OUTCOME
OF CATARACT SURGERY IN HIV-POSITIVE PATIENTS
NWOSU SNN (FMCOPH,
FWACS, FICS, FACS)1,2, OKPALA NE (FMCOPH,
FWACS)1,2, NNUBIA CA (MBBS)2,
AKUDINOBI CU (FMCOPH)
1Department
of Ophthalmology, Nnamdi Azikiwe University, Awka, Nigeria
2Guinness Eye
Center, Onitsha, Nigeria
Correspondence to: Prof. Nwosu SNN
Email: sabenwosu@gmail.com
Citation: Nwosu SNN,
Okpala NE, Nnubia CA, Akudinobi CU. Outcome Of Cataract Surgery In HIV-
Positive
Patients. Orient Journal of Surgical
Sciences. March 2020; 1 (1): 10 - 13
ABSTRACT
Objective: To determine
the visual outcome of cataract surgery in HIV-positive patients at the Guinness
Eye Center Onitsha.
Materials
and Methods: The case files of HIV-positive
patients who had cataract surgery at the Guinness Eye Center Onitsha
between 2006 and 2014 were retrieved. Information obtained included
socio-demographics, co-morbidities, pre- and post-operative visual acuity and
surgical complications.
Results:
Twenty six eyes of 18 patients (7 males, 11 females); age
range: 32-73 years; median – 51 years had cataract surgery.
Preoperatively, 22 eyes (84.6%) had visual acuity <3/60; 6 months after
surgery 17 (65.4%) had attained acuity
≥ 6/18, with 9
(34.6%) having acuity ≥
6/6. Post-operative blindness and low vision were due to pre-existing
co-morbidity, uveitis, endophthalmitis and posterior capsule opacity.
Conclusions:
The visual outcome of cataract surgery in HIV-positive
patients is encouraging. However, the patients need to be regularly
followed up post-surgery.
KEY
WORDS: HIV, Cataract, Surgery, Visual outcome, Nigeria
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INTRODUCTION
The first case of human immunodeficiency virus
infection/acquired immune deficiency syndrome (HIV/AIDS) in Nigeria was
reported in 19861. This was 5years after the disease was first
described in the United States of America2. In 1995 the first cases
of its ocular manifestations were reported in Nigeria3. Human
immunodeficiency virus (HIV) screening facilities became available in our
hospital in 1993. Since then, all patients going for eye surgery are routinely
screened using ELISA. Confirmatory test for those found positive is with the
Western Immunoblot. However no patient is refused treatment including surgery
because of HIV status.
Ocular and adnexal features of HIV/AIDS comprise surgical
and nonsurgical disorders. But surgical eye diseases prevalent in general
population do also occur in HIV/AIDS patients. One such disease is cataract-the
commonest cause of blindness in Nigeria4. Cataract is mostly
associated with ageing and may not be a direct complication of HIV/AIDS. On the
other hand, it has been observed that HIV-infected persons are predisposed to
premature ageing and are therefore at increased risk for age-related diseases
including cataract5. Persistent, recurrent uveitis is a known
complication of HIV infection6. A particular form of intraocular
inflammation which occurs in HIV-positive patients consequent upon immune
reconstitution following anti-retroviral therapy is known as immune recovery
uveitis7,8. Uveitis from any cause and its treatment with steroids
may lead to cataract formation.
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The
HIV-positive patient blind from cataract needs to be treated in order to
restore sight. Surgery is for now, the confident method of restoring vision in
the cataract blind.
However
it is not clear how well HIV/AIDS patients fare after cataract surgery because
of other blinding complications such as cytomegalovirus (CMV) retinitis, HIV
retinopathy and uveitis that may coexist6. Reports on outcome of
cataract surgery in HIV-positive patients are few. In a study in Denmark,
Rasmussen et al9 reported that HIV-infected persons were at
increased risk for cataract surgery compared to age- and sex-matched persons
without HIV infection. The highest risk was found in patients with CD4 count ≤
200 cell/µL. A review of 46 eyes of 27 HIV-positive patients that had cataract
surgery in Singapore reported that the outcomes were similar to that observed
in the general population10. However they cautioned that each
patient's ocular and general health should be optimized before surgery.
To
the best of the authors' knowledge, there has not been a report of the visual
outcome of cataract surgery in HIV-positive patients in Nigeria. The need to
bridge this knowledge gap is important. Therefore this study aimed at
determining the visual outcome of cataract surgery in HIV-positive patients at
the Guinness Eye Center, Onitsha, Nigeria.
MATERIALS AND
METHODS
The
case files of HIV-positive patients who had cataract surgery at the Guinness
Eye Center Onitsha between 2006 and 2014 were reviewed. Information obtained
included
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