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L. M. Rangwala, R. M. Lieberman, B. Alemayehu; One Year Results of an HIV Ophthalmic Screening Service in a Regional Ethiopian Hospital. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4855.
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To describe initial results, prevalence of ophthalmic disease, and challenges in the implementation of an HIV ophthalmic screening service in a regional Ethiopian hospital.
Protocols designed to screen and treat ophthalmic manifestations of AIDS include: referral/screening of all HIV positive patients, diagnosis of conditions, and appropriate tx/follow-up. Retrospective chart review of patients seen over the first year was performed to include method of referral, age, gender, CD4+ count, best corrected visual acuity (BCVA), and presence/absence of ophthalmic disease.
Between 1/10/2001 (Ethiopian Calendar) to 1/20/2002, 860 new patients were screened in the HIV clinic, with 445 (51.7%) referred to ophthalmology. Of these, 58 (6.74%) were examined in eye clinic. The patients seen and ocular diagnoses were analyzed on a monthly basis. Ages ranged from 15 to 55 yrs.; 13 male, 10 female; initial BCVA ranged from logmar 0.0 (6/6) to LP; CD-4+ counts ranged from 18 to 749.Normal exams were found in 35 (60.34%) patients and 8 patients (13.8%) had HIV retinopathy. 4 (6.90%) had squamous cell carcinoma (SCC), 4 (6.90%) active CMV retinitis, 2 (3.45%) each had uveitis or M. contagiosum, and 1 (1.72%) each had old CMV retinitis, toxoplasmosis, or vasculitis.. Ophthalmic disease was diagnosed in 27 self referred patients and was analyzed on a monthly basis. Etiologies were as follows: IRU 5 (18.52%), CMV retinitis 4 (14.81%), vasculitis 3 (11.11%), corneal ulcer 2 (7.41%), episcleritis/scleritis 2 (7.41%), preseptal cellulitis 2 (7.41%), SCC 2 (7.41%), syphilis 2 (7.41%), toxoplasmosis , H. zoster , lymphoma, anterior uveitis , optic neuropathy and optic atrophy each1 (3.70%), Ages ranged from 3 to 55 yrs.; 15 male, 12 female; BCVA ranged from logmar 0.0 to LP; CD-4+ ranged from 4 to 877; 23 were on ART and 4 were not. Referral patients were noted to have decreasing numbers on a monthly basis; self referrals did not.
Initial results demonstrate the prevalence of a variety of ocular diseases, often secondary to HIV/AIDS. The number of patients referred progressively decreased over time (monthly analysis). Of interest are the relatively large number of self referred patients with HIV related eye disease. Challenges include increasing the percentage of screened patients sent to eye clinic and limiting those lost to follow up. Remedies include reiteration of the importance of screening with both medical staff and patients and implementation of ophthalmic screening in the ART clinic.
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