[Correlation between neuroretinal rim and optic disc areas in normal melanoderm and glaucoma patients]. / Corrélation entre les surfaces des anneaux rétiniens et des papilles, chez des sujets mélanodermes normaux et glaucomateux.

BACKGROUND: To evaluate optic disc size and its relationship with neuroretinal rim areas. MATERIAL AND METHODS: The study was prospective; 400 hundred patients with 292 glaucomatous and 108 non glaucomatous were enrolled in this study. Optic disc size quantification was assessed by the use of Goldmann 3 mirror contact lens; diameter reading were adjusted by the magnification factor of the lens, squares of the disc and the cupping were calculated using an ellipse formula, the neuroretinal rim area was then obtained by reducing the cupping area from the whole optic disc area. RESULTS: The mean age of the sample was 36.80 years (sd: 15.68 years).The average value of the vertical disc diameter was 2.045 mm (sd: 0.254) for glaucoma patients and 1.966 mm (sd: 0.237) in the control group; p<0.001. Neuroretinal rim area was 1.886 mm(2) (sd: 0.675) in the glaucoma group; and 2.165 mm(2) (sd: 0.425) in the control one; p<0. 004. In the glaucoma group, 72.97% of large optic disc were found (vertical diameter over 1.90 mm); and 63.80% in the control one. In the control group, neuroretinal rim area was wider in the large optic discs compared to the small discs, p<0.001, Anova test. Neuroretinal rim area was thinner in the glaucoma large disc compared to the control, p<0.005, Student test. Meanwhile, there was no difference in the medium and the small discs in the glaucoma and control groups; p > 0.005, Student Newmann test. CONCLUSION: Neuroretinal rim areas are thinner in the large glaucoma discs compared to the non glaucoma large discs. In Africa, this parameter could be helpful in the diagnosis and survey of glaucoma patients.

[Cytomegalovirus retinitis and ocular complications in AIDS patients in Togo]. / Rétinites à cytomégalovirus et complications oculaires du SIDA au Togo.

BACKGROUND: Cytomegalovirus retinitis seems to be an uncommon complication in African AIDS patients. This study was conducted in 200 patients in order to evaluate AIDS eye related complications with specific focus to cytomegalovirus retinitis. MATERIAL AND METHODS: During a period of 20 months, 200 patients (83 men and 117 women) presenting WHO AIDS case definition diagnosis were enrolled for a complete ocular examination comprising external, anterior segment and retinal fundus and fluorescein angiographic examination. RESULTS: For the whole, 200 patients underwent ocular examinations; of them 121 (60.5%) developed ocular complications. The most frequent complications were cotton wool spots (25.5%), cytomegalovirus (CMV) retinitis (21.5%), retinal hemorrhage (6%), papilloedema (3%), chorioretinal toxoplasmosis (3%), peripheral retinal vascularitis (2. 5%), herpes zoster ophthalmicus (2%). Among those with CMV retinitis, bilateral lesions were found in 30 cases, and unilateral ones in 13 cases. Poor vision was associated with the presence of CMV retinitis in 88% of cases. Death occurred in a mean range of 22 days after the "presumed" diagnosis of CMV retinitis. CONCLUSION: Cytomegalovirus retinitis represents the second ocular complication in AIDS patients in this study. Poor visual outcome was associated in 88% of cases. These results demonstrate that in some west African countries, CMV retinitis may be a common complication in AIDS patients.

[Asymmetrical forms of primary open angle glaucoma]. / Les formes asymétriques du glaucome primitif à angle ouvert.

PURPOSE: The goal of this study is to describe asymmetrical forms of primary open angle glaucomas in black african originated patients. MATERIAL AND METHOD: Data of 514 glaucomatous patients (1022 eyes) followed between 1993 and 1997, and attending our hospital eye department are retrospectively analysed. All the participants were diagnosed as primary open angle glaucomas; asymetry was defined as a difference of 0.2 at least between the vertical cup disc ratio of the same patient. RESULTS: The mean age of all 514 glaucoma patients was 34.52 +/- 15.55 years; 254 patients (49.40%) had no differences between cup disc values while 260 remaining others had asymmetric glaucomas (50.58%). Of them, 189 (72.69%) had a difference of 0.2 between both eyes; 49 (18.8%) had 0.3 difference; 7 (2.69%) had 0.4 difference; 4 (1.53%) had 0.5 difference, and 11 (4.23%) a difference of 0.6. Besides, 114 eyes (11.15%) had a vertical ratio of 0.9 at the first diagnosis. CONCLUSION: Carefully recognition of asymmetric cup disc ratios is of great diagnostic value in the the early stages of primary open angle glaucoma because 50% of all patients presented with this clinical form in our experience. This strategy would improve early diagnosis of glaucoma in our areas.

[Morphometry of the optic disc in Togolese patients with glaucoma or suspected glaucoma. Preliminary study]. / Morphométrie de la papille chez des sujets togolais glaucomateux et suspects de glaucome. Etude préliminaire.

PURPOSE: The aim of this study was to measure morphometric parameters of the optic disc in Togolese glaucoma patients and suspects by the mean of the millimetric scale of the slit lamp and the Goldmann contact lens. MATERIAL AND METHOD: We selected 202 patients (393 eyes) with a mean age of 36.69 years +/- 15.33 (standard deviation); they were divided into 2 subgroups A (162 glaucomatous) and B (40 glaucoma suspects); direct reading of the slit lamp millimetric scale and the Goldmann contact lens was used. RESULTS: In the group A, the optic disc vertical diameter was 1.792 +/- 0.21 mm; the horizontal diameter was 1.701 +/- 0.198 mm. In the group B, vertical disc diameter was 1.700 +/- 0.262 mm; the horizontal one was 1.662 +/- 0.190 mm. The vertical cup disc diameter was 1.147 +/- 0.274 mm in the group A and 0.708 mm +/- 0.274 mm in the group B. The neuroretinal area was 1.360 +/- 0.524 mm2 in group A and 1.786 +/- 0.467 mm2 in group B. CONCLUSION: This study using millimetric scale of the slit lamp and the three mirrors Goldmann contact lens was easy, simple and useful clinically. It could be helpful in conducting quantitative studies in countries with low resources because this method is costless compared with others.

[Retinal complications in AIDS patients at the Lomé (Togo) University Hospital]. / Les complications rétiniennes chez des patients atteints de SIDA au CHU de Lomé (Togo).

BACKGROUND: The purpose of this study was to describe retinal complications observed in patients presenting with AIDS at Lome teaching hospital. MATERIAL: All patients who met WHO AIDS clinical case diagnostic in Africa, admitted for various signs in hospital, were followed between December 1996 and May 1997 for ocular examinations. RESULTS: We surveyed 94 patients; 41 (43.6%) had retinal lesions. Retinal complications were cotton whool spots (30 cases), retinal hemorrhages (4 cases), papilloedema (4 cases), cytomegalovirus retinitis (8 cases). Mortality in patients with retinal complications occurred 10 months after the clinical diagnosis of AIDS. CONCLUSION: This study has found a high retinal morbidity contrasting with other studies in Africa. This could be explained by the longer period of follow-up larger than in previous similar studies.

[Retinal involvement in drepanocytosis in Togo. Correlation between age, genotype and retinopathy]. / Atteinte rétinienne au cours de la drépanocytose au Togo. Corrélation entre âge, génotype et rétinopathie.

PURPOSE: To evaluate different retinal complications, study correlation with age and links with genotypic forms in Togolese sickle cell patients. MATERIAL AND METHOD: Patients were recruited between 1994 and 1996 at the hospital, genotypic diagnosis by electrophoresis, systematic angiofluorography were performed and laser photocoagulation of retinal neovascularisation if needed. RESULTS: A total number of 190 patients were recruited, 84 (44.21%) had retinopathy, while 106 (55.79%) were normal. The SC form was most affected with 50 patients (26.3%), followed by the SS group in 11.05% (21 patients), and AS trait, 2.65% (5 patients). Patients most affected by proliferative retinopathy were aged 35-44 years (n = 30; 15%), 25-34 years in 23.8% and 15-24 years in 20.6%. CONCLUSION: Young Togolese sickle cell patients aged 35 to 44 year-old and the SC forms appear to have a relative high risk of proliferative retinopathy in this study.

[Hemoglobinopathies and retinopathies in Lomé UHC]. / Hémoglobinopathies et rétinopathies au CHU de Lomé.

BACKGROUND: There are few publications concerning retinal complications of hemoglobinopathies in our country. We studied recruited patients to evaluate these complications. MATERIAL AND METHODS: From October 1993 to August 1995, 66 patients were recruited among clinical hematology out patients; all of them underwent acetate electrophoretic diagnosis and fluorescein angiographic examination. RESULTS: The mean age of the patients was 26,92 years, ranging from 5 years to 50 years; the genotypic forms were 34 SC (51.51%), 15 SS (22.72%), 11 AC (16.66%), 2 AS (3.03%), 2 CC (3.03%), and 2 A2F (3.03%). Thirty eight patients (57.57%) had retinopathies. The majority were proliferative retinopathies in 55,26% cases and in 44,73% non proliferarive retinopathies. These retinopathies were essentially present with SC (26 cases for 34 SC, 76.47%), predominantly proliferative forms (21 cases for 26 SC, 80.76%). CONCLUSION: Retinal complications are common in Togolese sickle cell patients; clinical course usually leads to proliferations. Early screening could help improve prevention, including laser photocoagulation.

[Idiopathic central serous chorioretinopathy: two case reports observed in Togo]. / Choriorétinopathie séreuse centrale idiopathique: à propos de 2 cas observés au Togo.

Central serous chorioretinopathy is due to accumulation of serous fluid between the sensory retina and pigmented epithelium. Our perusal of the literature did not turn up any reports on this topic in Black Africa. The disorder was observed in 2 patients from Togo who presented with unilateral reduction in visual acuity. Initially suspected by the presence of a macular lesion on the fundus and by ophthalmoscopic examination, diagnosis was confirmed by angiofluorography. Angiofluorography is the method of choice and the low incidence of this eye disorder in Black Africa is probably due to the poor availability of this method. Although the two patients in this study responded to corticosteroid therapy, treatment usually requires laser photocoagulation to eliminate the site of abnormal transudation and create a choroidal adhesion. In this regard recent studies indicate that the primary mechanism underlying this disorder is multifocal or diffuse hyperpermeability of the choroidal vessels.

[Chloroquine maculopathy and prevention of malaria]. / Maculopathie chloroquinique et prophylaxie du paludisme.

PURPOSE: Chloroquine maculopathy is a major complication observed during prophylactic treatment of malaria. We present here 18 cases recently documented at Lomé Teaching Hospital. METHOD: Retrospective data of patients presenting with macular fluoroscopic bull's eye are analysed, all had a history of prophylactic treatment for malaria. RESULTS: These patients presented with three models of prophylaxy, total toxic doses were 185 g, 557 g and 1,300 g in the case of low, mild or high and massive continuous prophylaxy. All eighteen patients presented with macular angiofluorographic bull's eye; 11 were male, 7 female, mean age was 41.72 years. CONCLUSION: Chloroquine retinopathy is a rare complication observed at our hospital. Because of the poor prognosis of the disease and our geographical situation in an endemic area, the threshold dose might be 185 g. Patients should have undergone systematic screening before these cumulative doses. The incidence of this major complication which could increase would question chloroquine prophylaxy with actual doses and methods.

[Retinal complications in hemoglobinopathies: report of 32 cases]. / Etude des complications rétiniennes au cours des hémoglobinopathies: à propos de 32 cas.

Hemoglobinopathies especially sickle cell disease causes neovascularization in the retina and lead to hemorrhage. To gain insight into the features and incidence of this retinopathy, a study was carried out in Lome, Togo, in 32 subjects (mean age: 31.1 years) presenting hemoglobinopathy. There were 25 patients with SC disease, 3 with SS, 2 with AC, and 2 with A2F. All were examined by the same ophthalmologist and underwent fluorescein angiography. Retinopathy was observed in 22 of the 32 patients including 21 of the 25 patients (84%) with SC and one patient with AC who presented macular hemorrhage. The main findings in patients with SC were formation of new blood vessels in the peripheral retina characteristic of proliferating retinopathy in 11 cases, black sun spots characteristic of non-proliferating retinopathy in 3 cases, and evidence of vitreous hemorrhage in 2 cases. These findings confirm the high incidence and seriousness of retinal complications in patients with SC disease. Prevention is necessary and requires systematic screening to allow early detection of complications which can be treated by laser photocoagulation.