic susceptibility of microbial keratitis in KwaZulu-Natal, South Africa.
(2014) Dullabh, Viresh.; Kruse, Carl-Heinz.
Aim: To determine the causative organisms for corneal ulcers in patients in KwaZulu-Natal, culture positivity rates and antibiotic sensitivity for the organisms cultured. Method: A retrospective chart review of laboratory results of patients presenting with a corneal ulcer to St Aidan’s Hospital and Addington Hospital in Durban, KwaZulu-Natal for the year 2012. Twenty eight records were received from the NHLS. The following information was extracted: age, sex, microbial isolate and antibiotic sensitivity and resistance. Results: All specimens were culture positive, 3 showed mixed growth. Of the 31 organisms cultured 71% were Gram positive, 25.8% were Gram negative and 3.2% were fungal. Streptococcus pneumoniae (59%) and Staphylococcus aureus (22.7%) were the common Gram positive organisms, Pseudomonas was the most common Gram negative organism. Gram positive organisms were 100% susceptible to Cephalothin and Ciprofloxacin. Gram negative organisms were 88% (p = 0.53) and 100% susceptible to Tobramycin and Ciprofloxacin respectively. Conclusion: This is the first study describing sensitivities for microbial keratitis in Durban, South Africa. Similar results have been published in Johannesburg. The current treatment protocol at the UKZN Department of Ophthalmology for corneal ulcers is appropriate.
Human immunodeficiency virus and CD4 count in ocular surface squamous neoplasia.
(2016) Jogi, Thenushka.; Kruse, Carl-Heinz.
During my time working at various eye clinics in Kwazulu-Natal, I observed that more often than not, patients with disfiguring ocular surface squamous neoplasia (OSSN) were Human Immunodeficiency virus (HIV) positive and generally quite ill, often requiring radical ophthalmic surgery for the tumour and urgent referral to the local Centre for Disease control (CDC) and HIV/Acquired Immunodeficiency Syndrome (AIDS) clinics, whereas the patients with conjunctival intraepithelial neoplasia (CIN) were usually HIV negative or HIV positive but well looking. This sparked the question of whether or not there may be a relationship between Cluster of Differentiation 4: a glycoprotein found on the surface of immune cells (CD4) counts and OSSN in HIV positive patients and could these findings – should they be in the affirmative – be used as a CDC case defining criteria for AIDS and streamlet referral of these patients for Highly Active Antiretroviral Therapy (HAART). Although HIV/AIDS is a global pandemic and has been linked to OSSN, an extensive literature search found no studies specifically looking at CD4 counts in these patients. My study titled “Human Immunodeficiency Virus and CD4 count in ocular surface squamous neoplasia” was thus born. I elected to perform my study in two parts. Firstly a prospective descriptive study to determine the prevalence of HIV in OSSN in my study population from September 2012 to December 2014, and secondly a case control study to determine the odds ratio of CD4 counts in HIV positive patients with OSSN (cases) and those without OSSN (controls) I hypothesized that: 1. >50% of patients with OSSN have HIV and 2. At least 90% of HIV patients with OSSN have a CD4 count <350 cells/μl. It was unfortunate that the number of cases recruited in the given time fell short of the ideal number required as outlined in my protocol, however a minimum of 3 controls per case (as opposed to one) all matched for age and gender were selected from the national data base in order to improve the statistical significance and proceed with the study. I had hoped that the results from this study could be used to include OSSN as a CDC case defining condition for AIDS but unfortunately, although illustrative of the possibility, larger studies will have to be conducted to prove this. I was however, able to achieve the listed aims of the study and prove both of the hypotheses. It is hoped that in doing so, the holistic management of these patients with OSSN will be improved with their referral for HIV and AIDS screening being streamlined and emphasized.
The knowledge of general practitioners in the Vaal Triangle concerning common eye diseases.
(2016) De Lange, Johannes Tobias.; Kruse, Carl-Heinz.
General Practitioners (GPs) are often the first clinician to be consulted regarding eye care problems. The incidence of avoidable visual impairment will increase significantly in the future raising concerns that the General Practitioner (GP) will be confronted even more with eye related complaints. Worldwide there is a tendency to decrease the amount of time spent in undergraduate training, in all smaller disciplines. Inadequate undergraduate training seems to leave a void in the knowledge of GPs concerning the management of primary eye care problems. Having been in Private GP Practice myself for five years and then starting to specialise, I realised that the undergraduate exposure to Ophthalmology is most probably insufficient. During my interaction with colleagues at a GP level, I found that this is a common feeling and that this contributed to uncertainty in treatment of patients with "eye problems”. This study aimed to examine the knowledge of GPs in the Vaal Triangle (Vereeniging, Vanderbijlpark and Sasolburg) regarding common eye diseases and to determine if any deficiencies in their knowledge existed. The second objective was to determine if a lack of knowledge regarding common eye diseases could be due to insufficient undergraduate training and to determine if a need to revise the curricula of the undergraduate ophthalmic programs of the various Universities exist. For a comprehensive revision of curricula, a complete examination of the contents and training methods should also be undertaken which is not the aim of this study. An observational descriptive cross-sectional study, utilising purposive sampling, was done by inviting all GPs in private practice in the Vaal Triangle area, registered with the Health Professional Council of South Africa (HPCSA) and the Board of Healthcare Funders (BHF), to participate. A questionnaire consisting of 10 primary care level ophthalmology questions, as well as questions to determine demographics and other variables, was emailed to each General Practitioner (GP). The questions were completed online by following a link provided in the email that was send. Most of the questions came from a similar study that was conducted in Cape Town by a different author. The response rate for this research project was 81.4% (79 out of 97 GPs). All eight South African universities with medical schools were represented in the research population. According to the feedback received 56.5% GP’s rated eye related complaints as 10% or more of their total workload. Alarmingly 44.3% GPs scored less than 50% in the questionnaire, yet 83% felt that the primary eye care should be done by the GP. The results further indicated that the longer the undergraduate rotation in the field of Ophthalmology, the better the performance is in terms of knowledge regarding primary eye care management. Duration in private practice did not contribute to better knowledge in the identification and management of eye related problems. Enhancing undergraduate training programmes for primary eye care may result in better clinical management of eye health by GPs.
A microscopic analysis of single-use versus multi-use Phacoemulsification tubing in maintaining sterility and patient safety.
(2018) Ndlovu, Lungile Thandeka.; Kruse, Carl-Heinz.
Cataract is first of the five most common causes of blindness and vision impairment (poor night vision, fading colours and haloes around light) worldwide. It is followed by glaucoma, macular degeneration, diabetic retinopathy and trachoma. Prevention of blindness remains one of the most important areas of research in the medical field. A blind person becomes a burden in the family and the community at large, and blindness also shortens life span. Cataract extraction with intraocular lens implant is the most common surgery worldwide. We live in a developing country where we need a balance between quality and safe health practises against cost-effective measures. We need to increase the number of cataract extractions in order to decrease vision impairment and blindness. At the same time, we need to find cost-effective ways so that this procedure does not deplete the health budget. One way of decreasing costs is to reuse equipment after cataract surgery. Cataract extraction has evolved over many years. It is one of the oldest surgical procedures, first documented in the fifth century BC. The most significant change which marked a modern era victory was the introduction of phacoemulsification (phaco) in 1967. Phacoemulsification involves the breakdown of the nucleus using ultrasonography, irrigation and aspiration of the lens material. This technique has fewer complications including less wound problems, the procedure is sutureless and the risk of endophthalmitis and suprachoroidal haemorrhage is significantly decreased. Two phacoemulsification tubes are connected to a phaco probe, one tube has fluid for irrigation and the other tube aspirates lens material and fluid. Both tubes do not enter the eye, only the probe does. The phaco probe can therefore not be reused without being first sterilised. The tubes, however, should remain sterile and could potentially be reused. This study looks particularly at the sterility of the irrigation tube which carries BSS (Balanced Salt Solution) to the eye. This observational descriptive prospective study was conducted at Edendale Hospital and Greys Hospital in the city of Pietermaritzburg (PMB). These hospitals are part of the PMB metropolitan complex in South Africa. In this complex there is no standard protocol with regards to whether we may reuse phaco tubing or not. Greys Hospital does not reuse tubing (they use one “phaco pack” per theatre case) whereas Edendale Hospital reuses the tubing: one tubing for 3 cases. For this study the tip of each tube was sent for culture to check for micro-organisms. Two unused phaco tubings were sent as controls. We used the same laboratory for all analyses. Guidelines from the manufacturer state that phaco packs (the tubing is found inside this pack) are for single use only (1). There is, however, lack of scientific proof to back this guideline. We endeavoured to assess whether reusing phaco tubing has a negative impact on the sterility (and therefore safety) or not. If not, then reusing the phaco tubes could be widely adopted in an effort to save money while maintaining patient safety. In summary, the aim of this observational descriptive prospective study is to assess if phacoemulsification tubing remains sterile during sequential phacoemulsification procedures. The objectives are to investigate whether there is a difference in growth of micro-organisms from phaco tubing that are used at the two sites; to investigate and compare micro-organisms, if identified, from each specimen; and to gather evidence for a future protocol regarding reusing phaco tubing for sequential phacoemulsification. More than half of all specimens in each group showed growth of the bacillus species and other organisms as a result of contamination. This study showed that there was a non-statistical difference between the contamination rates of the tubes from both hospitals. Although a statistical significance was not shown, this result is of great clinical significance. It highlights the need for further research into patient safety as our study showed significant contamination. Patient safety cannot be concluded from this study. A protocol to be followed by all the PMB complex hospitals cannot be drawn up as yet as further research into patient safety is warranted.
An observational study on the outcome of corneal cross-linking for Keratoconus at Greys tertiary hospital, Pietermaritzburg.
(2018) Pupuma, Noluthando.; Kruse, Carl-Heinz.
The purpose of this observational study was to evaluate the efficacy of corneal cross-linking for keratoconus, beginning when the procedure was performed up to a year after the procedure in patients at Greys Hospital in Pietermaritzburg, South Africa between January 2010 and December 2015. Keratoconus is a progressive, non-inflammatory ectatic corneal disorder characterised by a progressive corneal thinning that causes irregular astigmatism and decreasing visual acuity. It is often associated with allergic conjunctivitis and seems to also have a degree of familial inheritance. Onset is during the first decade and is progressive until the third decade of life when it often seems to stabilise. Amongst the corneal ectatic diseases it remains the most common cause of debilitating progressive visual impairment during childhood and adulthood. Individuals with keratoconus form a significant proportion of patients for a practitioner specialising in corneal diseases, yet it is a disease in which the pathogenesis is poorly understood and until recently there has been no treatment (apart from corneal transplantation) that could be offered that was curative or capable of slowing the progression of the disease. Collagen cross-linking treatment using riboflavin and UV light was developed in an attempt to address this need and the initial results were promising. Charts from a sample of 54 eyes from 49 patients aged between 13 and 35 years with keratoconus treated once with corneal cross-linking, were reviewed from the time of the procedure until 1 year after the procedure or for three consecutive follow-up visits after the procedure. Although less successful than similar studies on Caucasian patients, there was significant stability in the keratometric and pachymetry measurements. The results show that the cross-linking procedure for keratoconus is a useful conservative treatment modality to stop the progression of keratoconus. This also means that the need for corneal graft procedures is significantly reduced. The fairly minimal costs involved in this procedure compared to corneal graft procedures are also an important point to consider. More study is required to elicit whether corneal cross-linking is less successful in African patients than in Caucasians.

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