Browsing by Author "Braimah, I.Z."
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Item Bevacizumab versus ziv-aflibercept in branch retinal vein occlusion(Indian Journal of Ophthalmology, 2019-07-07) Braimah, I.Z.; Singh, S.R.; Uplanchiwar, B.; Mansour, A.M.; Chhablani, J.PURPOSE: To compare the effectiveness of treatment with intravitreal bevacizumab (IVB) and ziv-aflibercept (IVZ) in patients with macular edema (ME) post-branch retinal vein occlusion (BRVO). METHODS: Patients with treatment naïve ME post-BRVO were included retrospectively if they received either IVB (0.05 ml/1.25 mg) or IVZ (0.05 ml/1.25 mg) monotherapy with a follow up of 12 months. RESULTS: Thirty-two and 17 eyes received IVB and IVZ, respectively. The mean improvement in best corrected visual acuity (BCVA) was 0.36 ± 0.3 logarithm of minimum angle of resolution (logMAR) in the IVB group and 0.27 ± 0.3 in the IVZ group (P = 0.35). The mean change in central macular thickness was 178.9 ± 180.9 and 173.5 ± 344.4 μm in IVB and IVZ groups, respectively (P = 0.94). The mean number of injections was higher in the IVB group (4.0 ± 1.8) compared with 1.82 ± 0.8 in the IVZ group (P < 0.0001). The IVZ group had significantly fewer number of visits (P < 0.0001) and longer maximum treatment-free intervals (P = 0.0081). CONCLUSION: IVZ appears to be cost-effective with the similar visual outcome and less number of visits in comparison to IVB.Item Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population.(Eye, 2011) Essuman, V.A.; Braimah, I.Z.; Ndanu, T.A.; Ntim-Amponsah, C.T.PURPOSE: To evaluate the surgical outcome of combined trabeculotomy-trabeculectomy in Ghanaian children with primary congenital glaucoma. MATERIALS AND METHODS: A retrospective case series involving 19 eyes of 12 consecutive children with primary congenital glaucoma who had primary trabeculotomy-trabeculectomy from 12 August 2004 to 30 June 2008, at the Korle-Bu Teaching Hospital, Ghana. Main outcome measures were preoperative and postoperative intraocular pressures, corneal diameter, corneal clarity, bleb characteristics, duration of follow-up, surgical success, and complications. RESULTS: A total of 19 eyes of 12 patients met the inclusion criteria. Six of the patients were males. Mean age at diagnosis was 4.4 (range 2-8) months. Mean age at surgery was 5.9 months (range 3-16). Eight (67%) infants had bilateral disease. Mean duration of follow-up was 13.1 (range 5-38) months. The preoperative mean horizontal corneal diameter was 13.4 ± 1.1(range 12-16) mm. Complete success (intraocular pressure <21 mm Hg) was obtained in 15 (79%) eyes. The probability of success was 94.4, 83.3, 66.7, 44.4, 38.9, 33.3, and 13.3% at 3, 6, 9, 12, 15, 18, and 21 months, respectively (Kaplan-Meier analysis). All eyes had corneal oedema preoperatively. Seventeen eyes (90%) had clear cornea at their last follow-up. Mean preoperative and postoperative intraocular pressures were 30.3 ± 8.8 and 18.1 ± 6.8 mm Hg respectively (P<0.001, t-test). Twelve (63%) eyes had well-functioning blebs at the last follow-up. One eye (5%) developed seclusio pupillae and cataract postoperatively. CONCLUSION: The overall success for combined trabeculotomy-trabeculectomy in Ghanaian children with primary congenital glaucoma was 79%. The probability of success reduced from more than 66% in the first 9 months postoperatively to below 45% after that.Item Efficacy of intravitreal ziv-aflibercept in patients with macular edema following retinal vein occlusion in Korle-Bu Teaching Hospital, Ghana: a retrospective case series(springer, 2021) Braimah, I.Z.; Agyabeng, K.; Amoaku, W.M.To evaluate the efficacy of ziv-aflibercept in Ghanaian patients with macular edema (ME) secondary to retinal vein occlusion (RVO). Methodology In this retrospective study, the medical records of patients with ME secondary to RVO who had been treated with intravitreal ziv-aflibercept (IVZ) (1.25 mg/0.05 ml), as part of routine clinical practice, on pro re nata basis with a minimum follow-up of 6 months were retrieved and analyzed. The main outcome measures are mean change in best-corrected visual acuity (BCVA) and central subfield foveal thickness (CSFT) measured on optical coherence tomography from baseline to 12 months post-IVZ, and ocular and systemic safety. Results Forty-three eyes were included in this study. Their mean age was 62.8 ± 11.9 years, 67.4% had at least 12-month duration of follow-up, 50% had primary open-angle glaucoma and 38 (88.4%) eyes were treatment naive. There was significant improve ment in mean BCVA in LogMAR at 1 month post initiation of IVZ (0.8 ± 0.5 vs. 1.1 ± 0.6), and visual improvement was maintained up to 12 months (p\0.001). Eyes with ME following BRVO had better mean BCVA at baseline and on subsequent visits compared to eyes with CRVO/HRVO (p = 0.01). There was significant reduction in mean CSFT up to 12 months post-IVZ injection compared to baseline (p\0.001). Ocular complications observed were consistent with complications associ ated with RVO. We have observed significant improvement in functional and anatomic outcomes 12 months post-initiation of IVZ. There is the need to confirm long-term efficacy and safety of IVZ in a large prospective study.Item Focal Choroidal Excavation in Retinal Dystrophies(Seminars in Ophthalmology, 2016-08) Braimah, I.Z.; Rapole, S.; Dumpala, S.; Chhablani, J.Aim: To investigate the presence of focal choroidal excavation (FCE) in patients with retinitis pigmentosa (RP), Stargardt’s disease (STGD), and Best disease in the Indian population. Methods: This retrospective consecutive case series included 309 eyes of 157 patients with RP (183 eyes), STGD (93 eyes), and Best disease (33 eyes) with good-quality, enhanced-depth spectral domain optical coherence tomography scans. Comprehensive ophthalmic examination data were collected. Characteristics of FCE, including location of FCE, type (conforming and non-conforming), maximal width, and depth, were noted. Results: FCE was found in 2 out of 33 (6%) eyes with Best disease and no FCE was found in eyes with RP or STGD. The location of the FCE was extrafoveal in both cases. The first case had non-conforming FCE while the second case had the conforming type and the FCE occurred in association with choroidal neovascularization in the second case. The first case maintained good visual acuity of 20/20 over the entire period of follow-up (14 months), while the second case had a visual acuity of 20/200 at the last follow-up (three years) due to scarred choroidal neovascular membranes. The FCE showed no change in both eyes over the entire duration of follow-up. Conclusion: Focal choroidal excavation was found in 6% of eyes with Best disease, which remained stable throughout follow up. Eyes with RP and STGD did not have any FCE. Further studies are reItem Incidence and risk factors of retinopathy of prematurity in Korle-Bu Teaching Hospital a baseline prospective study(BMJ, 2020-08) Braimah, I.Z.; Enweronu-Laryea, C.; Sackey, A.Objective To determine the incidence of retinopathy of prematurity (ROP) and any associated risk factors among preterm infants at the Neonatal Intensive Care Unit (NICU) of Korle-Bu Teaching Hospital (KBTH). Design Prospective study. Setting Level 3 NICU of KBTH from June 2018 to February 2019. Participants Eligible infants with birth weight (BW) less than 2 kg or gestational age (GA) less than 37 weeks were examined at scheduled intervals until full maturity of their retina. Outcome measures The primary outcome measure was cumulative incidence of ROP and secondary outcome measure was risk factors associated with ROP. Results Of the 401 infants, 222 were females (55.4%), mean±SD GA was 32.3±2.4 weeks (median 32, IQR 31 to 34) and mean BW 1.6±0.4 kg (median 1.5, IQR 1.3 to 1.9). The cumulative incidence of ROP was 13.7% (95% CI: 10.5 to 17.5%), with 1.8% (seven infants) having type 1 ROP. Increased risk of ROP was observed in babies with supplemental oxygen exposure (p<0.001), BW less than 1.5 kg (p=0.019), confirmed neonatal sepsis (p=0.001), nasogastric tube feeding (p=0.03) and poor pupillary dilation (0.032). A reduced risk of ROP was observed in boys (p=0.004) and after delivery by caesarean section (p=0.019). Conclusion The rates of ROP at KBTH are comparable to other NICUs in sub-Saharan Africa. Birth weight less than 1.5 kg, confirmed neonatal sepsis, nasogastric tube feeding and poor pupil dilation were independently associated with increased incidence of ROP. ROP screening should be a part of the routine service for premature infants in Ghana.Item Incidence and risk factors of steroid-induced ocular hypertension following pterygium excision with conjunctival autograft(https://doi.org/10.46829/hsijournal.2023.6.4.1.448-456, 2023) Toseafa, R.D.K.; Braimah, I.Z.; Tagoe, N.N.; Abaidoo, B.; Adam, Y.S.; Dogbe, E.M.; Essuman, V.A.Background: Topical steroids are used to reduce post-operative inflammation after ocular surgery with the potential risk of ocular hypertension, glaucoma and blindness. There is a paucity of published data globally and locally on steroid-induced ocular hypertension (SiOH) post pterygium excision (PE) with conjunctival autograft (CAG). Objective: We aimed to determine the incidence and risk factors of SiOH post-PE with CAG in Korle-Bu Teaching Hospital, Accra, Ghana. Methods: In this prospective observational study, the demographic and clinical data of patients undergoing PE with CAG were collected and analyzed. Post-operative intraocular pressures (IOP) were measured on days 1, 7, 14, 28, and 42. The cumulative incidence of SiOH (proportion of the increase in IOP ≥ 10mm Hg at six weeks compared to baseline) and mean change in IOP from baseline were computed. Risk factors of SiOH were determined using a multiple logistic regression model. The Kaplan-Meier survival curve was used in estimating the median time to develop SiOH. Results: Overall, 101 patients participated in this study with a mean age of 46.8 ± 11.9 years. The majority (65.3%, n= 66/101) of participants were females. The mean pre-operative IOP in the study eyes was 15.3 ± 3.0 mm Hg. The overall mean post-operative IOP was 18.6 ± 2.8 mm Hg (p = 0.001). The overall incidence of SiOH six weeks post-PE with CAG was 32.7% (95% confidence interval (CI) = 23.7 - 42.7%). Male sex was the only independent factor associated with the development of SiOH [odds ratio (OR) = 3.3; 95% CI = 1.1 - 9.7; p = 0.032]. The median time to develop SiOH was 42 days (95% CI = 37.1 - 46.9 days, p = 0.022). Conclusion: The study showed that SiOH post-PE is a common complication with an overall six-weeks post-excision incidence of 32.7%. Males are more likely to develop SiOH after PE with CAG. Patients undergoing PE with CAG should be closely monitored postoperatively to prevent complications associated with prolonged raised IOP.Item Intravitreal Ziv-Aflibercept : Safety Analysis in Eyes Receiving More Than Ten Intravitreal Injections(Seminars in Ophthalmology, 2019-11-06) Braimah, I.Z.; Singh, S.R.; Chattannavar, G.; Ayachit, A.; Pimentel, M.C.; Alfaro, A.; Tiwari, S.; Heranjal, A.; Subramanyam, A.; Dhami, A.; Sachdev, P.; Mansour, A.; Chhablani, J.Purpose: To report the ocular and systemic adverse events in eyes receiving ≥10 intravitreal ziv-aflibercept (IVZ) injections. Methods: Medical records of patients who received ≥10 IVZ for various chorioretinal conditions with minimum follow up period of 12 months were retrospectively analysed. These eyes received standard dose of IVZ (1.25 mg/0.05 ml) on pro-re-nata (PRN) or treat and extend (T&E) protocol. The primary study outcome was ocular and systemic adverse events related to IVZ injections whereas secondary outcomes were change in best corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography (OCT) at last visit compared to baseline. Comparison of BCVA and CMT at baseline and final visit was done using paired t-test. Results: A total of 94 eyes which received a mean ± standard deviation (mean±SD = 14.4 ± 4.6) IVZ injections were studied. A total of 41 eyes were treatment naïve whereas 53 eyes received intravitreal injections in the past with last injection at least 3 months prior. Mean (±SD) follow up period was 26.7 ± 8.7 months. Ocular adverse events were limited with a case each of acute iridocyclitis, endophthalmitis, cataract progression and early epiretinal membrane formation. No systemic events were recorded within a month of IVZ injection. There was a significant improvement in BCVA (p = 0.001) and change in CMT (p = 0.001) at last visit. Conclusion: Ocular use of ziv-aflibercept is safe with limited ocular and systemic side effects. Multiple injections of IVZ can be used in various chorioretinal diseases over the long term.Item Intravitreal Ziv-Aflibercept for the Treatment of Choroidal Neovascularisation Associated With Conditions Other Than Age-Related Macular Degeneration(British Journal of Ophthalmology, 2017-01) Braimah, I.Z.; Stewart, M.; Videkar, C.; Dedhia, C.J.; Chhablani, J.To report the short-term outcomes of eyes with choroidal neovascularisation (CNV) associated with causes other than age-related macular degeneration (AMD) after treatment with intravitreal ziv-aflibercept (IVZ) injections. METHODS: This retrospective study included eyes with non-AMD-related CNV that were treated with IVZ (1.25 mg/0.05 mL) on a pro re nata basis. The primary outcome measure is the mean change in best-corrected visual acuity (BCVA) and secondary outcome measures include the mean change in central macular thickness (CMT) and adverse events. RESULTS: 23 eyes of 19 patients with CNV due to high myopia (9), macular telangiectasia (4), central serous chorioretinopathy (3), choroidal osteoma (2), choroiditis (2), Best's disease (2) and idiopathic (1) were treated. The mean follow-up period was 4±1.9 months. The median number of IVZ injections was 1 (range, 1-3) and the median treatment-free interval at the time of the final visit was 3 months (range, 1-8). The mean BCVA improved from 0.67 LogMAR to 0.58 LogMAR (p=0.0507). Nine of 23 (39%) eyes had BCVA gains of at least 0.1 LogMAR, 11 (48%) eyes had stable BCVA (within 0.1 LogMAR of baseline) and 3 (13%) eyes had a BCVA decline of at least 0.1 LogMAR at the final visit. The mean CMT improved significantly from baseline until the final visit (22 vs 174.5 μm; p=0.037). No ocular or systemic adverse events were noted. CONCLUSIONS: IVZ improves CMT in patients with CNV associated with causes other than AMD, but improvements in BCVA are modest.Item Response to Dr Rao(Eye (London, England), 2011-07) Essuman, V.A.; Braimah, I.Z.; Ndanu, T.A.; Ntim-Amponsah, C.T.Item Safety of 5914 intravitreal ziv-aflibercept injections(British Journal of Ophthalmology, 2018-07-02) Braimah, I.Z.; Singh, S.R.; Stewart, M.W.; Chattannavar, G.; Ashraf, M.; Souka, A.; ElDardeery, M.; Wadhwa, N.; Sarvaiya, C.; Mansour, A.M.; Marashi, A.; Ramchandani, S.; Bonyadi, M.H.J.; Ramezani, A.; Soheilian, M.; de Oliveira Dias, J.; de Andrade, G.C.; Maia, A.; Rodrigues, E.B.; Farah, M.E.; Banker, A.; Chhablani, J.Purpose To analyse the pooled safety data of intravitreal ziv-aflibercept (IVZ) therapy for various retinal conditions. Methods This was a retrospective, observational study which included patients from 14 participating centres who received IVZ. The medical records of patients who received IVZ from March 2015 through October 2017 were evaluated. Patient demographics and ocular details were compiled. Ocular and systemic adverse events that occurred within 1 month of IVZ injections were recorded and defined as either procedure-related or drug-related. Results A total of 1704 eyes of 1562 patients received 5914 IVZ injections (mean±SD: 3.73±3.94) during a period of 2.5 years. The age of patients was 60.6±12.8 years (mean±SD) and included diverse chorioretinal pathologies. Both ocular (one case of endophthalmitis, three cases of intraocular inflammation, and one case each of conjunctival thinning/necrosis and scleral nodule) and systemic adverse events (two cases of myocardial infarction, one case of stroke and two deaths) were infrequent. Conclusion This constitutes the largest pooled safety report on IVZ use and includes patients from 14 centres distributed across the globe. It shows that IVZ has an acceptable ocular and systemic safety profile with incidences of adverse events similar to those of other vascular endothelial growth factor inhibitory drugs. The analysis supports the continued use of IVZ in various retinal disorders.Item Safety of intravitreal ziv-aflibercept in choroido-retinal vascular diseases: A randomised double-blind intervention study(Plos One, 2019-10-24) Braimah, I.Z.; Kenu, E.; Amissah-Arthur, K.N.; Akafo, S.; Kwarteng, K.O.; Amoaku, W.M.Aim To evaluate the safety of 1.25mg and 2mg intravitreal ziv-aflibercept (IVZ) in Ghanaian eyes with choroido-retinal vascular diseases. Design Prospective, randomised, double blind, interventional study. Methods Twenty patients with centre involving macular oedema in diabetic retinopathy, retinal vein occlusion, and neovascular age-related macular degeneration were assigned to 2 groups receiving 3 doses of 1.25mg/0.05ml (group 1) and 2mg/0.08ml IVZ (Group 2) at 4 weekly intervals. Safety data was collected after 30 minutes, 1 and 7 days, and 4, 8 and 12 weeks after injection. Changes in continuous variables were compared using paired t-test and categorical variables were compared using chi-square test of proportions. Repeated-Measures ANOVA with nesting test was used to compare variations in continuous variables by IVZ dose over time. Primary outcome measures were ocular and systemic adverse events at 4 weeks. Results Eleven females and nine males, with mean age of 63.2± 7.3 years were included. Ocular adverse events included subconjunctival haemorrhage in 1 eye, intraocular pressure (IOP) >21mmHg at 30 minutes in 6 eyes and mild pain in 3 eyes at 1-day. There was no significant difference in IOP rise between the 2 groups at 30 minutes (p = 0.21). No other ocular or systemic adverse events were observed. There was significant improvement in the best corrected visual acuity (LogMAR) from 0.95±0.6 to 0.6±0.4 (p<0.01) and 0.47±0.3 (p<0.01),reduction in central subfield foveal thickness from 405.9±140 um at baseline to 255.6±75 um (p<0.01) and 238±88 um (p<0.01) at 4 and 12 weeks respectively, although no difference was observed between the 2 groups (p = 0.34). Conclusion IVZ at 1.25mg and 2mg had similar safety profiles, and did not have any major unexpected adverse events. Further studies with larger cohorts are required to confirm efficacy.Item Scleral buckle surgery in Ghana: a decade comparison of the anatomic and visual outcome(Clinical Ophthalmology, 2018-12) Braimah, I.Z.; Akafo, S.; Chhablani, J.Purpose To compare the anatomic and visual outcome of scleral buckle (SB) surgery in Korle Bu Teaching Hospital between 2002 and 2005 and 2011 and 2014. Materials and methods In this retrospective comparative study, the medical records of patients who have undergone SB for rhegmatogenous retinal detachment from January 2002 to December 2005 (group A) and from January 2011 to December 2014 (group B) in Korle Bu Teaching Hospital were examined. The clinical history, surgical techniques, and outcomes of treatment were analyzed. The main outcome measures were primary anatomic success (retina reattached for at least 3 months postoperatively after a single procedure), overall anatomic success (combined primary anatomic success and success following revision of SB with at least 3 months follow-up), mean postoperative best-corrected visual acuity (BCVA), and complications. Results One hundred fifty-eight eyes (71 eyes in group A and 87 eyes in group B) were treated with SB in this study. The mean duration of rhegmatogenous retinal detachment was 105.5 days. Thirty-four (21.8%) of fellow eyes had BCVA worse than 6/60 at presentation. The primary anatomic success was comparable between the two groups; 70% in group A and 67.9% in group B (P=0.79). The overall anatomic success was also comparable between the two groups (76.7% in group A vs 79.8% in group B) (P=0.788). The mean postoperative BCVA in logMAR was significantly better than the mean preoperative BCVA (P<0.0001). Group B had significantly better mean BCVA (P=0.002) and longer duration of follow-up (P<0.0001) compared with group A at the last follow-up visit. Conclusion The anatomic success of SB between the two time periods was comparable. A longer postoperative duration of follow-up was associated with a better visual outcome after SB.