ETD Collection

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Now showing 1 - 4 of 4
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    Outcomes of retinal detachment surgery at Charlotte Maxeke Johannesburg Academic Hospital
    (2018) Mofokeng, Salamina Mathabo
    Purpose: The aim of this study was to determine the visual acuity and anatomical outcome of retinal detachment repair at Charlotte Maxeke Johannesburg Academic hospital. Methods: Retrospective record review (clinical audit) of outcomes in patients who had retinal surgery (pars plana vitrectomy) for either rhegmatogenous retinal detachment or diabetic retinal detachment (tractional detachment or combined tractional and rhegmatogenous detachment) at Charlotte Maxeke Johannesburg Academic hospital during the period from 1 January 2010 to 31 December 2014. Results: During the specified time period 941 pars plana vitrectomies (including repeat surgery) were performed at the hospital. After exclusion for indications other than retinal detachment repairs and for missing or incomplete records, a total of 164 records of 164 patients were reviewed. The patients were divided into two groups: a rhegmatogenous retinal detachment group (n=99) and a diabetic retinal detachment group (n=65). Rhegmatogenous retinal detachment Ninety nine patients with rhegmatogenous detachment were included in the study, 62% male and 38% female. The mean age (± standard deviation) was 48(±18.4) years. The most common cause of rhegmatogenous detachment was trauma followed by cataract surgery, accounting for 37 % and 21% of all causes respectively. Sixty three percent of these detachments involved the macula at the time of presentation, and 58% had proliferative vitreoretinopathy (PVR). Eighty three eyes (84%) obtained vision improvement or stabilization and retinal attachment. Forty eyes (40%) had visual acuity improvement, 43 eyes (43%) retained the same vision. Successful anatomical reattachment of the retina was obtained in 93% (n=92) of eyes including those that needed a repeat surgery. Diabetic retinal detachment Sixty five patients with diabetic retinal detachment were included in the study. Sixty three percent (n=41) were males and the mean age (± standard deviation) was 54± 12.2 years. Sixty eight percent (n=44) had tractional retinal detachment and 32% (n=21) had a combined tractional and rhegmatogenous retinal detachment. Thirty two percent of patients had detachments associated with vitreous haemorrhage, and 60% had macular involving detachments. Forty six eyes (71%) obtained vision improvement or stabilization and attachment of the retina; 36.9% (n=24) had visual acuity improvement, 33.9% (n=22) retained the same visual acuity and 29.2% (n=19) lost vision. Eighty five percent (n=55) had successful anatomical reattachment of the retina and 15% (n=10) had re-detachments after surgery. Conclusions: This study found that the majority of patients, whose files were reviewed, benefited from surgical intervention for rhegmatogenous and diabetic retinal detachment in terms of stabilisation or improvement of vision. The major limitation of this study is the large number of missing or incomplete records. The results of this study are therefore not generalisable to our retinal detachment patient population.
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    The clinical outcome of macula hole surgery done at Charlotte Maxeke Johannesburg Academic Hospital
    (2017) Mailane, Dimakatso Lorraine
    Purpose: To describe and analyse demographics, clinical features, visual and anatomical outcomes of patients with macula hole (MH) treated at Charlotte Maxeke Johannesburg Academic Hospital. Methods: A retrospective review of pre- and post- operative findings of 39 patients who underwent MH surgery from January 2008 to 30 October 2012. Results: 39 patients were enrolled in the study. The mean age was 63 years. 49% were males and 51% were females. Majority were black, 59% of the participants. The average duration of symptoms was 12 months. The median preoperative Best corrected visual acuity (BCVA) was logMar1.0. At 1month following surgery, only 23 patients had records. The median BCVA was logMar1.3. About 60% had the same BCVA, 13% had an increase in BCVA and 17% had decreased BCVA. 65% had closed MH and 35% patients had open MH. At 3 months, 7 patients met the criteria and the rest were excluded due to lack of relevant data. 58% had no change in BCVA, 28% had improvement in BCVA and 14% had decreased BCVA. The median gain in BCVA between pre-op and 1 month to 3 month visit was logMar1.0, 1line improvement. The median pre-operative Inner hole diameter (IHD) was 377um and the Basal hole diameter (BHD) was 766um. 86% of patients had closed MH and 14% had open MH. Conclusion: Best corrected visual acuity and MH improved at 3 months following MH surgery in our African population. Patients demographics, clinical features and characteristics are similar to patients in other studies in different countries. A larger and longer duration study would be beneficial.
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    Preoperative fasting practices in adult elective surgery patients at Charlotte Maxeke Johannesburg academic hospital
    (2016) Herbst, Julie-Ann Melissa Elizabeth
    The literature describing the implementation of the latest preoperative fasting guidelines by South African health care professionals is limited. Preoperative fasting of adult patients in the health care system has been observed to be unnecessarily long. Prolonged preoperative fasting may result in detrimental effects such as hypovolaemia, dehydration, headache and hypoglycaemia. These effects impact upon patient wellbeing and satisfaction with healthcare. The aim of this study was to describe preoperative fasting practices in adult elective surgery patients at CMJAH. A prospective, contextual, descriptive study design was used in this study. A sample size of 62 adult patients who required anaesthesia for elective surgery estimated the mean instructed and actual fasting times to an accuracy of within 0.5%. The researcher collected data on the day of surgery using a standardised data collection sheet. The study included 64 patients from four surgical disciplines. The median instructed fasting time was 10 hours with a minimum of 8 hours and a maximum of 12 hours. The mean actual fasting time was 14.92 (S.D. 2.50) hours. The difference between the actual and instructed fasting times was statistically significant. There was however no difference in fasting times between the four surgical disciplines. The mean instructed and actual fasting times for adult elective surgery patients at CMJAH were longer than the recommended guidelines. The mean actual fasting time compared closely with local paediatric and international adult studies suggesting that prolonged preoperative fasting is a widespread problem.
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    The effect of preoperative apple juice on the prevalence of hypoglycaemia in paediatric patients
    (2013-01-24) Lee, Clover-Ann
    Background: Children have historically been fasted for prolonged periods preoperatively to reduce the volume and acidity of their gastric contents and thus the risk of regurgitation and pulmonary aspiration. Evidence shows that this risk is not increased by following the current recommended fasting guidelines, and that prolonged fasting may be detrimental to children, who may present with hunger, thirst, depleted intravascular volume, metabolic acidosis and hypoglycaemia. A recent study at Charlotte Maxeke Johannesburg Academic Hospital showed a 18.5% prevalence of biochemical hypoglycaemia, defined as a blood glucose concentration of less than 3.5 mmol/l, in children from one to five years of age presenting for elective surgery. Aims: The aims of this study were to document the prevalence of biochemical hypoglycaemia in children from the ages of one to five years who were given apple juice to drink at least two hours preoperatively, and to compare these results to a historical control group. Methods: A prospective, contextual comparative study design was used. Approval was obtained from the University of the Witwatersrandʼs Human Ethics Committee and other relevant authorities. The groups were matched for age and weight. Consent was obtained from the guardians of all children who met the inclusion criteria before being enrolled in the study. A standard 200 ml carton of commercially available apple juice was offered to each participant. The volume and time of the juice consumed was documented, along with relevant demographic data. Inhalational induction of anaesthesia proceeded a minimum of two hours later, and a venous glucose concentration was measured. Results: The prevalence of biochemical hypoglycaemia was statistically significantly reduced in the intervention group (p = 0.0163), eliminating the effect of prolonged preoperative fasting. Conclusion: The consumption of clear apple juice on the morning of surgery is a safe, inexpensive, effective way to reduce the prevalence of hypoglycaemia in children presenting for elective surgery.