Herpes Zoster Ophthalmicus in Africa

In EnglishHerpes zoster ophthalmicus involves V1 cranial nerve (n.ophthalmicus). Here are three examples of herpes zoster in 2 young men and one 7yo girl. Both men are HIV-positive (this must be an AIDS-stage). HZO is definitely second quickest germ to penetrate and destroy the cornea. Pseudomonas has no chance in comparison to those two. HIV is certainly a boost for the fulminant clinic.

in Russian / по-русскиГерпес зостер c вовлечением первой ветви из моей африканской практики. Случай у двух взрослых мужчин и у девочки 7 лет (активный у мужчин, и в исходе у девочки). Herpes zoster ophthalmicus – наверное второй по скорости разъедания роговицы после гонококковой инфекции. Синегнойная палочка определённо нервно курит в сторонке. Мужчины были однозначно ВИЧ-положительны, а это, как известно, означает стадию СПИД. И это конечно одна из основных причин для такой яркой и драматической клинической картины.

Advanced herpes zoster ophthalmicus with corneal melt and lens/uvea prolapse. HIV positive patient.

Advanced herpes zoster ophthalmicus with corneal melt and lens/uvea prolapse. HIV positive patient.

Advanced herpes zoster ophthalmicus with resultant corneal leucoma in 7yo girl.

Advanced herpes zoster ophthalmicus with resultant corneal leucoma in 7yo girl.

Advanced herpes zoster ophthalmicus with corneal melt and iris prolapse. HIV positive patient.

Advanced herpes zoster ophthalmicus with corneal melt and iris prolapse. HIV positive patient. Failed conjunctival flap adherence depicted.

What I have learnt from 2020 Paton Lecture

Global Ophthalmology Center at Wills Eye Institute organizes annually a great talk of international experts in global (tropical) ophthalmology. With a great pleasure I have seen a lecture yesterday from Dr. Bendjamin Roberts, a US-trained ophthalmoligist and VR-Surgeon, who is working in Kenya’s Tenwek Mission Hospital since 2006! I also enjoyed the reports of Wills’ residents, who travelled abroad to Haiti and Kenya (to Dr. Roberts) for a several weeks short-term programs.

So, what have I learnt from their experience?

1) There are numbers of western guys, who are working globally in tropics, and of whom I had unfortunately no idea. The rich experience depicted by Dr. Roberts impressed me much.

2) I especially enjoyed the story of building the brand new eye department and making it eventually self-sustainable and multi-specialized.

3) I learnt that people in this region of Kenya, unlike those in Western Zambia, may afford surgeries, which cost $200 (MSICS) or 500$ (phaco) per eye. In comparison, the cost of one MSICS surgery at our department was about 25$, which actually allowed to renew consumables but nothing more.

4) I learnt that the number of residency programs in the US, that offer global ophthalmology experience to their residents, is growing. It is now 9! Several years ago it was about 2. Unfortunately we in Russia are far from this. I know of not a single residency in Russia that offers such experience for our residents.

5) I have seen for the second time the western ophthalmologist who settled in the African country with the family including several kids. Both of them are from Mission Hospitals. Perhaps religion helps also in this regards.

Eye precancerous lesions mimic benign pyogenic granuloma

Not all pyogenic granulomas are equally safe. Some of them may comprise an elements of ocular surface squamous neoplasia, OSSN (conjunctival intraepithelial neoplasia, CIN). The paper Herwig-Carl MC, Grossniklaus HE, Müller PL, et al. Br J Ophthalmol Epub. doi:10.1136/ bjophthalmol-2018-312960 highlighted 9 such cases.

OSSN is extremely common in the areas with widespread HIV-prevalence. Human papilloma virus is responsible for this, as a typical opportunistic infection. Knowledge of the potential of OSSN to mimic pterygia and pyogenic granulomas is crucial, especially for the mid level ophthalmic personnel, as they are the primary surgeons for these conditions in many areas.

Pyogenic Granuloma Associated With Conjunctival Epithelial Neoplasia: Report of Nine Cases

Aims: To systematically describe the clinical and histopathological features of a case series of conjunctival carcinomatous lesions underlying as-and also masquerading-pyogenic granuloma.

Methods: Nine cases of conjunctival carcinomatous lesions underlying a pyogenic granuloma (which were clinically predominant) were retrospectively identified. Patients’ records were analysed for demographic data, clinical appearance and the postoperative course. Formalin-fixed paraffin-embedded specimens were routinely processed and stained with H&E and periodic acid-Schiff. Immunohistochemical stains for cytokeratin were performed in selected cases.

Results: All nine tumours were located in the conjunctiva (bulbar, tarsal, limbal conjunctiva) of patients between 44 and 80 years. The lesions exhibited clinical features of pyogenic granuloma which dominated the clinical appearance. Additional features comprised a papillomatous appearance of the adjacent conjunctiva, a more whitish aspect of the lesion and a history of squamous cell carcinoma (SCC) respectively surgery for other entities. Histopathological analysis revealed a carcinomatous lesion (conjunctival intraepithelial neoplasia or SCC) at the base of a classic pyogenic granuloma in all nine cases. Surgical removal (R0 resection) was performed. Three cases received adjuvant mitomycin C or interferon α2b treatment. Two lesions locally recurred within 2 years after initial presentation.

Conclusion: Carcinomatous lesions may be accompanied by a pyogenic granuloma which may dominate the clinical pictures. As the tumour is usually located at the base of the lesion, a complete surgical excision followed by histopathological analysis is mandatory for each lesion appearing as conjunctival pyogenic granuloma.

Keywords: conjunctival intraepithelial neoplasia; histology; pyogenic granuloma; squamous cell carcinoma; tumour.

How many ophthalmologists are there in the world?

A new data from 2015 (ICO and co.). Actually, there are 232,866 ophthodocs, which makes it 31,7 ophthalmologists per 1,000,000 of world population. Not bad, until we dig into the details.

Take Zambia or Zimbabwe: ~ 30 ophthalmologists per 16,000,000 of population of each country. ~1,9 ophthalmologist per million!

Russia: 13,700 ophthalmologists (95,5 ophthalmologists per 1,000,000).

Germany: 7,300 ophthalmologists (90,5 per million).

USA: 17,600 (54,7 per million).

UK: 3000 (46,4 per million).

Australia: 961 (40,1 per million).

Belarus: 600 (63,2)

Ukraine: 2973 (66,3).

A great job done by the ICO and S. Resnikoff:

Br J Ophthalmol. 2020 Apr; 104(4): 588–592.
Published online 2019 Jul 2. doi: 10.1136/bjophthalmol-2019-314336
PMCID: PMC7147181
PMID: 31266774
Estimated number of ophthalmologists worldwide (International Council of Ophthalmology update): will we meet the needs?

Background/aims
To estimate 2015 global ophthalmologist data and analyse their relationship to income groups, prevalence rates of blindness and visual impairment and gross domestic product (GDP) per capita.

Methods
Online surveys were emailed to presidents/chairpersons of national societies of ophthalmology and Ministry of Health representatives from all 194 countries to capture the number and density (per million population) of ophthalmologists, the number/density performing cataract surgery and refraction, and annual ophthalmologist population growth trends. Correlations between these data and income group, GDP per capita and prevalence rates of blindness and visual impairment were analysed.

Results
In 2015, there were an estimated 232 866 ophthalmologists in 194 countries. Income was positively associated with ophthalmologist density (a mean 3.7 per million population in low-income countries vs a mean 76.2 in high-income countries). Most countries reported positive growth (94/156; 60.3%). There was a weak, inverse correlation between the prevalence of blindness and the ophthalmologist density. There were weak, positive correlations between the density of ophthalmologists performing cataract surgery and GDP per capita and the prevalence of blindness, as well as between GDP per capita and the density of ophthalmologists doing refractions.

Conclusions
Although the estimated global ophthalmologist workforce appears to be growing, the appropriate distribution of the eye care workforce and the development of comprehensive eye care delivery systems are needed to ensure that eye care needs are universally met.