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Purpose: To examine the demographic, sociocultural and socioeconomic factors that prevent families of cataract blind children from accepting free pediatric cataract surgery in Malawi. Methods: A total 58 parents of 62 children were recruited into the study. Of these, 53 parents partook in in-depth interviews and focus group discussions after the children were screened and the parents offered free cataract surgery. Overall, 37 parents accepted (acceptors) and 16 parents did not accept (non-acceptors) cataract surgery. All interviews were transcribed and iteratively analyzed. Household economic status was quantified using the Progress out of Poverty Index for Malawi. Results: Acceptors were better off economically ( p = 0.13). Understanding of cataract, its causing blindness and impairment, as well as treatment options, by the decision makers in the families was poor. Decision-making involved a complex array of aspects needing consideration before accepting, of which distance to the health facility was a frequently mentioned barrier. Non-acceptors were more likely to come from twice the distance compared to acceptors ( p = 0.0098). Non-acceptors were more likely to be peasant (subsistence) farmers than acceptors ( p = 0.048). Non-acceptors were more likely to live in a house made of mud bricks with a roof of grass thatch ( p = 0.001). There was no significant difference in acceptance rate between educated and non-educated mothers ( p = 0.11). Intensive counseling as provided in this project increased the likelihood of accepting surgery. Conclusion: Economic hardship and long distances to health facilities decrease acceptance even of free pediatric cataract surgical services, highlighting that just providing surgery free of cost may not be sufficient for the most economically disadvantaged in rural Africa. [ABSTRACT FROM AUTHOR]

AimsRecently, a new rebound tonometer has been introduced into the market, which might be useful for glaucoma screenings in developing countries. Disposable probes, that are potentially reusable, are recommended by the manufacturer. Our study aimed to address the question of microbial transmission risks if the probes are reused.MethodsIOP measurements were obtained from 100 healthy eyes. The used probes were inoculated on broth and culture media. In addition, 10 probes were analyzed using environmental scanning electron microscopy in saturated hydrogen-steam atmosphere after usage and wipe disinfection technique with Sekusept 4% solution or Isopropanol 70%.ResultsNo bacterial or fungal growth could be detected in any of the inoculated agar plates or broth tubes. No microorganisms, clumps of cells, or single intact epithelium cells were detected in any of the probes using environmental scanning electron microscopy. Cell debris was detected on seven probes; three probes were completely free of any residual cell elements.ConclusionTransmission of possibly infective material through reused probes is significantly less than for reusable Goldmann probes if the same sterilization protocols are applied. Re-usage of the probes appears safe and is helpful in avoiding unnecessary costs. [ABSTRACT FROM AUTHOR]

Congenital clinical anophthalmos and blind microphthalmos describe the absence of an eye or the presence of a small eye in the orbit. Between 1999 and 2013, 97 children with anophthalmos or microphthalmos were treated with self-inflating, hydrophilic gel expanders at the Rostock Eye Clinic. More than a decade later, this study investigated the perspective of patients and parents regarding the treatment, the surgical outcome, and the emotional and social well-being of the patients. A total of 22 families with 16 patients sighted in the other eye and six patients blind in both eyes participated. Questionnaires were developed, including items on physical, emotional, social, and medical aspects. The patients felt emotionally stable and integrated into their social environment, with no major limitations reported by the majority. These statements were confirmed by most of the parents. Parents (67%) indicated that the success of the operation was already apparent after the first intervention and that the current situation did not play a role in the patients' social environment. The study provided new insights into the therapy results, the postoperative care, and the social and emotional stability of the prosthesis-wearing patients, indicating the chosen expander methods as promising in terms of positive postoperative care.

Purpose: The study aimed to construct a new retinal tack design with high retention forces to prevent spontaneous disentanglement in cases of complicated retinal surgery., Methods: Six new forms for the peak of a retinal tack were developed using computer-aided design (CAD); then a prototype was produced for each model. Finally, standardised design testing was conducted using human (ex vivo) sclera by logging 15 consecutive measurements for each model., Results: Seven different models underwent pull-out testing (six new models and the original tack model), but two tack models (Model 4, Model 5) failed to penetrate the human tissue. The highest pull-out forces (median) were measured for Model 3, followed by Model 6, Model 2 and Model 1. The original Heimann tack (Model H) was found to have the lowest retention forces., Conclusion: The different tack designs altered the penetration and holding forces. The retention forces of the proposed peak design led to a significant increase in the retention forces that were more than twice as high as those in the original Heimann Model.

Purpose: To discover what cataract patients see during phacoemulsification and if these light phenomena influence their anxiety levels during surgery., Methods: In all, 200 patients were interviewed intraoperatively at the Eye Hospital, Petrisberg, Trier, Germany. The quality of the visual experiences was described and if these were pleasant, neutral or unpleasant. Systemic sedation was noted., Results: Among 200 patients (209 eyes): 88 were men (91 eyes; 44%) and 112 were women (118 eyes; 56%). Median age (years): men (71), women (70). Mean operating time was 8 min. 49/209 (23%) were not anxious before and during surgery. 110/209 (52%) were more anxious before than during surgery, 50/209 (24%) were still anxious during surgery, 27/209 (13%) got sedation with midazolam (1-5 mg). Colours in descending order seen: blue, red, pink, yellow, green, purple, turquois, and orange. The most dominant colour combination was red/blue. Structures were seen by 162/209 (78%). Most (61%) intraoperative visual experiences were pleasant, 38% were neutral, and 1% found them transiently unpleasant. Three patients felt blinded by the light of the operating microscope., Conclusions: The experience of colours and other light phenomena was pleasant for most patients during phacoemulsification under topical anaesthesia. They occur spontaneously when the patient is fixating on the operating light. They are not dependent on the individual or environment. Sedation only in 13%. Direct questioning for visual sensations by the operating surgeon may lead to less need for sedation and lead to less side effects for elderly and multimorbidity people postoperatively. The surgeon can use this knowledge to reassure patients during surgery.

A 3-year-old girl presented to the Eye Hospital, Blantyre, Malawi, with multiple ulcerating lesions on her face and in her eyes. Her skin was freckled, with hypopigmented and hyperpigmented areas (poikilodermia) typical of xeroderma pigmentosa. The tumors on the conjunctiva of the right eye and the lower eyelid of the left eye appeared to be squamous cell carcinomas. Chemotherapy with intravenous 5-flourouracil (1000 mg/m) for 5 days and cisplatin (50 mg/m) for 2 days for 3 cycles every 3 weeks was well tolerated. Good response occurred after 1 cycle and after 2 more courses the tumors had resolved.

Purpose: To investigate if low-dose 810 nm transscleral cyclophotocoagulation (TSCPC) can be used as single treatment in Malawian glaucoma patients., Methods: Forty-seven eyes of 28 patients with primary open-angle and pseudoexfoliation glaucoma were treated with TSCPC using 12 spots with 900 mW, 2,000 ms (1.8 J per spot); six spots in the upper half, six in the lower by sparing the 3 and 9 o'clock positions ±20°. Intraocular pressure (IOP) and uncorrected visual acuity (UVA) were measured by an independent examiner preoperatively, on the first postoperative day, after 2 weeks, and after 3 months., Results: Twenty-four (86%) and 18 (64%) of 28 patients (31 of 47 eyes; 66%) completed follow-up at 2 weeks and at 3 months respectively. After a single treatment session, IOP decreased by at least 25 % in 88% (21 of 24) after 2 weeks, and in 50% (nine of 18) of patients after 3 months. Mean IOP was 38.5 mmHg before TSCPC, 23.5 mmHg (p < 0.001) after 1 day, 24.5 mmHg (p < 0.001) after 2 weeks, and 35.6 mmHg (p = 0.37) after 3 months. In three patients, however, IOP increased after 3 months to levels significantly higher than before TSCPC., Conclusion: Low-dose TSCPC caused a significant IOP lowering for up to 2 weeks (15 mmHg less from baseline) in most patients. After 3 months, this effect was stable in 50% of patients; in the other half, IOP nearly returned back to baseline.

Stevens-Johnson syndrome (SJS) is a severe form of erythema multiforme that primarily affects skin and mucous membranes. In Malawi, manifestations of SJS may become more common in human immunodeficiency virus-infected patients receiving nevirapine-based antiretroviral therapy (ART) because the CD4 cell threshold for starting ART has increased from 250 to 350 cells/μL. We describe a patient with severe ocular complications from SJS that developed soon after initiation of nevirapine-based ART and cotrimoxazole preventive treatment, which led to blindness. We draw attention to preventive measures that can potentially reduce permanent ocular damage from SJS.

Background: Controversy still surrounds the intravenous (IV) treatment of endophthalmitis. The purpose of this study was to compare IV and intraocular (IO) treatment in experimental Staphylococcus aureus endophthalmitis: intravitreal injection of vancomycin and amikacin (VA/AN) in comparison with IV imipenem (IPM) and a combination of IV and IO (IV+IO) therapy., Methods: The right eyes of 27 rabbits were injected with 25000 S. aureus. After 24 h, animals were either treated with IO VA/AN ( n=5; 1.0 mg/0.4 mg in 0.1 ml saline), or IV IPM ( n=9; 37 mg/kg body weight 3x daily), or IV+IO therapy ( n=7), or served as untreated controls ( n=6). Clinical appearance was evaluated daily and vitreous aspirates were obtained for bacterial culture 24 h and 6 days after therapy, when the eyes were enucleated for histopathologic examination., Results: Eyes in the IO or IO+IV treatment group had a significantly better appearance clinically and histologically than did eyes in the IV or untreated control group. Eyes in the IO+IV group had a similar appearance to the IO-treated eyes. All aspirates from the IO and IO+IV groups were culture-negative 24 hours after therapy, whereas only five of nine in the IV-treated group were culture-negative. Aspirates from all treatment groups were culture-negative by day 6 after the initiation of therapy. Untreated control eyes were culture-positive at all times., Conclusion: IO therapy with VA/AN proved more effective in treating experimental S. aureus endophthalmitis than did IV therapy with IPM alone. IV+IO treatment was not superior to IO treatment alone.

Background: To compare the efficacy of intravenous (IV) imipenem (IPM) and a combination of IV ceftazidime (CAZ) and amikacin (AN) in the treatment of Staphylococcus aureus endophthalmitis in a rabbit model., Methods: Right eyes of 60 albino rabbits were injected with 1000 colony-forming units of S. aureus intravitreally. After 24 h, treatment with either IV IPM (37.5 mg/kg) every 8 h ( n=18) or IV CAZ (50 mg/kg) and AN (10 mg/kg) every 8 hours ( n=18) was begun and continued until the animals were killed at the indicated timepoints; 24 control animals received no treatment. The concentration of bacteria in the vitreous from six animals per group was determined microbiologically on days 2, 3, and 5 after infection, and histologic examination was performed on all eyes., Results: The number of eyes with positive cultures on day 5 was lower in the group that received IV IPM (2/6) compared with the IV CAZ/AN group (4/6) and the control group (6/6). For the culture-positive eyes, the bacterial concentrations were significantly lower for the IV IPM group compared with the IV CAZ/AN group on days 2 and 5 ( P<0.05 and P<0.0065, respectively), but not on day 3 ( P <0.8. Bacterial counts in both treatment groups were significantly lower than in the control group ( P<0.005). Eyes in all groups, however, showed severe intraocular inflammation., Conclusions: IV IPM is more effective than is IV CAZ/AN in reducing the number of bacteria in an animal model of S.aureus endophthalmitis.

Objective: To study whether the clinical outcome of Staphylococcus epidermidis-induced endophthalmitis in rabbits is related to the antibiotic resistance pattern of the infecting strain., Design: Experimental animal study., Participants: The right eyes of 36 New Zealand white albino rabbits were inoculated with strains of S. epidermidis that displayed various patterns of antibiotic resistance., Methods: There were 12 rabbits in each of three study groups: fully antibiotic susceptible (FS), partially antibiotic resistant (PR), and multiresistant (MR). Five days after inoculation, the eyes were enucleated and prepared for histologic studies., Main Outcome Measures: Comparisons among the three groups were made based on electroretinographic (ERG) findings, histologic evaluation by a masked observer, and clinical examination., Results: Electroretinographic findings on all rabbits were made by an unmasked observer. At 30 hours after inoculation, the ERG was diminished to 65% of normal for group FS, compared with a flat ERG waveform for groups PR (P < 0.05) and MR (P < 0.05). The ERG waveform was flat for all three groups at 72 hours after inoculation. Histologic evaluation by use of a histologic score revealed that the degree of inflammation and destruction of the retina was less for group FS (n = 10) compared with groups PR (n = 8) and MR (n = 8). Clinical examination revealed that there was a trend of less ocular inflammation for group FS compared with groups PR and MR., Conclusions: In a rabbit model of S. epidermidis-induced endophthalmitis, antibiotic-susceptible strains caused less inflammation and destruction of the infected retina than did antibiotic-resistant strains.