Nagib Du Toit - Academia.edu (original) (raw)

Papers by Nagib Du Toit

Research paper thumbnail of Impact of COVID 19 on Ophthalmic Surgical Procedures in Sub-Saharan Africa: A Multicentre Study

Research paper thumbnail of Telemedicine and artificial intelligence come to the fore

Research paper thumbnail of The gradual loss of vision

South African Family Practice, 2013

Research paper thumbnail of Sudden loss of vision

South African Family Practice, 2013

Abstract Sudden loss of vision, which causes consternation for both the patient and clinician, is... more Abstract Sudden loss of vision, which causes consternation for both the patient and clinician, is a clinical problem that is encountered fairly regularly in most primary healthcare settings. Sudden visual loss or obscuration which is transient may simply be a symptom of a dry eye or a migraine, but it may also be the onset of irreversible visual loss or a stroke. Most cases of sudden loss of vision are serious, require referral and have an associated underlying systemic disease. Visual loss is usually unilateral, but may be bilateral. This clinical problem may present a diagnostic challenge. No cause may be found in some instances. However, it is important to remember that the more sinister causes of sudden visual loss, such as temporal arteritis, carotid or cardiac emboli that cause retinal vascular occlusion, retinal detachment, vitreous haemorrhage and orbital masses, need to be identified early. Using the duration of the visual loss as the primary differentiating factor, with associated symptoms and signs as supplementary factors, the causes can be narrowed down. A thorough history, goal-directed examination, proper investigation and appropriate referral should enable early diagnosis and adequate management. This will prevent further ocular morbidity, and even patient mortality.

Research paper thumbnail of Axial length elongation in adults with long-standing unilateral traumatic cataract

African Vision and Eye Health, 2016

Background: Unilateral eye elongation with resultant axial myopia has been reported to occur seco... more Background: Unilateral eye elongation with resultant axial myopia has been reported to occur secondary to visual deprivation from birth or early childhood. Acquired axial length elongation secondary to visual deprivation in adults has rarely been reported.Aim: To report acquired axial myopia in adults with visual deprivation due to long-standing unilateral traumatic cataract.Methods: Eleven consecutive adult patients who presented for cataract surgery with unilateral, long-standing, mature, traumatic cataracts and an interocular axial length difference of more than 1 mm were studied. Patients with a post-operative best corrected visual acuity (BCVA) of < 6/12 were excluded to rule out possible pre-existing anisometropic amblyopia.Results: Of the 11 patients with significant interocular axial length difference, 5 patients were excluded on the basis of possible pre-existing amblyopia. The remaining 6 patients had final BCVA of 6/12 or better. The median length of the cataractous ey...

Research paper thumbnail of Eye, rheumatoid arthritis

SpringerReference

Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with a number of extra-ar... more Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with a number of extra-articular organ manifestations. Eye involvement is a frequent finding in patients with RA. Ocular conditions which occur due to RA are keratoconjunctivitis sicca, episcleritis, scleritis, corneal pathology and retinal vasculitis. Optic nerve involvement in the form of neuritis or ischaemic neuropathy has been reported and tenosynovitis of the superior oblique muscle sheath (Brown syndrome) is also an occasional manifestation. It should also be borne in mind that the eye may also be affected by the treatment of RA with drugs such as chloroquine which can cause loss of vision as a result of maculopathy.

Research paper thumbnail of How useful is visual field testing in an African glaucoma clinic?

Clinical Ophthalmology, 2014

Purpose: To investigate the usefulness of visual field testing in the diagnosis and subsequent ma... more Purpose: To investigate the usefulness of visual field testing in the diagnosis and subsequent management of glaucoma in a specialist glaucoma clinic at Groote Schuur Hospital, Cape Town, South Africa. Methods: A retrospective case note review of 344 patients who attended the glaucoma clinic between January and June 2010. Results: The study population consisted of 201 (58%) females and 143 (42%) males. The diagnoses included 207 (60%) cases with primary open-angle glaucoma, 58 (17%) cases with chronic angle closure glaucoma, 46 (13%) cases with secondary glaucoma, 17 (5%) cases with normal pressure glaucoma, ten (3%) cases with ocular hypertension, and six (2%) glaucoma suspects. Visual field testing contributed to the diagnosis of glaucoma in only 34 (10%) cases. A total number of 2,604 fields were performed. Of these fields, 1,931 (74%) were reliable. A baseline was reached in only 141 (53%) patients. There was evidence of field progression in only 24 (9%) cases. Changes to glaucoma treatment were based on inadequate control of intraocular pressure alone in 309 (90%) patients. Visual field progression contributed to changes in treatment in only 15 (4%) cases. Conclusion: Visual fields are not used in the diagnosis and management of glaucoma in the majority of patients in our clinic. Patients present with advanced disease, which is easily diagnosed without the use of visual fields. Progression of fields seldom contributes to monitoring and intraocular pressure is mainly used to monitor the adequacy of treatment.

Research paper thumbnail of Herpetic ulcer of the eyelids in an immunocompromised patient

A 24-year-old black female (HIV-positive) was referred to our clinic with a 4-week history of an ... more A 24-year-old black female (HIV-positive) was referred to our clinic with a 4-week history of an ulcerative lesion of the right upper and lower eyelids. She was on treatment for pulmonary tuberculosis and had been admitted to a secondary level hospital. She had no other ocular symptoms or signs. A tissue biopsy of the lesion revealed multinucleate squamous cells with ground glass viral nuclear inclusion bodies, indicative of herpes simplex virus (HSV) infection. The ulcer healed with oral and topical acyclovir therapy, confirming a herpetic origin. There is only one other reported case of this type of ulcerative eyelid lesion caused by HSV; the patient in this case was also immunocompromised.

Research paper thumbnail of Evisceration and Sympathetic Ophthalmia: Is there a risk?

Research paper thumbnail of Isolated Rupture of the Superior Rectus Muscle following Blunt Trauma – A Case Report

Global Journal of Medical and Clinical Case Reports

We report the rare case of a left isolated superior rectus muscle (SRM) rupture due to a bizarre ... more We report the rare case of a left isolated superior rectus muscle (SRM) rupture due to a bizarre mechanism of injury, where a universal serial bus (USB) fl ash drive entered the orbit during a motor vehicle accident leading to rupture of the SRM 7mm from the limbus. The proximal stump was relocated and reattached using a non-absorbable hangback suture. Post-operatively the patient had a residual 5 prism diopter left hypotropia (LHoT), which allowed for fusion in primary, with a slight chin up position, as well as downgaze. The globe, eyelids and orbit were spared of injury and orbital fractures were absent. We discuss our experience and surgical management of the case, which included locating the lost muscle and repairing it primarily in preference to a transposition.

Research paper thumbnail of The eye in systemic disease

South African Family Practice, Jan 8, 2013

Research paper thumbnail of Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system

International journal of ophthalmology, 2015

To determine the visual outcomes in adult patients who sustained open globe injuries and to deter... more To determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS. A prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome. There were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outc...

Research paper thumbnail of Open-Angle Glaucoma and an Enlarged Superior Orbital Fissure Caused by Trauma

JAMA ophthalmology, Jan 19, 2015

Research paper thumbnail of Herpetic ulcer of the eyelids in an immunocompromised patient

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2012

A 24-year-old black female (HIV-positive) was referred to our clinic with a 4-week history of an ... more A 24-year-old black female (HIV-positive) was referred to our clinic with a 4-week history of an ulcerative lesion of the right upper and lower eyelids. She was on treatment for pulmonary tuberculosis and had been admitted to a secondary level hospital. She had no other ocular symptoms or signs. A tissue biopsy of the lesion revealed multinucleate squamous cells with ground glass viral nuclear inclusion bodies, indicative of herpes simplex virus (HSV) infection. The ulcer healed with oral and topical acyclovir therapy, confirming a herpetic origin. There is only one other reported case of this type of ulcerative eyelid lesion caused by HSV; the patient in this case was also immunocompromised.

Research paper thumbnail of Open globe injuries in patients seen at Groote Schuur Hospital, Cape Town, South Africa : trauma

South African Journal of Surgery Suid Afrikaanse Tydskrif Vir Chirurgie, Jul 31, 2013

Research paper thumbnail of Paediatric ophthalmology at primary healthcare level

South African Family Practice, 2014

ABSTRACT

Research paper thumbnail of Open globe injuries in patients seen at Groote Schuur Hospital, Cape Town, South Africa

South African Journal of Surgery, 2013

Ocular trauma accounts for a significant proportion of admissions to the eye ward at Groote Schuu... more Ocular trauma accounts for a significant proportion of admissions to the eye ward at Groote Schuur Hospital (GSH), Cape Town, South Africa. There are few published studies on ocular trauma in South Africa. Some studies elsewhere have shown an association between open globe injuries and recent alcohol use, but no such study has been conducted in this country. To identify causes of and outcomes after open globe injuries at GSH, with emphasis on the association between assault and alcohol use as well as the relationship, if any, between victim and assailant. This was a prospective case series of all adult patients admitted to GSH with open globe injuries over a 2-year period. Ocular findings were recorded with a minimum 3-month follow-up period. There were 249 open globe injuries. Assault had occurred in 183 (73.5%), and 66 (26.5%) were accidental. In the assault-related cases, 95 (51.9%) of the assailants were reported to have used alcohol and 121 (66.1%) of the victims admitted to alcohol use prior to the assault. There was a statistically significant relationship between ethanol use and type of injury, 71.4% of assault cases overall being associated with ethanol use. In assault-related cases, the assailant was known to the victim in 113 cases (61.7%). Of the patients, 78.7% had a final acuity of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;3/60 in the traumatised eye. A significant number of open globe injuries due to assault are related to ethanol abuse and occur when the victim and assailant are known to each other. Such injuries are likely to have a poor prognosis.

Research paper thumbnail of How useful is visual field testing in an African glaucoma clinic?

Clinical Ophthalmology, 2014

of surgery, groote schuur hospital, Cape Town, south africa; 2 The University of Cape Town, Cape ... more of surgery, groote schuur hospital, Cape Town, south africa; 2 The University of Cape Town, Cape Town, south africa Purpose: To investigate the usefulness of visual field testing in the diagnosis and subsequent management of glaucoma in a specialist glaucoma clinic at Groote Schuur Hospital, Cape Town, South Africa. Methods: A retrospective case note review of 344 patients who attended the glaucoma clinic between January and June 2010.

Research paper thumbnail of Impact of COVID 19 on Ophthalmic Surgical Procedures in Sub-Saharan Africa: A Multicentre Study

Research paper thumbnail of Telemedicine and artificial intelligence come to the fore

Research paper thumbnail of The gradual loss of vision

South African Family Practice, 2013

Research paper thumbnail of Sudden loss of vision

South African Family Practice, 2013

Abstract Sudden loss of vision, which causes consternation for both the patient and clinician, is... more Abstract Sudden loss of vision, which causes consternation for both the patient and clinician, is a clinical problem that is encountered fairly regularly in most primary healthcare settings. Sudden visual loss or obscuration which is transient may simply be a symptom of a dry eye or a migraine, but it may also be the onset of irreversible visual loss or a stroke. Most cases of sudden loss of vision are serious, require referral and have an associated underlying systemic disease. Visual loss is usually unilateral, but may be bilateral. This clinical problem may present a diagnostic challenge. No cause may be found in some instances. However, it is important to remember that the more sinister causes of sudden visual loss, such as temporal arteritis, carotid or cardiac emboli that cause retinal vascular occlusion, retinal detachment, vitreous haemorrhage and orbital masses, need to be identified early. Using the duration of the visual loss as the primary differentiating factor, with associated symptoms and signs as supplementary factors, the causes can be narrowed down. A thorough history, goal-directed examination, proper investigation and appropriate referral should enable early diagnosis and adequate management. This will prevent further ocular morbidity, and even patient mortality.

Research paper thumbnail of Axial length elongation in adults with long-standing unilateral traumatic cataract

African Vision and Eye Health, 2016

Background: Unilateral eye elongation with resultant axial myopia has been reported to occur seco... more Background: Unilateral eye elongation with resultant axial myopia has been reported to occur secondary to visual deprivation from birth or early childhood. Acquired axial length elongation secondary to visual deprivation in adults has rarely been reported.Aim: To report acquired axial myopia in adults with visual deprivation due to long-standing unilateral traumatic cataract.Methods: Eleven consecutive adult patients who presented for cataract surgery with unilateral, long-standing, mature, traumatic cataracts and an interocular axial length difference of more than 1 mm were studied. Patients with a post-operative best corrected visual acuity (BCVA) of < 6/12 were excluded to rule out possible pre-existing anisometropic amblyopia.Results: Of the 11 patients with significant interocular axial length difference, 5 patients were excluded on the basis of possible pre-existing amblyopia. The remaining 6 patients had final BCVA of 6/12 or better. The median length of the cataractous ey...

Research paper thumbnail of Eye, rheumatoid arthritis

SpringerReference

Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with a number of extra-ar... more Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with a number of extra-articular organ manifestations. Eye involvement is a frequent finding in patients with RA. Ocular conditions which occur due to RA are keratoconjunctivitis sicca, episcleritis, scleritis, corneal pathology and retinal vasculitis. Optic nerve involvement in the form of neuritis or ischaemic neuropathy has been reported and tenosynovitis of the superior oblique muscle sheath (Brown syndrome) is also an occasional manifestation. It should also be borne in mind that the eye may also be affected by the treatment of RA with drugs such as chloroquine which can cause loss of vision as a result of maculopathy.

Research paper thumbnail of How useful is visual field testing in an African glaucoma clinic?

Clinical Ophthalmology, 2014

Purpose: To investigate the usefulness of visual field testing in the diagnosis and subsequent ma... more Purpose: To investigate the usefulness of visual field testing in the diagnosis and subsequent management of glaucoma in a specialist glaucoma clinic at Groote Schuur Hospital, Cape Town, South Africa. Methods: A retrospective case note review of 344 patients who attended the glaucoma clinic between January and June 2010. Results: The study population consisted of 201 (58%) females and 143 (42%) males. The diagnoses included 207 (60%) cases with primary open-angle glaucoma, 58 (17%) cases with chronic angle closure glaucoma, 46 (13%) cases with secondary glaucoma, 17 (5%) cases with normal pressure glaucoma, ten (3%) cases with ocular hypertension, and six (2%) glaucoma suspects. Visual field testing contributed to the diagnosis of glaucoma in only 34 (10%) cases. A total number of 2,604 fields were performed. Of these fields, 1,931 (74%) were reliable. A baseline was reached in only 141 (53%) patients. There was evidence of field progression in only 24 (9%) cases. Changes to glaucoma treatment were based on inadequate control of intraocular pressure alone in 309 (90%) patients. Visual field progression contributed to changes in treatment in only 15 (4%) cases. Conclusion: Visual fields are not used in the diagnosis and management of glaucoma in the majority of patients in our clinic. Patients present with advanced disease, which is easily diagnosed without the use of visual fields. Progression of fields seldom contributes to monitoring and intraocular pressure is mainly used to monitor the adequacy of treatment.

Research paper thumbnail of Herpetic ulcer of the eyelids in an immunocompromised patient

A 24-year-old black female (HIV-positive) was referred to our clinic with a 4-week history of an ... more A 24-year-old black female (HIV-positive) was referred to our clinic with a 4-week history of an ulcerative lesion of the right upper and lower eyelids. She was on treatment for pulmonary tuberculosis and had been admitted to a secondary level hospital. She had no other ocular symptoms or signs. A tissue biopsy of the lesion revealed multinucleate squamous cells with ground glass viral nuclear inclusion bodies, indicative of herpes simplex virus (HSV) infection. The ulcer healed with oral and topical acyclovir therapy, confirming a herpetic origin. There is only one other reported case of this type of ulcerative eyelid lesion caused by HSV; the patient in this case was also immunocompromised.

Research paper thumbnail of Evisceration and Sympathetic Ophthalmia: Is there a risk?

Research paper thumbnail of Isolated Rupture of the Superior Rectus Muscle following Blunt Trauma – A Case Report

Global Journal of Medical and Clinical Case Reports

We report the rare case of a left isolated superior rectus muscle (SRM) rupture due to a bizarre ... more We report the rare case of a left isolated superior rectus muscle (SRM) rupture due to a bizarre mechanism of injury, where a universal serial bus (USB) fl ash drive entered the orbit during a motor vehicle accident leading to rupture of the SRM 7mm from the limbus. The proximal stump was relocated and reattached using a non-absorbable hangback suture. Post-operatively the patient had a residual 5 prism diopter left hypotropia (LHoT), which allowed for fusion in primary, with a slight chin up position, as well as downgaze. The globe, eyelids and orbit were spared of injury and orbital fractures were absent. We discuss our experience and surgical management of the case, which included locating the lost muscle and repairing it primarily in preference to a transposition.

Research paper thumbnail of The eye in systemic disease

South African Family Practice, Jan 8, 2013

Research paper thumbnail of Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system

International journal of ophthalmology, 2015

To determine the visual outcomes in adult patients who sustained open globe injuries and to deter... more To determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS. A prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome. There were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outc...

Research paper thumbnail of Open-Angle Glaucoma and an Enlarged Superior Orbital Fissure Caused by Trauma

JAMA ophthalmology, Jan 19, 2015

Research paper thumbnail of Herpetic ulcer of the eyelids in an immunocompromised patient

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2012

A 24-year-old black female (HIV-positive) was referred to our clinic with a 4-week history of an ... more A 24-year-old black female (HIV-positive) was referred to our clinic with a 4-week history of an ulcerative lesion of the right upper and lower eyelids. She was on treatment for pulmonary tuberculosis and had been admitted to a secondary level hospital. She had no other ocular symptoms or signs. A tissue biopsy of the lesion revealed multinucleate squamous cells with ground glass viral nuclear inclusion bodies, indicative of herpes simplex virus (HSV) infection. The ulcer healed with oral and topical acyclovir therapy, confirming a herpetic origin. There is only one other reported case of this type of ulcerative eyelid lesion caused by HSV; the patient in this case was also immunocompromised.

Research paper thumbnail of Open globe injuries in patients seen at Groote Schuur Hospital, Cape Town, South Africa : trauma

South African Journal of Surgery Suid Afrikaanse Tydskrif Vir Chirurgie, Jul 31, 2013

Research paper thumbnail of Paediatric ophthalmology at primary healthcare level

South African Family Practice, 2014

ABSTRACT

Research paper thumbnail of Open globe injuries in patients seen at Groote Schuur Hospital, Cape Town, South Africa

South African Journal of Surgery, 2013

Ocular trauma accounts for a significant proportion of admissions to the eye ward at Groote Schuu... more Ocular trauma accounts for a significant proportion of admissions to the eye ward at Groote Schuur Hospital (GSH), Cape Town, South Africa. There are few published studies on ocular trauma in South Africa. Some studies elsewhere have shown an association between open globe injuries and recent alcohol use, but no such study has been conducted in this country. To identify causes of and outcomes after open globe injuries at GSH, with emphasis on the association between assault and alcohol use as well as the relationship, if any, between victim and assailant. This was a prospective case series of all adult patients admitted to GSH with open globe injuries over a 2-year period. Ocular findings were recorded with a minimum 3-month follow-up period. There were 249 open globe injuries. Assault had occurred in 183 (73.5%), and 66 (26.5%) were accidental. In the assault-related cases, 95 (51.9%) of the assailants were reported to have used alcohol and 121 (66.1%) of the victims admitted to alcohol use prior to the assault. There was a statistically significant relationship between ethanol use and type of injury, 71.4% of assault cases overall being associated with ethanol use. In assault-related cases, the assailant was known to the victim in 113 cases (61.7%). Of the patients, 78.7% had a final acuity of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;3/60 in the traumatised eye. A significant number of open globe injuries due to assault are related to ethanol abuse and occur when the victim and assailant are known to each other. Such injuries are likely to have a poor prognosis.

Research paper thumbnail of How useful is visual field testing in an African glaucoma clinic?

Clinical Ophthalmology, 2014

of surgery, groote schuur hospital, Cape Town, south africa; 2 The University of Cape Town, Cape ... more of surgery, groote schuur hospital, Cape Town, south africa; 2 The University of Cape Town, Cape Town, south africa Purpose: To investigate the usefulness of visual field testing in the diagnosis and subsequent management of glaucoma in a specialist glaucoma clinic at Groote Schuur Hospital, Cape Town, South Africa. Methods: A retrospective case note review of 344 patients who attended the glaucoma clinic between January and June 2010.