[Pediatric cataract: Epidemiological, etiological, clinical and therapeutic features at the Yaounde gyneco-obstetrics and pediatric hospital]. / Cataracte de l'enfant : aspects épidémiologiques, étiologiques, cliniques et thérapeutiques à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé.

INTRODUCTION: The number of blind children in the world is approximately 1.5 million, a large proportion of which is attributable to congenital cataracts. Our goal is to describe the epidemiological, etiological, clinical and therapeutic aspects of childhood cataracts at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital (YGOPH). MATERIAL AND METHODS: This is a retrospective, descriptive study of cataracts diagnosed in children under 16 years of age from January 2010 to December 2017. Variables analyzed were age, sex, reason for consultation, laterality and duration of symptoms, type of cataract and treatment administered. RESULTS: We collected 82 patient records. The sex ratio was 1.56. The most frequent age group was 0-4 years at 42.5% (34), and the mean age was 6.6 years (1 day-15 years). The main reasons for consultation were decreased visual acuity in 46.3% (37) and leukocoria in 37.5% (30). Cataracts were unilateral in 72% (59) of the cases. The most common onset of the cataracts was congenital (40.8%) (31), and traumatic cataracts accounted for 27.6% (21). Mature white cataracts accounted for 39% (32), predominantly congenital etiologies in 41.5% (34). Cataract surgery was performed in 33 eyes. Small incision cataract surgery was the most common technique at 51.5% (17). CONCLUSION: Pediatric cataracts are relatively rare. Identification of risk factors may help decrease their incidence.

[Retinal vein occlusions treated by intravitreal bevacizumab injections at the Hospital of Instruction, Application and Reference of the Armed Forces of Yaoundé]. / Occlusions veineuses rétiniennes traitées par injections intra-vitréennes de bévacizumab à l'hôpital d'instruction, d'application et de référence des armées de Yaoundé.

OBJECTIVE: To assess the anatomical and functional results of intravitreal bevacizumab injections in retinal vein occlusions at the Hospital of Instruction, Application and Reference of the Armed Forces of Yaoundé. PATIENTS AND METHODS: A prospective and descriptive study was conducted from October 2016 to August 2017 at the Hospital of Instruction, Application and Reference of the Armed Forces of Yaoundé. All eyes with edematous or mixed retinal vein occlusion were treatment naive and received at least 3 intravitreal injections spaced at least 28 days apart of bevacizumab 25mg/ml at a dose of 0.05ml per session according to the strategy of 3 injections or "3 I". At least 3 months after the final injection, visual acuity and macular thickness, assessed by optical coherence tomography, were analyzed with the IBM-SPSS 22 software. The Student's test was used to compare means, with a significance P<5%. RESULTS: We included nineteen eyes of 18 patients with a mean age of 62.83±9.57 years. The male to female sex ratio was 0.8. Branch vein occlusion was predominant in 14 (73.68%) eyes. The edematous type was noted in 17 (89.5%) eyes. Serous retinal detachment was present in 6 (31.6%) eyes. The mean number of injections was 4.2±1.2. The mean baseline visual acuity changed from +0.9 Log MAR (40 ETDRS) to +0.6 Log MAR (55 ETDRS) at 6 months, while the mean macular thickness went from 550.16±180µm to 338.58±127µm, with statistically significant differences. CONCLUSION: Intravitreal bevacizumab injections proved to be effective in the management of edematous retinal vein occlusions in our practice setting despite the lack of market authorization for this indication.

[What about tropical endemic vernal keratoconjunctivitis? Which relationship with intestinal parasites?] / Que savons-nous de la limboconjonctivite endémique des tropiques ? Et quel rapport avec les parasites intestinaux ?

Given the causative parasite hypothesis for tropical endemic limbo-conjunctivitis (TELC), we conducted an analytical case-control study of all children with tropical endemic limbo-conjunctivitis seen in the ophthalmology department of Laquintinie hospital in Douala during the period from January 2nd to April 30, 2015. RESULTS: We identified 64 cases of tropical endemic limbo-conjunctivitis out of 550 children seen; a hospital prevalence of 11.6%; thirteen cases (eight boys and five girls) did not meet inclusion criteria, and 51 cases were included, 31 boys (60.8%) and 20 girls (39.2%) with a male/female (M/F) sex-ratio of 1.41. For controls, we included 28 males (54.9%) and 23 girls (45.1%) for a M/F sex-ratio of 1.22. The prevalence of tropical endemic limbo-conjunctivitis in boys was 12.1%, and for girls it was 7.1% in the case group. Stage II was the most frequent at 29 cases (56.9%), as well as the mixed form at 31 cases (60.8%). The frequency of intestinal parasites was 14 cases (27.5%) in the group of tropical endemic limbo-conjunctivitis patients and 6 cases (11.8%) in the control group (P=0.08). Entamoeba histolytica in its cystic form was the most intestinal parasite found in both groups, 10 cases for tropical endemic limbo-conjunctivitis (19.6%) and 6 cases in the control groups (11.8%). The mean serum IgE among cases was 81.2 IU/ml, while in the controls it was 15.6 IU/ml (P=0.001) CONCLUSION: There is no relationship between intestinal parasitic infection and the occurrence of tropical endemic limbo-conjunctivitis.

[What is the cost of treatment of diabetic retinopathy by argon laser in Yaoundé?] / Quel coût pour le traitement de la rétinopathie diabétique par laser argon à Yaoundé ?

PURPOSE: To evaluate the total cost of treatment of diabetic retinopathy by argon laser for a patient when indicated. PATIENTS AND METHOD: Prospective cross-sectional and descriptive survey, carried out in the angiography and laser center of the Yaoundé Central Hospital from October 2014 to October 2015. All consecutive diabetic patients with retinopathy and suitable indication for argon laser treatment were included. The costs related to the initial and final fluorescein angiography, the appointment for follow-up, round-trip transportation costs from the patient's home and the cost of laser treatment were included. RESULTS: Included were 43 (13 %) patients out of 330 with diabetic retinopathy. The mean age was 55.67±8.40years. There were 25 women (58.1 %) and 18 men (41.9 %) for a M/F ratio of 0.7. Unemployed patients were represented by 28 (65.1 %) versus 15 employed (34.9 %). Twenty-seven patients (62.8 %) were self-pay for all their expenses, 14 (32.6 %) were assisted by their families, and 2 (4.6 %) were insured. On average, the total expenditure was 86002±67197 f CFA per eye, corresponding to 131±102 euros with an exchange rate of 1 euro for 656 f CFA. CONCLUSION: The cost of treatment of diabetic retinopathy by argon laser is high, mostly increased by the additional costs related to transportation in our area. The creation of satellite centers in the 10 regions of Cameroon would reduce these costs.

Epidémiologie et clinique des occlusions veineuses rétiniennes en milieu hospitalier camerounais

But. Décrire les caractéristiques épidémiologiques et cliniques des occlusions veineuses rétiniennes en milieu hospitalier camerounais. Patients et Méthodes. Cette étude transversale descriptive a porté sur 5055 dossiers de patients diabétiques examinés de Janvier 2010 à Décembre 2015 au Centre de Référence de Rétine pour la Prévention et de Prise en Charge de la Rétinopathie Diabétique de Yaoundé. Les variables étudiées incluaient l'œil atteint, la topographie des lésions, le type d'occlusion et les principaux facteurs de risque. Résultats. Soixante dix cas (72 yeux) d'occlusions veineuses rétiniennes ont été observés, soit une prévalence hospitalière de 1,38%. L'âge moyen des patients était de 61± 5,6 ans et le sex ratio de 1,33. L'œil droit était atteint dans 43 (62,26 %) cas. L'occlusion était de branche veineuse dans 44 (61,10 %) yeux et centrale dans 28 (38,88 %). Le type œdémateux prédominait avec 38 (54,90%) cas suivi de l'ischémique avec 27 (37,59 %) et du mixte avec 5 (7,48 %) cas. Les facteurs de risque étaient principalement l'hypertension artérielle avec 15 (21,42 %) cas, le diabète de type 2 avec 12 (17,14 %) et l'hypertonie avec 10 (14,28 %). Conclusion. Les occlusions veineuses rétiniennes sont fréquentes et devraient faire l'objet d'une recherche étiologique systématique pour chacun des cas dans notre milieu

Aspects épidémiologiques et cliniques du glaucome au CHU de Brazzaville / Epidemiological and clinical aspects of glaucoma at the University Hospital of the Brazzaville

Introduction. Le glaucome touche environ 67 millions d'individus dans le monde. Il est responsable d'une cécité non curable. C'est la deuxième cause de cécité au Congo-Brazzaville avec une prévalence hospitalière estimée à 13%. Il est admis que cette maladie est plus précoce chez le mélanoderme. Objectif. Décrire les aspects épidémiologiques et cliniques du glaucome au CHU de Brazzaville. Matériels et méthodes. Étude transversale descriptive rétrospective basée sur les dossiers des patients glaucomateux vus entre janvier 2009 et décembre 2010 dans le service d'Ophtalmologie du CHU de Brazzaville. Le glaucome congénital était défini par l'association d'une buphtalmie et d'une dysgénésie de l'angle iridocornéen avec ou sans atteinte du nerf optique. Les autres types de glaucome étaient définis par des altérations papillaires avec ou sans atteinte du champ visuel. Quatre paramètres ont été évalués : âge, sexe, type de glaucome, aspect de la papille. Résultats. Les dossiers de 151 patients (correspondant à 289 yeux glaucomateux) ont été retenus. L'âge moyen était de 47,9 ± 18,7 ans (1 an - 86 ans). Les patients de plus de 40 ans étaient les plus touchés (72,2% des cas). Le sex ratio était de 1,8. Le glaucome primitif à angle ouvert (GPAO) était le type le plus fréquent (90,6% des cas). Le croissant nasal (49,4%) et le ''notch'' temporal étaient les principales atteintes papillaires observées (41,0%). Conclusion : Le glaucomateux type à Brazzaville est un patient de sexe masculin, âgé d'au moins 40 ans, souffrant du GPAO avec déjà des altérations papillaires significatives lors du diagnostic

Introduction. Glaucoma affects about 67 million people worldwide. It is a cause of incurable blindness. It is the second leading cause of blindness in Congo-Brazzaville with an estimated hospital prevalence of 13%. It is recognized that this disease is earlier in melanoderm. Objective. To describe the epidemiological and clinical aspects of glaucoma at the University Teaching Hospital of Brazzaville. Materials and methods. This was a cross-sectional retrospective and descriptive study based on the records of glaucomatous patient seen between January 2009 and December 2010 in the Ophthalmology department of the Brazzaville University Teaching Hospital. Congenital glaucoma was defined by the association of buphthalmia and dysgenesis of the iridocorneal angle with or without involvement of the optic nerve. Other types of glaucoma were diagnosed in the presence of papillary alterations with or without damage of the visual field. Four parameters were evaluated: age, sex, type of glaucoma, aspect of the papilla. Results. 151 patients (corresponding to 289 glaucomatous eyes) were studied. The mean age was 47.9 ± 18.7 years (1 year - 86 years). Patients over 40 years of age represented 72.2% of cases. The sex ratio M/F was 1.8. Primary open angle glaucoma (POAG) was the most common type (90.6% of cases). Nasal crescent (49.4%) and temporal 'notch' (41.0%) were the main papillary lesions. Conclusion. The typical glaucomatous patient in Brazzaville is a male, at aged 40 or more, presenting GPAO with significant papillary alterations at the first visit

[The problem of oculo-orbital trauma due to motor vehicle accidents involving commercial motorbikes in Douala, Cameroon]. / Les traumatismes oculo-orbitaires dus aux accidents de motos taxis à Douala au Cameroun.

UNLABELLED: A prospective and longitudinal study was carried from January 2 to December 31, 2013 in which victims of commercial motor bike accidents presenting to the Laquintinie Hospital in Douala were examined in search of oculo-orbital injuries with the double goal of identifying and evaluating the physical impact of the observed oculo-orbital lesions. RESULTS: We included 88 cases with oculo-orbital trauma due to commercial motor bike accident. There were 71 males (80.7%) and 17 females (19.3%). The mean age was 32.8±10.6 years. Collision between two motorbikes was the most frequent mechanism and accounted for 42% of cases of oculo-orbital trauma (n=37). None of the 81 patients on a motor bike reported wearing a helmet at the time of the accident (7 pedestrians were victims). Injuries of the globe were present in 16.5% of eyes (n=29); while orbital injuries were present in 22% of eyes (n=39). The most frequent orbital injury was orbital wall fracture, occurring in 31 eyes (17.6%). Lesions of the eyelids were found in 50 cases (28.4%). ENT lesions were associated in 27 cases (30.7%), cranial trauma in 3 cases (3.4%). Orbital dystopia, oculomotor palsy, ptosis, ectropion and unilateral blindness (rate of 9%) were sequelae recorded after six months of follow-up. CONCLUSION: The existing rules and regulations on driving licenses, vehicle code and compulsory use of helmets in the area of commercial motorbike activity should be strictly applied in Douala to avoid these preventable oculo-orbital trauma which lead to unsightly scars and blindness.

[Ocular trauma in an urban Cameroonian setting: A study of 332 cases evaluated according to the Ocular Trauma Score]. / Les traumatismes oculaires en milieu urbain camerounais : à propos de 332 cas évalués selon l'Ocular Trauma Score.

PURPOSE: To determine the epidemiologic and clinical characteristics of ocular trauma after evaluation with the ocular trauma score at the Army Teaching Hospital in Yaoundé, Cameroon. PATIENTS AND METHODS: A descriptive and retrospective monocentric hospital study was carried out from January 2008 to December 2010. Our sample included all patients with ocular trauma. Each traumatized eye was evaluated using the ocular trauma score after measurement of visual acuity. The most severe diagnoses observed were classified according to the Birmingham Eye Trauma Terminology system. RESULTS: The frequency out of 364 eyes was 3.56%. There were 204 men (61.44%) with a male/female ratio of 1.59. The mean age was 32.95 years with predominance of 21-30 years. The most affected groups were laborers and craftsmen (28.61%), followed closely by students (23.80%), then armed forces personnel (19.58%). Fights were noted as the most common cause in 31.02% of cases. Punches predominated in 21.39% of cases. In 37.34% of cases, patients were seen within 72 hours of the trauma. Three hundred (90.36%) traumas were unilateral vs. 32 (9.64%) bilateral. The mean visual acuity at the first consultation was 0.3 logMAR. Grading after evaluation was as follows, 13 eyes were grade 1, 19 grade 2, 25 grade 3, 54 grade 4 and 253 grade 5. Fragile and exposed anatomical structures were the most commonly injured. Seventeen eyes exhibited elevated IOP (22 to 45) vs. 7 which were hypotonous. Two hundred and one (55.22%) oculo-palpebral contusions were noted, followed by 110 (30.22%) lacerations. Visual loss was reported in 16.20% and blindness in 8.79% of cases. CONCLUSION: In the emergent setting, a good, timely clinical evaluation of each case according to the ocular trauma score may lead to effective management.

[Epidemiological, clinical and therapeutic features of pediatric ocular injuries in an eye emergency unit in Île-de-France]. / Aspects épidémiologiques cliniques et thérapeutiques des traumatismes oculaires de l'enfant dans un service d'urgences ophtalmologiques en Île-de-France.

INTRODUCTION: Ocular and orbital trauma is a leading cause of acquired monocular blindness in childhood. These injuries differ from those in adults in some aspects of the management and prognosis, notably the risk of amblyopia. The goal of this study was to analyze the epidemiological, clinical and therapeutic features of ocular trauma in children who consulted in an eye emergency department in Île-de-France. PATIENTS AND METHODS: This was a descriptive, prospective and longitudinal study. Over a period of 6 months, we included children aged 15 years old or less, who consulted during calls for ocular trauma. Each child received an ophthalmologic examination as complete as his or her condition and cooperation permitted. Mechanical injuries of the eyeball and chemical ocular burns were distributed respectively according to the Birmingham Eye Trauma Terminology and Dua's classification. The visual prognosis was defined as the best corrected visual acuity of the affected eye, measured at the conclusion of treatment. RESULTS: Among 586 children who consulted during the study period, 265 suffered from ocular trauma (45.22%). The male:female ratio was 1.6:1. The main places of occurrence of the injuries were home (64.15%) and school (18.11%). Injuries from finger nail scratch were the most frequent (12.45%). One hundred and fifty-seven patients consulted within 6 hours (59.19%). The cornea was the predominant site of the injury (44.40%). Mechanical injuries of the eyeball accounted for 75% of cases. The incidence of ocular chemical burns was 6.41%. Eyelid and orbital injuries were observed in 22.26% and 2.26% of cases respectively. Surgical treatment was required in 6.79% of cases. The incidence of hospitalization was 3.02% with a mean length of stay of 3 days. Four children developed sequelae, including 2 corneal scars and 2 cataracts. No case of blindness was recorded. DISCUSSION: The high frequency of traumatic ocular and orbital pathology in our study may be due to its sudden and accidental onset, leading parents to seek emergency care. Most injuries occurred at home and at school, which reflects the presence in these places of potential hazards, often unrealized or neglected. The low frequency of open-globe injury may be related to the ubiquitous recruitment. Indeed, in studies including only severe trauma, this rate may reach 73.4%. This clinical presentation is associated with a poor prognosis because of the risk of infection and sequelae causing decreased visual acuity and amblyopia. Few children were hospitalized. This could be explained by the predominance of mild to moderate trauma. CONCLUSION: Ocular trauma accounts for nearly half of pediatric conditions encountered in the eye emergency unit. Adequate emergency care improves the visual prognosis.

[Tropical endemic limboconjunctivitis (vernal conjunctivitis) in northern Cameroon]. / La limboconjonctivite endémique des tropiques au nord Cameroun.

INTRODUCTION: A retrospective study was conducted in the ophthalmology unit of the Garoua regional hospital on children examined from January 2001 to December 2007. We aimed to determine the epidemiological aspects of tropical endemic limboconjunctivitis in northern Cameroon. Included were all the files of patients aged 0-15 years seen with a positive diagnosis of tropical endemic limboconjunctivitis. The data analyzed were obtained through inspection, interview, and a comprehensive ocular exam done for every case, assessing far visual acuity, slit lamp biomicroscopy, and funduscopy when possible. The variables analyzed were age, sex, signs and symptoms, residential area, associated pathologies, and the month and the year of the diagnosis. The data were analyzed with Epi-Info, version 6.04d (French) and the results compared with the Chi(2) test with a 95% confidence interval. RESULTS: A total of 6453 children were included: 2036 had a positive diagnosis of tropical endemic limboconjunctivitis, with a frequency of 31.55%. The mean age was 6.5 years. The 1- to 4-year-old age group had the highest number of patients, with a frequency of 33.25%. There were 1120 males (55%). Itching was the most frequent complaint encountered in 60.90% of the patients. Ocular involvement was always bilateral. Tropical endemic limboconjunctivitis is an allergic conjunctivitis present throughout the year with two peaks in March and July. DISCUSSION: Tropical endemic limboconjunctivitis can be considered an allergic conjunctivitis affecting boys more frequently than girls in warm and dry environments. It is frequent in children less than 5 years old and regresses with age. CONCLUSION: Tropical endemic limboconjunctivitis is a tropical disease with an intertropical aspect.

[Extent of visual impairment in a population attending an ophthalmology center in Africa. Findings in 828 cases at the Tropical Ophthalmology Institute of Africa in Bamako, Mali]. / Importance du handicap visuel dans une population de consultants en ophtalmologie: a propos de 828 cas à l'Institut d'Ophtalmologie tropicale de l'Afrique de Bamako.

The purpose of this prospective observational study was to evaluate the extent of visual impairment in a socially and professionally active population attending the Tropical Ophthalmology Institute of Africa (IOTA). Thanks to high recruitment rate at the IOTA, which is the third reference eye centre, a total of 828 patients ranging from 18 and 50 years of age and consulting for the first time were included between February 1 and May 4, 2003. Each patient underwent a thorough ocular examination. Data were recorded using a dedicated study form. Most patients (40%) consulted for reduced visual acuity. Diagnosis determined organic disease in 75.6% of cases (626 patients) and ametropia (including presbyopia) in 18.5% (153 patients). In the remaining 6% of cases (49 patients), ophthalmic examination was normal. Bilateral blindness was observed in 5.8% of cases (48 patients). The main cause of bilateral blindness was cataract (19.2%). The third most common cause (14.6%) was ocular manifestations of HIV infection, confirming that the epidemiology of blindness is changing and that HIV/AIDS should be taken into account. Unilateral blindness accounted for 11.5% of cases (95 patients). The main causes of unilateral blindness were trauma (50.5%), infection (26%) and degenerative disease (18%). Low vision accounted for 8.5% of cases (70 patients). The main cause of low vision was ametropia. This is one of the few hospital-based studies on causes of blindness in West Africa. The major finding is the high prevalence of blinding ocular complications of HIV infection. Another important finding is the high incidence of low vision that is often disregarded in West Africa.

Importance du handicap visuel dans une population de consultants en ophtalmologie: a propos de 828 cas l'Institut d'Ophtamologie tropicale de l'Afrique de Bamako

Cette etude se propose d'evaluer l'importance du handicap visuel a l'Institut d'Ophtalmologie Tropicale d'Afrique (IOTA) dans la population la plus active sur le plan economique et social. Il s'agit d'une enquete hospitaliere transve rsale sur deux mois; menee a l'IOTA; centre de 3e reference en ophtalmologie; qui a permis d'incl u re 828 patients ages de 18 a 50 ans; venus pour une premiere fois en consultation entre le 1er avril et le 4 mai 2003. Chaque patient a subi un examen ophtalmo-logique complet et les donnees ont ete recueillies sur un formulaire d'enquete. Huit cent vingt huit patients ont ete inclus dans l'etude. Le principal motif de consul-tation etait la baisse d'acuite visuelle pour 40d'entre eux. Le bilan diagnostic avait retrouve 626 cas (75;6) d'atteintes organiques et 153 cas (18;5) d'ametropies. L' examen oculaire etait normal pour 49 patients (6). La cecite binoculaire (48 cas) representait 5;8des cas. Les causes etaient dominees par la cataracte (29;2). Les manifestations oculaires VIH/SIDA representaient la 3e cause de cecite binoculaire avec 14;6cas; ce qui montre que le VIH/SIDA serait en train de modifier les donnees epidemiologiques de la cecite; une transition epidemiologique a prendre en conside-ration. La cecite monoculaire (95 cas) representait 11;5de l'ensemble des patients. Les traumatismes (50;5); les infections (26) les affections degeneratives (18) en etaient les principales causes. La basse vision (70 cas) representait 8;5cas. Les causes etaient dominees par les ametropies (23). Il y a peu d'enquetes en milieu hospitalier sur les causes de cecite. Le resultat le plus marquant de cette etude est la place importante prise par les complications oculaires de l'infection par le VIH. L' importance de la basse vision; souvent negligee en Afrique de l'Ouest; est a souligner