[Features of macular ganglion cell complex in normal black subject in Lomé]. / Caractéristiques du complexe de cellules ganglionnaires chez le sujet normal à Lomé.

PURPOSE: To determine the features of the macular ganglion cell complex and its correlations in normal black subjects in Lomé. MATERIALS AND METHODS: We conducted a descriptive, analytical, retrospective study over 32 months from November 2014 to June 2017. This study was based on records of healthy patients with normal IOP, optic discs and ganglion cell complexes (GCC). The 3D - OCT 2000 (Topcon Corporation, Tokyo, Japan) was used with standard image acquisition protocols. RNFL and the GCC parameters were analyzed. Univariate linear regression tests were used, with the Pearson correlation coefficient (r2) to assess correlations between the various parameters. RESULTS: A total of 277 eyes of 155 patients were examined - 146 right eyes and 131 left eyes. The mean age of the patients was 37.7±15.2 (5-60) years. The mean RNFL thickness was 108.3±7.1µm, 134.8±11.1µm in the lower quadrant, 128.3±13.8µm in the upper, 92.2±12.8µm in the nasal and 77.9±11.6µm in the temporal quadrant. There was 6% asymmetry in the macular fibers, with a mean thickness of 33.1±3.5µm superiorly and 35.3±3.8µm inferiorly. There was 2% asymmetry in the macular cells, with a mean thickness of 71.6±5.7µm superiorly and 70.5±5.2µm inferiorly. The macular GCC thickness showed 1% asymmetry, with a mean thickness of 105.0±7.1µm superiorly and 106.1±6.7µm inferiorly. The thickness of the superior macular GCC was strongly correlated with the inferior (r2=0.8; p <0.05). The thickness of the macular GCC was weakly correlated with age (r2=0.05; p =0.0003), gender (r2=0.01; p =0.2), optic nerve head surface area (r2=0.2; p < 0.05) and RNFL thickness (r2=0.15; p <0.05) CONCLUSION: The results of this study will help to establish a normative database for GCC parameters in normal black Africans.

[Accuracy of Optical Coherence Tomography versus Ultrasound in pachymetry]. / Fiabilité de la pachymétrie par OCT comparée à la pachymétrie par ultrasons.

PURPOSE: Measuring the central corneal thickness is an important step in the diagnosis and monitoring of glaucoma. Ultrasound pachymetry was the gold standard before the advent of OCT. The purpose of this study is to assess the reliability of OCT pachymetry compared to ultrasound pachymetry in black patients. PATIENTS AND METHODS: Pachymetry was performed as part of a glaucoma work-up. Ultrasonic pachymetry was measured using the Alcon Ocuscan by the same operator and OCT pachymetry using the Topcon 2000 OCT. The Student's t-test was used to compare means with statistical significance of 5%. The Pearson's correlation coefficient (r2) was used to measure correlations. RESULTS: One-hundred thirty-five right eyes and 135 left eyes, corresponding to 270 eyes of 135 patients, were examined. There was a female predominance (59 men/76 women), with a gender ratio of 0.78. The mean age was 42.3±17.3 [8-86] years. In the right eye, the mean OCT pachymetry was 522.4±36.8µ versus 528.2±37.9µ for ultrasonic pachymetry (P=1.00). In the left eye, the mean OCT pachymetry was 522.0±33.8µ versus 524.9±42.5µ for ultrasonic pachymetry (P=1.00). The overall mean OCT pachymetry was 522.2±35.2µ versus 526.5±40.2µ, with a non-significant difference (P=1.00). There was a strong correlation between ultrasonic pachymetry and OCT pachymetry (r2=0.83; P<0.05). On the other hand, there was a very low correlation between pachymetry and age (r2=0.09; P<0.05). Pachymetry decreased by 5µ per 10 years, corresponding to corneal thinning of 0.5µ per year. CONCLUSION: OCT pachymetry can be a reliable alternative to ultrasound pachymetry and could be performed at the same time as the OCT for glaucoma assessment.

[Optic disc features on OCT in glaucomatous and normal black Africans]. / Caractéristiques de la papille chez les sujets glaucomateux et normaux à l'OCT dans une population Noire Africaine.

PURPOSE: To determine the correlations between the size of the optic disc and glaucomatous defects in black Africans. DESIGN: Retrospective observational study. METHODS: The study was conducted over a two-year period from November 2014 to October 2016, based on records of black Togolese patients who had undergone optic nerve head (ONH) OCT or ganglion cell complex OCT for assessment of glaucoma. The population was divided into 3 groups (I, II and III) depending on the size of the ONH. The ONH was considered small (Group I) if its size was less than the mean -1 SD, medium (Group II) if its size was within 1 SD of the mean, and large (Group III) if its size was greater than the mean+1 SD. Glaucomatous lesions were qualitatively identified on RNFL and or GCC. The ONH parameters were compared in the 3 groups. The Chi-square test was used to compare the percentages, and the t test to compare the means with statistical significance of 5%. The Pearson correlation coefficient (r2) was used to measure correlations. RESULTS: A total of 586 eyes of 298 patients were examined, 314 glaucomatous eyes and 272 healthy eyes. The mean age was 41.0±15.7 [6; 86] years. There were 159 men vs. 137 women, with a sex ratio of 1.2. The mean surface area of the ONH was 2.80±0.55mm2. Small ONH's (Group I) were defined as a surface area of less than 2.25mm2, medium-sized ONH's (Group II) as an area between 2.25 and 3.35mm2 and large ONH's (Group III) as an area greater than 3.35mm2. Small ONH's represented 14.7%, (86 eyes), medium-sized 68.6% (408 eyes) and large ONH's 16.8% (98 eyes). The mean surface area of the neuroretinal rim, cup, the cup-disc ratio and the RNFL thickness were statistically significant in the 3 groups. Similarly, all these parameters were significant in groups of glaucomatous or non-glaucomatous eyes, except for the surface area of the cup. The RNFL thickness was weakly correlated with the surface area of the ONH (r2=0.39), moderately correlated with the surface area of the neuroretinal rim (r2=0.57). The surface area of the ONH was strongly correlated with the surface area of the cup (r2=0.7). The neuroretinal rim surface area was strongly correlated with the cup-disc ratio (r2=0.66). CONCLUSION: The size of the ONH was correlated with the size of the cup, but it was not correlated to the surface area of the neuroretinal rim or the thickness of the nerve fibers. Analysis of the RNFL and GCC is essential for the diagnosis, especially in the case of large ONH's.

[OCT topographic characteristics of the optic nerve in patients clinically suspected to have large optic disc cupping in Togo]. / Les caractéristiques topographiques à l'OCT du disque optique chez des patients cliniquement suspects de grande excavation papillaire (GEP) au Togo.

PURPOSE: To describe topographic characteristics of optic discs clinically suspected of large cupping. MATERIALS AND METHODS: This is retrospective study conducted from the January 2 to December 31 on the OCT registry and data base of a private ophthalmologic center in Lomé (Togo). We included records of patients with large cupping - CDR (cup-to-disc ratio) ≥ 0.4 -clinically observed and having undergone OCT-optic disc analysis. RESULTS: Three hundred and thirty-five patients (619 eyes) were studied, with a mean age of 41.87 years±17.51 years [6 years and 80 years] and a sex-ratio of 1.01 with a slight female predominance. The mean clinical CDR was 0.51±0.126 [0.4 and 0.9] (95 % CI [0.503 to 0.531]). The clinical CDR was ≥ 0.7 in 7.75 % of cases. The mean neuroretinal rim area was 1.63±0.43 mm2 [0.34 and 2.85 mm2]. The mean cup area was 1.43±0.54 mm2 [0.13 and 4.29 mm2], and the mean cup volume 0.47±0.28 mm3 [0.01 and 1.72 mm3]. The mean global CDR on OCT was 0.46±0.13 [0.21 and 0.87], of which 30.85 % (191 cases) had CDR <0.4. The CDR on OCT was >0.7 in 40 (6.46 %) eyes vs. 48 (7.75 %) eyes on clinical examination. CONCLUSION: On the average, optics discs exhibit large size and large cup volume. Topographic evaluation of the optic disc by the means of OCT offers important data and gives way to etiological research of large cupping in the black African.

[Optic disc changes by optical coherence tomography in optic disc edema in Lomé]. / Modifications papillaires en tomographie par cohérence optique dans l'œdème papillaire à Lomé.

OBJECTIVE: To study the influence of optic disc edema (ODE) on the dimensions of the disc and the thickness of the retinal nerve fiber layer (RNFL) by optical coherence tomography (OCT) in Lomé. PATIENTS AND METHODS: This was a retrospective study which took place in a general ophthalmology office in the city. Twenty-six eyes were examined for ODE (cases) between January 2013 and May 2015, and 26 healthy eyes (control group) were considered in this study. The control group was recruited taking age into account with a variation not exceeding 5 years compared to the ODE cases. Topcon 3D-OCT 2000 software was used to analyze the disc and to measure the thickness of the peripapillary RNFL. The results were compared with software integrated into the OCT device, to the normal range of databases (normative basis) of RNFL thickness. The variables studied were age, gender, etiology of the edema, disc dimensions (optic disc surface area, vertical cup to disc ratio [CDR]), and the thickness of the peripapillary RNFL. Chi2 tests were used for comparison of proportions with a significance level less than or equal to 0.05. RESULTS: Twenty-six eyes of 16 patients with ODE (mean age 25.88±14.35years) and 26 eyes of 16 control group patients (mean age 25.73±15.90 years) were recruited. The ODE was caused by inflammatory optic neuropathies in 10 cases, malignant hypertension in 8 cases and intracranial hypertension in 8 cases. The surface area of the disc was 3.77±1.82mm2 for the ODE group vs. 2.74±0.57mm2 for the control group (P=0.009). The vertical CDR was 0.11±0.15 for the ODE group vs. 0.50±0.15 for the control group (P=0). The mean RNFL thickness was 117.12±18.30µm for the ODE group vs. 95.77±2.52µm for the control group (P=0.006). This study reveals an increase in RNFL in all quadrants (superior, P=0.027; inferior, P=0.007; nasal, P=0.026; temporal, P=0.032). Of the 26 ODE cases, we noted an increase beyond the normative base; superiorly (in 9 cases), inferiorly (in 12 cases), nasally (in 10 cases) and temporally (in 11 cases). CONCLUSION: The study of papillary changes with OCT in ODE has allowed us to note an increase in the surface area of the disc, a reduction of the vertical CDR, and an increase in the thickness of the average RNF in all quadrants.

Cataracts in rural areas in Togo: awareness and attitudes.

To assess the prevalence of senile cataracts and the awareness and attitudes of patients with them in a rural area in Togo. We conducted a 10-weeks cross-sectional ophthalmic screening in the prefecture of VO, 57 km from Lomé, which sought to include individuals aged 50 years and older living in the study area. All patients underwent a comprehensive ophthalmic examination. Of the 3111 patients expected, 767 came for the examination, for a participation rate of 24.6%. The sex ratio was 0.8, and the patients' mean age was 60.1 ± 8.7 years. The frequency of senile cataracts was 40.28%. Women had cataracts more often than men, with a sex ratio of 0.63. The frequency of unilateral blindness was 1.62% and 22% for bilateral blindness related to cataracts. Almost every participant (99.7%) knew the disease named cataract, but fewer than half (41.59%) knew its causes. Most patients (97.09%) accepted the idea of cataract surgery, but the lack of financial resources was a major barrier to it (64.72%). The frequency of senile cataracts is high in rural area. Decentralization of eye care is essential to give the right to sight to the population living in these areas.

[Compliance with medical treatment in primary open-angle glaucoma in Lomé]. / Observance du traitement médical dans le glaucome primitif à angle ouvert à Lomé.

OBJECTIVE: To assess the compliance rate among glaucoma patients with medical treatment, to investigate the factors influencing their attitude and survey their expectations vis-à-vis the doctor. PATIENTS AND METHODS: This is a prospective descriptive study conducted in four eye clinics in Lomé from January 2013 to July 2013. It included all glaucoma patients aged 40 years and above who have been under medical treatment for at least 6 months, with no history of surgical treatment of glaucoma. The evaluation was performed on the basis of a questionnaire. Compliance was rated good, fair or poor according to the regularity of treatment, compliance with the prescribed dosage and schedule of instillations, good instillation technique and compliance with follow-up visits. Patients consented to participate in the survey. RESULTS: A total of 107 patients responded to our questionnaire. There were 43 men and 64 women with a sex ratio (M/F) of 0.67. The mean age was 52.40±11.03 years. In total, 7.5% of patients were illiterate. Compliance rate was estimated good in 10.3% of cases, fair in 65.4% of cases, and poor in 24.3% of cases. Only the regularity of treatment, schedule adherence and good instillation technique, as well as compliance with monitoring visits were found as significant factors (P<0.05). Concerning patients' expectations vis-à-vis the doctor, 49.5% said they expected nothing from the doctor, 12.1% were hoping for advice and moral support, and 11.2% were hoping for the prescription of effective but less expensive eye drops. CONCLUSION: A good compliance rate was very low. The improvement of this compliance rate requires better information, education and communication for behavior change, and it also requires a higher quality of care and accessibility of anti-glaucoma drugs.

[Neurological manifestations of Gougerot and Sjögren disease: a Black African case]. / Les manifestations neurologiques du syndrome de Gougerot et Sjögren: à propos d'un cas en Afrique noire.

Primitive Gougerot-Sjögren syndrome (PGSS) is a systemic autoimmune exocrinopathy in which twenty percent of affected patients develop neurological manifestations. It has been little described in the Black African literature. We report a case of PGSS in a 64-year-old Black woman as revealed by neurological manifestations in an inflammatory context. Central neuropathy was present and the patient fulfilled at least four of the six Vitali American-European diagnostic criteria. There were abnormal aspects on the sylvian artery and hyperintense lesions of periventricular predominance. PGSS is a serious disease which we must consider when we encounter any unexplained neurological manifestations especially those associated with vasculitic lesions.

[Ten years of destructive eyeball surgery in Lomé]. / Bilan de dix ans de chirurgies mutilantes oculaires à Lomé.

INTRODUCTION: Destructive surgery of the eyeball comprises radical procedures - evisceration, enucleation, and exenteration - with various indications. The purpose of this study was to determine the features of these procedures in Lomé. PATIENTS AND METHODS: We conducted a retrospective study reviewing records for all patients undergoing these procedures in 3 ophthalmic centers in Lomé in the decade from 2002 through 2011. RESULTS: Of 6240 eye operations, 76 involved one of these three procedures, for a frequency of 1.2%. Patients' mean age was 40.1 ± 26.9 years (range: 1 day to 91 years). The sex ratio (of men to women) was 1.2. The principal indications were staphyloma (38%), ocular and orbital tumors (30%), and phthisis bulbi (24%). Retinoblastoma was the leading type of ocular/orbital tumor (52%). Local anesthesia was performed in 64% of cases, and general anesthesia in 36%. Evisceration was practiced in 67% of cases, enucleation in 24%, and exenteration in 9%. An ocular prosthesis was placed in 46%. CONCLUSION: Staphyloma was the leading indication for destructive surgery. Given the damage of this type of procedure, primary prevention is important, including early and adequate management of ocular conditions.

[Ocular tumors in Togo: epidemiological, clinical, and histopathological features observed at the Lomé Teaching Hospital of Sylvanus Olympio]. / Tumeurs oculaires au Togo: aspects épidémiologiques, cliniques et histopathologiques à propos de quarante-cinq cas observés au CHU Sylvanus-Olympio de Lomé.

PURPOSE: To describe the epidemiological, clinical, and histopathological features of ocular tumors in Togo. METHODS: We have a retrospective and descriptive study of the ocular specimens registered in the pathology laboratory from January 1, 2006, to December 31, 2010. The frequency of ocular tumors, the patients' age and sex, the department from which the specimen came, the sampling procedure, and the histopathological patterns were analyzed. RESULTS: During the study period, 80 ocular specimens were recorded among a total of 6000, for a frequency of 1.33%. Histopathological results were available for 45 cases in our sample. The mean age was 30.9 ± 15.1 years, and the sex ratio 0.88 (21M/24F). The two teaching hospitals in Lomé furnished 73.4% of the ocular specimens. The most common site was the conjunctiva, accounting for 75.5% of the cases. Benign tumors represented 69.9% of the histological diagnoses. Papilloma was the histopathological diagnosis in 33.3% of cases. CONCLUSION: Ocular tumors are relatively common, occur at any age, and are located most often in the conjunctiva. Close collaboration between the pathologist and the ophthalmologist is essential for the best management of these tumors.

[Severe ametropia in children in Lomé (Togo)]. / Les amétropies fortes chez l'enfant à Lomé (Togo).

AIMS: To determine the features of severe ametropia (refractive errors, including myopia, hyperopia, and astigmatism) in children in general practice in Lomé. PATIENTS AND METHODS: We conducted a retrospective study based on records of patients aged 5-16 years seen in a private clinic in Lomé from 1 January, 2001, to 31 December, 2010. We analyzed subjective refraction after automated refraction or retinoscopy. RESULTS: Among 1303 cases of ametropia in children, 58 cases were severe, for a frequency of 4.5%. The mean age of these patients was 12.7 years. The sex ratio (M/F) was 0.7. Among these severe cases, astigmatism was most frequent, accounting for 46.6%, followed by myopia (27.6%) and hyperopia (25.6%). Among children with hyperopia, 80% were assessed at +3.50 D to +6.50 D and 20% from +6.75 D to +9.50 D; among those with myopia, 75% were assessed at -6D to -9.50 D and 25% from -10 D to -14 D. Bilateral amblyopia was found in 9 cases for a frequency of 0.45%. The amblyopia was caused by astigmatism in 1 case, hyperopia in 4 cases, and by myopia in 4 cases. CONCLUSION: The relative frequency of severe ametropia underlines the importance of a routine ophthalmology examination for children starting school.

[Tropical endemic limbo-conjunctivitis (TELC) and allergic management: a preliminary study in Togolese children]. / Limbo-conjonctivite endémique des tropiques (LCET) et prise en charge allergologique : étude préliminaire chez l'enfant togolais.

PURPOSE: To study the impact of certain allergens on the manifestations of tropical endemic limbo-conjunctivitis (TELC) in Togolese children. METHODS: This is a 3-year prospective study of 36 Togolese children with acute recurrences of TELC after 1 to 5 months of remission. Skin prick tests were conducted with five perennial respiratory allergens (dust mites, paper mites, roaches, dog and cat, grass pollen) and three food allergens (egg, peanut, shrimp). The reactions were compared to a negative control (saline solution) and a positive control (histamine or codeine sulfate). Length of remissions between acute exacerbations before and after allergy testing were noted. RESULTS: Thirty-five children were polysensitive. Individual allergens were: dust mites (83.3%), followed by cockroach (72.2%), shrimp (61.1%), peanuts (55.6%), eggs (44.4%), the cat and/or dog dander (38.9%), and grass pollen (22.2%). The rate of remission prior to allergy testing was 77.8% within 2 months after treatment of an exacerbation; with allergy management, 55.5% of patients experienced remission beyond 1 year. DISCUSSION: The literature reports that TELC is caused by multiple antigens. The clear predominance of respiratory and food allergens may lead to a new pathway for managing TELC in Togolese children. CONCLUSION: Allergy testing is of great importance for patients with frequent acute exacerbations of TELC.

[Distribution of central corneal thickness in a melanoderm population]. / Distribution de l'épaisseur cornéenne centrale dans une population mélanoderme.

PURPOSE: To describe characteristics of central corneal thickness in a defined melanoderm population. PATIENTS AND METHODS: A retrospective study was performed on patients with and without glaucoma followed on the ophthalmology service of Tokoin teaching hospital in Lomé from January to September 2005. All subjects underwent central corneal thickness measurement by ultrasonic pachymetry between 8:00 and 11:00 am by the same operator. RESULTS: A total of 1205 subjects (609 men and 596 women) were included in the study, corresponding to 2410 eyes. The participants were 3 to 85years old. Mean central corneal thickness was 532.94±34.82µm for the entire population, 532.56±36.25µm for the right eye, 533.44±35.96µm for the left eye, 536.38±34.67µm in men and 529.41±34.64µm in women. Central corneal thickness was greater (542.94µm) in the 6- to 10-year-old group and gradually decreased after 35years. CONCLUSION: Melanoderm subjects have thinner central corneas, which may be related to the higher prevalence of ocular hypertension and glaucoma in our populations. Incorporation of corneal pachymetry with intraocular pressure measurements is essential in the early management of ocular hypertension and glaucoma, particularly in melanoderm subjects.

[Management of a case of unilateral exophthalmos due to an intraorbital lipofibroma at Kara teaching hospital in Togo]. / Prise en charge d'un cas d'exophtalmie unilatérale due à un lipofibrome intra-orbitaire au CHU de Kara au Togo.

In childhood, benign tumors are uncommon causes of exophtalmos. We report a case of intraorbital lipofibroma in an 11-year-old girl who presented with painless, progressive proptosis of the right eye over the preceding 6 months. Ultrasound had shown an extraconal intraorbital mass. Complete excision and pathologic examination were performed, revealing a lipofibroma with no signs of malignancy This case report is notable due to the rarity of the condition.

[What remains today of neonatal conjunctivitis in prefecture of Kozah in Togo?]. / Que reste-t-il aujourd'hui des conjonctivites néonatales dans la préfecture de la Kozah au Togo ?

AIM: The purpose of this study is to screen the neonatal conjunctivitis in order to evaluate its incidence and especially to seek for the causative germs. PATIENTS AND METHODS: We have realized cross-sectional study in three health centers of the prefecture of Kozah from March 24 to May 12, 2009. All the newborns followed in these centers are examined in the search of signs of conjunctivitis. A biological diagnosis of conjunctival secretions was carried out at the suspect newborns. RESULTS: During the study period, 348 newborns were examined including 185 boys and 163 girls corresponding to a sex-ratio (M/F) of 1.1. The middle age was 3.7 days. Twenty-eight newborns presented conjunctivitis, that is to say a rate of incidence of 8%. The cases of conjunctivitis were observed the first four days of life in 39.3% of cases. Eighteen of the newborns presenting conjunctivitis were vaginal deliveries (64.3%) against ten (35.7%) by caesarian. All the mothers of the ill newborns had a syndrome of sexually transmissible infection (STI) during the third quarters of pregnancy. After biological diagnosis, Staphylococcus aureus was found in 25% of the cases. CONCLUSION: Despite the common herd of neonatal conjunctivitis prophylaxis by Crede's method, its remains in the prefecture of Kozah. In hope for neonatal conjunctivitis eradication, treatment of STI on pregnant women associated to education and communication on the prevention of the infection in neonatal health care centers and at home by hygiene rule application are necessary.