Glaucoma Treatment Patterns in Sub-Saharan Africa.

PRCIS: Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma. Laser therapy was underutilized where they were available. Physicians were more likely to recommend surgery in severe glaucoma, laser therapy in mild glaucoma, while recommendation of medical therapy did not depend on glaucoma severity. PURPOSE: To characterize treatment patterns for newly diagnosed glaucoma in sub-Saharan Africa (SSA). METHODS: This was a multicenter cross-sectional study of adults newly diagnosed with glaucoma at 27 eye care centers in 10 African countries. In addition to demographic and clinical data, physician treatment recommendations (medication, laser, surgery, or no treatment) were recorded. Statistical analyses were performed using STATA version 14.0. RESULTS: Data from 1201 patients were analyzed. Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma (69.4%), with laser (13.2%), surgery (14.9%), and no treatment (2.5%) recommended to the remaining patients. All sites had medical therapy available and most (25/27, 92.6%) could provide surgical treatment; only 16/27 (59.3%) sites offered laser, and at these sites, 30.8% of eyes were recommended to undergo primary laser procedures. As glaucoma severity increased, the laser was recommended less, surgery more, and medications unchanged. Patient acceptance of medical therapy was 99.1%, laser 88.3%, and surgery 69.3%. CONCLUSIONS: Medical therapy for first-line glaucoma management is preferred by most physicians in SSA (69%). Laser therapy may be underutilized at centers where it is available. These findings underscore the need for comparative studies of glaucoma treatments in SSA to inform the development of evidence-based treatment guidelines and of programs to reduce glaucoma blindness in SSA. Strategic approaches to glaucoma therapy in SSA must address the question of whether medical therapy is the most optimal first-line approach in this setting.

[Congenital ocular anomalies at the University Hospital Campus in Lomé, Togo]. / Les anomalies congénitales oculaires au Centre Hospitalier Universitaire-Campus de Lomé, Togo.

INTRODUCTION: congenital ocular anomalies are rare clinical entities. The purpose of this study is to describe the epidemiological and clinical features of congenital ocular anomalies at the University Hospital Campus in Lomé. METHODS: we conducted a retrospective study at the Department of Ophthalmology of the University Hospital Campus in Lomé, over a 3-year period, from January 2016 to December 2018. It involved children with congenital ocular anomalies. The study variables were: sex; age at diagnosis; type of congenital ocular anomalies; laterality. RESULTS: out of 2621 children assessed during the study period, 103 (3.9%) had congenital ocular anomalies. Of these, 60 (58.2%) were boys and 43 (41.8%) girls. The average age at diagnosis was 16 ± 5.2 months (ranging from 1 months to 5 years). The most common congenital ocular anomaly was cataract (53.4%). Unilateral alterations were predominant (56.3%). Congenital ocular anomalies were isolated (82.5%); associated with systemic anomalies (11.7%); associated with each other (5.8%). CONCLUSION: these results show that the epidemiological and clinical features of congenital ocular anomalies are similar to those reported in the literature. However, in our Hospital, the frequency of congenital ocular anomalies and patients' age at diagnosis are high. Early diagnosis is essential to ensure adequate management and preserve visual function.

Ocular and Mucocutaneous Sequelae among Survivors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Togo.

AIM: The aim of this study was to assess ocular and mucocutaneous sequelae among SJS/TEN survivors and identify risk factors of ocular sequelae. PATIENTS AND METHOD: Late complications among SJS/TEN survivors were assessed using 2 methods: a retrospective assessment of medical records only or a retrospective assessment of medical records and physical examination of survivors who were contacted by phone. RESULTS: Between January 1995 and December 2017, 177 cases of SJS/TEN (138 cases of SJS, 29 cases of TEN, and 10 cases SJS/TEN overlap) were admitted into two university hospitals of Lomé (Togo). There were 113 women and 64 men, with an average age of 31.7±13.0 years (range: 5 to 80 years). The most used drugs were antibacterial sulfonamides (35.6%) and nevirapine (24.3%). HIV serology was positive in 68 (59.1%) of the 115 patients tested. Sixty-four (52,5%) of the 122 patients, who had been examined by an ophthalmologist during the acute stage, had acute ocular involvement, which was mild in 27.9% of patients, moderate in 13.1%, and severe in 11.5%. We recorded 17 deaths (i.e., three cases of SJS, 12 of TEN, and two of SJS/TEN overlap), including 11 cases of HIV infected patients. Of the 160 SJS/TEN survivors, only 71 patients were assessed 6 months after hospital discharge. Among them, forty-three (60.6%) patients had sequelae. Concerning mucocutaneous sequelae, the main lesions were diffuse dyschromic macules (38.0% of patients) and ocular sequelae were dominated by decreased visual acuity (14.1% of patients). In multivariate analysis, exposure to sulfadoxine (odds adjusted ratio = 5.95; 95%CI= [1.36-31.35]) and moderate (adjusted odds ratio = 5.85; 95%CI = [1.23-31.81]) or severe (adjusted odds ratio = 48.30; 95%CI = [6.25-1063.66]) ocular involvement at acute stage were associated with ocular sequelae. CONCLUSION: Ocular and mucocutaneous sequelae are common in SJS/TEN survivors. Exposure to sulfadoxine and severity of acute ocular involvement are risk factors of ocular sequelae.

[Juvenile myasthenia gravis in sub-Saharan Africa: a case study of two consanguine sisters born from consanguinity in Togo]. / Myasthénie juvénile oculaire en Afrique Subsaharienne: cas de deux sœurs germaines issues d'un mariage consanguin au Togo.

Myasthenia gravis is a rare acquired autoimmune pathology causing neuromuscular transmission impairment. Juvenile onset of myasthenia gravis is often characterized by ocular involvement. We report two cases of ocular juvenile myasthenia gravis (JMG) in two siblings. They were two young girls, XA and XB, aged 11 and 9 years, of Malian origin, residing in Togo, born from first-degree of consanguinity presenting to Ophthalmology due to progressive decrease in visual acuity. XA showed visual acuity 8/10 on both eyes while XB showed improvement in visual acuity from 3/10 to 7/10 using a pinhole occluder, suggesting ametropia. XA had a 2-year history of bilateral ptosis lifting the upper eyelid of 7 mm, while XB had a 3-year history of bilateral ptosis with no lifting of the upper eyelid. Ice pack test was strongly positive in both patients. They had Cogan's lid twitch with paresis of the oculomotor nerve without diplopia. The dosage of acetylcholine receptor autoantibodies was normal. The diagnosis of JMG associated with ametropia was suspected. Ametropia was corrected by glasses and a specific treatment with pyridostigmine was initiated, but both patients were lost to follow-up. Autoimmune myasthenia gravis with inaugural ophthalmologic manifestation is rare but it can occur among children living in sub-Saharan Africa. Studies should be conducted to establish the features of this disease.

[Risk factors for retinal detachment in Togo]. / Facteurs de risque du décollement de rétine au Togo.

INTRODUCTION: Retinal detachment poses management problems in developing countries due to the shortage of technical equipment. Prevention passes through knowledge and elimination of risk factors. This study aimed to identify the risk factors for retinal detachment in people living in Togo. METHODS: We conducted a retrospective and descriptive study in the Department of Ophthalmology at the Chu-Campus and in an ophthalmology office in Lomé from 2 January 2011 to 31 December 2015. The medical records of patients with retinal detachment were included in the study. The diagnosis of retinal detachment was confirmed based on funduscopic exam or ocular ultrasound. RESULTS: in total, 116 eyes of 100 patients had retinal detachment of whom 40 in the RE, 44 in the LE and 16 bilaterally. The average age of patients was 46.65 ± 16.46 years [07 years; 87 years], with a male predominance and with a sex-ratio = 0.32 (W/M). Diabetic patients accounted for 17% and patients with sickle cell disease accounted for 16%. Myopic patients accounted for 5%, pseudophakic patients accounted for 17.2% and aphakic patients accounted for 3.4%. Four patients had retinal tear (14.28% of rhegmatogenous detachment) including 2 superotemporal tears, 1 inferior nasal tear and 1 inferior temporala tear. 35 eyes (52.2%) had total retinal detachment while 24 eyes (35.8%) had partial retinal detachment. Twenty eyes had vitreoretinal proliferations, 5 eyes had itreous hemorrhage and 6 eyes had hyalite. Diabetes and sickle cell disease were the risk factors for tractional RD (p=0.006 and p=0.0003) while cataract surgery was the risk factor for rhegmatogenous RD (p=0.0097). CONCLUSION: Diabetes, sickle cell anemia and eye surgery were the major risk factors for RD. A better management of these pathologies and ophthalmologist's mastery of cataract surgery may prevent retinal detachment.

[Management and functional results of traumatic cataract in the central region of Togo]. / Prise en charge et résultats fonctionnels des cataractes traumatiques dans la région centrale du Togo.

INTRODUCTION: Traumatic cataract is a serious condition because it can cause partial or total vision loss. Our study aims to assess the postoperative functional outcomes of patients undergoing surgery for traumatic cataract in the Central region of Togo. METHODS: We conducted a retrospective study based on the analysis of medical records of patients who underwent surgical treatment for traumatic cataract in hospital based and outreach eye care services between 1 January 2009 and 30 June 2011. RESULTS: Out of a total of 1086 cases with cataract undergoing surgery during this period, 131 (12.06%) had traumatic cataract. The average age was 30.01 ± 16.61 years, ranging betrween 5 and 70 years, 85% of patients underwent implantation with good or average success rates of 66% after correction in the first postoperative day (according to WHO classification). At two months follow up, 85% of patients had visual acuity above 3/10. CONCLUSION: Despite micro-ophthalmic surgery advances, access to traumatic cataract surgery remains difficult for both the patient and the practitioner, especially in developing countries. For these reasons priority must be given to ocular trauma prevention.

[Neonatal conjunctivitis in the district of Glidji in Southern Togo: a cross sectional study about 159 new-borns]. / Les conjonctivites néonatales dans le canton de Glidji au Sud du Togo: une étude transversale à propos de 159 nouveau-nés.

INTRODUCTION: Describe the epidemiology of neonatal conjunctivitis in the Canton of Glidji in southern Togo. METHODS: We conducted a cross-sectional study in 4 Satellite Health Care Units in the Canton of Glidji from 19 March to 13 May 2009 (8 weeks). All newborns were included in the study and neonatal conjunctivitis was defined by the presence in a newborn of at least two of the following signs: conjunctival hyperemia, eyelid swelling, chemosis, purulent discharges, lacrimation. The parameters studied were: age, sex, risk factors, medical history, presence or absence of conjunctivitis, germs responsible for conjunctivitis and evolution under treatment. RESULTS: During the inclusion period, 159 newborns were examined. The average age was 10.9 days with 0-28 day interval. The study involved 80 boys and 79 girls (sex ratio 1.01). Of the 159 infants, 7 cases of conjunctivitis were diagnosed, representing an overall prevalence of 4.4%. Identified risk factors were: vaginal delivery and the presence of STI during pregnancy. Of the 7 cases of conjunctivitis, cytobacteriological examination allowed the isolation of Staphylococcus aureus in 2 cases. The evolution of the cases of conjunctivitis under treatment was favorable with regression of the signs since the 3rd day. CONCLUSION: Neonatal conjunctivitis had a prevalence of 4.4% in the Canton of Glidji in southern Togo and Staphylococcus aureus was the causative germ. Their prevention requires good follow-up prenatal visit and the administration of antibiotic eye drops at birth.