Category: Tropical papers

Vernal-like keratoconjunctivitis in adults with HIV

An Entity, of which I was not aware…

The role of human immunodeficiency virus in the pathogenesis of vernal keratoconjunctivitis-like disease in adults: A demographic and epidemiological study
Indian J Ophthalmol. 2020 Aug;68(8):1551-1554. doi: 10.4103/ijo.IJO_1608_19.
Anine Kritzinger 1 , Anthony G Zaborowski 1 , Wilbert Sibanda 2 , Linda Visser 1
1 Department of Ophthalmology, University of KwaZulu-Natal, Durban, South Africa.
2 School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa.
PMID: 32709773
PMCID: PMC7640813
DOI: 10.4103/ijo.IJO_1608_19
Free PMC article
Purpose: The purpose was to identify and describe patients with new-onset vernal keratoconjunctivitis-like (VKC-like) disease after puberty.

Methods: The study consisted of two parts: a prospective observational descriptive study of patients with new-onset VKC-like disease, and a case-control study to determine the relationship of a CD4 count with VKC-like disease in adults, in the setting of human immunodeficiency virus (HIV). Patients were recruited between January 2016 and November 2017 from a Provincial Eye hospital, one of two large referral hospitals in KwaZulu-Natal, South Africa. Patients presenting to the eye clinic were screened and diagnosed at the Primary Eye Care Unit. Inclusion criteria: age 15 years and older with signs and symptoms of new-onset VKC-like disease. Exclusion criteria: a history of childhood atopic diseases, atopic keratoconjunctivitis and patients who declined HIV testing. Data collected included HIV status, CD4 count, antinuclear antibodies and total serum immunoglobulin E.

Results: Thirty-three patients were included; females n = 16 and males n = 17. The mean age at presentation was 32.45 ± 9.93 years, 95% CI = 28.94-35.97. Twenty-six patients (78.8%) were HIV positive, 95% CI (62-89). The proportion of HIV positive patients was statistically different from the HIV negative group, Chi-squared = 21.866, P value <0.0001. In the group of HIV positive patients, 72% were classified as immunodeficient according to their CD4 counts. An association was proven between severely immunodeficient patients and the risk of VKC-like disease (Chi-squared = 4.992, P value = 0.0255).

Conclusion: In this cohort, a statistically significant association was found between VKC-like disease in adults and an HIV positive status. This association calls for more research on the subject.

Keywords: Allergy; VKC-like disease in adults; immunocompromised; ocular manifestations of HIV; vernal keratoconjunctivitis.

Retinopathy of Prematurity-related Child Blindness in Africa

Blindness Secondary to Retinopathy of Prematurity in Sub-Saharan Africa
Scott K Herrod et al.
Ophthalmic Epidemiol. 2021 Apr 4;1-8.
doi: 10.1080/09286586.2021.1910315

Scott K Herrod 1 , Adedayo Adio 2 , Sherwin J Isenberg 3 , Scott R Lambert 4


Department of Public Health, Brigham Young University, Provo, Utah, USA.
Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
Department of Ophthalmology, Stein Eye Institute, UCLA School of Medicine, Los Angeles, California, USA.
Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA.

PMID: 33818253
DOI: 10.1080/09286586.2021.1910315

Purpose: Retinopathy of Prematurity (ROP) has been suggested to be increasing in Africa. However, it was only previously documented as a cause of blindness in 8 of 48 (16.7%) sub-Saharan African countries. The purpose of this study was to better understand the magnitude and breadth of blindness from ROP in sub-Saharan Africa.Methods: A questionnaire was sent to 455 ophthalmologists practicing in sub-Saharan Africa; the questionnaire was available in English, French and Portuguese.Results: Responses were received from 132 of 455 (29%) ophthalmologists to whom the survey was sent. Eighty-three respondents were identified as ROP-involved ophthalmologists and were from 26 of 48 (54%) sub-Saharan African countries. Ophthalmologists in 23 countries reported that they examined at least one child who was blind from ROP during the last 5 years. Sixteen of these countries had not previously reported cases of blindness from ROP in the literature. The perceived occurrence of Type 1 or more severe ROP was reported to be increasing by 31 of 77 (40%) ROP-involved ophthalmologists. ROP-involved pediatric ophthalmologists and retinal surgeons reported the number of infants they examined annually with Type 1 or more severe ROP increased from a median of 1 (range: 0-15) to a median of 4 (range: 0-40) from 2015 to 2019. ROP was estimated to be the cause of blindness for 10% of all blind children examined by ROP-involved pediatric ophthalmologists and retinal surgeons during 2019.Conclusions: ROP is becoming a more important and widespread cause of childhood blindness in sub-Saharan Africa.

Ocular surface squamous neoplasia in Zambia

In this blog one may find lots of pictures of OSSN. Finally we got some science for that!

Clinical and Pathologic Presentation of Primary Ocular Surface Tumors among Zambians
Peter Julius et al. Ocul Oncol Pathol. 2021 Mar;7(2):108-120.
doi: 10.1159/000511610. Epub 2021 Jan 21.

Peter Julius 1 , Stepfanie N Siyumbwa 1 , Phyllis Moonga 2 , Fred Maate 1 , Trevor Kaile 1 , Guobin Kang 3 , John T West 4 , Charles Wood 3 , Peter C Angeletti 3

1 Department of Pathology and Microbiology, School of Medicine, Lusaka, Zambia.
2 University Teaching Hospital, Eye Hospital, Lusaka, Zambia.
3 Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, USA.
4 Nebraska Center for Virology and the Department of Biochemistry, University of Nebraska-Lincoln, Lincoln, Nebraska, USA.

PMID: 33869164
PMCID: PMC8024974 (available on 2022-03-01)
DOI: 10.1159/000511610

Aim: This study aimed to characterize the clinical and pathologic presentation of ocular surface tumors (OSTs) and to more precisely differentiate the grades of ocular surface squamous neoplasia (OSSN) and benign lesions among Zambians.

Methods: Two-hundred sixty-five Zambian patients presenting with ocular surface growths, suspicious for OSSN, were recruited between November 2017 and November 2019 to a cross-sectional study to investigate their lesions. Sociodemographic data were collected, HIV infection status and vision tests were performed, and lesions were measured and documented. Lesions >2 mm in diameter were excised and sent for pathology analysis. In addition to the biopsies, tears, blood, and buccal swabs were collected. CD4+ T-cell counts were measured by flow cytometry. Lesions were classified according to the WHO guidelines. χ2 and bivariate correlations were used to analyze variable associations and strengths with phi/Cramer’s V and correlation coefficients, respectively. Binary logistics was used to adjust for covariance.

Results: In this study, 68.3% of the participants were found to be HIV positive. The most frequent diagnoses were invasive OSSN (45.3%), preinvasive OSSN (29.1%), and pterygium (22.6%). Invasive OSSN comprised keratinizing squamous cell carcinoma (SCC) (87.5%), basaloid SCC (3.3%), and spindle cell carcinoma (3.3%). Unusual carcinomas, not described previously, included hybrid SCC (5.0%) and acantholytic SCC (0.8%). Invasive OSSN had advanced tumor (T3/T4) staging (93.3%) at diagnosis. Lymphadenopathy was rare (2.3%), and metastasis was absent. Patients were mostly female (59.2%). Median age was 36 (interquartile ranges 33-41) years (ranges 18-81). Patients with invasive OSSN were more likely to present with pain (p = 0.007), redness (p = 0.034), excessive tearing (p = 0.0001), discharge (p = 0.011), bleeding (p = 0.007), reduced vision (p = 0.0001), fungating lesion (p = 0.001), and blindness (p = 0.005); location at temporal limbus (p = 0.0001), inferior limbus (p = 0.0001), or circumlimbal (p = 0.001); and extension to cornea (p = 0.006) and forniceal palpebral conjunctiva (p = 0.001). Invasive OSSN was associated with any smoking habit and alcohol consumption (p = 0.04 and 0.03, respectively). HIV positivity was strongly associated with OSSN (74.6% OSSN vs. 49.3% benign lesions; p = 0.0001; phi: 0.237 [p = 0.0001]).

Conclusion: OSTs are very common in Zambia and are strongly associated with HIV coinfection. Patients with OSSN were more likely to be HIV positive than those with pterygia. Despite the commonality of OSTs in sub-Saharan Africa, these cancers have historically been poorly characterized

Undetected Glaucoma in Africa… Too much is too little

In 2020, 43.78 million POAG cases were undetected, of which 76.7% reside in Africa and Asia.