[Contribution of Optical Coherence Tomography in the evaluation of the iridocorneal angle in Cameroon]. / Apport de la tomographie en cohérence optique dans l'évaluation de l'angle irido-cornéen du camerounais.

INTRODUCTION: Our work was aimed at determining the sensitivity and specificity of anterior segment OCT (AS-OCT) in the evaluation of the iridocorneal angle (ICA) in Cameroon. METHODOLOGY: We conducted a cross-sectional, analytical study from January 2 to June 30, 2019 in Yaoundé. One hundred and twenty five patients over 35 years of age underwent three-mirror manual glass gonioscopy and AS-OCT. The angle was defined as occludable on manual gonioscopy if the posterior trabecular meshwork, was not visible and on OCT if there was contact between the iris root and the posterior surface of the peripheral cornea. Quantitative parameters (angle opening distance, angle recess area, and trabecular-iris space area) in the nasal and temporal quadrants were recorded for the analysis. RESULTS: Men accounted for 56.20% of the 96 patients selected (192 eyes). The mean age was 54.78±10 years. The prevalence of occludable angles was 18.75% (18/96 patients) and 28.125% (27/96 patients) on manual and automated gonioscopy respectively. Schaeffer-Etienne grades ≤ 2 were identified in 43/192 (21.94%) nasal quadrants and 33/192 (19.18%) temporal quadrants. The area under the curve (AUC) was maximal for the 500 µm goniometric parameters (> 0.8). An Angle Opening Distance ≤ 333.50 µm was found in 52/192 nasal quadrants (27.10%) and 53/192 (27.60%) temporal. The sensitivity and specificity of AS-OCT in the detection of occludable angles at 500 µm, were 62.8% and 83.2% respectively in the nasal quadrant, and 66.7% and 80.5% respectively in the temporal quadrant. There was a positive correlation between goniometric parameters on AS-OCT and gonioscopy (P=0.01). CONCLUSION: Given its higher specificity, AS-OCT should be a supplemental examination in the analysis of an angle which appears closed on manual gonioscopy.

[Measurement of lacrimal secretion in chronic hemodialysis patients at Douala General Hospital - Cameroon]. / Mesure de la sécrétion lacrymale chez des patients hémodialysés chroniques à l'hôpital général de Douala-Cameroun.

PURPOSE: To measure lacrimal secretion and to investigate dry eye symptoms in chronic hemodialysis patients. PATIENTS AND METHODS: This was a cross-sectional descriptive study carried out in the hemodialysis center of Douala General Hospital from June to August 2016. The degree of symptomatology related to dry eye was assessed by the Ocular Surface Disease Index (OSDI) questionnaire. Lacrimal secretion was measured by the Schirmer test without anesthesia. We defined normal as wetting>10mm and hyposecretion as a value≤10mm after 5minutes. RESULTS: Thirty-five patients were involved in the study, 16 men (45.7%) and 19 women (54.3%) for a total of 70 eyes examined. The mean age was 41.9 years, with an average duration of dialysis of 35.5 months±30.2. The symptoms were "normal" for 21 patients (60%), "minimal" for 5 (14.3%), "moderate" for 8 (22.9%) and "severe" for 1 (2.8%). Lacrimal hyposecretion was found in 19 eyes (27.1%). It was severe in 8 eyes. A correlation was found between diabetes, gender and hyposecretion. CONCLUSION: Hemodialysis patients are likely to develop lacrimal hyposecretion mostly because of comorbities. It is therefore important to systematically evaluate lacrimal secretion in these patients.

[Meibomian glands dysfunction and ocular surface in black people]. / Dysfonctionnement des glandes de Meibomius et surface oculaire du sujet âgé mélanoderme.

Meibomian gland dysfunction is the leading cause of evaporative-type dry eye syndrome. Our goal was to determine the epidemiological and clinical features of meibomian gland dysfunction as well as its impact on the ocular surface in elderly black patients in Cameroon. PATIENTS AND METHODS: We performed a cross-sectional analysis from January 2 through May 31, 2017 in the ophthalmology department of Laquintinie Hospital in Douala, including blacks aged 50 years and older. The examination focused on the Meibomian glands, Tear film Break Up Time and Schirmer I test for qualitative and quantitative assessment of tears. The relationship between the quantitative and qualitative variables and meibomian gland dysfunction was determined by linear regression tests. RESULTS: We enrolled 340 elderly black patients. The mean age was 62±9 years. The prevalence of meibomian gland dysfunction was 71.8 % and did not increase with age. The hypoproductive clinical form was the most frequent (47.9 %). The prevalence of asymptomatic Meibomian gland dysfunction was 19.7 %. Evaporative dry eye disease was the most frequent (34.7 %). Aside from advanced age, Meibomian gland dysfunction was associated with high blood pressure (P=0.020), cataract surgery (P=0.034), long-term glaucoma medication (P=0.041) and alcohol consumption (P=0.043). CONCLUSION: Meibomian gland dysfunction is very common in elderly black patients in Cameroon.

Résultats fonctionnels de la chirurgie de la cataracte à l'hôpital gynéco-obstétrique et pédiatrique de Douala: bilan des deux premières années

But: Evaluer les résultats fonctionnels de la chirurgie de la cataracte à l'Hôpital Gynéco Obstétrique et Pédiatrique de Douala (HGOPED). Méthodologie: Nous avons mené une étude descriptive et rétrospective. Nous avons colligé les dossiers des patients opérés de cataracte entre le 1er Janvier 2016 et le 31 Décembre 2017. Nous avons classé les meilleures acuités visuelles de loin corrigées (AVLC) en: faibles (AV ˂ 1/10), moyennes (1/10 ≤ AV ˂ 3/10) ou bonnes (AV ≥ 3/10). Résultats: Trente-deux dossiers de patients ont été sélectionnés pour 38 cataractes opérées. L'âge moyen était de 59,06 ± 16,68 ans avec un sex ratio de 0,77. Avant la chirurgie, la meilleure acuité visuelle de loin corrigée était faible pour 44,7% des yeux et moyenne pour 39,5%. L'acuité visuelle était de 4/10 pour 15,8% des yeux. Un mois après la chirurgie, elle était moyenne pour 23,7% des yeux et bonne pour 76,3%. Après 2 mois, tous les yeux examinés avaient une bonne acuité visuelle. Conclusion: La chirurgie de la cataracte est effective et les résultats fonctionnels sont encourageants à l'HGOPED

[Ocular complications of HIV/AIDS in Cameroon: is there is any correlation with the level of CD4 lymphocytes count?]. / Complications oculaires de l'infection a VIH-SIDA en milieu Camerounais: y a-t-il une correlation avec le taux de CD4?

PURPOSE: This study aimed to identify the ocular complications of HIV/AIDS in Cameroon and to determine if there is any correlation between their occurrence and the level of CD4 lymphocytes count. MATERIAL AND METHODS: This prospective study was carried out at the General Hospital, Douala, from October 2004 to September 2005. All HIV positive patients with known CD4 count were retained for the study. Each patient had an exhaustive ocular examination. RESULTS: A total of 57 patients including 30 females (52.9%) and 27 males (47.4%) were examined. The mean age was 38.9 years +/- 10.3. The eye examination was pathological in 36 patients (63.2%) and normal in 21 patients (36.8%). An ocular complaint was the inaugural manifestation of the disease in 31.6% of patients. The principal lesions of the anterior segment were herpetic keratitis (10.5%) and herpes zoster ophthalmicus (12.3%). The most common posterior segment lesions were cytomegalovirus retinitis (14%) and uveitis (15.8%). The mean CD4 count in our series was 118.3/mm3 +/- 106.7. 91.7% of patients with ocular complications have a CD4 count of less than 200/mm3. A non linear correlation was found between the CD4 level and the occurrence of ocular complications. CONCLUSION: With the improvement of access to antiretroviral treatment, the ocular complications of HIV/AIDS are more common. The role of the ophthalmologist is therefore essential in the diagnosis and management of these patients.

[Juvenile glaucoma in Cameroon]. / Le glaucome juvénile au Cameroun.

AIM: To determine the prevalence and the visual morbidity of juvenile glaucoma in an urban black population. MATERIAL AND METHODS: A retrospective analysis of 1343 files of glaucomatous patients was carried out from January 1991 to December 2001 at the Douala General Hospital in Cameroon (Central Africa). Ninety four of them had juvenile glaucoma. Of the patients, 54 (57.4%) were males and 40 (42.6%) were females. Each subject underwent the following investigations: visual acuity, visual field testing, slit lamp examination, applanation tonometry, gonioscopy, and optic disc examination and photographies after mydriasis. RESULTS: The prevalence of juvenile glaucoma in our population was 0.4%. The mean patients age at diagnosis was 26 +/- 6.8 years (range, 10 to 35 years). Among them, 88.3% had a positive family history of glaucoma. The mean intraocular pressure at diagnosis was 28.2 +/- 9.3 mmHg (range: 14 to 56 mmHg). It was lower than 21 mmHg in 5.3% of the cases. The mean recorded cup/disc ratio at diagnosis was 0.7 +/- 0.3. It was equal to 1.0 in 25.6% of the cases. Gonioscopy showed that the angles were open, with no abnormal pigmentation, iris processes, or embryonic tissue. The prevalence of monocular and bilateral blindness was 3.2% and 33% respectively at the first examination. The affected eye was blind in 50% (6/12) of patients with unilateral juvenile glaucoma. The mean IOP of the treated 166 eyes with topical medications decreased from 28 +/- 8.7 mmHg (range: 15 to 56 mmHg) to 19.1 +/- 8 mmHg (range: 8 to 48 mmHg) after a follow-up period average 1.6 +/- 2.3 years (range: one month to 11 years). Trabeculectomy was required in 10 eyes. Follow-up period of surgery ranged from 1 to 8 years (mean 3.8 +/- 3.3 years). The mean IOP decreased from 30.8 +/- 14 mmHg (range: 17 to 54 mmHg) preoperatively to 15.7 +/- 4.6 mmHg (from 10 to 25 mmHg) postoperatively. CONCLUSION: This study confirms the high prevalence of juvenile glaucoma among black Cameroonian population. The screening, the treatment as well as the genetic studies of this glaucoma bump into strong economic contingencies in our regions. In the cases where topical medications were ineffective in controlling IOP, surgery was needed to obtain long-term pressure control.

[Amblyopia and strabismus in our environment]. / L'amblyopie chez le strabique en milieu camerounais.

PURPOSE: This study aimed to identify the characteristics of amblyopia in a group of strabismic patients in our environment in order to improve management. METHODS: A prospective study was carried out in the General Hospital, Douala, from July 1991 to July 2003. All strabismic patients had a complete ophthalmological examination including an oculomotor evaluation and skiascopy after cycloplegia. RESULTS: 330 patients were examined. The mean age at initial consultation was 13.97 years +/- 12.21. The prevalence of amblyopia was 80.46% in esotropia and 59.40% in exotropia. The precocity of strabismus, eccentric fixation, torticollis, presence of a vertical element and nystagmus were aggravating factors for amblyopia. CONCLUSION: In order to carry out early and coherent management of strabismus, it is important to train and inform all those who are involved in the care process.

[Post-traumatic glaucoma with irido-corneal angle injuries in Cameroon]. / Le glaucome post-traumatique a angle ouvert au Cameroun.

AIM: To study the particularities of late post-traumatic glaucoma with irido-corneal angle injuries in black Cameroonians. MATERIAL AND METHODS: Retrospective analysis of 1343 files of glaucomatous patients was carried out from January 1991 to December 2001 at the Douala General Hospital in Cameroon in Central Africa. Fifty seven of them had post-traumatic glaucoma. Of these 28 were secondary to irido-corneal angle injuries. RESULTS: The prevalence of post-traumatic glaucoma related to irido-corneal angle injuries in our population was 2.1%. The mean patients age was 45.9 +/- 18.3 years (range, 17 to 67 years). The time from injury to diagnosis ranged from 1 year 4 months to 7 years (median: 3.7 years). The follow-up period ranged from 3 months to 5 years 6 months, with a mean of 1.7 +/- 1.9 years. The prevalence of monocular blindness was 61.9% and 81% at the first and last examination respectively. The mean intraocular pressure was 36.9 +/- 13.8 mmHg (range: 22 and 66 mmHg) at the first examination and 24.3 +/- 13 mmHg (range: 12 and 29 mmHg) at the last examination. The mean recorded cup/disc ratio was 0.8 +/- 0.2. It was equal to 1.0 in 61.9% of cases. Irido-corneal angle recession was the most common lesion (61.9%) followed by iridodialysis (38.1%) and cyclodialysis (14.3%). Normalization of the intraocular pressure was achieved with medical treatment in 23.8% and with trabelectomy in 12.3% of the cases. Neovascular glaucoma was found in 4.8% of the cases. CONCLUSION: The treatment of secondary post-traumatic open angle glaucoma is disappointing. The patients are young, the disease is advanced, and the compliance and follow-up are poor. The prevention of post-traumatic glaucoma is based on the control of ocular trauma and the periodic follow-up of patients with and history of non perforating injury of the eye.

[Les amétropies statiques du noir camerounais]. / Static ametropias in black Cameroonian.

PURPOSE: We undertook this study with the aim to determine static ametropias of black Cameroonians as well as their clinical manifestations. It is a prospective study carried out in the Department of Ophthalmology of Douala General Hospital from January 1996 to December 1998. PATIENTS AND METHOD: During this period, all patients who fulfilled our criteria had a skiascopy done under cycloplegia. We thus examined 2,484 patients (4,968 eyes). 66.2% of them were female and 33.8% were male. RESULTS: In our series, hyperopia was found in 51% of the cases, hyperopic astigmatism in 27.5% of the cases, myopic astigmatism in 9.3% of cases, mixed astigmatism in 7.7% of cases and myopia in 4.5% of cases. Distribution of ametropias is influenced by age, not by sex or laterality. DISCUSSION AND CONCLUSION: Functional signs just have an indicative value; only objective refraction under cycloplegia can determine exactly the ametropia.

Ocular complications of leprosy in Cameroon.

PURPOSE: This study aimed to identify the main ocular complications of leprosy in Cameroon. PATIENTS AND METHODS: It is a prospective cross-sectional study which took place from July 1998 to January 1999 in five leprosaria in Cameroon. The ophthalmological examination of all patients was performed by the same team. RESULTS: Of the 218 patients examined, 60.1% were males and 39.9% females. 72.5% had a paucibacillary leprosy and 27.5% a multibacillary form. 77.5% of patients had at least one ocular lesion and 38.3% of eyes had visual acuity < or = 1/10. Madarosis and anterior uveitis were more frequent in multibacillary forms while lagophthalmos and cataract were so in paucibacillary forms. CONCLUSION: Ocular complications are frequent in leprosy in Cameroonians. It is a true public health problem and it is important to prevent these lesions by early diagnosis and adequate treatment.

[Hereditary factors in strabismus]. / Les facteurs héréditaires dans le strabisme.

This retrospective study took place in the Ophthalmology Department of Douala General Hospital. The aim was to determine the importance of hereditary factors in a group of strabismic Cameroonians. In a series of 275 patients with strabismus, we found 79 familial cases (28.72%). Among them, 22.78% had more than one relative with squint and 75% had the same type of strabismus as their relative. There was no significant difference in the percentage of familial cases with regard to the type of strabismus, the sex, the mode of fixation and the impairment of ductions. As far as ametropias are concerned, only myopia showed a hereditary tendency in our series. The authors agree with the literature in that there is a significant hereditary component in the cause of strabismus, but its genetic sites are yet to be identified. There is strong hope in this direction with the decoding of the human genom and the advances in molecular biology. However, the study of familial cases is important since it allows high risk groups to be defined and screened. It thus makes it possible to successfully fight amblyopia through early detection and treatment.

[Autologous blood injections for treating hypotonies after trabeculectomy]. / Injections de sang autologue dans les hypotonies après la trabéculectomie.

The authors carried out a retrospective study in order to assess the efficacy of intrabled autologous blood injections after trabeculectomy. The indication for treatment was hypotony associated with overfiltration. Twelve eyes of 12 patients including seven men (58.3%) and five women (41.67 %) underwent from one to four (mean 1.7) subconjunctival injections. The age of the patients ranged from 31 to 66 years (mean 52.4 years). All the patients were diagnosed with open-angle glaucoma. Three eyes underwent trabeculectomy with mitomycine C, one with 5-fluorouracil and eight with no antimetabolite. The mean post-needling period was 12.3 months (ranging from 7 to 28 months). After intrabled blood injections, the average intraocular pressure increased from 2.7 1.2 mmHg (ranging from 0 to 6 mmHg) to 8.2 4.2 mmHg (ranging from 4 to 16 mmHg). The difference was statistically significant (P < 0.5). After treatment, the average visual acuity increased from 1.8/10 to 3.2/10. This difference was not statistically significant (P > 0.5). However, the procedure was ineffective in two patients (16.7%) as regards intraocular pressure and in seven patients (58.3%) as regards visual acuity. Hyphema, the most frequent complication (58.3% of our cases) is usually small, transient, and without sequelae. Although it may be delayed, it may be important and it induce intraocular hypertony (10% of our cases) or it may be associated with intravital blood.

[Uveitis: epidemiological aspects at the Hospital Laquintinie de Douala]. / Les uvéites: aspects épidémiologiques à l'hôpital Laquintinie de Douala

PURPOSE: This retrospective study was carried out to determine the epidemiological characteristics of uveitis in our country. PATIENTS AND METHODS: 38 patients, of 5,420 consulted, presented with uveitis (0.7%). 13 of them were female and 25 were male. Their ages ranged from 10 to 17 years (mean 33.9 years). RESULTS: The uveitis was unilateral in 81.6% of the cases, and the anterior form was found in 51.1% of the cases. An etiology was identified or suspected for 24 patients (63.1%), the most frequent being sinusitis (45.8%) and toxoplasmosis (29.2%). The treatment was generally effective (status improved in 72.2%), although 2 patients (3 eyes) lost their vision. DISCUSSION AND CONCLUSION: In spite of the low frequency of this disease, ophthalmologists are concerned about uveitis because of the difficulty of its etiological diagnosis and its ineluctable evolution, sometimes to blindness.

[Sensory heterotropias: epidemiological aspects at Douala General Hospital (Cameroon)]. / Les tropies sensorielles: aspects épidémiologiques à l'Hôpital général de Doula (Cameroun).

The aim of this retrospective study was to determine the epidemiological characteristics of the sensory heterotropia cases seen in the Opthamology Department of Douala General Hospital between November 1991 and November 1999. Sensory heterotropia accounted for 22.5% of the cases of strabismus reported. Onset was before the age of one year in 80.4% of cases and after the age of one year in 19.6% of cases. All cases of esotropia were apparent before the age of one year. Sensory heterotropia was associated with amblyopia in 89.3% of cases, with eccentric fixation in 78.6% of cases and with nystagmus in 53.6% of cases. Etiology was diverse, the most frequent causes being: albinism (19.6%), chorioretinal scars (16.1%), unilateral cataracts (16.1%), atrophy of the optic nerve (16.1%) and ametropia (8.9%). We recommend preventive measures for some etiologies.

[Visual problems in albinos: a hospital study carried out at the Douala General Hospital]. / Les troubles visuels de l'albinos. Etude hospitalière réalisée à l'Hôpital général de Douala.

We report here a clinical study investigating the main visual problems associated with albinism, with a view to determining the best treatment. We came across 42 cases of albinism during the course of this study, corresponding to a prevalence for albinism of 0.15%. One in ten albinos were of the yellow mutant type and more of the albinos were men than were women (sex ratio 1.21). The maximum visual acuity recorded was 3/10 and 40.47% of the patient had a best visual acuity score no higher than 1/10. Vision was best in the yellow mutants and it improved with age. We found that 33.33% of the albino patients had a squint and 35.71% had torticullis at primary fixation. In contrast to the results of previous studies, the most common ametropia was myopic astigmatism (61.9%). These findings have potential implications for the treatment of visual problems in albinos.

[Exotropia in black Cameroonians]. / Léxotropie chez le Noir camerounais.

We carried out this study to increase our knowledge and understanding of exotropia (divergent strabismus) in general, but particularly in black people, in whom it occurs more frequently. We carried out a prospective study in the department of ophthalmology of Douala General Hospital from November 1991 to June 1998. All patients underwent oculomotor examination and skiascopye. In a series of 225 consecutive strabismus cases, we identified 147 cases of exotropia (59.51%) in 67 male patients (45.58%) and 80 female patients (54.42%). In 59.86% of these cases, exotropia was evident before the age of one year and 59.19% had amblyopia. The mean age at first examination was 17.04 years (+/- 12.12 years). Hyperopia was the most common form of ametropia (59.86%) and 39 patients (26.53%) had parents, children or siblings who also had exotropia. We found that exotropia was the most common form of strabismus in black people in Cameroon and that it spontaneously progressed to amblyopia in a significant number of cases. We therefore recommend early, active treatment.

[Intraocular pressure in a young Cameroonian population]. / Etude de la pression intraoculaire dans une population de jeunes Camerounais.

Glaucoma is one of the major causes of blindness throughout the world; mostly because patients come to consultation late. We performed a prospective study of the intraocular pressure, fundus and perimetry in 307 young Cameroonians (20 to 39 years old). Glaucoma was found in 5.8% of cases. This study shows that the disease appears early in black people and must be detected in patients under 40 years old.

Pterygium: epidemiological, clinical and therapeutical aspects at the Douala General Hospital.

Authors report the results of a retrospective study of epidemiological, clinical and therapeutical aspects of pterygium carried at the ophthalmological service of the Douala General Hospital. During the period of the study, 167 patients with pterygium were registered, which means a prevalence of 1.10%. The mean age of the patients was 41.76 years with standard deviation of 10.89. The noticed that men were a little bit predominant as compared to women with respectively 54.8% and 45.2% of cases. The pterygium were in the nasal side in 93.66% of cases and bilateral forms represented 31.73% of cases. 67 eyes were operated by excision technic more often associated to conjunctival translation. The relapse rate at 6 months was 7.44%. Authors recommend: 1 degree)-not to operate small and non-evaluative pterygium 2 degrees)-to use a magnifying system and if possible the operatory microscope 3 degrees)-to institute systematically an early, intensive, prolonged but degressive corticotherapy after surgery. 4 degrees)-to prescribe tinted or photochromic glasses to patients.