A thesis submitted to the faculty of medicine,
University of the Witwatersrand, Johannesburg
for the degree of Doctor of Philosophy (Medicine). Johannesburg 1991. / This thesis describes corneal ulceration in the black South African and how the pattern
of the disease differs from that seen in white South Africans.
Initial comparative surveys of one year each were conducted at St John Eye Hospital and
the Johannesburg Hospital. These surveys showed that the main problem area in the black
patient was central bacterial corneal ulcers while in the white, central viral ulcers
accounted for most of the cases seen. Marginal catarrhal ulceration. in the black was
commonly seen but it showed a better response to treatment and a better visual outcome.
There was generally a marked male predominance in blacks and this was mainly related
to predisposing factors. TIle commonest predisposing factors. in the black. patient were
episodes of corneal trauma, climatic droplet keratopathy, corneal scarring, malnutrition
and alcohol abuse. Pretreatment with antibiotics was found in nearly half of the patients
and this was significantly associated with the absence of significant isolates in 40% of
central ulcers. Single Gram-posltlve bacterlal isolates were round in 30% of-central ulcers
and single Gram-negative isolates in 15%, While fungal isolates were recovered in 5.5%
of central ulcers. Streptococcus pneumoniae was by far the commonest orgllnism.
accounting for 42% of SIgnificant bacterial. isolates. This organism and Pseudomonas
aeruginos were associated with some of the major complications (deseemetocoeles and
perforations). Using fixed treatment regiments the results of treatment in mild and
moderate bacterial and fungal keratitis were good, as well as most types of marginal
ulcers. Vision was shown to improve significantly in the moderate bacterial infections but
not in the severe and complicated bacterial cases,
A numerical ranking system for the statistical analysis of visual. acuity is described and
the method was found to produce consistent results.
In a controlled clinical trial using topical steroids plus antibiotics versus antibiotics alone,
no difference in visual outcome could be shown. Complications in the two groups were
similar, however, and the steroid did not appear to retard the rate of heating.
Recommendations for the incorporation of topical steroid Into a treatment regimen are
made. Principles for the management of suppurative keratitis in a developing population
are outlined in the conclusions. / AC2017
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/22087 |
| Date | January 1991 |
| Creators | Carmichael, Trevor Robin |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | Online resource (217 leaves), application/pdf |
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