Refractive errors in Cameroonians diagnosed with complete oculocutaneous albinism.

BACKGROUND: Albinism causes significant eye morbidity and amblyopia in children. The aim of this study was to determine the refractive state in patients with complete oculocutaneous albinism who were treated at the Gynaeco-Obstetric and Paediatric Hospital, Yaoundé, Cameroon and evaluate its effect on vision. METHODS: We carried out this retrospective study at the ophthalmology unit of our hospital. All oculocutaneous albino patients who were treated between March 1, 2003 and December 31, 2011 were included. RESULTS: Thirty-five patients (70 eyes) diagnosed with complete oculocutaneous albinism were enrolled. Myopic astigmatism was the most common refractive error (40%). Compared with myopic patients, those with myopic astigmatism and hypermetropic astigmatism were four and ten times less likely, respectively, to demonstrate significant improvement in distance visual acuity following optical correction. CONCLUSION: Managing refractive errors is an important way to reduce eye morbidity-associated low vision in oculocutaneous albino patients.

Eye malformations in Cameroonian children: a clinical survey.

SUMMARY: The aim of this work was to describe the clinical aspects of eye malformations observed at the ophthalmology unit of the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital. PATIENTS AND METHODS: We carried out a retrospective study of all malformations of the eye and its adnexae observed among children aged 0-5 years who were seen at the ophthalmology unit from January 2003 to December 2009. RESULTS: Out of the 2254 children who were examined, 150 (6.65%) presented eye malformations. The mean age was 14.40 ± 4 months. Eye malformations were diagnosed in 71.66% of cases during the first year of life. The most frequent malformations were congenital lacrimal duct obstruction (66.66%), congenital cataract (10.9%), congenital glaucoma (10.9%), microphthalmos (5.03%), and congenital ptosis (3.77%). CONCLUSION: Eye malformations among children can lead to visual impairment and are a cause for discomfort to children and parents. Therefore, systematic postnatal screening is recommended to enable early management.

Bilateral intraorbital abscesses with intracranial complications in a young Cameroonian girl: a case report.

BACKGROUND: Intraorbital abscess is a very severe infection with ophthalmologic and neurologic complications that are sometimes life-threatening. OBJECTIVE: To report the etiologic, clinical, radiologic, and prognostic features of one case of bilateral intraorbital abscesses with intracranial complications. CASE REPORT: A 15-year-old Cameroonian girl in a comatose state (11/15 on the Glasgow Coma Scale) with meningeal signs, right hemiplegia, right facial palsy, and bilateral exophthalmia was admitted for meningitis and cerebral abscess secondary to orbital cellulitis. A lumbar tap was carried out, no organisms were seen by Gram stain, and culture was negative due to previous antibiotic therapy. A computed tomography scan showed a left internal capsule infarct and a pansinus opacification. Bilateral superior orbitotomies were performed and the abscess evacuated. Microscopy and culture of surgical material were negative. The patient was discharged 4 weeks after hospital admission with a visual acuity of 0.1 in both eyes, aphasia, and right hemiplegia. Nine months later, there was complete visual recovery (visual acuity 1.0 in both eyes). Anterior and posterior segments were normal on slit-lamp examination. There was no aphasia, but right-sided hemiparesis persisted. CONCLUSION: The authors emphasize the need for prevention, early diagnosis, and adequate treatment of orbital cellulitis in order to avoid complications.

Prevalence and causes of blindness at a tertiary hospital in Douala, Cameroon.

PURPOSE: The aim of this study was to determine the prevalence and causes of bilateral and unilateral blindness in the town of Douala and its environs based on data from the ophthalmic unit of a tertiary hospital in Douala. METHODS: We conducted a retrospective epidemiological survey of consultations at the eye unit of the Douala General Hospital over the last 20 years (from January 1, 1990 to December 31, 2009). RESULTS: Out of the 1927 cases of blindness, 1000 were unilateral, corresponding to a hospital prevalence of 1.84% and 927 cases were bilateral, corresponding to a hospital prevalence of 1.71%. No statistically significant difference was noted between the two (P = 0.14). The leading causes of bilateral blindness were cataract (50.1%), glaucoma (19.7%), and diabetic retinopathy (7.8%) while the leading causes of unilateral blindness were cataract (40.4%), glaucoma (14.1%), and retinal detachment (9.1%). Cataract (51.2%), cortical blindness (16.3%), and congenital glaucoma (10%) were the leading causes of bilateral blindness in children aged less than 10 years. CONCLUSION: Blindness remains a public health problem in the Douala region with a hospital prevalence which is relatively higher than the national estimate given by the National Blindness Control Program.

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.

Indications for destructive eye surgeries at the Yaounde Gynaeco-Obstetric and Paediatric Hospital.

OBJECTIVE: To determine the indications and rate of acceptance for destructive eye surgeries at the ophthalmology unit of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital. METHODS: A retrospective consecutive case series in which the medical records of all patients consulting in this unit over a 9-year period (2002 to 2010) were reviewed. Records in which destructive surgery was recommended were retained. Information collected included demographic data, eye affected, clinical diagnosis, acceptance or refusal of surgery, and the outcome in those in whom surgery was performed. RESULTS: A total of 48 patients had a recommendation for destructive eye surgery, of whom 30 (62.5%) were males and 18 (37.5%) were females. Mean age was 43.78 (SD = 28.11; range 1 month to 91 years). Children <10 years comprised 23.10%. The leading causes were endophthalmitis/panophthalmitis (47.9%), neoplasm (20.8%), and absolute glaucoma (14.6%). Surgery was done in 20 cases (41.7%). Evisceration was the most performed surgical procedure (50%), with endophthalmitis/panophthalmitis and neoplasm combined accounting for 65% of surgeries. CONCLUSION: The high rate of refusal is an indication of the psychological devastation undergone by patients or the families of children in whom eye removal is recommended. Awareness should be raised on preventive measures and the need to rapidly seek eye care.

Central corneal thickness in black Cameroonian ocular hypertensive and glaucomatous subjects.

PURPOSE: To evaluate central corneal thickness (CCT) in a black Cameroonian population of ocular hypertensive and glaucomatous subjects. MATERIAL AND METHODS: This was a prospective study undertaken with an ultrasonic pachymeter from January 2009 to December 2009 in an eye clinic (INNEL Medical center) in Yaoundé, Cameroon. RESULTS: One hundred subjects (200 eyes) were enrolled in the study. Sixty subjects were glaucomatous (primary open angle glaucoma, POAG group), and 40 ocular hypertensive (OHT group). The mean age of the sample was 52.60 ± 12.23 years. For the whole sample, CCT was 534.71 ± 37.95 µm in the right eye and 533.61 ± 37.67 µm in the left eye, with no statistically significant difference between the 2 eyes (P = 0.446). CCT in the POAG group was 526.30 ± 37.34 µm in the right eye and 524.90 ± 35.92 µm in the left eye. CCT in the OHT group was 547.32 ± 35.71 µm in the right eye and 546.67 ± 36.85 µm in the left eye. There was a statistically significant difference between CCT of the 2 groups (right eye: P = 0.013; left eye: P = 0.007). CONCLUSION: Mean CCT of ocular hypertensive subjects was thicker than CCT of glaucomatous ones in our Cameroonian sample. However, in both ocular hypertensive or glaucomatous patients, CCT of black Cameroonians is thinner than that reported in other studies in Caucasian populations.

Blindness and visual impairment in retinitis pigmentosa: a Cameroonian hospital-based study.

AIM: We performed a retrospective, analytical study in February 2010 on all retinitis pigmentosa cases seen during ophthalmologic consultation at the Gyneco-Obstetrics and Pediatric Hospital of Yaounde between March 2002 and December 2009 (82 months). The aim of this research was to determine the significance of blindness and visual impairment associated with retinitis pigmentosa in Cameroon. RESULTS: Forty cases were reported, corresponding to a hospital prevalence of 1.6/1000 (21 men and 19 women). The average age of the patients was 43.3 +/- 18 years, ranging between 6 and 74 years. Bilateral blindness and low vision was noted in 30% and 27.5% of patients, respectively. The average age of patients with low vision was 40.38 +/- 16.27 years and the average age of those with bilateral blindness was 51.08 +/- 15.79 years. Retinitis pigmentosa was bilateral in all cases and isolated (without any eye or general additional disease) in 67.5% of cases. CONCLUSION: Visual impairment is common and becomes even more severe with aging. Patients should be screened to enable them to benefit from management focusing on both appropriate treatment and genetic counseling.

Central corneal thickness and intraocular pressure in the Cameroonian nonglaucomatous population.

AIM: We performed a prospective, analytical study from 01 January to 31 March 2009 in the Ophthalmology Unit of the Gyneco-Obstetric and Pediatric Hospital of Yaounde, aiming to determine the profile of central corneal thickness (CCT) in the Cameroonian nonglaucomatous black population and its relationship with intraocular pressure (IOP). RESULTS AND DISCUSSION: Four hundred and eighty-five patients (970 eyes) meeting our inclusion criteria were selected for this study. The average CCT was 529.29 +/- 35.9 mum in the right eye (95% confidence interval [CI]: 526.09-532.49), 528.19 +/- 35.9 mum in the left eye (95% CI: 524.99-531.40) and 528.74 +/- 35.89 mum in both eyes (95% CI: 526.48-531.00), range 440 to 670 mum. The average IOP was 13.01 +/- 2.97 mmHg in both eyes (95% CI: 12.82-13.19). A rise in CCT by 100 mum was followed by an increase in IOP of about 2.8 mmHg (95% CI: 2.3-3.6) for both eyes taken together. Linear regression analysis showed that corneal thickness was negatively correlated with age and IOP was positively related with age. CONCLUSION: CCT in the Cameroonian nonglaucomatous black population was found to be lower compared with CCT values in Caucasian and Asian populations. On the basis of reference values ranging between 527 and 560 mum, an adjustment of IOP values by a correction factor is required for many Cameroonian patients. This will improve the diagnosis and follow-up of glaucoma by helping to detect true ocular hypertension.

Cerebral and ocular congenital toxoplasmosis complicated by West syndrome.

We report a case of a child who presented cerebral and ocular congenital toxoplasmosis associated with West syndrome. He was seen and followed-up in the in patients pediatric and ophthalmologic units at the Gyneco-Obstetric and Pediatric Hospital of Yaoundé in Cameroon between July 2008 and February 2010.

[Eye disease in children aged 6 to 15 years: a hospital-based study in Yaounde]. / La pathologie oculaire de l'enfant âgé de 6 à 15 ans: étude hospitalière à Yaoundé.

UNLABELLED: This prospective study was conducted in the ophthalmology department of the Gynaeco-Obstetric and Paediatric Hospital in Yaoundé and included 422 children recruited from January to April 2008. The aim was to identify the eye diseases seen frequently seen in school-aged children from 6 to 15 years and examine their epidemiological characteristics. RESULTS AND DISCUSSION: The study group included 201 boys and 221 girls, with a mean age of 10,3 +/- 3.2 years. The most frequent disease was ametropia (refractive errors, 43.1%), including hyperopia, which had a prevalence of 23.7% Conjunctival disorders came next, accounting for 33%, more than half due to tropical endemic limbo conjunctivitis (17.8%). Binocular blindness affected 0.9% (n = 4), and low vision 0.7% (n = 3). CONCLUSION: This study, the first in its kind for the age group of 6-15 years in a developing country, allowed us to identify refractive errors as the principal complaint in consultations and led us to propose a reinforcement of screening in schools.

Prevalence and etiologies of visual handicaps in leprosy patients in the south of Cameroon.

UNLABELLED: We report on a prospective study undertaken in April 2008, in 11 leper villages of the Southern Cameroon. Our aim was to determine the prevalence and the causes of bilateral blindness, low vision and unilateral blindness in the population of leprosy patients, irrespective of the clinical aspects of the illness. RESULTS: Two hundred thirty-five known and newly diagnosed leprosy patients were examined. These patients included 149 cases (63.4%) of multibacillary leprosy and 86 cases (36.6%) of paucibacillary leprosy. There were 111 case of visual handicap, representing 47.2% of the population. These visual handicap cases were subdivided into 45 cases (19%) of bilateral blindness, 35 cases (15%) of unilateral blindness and 31 cases (13.2%) of low vision. DISCUSSION: The prevalence of visual handicap among leprosy patients in Cameroon is too high. Causes in the majority of cases are age-related degenerative pathologies, and one third of cases are linked to the leprosy mycobacterium. CONCLUSION: Discovering a cure for ophthalmic pathologies is important in order to provide a better quality of life for this particular population.

Unilateral childhood blindness: a hospital-based study in Yaoundé, Cameroon.

INTRODUCTION: We performed an analytic and prospective study over a period of 12 months from January 2nd to December 31st, 2008, at the Gynaeco-Obstetric and Paediatric Hospital of Yaoundé, Cameroon. Our aim was to determine the prevalence and causes of unilateral blindness in school children aged 6 to 15 years. RESULTS: Among the 1,266 children aged 6 to 15 years who were recruited, 60 presented with unilateral blindness (4.7%): 42 boys (6.96%) and 18 girls (2.71%). The mean age was 10.15 +/- 3.4 years. In patients with unilateral blindness, 65% was due to ocular trauma. DISCUSSION: The hospital-based prevalence of unilateral blindness in children is relatively high and ocular trauma is the leading etiology. CONCLUSION: Unilateral blindness in school children is avoidable and its incidence could be markedly reduced by emphasizing an information strategy and education based on prevention of ocular trauma. Early management of nontraumatic diseases such as infantile glaucoma and some tumors could improve outcome and avoid blindness.

[Clinical and epidemiological characteristics of chronic open angle glaucoma at a Yaoundé Hospital]. / Caractéristiques cliniques et épidémiologiques du glaucome chronique à angle ouvert.

UNLABELLED: This retrospective study examined the files of patients who consulted at the Women's and Children's Hospital of Yaoundé in Cameroon from March 2003 through December 2006. The main objective was to determine the epidemiological and clinical characteristics of patients diagnosed with chronic open-angle glaucoma (COAG). RESULTS: Of 8,123 files reviewed, 184 patients (54.3% women) were diagnosed with COAG, all but one binocular. Their mean age was 62.2+/-13.01 years. According to the WHO definition of blindness, the rate of bilateral blindness was 34.2%, that of unilateral blindness 21% and low vision 17.4%. Significant statistic correlations were observed between the cup depth of the optic disc and visual acuity on one hand, and between the level of intraocular pressure and cup depth on the other, p=0.0001. Approximately 90.67% of the eyes with glaucoma had high pressure and 9.23% normal pressure. DISCUSSION: COAG is a major cause of visual disability in Cameroon. Intraocular pressure is an important risk factor, but its positive predictive value for the impairment of optic disc fibres is low (R=0.29); other factors (apoptosis and ischemia of the optic disc) are associated with it. CONCLUSION: Advanced strategies for early diagnosis of COAG are essential, for this disease is an important cause of blindness. Such programmes would significantly delay the onset of visual disabilities.

Intraocular live male filarial Loa loa worm.

We report a case of Loa loa filariasis in an 8-month-old child who presented with a 3-month history of irritated acute red eye and insomnia. Examination revealed a living and active adult Loa loa worm in the anterior chamber of the left eye. The worm was extracted under general anesthetic.

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.