Includes abstract. Includes bibliographical references (leaves 42-45). Library also has copy on CD-ROM.

Includes abstract. / Includes bibliographical references (leaves 38-43). / The purpose of this study was to determine the visual function and quality of life of patients 6 months after undergoing pars plana vitrectomy for diabetic retinopathy complications at the Groote Schuur Hospital. The study also investigated the association between quality of life and the indications for surgery, the type of procedure performed, pan-retinal photocoagulation before surgery, the duration of complications, age, gender, the presence systemic disease and best-corrected visual acuity (BCVA).

Objective: The primary objective of the study is to determine the efficacy of diode laser cyclophotocoagulation in terms of the amount of intraocular pressure (IOP) drop achieved in glaucoma patients at Groote Schuur Hospital. The secondary objective is to determine the safety of the procedure by analysing the complications that arose as a result of the cyclodiode treatment. Methods: A retrospective file review was conducted on the diode laser cyclophotocoagulation (cyclodiode) procedures done at Groote Schuur Hospital Eye Clinic over a one year from 1 January 2014 to 31 December 2014. All the patients who received cyclodiode therapy at Groote Schuur Eye Clinic during this time period were included. There were no exclusion criteria. Data was collected on age, gender, laterality of procedure, pre-procedure visual acuity (VA), pre-procedure IOP, post-procedure VA at 3, 6 and 12 months, post-procedure IOP at 3, 6 and 12 months, medication pre- and post-procedure, type of glaucoma, prior glaucoma surgery, total number of laser spots applied, average laser power used (mW), number of laser sessions received and complications of the procedure documented at 3 months post procedure. Data analysis was performed using Microsoft Excel 2016. Results: There were 64 eyes treated over the 12-month period. Neovascular glaucoma was the most common glaucoma (44%). There was a significant difference between the pre- and the post-treatment IOP at each of three (p<0.00001), six (p=0.00026), and 12 months (p=0.0012) (paired samples t-test) with a mean IOP drop of 10mmHg. There was no significant difference between the visual acuity before and after treatment at three months (p=0.13) (paired samples t-test). There was a significant difference between the visual acuity before and after treatment at six months (p=0.0078) and at 12 months (p=0.0083) (paired samples t-test). Before treatment, 98% of patients were receiving anti-glaucoma medical treatment and at three months after treatment, the number of eyes on medical treatment had decreased to 90% of the patients. This decrease was not significant (p=0.06) (chi-squared test). The mean number of three anti-glaucoma medications being used remained unchanged but the number of patients receiving oral anti-glaucoma treatment decreased from 59% to 37% post-procedure. No complications were found in 60% at 3 months post-procedure. Conclusion: Transscleral cyclodiode is a safe procedure with a mean IOP decrease exceeding 10mmHg. Although this may not be enough to allow the cessation of all anti-glaucoma medication, it is often enough to allow the cessation of oral anti-glaucoma medication.

Includes bibliographical references / Objectives 1. To review the clinical presentation, management and outcomes of patients who were diagnosed and treated for cytomegalovirus (CMV) retinitis at Groote Schuur Hospital over a 10 year period 2. To review and compare the treatment protocols of thirteen public hospital centres in South Africa that treat patients for CMV retinitis Design & method This is a retrospective cohort study. A record review of 141 eyes in 91 patients diagnosed with and treated for CMV retinitis between 2003 and 2013 was performed. Additionally, a standard questionnaire was sent to thirteen public hospitals in South Africa that treat patients for CMV retinitis to determine current treatment protocols. At Groote Schuur Hospital, all cases of suspected CMV retinitis undergo a vitreous biopsy for polymerase chain reaction (PCR) confirmation. Treatment consists of weekly intravitreal ganciclovir injections until clinical resolution has taken place. Patients not on highly active anti-retroviral treatment (HAART) are referred for initiation of treatment. Ganciclovir treatment is continued until immune reconstitution has taken place.

Background Completing a research dissertation or Master of Medicine (MMed) degree during ophthalmology specialist training has now become compulsory in order to qualify as an ophthalmologist in South Africa. At a national level there is currently no co-ordinated effort to standardize research training and resources for trainees. Objectives The primary objective was to determine if South African ophthalmology trainees were interested in doing research. Secondary objectives were to determine: whether they felt that their current research training was adequate; whether a national web-based research support system would be desirable; and whether such a support platform would stimulate involvement in further research once training was completed. Methods A questionnaire was designed and anonymously completed by the trainees in each training unit in South Africa. Categorical responses were summarized using crude and weighted means with 95% confidence intervals (CI). Free text responses were analyzed thematically using an inductive approach. Results Out of 81 trainees (registrars) in South Africa at the time of the survey, 64 fully completed the questionnaire - a response rate of 79%. Seventy-two percent (95% CI 57% to 87%) of the trainees reported that they were interested in doing research. Only 28% (95% CI 18% to 41%) of respondents felt that their current research training was adequate. Ninety five percent (95% CI 86% to 99%) of trainees advocate a web-based support platform would be beneficial an eighty six percent (95% CI 74% to 93%) reported such would motivate them to continue to do research once their training was complete. The themes from the qualitative data were in keeping with the quantitative results and identified variation between training institutions in terms of available research resources, supervision and allocated time to perform research. Conclusion The trainee ophthalmologists in South Africa are interested in performing research. They feel that their current research training programs are inadequate. There is a strong need for nationally standardised research guidance to eliminate the current variation between training institutions. Guidance on dedicated time allocation to complete the research component of training should be provided by regulatory bodies. A proposed web-based support system may be a good option to standardize selected available research resources and provide equal access to all trainees nationally as well as to supplement research output during and after specialist training. Further research should address the reported lack of supervision and elucidate additional barriers to performing research in South Africa.

Objective To report 10 cases of dual-positive intraocular fluid PCR results in infectious retinitis where both pathogens may be clinically relevant. Methods A retrospective observational case series including 10 patients with infectious retinitis who demonstrated more than 1 positive result on PCR testing over a 10-year period at a single referral centre. Results Of 619 patients who underwent intraocular fluid PCR testing for infectious retinitis, we identified 10 patients (1.62%) where 2 organisms were isolated. All 10 patients were HIV positive with profound immunosuppression (mean CD4 count 67cells/mm3) and extensive retinitis. CMV was identified in all 10 cases whilst the additional pathogen was VZV in 6 cases, Toxoplasma gondii in 3 cases and HSV in 1 case. Conclusions PCR analysis of ocular fluids is important in this clinical scenario since more than one pathogen may be present and clinically relevant. Clinicians should be aware of this rare phenomenon to ensure that, when it does occur, consideration be given to adjusting treatment to cover both organisms.

AIMS: Missed cataract surgical appointments are an important cause of inefficiency, with delays in appropriate treatment, loss of continuity of care, and wasted resources. This study was conducted to determine if an SMS reminder system will reduce the failure to attend (FTA) rate by our patients who are booked for cataract surgery. METHODS: A randomised controlled trial was conducted at Groote Schuur Hospital between June 2015 and June 2016. Eligible patients were randomised into one of two study groups: either the "NO reminder control group "or the "SMS reminder intervention group". Patients in the SMS reminder group were entered into a secure web platform from which the automated SMS reminder system dispatched an SMS reminder one month, four days and one day pre-operatively between 10am and 12am. The message contained the following: "Dear "Mr/Mrs name", this is to confirm your cataract surgery at Groote Schuur Hospital, booked for "date". Please phone 021 404 3541 if any queries." RESULTS: 234 patients were enrolled into this study, and 15 patients were excluded. Of the remaining 219 patients, 111 were randomised into the NO reminder group (control) and 108 into the SMS reminder group (intervention). SMS reminders reduced the FTA rate by 52.6% from 11.7% to 5.6% (p=0.11). Transport problems were identified as the most common reason for non-attendance. CONCLUSION: An SMS reminder system aids in the reduction of non-attendance for booked cataract surgery. With an estimated cost of only 54 cents for three SMS reminders, this affordable intervention results in an improved efficiency of clinical service delivery.

Objective: To determine the clinical profile, causes and response to corticosteroid therapy in patients admitted and treated for optic neuritis at a tertiary hospital in Cape Town, South Africa. Methods: A retrospective case review was conducted of 117 patients admitted to Groote Schuur Hospital and treated for optic neuritis between January 2002 and December 2012. Inclusion criteria were based on clinical findings of acute optic nerve dysfunction with or without optic disc swelling. Demographic information, clinical presentation, course of illness, investigations performed and visual outcomes at discharge and at three month follow up were collected. Data analysis was performed using STATA version 10.0. Results: 60 of 117 patients (51%) had an identifiable secondary cause for optic neuritis. Of the 57 patients with idiopathic optic neuritis only 14 had features of "typical optic neuritis" associated with demyelinating disease. HIV and syphilis accounted for 62% of secondary causes of optic neuritis. Presenting visual acuity of hand movements (HM) or worse and absence of pain with extra ocular movement were associated with poorer final visual outcomes in the idiopathic optic neuritis group. Conclusion: Optic neuritis in our patients, as elsewhere in Africa,tends to be atypical in presentation, with a high proportion of patients having an identifiable, most commonly infectious, cause.These patients thus require more extensive investigation in order to identify possible causes which may influence management. In settings with a high HIV prevalence, HIV and syphilis testing should form part of the routine first line investigations for patients with optic neuritis.Secondary optic neuritis and idiopathic atypical optic neuritis carry a poorer prognosis than typical demyelinating optic neuritis.

Background: Ethambutol hydrochloride and linezolid are commonly used anti-tuberculous agents. Both agents can cause potentially blinding toxic optic neuropathy. Currently there is no low-cost, sensitive screening tool to detect early toxicity before permanent vision loss has occurred. Purpose: To evaluate the ability of the Adams D-15 colour vision test to detect early ethambutol- and linezolid-induced optic neuropathy. Methods: This was a retrospective case series of 15 patients who were screened for ethambutol- and linezolid-induced toxic optic neuropathy. At screening and follow-up visits, a detailed clinical history was taken, a standard of care examination performed and a battery of side-room investigations conducted, including: Farnsworth Munsell D15 (FM D15) and Adams D15 colour vision tests, retinal nerve fiber layer optical coherence tomography (RNFL-OCT) and a Humphrey visual field 24-2 (HVF 24-2). According to the results of these tests, the patients were classified into 3 groups: “No toxicity”, “Uncertain toxicity” or “Confirmed toxicity”. Results: Six patients were classified as “No toxicity”, 3 were “Uncertain toxicity” and 6 were classified as “Confirmed toxicity”. The Adams D15 showed a sensitivity of 100% for detecting a toxic optic neuropathy. Conclusion: The Adams D15 is a sensitive screening tool for the detection of early ethambutol- and linezolid-induced optic neuropathy.

Purpose/Aim of the study: To assess if corneal epithelium can be cultured ex-vivo from corneas eviscerated due to irretrievable trauma, according to a cell culture method which made use of autologous platelet-rich plasma (A-PRP) as culture substrate. To compare corneal epithelium cultured ex vivo from corneas eviscerated following trauma using A-PRP combined with DMEM (Dulbecco's modified Eagles medium), versus DMEM alone. Materials and Methods: This was a laboratory case controlled study of human corneal cells cultured in a mixture of A-PRP and DMEM, versus DMEM alone from 6 eviscerated corneas. A hundred explants were created of which fifty explants were plated on A-PRP-gel construct combined with DMEM and fifty controls were placed in serum free DMEM alone. Donor patients received systemic antibiotics prior to evisceration. Results: Confluent epithelium in mono-layers could be cultured when donor limbal biopsies were placed in a mixture of A-PRP culture medium and DMEM. No growth were observed when corneas were placed in serum-free DMEM medium only (p<0.05). No bacterial infection was observed in cultures. Conclusions: This study demonstrated that autologous platelet rich plasma is a viable and effective alternative to bovine serum for the ex-vivo expansion of limbal epithelial cells. It also shows that eviscerated corneas are a viable source of donor tissue for this purpose in South Africa where access to tissue banks is limited.