Simultaneous Bilateral Cataract Surgery in Outreach Surgical Camps.

OBJECTIVES: The aim of this study was to evaluate the safety and visual outcomes of simultaneous bilateral cataract surgery (SBCS) with intraocular lens implantation performed in outreach surgical eye camps. METHODS: The medical records of 47 consecutive patients who underwent simultaneous bilateral small-incision cataract surgery between January 2010 and December 2015 in outreach surgical camps in rural Cameroon were reviewed. The measures included postoperative visual outcomes and intraoperative and postoperative complications. RESULTS: Data from 94 eyes of 47 participants (30 men, 17 women; mean age: 60.93 ± 13.58 years, range: 45-80 years) were included in this study. The presented best visual acuity (VA) was less than 3/60 in 100% of the eyes. At the 4-week follow-up, 84.04% of the eyes showed increased VA of 1 line or more (P = .001). Of these, 71 (75.53%) achieved good VA (greater than 6/18). Intraoperative or postoperative complications occurred in 19 (20.21%) eyes. The most serious intraoperative complication was a posterior capsule rupture and vitreous loss (2 patients, 2 eyes). The postoperative complications included a transient elevation in the intraocular pressure (6 eyes), chronic corneal oedema (5 eyes), iris capture (3 eyes), lens decentration (2 eyes), and hyphema (1 eye). No cases of postoperative endophthalmitis were recorded. CONCLUSIONS: Under the strict observation of endophthalmitis prophylaxis, SBCS is an option to reduce the cataract blindness backlog in rural areas of developing countries.

Conjunctival Flora of Human Immunodeficiency Virus Patients on Antiretroviral Treatment.

OBJECTIVES: To determine the conjunctival flora of human immunodeficiency virus (HIV) patients on antiretroviral treatment (ART). METHODOLOGY: A total of 104 conjunctival swabs from 104 HIV patients on ART underwent microbiological evaluation to describe the flora. RESULT: There were 71 (68.26%) women and 33 (31.74%) men. The mean age was 42.9 ± 9.77 (range: 22-70) years. Negative cultures were found in 39 (37.50%) cases. Bacterial growth occurred in 65 (62.50%) cases. Coagulase-negative Staphylococcus was found in 59 eyes (90.76%), and coagulase-positive in 3 eyes (4.61%). There was a significant correlation between the duration of ART, the degrees of immunosuppression, and bacterial growth. CONCLUSIONS: Knowledge of the conjunctival flora in HIV patients may provide a better guideline in the choice of antibiotic for the management of ocular surface infections.

Uveal coloboma: about 3 cases at the University Teaching Hospital, Yaounde, Cameroon.

Uveal coloboma is a rare eye malformation caused by failure of the optic fissure to close during the fifth to seventh weeks of foetal life. The risk of retinal detachment increases with age in colobomatous eyes. Preventive measures such as early detection of the retinal break, prophylactic laser photocoagulation along the coloboma margin, confer a significant benefit in reducing this risk of retinal detachment. Difficulties linked to the diagnosis and management of uveal colobomas in developing countries setting are presented in this study.

Orbital exenteration in immunodeficiency virus-infected patients.

BACKGROUND: Orbital exenteration (OE) is a disfiguring procedure most commonly performed for locally advanced and potentially life-threatening periorbital malignancies. METHODS: We retrospectively reviewed records of 11 consecutive HIV patients who underwent OE for invasive orbital malignancy at our institution from January 2005 to December 2015. Patient demographic and clinic data and histopathology of the tumor were analyzed. RESULTS: There were eight (72.72%) female and three (27.28%) male participants ranging in age from 31 to 52 years with an mean of 39.4 years. Nine patients had been known to be HIV-positive for at least 2 years, and HIV-positive status was revealed at presentation for two patients. The mean CD4 cell count was 154.4 cells/mm3. Histopathological examination showed invasive orbital squamous cell carcinomas in nine patients (81.81%), achromic orbital melanoma in one patient (9.09%), and adenoid cystic carcinoma in one patient (9.09%). None of the patients underwent primary orbital reconstruction. The mean follow-up time was 3.4 months. Only one patient who underwent adjuvant radiotherapy was seen after 12 months. CONCLUSION: Oculo-orbital malignancies are very aggressive in HIV-positive individuals, especially in untreated patients. Routine screening for suspected ocular surface lesions and early surgical removal of all these lesions could help to avoid the need to perform the radical and disfiguring OE procedure.

Cataract surgery with intraocular lens implantation in children aged 5-15 in local anaesthesia: visual outcomes and complications.

The aim of this study was to report feasibility, the visual outcomes and complications of pediatric cataract surgery with primary intraocular lens implantation in children aged 5 to15 years in local anesthesia. This retrospective interventional case series included 62 eyes from 50 children who underwent pediatrc cataract surgery with primary intraocular lens implantation at the Mana eye Clinic Nkongsamba between 2006 and 2015 Main outcome measures were: best-corrected post operative visual acuity, and intraoperative and postoperative complications. Mean age at surgery was 10.18 ± 3.21 years. Mean follow up length was 15.75 ± 3.36 weeks. Etiology included: 10 congenital cataracs (16.12%). 35 developmental cataracts (56.45%) and 17 traumatic cataracts (27.41%). The mean preoperative BCVA was logMAR 1.19 ± 0.33. (range 0.6-2.3). After cycloplegia refraction 2 weeks after surgery, the mean postoperative BCVA was log MAR 0.58 ± 0.88 ( range 0.5-1.8). The mean implanted IOL power was 22.01 ±3.16 D. IOL was succefuly implanted in 54 eyes (87.07%). Eight eyes (9.67%) were left aphakic. Increase in BCVA of 4 logMAR lines and above was recorded in 27 patients (43.55%). Intraoperative complications included: 4 posterior capsule holes with vitrous lost, 3 lenses subluxation and 1 case of iris dialyse. Late postoperative complications included: posterior capsular opacity which occurred in 16 patients, 3 posterior synechia, 2 retinal detachment. Peribulbar anaesthesia can be considered as a viable option in selected patients presenting developmental cataract undergoing cataract surgery in developing countries. Effort should be made to improve the early identification of congenital cataract and its early surgical intervention and prompt optical rehabilitation to prevent amblyopia.

Modified Small Incision Cataract Surgery and Intraocular Lens Implantation in HIV Patients.

AIM: To describe a surgical technique suitable for cataract surgery in regions with a high prevalence of HIV infection. METHODS: We reviewed the medical records of 20 consecutive AIDS patients with cataract who underwent modified small-incision cataract surgery (mSICS) with posterior chamber lens implantation. Classic extracapsular cataract extraction (ECCE) was compared to mSICS. The number of potentially risky steps for contamination during surgery and duration of surgery were analyzed. A risky step was defined as any time when the surgeon had to use a sharp instrument. Student's paired t-test was carried out to compare continuous variables, and P-values <0.05 were considered statistically significant. RESULTS: Twenty patients were included in the study, 13 males (65%) and seven females (35%). The mean age was 46.3 ± 13.6 years (range 22-70 years). The number of potentially risky steps for contamination was significantly higher in the classical ECCE than in mSICS (P < 0.001). The mean duration of cataract surgery with mSICS was significantly shorter as well (P < 0.001). CONCLUSION: Conversion to mSICS is essential in order to reduce accidental injuries during cataract surgery in sub-Saharan countries. Sharp instruments should be passed through a neutral zone to ensure that the surgeon and nurse do not touch the same instrument at the same time.

Aphakia correction by injection of foldable intra ocular lens in the anterior chamber.

We assessed the outcomes of the use of anterior chamber foldable lens for unilateral aphakia correction at the University Teaching Hospital of Yaounde. In this retrospective, non-comparative, consecutive case series study, we reviewed the records of patients who underwent an operation for aphakia correction by the means of injection of an angular supported foldable lens between January 2009 and December 2011 in the University Teaching Hospital Yaounde. Student's paired t-test was carried out to compare pre-operative and post-operative visual acuity (VA) and intraocular pressure (IOP). P-values less than 0.05 were considered statistically significant. Twenty-one patients were included in the study; twelve were male (57.1%) and nine were female (42.9%). The mean age was 55.38 ± 17.67 years (range 9-75 years). The mean follow-up duration was 5.95 ± 3.14 months (range 2-12 months). The mean log-MAR visual acuity was 1.26 ± 0.46 pre-operatively and 0.78 ± 0.57 post-operatively (P = 0.003). The change in intraocular pressure was not statistically significant. Complications included intraocular hypertension (over 21 mmHg) in 3 patients (14.3%) and macular edema, pupillar ovalization, and retinal detachment in one patient each. The results indicate that injection of an angular support foldable lens in the anterior chamber is a useful technique for the correction of aphakia in eyes without capsular support. More extended follow-up, however, and a larger series of patients are needed to ascertain the effectiveness and safety of this procedure.