African Vision and Eye Health
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2410-1516, 2413-3183

2022 ◽  
Vol 81 (1) ◽  
Author(s):  
Roland Hӧllhumer

Background: Peripheral ulcerative keratitis (PUK) is a severe inflammatory disease of the peripheral cornea that can be caused by local factors or systemic inflammatory disease.Aim: The purpose of this review is to give an overview of the pathophysiology, aetiology, clinical features, diagnosis, and management of PUK.Method: A PubMed search was conducted using the keywords, ‘peripheral ulcerative keratitis’ and ‘Mooren’s ulcer’.Results: The peripheral cornea has unique characteristics the predispose to the development of PUK. These include fine capillary arcades that allow for deposition of immune complexes and subsequent activation of an inflammatory cascade with corneal melt. Several conditions have been implicated in the aetiology of PUK. The most commonly cited causes are rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA) and various dermatoses. In patients with RA, PUK usually presents in established disease, whereas in GPA, PUK may be the presenting feature in up to 60% of cases. In RA it heralds the onset of a systemic vasculitis with significant associated morbidity and mortality. The management of PUK follows an individualised stepwise approach. All patients require supportive measures to encourage healing and halt the process of keratolysis. Systemic autoimmune conditions need a systemic corticosteroid as a fast-acting agent to halt the inflammatory process while cytotoxic therapy maintains long term disease control. Failure to achieve disease control with CTT, necessitates the use of a biologic agent.Conclusion: Peripheral ulcerative keratitis is a severe inflammatory disease of the peripheral cornea that needs a thorough diagnostic workup and stepwise management approach.


2022 ◽  
Vol 81 (1) ◽  
Author(s):  
Hlupheka L. Sithole

Background: There are many fragmented public health policies that give directives towards various aspects of healthcare needs and implementation. However, none of these policies make specific reference to eye health promotion (EHP) as an enabler for individuals to take control of the determinants of their eye health (EH) needs.Aim: The current study sought to identify EHP messages in the various available policy documents at both national and provincial health department levels with a view to assessing awareness on the available gaps for the development of an integrated EHP policy in South Africa.Setting: The study used documents provided by the National Department of Health and those that were available online from various other provincial Departments of Health in the country.Methods: Content analysis of EH policies requested from the Directorate of Chronic Diseases, Disabilities and Geriatrics was conducted. Various other health policies that were enacted post-1994 and endorsed by the National and Provincial Departments of Health were also considered for analysis.Results: Twenty-four documents were considered for content analysis. The national guidelines on eye healthcare made reference to EH activities such as immunisation of children, vision screening of the elderly, vitamin A supplementation and maternal services to detect sexually transmitted diseases, amongst others. Of the 20 national and provincial health documents analysed, only four made reference to EH. None of these documents made any specific reference to EHP.Conclusion: Although four national guidelines contain content related to EHP, the fragmentation and lack of integration with other health policy documents may lead to eye healthcare messages not being prioritised for dissemination even where they are highly required. Also, public eye healthcare services in general will continue to lag behind as is the case in most provinces in South Africa.


2022 ◽  
Vol 81 (1) ◽  
Author(s):  
Kashmira Rawjee ◽  
Teboho Seobi ◽  
Aubrey Makgotloe

Intravitreal chemotherapy (IVitC) in the management of retinoblastoma has increased the rate of globe salvage, specifically in patients with recurrent disease and associated vitreous seeds. A significant number of children with retinoblastoma in developing countries present late, resulting in higher intraocular tumour-stage at presentation. Treatment requirements for such tumours usually include intravenous chemotherapy (IVC) and/or intra-arterial chemotherapy (IAC). While IVC has a long usage track record and a good efficacy, it has been reported to be associated with higher recurrence rates in a significant number of patients. Intra-arterial chemotherapy has the advantage of lower recurrence rates but requires personnel with advanced interventional radiology skills and has limited efficacy in treating intravitreal seeds. Intravitreal chemotherapy has gained popularity recently, largely because of its superior efficacy in the management of vitreous seeds, subretinal seeds and recurrent retinal tumour. An 8-month-old male infant initially presented with bilateral retinoblastoma, International Classification System for Intraocular Retinoblastoma (ICRB) Group E in the right eye and Group B on the left eye. The right eye was enucleated and currently has a prosthesis. The left eye had tumours that initially responded to brachytherapy and transpupillary thermotherapy (TTT). Approximately two years later his tumours recurred with vitreous seeds and were successfully managed with the use of cryotherapy and intravitreal chemotherapy. The simplicity of the technique of IVitC and its efficacy in controlling vitreous seeds and recurrent retinal tumours makes this route of regional chemotherapy a viable one in areas with limited expertise and resources such as South Africa.


2021 ◽  
Vol 80 (1) ◽  
Author(s):  
Editorial Office

No abstract available.


2021 ◽  
Vol 80 (1) ◽  
Author(s):  
Anitha Arvind ◽  
Peter C. Clarke-Farr ◽  
Kovin S. Naidoo

Background: Optometrists with different levels of optometric education in India provide eye care services under various capacities to the public.Aim: The study evaluated the status of optometrists in terms of their knowledge, skills and frequency of skill utilisation in public and private sectors.Setting: A quantitative study design was adopted using a survey questionnaire that was distributed to optometrists providing eye care services in public and private sectors.Methods: A structured and validated questionnaire with closed-ended questions was administered to 650 participants.Results: A total of 400 completed questionnaires were received (response rate = 62%) of which 207 respondents were males (52%) and 193 females (48%). Most (57%) of the respondents were bachelor’s degree holders with 86% of the respondents in the private sector and 14% in the public sector. The knowledge level of ancillary and diagnostic tests (69%) was the least amongst public sector optometrists whilst it was binocular indirect ophthalmoscopy (66%) for private sector optometrists. The skill levels in indirect ophthalmoscopy was least amongst the public sector (56%) and private sector (44%) optometrists. Indirect ophthalmoscopy showed the least frequency of skill utilisation amongst public sector (13%) and private sector (34%) optometrists.Conclusion: The study highlighted the need for mandating best practice standards, and expanding the scope of defined practice, as optometrists are better suited for diagnostic roles and comprehensive eye examinations, and can contribute effectively towards averting preventable blindness.


2021 ◽  
Vol 80 (1) ◽  
Author(s):  
Shonisani E. Tshivhase ◽  
Ntsieni S. Mashau ◽  
Daphney Mathebula

2021 ◽  
Vol 80 (1) ◽  
Author(s):  
Minette Devenier ◽  
Rekha Hansraj ◽  
Tuwani Rasengane

Background: The transition from traditional print medium to a digital medium may affect the accommodative response (AR) because of the differences in the characteristics of the targets viewed.Aim: This study investigated how the accommodation system responded to targets displayed on a tablet computer compared to that on paper.Setting: The study was conducted amongst students at a university in South Africa.Methods: Using a quantitative, cross-sectional study the AR, amplitude of accommodation (AA), and accommodative facility (AF) were assessed with a target on an iPad and a paper-based one on a non-probability sample of 30 university students. Data was analysed using descriptive statistics and Bland Altman plots.Results: The median AR with a tablet was +0.25 dioptre (D) compared to +0.21 D with the paper-based target. This difference was neither statistically nor clinically significant. The median AA with a tablet computer target was 10.59 D and 9.85 D with a paper-based target. While this difference was statistically significant (p = 0.002), Bland Altman analysis revealed comparable measurements with both types of targets. Both Wilcoxon Signed Ranks Test (p = 0.462) and Bland Altman analysis found comparable medians for AF obtained with a target on paper (7.67 cycles per minute [cpm]) and a target on the tablet computer (7.17 cpm) to be comparable.Conclusion: The accuracy, strength and flexibility of accommodation were comparable for tablet computer and paper-based targets.


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