Retinal detachment in southwest Ethiopia: a hospital based prospective study

Effect of race and ethnicity on surgical outcomes for rhegmatogenous retinal detachments

OBJECTIVE

To evaluate the effect of socioeconomic and demographic factors on outcomes in rhegmatogenous retinal detachments (RRDs).

DESIGN

Retrospective cohort study.

METHODS

A total of 71 white and 124 black and/or Hispanic patients who had surgical repair of RRDs between October 2013 and September 2021 at a single-centre safety net hospital. Main outcomes were single surgery success rates (SSSR) and postoperative visual acuity at 6-month and final follow-up.

RESULTS

Black and (or) Hispanic patients were significantly younger (black and [or] Hispanic, 50.7 years vs white, 57.6 years; p = 0.003), had lower mean household incomes (black and [or] Hispanic, $80,932 vs white, $92,911; p = 0.007), were more likely to have more than 1 retinal break (black and [or] Hispanic, 65% vs white, 49%; p = 0.04), and had higher rates of proliferative vitreoretinopathy (PVR) at presentation (black and [or] Hispanic, 35% vs white, 18%; p = 0.02). SSSR was similar (black and [or] Hispanic, 73.4% vs white, 73.2%; p = 0.98), but black and (or) Hispanic patients had worse visual acuity postoperatively (black and [or] Hispanic, 20/63 vs white, 20/40 at final follow-up; p = 0.03). While race was linked to visual outcome in univariate testing; multivariate analysis revealed only macula status (p = 0.007 at 6 months; p = 0.01 at final follow-up), presence of PVR (p < 0.001 at both time points), and SSSR (p = 0.003 at final follow-up) as predictors of worse visual outcomes.

CONCLUSIONS

Preoperative factors such as higher rates of PVR may contribute to worse vision outcomes in black and (or) Hispanic patients undergoing surgical repair for RRD.

The fellow eye of retinal detachment patients: Vision and clinical presentation

Background

The fellow eye of a retinal detachment is at risk of developing a retinal detachment and other visually debilitating disease.

Aim

To investigate the rate of bilaterality of retinal detachment (RD), the presenting visual acuity (VA), and the presence of ocular morbidity in the fellow eye of patients with RD.

Patients and Methods

A multicenter, prospective, cross-sectional study examining the fellow eye of consecutive patients who were diagnosed with different types of RD. The patients were seen within one year and examined in four Nigerian eye hospitals and clinics. Demographics, VA, and clinical findings at the presentation were reported on examination of the fellow eyes.

Results

Twenty-seven (11.4%) out of 237 patients (264 eyes) had an RD in the fellow eye. The mean age of all study patients was 46.2 ± 16.8 years, M/F: 161 (67.9%)/76 (32.1%). The rates of bilaterality for rhegmatogenous, exudative, and tractional RDs were 4.2%, 11.1%, and 31.1%, respectively. Diagnosis of RD in an eye was associated with a risk of developing fellow eye rhegmatogenous retinal detachment (RRD) (P < 0.001) and tractional RD (P < 0.001), respectively. RRD in an eye was associated with a 17% risk of developing RD in the fellow eye (β = -1.6, OR = 0.202, P < 0.001). The BCVA in the fellow eye of the three types of RD varied significantly (P < 0.001). The fellow eye was blind in 25.2% of RRD, 54.1% of tractional retinal detachment (TRD), and 11.1% of exudative retinal detachment (ERD). Bilateral RD eyes were blind in RRD (85.7%), TRD (71.1%), and ERD (50%). One hundred and seven eyes (40.5%) of the total 264 RD eyes studied had other fellow eye events at the presentation.

Conclusion

A patient with an RD in one eye is at significant risk of developing a blinding RD in the fellow eye. This risk varies with the type of RD and is highest with TRD. However, RRD, the commonest type of RD, can benefit from prophylactic treatment to the fellow eye RD predisposing lesions.

Neglected cause of retinal detachment: a hospital-based case-control study on occupational heavy lifting as a risk factor

Background

Heavy lifting may lead to sudden increase in venous, intra-abdominal, and intraocular pressure which in turn may cause retinal detachment (RD). The epidemiological evidence for this association is still inconclusive. This study was carried out to investigate the relationship between occupational heavy lifting and RD.

Methods

A case-control study was carried out on 151 RD cases and 113 controls free of RD attending the ophthalmology outpatient clinic at Ain Shams University. Personal, medical, and occupational data were collected using interview questionnaires in addition to conducting full ophthalmologic examination.

Results

The mean age of study participants was 45.8 ± 9.1 years (46.8 ± 8.9, 44.4 ± 9.2 for RD cases and controls respectively). Statistically significant differences were found between cases and controls regarding years of working, occupational categories, frequency of occupational heavy lifting, non-work heavy lifting, history of head trauma, history of eye surgeries, and family history of RD. Multivariate logistic regression analysis showed that lifting (Odds ratio (OR) = 4.8, p < 0.0001), history of head trauma (OR = 3.3, p = 0.013), diabetes mellitus (DM) (OR = 4.96, p < 0.0001), and previous eye surgeries (OR = 3.5, p = 0.003) increased the risk of RD.

Conclusion

Occupational heavy lifting is associated with RD. Occupational categories, duration of lifting heavy objects during work and family history of RD had a significant effect on RD. An ergonomic approach should be adopted and practiced as it has a significant impact on reducing the risks of lifting and carrying heavy objects. The workplace’s design (including having appropriate mechanical aids available) is also of significant importance to reducing the risks. During the patient’s visit, ophthalmologists should consider and look for the occupational heavy lifting history as a potential risk factor of the patient’s symptoms.

MYP2 locus genes: Sequence variations, genetic association studies and haplotypic association in patients with High Myopia

High Myopia (HM) is a common complex-trait eye disorder. There is essential evidence that genetic factors play a significant role in the development of nonsyndromic high myopia. Identification of susceptibility genes of high myopia will shed light on the pathophysiological mechanism underlying their genesis. This was a case control study examining the prospect of association of DLGAP1, EMILIN2 & MYOM1 genes on MYP2 locus in purely ethnic (Kashmiri) population representing a homogeneous cohort. Genomic DNA was extracted using phenol chloroform and salting out method. Extracted DNA was genotyped for polymorphic variations in MYOM1, EMILIN2 and DLGAP1 genes involving Sanger di-deoxy method. Allele frequencies were tested for Hardy-Weinberg disequilibrium in 224 cases and compared with 220 emmetropic controls. In DLGAP1, documented single nucleotide polymorphism (SNP); Pro517Pro was observed. A previously reported Asn451Asn SNP was observed in EMILIN2. MYOM1 showed five polymorphic variations; two in coding region (Gly333Gly & Gly341Ala) and three intronic (c.1022+23, G>A; c.3418+44 G>T & c.3418+65; C>G). All of the elucidated SNPs were having statistical significant role in increasing or decreasing the risk of disease. Although not statistically significant, a novel Glu507Lys SNP was observed in DLGAP1 (P>0.05). In silico predictions showed MYOM1 Gly341Ala to be benign & tolerated substitution while as DLGAP1 Glu507Lys to be possibly damaging substitution. The studied SNPs followed Over-Dominant, Recessive and Co-Dominant mode of inheritance with specific haplotypes associated with the disease. Our study reveals the involvement of MYP2 locus candidate gene polymorphism in the pathogenesis of HM.

Indications and outcomes of vitrectomy surgery in a series of 1000 black African eyes

Objective

To determine the common indications for, and outcomes of pars plana vitrectomy surgery among black Africans in a low-resource setting.

Methods and Analysis

A retrospective, non-comparative case review was undertaken. Data from 1000 consecutive eyes of 1000 patients in a single centre who underwent pars plana vitrectomy surgery between May 2005 and July 2013 were used for the study. Demographic data, primary indication for surgery, ocular status and outcomes were assessed.

Results

Rhegmatogenous retinal detachment was the most common primary indication occurring in 61.8% of eyes. Diabetic vitrectomy, trauma and proliferative sickle cell retinopathy were also common indications occurring in 10.1%, 6.1% and 4.5% of eyes, respectively. At presentation, 33% of patients with retinal detachment had some form of proliferative vitreoretinopathy, and half of those had the more advanced grades C and D. Patients presented on an average of 13.5 months after onset of symptoms. As a result, visual outcomes were less than other reported studies.

Conclusion

Retinal detachment was the most common indication for vitrectomy, but even these cases presented late with an advanced presentation. This study highlights the need for affordable and accessible vitreoretinal services in Sub-Saharan Africa and increased awareness of general eye health, along with strategies to reduce trauma and identify early those at risk of chronic eye diseases, such as diabetic retinopathy and sickle cell retinopathy.

Prevalence, pattern, magnitude and associated factors of trauma in the Emergency Department at Health Institutes in Ethiopia: A systematic review

BACKGROUND

Trauma is one of the important public health problems that causes significant economic and social crisis with more than 10% of all disease cases are associated with it. We aimed to identify and describe the prevalence, patterns, magnitude and associated factors of trauma in the Emergency Department at Health Institute in Ethiopia.

METHODS

In this systematic review, we searched for peer-reviewed and grey literature publications reporting the prevalence, pattern, magnitude and associated factors of trauma between 2000 and 2019. The documents which recruited are directly related to trauma and emergency department. In this regard, we searched databases of PubMed, Elsevier, Science directed, MEDLINE, and Google scholar by using Google as searching engine. Furthermore, publication with secondary data and not in English was excluded.

FINDINGS

A total of 9,768 injured participants were included in the studies, of which 71.2% (6950) were males. Among the injured participants, 53.4% of cases were living in Addis Ababa followed by Gondar and Jimma with 20.3% and 11.3% cases, respectively. Severe road traffic accident, occupational injury, and surgical patients were among the major risk factors of trauma. The mortality rate of the trauma case fatality was reached about 4%. The majority of the studies (37.5%) analyzed the pattern and magnitude of trauma among patients seen at emergency outpatient department of health institutes in Ethiopia. The largest percentage of studies (62.5%) relied on systematic random sampling. Thirty eight percent of the reviewed studies were utilized retrospective approaches to address the research questions. An completed the registry forms and/or Kampla Trauma Score (KTS), which accounted for 37.5% of articles on prevalence, pattern, magnitude and associated factors of trauma in the emergency was the most commonly used strategy. The majority (75%) of the reviewed studies were used both descriptive statistics and bivarate and multivariate logistic regression for data analysis. The majority 6950 (71%) of the participants who have been included in those reviewed articles were male and 2818 (29%) were female by gender. Meanwhile, the majority 5 (62.5%) of reviewed studies had included < 1000 injured persons.

CONCLUSION

The degree and types of injuries in different hospitals in Ethiopia was considerably high and its casualty is also under predictable. Therefore, a variety of actions including policy decision should be implemented in order to minimize the incidence of trauma at department of emergency care center in the country.

Management of a rhegmatogenous retinal detachment in a low-resource setting: treatment options when there is no vitreoretinal surgeon

We discuss the case of a 49-year-old soldier with a macula-on rhegmatogenous retinal detachment in Sierra Leone. The case highlights the challenge of accessing visually preserving ophthalmic specialist care in sub-Saharan Africa (SSA) for vitreoretinal (VR) disease. It highlights a shortage of VR surgeons in SSA, limited examination facilities, the larger issue of accessing specialist care urgently and the costs associated with accessing surgery out-of-country. It also identifies a shortage in epidemiological data on the issue which limits the assessment of the scale of the problem.

Rhegmatogenous retinal detachment in uveitis

Background

Retinal detachment is more common among uveitis patients than in the general population. Here, we aimed to assess the prevalence of rhegmatogenous retinal detachment (RRD) in a uveitis population.

Methods

We retrospectively studied 851 uveitis patients, recording characteristics such as uveitis duration, anatomical location, and cause; RRD occurrence; proliferative vitreoretinopathy (PVR) at presentation; surgical approach; reattachment rate; and initial and final visual acuity (VA).

Results

RRD occurred in 26 patients (3.1%; 29 affected eyes) and was significantly associated with posterior uveitis (p < 0.001), infectious uveitis (p < 0.001), and male gender (p = 0.012). Among cases of infectious uveitis, cytomegalovirus and varicella zoster virus were most commonly associated with RRD development. RRD in non-infectious uveitis was not found to be associated with any specific uveitis entity. The rate of single-operation reattachment was 48%, and the rate of final reattachment was 83%. Mean final VA was 20/125, with 41% of eyes ultimately having a VA of less than 20/200.

Conclusion

Uveitis is a risk factor for RRD development, which carries a poor prognosis.

[Risk factors for retinal detachment in Togo]

INTRODUCTION

Retinal detachment poses management problems in developing countries due to the shortage of technical equipment. Prevention passes through knowledge and elimination of risk factors. This study aimed to identify the risk factors for retinal detachment in people living in Togo.

METHODS

We conducted a retrospective and descriptive study in the Department of Ophthalmology at the Chu-Campus and in an ophthalmology office in Lomé from 2 January 2011 to 31 December 2015. The medical records of patients with retinal detachment were included in the study. The diagnosis of retinal detachment was confirmed based on funduscopic exam or ocular ultrasound.

RESULTS

in total, 116 eyes of 100 patients had retinal detachment of whom 40 in the RE, 44 in the LE and 16 bilaterally. The average age of patients was 46.65 ± 16.46 years [07 years; 87 years], with a male predominance and with a sex-ratio = 0.32 (W/M). Diabetic patients accounted for 17% and patients with sickle cell disease accounted for 16%. Myopic patients accounted for 5%, pseudophakic patients accounted for 17.2% and aphakic patients accounted for 3.4%. Four patients had retinal tear (14.28% of rhegmatogenous detachment) including 2 superotemporal tears, 1 inferior nasal tear and 1 inferior temporala tear. 35 eyes (52.2%) had total retinal detachment while 24 eyes (35.8%) had partial retinal detachment. Twenty eyes had vitreoretinal proliferations, 5 eyes had itreous hemorrhage and 6 eyes had hyalite. Diabetes and sickle cell disease were the risk factors for tractional RD (p=0.006 and p=0.0003) while cataract surgery was the risk factor for rhegmatogenous RD (p=0.0097).

CONCLUSION

Diabetes, sickle cell anemia and eye surgery were the major risk factors for RD. A better management of these pathologies and ophthalmologist's mastery of cataract surgery may prevent retinal detachment.

Outcomes of Vitrectomy in Pediatric Retinal Detachment with Proliferative Vitreoretinopathy

AIM

To report outcomes of pars plana vitrectomy (PPV) in pediatric retinal detachment (RD) with proliferative vitreoretinopathy (PVR), complications, factors influencing the final anatomical and functional results.

METHODS

Retrospective consecutive case series of 14 eyes. Average postoperative follow-up period was 34 months.

RESULTS

Mean age of patients was 10 years; eleven patients (79%) were males. The most common etiology was trauma (57%), the second-myopia (36%) and one case of uveitis (7%). At the day of presentation, the best-corrected visual acuity (BCVA) was worse than hand motion (50%); macula was detached in 86% of cases. Simultaneous PPV and phacoemulsification with intraocular lens (IOL) implantation were performed in 12 cases (86%). The most common endotamponade during PPV was silicone oil (93%). Anatomic reattachment was accomplished in 86% of cases. Final BCVA was equal or better than 0.1 in 50% of patients. The postoperative complications were found in 5 eyes (36%).

CONCLUSION

Complete PPV was allowed for anatomically reattached retina and preserved vision in pediatric complex RD with PVR. However, visual outcomes were not satisfactory. Preserving vision in children with RD is of great importance for their future motor and intellectual development. This trial is registered with ClinicalTrials.gov Identifier: NCT03208205.

Incidence and risk factors associated with retinal redetachment after silicone oil removal in the African population

The purpose of this study was to investigate the incidence and risk factors associated with retinal redetachment after silicone oil (SO) removal in the African population. A retrospective cohort study was performed on patients undergoing SO removal over a period of 4 years. The risk factors assessed were (1) characteristics of the retinal detachments including type of retinal detachment, type, number and location of the retinal tears, and proliferative vitreoretinopathy (PVR) score, and (2) surgical factors including type of silicone oil used, use of laser prior to SO removal, and location of the laser (360° or around the tear only). SO was removed either through a pars plana approach or transpupillary approach and anterior limbal incision. Ninety-nine eyes met the inclusion criteria during the study period. Twelve patients (12 %) had retinal redetachment after SO removal. Factors associated with redetachment were a preexisting macular hole, PVR grade B or worse, and no intraoperative endolaser photocoagulation. The incidence of redetachment in African population is similar to that reported from developed countries and other advanced vitreoretinal centers. Redetachment occurred at higher rates in patients with preexisting macular holes and tears who did not receive intraoperative endolaser photocoagulation and patients with a severe grade of PVR.

RISK OF RHEGMATOGENOUS RETINAL DETACHMENT WITH CENTRAL SEROUS CHORIORETINOPATHY

PURPOSE

To investigate the risk of rhegmatogenous retinal detachment (RRD) after central serous chorioretinopathy (CSCR).

METHODS

The study included 2,830 patients with CSCR and 16,980 control patients matched using a propensity score for age, sex, and comorbidities including status after cataract operation, blunt trauma, myopia, diabetes mellitus, hypertension, and hyperlipidemia from January 2001 through December 2010 from the Taiwan Longitudinal Health Insurance Database 2000. Information of each patient was collected until December 2011. Cox proportional hazard regression analysis was used to obtain the adjusted hazard ratio for RRD. The RRD-free survival rate was calculated using Kaplan-Meier analysis.

RESULTS

Thirty-five patients with CSCR (1.24%) and 27 controls (0.16%) had RRD (P < 0.0001) during follow-up, resulting in a significantly higher risk of RRD in the patients with CSCR (incidence rate ratio = 7.83, 95% confidence interval = 4.74-12.93). After adjustment for potential confounders, the adjusted hazard ratio for developing RRD was increased 7.85 times in the cohort of total sample (adjusted hazard ratio = 7.85, 95% confidence interval = 4.75-12.97).

CONCLUSION

It was found that CSCR increased the risk of RRD even after adjustment for age, sex, and comorbidities including status after cataract operation, blunt trauma, myopia, diabetes mellitus, hypertension, and hyperlipidemia.

Genetic analysis of axial length genes in high grade myopia from Indian population

Purpose

To study the putative association of Membrane frizzled related protein (MFRP) and Visual system homeobox protein (VSX2) gene variants with axial length (AL) in myopia.

Method

A total of 189 samples with (N = 98) and without (N = 91) myopia were genotyped for the MRFP and VSX2 variations in ABI Prism 3100 AVANT genetic analyzer. Genotype/haplotype analysis was performed using PLINK, Haploview and THESIAS softwares.

Results

Fifteen variations were observed in the MFRP gene of which, rs36015759 (c.492C > T, T164T) in exon 5 was distributed at a high frequency in the controls and significantly associated with a low risk for myopia (P = 4.10 ∗ e^− 07 OR < 1.0). An increased frequency for the coding haplotype block [CGTCGG] harboring rs36015759 was observed in controls (31%) than cases (8%) that also correlated with a decreased mean AL (− 1.35085; P = 0.000444) by THESIAS analysis. The ‘T’ allele of rs36015759 was predicted to abolish the binding site for splicing enhancer (SRp40) by FASTSNP analysis.

Conclusion

Myopia is a complex disorder influenced by genetic and environmental factors. Our work shows evidence of association of a specific MFRP haplotype which was more prevalent in controls with decreased AL. However, replication and functional studies are warranted to confirm these findings.