The Kenya Eye Health Journal (KEHJ) is an open access journal published by the OSK, with the aim of advancing research by all eye care practitioners and teams in Kenya. The inaugural edition of KEHJ was preceded by a baseline situation analysis to assess the need and feasibility of starting a scientific journal with OSK as the publisher. The analysis included consultations with OSK leadership, researchers, leaders in academia, experts in editorial and review processes and OSK members. Oral consultations were supplemented with sensitization via email and WhatsApp communications to eye health actors in Kenya. The main finding of the situation analysis was that there is both the need and the resources to publish the journal.
A case report of a patient with spontaneous retrobulbar hemorrhage
Introduction: Retrobulbar hemorrhage (RBH) is a potentially blinding consequence of orbital trauma that can lead to orbital compartment syndrome (OCS). Although RBH commonly follows trauma, spontaneous cases have been reported, often associated with coagulopathies, thrombolytic therapy, lymphangiomas, or Valsalva maneuvers. In some cases, however, no risk factors are identified. OCS should be suspected in the presence of declining visual acuity, proptosis, raised intraocular pressure, a tight orbit, relative afferent pupillary defect, intraocular vascular changes, or restricted eye movements. Timely recognition of RBH is essential to prevent ischemic blindness. Case report: We report a 17-year-old healthy female who presented with sudden right eye proptosis, reduced ocular motility, and visual decline. She denied trauma or medication use. Initially treated for orbital cellulitis with intravenous antibiotics for a week without improvement, she was referred to our facility. Examination suggested OCS, prompting emergency canthotomy and cantholysis, followed by orbitotomy, which evacuated about 10 mL of blood. Postoperatively, proptosis resolved, but vision remained no perception of light. This case highlights the rarity of spontaneous RBH and the importance of maintaining a high index of suspicion in acute proptosis. It also underscores the role of prompt imaging and intervention in preserving vision. Conclusion: RBH with OCS is an ophthalmic emergency requiring urgent diagnosis and management to prevent irreversible vision loss.
A case report of a patient with ocular manifestation of monkey pox
Introduction: Monkey pox (Mpox) is a rare viral zoonotic disease caused by a double stranded DNA virus. Monkeys are the primary host; the specific animal reservoir remains unknown. Mpox can spread through close contact with an affected per- son, contact with contaminated material or direct contact with live or dead infected wild animals. Clinical presentation can vary widely from a mild, self-limiting illness to a severe disease with life-threatening complications in immunocompromised individuals. Most individuals with Mpox experience a self-limiting illness and typically recover fully within two to four weeks after onset of symptoms. Ocular involvement is a serious complication that can lead to blindness. Treatment is mostly supportive. Antiviral therapy can be given in some circumstances. Case: An eleven-year-old boy presented with a week’s history of right lower eyelid swelling, followed by nodular rash involving the face and upper limbs associated with fever. He was seen at the eye clinic at Kenyatta National Hospital and admitted to the infectious disease unit with differential diagnoses of mpox blepharoconjunctivitis and molluscum contagiosum conjunctivitis. Lesion swabs done and sent for PCR were positive for monkey pox virus. The patient was managed by a multidisciplinary team involving Dermatology and Ophthalmology and was discharged after eleven days of isolation. Conclusion: Ophthalmologists and general clinicians should maintain a high index of suspicion for Mpox in patients presenting with vesicular or umbilicated lesions around the eyes, particularly during outbreaks or in those with epidemiological risk factors. There is need for multidisciplinary involvement in the management of patients for proper identification and effective treatment.
Unusual ocular chemical injury from a dental whitening solution
Introduction: Accidental ocular burns from the inadvertent use of substances packaged in plastic dropper bottles have been reported for decades and remain a clinical concern, as they may result in severe corneal injury. We report a case of a patient who mistakenly instilled dental whitening drops, causing a serious corneal burn. Prompt, aggressive management resulted in a favorable visual outcome. Case report: An 11-year-old male patient presented with left eye pain, swelling, and reduced vision after accidentally instilling a drop of dental whitening solution (alkali) instead of Probeta-N (betamethasone 0.1% and Neomycin 0.5%). His mother rinsed the eye immediately and took him to a health facility, where further irrigation and eye drops (cyclopentolate 1%, diclofenac, and gentamicin) were administered before referral to Kenyatta National Hospital (KNH). At KNH, he was diagnosed with a left eye chemical injury (Roper-Hall grade 3) and treated with moxifloxacin 0.5% eye drops, cyclopentolate 1%, prednisolone acetate 1%, artificial tears, oral vitamin C, and a bandage contact lens. Our patient experienced good outcomes; visual acuity was 6/6 after 1 month, and during the first review, the corneal epithelium had fully regenerated. The primary factors influencing these favorable outcomes included timely and adequate irrigation, the amount of the caustic agent, and early presentation to the healthcare facility. Conclusion: This case highlights the importance of proper labeling, patient education, and careful administration of eye drops to prevent such incidents. Chemical eye injuries due to mistaken use of medications can lead to severe ocular damage, potentially resulting in long-term visual impairment. Early recognition and prompt management are crucial in minimizing complications and preserving vision.
Oedipism: A rare case of an incomplete self-inflicted eye removal
Introduction: The term oedipism is derived from Greek mythology meaning self-enucleation. Oedipism is a rare but serious ophthalmologic and psychiatric emergency. Occurs in patients with severe mental disorders such as schizophrenia and can be life-threatening. Besides psychiatric illnesses, self-enucleation is also at times associated with alcohol/drug-related disorders. Case report: We present a case of 32-year-old male who self-enucleated his right eye, Patient was well until 26/12/24 when he started having delusional thoughts that someone wanted to harm him. Noted to be bleeding from the little finger of his right hand. He was immediately rushed to a health center and first aid done and discharged. A few hours later lots of blood was noted coming from his right eye with luxation of the right globe. Patient denied history of trauma. Referred to Kenyatta National Hospital for further management. Conclusion: Oedipism is a very rare condition though presents amidst our society. Mental health awareness, early treatment of persons with mental disorders can prevent this extreme self-harm.
ophthalmologic and psychiatric emergency
Periorbital necrotising fasciitis: Rare cases with complex diagnosis and surgical treatment-case series
Introduction: Necrotising fasciitis (NF) is a severe and aggressive pathology with a rapid progression and high mortality risk. Periocular NF is a rare condition associated with a lower mortality risk but significantly higher disabling sequelae. The infection can follow local blunt trauma, penetrating injuries and facial surgery, but in some cases no cause is identified. Non-specific erythema and localised painful swelling of the eyelids characterise the earliest manifestation of the disease, followed by formation of blisters and necrosis of the periorbital skin and subcutaneous tissues. The causative organism in periorbital infection is mainly β-haemolytic Streptococcus alone, occasionally in combination with staphylococcus aureus. Cases report: We present two cases of NF. A 33-year-old male patient, a victim of accidental glass prick from a glass window while in a vehicle, with a delayed diagnosis of periocular necrotising fasciitis. Additionally, we report a case of a 1-year-old female patient, a victim of acute dacryocystitis, which complicated to deep tissue necrosis with medial canthal defect and lacrimal drainage system necrosis. Both patients underwent surgical and medical treatment. The patient’s survival outcomes were favorable; the sequelae were not disabling. The rarity of such cases and the peculiarities of the cases dictate that prompt clinical examination and aggressive surgical and medical management are key to preventing NF. Conclusions: Understanding the signs, symptoms, and predisposing factors, as well as the potential rare localisations of NF, including the periocular region, can lead to the early diagnosis and treatment with good functional and aesthetic outcomes, minimising significant disabilities.
The Kibata protocol for management of cataract, vitreous haemorrhage, and glaucoma in diabetic patients
Background: Diabetes mellitus is a major cause of visual impairment worldwide, associated with cataract, diabetic retinopathy (DR), vitreous haemorrhage, and glaucoma. Cataract surgery, while often necessary, increases the risk of postoperative complications including DR progression and macular edema. Despite this burden, practical guidelines for managing these conditions in diabetic patients remain scarce. Objective: To present the Kibata Protocol, a structured set of recommendations for the management of cataract, vitreous haemorrhage, and glaucoma in patients with diabetes. Methods: Relevant literature and consensus statements were reviewed, and key mechanisms, risk factors, and treatment strategies were synthesized into guideline recommendations. Results: The kibata Protocol emphasizes: Preoperative systemic optimization: Glycaemic control: HbA1c of <8% and RBS of <10 on day of surgery is crucial in diabetic patients undergoing ophthalmic surgery, as poor control increases the risk of postoperative infection, delayed healing, and macular edema. [1-4]. Blood Pressure (BP) control: BP should be below 180/110 mmHg, provided the patient is otherwise stable. Avoid sudden BP reduction on the day of surgery to prevent ocular hypoperfusion. [5,6] In patients with advanced retinopathy or maculopathy, maintaining BP below 160/100 mmHg is preferable to reduce the risk of retinal haemorrhage or macular edema exacerbation. [7-9] Careful ocular evaluation and consideration of preoperative anti-VEGF therapy. Minimally traumatic cataract surgery techniques to reduce inflammation. Early vitrectomy when indicated for vitreous haemorrhage.• Vigilant glaucoma monitoring, with combined procedures where appropriate. Conclusion: Adoption of the Kibata Protocol may reduce complications and improve surgical outcomes in diabetic patients.
Changes in central corneal thickness three months after cataract surgery using phacoemulsification
Introduction: The cornea is the most powerful refractive surface of the eye with the central cornea being pivotal to the visual axis, and hence visual acuity. Phacoemulsification is a method of cataract surgery that emits both thermal and ultrasonic energy which affects the cornea. Our study is to establish changes to the central corneal thickness (CCT) three months after surgery. Objective: To establish the changes in CCT three months following phacoemulsification and the factors that influence these changes. Materials and Methods: The study was a prospective case series carried out at the Eagle Eye and Laser Centre in Lavington, Nairobi. The recruitment of patients into the study was for 6 months between 1st August 2018 and 31st January 2019, and this was followed by a 3-month follow-up period until 30th April 2019. Eyes of patients who underwent phacoemulsification surgery were included. Eyes with pre-existing pathology, intra-operative and post-operative complications, were excluded. The CCT was measured using a Tomey EM-3000, a non-contact specular microscope; axial length and anterior chamber depth were taken from biometry readings by ZeissIOLMasterâ. Phacoemulsification was carried out by two surgeons using the same Alcon Accurusä Phacoemulsifier. Results: A total of 41 eyes of 33 patients were studied. There was an overall 6.2% decrease in CCT in our study, which showed that despite the endothelial injury expected during phacoemulsification, our study population experienced good healing of their corneas. Corneas of diabetic patients were found to be thicker both before and after surgery likely due to the metabolic changes caused by disease. Anterior chamber depth was found to be a statistically significant predictor of post- operative CCT. Conclusions: Uncomplicated phacoemulsification surgery has minimal effect in eventual CCT.
The Kenya Eye Health Journal: A novel tool for enhancing interprofessional collaboration in eye health
Publication of the Kenya Eye Health Journal (KEHJ) resonates well with the theme of the 2025 Ophthalmological Society of Kenya (OSK) congress which reads: “Bridging the gap: Innovation, Access, and Equity in eye health”. Moreover, the first sub-theme is “interprofessional collaboration” (IPC) and the tagline of the Congress is “Local is good, can be better”. The World Health Organization defines IPC as the collaborative practice which happens when multiple health workers from different professional backgrounds work together with patients, families, carers, and communities to deliver the highest quality of care.(1) Any individual whose skills can help achieve local health goals should be engaged. Likewise in Kenya, eye health services have been evolving since 1956 and the development of a strong eye health workforce is a top priority.(2, 3) The workforce comprise of medical and non-medical professionals who play different but complementary roles in clinical care, public health, management, training, and research. These roles cannot be optimally performed without effective IPC strategies and the creation of KEHJ is one such strategy.
Barriers and enablers to uptake of cataract surgery services at the Siaya County Referral Hospital, Kenya
Introduction: Cataracts are the leading cause of blindness globally, affecting approximately 94 million people, predominantly the elderly. Despite effective surgical interventions, disparities in access to cataract surgery persist in Kenya, with surgical coverage below 35% in rural areas. This study identified barriers and facilitators to the uptake of cataract surgical services at Siaya County Referral Hospital. Methods: A descriptive cross-sectional study with a mixed-methods approach was conducted. A survey questionnaire was administered to patients with cataracts, complemented by key informant interviews with four healthcare providers and focus group discussions with patients. Findings: A total of 239 cataract patients participated in the study. Majority of the respondents (84.3%) were over 60 years old (median age: 79, age range of 35–93 years), with 53.1% male. Cataract was correctly identified as an eye disease by 59.8%. Barriers included lack of awareness (30.4%), fear (30.1%) and geographical distance (33.7%), while facilitators were counselling (69.5%), proximity to facilities (39.3%), and financial support (32.2%, NHIF). Religious factors significantly influenced surgical willingness (p = 0.01, χ² = 11.234). No significant associations were found with education, marital status, or occupation. Conclusion: Lack of awareness, fear, and distance are major barriers to cataract surgery uptake, while counselling, facility proximity, and financial aid are key enablers. Recommendations include enhanced community education, strengthened counselling, and additional surgical facilities to improve access in underserved areas.
Copyright (c) 2025 KENYA EYE HEALTH JOURNAL
Management practices for diabetic macular edema (DME) at one comprehensive eye unit in Kenya.
Introduction: Diabetic macular edema (DME) is a leading cause of vision impairment among diabetic patients. Traditional grid laser treatment is no longer considered the gold standard treatment, with anti-VEGF therapy emerging as the preferred approach. The objective of this study is to evaluate the management practices for diabetic macular edema (DME) by consultants ophthalmologists at Kikuyu Eye Unit, particularly in the context of the paradigm shift introduced by anti- vascular endothelial growth factor (anti-VEGF) therapy, and to assess the associated visual acuity outcomes. Materials and Methods: A retrospective hospital-based case study was conducted over six months (October to March 2018). Data were extracted from theatre lists and laser room registration books. Patient files and records were reviewed to gather information on individuals treated with intravitreal injections or laser for DME during this period. All patients treated for DME within the study period were included. Results: The study population had a mean age of 50 years or older in 95.9% of patients. Treatment distribution was as follows: 146 eyes (61.3%) received anti-VEGF monotherapy, 6 eyes (2.5%) received triamcinolone alone, 50 eyes (21.0%) underwent central laser treatment, and 36 eyes (15.1%) received combination therapies. Notably, 93 eyes (39.1%) received three or more anti-VEGF intravitreal injections. Post-treatment, 58% of eyes demonstrated a satisfactory visual acuity outcome, defined as a gain of ≥5 ETDRS letters. However, follow-up adherence was suboptimal, and a limited number of patients underwent blood glucose monitoring and optical coherence tomography (OCT) evaluations. Conclusion: The management of DME at KEU aligns with current treatment guidelines, with anti-VEGF therapy being the most common approach. Visual acuity outcomes were satisfactory for 58% of eyes tested post-treatment. However, there is a need for improved patient follow-up and complementary investigations to enhance treatment outcomes. DME remains a significant challenge for ophthalmologists.
Modified pre-descements endothelial keratoplasty (PDEK) and the effect of using Viscoat® in minimizing endothelial cell loss during tissue preparation
Objective: To prepare large sized Pre-Descemet’s endothelial keratoplasty (PDEK) lenticule with stromal (PDEK-S) and to assess the effect of using Viscoat® in minimizing endothelial cell loss during its preparation. Methods: Paired corneas were randomly assigned for Pre-Descemet’s endothelial keratoplasty (PDEK) donor lenticule preparation in two groups depending on the application of Viscoat. Type-1 air bubble was formed with a 30-gauge needle, bevel up with a 3-cc volume syringe. Stromal tissues were excised from the periphery. The percentage of endothelial cell loss before and after dissection was estimated with Trypan blue Photo. Results: A total of 20 paired eyes were used. The average donor age was 57years. A 15% of endothelial cell loss induced by the preparation process was observed in both groups. The percentage of Endothelial Cell Loss was not significantly associated with the use of Viscoat during preparation (p - 0.87). We observed that larger diameter donor lenticules were associated with younger donors (p- 0.028). The largest diameter of Pre-Descemet’s endothelial keratoplasty (PDEK) lenticule was 9.5mm. Conclusion: The use of Viscoat as an endothelial shield during Pre-Descemet’s endothelial keratoplasty (PDEK) donor lenticule preparation has no significant effect in reducing the percentage of endothelial cell loss. The size of Pre-Decrement’s endothelial keratoplasty (PDEK) donor lenticule can be increased by adding thin stroma at the periphery (PDEK-S). PDEK-S allows the utility of corneas from younger patients for endothelial keratoplasty, and Younger aged donors are associated with larger sized donor lenticules.
Awareness, knowledge, and perception of strabismus among parents and caregivers of children attending the paediatric eye clinic at the Kenyatta National Hospital, Kenya
Background: Strabismus, a common eye condition affecting children, can lead to various complications, emphasising the need for early detection and management. This study aimed to assess parental knowledge, awareness, and perception of strabismus at the paediatric eye clinic of Kenyatta National Hospital in Nairobi, Kenya. Methods: This was a cross-sectional study done in the paediatric eye clinic at Kenyatta National Hospital between 17th July 2023 and 4th August 2023. A consecutive sampling method was used to select parents/caregivers who were interviewed using a structured questionnaire. Results: The study involved all the recruited 96 parents and caregivers (88.5% females, 93.8% parents). A high level of aware- ness was found in 40.6% of respondents, significantly associated with a family history of strabismus (p<0.001) and eye disease (p<0.001). Only 42.7% correctly defined strabismus, with heredity being the most recognised cause (33.3%) and dehydration frequently mistaken as one (21.9%). Treatment options were correctly identified by 56.3% for glasses, 49.0% for surgery, and 44.8% for eye muscle exercise. Relatives/friends (47.9%) and internet/social media (40.6%) were common knowledge sources. Participants highly appreciated parents’ roles, especially in early detection (99.0%) and compliance with treatment (96.9%). Both sexes showed moderate knowledge, with no significant difference based on education level. Positive attitudes towards strabismus management were notably observed, particularly among mothers, despite identified misconceptions and underestimation of its psychosocial and economic impacts. Conclusion: Nearly half of caregivers demonstrated high awareness of strabismus, with most showing adequate treatment knowledge, though significant gaps persisted in recognising early signs and understanding causes. Importantly, the majority maintained positive perceptions of strabismus management, suggesting a foundation for targeted educational interventions.
The presentation, patterns, and outcomes of corneal injuries in children seen in Lighthouse for Christ Eye Centre, Mombasa
Introduction: Corneal injuries constitute a significant cause of corneal blindness, impacting vision significantly, with approximately 1.5 to 2 million new cases of monocular blindness. Children’s quality of life and Disability Adjusted Life Years may be impacted by ocular trauma, which is a significant and leading cause of acquired and preventable monocular blindness, particularly in developing nations. Study objectives: The study aimed to determine the patterns and outcomes of corneal injuries in children seen in Lighthouse for Christ Eye Centre, Mombasa between January 2018 and December 2022. Methods: A hospital-based retrospective case series study design was carried out and 90 medical records of all children up to 18 years of age with corneal injuries were included. A structured questionnaire was used to retrieve information from the medical records. It encompassed the clinical presentation, patterns, outcomes and complications of corneal injuries. Data was coded and entered in SPSS version 26 for analysis. Descriptive statistics such as tables, charts and frequencies were used to summarize the retrieved information. Results: The male-to-female ratio was 2:1.2 and the 5-10 years age group sustained most injuries with a mean age of 6.7 years and a median age of 6 years. The time-to-presentation was 2-7 days. Corneal lacerations were the most common pattern of corneal injuries mostly caused by sticks. Associated ocular injuries included cataracts and hyphema. Uncorrected visual acuity of 6/12 or better was attained by 12.2% at 1 month and 7.8% at 3 months. About 1/3 of the patients were blind in the injured eye at 3 months post- injury, according to the Distance Visual Impairment grading (ICD 11). Corneal scars were the most common complication of corneal injuries. Conclusions: Corneal injuries in children occurred mostly during playtime due to the curious nature of play and unsupervised play among older children. Males sustained more injuries attributed to their carefree and aggressive nature of play. Corneal lacerations were the most common injury.
Birmingham Eye Trauma Terminology System
Coats disease masquerading as retinoblastoma at Kenyatta National Hospital – a case series
Aim: To describe 5 cases of coats disease that were referred as retinoblastoma to Kenyatta National Hospital Study design: A retrospective case series. Study location and period: Ophthalmology Eye Unit at Kenyatta National Hospital between June 2023 and September 2024. Methods: The files for patients who had been referred to Kenyatta National Hospital as retinoblastoma and turned out to be cases of coats disease were reviewed. Data collected included age, sex, presenting visual acuity, findings on fundus examination and other ancillary tests. Results: The five cases presented were referred to Kenyatta national hospital with unilateral leukocoria and a tentative diagnosis of unilateral retinoblastoma. There were four males and one female, and all the children were less than three years of age. All the children had profound visual loss of the affected eye at presentation. The right eye was affected in three children and left eye in two children. Even though all of the patients had an initial diagnosis of retinoblastoma at presentation, further work up at Kenyatta National hospital ruled out retinoblastoma in four of them. However, the clinical diagnosis was not clear-cut for one patient and the diagnosis of retinoblastoma was upheld and enucleation of the affected eye done. The histology of the enucleated eye however showed features of coats disease. Conclusion: Coats disease is a rare ocular condition, and it is sometimes difficult to differentiate from retinoblastoma clinically. Proper work up however can pick most cases, and unnecessary enucleations can be avoided. Sometimes the diagnosis can only be confirmed histologically after enucleation.
Interprofessional collaboration between anesthesiology and ophthalmology: the experiences of clinician-educator-researcher-administrators
Introduction Interprofessional collaboration is the working together of different health professional cadres to positively impact health care and advance knowledge. The complexities of modern healthcare demand a collaborative approach, where specialists from different disciplines have a combined action to achieve a goal. It has been argued that efficient interprofessional collaboration can increase job satisfaction among health professionals, help overcome fragmented service delivery, and improve safety, quality, and continuity of care1. According to the World Health Organization’s Framework for Action on Interprofessional Education & Collaborative Practice, such collaboration can play an important role in mitigating the global health workforce crisis2.
Accuracy of references in the Kenya Eye Health Journal Volume 1 Number 1
Background: Accurate referencing is essential in academic and research publications, ensuring objectivity, rigor, and credibility. Such referencing provides context, builds on existing work, strengthens the reliability of articles, and guides readers to relevant sources. Errors in referencing pose a challenge in information retrieval and reduce access to information. This study aimed to evaluate the accuracy of references in articles published in Issue 1 of the Kenya Eye Health Journal (KEHJ). Methods: References from articles published in KEHJ Issue 1, were extracted and analyzed for accuracy of bibliographic elements such as author, title, publisher, place of publication, year of publication, volume, issue, and page number, along with adherence to the Vancouver referencing format. Descriptive analysis was used to quantify the frequency and distribution of errors. Result: All the 89 references from 7 articles were analyzed. Journal articles 69(78%) were the most frequently referenced. Two of the seven articles contributing 25/89 (28%) references did not use the Vancouver referencing style. Among the 50(56%) references which followed the recommended referencing style, 15(30%) were incorrectly formatted. The most common errors were author list (26%), omissions of DOI (45%), and errors in year of publication (15%). Conclusion: The findings revealed gaps in adherence to journal author guidelines and errors in referencing accuracy. These inaccuracies highlight the need for training among authors, peer reviewers, and editorial teams to improve referencing consistency. Implementing strict verification measures and providing clear referencing support such as engaging information scientist and embedded video tutorials can help mitigate these errors.
Knowledge and utilization of diabetic retinopathy screening services among diabetic patients: A study at the Nakuru Level 5 Hospital, Kenya
Introduction: Diabetic Retinopathy (DR) is a leading cause of vision loss globally. Early detection and timely treatment of DR through screening can avert vision loss. Objectives: The aim of this study was to assess the knowledge of DR, utilization of DR screening services (DRS), and factors associated with utilization of DRS among diabetic patients attending the Nakuru Level 5 Hospital in Kenya. Materials and Methods: This hospital-based cross-sectional study used a quantitative approach and targeted 228 patients aged 18 years and above attending the Nakuru Level 5 Hospital Diabetic Clinic. A structured questionnaire was used to assess knowledge of DR, utilization of DRS, and factors associated with knowledge and utilization of DRS. Descriptive statistics, bivariate, and multivariate analyses was conducted. Results: The response rate was 100%. Mean age of respondents was 51years (range 18 - 86 years), 56.6% (129/228) had knowledge of DR, 33.8% (n=228) had utilized DRS. Factors positively associated with DR knowledge were higher education (p<0.0001) and higher income (p=0.002). On multivariate analysis, only higher education level was positively associated with knowledge of DR (OR 1.5 [95% CI 1.1-2.3], p=0.029). Factors positively associated with DRS utilization included knowledge on diabetic retinopathy (p<0.001), higher education level (p=0.05), residing in an urban area (p=0.039) and higher income level(p=0.031). On multivariate analysis, higher education level (OR 4.1 [95% CI 1.4-11.7], p=0.008) was positively associated with utilization of DRS. Conclusion: Knowledge and utilization of DRS in Nakuru Level 5 Hospital was sub-optimal. Higher level of education was associated with increased knowledge and utilization of DRS. Strategies to increase knowledge and utilization of DRS are needed.
Editorial Seeing the unseen: Indicators for clinicians-educators- researchers-administrators
The practice of eye care demands more than clinical expertise, irrespective of whether one is practising in the public or private sector. At the different stages in our careers, we are called upon to be clinicians, researchers, educators, and administrators; often simultaneously and integrated, rather than separately. This multifaceted role, while challenging, presents a unique opportunity to shape eye care delivery, advance knowledge, and nurture future generations of the eye care workforce.
A tribute to Dr. Amos Kibata Githeko, an Eye Health Hero
A tribute is an act or statement that shows gratitude, respect or admiration. Dr. Amos Kibata Githeko who passed into eternity on Tuesday afternoon September 17th, 2024 evoked all these in life and in death. There are many, young and old who were grateful for his numerous acts of kindness and admired his courageous yet humble approach. Those who did not know of his works got to hear them in written and spoken tributes and the reactions were the same as those who knew him in life. The ophthalmology community and thousands of patients have lost an icon. When did Dr. Kibata become an ophthalmologist, and what a great one he was? According to the medical board it was the day he earned his specialist registration. In this article I opine that he became what he is earlier than we thought. How did he become so great? What can we learn from his life? The answers depend on who you ask. I will delve into this question as you read along. It is said that success has many fathers and failure is an orphan. Many would therefore wish to claim to be a part in his success. I say this because it is hard to tell the story of Dr. Kibata in isolation. There was a host of people sent his way to make him who he was.
Copyright (c) 2024 KENYA EYE HEALTH JOURNAL
The past, the present, and the future Kenya eye care programs, “Lest we forget"
This article is intended to remind future generations to never forget and to sustain the great efforts made by pioneers of eye care services in Kenya. The information was collated through review of document and phone interviews. Kenya was a British colony from 1920 to 1963. The British Empire Society for the Blind (BESB) was founded in 1950, renamed Royal Commonwealth Society for the Blind in 1957 and Sightsavers in 1987. In 1956, BESB established the Kenya Society for the Blind and the Kenya Ophthalmic programme (KOP). Sightsavers has been supporting Kenya since then. During the launch of VISION 2020 in 2001, KOP was upgraded to a Division of Ophthalmic Services (DOS) of the Ministry of Health. In 2010, health services were devolved to Counties. In 2013, DOS was renamed Ophthalmic Services Unit and Eye Health Section in 2023. Training of Ophthalmic clinical officers, ophthalmologists, community eye health workers, ophthalmic nurses, optometry technologists, BSc optometrists, BSc Comprehensive Ophthalmology and Cataract Surgery, and ophthalmology fellows started in 1959, 1978, 1996, 2003, 2006 and 2009, 2015, 2024 respectively.
The Mission to launch the Kenya Eye Health Journal (KEHJ): rationale, goals and features
The most challenging term of reference for the Scientific and Education Committee of the Ophthalmological Society of Kenya (OSK) has been to launch a peer-reviewed journal. From the word go the Committee was cognizant of the monumental task ahead but took up the challenge with courage and determination. As the Chinese philosopher Lao Tzu once said, “the journey of a thousand miles begins with a single step”. We thank God that our journey has been successful, culminating in the launch of KEHJ at the annual OSK Congress in November 2024. This inaugural editorial provides an overview of this journey.
The Ten simple rules for developing a research mentorship program: The experience of the postgraduate mentorship program at the Kenya Medical Training College
Introduction: The development and implementation of research mentorship programs are pivotal for cultivating future scholars and advancing academic research. This case description explores the application of ten essential rules within the postgraduate mentorship program at the Kenya Medical Training College (KMTC). The program was designed with clear objectives and selection criteria to ensure that both mentors and mentees were well-matched and prepared for their roles. Program description: Specific goals for the program were established and implemented through structured communication strategies. Daily check-ins via WhatsApp and weekly meetings facilitated consistent interaction between mentors and mentees, while professional and supportive language was used to create a respectful and constructive environment. Ground rules were set to manage expectations and ensure productive engagements. A centralized online platform was utilized to streamline information sharing, improving accessibility to resources and enhancing collaboration. The feedback on the program’s effectiveness was gathered through key performance indicators, including participation rates, engagement levels, and satisfaction surveys. The insights revealed that regular communication and personalized support were crucial for building strong mentor-mentee relationships. Based on these findings, the program was refined to include tailored training sessions and improved feedback mechanisms, which led to better academic performance and career outcomes for participants. Conclusion: In conclusion, this case description underscores the importance of applying structured rules and continuous evaluation in developing research mentorship programs. The practical guidelines derived from the KMTC experience offer valuable insights for similar initiatives, emphasizing the need for clear objectives, effective communication, and ongoing refinement to achieve successful mentorship outcomes.
Outcomes of combined cataract and trabeculectomy surgery in Kenya: A multicenter retrospective case series study
Background: Globally, cataracts and glaucoma are the leading causes of blindness accounting for 43% and 12% of the total cases respectively. In developing countries, glaucoma is generally diagnosed at an advanced stage, only when the patient seeks advice for cataract surgery. This study aimed to evaluate the outcome of combined trabeculectomy and cataract surgery in terms of intraocular pressure, visual acuity, associated complications, and clinically relevant factors that are associated with a poor outcome. Methods: Hospital-based, retrospective case series. Patients who underwent combined cataract and glaucoma surgery at Kisii Eye Hospital, Tenwek Mission Hospital and the Kenyatta National Hospital from January 2012 to December 2016 were included. Data was collected using a questionnaire and analysed using SPSS version 23. Descriptive analysis was done to determine the means, frequencies and proportions of the various variables. Chi-square was used to test association; confidence level was taken as 95% (p <0.05) where applicable. Results: Majority of the patients did not have sustained pressure control, especially for the subgroups of patients with longer follow-ups. Over sixty-two per cent of those who returned for 4 – 8 weeks of follow-up achieved an improvement in visual acuity and nearly 21% achieved 6/18 or better. Acute postoperative complications included corneal edema, flat bleb, and encapsulated bleb among others. Different age groupings were found to be a significant risk factor for poor visual outcomes in patients who underwent combined surgery. There was no statistically significant difference in baseline characteristics and mean IOP between phaco-trab and small incision cataract surgery with trabeculectomy (SICST) surgery groups except for LogMAR visual acuity (p = 0.015). Conclusion: Poor follow-up limited the precision of the findings but also means that a ‘one-stop’ operation for glaucoma and cataracts may be a viable and practical approach to management.
Cataract surgery, trabeculectomy, phacoemulsification, trabeculectomy, intraocular pressure
Management of Advanced Keratoconus using a semi-scleral contact lens: A non-surgical option
Keratoconus is a bilateral, progressive disease characterised by steepening and thinning of the cornea. In the early stages, spectacles improve visual acuity (VA) but as the disease progresses, rigid contact lenses (CL) are required to neutralise the irregular cornea. In advanced cases, when CLs do not provide a satisfactory fit or VA or are intolerable, keratoplasty is indicated. In Kenya, corneal donor tissue may not be readily available or affordable. Case: This report describes the fitting of semi-scleral CLs in a patient with advanced keratoconus. A 23-year-old female, referred for CL fitting, presented with advanced keratoconus with minimal improvement in VA on refraction. Tomography revealed a maximum anterior corneal curvature of 90.86 D in the right eye (RE) and 76.52 D in the left eye (LE). Both eyes were fitted with semi-scleral CLs using a diagnostic fitting set. After fitting, using several trial lenses to achieve the optimal central and peripheral fit, VA improved from 1.3 logMAR to 0.3 logMAR and 1.0 logMAR to 0.2 logMAR in the RE and LE respectively. The patient reported to be comfortable wearing the CLs for approxiamtely 12 hours a day. Conclusion: Noting the limited access to keratoplasty, this case report shows that semi-scleral CLs provide a satisfactory, non-surgical alternative to improve VA in patients with advanced keratoconus.
Eyelid adenoid cystic carcinoma: An analysis of one case with clinicopathological features mimicking sebaceous gland carcinoma
Background: Adenoid cystic carcinoma (ACC) is a rare malignant epithelial tumor representing 1–2% of all head and neck tumors and 10–15% of malignant salivary gland tumors. In the eyelid, it can arise from the glands of Moll, the palpebral lobe of the lacrimal gland, the accessory lacrimal glands in the conjunctiva, or from ectopic lacrimal gland tissue. It is the most common primary malignant epithelial tumor of the lacrimal glands and accounts for approximately 1.6% of all orbital tumors. In this case, we see adenoid cystic carcinoma arising from the skin of the eyelid with features simulating the more commonly seen sebaceous gland carcinoma. Case: A 74-year-old male patient presented with a two-year history of swelling in the left upper lid. The lesion was excised without being sent for histology. Subsequently, there was a recurrence of the swelling, and the patient was referred to Kenyatta National Hospital. Upon admission, the working diagnosis was left upper lid sebaceous gland carcinoma, and the patient underwent a wide full-thickness excisional biopsy of the left eyelid. The histological diagnosis revealed adenoid cystic carcinoma of the eyelid. The patient then underwent lid reconstruction surgery. Conclusion: Malignant eyelid lesions may masquerade as several different clinically benign conditions and all excised eyelid lesions should be submitted for histopathologic confirmation.
Case reports on the lurking danger of mobile phone battery explosion
Eye injuries are commonly known to be as a result of road traffic accidents or physical assault but there is an emerging concern of injuries caused by phone battery explosion. With the common everyday use of mobile phones by Kenyans, it is important to highlight the potential risks of phone battery explosion. The explosion results in serious eye injuries from physical, thermal, and chemical injuries. We present three patients with eye injuries due to mobile phone battery explosion seen at the Kenyatta National hospital in Nairobi Kenya between July 2019 and August 2024. The patients had severe eye injuries. Their management included both surgical and medical treatment. The visual outcomes of the injured eyes ranged from moderate to severe visual impairment. The findings of this study show the profound impact of these types of injury on vision. It is recommended by the authors of this article that there is need to educate the public on the risks and preventive measures.
Mobile phone, battery, explosion, eye injury, case report
Case report of a patient with bilateral optic nerve coloboma
Coloboma is a congenital defect that can affect the anterior and posterior segment of one or both eyes and may cause visual impairment or can be associated with the rare but serious CHARGE (Coloboma of the eye, Heart defects, Atresia of the Nasal choanae, Retardation of growth and/or development, Genitourinary malformation Ear abnormalities and/or deafness) syndrome. We present the case of a 10-year-old girl from a rural eye center in Kenya, who reported to the hospital for the first time with a smaller left eye and poor vision since birth. Her uncorrected visual acuity (UCVA) was 20/250 in the right eye (RE) and 20/400 in the left eye (LE). Examination revealed 15-degree esotropia in the LE, anisometropia, and bilateral coloboma. Systemic examination was normal. Best-corrected visual acuity (BCVA) was 20/60 in the RE with a refraction of +5.75/-0.50 × 112° and 20/150 in the LE with +4.50/-1.25 × 120°. Imaging with a Zeiss Clarus 700 fundus camera confirmed a larger chorioretinal coloboma in the LE, with no signs of retinal detachment. Genetic testing was not available. The patient was provided with spectacles and advised to have serial fundus photographs taken every six months at our center. This case highlights the need to ensure the early diagnosis of coloboma and to assess for potentially life-threatening associations, such as CHARGE syndrome.