[Accuracy of Optical Coherence Tomography versus Ultrasound in pachymetry]. / Fiabilité de la pachymétrie par OCT comparée à la pachymétrie par ultrasons.

PURPOSE: Measuring the central corneal thickness is an important step in the diagnosis and monitoring of glaucoma. Ultrasound pachymetry was the gold standard before the advent of OCT. The purpose of this study is to assess the reliability of OCT pachymetry compared to ultrasound pachymetry in black patients. PATIENTS AND METHODS: Pachymetry was performed as part of a glaucoma work-up. Ultrasonic pachymetry was measured using the Alcon Ocuscan by the same operator and OCT pachymetry using the Topcon 2000 OCT. The Student's t-test was used to compare means with statistical significance of 5%. The Pearson's correlation coefficient (r2) was used to measure correlations. RESULTS: One-hundred thirty-five right eyes and 135 left eyes, corresponding to 270 eyes of 135 patients, were examined. There was a female predominance (59 men/76 women), with a gender ratio of 0.78. The mean age was 42.3±17.3 [8-86] years. In the right eye, the mean OCT pachymetry was 522.4±36.8µ versus 528.2±37.9µ for ultrasonic pachymetry (P=1.00). In the left eye, the mean OCT pachymetry was 522.0±33.8µ versus 524.9±42.5µ for ultrasonic pachymetry (P=1.00). The overall mean OCT pachymetry was 522.2±35.2µ versus 526.5±40.2µ, with a non-significant difference (P=1.00). There was a strong correlation between ultrasonic pachymetry and OCT pachymetry (r2=0.83; P<0.05). On the other hand, there was a very low correlation between pachymetry and age (r2=0.09; P<0.05). Pachymetry decreased by 5µ per 10 years, corresponding to corneal thinning of 0.5µ per year. CONCLUSION: OCT pachymetry can be a reliable alternative to ultrasound pachymetry and could be performed at the same time as the OCT for glaucoma assessment.

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

[Optic disc features on OCT in glaucomatous and normal black Africans]. / Caractéristiques de la papille chez les sujets glaucomateux et normaux à l'OCT dans une population Noire Africaine.

PURPOSE: To determine the correlations between the size of the optic disc and glaucomatous defects in black Africans. DESIGN: Retrospective observational study. METHODS: The study was conducted over a two-year period from November 2014 to October 2016, based on records of black Togolese patients who had undergone optic nerve head (ONH) OCT or ganglion cell complex OCT for assessment of glaucoma. The population was divided into 3 groups (I, II and III) depending on the size of the ONH. The ONH was considered small (Group I) if its size was less than the mean -1 SD, medium (Group II) if its size was within 1 SD of the mean, and large (Group III) if its size was greater than the mean+1 SD. Glaucomatous lesions were qualitatively identified on RNFL and or GCC. The ONH parameters were compared in the 3 groups. The Chi-square test was used to compare the percentages, and the t test to compare the means with statistical significance of 5%. The Pearson correlation coefficient (r2) was used to measure correlations. RESULTS: A total of 586 eyes of 298 patients were examined, 314 glaucomatous eyes and 272 healthy eyes. The mean age was 41.0±15.7 [6; 86] years. There were 159 men vs. 137 women, with a sex ratio of 1.2. The mean surface area of the ONH was 2.80±0.55mm2. Small ONH's (Group I) were defined as a surface area of less than 2.25mm2, medium-sized ONH's (Group II) as an area between 2.25 and 3.35mm2 and large ONH's (Group III) as an area greater than 3.35mm2. Small ONH's represented 14.7%, (86 eyes), medium-sized 68.6% (408 eyes) and large ONH's 16.8% (98 eyes). The mean surface area of the neuroretinal rim, cup, the cup-disc ratio and the RNFL thickness were statistically significant in the 3 groups. Similarly, all these parameters were significant in groups of glaucomatous or non-glaucomatous eyes, except for the surface area of the cup. The RNFL thickness was weakly correlated with the surface area of the ONH (r2=0.39), moderately correlated with the surface area of the neuroretinal rim (r2=0.57). The surface area of the ONH was strongly correlated with the surface area of the cup (r2=0.7). The neuroretinal rim surface area was strongly correlated with the cup-disc ratio (r2=0.66). CONCLUSION: The size of the ONH was correlated with the size of the cup, but it was not correlated to the surface area of the neuroretinal rim or the thickness of the nerve fibers. Analysis of the RNFL and GCC is essential for the diagnosis, especially in the case of large ONH's.

[OCT topographic characteristics of the optic nerve in patients clinically suspected to have large optic disc cupping in Togo]. / Les caractéristiques topographiques à l'OCT du disque optique chez des patients cliniquement suspects de grande excavation papillaire (GEP) au Togo.

PURPOSE: To describe topographic characteristics of optic discs clinically suspected of large cupping. MATERIALS AND METHODS: This is retrospective study conducted from the January 2 to December 31 on the OCT registry and data base of a private ophthalmologic center in Lomé (Togo). We included records of patients with large cupping - CDR (cup-to-disc ratio) ≥ 0.4 -clinically observed and having undergone OCT-optic disc analysis. RESULTS: Three hundred and thirty-five patients (619 eyes) were studied, with a mean age of 41.87 years±17.51 years [6 years and 80 years] and a sex-ratio of 1.01 with a slight female predominance. The mean clinical CDR was 0.51±0.126 [0.4 and 0.9] (95 % CI [0.503 to 0.531]). The clinical CDR was ≥ 0.7 in 7.75 % of cases. The mean neuroretinal rim area was 1.63±0.43 mm2 [0.34 and 2.85 mm2]. The mean cup area was 1.43±0.54 mm2 [0.13 and 4.29 mm2], and the mean cup volume 0.47±0.28 mm3 [0.01 and 1.72 mm3]. The mean global CDR on OCT was 0.46±0.13 [0.21 and 0.87], of which 30.85 % (191 cases) had CDR <0.4. The CDR on OCT was >0.7 in 40 (6.46 %) eyes vs. 48 (7.75 %) eyes on clinical examination. CONCLUSION: On the average, optics discs exhibit large size and large cup volume. Topographic evaluation of the optic disc by the means of OCT offers important data and gives way to etiological research of large cupping in the black African.

Cataracts in rural areas in Togo: awareness and attitudes.

To assess the prevalence of senile cataracts and the awareness and attitudes of patients with them in a rural area in Togo. We conducted a 10-weeks cross-sectional ophthalmic screening in the prefecture of VO, 57 km from Lomé, which sought to include individuals aged 50 years and older living in the study area. All patients underwent a comprehensive ophthalmic examination. Of the 3111 patients expected, 767 came for the examination, for a participation rate of 24.6%. The sex ratio was 0.8, and the patients' mean age was 60.1 ± 8.7 years. The frequency of senile cataracts was 40.28%. Women had cataracts more often than men, with a sex ratio of 0.63. The frequency of unilateral blindness was 1.62% and 22% for bilateral blindness related to cataracts. Almost every participant (99.7%) knew the disease named cataract, but fewer than half (41.59%) knew its causes. Most patients (97.09%) accepted the idea of cataract surgery, but the lack of financial resources was a major barrier to it (64.72%). The frequency of senile cataracts is high in rural area. Decentralization of eye care is essential to give the right to sight to the population living in these areas.

[Ten years of destructive eyeball surgery in Lomé]. / Bilan de dix ans de chirurgies mutilantes oculaires à Lomé.

INTRODUCTION: Destructive surgery of the eyeball comprises radical procedures - evisceration, enucleation, and exenteration - with various indications. The purpose of this study was to determine the features of these procedures in Lomé. PATIENTS AND METHODS: We conducted a retrospective study reviewing records for all patients undergoing these procedures in 3 ophthalmic centers in Lomé in the decade from 2002 through 2011. RESULTS: Of 6240 eye operations, 76 involved one of these three procedures, for a frequency of 1.2%. Patients' mean age was 40.1 ± 26.9 years (range: 1 day to 91 years). The sex ratio (of men to women) was 1.2. The principal indications were staphyloma (38%), ocular and orbital tumors (30%), and phthisis bulbi (24%). Retinoblastoma was the leading type of ocular/orbital tumor (52%). Local anesthesia was performed in 64% of cases, and general anesthesia in 36%. Evisceration was practiced in 67% of cases, enucleation in 24%, and exenteration in 9%. An ocular prosthesis was placed in 46%. CONCLUSION: Staphyloma was the leading indication for destructive surgery. Given the damage of this type of procedure, primary prevention is important, including early and adequate management of ocular conditions.

[Ocular tumors in Togo: epidemiological, clinical, and histopathological features observed at the Lomé Teaching Hospital of Sylvanus Olympio]. / Tumeurs oculaires au Togo: aspects épidémiologiques, cliniques et histopathologiques à propos de quarante-cinq cas observés au CHU Sylvanus-Olympio de Lomé.

PURPOSE: To describe the epidemiological, clinical, and histopathological features of ocular tumors in Togo. METHODS: We have a retrospective and descriptive study of the ocular specimens registered in the pathology laboratory from January 1, 2006, to December 31, 2010. The frequency of ocular tumors, the patients' age and sex, the department from which the specimen came, the sampling procedure, and the histopathological patterns were analyzed. RESULTS: During the study period, 80 ocular specimens were recorded among a total of 6000, for a frequency of 1.33%. Histopathological results were available for 45 cases in our sample. The mean age was 30.9 ± 15.1 years, and the sex ratio 0.88 (21M/24F). The two teaching hospitals in Lomé furnished 73.4% of the ocular specimens. The most common site was the conjunctiva, accounting for 75.5% of the cases. Benign tumors represented 69.9% of the histological diagnoses. Papilloma was the histopathological diagnosis in 33.3% of cases. CONCLUSION: Ocular tumors are relatively common, occur at any age, and are located most often in the conjunctiva. Close collaboration between the pathologist and the ophthalmologist is essential for the best management of these tumors.

[Severe ametropia in children in Lomé (Togo)]. / Les amétropies fortes chez l'enfant à Lomé (Togo).

AIMS: To determine the features of severe ametropia (refractive errors, including myopia, hyperopia, and astigmatism) in children in general practice in Lomé. PATIENTS AND METHODS: We conducted a retrospective study based on records of patients aged 5-16 years seen in a private clinic in Lomé from 1 January, 2001, to 31 December, 2010. We analyzed subjective refraction after automated refraction or retinoscopy. RESULTS: Among 1303 cases of ametropia in children, 58 cases were severe, for a frequency of 4.5%. The mean age of these patients was 12.7 years. The sex ratio (M/F) was 0.7. Among these severe cases, astigmatism was most frequent, accounting for 46.6%, followed by myopia (27.6%) and hyperopia (25.6%). Among children with hyperopia, 80% were assessed at +3.50 D to +6.50 D and 20% from +6.75 D to +9.50 D; among those with myopia, 75% were assessed at -6D to -9.50 D and 25% from -10 D to -14 D. Bilateral amblyopia was found in 9 cases for a frequency of 0.45%. The amblyopia was caused by astigmatism in 1 case, hyperopia in 4 cases, and by myopia in 4 cases. CONCLUSION: The relative frequency of severe ametropia underlines the importance of a routine ophthalmology examination for children starting school.

[What remains today of neonatal conjunctivitis in prefecture of Kozah in Togo?]. / Que reste-t-il aujourd'hui des conjonctivites néonatales dans la préfecture de la Kozah au Togo ?

AIM: The purpose of this study is to screen the neonatal conjunctivitis in order to evaluate its incidence and especially to seek for the causative germs. PATIENTS AND METHODS: We have realized cross-sectional study in three health centers of the prefecture of Kozah from March 24 to May 12, 2009. All the newborns followed in these centers are examined in the search of signs of conjunctivitis. A biological diagnosis of conjunctival secretions was carried out at the suspect newborns. RESULTS: During the study period, 348 newborns were examined including 185 boys and 163 girls corresponding to a sex-ratio (M/F) of 1.1. The middle age was 3.7 days. Twenty-eight newborns presented conjunctivitis, that is to say a rate of incidence of 8%. The cases of conjunctivitis were observed the first four days of life in 39.3% of cases. Eighteen of the newborns presenting conjunctivitis were vaginal deliveries (64.3%) against ten (35.7%) by caesarian. All the mothers of the ill newborns had a syndrome of sexually transmissible infection (STI) during the third quarters of pregnancy. After biological diagnosis, Staphylococcus aureus was found in 25% of the cases. CONCLUSION: Despite the common herd of neonatal conjunctivitis prophylaxis by Crede's method, its remains in the prefecture of Kozah. In hope for neonatal conjunctivitis eradication, treatment of STI on pregnant women associated to education and communication on the prevention of the infection in neonatal health care centers and at home by hygiene rule application are necessary.

[Trachoma rapid assessment in the infantile population of Togo]. / Evaluation rapide du trachome infantile au Togo.

AIM: The aim of this study was to determine the prevalence and types of trachoma in children of central Togo. MATERIALS AND METHODS: This descriptive cross-sectional investigation was conducted in central Togo in November 2009. At every peripheral health unit (PHU) in 2 villages of the sanitary district, 15 schoolchildren between 6 and 9 years old and 35 children from the community between 1 and 5 years old were examined to detect signs of trachoma using a lamp wipes coupled with binocular magnifying loupes (2.5X). Data were analysed with Excel 2007. RESULTS: A total of 8200 children were examined at 82 PHU in 164 villages in the sanitary districts. In the 1-5 year age group including 5,740 children, follicular trachomatous inflammation (TF) was observed in 326 cases and intense trachomatous inflammation (TI) in 9 for a prevalence rate of 5.83%. In the 6-9 year age group including 2,460 schoolchildren, TF was observed in 144 and TI in 8 for a prevalence rate of 6.18%. The overall prevalence rate of active trachoma was 5.94 % (n = 487). CONCLUSION: This study confirms the persistence of active trachoma in children in central Togo. Trachoma may be public health problem in 2 districts: Blitta and Sotouboua. A population-based survey will be carried our to evaluate trachoma prevalence prior to implementation of the SAFE strategy in this region.

[Characteristics of cup/disc ratios in a population of northern Togo aged 20-40 years]. / Caractéristiques de l'excavation papillaire dans une population jeune de 20 à 40 ans du Nord Togo.

AIM: To describe the characteristics of cup/disc ratio in a young population belonging to a homogenous ethnic group in northern Togo. PATIENTS AND METHODS: The study population comprising 1010 persons (550 men and 460 women aged 20-40 years) was selected in 12 villages in the Doufelgou area. Eye assessment was conducted in the local health center facilities using a visual acuity chart, an ophthalmoscope, and light magnification for exploration of the anterior segment. RESULTS: The mean age of the participants was 30.4 years. The mean cup/disc ratio was 0.36 (range, 0.3-0.9). The most frequently found cup/disc ratio was 0.3, in both eyes, and was predominant in the 20- to 24-year age group: 56.6% of the right eyes and 58.7% of the left eyes. Cup/disc ratios over 0.5 were found in 14.4% of the right eyes and 12.4% of the left eyes; a cut-off point over 0.7 gave an abnormal cup/disc ratio prevalence of 3.2% in the right eye and 3.5% in the left eye. In 75% of the cases, the cupping appeared round and was elliptic in 25% of the patients. The cupping position was central in 63%, temporal in 18.3%, and nasal in 18.7% of the cases. In 7.8%, cupping was asymmetric. CONCLUSION: More than 3% of the young population of northern Togo has a 0.7 or higher cup/disc ratio, which shows a high prevalence of primary open-angle glaucoma if cup/disc ratio is considered a criterion for definition.

[Ocular manifestations in HIV/AIDS patients undergoing highly active antiretroviral treatment (HAART) in Togo]. / Atteintes oculaires chez les personnes vivant avec le VIH/sida sous trithérapie au Togo.

AIM: The twofold purpose of this study in people living with human immunodeficiency virus (PLHIV/AIDS) and undergoing highly active antiretroviral treatment (HAART) was to determine the prevalence of ocular manifestations and its correlation with CD4 T-cell count. PATIENTS AND METHODS: All patients who attended 2 NGO care centers that manage PLHIV/AIDS in Lomé, Togo between August and October 2005 were recruited. CD4 T-cell counts and use of antiretroviral treatment was noted. A thorough eye examination was performed in all cases. RESULTS: A total of 422 PLHIV/SIDA were recruited including 281 who were undergoing HAART. The sex-ratio was 2 female/1 male. Mean age was 34 +/- 2294 years. Involvement of the anterior segment was observed in 36.3% of patients and involvement of the posterior segment in 54.1%. The second most common ocular manifestation was ophthalmic herpes zoster of the anterior segment (19.6%) secondary to conjunctivitis (57.8%). One case of palpebral and conjunctival Kaposi's sarcoma was noted. The most common type of posterior segment involvement was cotton-wool nodules (35.5%). Five cases of CMV retinitis were observed. CONCLUSION: A longitudinal study in PLHIV/AIDS will be needed to better evaluate the correlation between ocular manifestations and CD4 T-cell count.