Association of insulin treatment versus oral hypoglycaemic agents with diabetic retinopathy and its severity in type 2 diabetes patients in Cameroon, sub-Saharan Africa.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease associated with multiple macro and microvascular complications, diabetic retinopathy (DR) being the commonest one. Recent literature has reported an increased risk of DR with insulin use. METHODS: We carried out a cross-sectional study at the Ophthalmology Department of the Douala General Hospital (DGH) during a 2-year period to explore the association between insulin treatment and both DR and its severity as compared with oral hypoglycemic agents (OHAs) in Cameroonian T2DM patients aged ≥35 years, and who were all screened for DR through eye examination including exhaustive retinal evaluation. RESULTS: In total, medical files of 134 T2DM patients were analyzed. The frequency of DR was 54.1% among patients on OHA and 73.9% among those on insulin treatment, giving an overall frequency of 57.5%. There were significantly more OHA treated patients than insulin treated patients (82.8% vs. 17.2%, P<0.001). As expected, both the OHA and insulin groups were comparable by age, sex, duration of diabetes, past history of hypertension, alcohol misuse, and current tobacco smoking. DR was almost significantly more frequent in T2DM patients under insulin regimen than in patients under OHA [73.9% vs. 54.1%; odds ratio (OR) 2.4; 95% confidence interval (CI), 0.9-6.6; P=0.06]. Proliferative diabetic retinopathy (PDR) was significantly more observed in insulin treated patients than in OHA treated patients (34.8% vs. 15.3%; OR 2.95; 95% CI, 1.1-8; P=0.035). Irrespective of staging, the frequency of diabetic macular edema (DME) was significantly higher in the insulin group than in the OHA group (43.5% vs. 19.8%; OR 3.1; 95% CI, 1.2-8; P=0.019). CONCLUSIONS: Compared with OHA, insulin therapy may be associated with DR, DR severity and DME in these T2DM sub-Saharan African patients.

Secondary cataract: an epidemiologic and clinical survey at the Yaounde Gynaeco-obstetric and Paediatric Hospital.

OBJECTIVE: To determine the incidence and risk factors of secondary cataract. MATERIALS AND METHODS: A retrospective study involving a review of medical records in the ophthalmology unit of the Yaoundé Gynaeco-obstetric and Paediatric Hospital in Yaoundé, Cameroon, was carried out. All patients who had cataract surgery between January 2006 and September 2010 were included. Variables included age, sex, past medical history, morphology of primary cataract, type of surgery, intraocular lens implantation, site of implantation, intra- and postoperative complications, and the time lapse for the presentation of secondary cataract. Both univariate and bivariate analyses were carried out. The χ(2) test was used to compare proportions, and P-values <0.05 were considered statistically significant. RESULTS: A total of 864 eyes of 718 patients had cataract surgery. Ninety-two eyes developed posterior capsule opacification, giving an incidence of 10.65%. The mean age of patients who developed secondary cataract was 52.3 ± 23.05 years, with a range of 4 years to 84 years. Secondary cataract was more frequent in the age group of 0-20 years. The time lapse for presentation of secondary cataract was 64.7 ± 9.53 days, with a range of 1 to 504 days. Risk factors for the development of secondary cataract were age (P = 0.000), sex (P = 0.011), cortical cataract (P = 0.000), and postoperative inflammation (P = 0.000). CONCLUSION: The incidence of secondary cataract, though high in this study, is lower than that reported in other studies.

Surgical management of primary exotropia in Cameroon.

AIM: To assess the results of surgery of primary exotropia in Cameroon. PATIENTS AND METHODS: This is a retrospective study of all patients operated for primary exotropia in the Reference Hospital, Douala-Cameroon, between January 1992 and December 2005. Each case was operated once. The preoperative squint angle was measured the previous evening to surgery and the postoperative angle one year after surgery. The result was considered good when the postoperative angle was less than 10 prismatic dioptries (PD < 10). RESULTS: 61.3% of the 41 patients operated had good results. The average age of patients at the time of surgery was 18.7 years +/- 11.2. 80% of the patients had bilateral recession of the lateral recti and resection of the medial rectus of the more squinting eye under general anesthesia. The average preoperative angle of deviation was 44 +/- 9.5 PD and the average postoperative angle was 7.4 +/- 6.6 PD. None of the following factors affected the postoperative result: age at which squint manifested, preoperative angle, age at surgery, surgical technique, presence of amblyopia and whether the squint was intermittent or constant. CONCLUSION: Our results are encouraging and reinforce our plea for the training of more ophthalmologists and the equipment of more hospitals for squint surgery.

[Prevalence of glaucomas in a Black Cameroonian population]. / La prévalence des glaucomes dans une population de Noirs camerounais.

OBJECTIVES: To determine the prevalence and the various types of glaucoma in a Black urban Cameroonian population. MATERIAL AND METHOD: A retrospective analysis of 1,343 glaucomatous patients' files (757 men and 586 women) from a total of 24,462 Cameroonian patients of all ages was carried out from January 1991 to December 2001 in the Douala General Hospital in Cameroon in Central Africa. RESULTS: The prevalence of glaucoma of all types is 5.5%. It increases with age. Of subjects with glaucoma, 79.6% had not been previously diagnosed. The mean patient's age is 53.3 (+/-17.1) years. The mean intraocular pressure is 29.6 (+/-12.6) mmHg. The mean vertical cup-disc ratio is 0.7 (+/-0.2). The prevalence of primary glaucoma of any type is 4.5%. The overall prevalence of primary open-angle glaucoma, primary angle-closure glaucoma and congenital glaucoma was 4.3%, 0.03% and 0.07%, respectively. The normal-tension glaucoma is rare in this study (6.3% of primary open-angle glaucoma).The most common form of primary angle closure glaucoma is chronic angle closure glaucoma (61,1%) and is usually undiagnosed due to a lack of gonioscopic evaluation. The prevalence of secondary glaucoma of any type is 1%. The most common forms of secondary angle closure glaucoma were neovascular glaucoma (47.4% of cases with the prevalence of 0.5%) and post-traumatic glaucoma (23.1% of cases with the prevalence of 0.2%). Prevalence of bilateral and monocular blindness due to glaucoma is 8% (108/1,343) and 32.9% (441/1,343) respectively of glaucoma patients. CONCLUSION: This study confirms the high prevalence of glaucoma in a black African population. Gonioscopy is an important diagnostic tool that should be promoted to guide more effective glaucoma treatment in our region. The very high rate of blindness among the glaucoma patients in Cameroon is due to a lack of care. The patients are young, the disease is advanced, and compliance and follow-up are poor. Glaucoma surgery therefore offers a favourable option from an economical standpoint. Glaucoma is a devastating disease and constitutes a significant public health problem.