[Profile of macular holes in Cotonou]. / Profil des trous maculaires à Cotonou.

PURPOSE: To establish the epidemiological and tomographic profile of macular holes in the Beninese subject. PATIENTS AND METHODS: This cross-sectional study included consecutive patients seen for macular testing during the period from January 2016 to August 2017 at the St. Anthony of Padua Retinal Testing Center in Cotonou (Benin). All patients who had a macular hole and macular OCT were included. To define macular hole types, we used the 2013 DUKER New Classification and analyzed for each case: age sex, history, involved eye, fellow eye, visual acuity, hole type, hole diameter, status of the vitreous cortex, edge edema, mean macular thickness, presence of vitreomacular traction, epimacular membrane, and retrofoveal choroidal thickness. Patients with a pseudo-macular hole or lamellar hole were excluded. RESULTS: During this study period, 401 patients underwent a macular OCT procedure at the Retinal Testing Center, with 22 patients having a macular hole, of which 15 women and 07 men for a sex ratio of 2.14 women to men. The mean age of the patients was 61±10 years, with a median age of 63 years. The mean diameter of the holes was 705µm±232µm. No small holes were found. The mean central macular thickness was 272µm±39µm. In 52.4% of cases, the condition of the felloweye indicated the presence of vitreomacular traction. The etiological profile of the macular hole found in 72.7% a primary origin, and a secondary origin (diabetic and traumatic) in 13.6% and 9.09% respectively. DISCUSSION: The majority of the macular holes observed were large macular holes, which could be explained by the progressive course of these macular holes as well as late detection. Over half of the fellow eyes showed vitreomacular traction, reflecting the potential risk of bilateralization. CONCLUSION: Macular hole is a pathology of the vitreomacular interface, tending to be large in our geographic context. On OCT, the data found remain comparable those reported in the literature.

[Tomographic appearance and etiologies of epimacular membranes in Cotonou]. / Aspects tomographiques et étiologiques des membranes épimaculaires à Cotonou.

PURPOSE: To study the tomographic appearance and etiologies of epimacular membranes in Cotonou. PATIENTS, MATERIALS AND METHODS: This was a descriptive, analytical study with retrospective data collection. It took place at the Cotonou Retinal Testing Center and included all patients who underwent macular OCT testing between January 1, 2016 and June 30, 2018. RESULTS: Of the 604 subjects examined, 32 patients (5.3%) exhibited an epimacular membrane. Epimacular membrane in combination with posterior vitreous detachment and contraction accounted for 44.74% of cases. 42.31% of the fellow eyes had developed a posterior vitreous detachment. The majority of the membranes were idiopathic. Proliferative diabetic retinopathy and posterior uveitis were the main risk factors for secondary membranes. CONCLUSION: Epimacular membrane is a potentially blinding condition. The risk of bilateral involvement is significant, and patient access to OCT remains a concern in developing countries.

Aspects épidemiologiques, cliniques, thérapeutiques et évolutifs du rétinoblastome, à l'hôpital ophtalmologique Saint André de Tinré / NA

Introduction : Le rétinoblastome est une tumeur intra oculaire embryonnaire hautement maligne de l'enfant. Il met le plus souvent en jeu le pronostic visuel et fonctionnel en absence de prise en charge précoce. Méthode : Il s'agissait d'une étude ambidirectionnelle, réalisée sur une période de 30 mois à l'Hôpital Saint André de Tinré. Elle a concerné tous les enfants suivis dans cet hôpital pour le rétinoblastome. Résultats : La fréquence du rétinoblastome était de 0,73% (41/5592 patients). L''âge moyen des enfants était de 35,60 ± 15,70 mois. Une prédominance était observée à 51,22% avec un sex-ratio de 0,95. Les principaux signes cliniques étaient repésentés par l'exophtalmie à 46,34% et la leucocorie à 39,02%. La notion de consanguinité était retrouvée dans 7,32% des cas. Selon la classification internationale, les groupes D et E étaient les plus représentés dans 36,59% chacun. Le traitement a consisté en une énucléation pour 26 yeux (soit 63,43%) parmi lesquels 36,59% ont reçu une chimiothérapie néoadjuvante et 2,44% une chimiothérapie adjuvante. L'évolution a été marquée par la survenue de la guérison chez 3 patients (soit 7,32%) et la récidive chez 2 patients (4,88%) avec 78,05% des patients qui étaient perdus de vue. Conclusion : L'amélioration de la prise en charge du rétinoblastome nécessite une sensibilisation de la population sur ses signes d'appels mais aussi le renforcement de la relation médecin et parents de ces enfants pour une bonne adhérence thérapeutique.

Introduction: Retinoblastoma is a highly malignant intraocular embryonic tumor in children. It more often brings into play the visual and functional prognosis in the absence of early treatment. Method: This was an ambidirectional study, carried out over a period of 30 months at Saint André Hospital in Tinré. It concerned all the children followed in this hospital for retinoblastoma. Results: The frequency of retinoblastoma was 0.73% (41/5592 patients). The average age of the children was 35.60 ± 15.70 months. A predominance was observed at 51.22% with a sex ratio of 0.95. The main clinical signs were represented by exophthalmos at 46.34% and leukocoria at 39.02%. The notion of consanguinity was found in 7.32% of cases. According to the international classification, groups D and E were the most represented in 36.59% each. The treatment consisted of enucleation for 26 eyes (63.43%) of which 36.59% received neoadjuvant chemotherapy and 2.44% adjuvant chemotherapy. The course was marked by the onset of healing in 3 patients (7.32%) and recurrence in 2 patients (4.88%) with 78.05% of the patients who were lost to follow-up. Conclusion: Improving the management of retinoblastoma requires raising public awareness of its warning signs but also strengthening the relationship between the doctor and the parents of these children for good therapeutic adherence

[Evaluation of intravitreal injection practice patterns in Cotonou]. / Évaluation de la pratique de l'injection intravitréenne à Cotonou.

INTRODUCTION: Intravitreal injections of medication are designed to obtain a high concentration in the posterior segment. We conducted a retrospective study of our practice of intravitreal injections to assess safety of the technique and short- and medium-term tolerability, and to analyze indications and the complications. PATIENTS AND METHODS: This analytic retrospective study focused on consecutive patients treated with intravitreal injections for the period of January 2015 to June 2016 in the "Lumière" ohthalmology clinic in Cotonou, with incidents or accidents during the injection procedure as a measure of safety. Included were all patients undergoing one or more intravitreal injections regardless of the type of product injected, who had undergone a complete ophthalmologic work-up prior to injection and who had been followed at one week (W1) and 1 month (M1) after treatment. RESULTS: During the study period, we safely performed 124 intravitreal injections on 49 patients. The indications were diabetic macular edema in 53.06% and macular edema due to vein occlusions in 26.53%. The main complication observed was ocular hypertension in 60%, mainly related to triamcinolone injection. In 51.02%, the drug used was Ranibizumab, followed by Bevacizumab in 28.54% and Triamcinolone in 20.40%. DISCUSSION: The main goal of intravitreal injection is to achieve instantly effective concentrations in the center of the globe. Intravitreal injection is a safe, feasible practice in our context. The male predominance observed in our series is explained by the low socio-economic status of women in our context as well as the economically difficult accessibility of important drugs such as anti-VEGF. Significant improvements in D7 and D30 visual acuity in our patients highlights the beneficial effects of the presence of the active molecule in the vitreous cavity for these indications. CONCLUSION: Intravitreal injection is a common practice in our context, which is being performed safely. The indications are many, and ocular hypertension is a significant complication. The difficulties in terms of supply and preservation of the main drugs used (anti-VEGF) remains to be resolved.

Aspects cliniques de la maladie de Stargardt: cas d'une atteinte familiale / NA

La maladie de Stargardt est la plus connue des dystrophies maculaires juvéniles. Encore appelé fundus flavimaculatus, elle est une dystrophie maculaire héréditaire qui se transmet souvent sur un mode autosomique récessif et rarement sur un mode autosomique dominant. Elle est typiquement caractérisée par une déficience de la vision centrale, qui se manifeste autour de la première et ou de la deuxième décennie de la vie. Nous présentons les cas de deux frères et une soeur atteints de la maladie. La présentation, le diagnostic et les modalités thérapeutiques sont discutés.

Stargardt's disease is the best known of juvenile macular dystrophies. Also called fundus flavimaculatus, it is an inherited macular dystrophy that is often transmitted in an autosomal recessive fashion and rarely in an autosomal dominant mode. It is typically characterized by a deficiency of central vision, which manifests itself around the first and / or second decade of life. We present the cases of two brothers and one sister with the disease. Presentation, diagnosis and therapeutic modalities are discussed.

Carcinome épidermoïde conjonctival au cours de l'infection au virus de l'immunodeficience humaine (VIH)

Le carcinome épidermoïde de la conjonctive est une tumeur maligne rare des cellules souches limbiques conjonctivales. Cependant, il représente la tumeur maligne la plus fréquente de la surface oculaire.Son évolution peut se faire vers l'orbite ou l'oeil et aboutir à la perte fonctionnelle du globe oculaire,en absence du traitement. Son traitement est essentiellement chirurgical mais les récidives sont fréquentes

Carcinome adenoïde kystique de la glande lacrymale

Le carcinome adénoïde kystique de la glande lacrymale est la tumeur maligne épithéliale d'agressivité locale et d'évolution lente. Cette tumeur se développe aux dépens des cellules glandulaires salivaires.Sa localisation orbitaire aux dépens des glandes lacrymales est exceptionnelle. Elle touche préférentiellement la jeune femme. Son traitement est essentiellement chirurgical. Les récidives sont fréquentes

[Socioeconomic aspects of the management of primary open angle glaucoma in Benin]. / Aspects socio-économiques de la prise en charge du glaucome primitif à angle ouvert au Bénin.

INTRODUCTION: The purpose of our study is to present the socioeconomic aspects of the management of primary open angle glaucoma in Benin. PATIENTS AND METHODS: The study was a multicentric descriptive, record review from January 1st, 2011 to June 30th, 2013 and prospective from May 1st to July 31st, 2013. It included patients over 15 years of age, and treated for a diagnosis of primary open angle glaucoma during the study period. RESULTS: Of 15,592 patients, 227 were diagnosed with glaucoma, for a 1.5% hospital prevalence with male predominance (64%). Medical treatment was the rule, with an average duration of 7.4 ± 7.4 months. A total of 10.6% of the patients were followed regularly. The average monthly cost of medications was 17.8 ± 10.8 euros. That of the consultations and diagnostic tests was an average of 79.5 ± 59.9 euros. The average cost of transportation to each visit was 1.6 euros. Stable glaucoma was more costly. A total of 17.6% of the patients were accompanied to visits for which the waiting time was always longer than one hour. The monthly average income of the patients was 187.7 euros. Loss of income associated with waiting was not evaluated. A total of 72.7% of the patients were self-insured, corresponding to 58.3% of their average monthly income. DISCUSSION: Patients cannot logically afford their medication. Practitioners should rely more on lower-cost surgical treatments.

[High intraocular pressure and open angle glaucoma]. / Hypertonie oculaire et glaucome primitif à angle ouvert.

PURPOSE: To study the correlation between high intraocular pressure and the primitive glaucoma with opened angle among beninese patients. METHOD: Our study was accomplished in the ophtalmological department of the university national hospital center of Cotonou. It was retrospective with descriptive and analytical aim and extended over a period of 3 years going from January 1st, 2007 till December 31st, 2009. It took into account all the patients' files having presented high intraocular pressure and to whom the search for primitive glaucoma with opened angle was carried out. RESULTS: Among 9406 patients received in consultation during the period of study, 129 (corresponding with 258 eyes) presented high intraocular pressure that is 1.37%. The age of the patients was included between 11 years and 82 years, with a medium age of 54.48 years ±13.94 years. Male subjects prevailed (57%), with a sex ratio of 1.3. All the patients (100%) consulted for visual decline by far, by near or both at the same time. A significant number of eyes (80 eyes - 31%) had a vision by far lower or equal with 3/10. The values of ocular pressure were included between 22 mmHg and 62 mmHg, with an average of 28.13 mmHg ±6.06 mmHg. The ratios cup/disc varied from 0.3 to 1 with a medium cup/disc of 0.46±0.34. The examination of the field of vision with the automatic perimeter showed deteriorations of glaucoma type in 170 eyes (65.89%). High ocular pressure, optic disc glaucoma excavation and visual field defects were associated in 58.13% of the cases with a coefficient of correlation (r) higher than 0.87. DISCUSSION: Although the high intraocular pressure does not allow to confirm the diagnosis of primitive glaucoma with opened angle, it constitutes an essential risk factor. CONCLUSION: We showed in this study that in 58.13% of the cases, there is a correlation between the high intraocular pressure and the primitive glaucoma with opened angle. Efforts must be made to sensitize our populations on the existence of this serious affection that is primitive glaucoma with opened angle and on its early tracking which begins with the measure of the eye pressure.

[Cervicofacial cellulitis of dental origin: etiology, epidemiological and therapeutic aspects]. / Aspects étio-épidémiologiques et thérapeutiques des cellulites cervico-faciales d'origine dentaire.

OBJECTIVES: Cervicofacial cellulitises are dominated by dental affections. The aim of this study is to describe etio-epidemiological and therapeutic aspects of cervicofacial cellulitis of dental cause at the CNHU-HKM in Cotonou (Benin). METHODS: It's a retrospective study from 1998 to 2007 included patients with inflammatory cervicofacial tumefaction of dental cause. A glycaemia, a HIV serology and a blood formula numeration are realized. Some patients practiced standard oral and dental radio. Patients were hospitalized and received mono, bi or triple antibiotic. Lancing with swab of pus for cytobacteriological and antibiogram examination was realized for some of patients. Dental cares were been systematic. RESULTS: 68 cases whose 53 dental cause where been collected 77.94%. Bracket concern patients between 0-20 and 20-40 years old (64.15%). Males were, more concerned. Dental traumatisms find again (18.88%), tooth decay (56.60%) and 24.53% patients practiced dental extraction. Anti inflammatory practiced by 67.92% patients associated to antibiotic in 41.51% cases. The three latest molar were concerned to 26 patients. Among those last 22 had attack of mandibular teeth. Treatment consisted in lancing drainage to 2/3 patients in 83.40% cases associated to tri antibiotic. Evolution has been favourable with recovery to 86.67%; 6 decreases to 13.33% cases. CONCLUSIONS: Cervicofacial cellulitises are dangerous, rapidly responsible of deceases by extension. A better oral and dental hygiene would improved prognosis.

[Seven cases of inverted nasosinusal papilloma treated at Cotonou]. / Sept cas de papillome inversé nasosinusien pris en charge à Cotonou.

OBJECTIVE: Sinonasal inverted papilloma is a rare benign tumor with a high recurrence rate and potential malignant transformation. The purpose of this study was to analyze the clinical and radiological aspects and to identify the suitable surgical approaches to be used in developing countries. METHODOLOGY: In 3 years, 7 cases have been analyzed in a retrospective study. Patients presented with unilateral nasal obstruction and epitasis, a whitish unilateral polypoid mass, sinonasal opacity with osteolysis on CT scan or on sinus X-ray. Using these data we adopted the Krouse staging which classifies the disease in four stages and accordingly the appropriate surgical approach was used. The diagnosis was confirmed by histological examination of the biopsied specimen. RESULTS: Average age 48.28 years, predominant sex male. Symptom: unilateral nasal obstruction 5, bilateral nasal obstruction 1, epistaxis 5. The average time-delay before consultation was 73 months. The combined endonasal endoscopic and vestibular was the most commonly used approach (4 cases). The results were satisfying. After a minimal follow up of 2 years, one case of recurrence was detected after 4 years. CONCLUSION: CT scan is an essential tool for the diagnosis and detecting the extension of sinonasal inverted papillomas. Better results were obtained with a surgical approach that combined a vestibular approach and an endonasal endoscopic approach in our region.

[Cemento-ossifing fibroma: two cases]. / Le fibrome cémento-ossifiant: deux cas.

INTRODUCTION: Cemento-ossifying fibroma is a rare benign tumor which can affect both jaw bones, particularly the mandible. CASE REPORTS: We report two cases of cemento-ossifying fibroma which illustrate the radiological and anatomic features of these tumors. Differential diagnosis between cementifying fibroma and ossifying fibroma was particularly difficult. The cementifying fibroma was treated by surgical resection followed by immediate reconstruction with an iliac bone graft. The ossifying fibroma was treated by enucleation-resection. DISCUSSION: The clinical, radiological and histological features of cementifying and ossifying fibroma allow distinction. Surgical treatment is achieved by enucleation resection for small-sized ossifying fibromas and mono-bloc resection with bone reconstruction for large-sized cementifying and ossifying fibromas.

[Parathyroid cervical hematoma: a case report]. / Hématome cervical d'origine parathyroïdienne: à propos d'un cas.

Haemorrhagic cysts of the parathyroid gland are rare. Our case report concerns a presentation with a constrictive cervical haematoma, confirmed by ultrasound-guided aspiration. The haematoma, rapidly recurred, indicating exploration of the neck and haemostasis. Histological examination of excised tissue showed the haemorrhagic nature of the cyst.