[Pediatric orbital Rosai-Dorfman disease: An unusual case]. / Maladie de Rosai-Dorfman à localisation orbito-palpébrale de l'enfant : à propos d'une observation exceptionnelle.

INTRODUCTION: Rosai-Dorfman disease (RDD) is a sinus histiocytosis with massive lymphadenopathy. This rare condition is a benign disease of unknown etiology. Bilateral orbital localization of RDD is rare. OBSERVATION: The authors report the case of a 6-year-old child who presented with bilateral orbital-palpebral masses associated with chronic cervical lymphadenopathy. There were no laboratory signs of inflammation. Serological and tuberculosis screening tests were negative. Histopathological examination of a lymph node biopsy established a diagnosis of Rosai-Dorfman disease. The patient underwent surgical excision of the orbital lesions followed by long-term corticosteroid therapy. A favorable course was observed, with no sign of recurrence after one year of follow-up. CONCLUSION: Rosai-Dorfman disease is very rare in its bilateral orbital presentation. Histopathological diagnosis remains challenging. In Africa, the presence of chronic oculo-palpebral tumor associated with or without cervical lymphadenopathy must raise the suspicion of Rosai-Dorfman disease after ruling out tuberculosis and lymphoma.

Severe infectious keratitis in tropical environments: 118 cases collected over 10 years.

INTRODUCTION: The aim of our study was to evaluate the clinical, microbiological, and contributing factors of microbial keratitis in tropical environment. Materiel and methods: We performed a retrospective study of all patients admitted to the ophthalmology department of Principal Hospital in Dakar for infectious keratitis, over ten years from January 2006 to December 2015. Clinical, microbiological, and contributing factors as well as visual effects were studied. RESULTS: We collected data of 118 patients hospitalized for unilateral infectious keratitis in 10 years, for an average of 12 cases per year. The patients' mean age was 50 years. At least one local risk factor was found in 58.5% of cases. These were mainly ocular trauma (39%), followed by local treatment of glaucoma (16%), and recent eye surgery (14.5%). In 9 cases (8%), the only risk factor for abscess was an isolated general factor. This was diabetes in 7 cases. The clinical aspects described can be grouped according to topography, depth, and severity in pre-perforation state or perforation (45%), anterior chamber Tyndall effect greater than 1 cross, reaching a hypopyon stage (24%), stromal infiltrate larger than 2 mm (18%) and the abscess located within 3 mm of the corneal center (13%). The microbiological examination isolated a germ in 17% of cases, principally Pseudomonas aeruginosa (40%), followed by Staphylococcus aureus (20%). Prognosis was severe with visual acuity of less than 1/10 in 90% of cases and evisceration in 16% of cases. DISCUSSION: The most common risk factor was local ocular trauma by foreign bodies in the cornea. The poor prognostic factors were possible delay in consultation, low initial visual acuity, and low rate of positive microbiological examinations. CONCLUSION: Infectious keratitis is a potentially serious condition that can lead to blindness and eventually to loss of the ocular globe in tropical environments. Local risk factors are largely dominated by ocular trauma. Only early management based on the microbiological results improves the prognosis.

[Profile of neovascular glaucoma in Senegalese patients]. / Profil du glaucome néovasculaire chez les patients sénégalais.

OBJECTIVE: To describe the etiologies, clinical presentation and therapeutic management of neovascular glaucoma (NVG) in Senegalese patients. PATIENTS AND METHODS: We retrospectively studied the records of patients followed for NVG between 1993 and 2016. We included eyes with Iridis rubeosis with or without ocular hypertension. We recorded age, sex, medical and ophthalmologic history, results of the eye examination, treatment modalities broken up into hospitalisation, procedural interventions and number of antiglaucoma medications prescribed. The data analysis was performed by epi-info 7. RESULTS: Forty-eight eyes of 44 patients were included. The mean age was 59.7 years and sex ratio 2.1. Etiologies were type 2 diabetes in 31.8 % cases and central retinal vein occlusion in 16.6 % cases. All eyes were blind. Eye pain was present in 75 % of eyes, a limbal flush in 29.1 % of eyes and mydriasis in 31.25 % of eyes. Mean intraocular pressure was 49.7mmHg. Corneal edema occured in 54.1 % of eyes. Fundus examination showed proliferative retinopathy in 14.5 %. Treatment required hospitalisation for 43.75 % of patients. Therapeutic procedures were cyclocryoapplication for 31.25 % of eyes, retrobulbar xylo-alcohol injection for 14.5 % of eyes and panretinal laser photocoagulation (PRP) for 12.5 % eyes. Antiglaucoma preparations were used in dual therapy for 29 % of eyes, in triple therapy and quadruple therapy for 25 % of eyes each. DISCUSSION: The etiologies are comparable to those described in the literature. The diagnosis was late and treatment limited by adverse economic conditions. CONCLUSION: NVG in Senegalese patients is an affection of men in their sixties. It is responsible for irreversible painful blindness for which treatment is difficult - thus the interest in prevention by strict monitoring and prompt treatment of any retinal ischemia.

[Etiology and prognosis of the eye traumas by war weapons in the Senegalese army]. / Étiologies et pronostic des traumatismes oculaires par armes de guerre dans l'armée sénégalaise.

INTRODUCTION: The aim of this work is to identify the main weapons causing eye injuries during the campaigns of the Senegalese army in the south of the country, as well as the prognosis of these traumas. PATIENTS AND METHODS: This study is retrospective and concerns soldiers wounded by the weapons of war during the exercise of their mission within the Senegalese armed forces of 1991 in 2005. They are mainly soldiers affected in the south of the country during a war, clashes with the rebels or in Guinea-Bissau during operation Gabou in 1998. And they were evacuated to the ophthalmology department of the Principal Hospital in Dakar, which is a level 3. RESULTS: Thirty-seven military all male, with an average age of 30.5 years. Forty-six eyes including 9 bilateral cases. The trauma agent is a burst of RPG7 shells in 62% of cases, mine explosion in 13.5%, offensive grenade 10.8%, assault rifle 5.7% and flame lance-roquette anti-char (LRAC) accounts for 8%. We noted a phthisis of the globe for 14 eyes (30.43%) and for 15 eyes (32.60%) a functional loss of the affected globe. Inability to fight was decided by 29 wounded soldiers (78.37% of the cases), sedentary employment in 27 cases (72.97%) and 10 cases (27.03%) of reformed soldiers. DISCUSSION: In the conflict in southern Senegal, the RPG7 shell burst causes 62% of eye injuries. This RPG7 shell called "rebel weapon" is frequently used in conflicts in Africa. The prognosis of trauma with these types of weapons is severe. CONCLUSIONS: The combat goggles systematically integrated in the equipment of the Senegalese combatant, would be an invaluable contribution on the prevention of the traumatisms of the eye.

[Selective laser trabeculoplasty (SLT): our experience in African blacks]. / La trabéculoplastie au laser sélectif (TLS) : notre expérience chez le noir africain.

INTRODUCTION: The purpose of our study was to evaluate in the short and medium term, intraocular pressure results after selective laser trabeculoplasty in black patients with chronic open angle glaucoma or isolated ocular hypertension. MATERIALS AND METHODS: We conducted a retrospective study with a mean 12.5-month follow-up in black patients who underwent SLT. Inclusion criteria were: an open iridocorneal angle greater than or equal to Schaeffer grade 3, data recorded and available on trabecular pigmentation, data on SLT parameters available, and intraocular pressure by Goldmann applanation tonometry recorded.A positive result was defined as a post-laser IntraOcular Pressure (IOP) less than 21 mmHg after 1-month follow-up. The main motivation was the reduction of number of eye drops used. Performed first was a treatment of the inferior 180° (3:00-9:00), possibly supplemented by a second session at 15 days or 1 month if a pressure decrease was noted after the first session. IOP results were evaluated prior to SLT, immediately following SLT and then depending on the drop in pressure. Statistical analysis was performed using the EPI.info 7 software. RESULTS: A total of 69 eyes of 40 patients treated with SLT were identified. The mean IOP prior to SLT was 18.3 mmHg ± 4. Our results showed 90% of patients who positively responded to the treatment (10% failure) with a mean IOP decrease of 2.3 ± 1 mmHg, that is 13%, by the second week. The mean pressure decrease continued to 4.78 ± 1 mmHg for patients (30%) in the group treated for 360°, that is 27% in the same period of time. SLT permitted discontinuation of a prostaglandin in 60% (42 cases). Eyes on triple-drug therapy went from 23 before SLT to 5 following SLT (a 26% decline), eyes on two medications went from 32 to 16 (24% decline). In result association tests, only pigmentation of the angle and visual field stage had a statistically significant probability. DISCUSSION: In our experience, SLT is indicated in black patients to potentiate less effective treatments, to reduce the number of drops in order to limit side effects, but also to avoid or delay monotherapy treatment-naïve, hypertensive eyes. CONCLUSION: In the short and medium term, SLT brought about an IOP decrease in 90% of black patients, and discontinuation of a prostaglandin in 60% of our patients. In addition, the iridocorneal angle in blacks appears to be less pigmented than previously thought, and a protocol systematically treating 360° seems to provide better results.

[Central corneal thickness in Senegalese melanoderms with primary open angle glaucoma]. / Épaisseur cornéenne centrale chez le mélanoderme sénégalais atteint de glaucome primitif à angle ouvert.

PURPOSE: To measure the central corneal thickness (CCT) in Senegalese melanoderms with primary open angle glaucoma (POAG) and to determine its effect on visual impairment, intraocular pressure, optic nerve and perimetric damage. PATIENTS AND METHODS: We studied retrospectively the records of patients followed for POAG between May and July 2012. We recorded CCT measured by ultrasonic pachymetry and results of the first clinical examinations, including best-corrected visual acuity (CVA), intraocular pressure (IOP) by Goldmann tonometry, cup-to-disc ratio (C/D), and visual fields by automated perimetry according to the classification of Hodapp. RESULTS: Two hundred and thirty-four eyes of 117 patients were enrolled. Mean age was 56.53 ± 11.29 years and gender ratio was 2.77. Mean CCT was 525.40 ± 39.63 µm for all eyes, right and left (P=0.734). Women had a mean CCT of 521.20 ± 36.20 µm and men 526.91 ± 40.79 µm (P=0.332). Corneas were thinner in patients over 50 years (P=0.0047), in eyes having a CVA<3/10 (P=0.01) or a C/D ≥ 0.8 (P=0.043). CCT had no correlation with frequency of ocular hypertension (P=0.16) or advanced visual field defect (P=0.33). CONCLUSION: CCT of glaucomatous Senegalese is independent of laterality and sex, but decreased with age. A thin cornea is a risk for visual loss and optic cup enlargement, thus the importance of systematic measurement of CCT.

[Treatment of retinoblastoma: Senegalese experience]. / Thérapeutique du rétinoblastome: expérience sénégalaise.

INTRODUCTION: Retinoblastoma is a malignant tumor arising from retinal stem cells or retinoblasts. Its management has been well determined. The goal of this study is to report preliminary results obtained with combined chemotherapy and surgical treatment. PATIENTS AND METHODS: Our transverse prospective study includes retinoblastomas diagnosed and treated on our service from January 2006 to December 2010. Fundus examination under general anesthesia and radiological examination, orbital/brain CT or if unavailable, ultrasound, were systematically performed. MRI was able to be obtained in one case. The patients received 6 courses of chemotherapy (vincristin-carboplatin-etoposide or vincristin-cyclophosphamide), including 2 preoperative courses and 4 postoperative courses. A surgical procedure (enucleation or exenteration) supplemented the treatment, followed by histologic analysis of the specimen. External radiation therapy and conservative management were not available. RESULTS: Fifty-nine patients were treated. Median age at time of diagnosis was 9months (range 2months to 7years); the gender ratio was 1.18. Tumors were bilateral in 12 cases and unilateral in 47 cases, intraocular in 34 cases and extraocular in 25 cases. Optic nerve involvement was confirmed by histology in 12 cases. Twenty-one patients died from recurrence and/or metastatic disease, or during chemotherapy. Seven were lost to follow-up, and 31 have survived uneventfully. DISCUSSION: Improvement of mortality is still our major concern. Radiation therapy is essential in the presence of optic nerve involvement. CONCLUSION: Long-term survival will determine the efficacy of this form of management. The contribution of new therapeutic means will improve these results.

[Orbital mycetoma: a case report]. / Mycétome orbitaire : à propos d'un cas.

INTRODUCTION: Mycetomas are pathological processes through which exogenous fungal or actinomycotic etiological agents produce grains. These etiological agents live in the soil and plants of endemic areas. They are introduced traumatically, primarily into the foot. The orbital location is rare. OBSERVATION: We report the case of a 17-year-old student admitted for progressive left proptosis over 2 years, following penetrating trauma by a fork in a rural setting. Examination revealed a heterogenous orbital mass with multiple fistulae, producing pus and black grains, and suggested, due to the color of the grains, a diagnosis of fungal mycetoma. MRI revealed a destructive process at the level of the lamina papracea of the ethmoid and the orbital floor. Anatomopathological examination confirmed the fungal nature of the infection, while culture in Sabouraud's medium was inconclusive. The outcome was favorable after exenteration and debridementof the ipsilateral maxillary sinus and nasal cavities, along with 4 months of ketoconazole. No recurrence has been observed for 14 months after surgery. DISCUSSION: Mycetomas are endemic to northwest Africa. Most frequently located in the foot, they are seldom seen in the orbit. The color of the grains provides a clue as to the etiology. Black-grain mycetomas are always fungal and are treated surgically--essentially like cancer--as the persistence of a single grain will cause a recurrence. CONCLUSION: The orbital location of a mycetoma is rare. In the present case report, the concept of port of entry, the clinical appearance, and the color of the grains guided the diagnosis. The histological examination of the surgical specimen confirmed the diagnosis.

[Ocular lesions in melanodermia patients with chronic renal failure]. / Les lesions oculaires chez le patient melanoderme atteint d'insuffisance renale chronique.

AIM: To describe the and the factors that influence their occurrence. MATERIAL AND METHODS: A prospective study was performed over a year in the Ophthalmology clinic of Aristide le DANTEC Hospital, including 112 eyes of chronic renal failure patients followed up in the internal medicine unit of the same hospital. For each patient data of his follow up in the nephrology ward were recorded, even as the ophthalmological clinical examination which included colour test and angiography. All the lesions found were recorded on a questionnaire, seeking for any influence as far as age, sex, duration of signs, dialysis, and general complications were concerned. The analysis was performed using the 2005 Epi-info 6.0 software. RESULTS: Sex ratio was 1.54. 70% were above 40 years old. Blindness was found on 44.6% of the eyes. There were 20.5% cases of eye lids oedema, 15.8% conjunctival calcifications, 26.8% cataracts, 3 cases of ocular hypertension, 7.1% corneal lesions. Hypertensive retinopathy was found on 75.9% of the cases, amongst 14.3% classified stage 3, and retinal oedema signs associated on 13.8%, arteriosclerosis on 14.3% of the cases. 88.1% had confirmed signs of dyschromatopsia. On angiography, there was evidence of chorioretinal lesions due to high blood pressure, including decrease of the choroidal blood flow, choroidal ischemic areas, and halo peripapillary oedema. Age was a risk factor for eye lid oedema. Corneal and conjunctival lesions, even as eye lid oedema and hypertensive retinopathy were more frequent on patients, sick for less than a year. High blood pressure was a risk factor for papillary lesions, hypertensive retinopathy, and dyschromatopsia. Corneal and conjunctival calcifications were found mostly on patients on dialysis, whereas they had less eye lid oedema, hypertensive retinopathy, and maculopathy. CONCLUSION: Retinal lesion, especially due to high blood pressure is the most described. It permits to establish the prognostic of the disease. Patients on dialysis show a decrease of that retinopathy, but some sequels might persist which are invalidating, irreversible and may lead to blindness. This can be prevented by early screening of high blood pressure and an adequate treatment of chronic renal failure. Ophthalmologic examination remains a cheap and simple method to prevent the complications.

Les lesions oculaires chez le patient melanoderme atteint d'insuffisance renale chronique

But : Decrire les signes oculaires rencontres au cours de l'insuffisance renale chronique (IRC) chez le melanoderme senegalais et les facteurs influents leur survenue. Materiel et methodes : Nous avons realise a la clinique ophtalmologique de l'Hopital A. le Dantec; une etude prospective sur un an. Elle portait sur 112 yeux de patients atteints d'IRC et suivis a la clinique medicale du meme hopital. Pour chaque patient; nous avons releve les donnes de son suivi en nephrologie; de l'examen clinique ophtalmologique; du test des couleurs et de angiographie. Les lesions constatees ont ete correlees a l'age; au sexe; a la duree d'evolution des signes; a l'hypertension arterielle (HTA); au taux d'hemoglobine; au recours a la dialyse dans le traitement; a la presence de complications generales. Cette analyse a ete effectuee avec logiciel epi info 6.0 version 2005. Resultats : le sex ratio etait de 1;54 et 70avait plus de 40 ans. 44;6des yeux presentaient une cecite. On comptait 20;5d'oedemes palpebraux; 15;8de calcifications conjonctivales; 26;8de cataractes; 3 cas d'hypertonies oculaires; 7;1de lesions corneennes. La retinopathie hypertensive s'observait dans 75;9des cas; dont 14;3au stade 3. Elle s'accompagnait d'oedeme retinien dans 13;8des cas et d'arteriosclerose dans 14;3des cas. Les dyschromatopsies etaient objectivees dans 88;1des cas. L'angiographie objectivait des atteintes chorio-retiniennes de l'HTA; une reduction de la perfusion choroidienne; des zones d'ischemie choroidienne; des atrophies peripapillaires aureolaires. L'age exposait a l'oedeme palpebral. Les lesions corneoconjonctivales; l'oedeme palpebral et la retinopathie hypertensive etaient plus frequents chez ceux qui evoluaient depuis moins d'un an. L'HTA exposait aux lesions papillaires; a la retinopathie hypertensive et aux dyschromatopsies. Ceux qui beneficiaient de la dialyse presentaient plus de calcifications corneoconjonctivales et moins d'oedeme palpebral; de retinopathie hypertensive; de maculopathie. Conclusion: L'atteinte retinienne surtout celle liee a l'HTA; est la lesion la plus decrite. Elle permet d'etablir le pronostic de l'affection. Elle regresse chez les patients soumis a la dialyse. Cependant; elle peut laisser des sequelles invalidantes; irreversibles et cecitantes. Sa prevention passerait par un depistage precoce de l'HTA et une prise en charge adequate de l'IRC. L'examen ophtalmologique reste une methode simple et peu onereuse pour prevenir les complications

[Fungal keratitis in an intertropical area: diagnosis and treatment problems. Advantage of local use of polyvidone iodine]. / Problème diagnostique et thérapeutique de la kératite mycosique en zone intertropicale. Intérêt de l'usage local de la polividone iodée.

Fungal infection is rarely investigated in keratitis. The authors report five cases of fungal keratitis observed at the le Dantec University Teaching Hospital of Dakar, Senegal, involving two males and three females. Diagnosis was made by examination of smears and cultures of corneal scrapings revealing Candida albicans isolated in four patients and Acremonium strictium in another after 2 or 12 weeks of treatment with antibiotics, antivirals, or steroids. Povidone iodine 2.3% concentrated eye drop was used alone or with an azole for 4 a mean of weeks. All patients presented corneal scars. Fungal keratitis must be considered in presence of torpid corneal ulcer and corneal scraping must be systematically done. Topical povidone iodine alone or associated with azole may be an alternative fungal keratitis treatment in intertropical areas.