Purpose: To test the viability of implanting the Artisan®/VerisyseTM lens in a low-income monocular aphakic African population with insufficient capsular support where contact lens wear is expensive and spectacle correction is not possible, by assessing the postoperative visual functions. To further assess whether adverse effects (e.g.: pigment dispersion with secondary glaucoma, prolonged uveitis) in patients with highly pigmented irises would be as low as with patients in European and American trials. Methods: A prospective, randomised, controlled clinical trial comparing outcomes in two groups of unilateral aphakic patients. The patients in the first group received an Artisan intra-ocular iris-claw lens as a secondary procedure while the second group remained aphakic (the current treatment status quo for public patients in KwaZulu-Natal province in South Africa). Follow-up was done for 1 year. Results: The study was terminated early due to ethical and statistical reasons. Nine treated and five control patients were included. Monocular uncorrected vision was significantly higher in the treatment group (P=0,012) and patient satisfaction was higher (p=0,002). Changes in other variables (intraocular pressure, angle pigmentation, change in cup-to-disc ratio, iris pigment changes and best spectacle corrected vision) were not significantly different between the two groups. Conclusion: The Artisan®/VerisyseTM lens is a feasible option for aphakic African patients with regard to visual outcome, safety and patient satisfaction. This form of refractive correction should be the standard for patients with no capsular support and where other options are too expensive or carry greater risk. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2007.

Purpose: To compare the safety and efficacy of intravitreal (IVT) and sub-Tenon (ST) triamcinolone acetonide for the treatment of refractory diffuse diabetic macular oedema. Method: 29 eyes of 22 patients with long-standing, diffuse diabetic macular oedema refractory to argon laser treatment were randomly assigned to a single 4mg injection of IVT triamcinolone acetonide or a 40mg sub-Tenon injection. Patients were subsequently monitored for six to nine months. Outcome measures were visual acuity, intraocular pressure, macular thickness on optical coherence tomography and adverse effects. Results: There was no significant improvement in visual acuity in either group. A transient decrease in macular thickness was found in the IVT group but not in the ST group. There were no significant adverse effects apart from a mild to moderate intra-ocular pressure rise found more frequently in the IVT group. Conclusion: IVT and ST triamcinolone acetonide injections for refractory diffuse diabetic macular oedema appear relatively safe and well-tolerated. IVT injection produces a significant temporary decrease in macular thickness in patients with long-standing diffuse diabetic macular oedema while ST injection does not. Neither intervention was shown to significantly improve visual acuity in this group of patients.

Thesis (PhD (Surgical Sciences. Ophthalmology))--Stellenbosch University, 2008. / Purpose: To evaluate the outcome of primary adult optical penetrating keratoplasty (PKP) at a public health service hospital of a developing country. Patients and Methods: A retrospective review was performed of the medical records of every patient 12 years of age or older who underwent PKP for keratoconus, corneal edema, stromal scarring, or stromal dystrophy at King Khaled Eye Specialist Hospital in the Kingdom of Saudi Arabia between January 1, 1997, and December 31, 2001, and for whom a minimum of 3 months’ follow-up was available. Results: Of 910 eyes that met the inclusion criteria, there were 464 eyes with keratoconus, 188 eyes with corneal edema, 175 eyes with stromal scarring, and 83 eyes with stromal dystrophy. For the entire group, the probability of graft survival was 96.7% at 1 year, 86.2% at 3 years, and 80.9% at 5 years. Five-year survival probability was best with keratoconus (96.1%), followed by stromal dystrophy (85.9%), stromal scarring (71.1%), and corneal edema (40.3%). The probability of graft survival differed significantly among the surgical indications at all postoperative intervals (P<0.001). Factors associated with a significantly increased risk of graft failure on multivariate Cox proportional hazard regression analysis included increasing donor tissue age (P = 0.005) and decreasing recipient graft size (P = 0.02). Final visual acuity of 20/40 or better was obtained in 409 (44.9%) eyes. Visual acuity of 20/40 or better was obtained in 336 (72.4%) eyes with keratoconus and in 53 (63.9%) eyes with stromal dystrophy but in only 11 (6.3%) eyes with stromal scarring and 9 (4.8%) eyes with corneal edema (P<0.001). Overall, improvement in vision occurred in 750 (82.4%) eyes, remained the same in 97 (10.7%) eyes, and worsened in 63 (6.9%) eyes. Conclusions: The present study has conclusively demonstrated that primary adult optical PKP can be performed at a public health facility in the Kingdom of Saudi Arabia with graft survival and visual results that are comparable to those obtained in welldeveloped Western facilities. This success is attributed to the presence of a suitable infrastructure that provides modern eye care facilities, donor tissue, and pharmaceuticals to patients who have access to preoperative screening and evaluation, surgical intervention, and postoperative care by well-trained ophthalmologists and ancillary support personnel.