BACKGROUND: Cerebral malaria is a major cause of mortality and morbidity in children in tropical regions. The pathogenesis of this important complication of Plasmodium falciparum infection is not well understood. A number of observers have commented on the presence of retinal pathology in various types of malaria. Previous reports have not demonstrated that fundus findings are significantly associated with outcome. METHODS: The authors examined the ocular fundi, by direct and indirect ophthalmoscopy, of 56 children admitted consecutively with cerebral malaria. RESULTS: Every child with a normal fundus on admission recovered fully, but two conditions were found to be associated with a poor outcome. Patients with papilledema had a relative risk of poor outcome 5.2 times greater than those without this finding (P < 0.01). Patients with retinal edema outside the posterior vascular arcades had a relative risk of poor outcome 3.9 times greater than those without this finding (P < 0.01). These two fundus findings were independently predictive of a poor outcome. CONCLUSION: Fundus findings are useful as predictors of outcome in children with cerebral malaria. The authors' findings suggest that there may be two distinct mechanisms associated with poor outcome in these children.

Antimalarials↗

PubMed1993

Cell-mediated immunity in trachomatous scarring. Evidence from a leprosy population.

BACKGROUND: There is limited understanding of the mechanisms that mediate immunity after infection by Chlamydia trachomatis. Since it is known that the clinical course of leprosy is related to cell-mediated immunity and that such immunity contributes to the development of trachomatous conjunctival scarring, the authors examined patients to determine if there might be an association between leprosy status and trachomatous conjunctival scarring. METHODS: Leprosy patients registered at Shashemane Hospital were interviewed, examined, and patients with siblings residing in the vicinity were asked to return for further clinical examination. A subsample of sibships was selected for laboratory evaluation of cell-mediated immunity, measured by lymphocyte proliferative responses in vitro to stimulation by mycobacterial antigens. RESULTS: Conjunctival scarring was less severe in multibacillary leprosy patients (with suppressed cell-mediated immunity) than in their healthy siblings and more severe in paucibacillary leprosy patients (with enhanced cell-mediated immunity) than in their healthy siblings. The mean lymphocyte proliferative responses to mycobacterial antigens were greater in the sibling (whether leprous or healthy) with more severe conjunctival scarring, regardless of type of leprosy. CONCLUSION: The specific cellular immune responses to Mycobacterium leprae and p65 antigen in patients with increased conjunctival scarring provide evidence that early in the course of infection with C. trachomatis, factors related to an individual's cellular response are crucial to the development of conjunctival scarring. A delayed-type hypersensitivity reaction ("reversal reaction") found in paucibacillary leprosy patients could contribute to the increased trachomatous conjunctival scarring in these patients.

Adolescent↗

PubMed1993

Herpetic corneal ulcers in Malawi.

Explore the source record for details and available documents.

Child↗

PubMed1993

The epidemiology of blindness and visual loss in Hamar tribesmen of Ethiopia. The role of gender.

We conducted a population-based survey in the Hamar tribe of Ethiopia to assess the problem of blindness and ocular morbidity. Blindness was detected in 1.9% of the Hamar. Among the age group 40 and over < 1.0% of men and 13% of women were blind. Women with low vision or blindness comprised 30% of all women while men with low vision or blindness only comprised 8% of men in the age stratum. Cataract is responsible for the excess blindness in women. Even mild visual disability is less common in men. In Hamar society men have two roles: as herders and as warriors. Warriors with visual loss will be less successful in defending themselves. We suggest that Hamar men who develop visual loss have increased mortality compared to women with visual loss. Vision loss in women does not appear to have life-threatening consequences. Cessation of hostilities between the Hamar and their neighbours could, conceivably, lead to an 'increase' in the incidence of vision loss among men.

Adolescent↗

PubMed1992

Considerations in the integration of eye care into leprosy care services.

Little attention has been directed to the development, management and evaluation of eye care programmes for leprosy patients. This paper examines when an eye care programme for leprosy patients is needed, methods for integrating eye care into leprosy control programmes and lists of available ocular leprosy teaching materials.

Eye Diseases↗

PubMed1991

Ophthalmology in Ethiopia.

Explore the source record for details and available documents.

Blindness↗

PubMed1991

Comparison of the old and new W.H.O. leprosy disability grading scheme for ocular disabilities.

We compared the old (1970) and new (1988) World Health Organization schemes for classifying the ocular disabilities in leprosy patients. 509 leprosy patients from eight resettlement villages in central South Korea were examined and graded by eye according to both of the schemes. A more liberal definition of severely disabled in 1988 resulted in a 119% increase in eyes graded as severely disabled in this population. 59 eyes were graded as severely disabled by the old scheme and 129 eyes were so graded according to the new scheme. Keratitis, one of three measures of moderate disability in the old scheme, was replaced by corneal anaesthesia in the new scheme, but this change did not make a substantial difference in the number of patients in the moderately impaired category. In the absence of longitudinal studies documenting the significance of keratitis, it is unclear whether the change in an improvement. The new disability scheme improved upon the old by removing the criteria for mild impairment.

Adult↗

PubMed1991

Anatomical factors influencing development of trichiasis and entropion in trachoma.

There has been no published investigation into the reasons why some patients with severe trachomatous conjunctival scarring develop entropion and trichiasis while others do not. In a population of leprosy patients with severe trachomatous conjunctival scarring the authors found that lagophthalmos correlated with the absence of trichiasis and entropion. We suggest that orbicularis oculi muscle function, as well as other anatomical variations among individuals, may contribute to the development of trachomatous entropion and trichiasis in patients with conjunctival scarring.

Adult↗

PubMed1990

Problems with current concepts of the epidemiology of Mooren's corneal ulcer.

Results from an analysis of 287 patients in 20 series do not support widely held concepts of the descriptive epidemiology of Mooren's corneal ulcer, i.e., that bilateral disease is more common in younger patients and blacks. Our review shows that the disease is reported 1.6 times more frequently in males than in females regardless of race or age. Black patients are five times more likely to be young than are white patients. However these figures may be misleading since they are not calculated from population-based estimates. Our analysis highlights misconceptions and emphasizes the hazards of drawing conclusions about the epidemiologic characteristics of this disease based on currently available data.

Adult↗

PubMed1990

Intraocular pressure and iris denervation in Hansen's disease.

We retrospectively analyzed 255 Hansen's disease patients and found low intraocular pressure (less than 7 mm Hg) in 12% of them. We showed a correlation between low intraocular pressure and avascular keratitis and iritis. We also found that patients with low intraocular pressures had abnormally large postural changes in intraocular pressure. We speculate that abnormalities in the autonomic innervation of the anterior segment of the eye may be related to the intraocular pressure abnormalities. Further investigations along this line may increase our understanding not only of the pathophysiology of Hansen's disease but also of the mechanisms regulating homeostasis of intraocular pressure.

Autonomic Nervous System↗

PubMed1990

Training for primary eye care in leprosy.

Reported are the results of a primary eye care training programme for community-based leprosy control workers in the Republic of Korea. The 20-hour programme emphasized the detection and management of lagophthalmos (and its complications) and chronic iridocyclitis. Leprosy patients in four resettlement villages were examined independently by the health workers and an ophthalmologist. Agreement between the health workers and the ophthalmologist was good for the detection of most signs (lagophthalmos, acute iridocyclitis, and chronic iridocyclitis). Based on these preliminary results it is recommended that primary eye care be included as a part of the training for leprosy paramedical workers.

Community Health Workers↗

PubMed1989

A randomized trial of conjunctival autografting for pterygium in the tropics.

This is the first report of a randomized trial of the conjunctival autografting technique for pterygium removal. This trial was conducted in the Caribbean where risk of pterygium recurrence is considered to be high. Although not statistically significant, there was a lower recurrence rate in grafted cases (21% of 19 cases) than in controls done by the bare sclera technique (37% of 16 cases). The author found that age of the patient was strongly associated with recurrence regardless of which procedure was used. Findings of this study emphasize the importance of randomized controlled trials in assessing the efficacy of specific procedures for pterygium removal.

Adult↗

PubMed1989

Ocular autonomic dysfunction and intraocular pressure in leprosy.

We examined 241 leprosy patients and 135 age-matched healthy controls in central South Korea, measuring intraocular pressure in the supine and the upright positions and measuring the size of the pupils in darkness as an indication of ocular autonomic dysfunction. The mean intraocular pressure was significantly lower in the patients and the mean size of pupils was significantly smaller in the patients than in the controls. However, there was no correlation between pupil size and intraocular pressure in our patients. Our findings show that leprosy patients have ocular autonomic dysfunction, but do not support previous speculation that this dysfunction is the primary cause for low intraocular pressure in leprosy.

Adult↗

PubMedDate not supplied

Correlation of retinal haemorrhages with brain haemorrhages in children dying of cerebral malaria in Malawi.

Retinal haemorrhages increase in number with severity of Plasmodium falciparum malaria and occur in 35-40% of children with cerebral malaria. We performed clinical retinal examinations and histopathological examinations of retina, and parietal and cerebellar sections of the brains, in 33 children in Malawi who died with cerebral malaria, severe malaria anaemia, or coma of other causes. Haemorrhages were counted in a standardized fashion: the Spearman correlation coefficient between the number of haemorrhages in retina and brain was 0.741 for parietal tissue and 0.703 for cerebellar (P < 0.01 for both). Severity of haemorrhage in the retina correlates well with that in the brain. Retinal examination in cerebral malaria is a useful tool in predicting some of the pathophysiological processes occurring in the brain.

Autopsy↗