Cataract SurgeryPediatric cataracts are something that I never attempted in the USA, but here, it is necesary. I do a lot of them now, and they keep me very busy. Boa Vista is now the only center in Angola performing pediatric cataract surgery. We have children coming from all over Angola.
Below you can see Helder, a fun loving 6-year-old boy. He was born with congenital cataracts. After surgery on his left eye, the results were great. He really wanted a photo, and when he struck this pose I had to try to match his charisma (I know, I know, he pulled this off much better than me.)
Above is Milton. an 8-year-old boy who also was born with cataracts. I did surgery on both of his eyes as well. But his vision did not respond well because of Amblyopia (his brain never learned to see well because of his cataracts). He is a reminder to me that I want to grow our service to provide surgeries to infants. Currently children must be able to undergo local anesthesia, which disqualifies almost all babies. This is a critical time for surgery, if not operated on in a timely fashion, dense amblyopia may develop and nothing can fix it.
At Boa Vista we aim to decrease preventable blindness caused by cataracts by increasing our volume of surgeries performed. Our strategy, as mentioned above, is to train more Angolan doctors to do cataract surgery. We are making progress with Dr Mavitidi, but have a long way to go.
Cornea TransplantsThis man had a bacterial conjunctivitis that raged out of control until he suffered a cornea perforation. I did lab tests and diagnosed HIV infection, accounting for his prolonged course and corneal perforation. His vision here was counting fingers at 3 meters.
I like doing these peripheral grafts and thanks to Global Sight Network, I have access to glycerol perserved corneas for non-visual uses.
However, one of the future dreams I have for Angola is to establish a program for corneal transplantation for restoration of vision. This will require lots of work and more funding, but I'm confident it can become a reality.
Here is a 40-year-old man who came in with a spot on his eye. I ran some tests and diagnosed him for the first time with HIV.
I treated the tumor with a topical chemotherapy drop, 5-Fluorouracil, and it responded well, after 2 months his eye looked nearly normal(pictured below). I will continue to follow this over time to watch for recurrence and to give him encouragement to continue with his new medications for HIV.
Ocular TraumaUnfortunately, Angola has a large number of violent crimes and accidents. A favorite weapon is the glass beer bottle, see example below. I perform 2-3 of these emergency surgeries every week. We have become the major referal center in the country for eye trauma. I guess that is a good thing, but it means lots of work.
Congenital glaucomaLook at the size of the baby's right eye. Do you see how much larger it is than the left eye? Also the front clear part (cornea) is cloudy. He has congenital glaucoma, his eye pressure is high and so the eye stretches in response to the force.
RetinoblastomaThis child has a tumor inside of the right eye. Look at the ultrasound report, it shows the eye is full of tumor, as you see the left eye is clear.
1) 1 doctor is in the process of training.
2) we have done 1,800 individual cataract surgeries
3) Boa Vista provides a long list of potential treatments
4) Surgery for young children presents a challenge that requires new equipment
1) General anesthesia provided by an anesthesia team
2) Phacoemulsification cataract surgery (Another machine)
3) Purchase of new equipment to upgrade operating room for teaching cataract surgery.
4.)More nursing staff
5)Implement cornea transplantation for visual restoration
Thank you for your support during this year, we have unofficially agreed to stay in Angola for another two years, we are waiting to sign the contract. God Bless