13 research outputs found
Traditional eye medication and pterygium occurrence in Limpopo Province
Background. The relative importance of environmental and hereditary factors in the occurrence of pterygium in African blacks has not been reported.Aim. To investigate the relative significance of factors associatedwith pterygium occurrence.Methods. This was a prospective case-controlled study where150 pterygium patients and 150 controls participated. Interviewswere conducted, eyes examined and multivariate analysis done. Thefamilies of 51 pterygium cases and 50 controls were examined forpresence of pterygium.Results. Of 150 cases and 150 controls, 79 (52.6%) and 60 (40%)used traditional eye drops (odds ratio (OR) 2.03; p=0.009. Ten cases (6.6%) and 26 controls (17.3%) had unstable tear film (OR 0.30; p=0.007. Forty-six cases (30.6%) and 15 controls (10%) reported a positive family history (OR 3.93; p<0.001). Groups of 3 - 5 pterygium cases in a household occurred in 36 of 51 pterygium families (70.5%) v. 1 of 50 controls (2%).Conclusions. Pterygium occurrence was associated with the use of traditional eye drops, a positive family history and having groupsof diagnosed pterygium-affected relatives. However, unstable tearfilm seemed protective against pterygium occurrence
Traditional eye medicine use in microbial keratitis in Uganda : a mixed methods study [version 2; peer review: 2 approved]
Background: Traditional eye medicine (TEM) is frequently used to treat microbial keratitis (MK) in many parts of Africa. Few reports have suggested that this is associated with a worse outcome. We undertook this large prospective study to determine how TEM use impacts presentation and outcome of MK and to explore reasons why people use TEM for treatment in Uganda. Methods: In a mixed method prospective cohort study, we enrolled patients presenting with MK at the two main eye units in Southern Uganda between December 2016 and March 2018 and collected information on history, TEM use, microbiology and 3-month outcomes. We conducted qualitative interviews with patients, carers traditional healers on reasons why people use TEM. Outcome measures included presenting vision and at 3-months, comparing TEM Users versus Non-Users. A thematic coding framework was deployed to explore reasons for use of TEM. Results: Out of 313 participants enrolled, 188 reported TEM use. TEM Users had a delayed presentation; median presenting time 18 days versus 14 days, p= 0.005; had larger ulcers 5.6 mm versus 4.3 mm p=0.0005; a worse presenting visual acuity median logarithm of the minimum angle of resolution (Log MAR) 1.5 versus 0.6, p=0.005; and, a worse visual acuity at 3 months median Log MAR 0.6 versus 0.2, p=0.010. In a multivariable logistic regression model, distance from the eye hospital and delayed presentation were associated with TEM use. Reasons for TEM use included lack of confidence in conventional medicine, health system breakdown, poverty, fear of the eye hospital, cultural belief in TEM, influence from traditional healers, personal circumstances and ignorance. Conclusion: TEM users had poorer clinical presentation and outcomes. Capacity building of the primary health centres to improve access to eye care and community behavioural change initiatives against TEM use should be encouraged
Young patient’s age determines pterygium recurrence after surgery.
Background. It is not clear whether demographic or pterygium
characteristics or limbal stem cell deficiency determine pterygium
recurrence after surgery. Purpose. To determine whether the
demographic, pterygium characteristics, or limbal stem cell deficiency
determine pterygium recurrence after excision. Methods. Of 190 patients
operated and followed-up for 6 months, 101 and 89 underwent free
conjunctival autotransplant (CAT) or limbal conjunctival autotransplant
(LCAT) respectively. The age, gender, occupation, grade of pterygium
extent and degree of fleshiness, and laterality were compared between
recurrent and no recurrent pterygia. Multivariate analysis was
performed to determine the predictors of pterygium recurrence.
Recurrence rates after surgery were compared between CAT and LCAT.
Results. The age range of the 190 patients was 22-65 years, mean
±SD 46.4 ±10.8 years. Pterygium recurred in 52 (27.4%).
Thirty-nine (75%) of 52 patients with pterygia that recurred were aged
<50 years (young) vs. 72 (52%) of 138 young patients with no
recurrence; odds ratio (OR) = 1.54; 95% confidence interval (95% CI) =
0.70-3.36; p = 0.28. Thirty-one (60%) of 52 participants with
post-surgical recurrent pterygia had large pre-operative pterygium
(grade ≥3) vs. 130 (94%) of 138 patients with large pterygia that
did not recur; OR = 0.11; 95% CI = 0.04-0.28; p <0.001. Of 101
patients undergoing CAT, 29 (28.7%) experienced recurrence vs. 23
(25.8%) of 89 undergoing LCAT; p = 0.66. Conclusions. Young age seems
to be associated with pterygium recurrence after excision followed by
conjunctival graft. Large pterygia were protective
Chronic inflammatory cells and damaged limbal cells in pterygium
Background: Chronic inflammation in pterygium occurrence has not been
explained. Whether damaged limbal basal epithelial cells are associated
with pterygium occurrence in black Africans is not clear. Objective: To
explain chronic inflammation in pterygium, and to clarify whether
damaged limbal basal epithelial cells were associated with pterygium
occurrence in black Africans. Methods: Chronic inflammatory changes and
damaged limbal basal epithelial cells were assessed in 59 samples.
Results: Chronic inflammatory cells were present in 59 pterygia.
Inflammatory cell count in 5 (27.8%) of 18 small pterygia was >200
(high) while in 22 (53.7%) of 41 large growths was <200 (low); p =
0.25. The proportion of pterygia with high counts tended to increase
with pterygium extent. Twenty (33.9%) of 59 pterygia recurred after
surgery. Ten (50%) of 20 samples had high cell counts and 10 (50%), low
counts; p = 0.40. P53 expression was detected in 11 (18.6%) of 59
pterygium samples and 5 (71.4%) of 7 controls; p = 0.007. MMP 1
staining was present in 14 (23.7%) of 59 sections and 5 (71.4%) of 7
controls; p = 0.02. MMP2 in 16 (27.1%) cases and 5 (71.4%)controls; p =
0.03. MMP3 was overexpressed in 16 (27.1%) of 59 cases and 5 (71.4%)
controls; p = 0.03. Conclusions: Mild chronic inflammation has a
tendency to be more frequent than severe inflammation in pterygia. It
is clear that damaged limbal basal epithelial cells are unlikely to be
related to pterygium occurrence