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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.

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: The aim of this study was to evaluate the postoperative refractive status after pediatric cataract surgery with age-determined intraocular lens (IOL) implantation in children (age 0-8 years) in Malawi., Materials and Methods: Hospital-based retrospective study from January to June 2011 analyzing age, sex, origin, type of cataract surgery, IOL power and postoperative refractive status. In the absence of biometry, IOL powers were chosen according to the child's age and IOL availability., Results: A total of 58 eyes from 33 children were surgically treated of which 25 (76%) were bilateral and 8 (24%) unilateral. Best refractive outcome was achieved with a 25 diopter (D) IOL implanted in children 5-8 years old. None of the children aged 1-7 years achieved the previously calculated target refraction. Results showed a marked myopic variability. The range of postoperative refraction was from - 15 D to + 12.5 D and a large number of children (n=11, 33%) did not attend for follow-up., Conclusion: Implanting IOLs according to age groups is not a suitable surgical strategy even in resource-poor settings. Refractive outcomes were too variable with a marked myopic shift. Biometry and keratometry are required in order to undertake pediatric cataract surgery. Developing regional pediatric centres should be a focus of the VISION 2020 initiative.

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.

Purpose: The aim of this study was to determine the anatomic sites of severe visual impairment and blindness in children in an integrated school for the blind in Malawi, and to compare the results with those of previous Malawian blind school studies., Methods: Children attending an integrated school for the blind in Malawi were examined in September 2011 using the standard WHO/PBL eye examination record for children with blindness and low vision. Visual acuity [VA] of the better eye was classified using the standardised WHO reporting form., Results: Fifty-five pupils aged 6 to 19 years were examined, 39 (71 %) males, and 16 (29 %) females. Thirty eight (69%) were blind [BL], 8 (15 %) were severely visually impaired [SVI], 8 (15 %) visually impaired [VI], and 1 (1.8 %) was not visually impaired [NVI]. The major anatomic sites of visual loss were optic nerve (16 %) and retina (16 %), followed by lens/cataract (15 %), cornea (11 %) and lesions of the whole globe (11 %), uveal pathologies (6 %) and cortical blindness (2 %). The exact aetiology of VI or BL could not be determined in most children. Albinism accounted for 13 % (7/55) of the visual impairments. 24 % of the cases were considered to be potentially avoidable: refractive amblyopia among pseudophakic patients and corneal scaring., Conclusions: Optic atrophy, retinal diseases (mostly albinism) and cataracts were the major causes of severe visual impairment and blindness in children in an integrated school for the blind in Malawi. Corneal scarring was now the fourth cause of visual impairment, compared to being the commonest cause 35 years ago. Congenital cataract and its postoperative outcome were the commonest remedial causes of visual impairment., (Georg Thieme Verlag KG Stuttgart · New York.)

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: Training regulations in Germany and Malawi are compared. One German "Facharztausbildungsordnung" was compared with the syllabus of the Malawian Master of Medicine Degree in Ophthalmology. Germany nowadays has got 7000 ophthalmologists, Malawi nine; population in Germany 80 million, in Malawi 14 million., Methods: We present a written comparison underlined with one illustrative table., Results: Modalities in resident training are very different. Training period: Germany 60 months, Malawi 48 months. Training manner: In Germany mostly theoretical private studies at hospitals and in private practices. Practical advice comes from senior residents, specialists and consultants. It is qualitywise and quantitatively very different within the country. The Malawian syllabus is very structured according to teaching in theory and practice. There are 250 hours of regular teaching each year. Lecturers are especially paid for teaching from outside the country. Training aim in Germany is mainly a medical ophthalmologist whereas in Malawi it is an ophthalmic surgeon. Exams: Germans take part in an oral exam of 30 minutes after 60 months training. Malawian residents take exams every two years: written, oral, practical. Furthermore they are supposed to take part in exams of the ICO (International Council of Ophthalmology) - until now with 100% success for the first attempts., Conclusion: German residents have lots of academic freedom during their training. It is non-uniform. Training aim in Germany is mainly a medical ophthalmologist whereas in Malawi it is an ophthalmic surgeon. The Malawian postgraduate training is uniform with scheduled instructions. That is why quality among candidates can be better compared., (© Georg Thieme Verlag KG Stuttgart · New York.)

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.

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.

Background: As the lens may become absorbed spontaneously extraction of the congenital cataract in the Hallermann-Streiff syndrome is controversial., Patient: A male newborn with Hallermann-Streiff syndrome was referred to the eye clinic because of a bilateral mature cataract. The risks of an operation seemed too serious because the eyes were extremely microphthalmic (a-p diameter approx. 10.5 mm). Instead, it was decided to await spontaneous lens absorption which then occurred slowly and completely between the beginning of the 2nd and the end of the 3rd year of life without considerable inflammatory responses. In the meantime, the child has a good orientation and is able to paint and to discriminate colours without optic correction., Conclusions: The critical investigation of the literature reveals that the frequency of spontaneous lens absorption in the Hallermann-Streiff syndrome is probably (widely) underestimated. It can be estimated with up to 50% (or even more) if patients which were operated on are excluded and if untreated patients are followed up till the end of the 5th year of life. Functional results seem to be quite similar for treated and untreated eyes. Therefore we would recommend to await the spontaneous lens absorption in the Hallermann-Steiff syndrome especially when the cataract is combined with considerable microphthalmia.