Limitations in cataract surgical services for children in Ethiopia: a nationwide survey of pediatric cataract surgeons.

BACKGROUND: Bilateral cataract is a significant cause of blindness in children in Ethiopia. This study aimed to identify the resources available for cataract surgery in children, and to assess current surgical practices, surgical output and factors affecting the outcome of surgery in Ethiopia. METHODS: A Google Forms mobile phone questionnaire was emailed to nine ophthalmologists known to perform cataract surgery in young children (0-5 years). RESULTS: All nine responded. All but one had received either 12- or 3-5-month's training in pediatric ophthalmology with hands-on surgical training. The other surgeon had received informal training from an experienced colleague and visiting ophthalmologists. The surgeons were based in seven health facilities: five in the capital (Addis Ababa) and eight in six public referral hospitals and one private center. Over 12 months (2017-2018) 508 children (592 eyes) aged 0-18 years (most < 15 years) were operated by these surgeons. 84 (17%) had bilateral cataract, and 424 (83%) had unilateral cataract mainly following trauma. A mean of 66 (range 18-145) eyes were operated per surgeon. Seventy-one additional children aged > 5 years were operated by other surgeons. There were substantially fewer surgeons per million population (nine for 115 million population) than recommended by the World Health Organization and they were unevenly distributed across the country. Methylcellulose and rigid intraocular lenses were generally available but less than 50% of facilities had a sharp vitrectomy cutter and cohesive viscoelastic. Mean travel time outside Addis Ababa to a facility offering pediatric cataract surgery was 10 h. CONCLUSION: Despite the high number of cases per surgeon, the output for bilateral cataracts was far lower than required. More well-equipped pediatric ophthalmology teams are urgently required, with deployment to under-served areas.

Central corneal thickness in newly diagnosed glaucoma patients in South West Ethiopia: a cross-sectional study.

BACKGROUND: Reports of central corneal thickness (CCT) among glaucoma patients, particularly for pseudoexfoliative glaucoma (PXG) and Primary Angle Closure Glaucoma (PACG) are scarce in the Sub-Saharan African (SSA) population. The aim of this study is to evaluate CCT in black patients with newly diagnosed glaucoma and ocular hypertension (OHT) in South West Ethiopia. METHODS: This was a prospective study undertaken with an ultrasonic pachymeter from June 2014 to February 2015 in Jimma University Specialized Hospital. Patients aged 18 years and older newly diagnosed with glaucoma or OHT were included. RESULTS: A total of 162 eyes of 162 subjects were included. Hundred and fifty five subjects were glaucomatous: (67 PXG, 42 Primary Open Angle Glaucoma (POAG), 28 PACG, 14 Normal Tension Glaucoma (NTG), 5 Juvenile Open Angle Glaucoma (JOAG) and 6 (OHT). The mean age was 59.3 ± 12.8 years. For the whole sample, CCT was 518.67 (±39.97) µm. OHT group had significantly greater CCT (576.33 ± 49.32 µm) than the glaucomatous groups (p = 0.004). POAG (506.69 ± 35.08 µm) and NTG (510.79 ± 44.37 µm) groups had thinner CCT than PXG (520.48 ± 38.95 µm), PACG (524.00 ± 37.16 µm), and JOAG (518.00 ± 30.82 µm) groups, but this was not statistically significant (p = 0. 296). There was a statistically significant decline of CCT with advanced age (P = 0.02). There wasn't significant difference of average CCT between the ethnic groups (P = 0.3) and gender (P = 0.064). CONCLUSION: The mean CCT of Ethiopian glaucoma patients is thinner than Caucasians and similar to those reported from previous studies in Sub Saharan Africa. OHT patients had thicker CCT; there was no statistically significant difference observed in average CCT amongst glaucoma subtypes.

Patterns of Uveitis among Patients Attending Jimma University Department of Ophthalmology, Jimma, Ethiopia.

Introduction: Uveitis is an important cause of blindness and ocular morbidity in the world. The patterns of uveitis have not been well characterized in sub-Saharan Africa. Purpose: To describe the characteristics of uveitis among patients presenting to Jimma University Department of Ophthalmology (JUDO) from July 2013 to December 2014. Methods: This hospital-based prospective cross-sectional study included all new uveitis patients visiting JUDO outpatient department during the study period. Results: Among 98 patients diagnosed with uveitis, anterior uveitis was found in 74.5% of patients. Majority of the patients, 83.7%, had unilateral uveitis. A uveitis syndrome was identified in 22.5% of cases; of these 15 (68.2%) were infectious. Herpes simplex uveitis was the commonest infectious cause (53.3%) while Toxoplasmosis was the most common cause of posterior uveitis (60%). Conclusion: Anterior uveitis was the most common pattern found among uveitis patients. Herpes simplex and toxoplasmic chorioretinitis were the most common-identified infectious causes.

Posttraumatic Stress Disorder and Associated Factors Among Drivers Surviving Road Traffic Crashes in Southwest Ethiopia.

BACKGROUND: Road traffic crashes (RTCs) can cause serious and long-lasting consequences for drivers, both in terms of physical and mental health outcomes. Posttraumatic stress disorder (PTSD) is the most frequent mental disorder occurring after traumatic exposure. Ethiopian drivers experience RTCs more frequently than other sub-Saharan countries. Despite this prevailing phenomenon, limited attention has been given to PTSD among drivers. OBJECTIVE: To determine the prevalence of PTSD and associated factors among drivers surviving RTCs in southwest Ethiopia. METHODS: A cross-sectional quantitative study was conducted among 402 male drivers who had survived RTCs. The study was conducted in Jimma zone, southwest Ethiopia from March to June, 2019. All drivers who had survived RTCs in the last year were included in the study. The Trauma Screening Questionnaire was used to determine the prevalence of PTSD. Data were entered in EpiData 3.1 and exported to SPSS 24 for analysis. RESULTS: The response rate of the study was 398(99%). Fifty of 398 (12.6%, 95% CI 9.5%-16.1%) met PTSD criteria based on the questionnaire. A history of near-miss RTCs (AOR 3.49, 95% CI 1.89-6.43), depression (AOR 3.32, 95% CI 1.36-5.12), and severe-risk cannabis use (AOR 2.51, 95% CI 1.96-7.52) were significantly associated with PTSD. CONCLUSION AND RECOMMENDATION: The prevalence of PTSD among drivers surviving RTCs was high compared to the general population. A record of near-miss RTCs, depression, and severe-risk cannabis use shown significant associations with PTSD. Strategies and guidelines must be developed to screen and treat PTSD among drivers surviving RTCs. Drivers with experience of near-miss RTCs, depression, and severe-risk cannabis use should be given priority when screening for PTSD.

Brainstem Anesthesia after Retrobulbar Block: A Case Report and Review of Literature.

BACKGROUND: Retro-bulbar anesthesia is one of the most common regional blocks used for intraocular surgeries. Complications associated with regional blocks may be limited to the eye or may be systemic. CASE REPORT: After a retro-bulbar block for glaucoma surgery, a 60-year-old man developed loss of consciousness, apnea with hypotension and bradycardia-features of brainstem anesthesia. We present the clinical features, treatment and comments on how to prevent the problem as well as a review of the literature on reported cases. CONCLUSION: Although it is rare, treating physicians should be aware of the potentially lethal consequences of retro-bulbar block, understand measures to reduce the risks and early recognition and treatment. Facilities where ophthalmic surgeries are performed under local anesthesia should be properly equipped and staffed for advanced resuscitation.