[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.

[Epidemiological and clinical characteristics of primary ocular cancers in blacks: our experience with 111 cases]. / Aspects épidémiologiques et cliniques des cancers oculaires primitifs du mélanoderme : notre expérience à propos de 111 cas.

INTRODUCTION: In this work, the authors aim to study clinical and epidemiological characteristics of ocular and orbital primary cancers in sub-Saharan African. PATIENTS AND METHODS: This is a retrospective study over a period of 21 years, from 1984 to 2004, including all cases of ocular cancer, histologically proven after surgery of the globe or the orbit. For each patient, we studied the following parameters: age, sex, reason(s) for consultation, the affected eye, and histological result of the operative specimen. These data were collected by studying the departmental surgical registry, patient medical records and the tumor registry of the anatomicopathology laboratory of a tertiary care hospital in sub-Saharan Africa. RESULTS: We collected data on 111 black patients, among whom 15 cases (13.5%) presented with bilateral involvement, for a total of 126 eyes. The sex ratio was 1.17. Presenting signs showed a predominance of leukocoria (30.2%) followed by proptosis (21.7%) and in third place, protruding conjunctival mass (10.8%). Retinoblastoma was found most frequently, representing 66.6% of the oculo-orbital tumors and 95.45% of the tumors of the globe; followed by epidermoid carcinoma, representing 15.08% of cases. Malignant melanoma was third most common, representing 4.76%, with 83% arising in the anterior uvea and 7% in the choroid. Basal cell carcinoma and rhabdomyosarcoma follow in fourth place. Basal cell carcinoma constituted half (50%) of the eyelid tumors. Rhabdomyosarcoma was the most common orbital tumor in our series (57%). Next were lymphomas with conjunctival localization (2.38%), acute leukemia with orbital localization (1.59%) and rare tumors, palpebral dermatofibrosarcoma (0.79%), an orbital angiosarcoma (0.79%), a glioblastoma of the globe (0.79%) and a malignant solitary fibrous tumor of the orbit (0.79%). CONCLUSION: Ocular and orbital primary cancers in blacks remain tumors of the young, equally distributed between the sexes. Retinoblastoma is the most frequent, followed by epidermoid carcinoma. The globe is the preferential localization of these cancers.

[Cataract surgery with posterior chamber lens implantation in Senegalese children less than 15 year-old]. / Chirurgie de la cataracte avec implantation en chambre postérieure chez l'enfant de moins 15 ans au Sénégal.

PURPOSE: To assess short and medium term outcomes of cataract surgery with intraocular lens implantation in Senegalese children less than fifteen years. METHODS: From 1992 to 1997, 50 eyes of 40 children between the age of 5 months and 14 years, suffering from cataract were operated. Some of them were seen untill 2000. Twenty-seven cataracts were congenital, 19 were traumatic, 2 were from corticosteroid side effects, 1 after uveitis, and 1 had no determined cause. Thirty-one had manual extracapsular surgery and 19 ultrasound cataract surgery. They all have a standard single-piece PMMA intraocular lens of 21 to 22 diopters, 12.0-12.5mm long, under the ciliaris silcus (34 cases) or in the capsular bag (16). The results were noted in the first week, at one month, at 3 months, and after. RESULTS: Exudative reactions were frequent in the anterior chamber: 20% of the eyes had such reactions during the operation, especially when a manual extracapsular extraction was performed, and 34% soon after operation. The reactions were generally revealed with one month of survey. Corticosteroids used before and after surgery reduced inflammation disorders but seemed to speed up the onset of secondary cataract. Posterior capsule opacification was observed in the first week after surgery. It increased from 45% at 3 months to 74% at 1 year and 100% after 3 years. Intraocular cristal lens implants are well tolerated with limited complications. Fifty-seven percent of the operated eyes we observed after 3 years had 30/60 or better visual acuity. CONCLUSION: Despite fairly frequent inflammation and secondary cataract, posterior chamber lens implantation in children is well tolerated. This suggest that, as in adults, intraocular lens implant would be the best treatment for aphakia.

[Non-sarcomatous bilateral exophthalmos disclosing acute myeloblastic leukemia in children]. / Exophtalmie bilatérale non sarcomateuse révélant une leucémie aiguë myéloblastique de l'enfant.

The authors report a bilateral exophthalmos due to a leukemic infiltration of the orbital lacrimal glands during an acute myeloblastic leukemia in a ten-year-old boy. This rare orbital localization revealed the leukemia. It was not a granulocytic sarcoma. Its importance leads to the extraction of the lacrimal glands in order to prevent the eyes from corneal perforation.

[Spontaneous and bilateral anterior luxation of the lens in a 5-year-old child]. / Luxation antérieure bilatérale et spontanée du cristallin chez un garçon de 5 ans.

The authors report a case of bilateral spontaneous dislocation of the lens in a five-year-old boy. This rare complication can be encountered in certain congenital abnormalities of the lens and zonule. The dislocation has been revealed by an acute glaucoma. The mains causes like Marfan's syndrome and homocystinuria were not found but due to their most severe prognosis. The patient must be followed carefully.

[A familial form of epidermoid carcinoma of the conjunctiva]. / Une forme familiale de carcinome épidermoïde de la conjonctive.

Two two-sided cases of conjunctival epidermoid carcinoma and one dysplasia in the same family are reported. The three sisters concerned were teenagers. This familial disease with bilateral localizations in young female patients, is quite rare. Clinical, histological and epidemiological conclusions were based on familial investigation.

La Retinopathie chloroquinique: une cause rare de sclerose areolaire centrale secondaire. [Lettre]

Les auteurs rapportent un cas de retinopathie chloroquinique tres evoluee realisant une sclerose areolaire centrale bilaterale. Ils pensent que la survenue de cette affection au cours de la prophylaxie antipalustre est negligeable. Compte-tenu de la mortalite elevee du paludisme dans les zones concernees; cette retinopathie ne devrait en aucun moment gener l'un des moyens de prevention les plus efficaces actuellement

Pronostic du traumatisme oculaire necessitant une hospitalisation : une evaluation du Service d'Ophtalmologie de l'Hopital Principal de Dakar sur une periode de 3 ans

Apres une analyse retrospective de 117 dossiers de patients hospitalises dans le service d'Ophtalmologie de l'Hopital Principal de Dakar pour un traumatisme oculaire de janvier 1990 a decembre 1992 dans le but d'evaluer leur pronostic; les auteurs constatent que les sequelles anatomiques et fonctionnelles sont tres importantes. 48;4 pour cent des sujets ont perdu l'usage de leur oeil traumatise. Le pronostic est plus grave entre 11-15 ans; apres 40 ans; chez la femme et paradoxalement sur les traumatismes operes en urgence. Les plaies corneennes depassant 2/3 de meridien et celles prenant la cornee de part en part sont redoutables; aboutissant presque toutes a la cecite et plus souvent a la phtyse. 46 pour cent des sujets ayant recu un projectile (jet de pierre surtout) perdent la vision. Les traumatismes par brindille de balai a cause de leur septicite n'ont laisse aucune chance de recuperation. Face a cette grande morbidite; les auteurs preconisent la prevention comme principal recours; meme s'il faut ameliorer sans cesse la prise en charge de ces patients

Le phlegmon orbitaire : ses origines et complications : a propos de 20 cas

Le phlegmon ou abces orbitaire se presente comme une exophtalmie inflammatoire aigue febrile. En vue d'en etudier les origines et les complications; les auteurs rapportent 20 cas colliges en 4 ans (1989-1993). 65 pour cent (13/20 sujets atteints) ont 20 ans ou moins; les sinusites en sont la premiere cause avec 11/20 cas soit 55 pour cent; les traumatismes suivent avec 25 pour cent (5/20 cas). Les phlegmons orbitaires (surtout d'origine ou traumatismes) se compliquent tres souvent; certaines complications peuvent rapidement engager le pronostic vital ou fonctionnel. tel a ete le cas de 2 deces suite a une thrombophlebite du sinus caverneux et 4 cecites dont 3 par atrophie optique. Pour ces raisons le traitement doit etre institue en urgence; utilisant une antibiotherapie puissante et adaptee associee aux anti-inflammatoires de preference cortisonnes. Le drainage de la collection sinusienne avec lavage a l'aide d'une solution antibiocortisonnee en cas de sinusite est tres efficace et permet d'eviter de nombreuses complications

[Posterior chamber implantation in black Africa. Apropos of 150 cases with an 18 months follow-up]. / L'implantation de chambre postérieure en Afrique noire. A propos de 150 cas suivis pendant 18 mois.

The purpose of this article is to report our study of 150 cases of posterior chamber implantations carried out at the Hôpital Principal de Dakar between 1988 and 1991. We report the specific difficulties of such operations in black Africans and their complications and follow-up. At the end of this study, after observations over an eighteen month period, we noticed a visual acuity of more than 20/30 for 105 patients (70%) and a secondary cataract in 22 cases (14.6%). Despite less favourable material conditions, we think that such an operation can perfectly be made in Africa and that it gives quite acceptable results.