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Background: The risk for glaucoma is 4-5 times higher in patients from sub-Saharan Africa. Thus, especially in developing countries an easy and effective method for assessing the intraocular pressure (IOP) is needed., Methodology: In this hospital-based survey 150 eyes were divided into 3 groups concerning the IOP (group I < 16 mmHg, group II 16-23 mmHg and group III > 23 mmHg) and underwent examination with ultrasound pachymetry followed by iCare tonometry (ICT) and Goldmann applanation tonometry (GAT). Agreement of the measurements by two tonometers was assessed with the Bland-Altman method and the influence of the central corneal thickness (CCT) on the ICT measurements was determined., Results: The mean difference between the IOD measured with GAT and ICT was 0.84 ± 2.63 mmHg. The differences were similar in all three groups (0.77-0.97 mmHg), however, the standard deviation in group III (4.04 mmHg) was greater than in groups I (1.98 mmHg) and II (1.79 mmHg). The mean CCT was 513.51 ± 36.22 µm., Conclusions: The agreement of measurements by GAT and ICT was good for lower IOP values but less accurate in patients with higher IOP values (group III). A dependency of the CCT on the ICT measurements was observed. In comparison to other countries the lowest CCTs were found in Malawian patients.

Purpose: To evaluate the prevalence of undiagnosed and asymptomatic HIV infection in patients with ocular surface squamous neoplasia (OSSN) in an urban patient population in Malawi., Methods: A consecutive series of patients presenting with OSSN was evaluated in an African academic centre. A detailed history and physical examination in 53 consecutive patients with conjunctival squamous cell carcinoma and conjunctival intraepithelial neoplasia were performed. Thirty eight (72%) patients agreed to undergo serological HIV testing., Results: Seventy-nine per cent (30 of 38) patients were HIV positive. None of the patients had previous HIV testing or was aware of having symptoms of HIV. Seventy per cent (n = 21) of the HIV-positive patients had no other symptoms suggestive of HIV infection or any other disease. Patients were far more likely to refuse HIV testing if they were married and male., Conclusions: The conjunctival tumour may be the primary and only apparent manifestation of HIV in patients presenting with OSSN in Sub-Saharan Africa.

Objective: To determine the prevalence of lens opacity in black Africans., Design: A retrospective study., Setting: Eye Ward, Queen Elizabeth Central Hospital (QECH), Blantyre between July and December 1997., Subjects: Case notes of 299 patients aged six months to 84 years with cataracts were studied., Results: Over 90% of the patients were referred from all ten district hospitals in the southern region. Of the 647 patients admitted in the Eye Ward, 299 patients (46.2%) had cataracts--206 (68.8%) males and 93 females (31.1%). Bilateral cataracts accounted for 61.9%; 22.4% were on the left eye and 15.7% on the right eye. Senility was the leading cause of cataracts in adults, being commonest among unskilled (48.8%) compared to skilled (15.1%) patients, but in children congenital cataracts (53.7%) were the most common., Conclusion: Cataracts accounted for nearly half the admissions in the eye ward. Laterality is reported probably for the first time in Central Africa--bilateral cataracts being more common than unilateral ones, and the leading cause of cataracts in adults was senility whereas congenital cataracts were commoner in children. The prevalence increased with age, males being affected more than females. These findings suggest cataracts as the leading cause of blindness. Community-based studies to determine the prevalence and profile of cataracts are recommended.