[Clinical and angiographical findings of age-related macular degeneration in Senegal. Preliminary results]. / Aspects cliniques et angiofluorographiques de la degenerescence maculaire liee a l'age au Senegal. Résultats préliminaires.

INTRODUCTION: Principal cause of legal blindness in industrialized countries, age-related macular degeneration (ARMD) have never been studied in West Africa. We report and analyse the clinical and angiographical characteristics of macular degeneration in our patients older than 50 years. MATERIAL AND METHODS: In this prospective study, we recruited during 13 months all patients presenting ARMD signs from our consultation department. Various clinic and angiography parameters were collected. The follow up varied between 6 and 20 months. RESULTS: The prevalence of this pathology was of 6.5 per 1000. Sex ratio was 0.36 and mean age 61.6 years (53 to 80 years). No familial history of ARMD was found. Three patients were more exposed to sun because of their profession, 9 had high blood pressure, 6 were hyperopes and 1 was smoking. A drop of visual acuity was noted in all cases but no metamorphopsies. Signs founded were miliar drusen (20 eyes), serous drusen (4 eyes), association of those two kinds (4 eyes) and retinal pigmented epithelium abnormalities (PE) (8 eyes) alone or associated with drusen. These signs were significant of age-related maculopathy (ARM). The fluorescein angiography confirmed the type of lesions and showed no signs of neovascularization. An aggravation of the pigment migration was noted in one case after 20 months. CONCLUSION: Age related macular degeneration doesn't seem frequent in our population of patients and shows essentially under its initial form of ARM even though facilitating factors seemed identical, excepted tobacco addiction, sun exposition and systemic hypertension. This study which short terms results we are presenting would need to be continue to give more precisions on those data.

[Perception of ocular blinding manifestations of sickle cell disease by practitioners in Dakar university hospital]. / Perception des lésions oculaires cécitantes de la drépanocytose par les praticiens hospitalo-universitaire de Dakar.

INTRODUCTION: In Senegal, 10% of the population are said to be carriers of hemoglobin S, the most widespread hemoglobinopathy in the world. It is responsible for potentially blinding ophthalmological manifestations. Few practitioners refer patients for ophthalmologic screening. The goal of our study was to assess the level of knowledge of practitioners of the blinding ocular lesions of sickle cell disease. MATERIALS AND METHODS: A cross-sectional prospective study was carried out over five months. It included Dakar university hospital practitioners aside from ophthalmologists. On the survey form, each practitioner specified his or her specialty and responded to eight questions regarding sickle cell patients seen in consultation, knowledge of the blinding lesions related to the disease, and ocular monitoring for blinding systemic diseases. The practitioners were divided into three groups: department of medicine and medical specialties (group I), surgery and surgical specialties (group II), and biology and functional testing (group III). The descriptive analysis was done with the EPI-INFO software version 6.04. RESULTS: The participation rate was 45.88%. Group I represented 45.29% of the sample, Group II 35.85% and Group III 18.86%. In all, 87.73% of practitioners saw sickle cell patients in consultation, 75.47% were aware of ocular involvement related to sickle cell disease, and 58.49% were aware of blinding lesions. 94.62% of practitioners saw sickle cell disease patients without systematically recommending ophthalmological consultation. CONCLUSION: Practitioners' level of knowledge of the blinding ocular lesions of sickle cell disease is considered to be low.

[A systemic approach to the diagnosis and treatment of allergic conjunctivitis]. / Démarche diagnostique et thérapeutique des conjonctivites allergiques.

The diagnosis of allergic conjunctivis begins by a meticulous questioning emphasizing the existence of ocular itching, the way of evolution of the signs and allergic preceeding. The examination searchs after follicles and papillae of the conjunctiva who usually go with serous discharges, blepharitis and keratitis. So four clinical forms may be described the chronic conjunctivitis, the vernal kerato-conjunctivitis, the atopic conjunctivitis and the giganto-papillar conjunctivitis. For the treatment, all non specific signs of allergy must be eliminated, the focal infections also and allergic substance isolated. If evolution is worse, an antiallergic eye drop is given until the disappearance of all the physical signs. In the same time, steroids and anti H1 drugs must be avoided. In case of failure, the specialist in allergy will be helpful to exam the patient.

[Isolated microspherophakia in a Senegalese family]. / Microsphérophakie isolée dans une famille sénégalaise.

PURPOSE: To report the clinical investigation of isolated microspherophakia involving a Senegalese family in order to appreciate its functional impact. OBSERVATIONS: This is a rural family comprised of 7 members. The sibship included three girls and two boys. One of the girls, who lived in a distant zone, was unable to be examined. Of all the examined members of the family, only the father was unaffected by the illness. There was no consanguinity. The general medical examination was normal. The best-corrected visual acuity (VA) for the girls was 2/10. For one of the boys, BCVA was 8/10 for both eyes, and for the other, BCVA was 10/10 for the right eye and 8/10 for the left eye. The mother's VA was 10/10 and P2 without correction. Myopia and astigmatism were present in the 4 children of the sibship. During the examination, we noted the presence of small crystalline lenses, which were very round and presented an abnormal visibility of the lens equator and zonular fibers. The diagnosis of microspherophakia was confirmed by measurement of the lens diameters by ultrasound biomicroscopy. Complications were present in the girls, including pupillary block glaucoma and amblyopia for the elder, and retinal degeneration and amblyopia for the younger daughter. The elder daughter was managed medically with glaucoma drops. The younger daughter received optical correction and a prophylactic Argon LASER treatment. The two boys received optical correction. No treatment was recommended for the mother. CONCLUSION: Microspherophakia is a rare condition. Some serious complications can lead to amblyopia. A better multidisciplinary evaluation would allow for early detection and a better prognosis.

[Ocular lesions of artificial depigmentation]. / Lésions oculaires de la dépigmentation artificielle.

PURPOSE: To evaluate the type and frequency of the ocular lesions found in patients practicing artificial depigmentation. PATIENTS AND METHOD: We conducted a prospective study over 3 months involving 108 patients, of whom 72 underwent depigmentation, and 36 did not, representing the controls. RESULTS: Among patients undergoing depigmentation, 100% were female, of whom 34.72% developed ocular lesions. Exogenous ochronosis lesions of the eyelid predominated (34.72%), followed by ocular ochronosis (25.81%). Cataract (19.35%) and glaucoma (6.45%) were the least frequent. Among the untreated, only 19.44% had ocular lesions. These included cataract (57.14%) and glaucoma (42.86%). Ocular lesions were more frequent in patients using products containing hydroquinone. CONCLUSION: Artificial depigmentation is responsible for ocular lesions of variable severity. Our study highlights the importance of the raising awareness amongst the general population of the complications of artificial depigmentation, particularly the ocular lesions.

[Fibrous histiocytoma of the orbit]. / A propos d'un histiocytome fibreux de l'orbite.

The authors reported a case, a large orbital fibrous histiocytoma, in a 14 year old girl. They emphasize nosologic problems and histologic aspects of this benign tumor. Because of the localisation and the size of the tumor, a double anterior orbitotomy (superior and inferior) was necessary for complete renoval. Anatomic, functional and esthetic results were satisfactory.

[Congenital serous cyst of the orbit with anophthalmos]. / Kyste séreux congénital de l'orbite avec anophtalmie.

The authors reported a case of orbital congenital serous cyst with anophtalmos. It was a third type of Duke Elder classification. Although it looked sporadic, this malformation is hereditary and due to a disharmony between optic cup growth and differenciation. Ultrasonography and scanner could confirm the diagnosis and helped to discard orbital and eyelid angioma and meningocele. After excision, a prosthesis must be adapted in the orbit.

[Dermoid of the cornea. Report of 2 cases of Ida Mann's 2nd type]. / Dermoïdes de la cornée. A propos de deux observations du 2e degré de Ida Mann.

At the opposite of epibulbar dermoids (which are isolated or combined), dermoids of IDA MANN's second type are uncommon. The two cases reported had a big size and covered almost the cornea, without damage on the descemet's membrane, the endothelium and the other eyeball structures. This lesion is classified by the W.H.O. among choristomas. It's made of skin recovering fat which includes in different figures, hair follicle, eccrine and sweat glands. Total excision is the best treatment, but couls become complicated by cornea perforation. It could be followed in some cases by keratoplasty. Amblyopia could go with this malformation.

[Frequency of retinal changes in myopia in a black population]. / Fréquence des lésions rhegmatogènes chez le myope mélanoderme.

PURPOSE: Retinal detachment is the main complication of peripheral retinal lesions in myopia but seems rare in black people. We analysed peripheral retinal changes in myopia in a black population. MATERIAL AND METHODS: This study was conducted by a single ophthalmologist. The tests included a refraction, a retinal biomicroscopy (with a Volk lens and a 3-mirror Goldmann lens) and an indirect ophthalmoscopy. The results were compared by a chi square test. RESULTS: 50 people (100 eyes) were available for examination. The mean age was 28.21 years, the two extremes being at 11 and 54 years, with 68% females and 32% males. In 50 eyes the spheric equivalent was between -1 and -5.75 diopters (group I). In 50 eyes the spheric equivalent was greater than or equal to -6 diopters (group II). Snow was found in 16% of cases in group I and 34% of cases in group II (p = 0.0366). Tears were found in 2% of cases in group I and 12% of cases in group II (p = 0.116). Lattice degeneration was found only in group II. CONCLUSION: Retinal tear frequency was similar to the results of other authors. Comparative studies are necessary to evaluate the risk of retinal detachment in black populations.

[Scleral mini-incision without ultrasound in the treatment of congenital cataract]. / Mini-incision sclérale sans ultrasons dans le traitement de la cataracte congénitale.

PURPOSE: Congenital cataract surgery can be performed by pars plana or limbal incision. We report our experience with scleral incision without ultrasounds in congenital cataract surgery. MATERIAL AND METHODS: Fifteen children with congenital cataract underwent surgery of both eyes (30 eyes). The zonular ciliaris and the lens anlage were normal in all cases. All procedures were performed by the same surgeon. A 3.2 mm scleral tunnel incision was made 2 mm from the limbus. Large capsulorhexis or capsulopuncture were performed after injection of a viscoelastic substance in the anterior chamber. After hydrodissection, the nucleus and cortex were aspirated. The wound was closed by apposition suture. RESULTS: The mean age was 70.13 months (range 5 months to 130 months). Mean induced astimatism calculated with the Cravy method was 0.70 dipoters. A posterior capsular tear was observed in 1 case. CONCLUSION: Small scleral incision without ultrasounds has advantages. No expensive instruments are required and astimatism is not induced. The anterior chamber lies deep during the operation, protecting the endothelial cells and facilitating aspiration. Postoperative inflammation is minimal. The small scleral incision technique is useful in selected cases of congenital cataract.

[Epidemiological and angiofluorographic aspects of diabetic retinopathy in Senegal]. / Aspects épidémiologiques et angiofluorographiques de la rétinopathie diabétique au Sénégal.

PURPOSE: Attempting to improve life expectancy among diabetics reveals degenerative complications, including diabetic retinopathy (DR) linked to microangiopathy. We assessed the incidence of diabetic retinopathy in its various forms amongst diabetics in Senegal. PATIENTS AND METHODS: We carried out a survey between March and October 1998. The 51 patients surveyed had been affected for more than 5 years. They were divided into two groups: insulin-dependent diabetes (IDD) and non-insulin-dependent diabetes (NIDD). Patients were aged 17-71 and included 27 IDD and 24 NIDD. Each patient was given both a biological checkup (blood sugar level, HBA1c, creatininemy, triglycerides, cholesterol, albuminaria and urinary glucose) and an ophthalmological checkup with angiography in fluorescence. RESULTS: Of the 51 patients studied, 26 presented a progression span of the disease of over 10 years. DR was detected in 62 eyes out of 102 (60.78%), with 37.25% of nonproliferating DR, 17.65% of preproliferating DR, and 5.88% of proliferating DR. Maculopathy was detected in 10 eyes (9.80%). Amongst the IDD patients, diabetic retinopathy accounted for 57.14% of diabetes, with a progression span of less than 10 years, compared to 84.62% for diabetes with a progression span of over 10 years. Amongst the NIDD patients, diabetic retinopathy accounted for 36.36% compared to 61.54%. DISCUSSION: Through these results, a connection can be made between diabetic retinopathy, the progression span of diabetes, the type of diabetes, and the other microangiopathies. We noted a rise in retinopathy that increased with the age of diabetes patients and their IDD group. CONCLUSION: A multidisciplinary support of diabetes ensures early detection of diabetic retinopathy; hence the need for closer collaboration between the endocrinologist and the ophthalmologist.

[Contribution of the Kansas technique for reducing complications of mature cataract surgery]. / Apport de la technique de Kansas dans la réduction des complications de la chirurgie des cataractes mûres.

PURPOSE: We report our experience with the Kansas technique of phakosection which eliminates or limits most complications of classic manual extracapsular extraction. PATIENTS AND METHODS: This retrospective study included our first 80 patients undergoing surgery for mature cataract between May 1996 and May 1998 where we used the Kansas technique. We compared outcome with a group of 30 patients who underwent classic manual extracapsular extraction in a study performed in 1995 by the same surgeon in the same hospital. RESULTS: Per- and post-operative complications were significantly lower with phakosection. Functional rehabilitation was quicker, better and provided better patient comfort. DISCUSSION: Despite some difficulties encountered in a public hospital (viscoelastic excessively fluid and in small quantity, lack of suitable knives or reuse of sterilized disposable knives), we found that the Kansas technique is very well adapted to mature cataracts and our working conditions. CONCLUSION: Phakosection allowed us to give our patients with mature or very mature cataracts the benefit of small incisions. With a moderate increase in cost, this technique significantly reduced our per- and post-operative complication rates and gave quicker and better visual recovery. In our countries, this technique provides better care than phakoemulsification.

[Compliance of medical treatment in primitive glaucoma open angle]. / L'observance au traitement médical dans le glaucome primitif à angle ouvert. Résultats préliminaires.

INTRODUCTION: Compliance to medical treatment expresses the patient's perception of the disease and the treatment prescribed by the doctors. Lack of compliance endangers chronic glaucoma care, which explains the importance it has been given these last years. The objectives of this survey were to evaluate the compliance of adult patients suffering from primary open angle glaucoma to discover the influential factors. MATERIALS AND METHODS: We conducted a survey at the ophthalmology clinic of Le Dantec Hospital from January 1997 to May 1998 among 31 adults being treated for primary open angle glaucoma. An indirect evaluation of the patients' compliance was made on the basis of a questionnaire after examination of their medical files. It was deemed good, average, or bad depending on: regularity of the patient's visits to the doctors, regularity of the treatment, respect of the doctor's prescription and the prescribed times for taking the medicine. The Chi square independence test was used to study the influence of the following factors: age, sex, residence, socioeconomic status, duration of symptom progression, level of instruction, counseling, and treatment. RESULTS: The patients' mean age was 60.5 years. Compliance was deemed good for 29% of the total cases, average for 32.3%, and bad for 38.7%. Only factors such as the regular visits to the doctor, the regularity of the treatment, and respect of the doctor's prescription and the prescribed times for taking the medicine were found to be influential (p<0.05). CONCLUSION: The medical treatment of primary open angle glaucoma, whether temporary or permanent, with a maximum of efficacy and a minimum of side-effects requires good compliance on the part of the patient. This compliance in turn requires a good doctor-patient relationship based on effective repeated counseling to educate patients, help them understand the disease, and act on the influential factors.

[Ocular side-effects of corticotherapy (analysis of 3 cases)]. / Accidents oculaires de la corticothérapie (analyse de trois observations).

Corticosteroids absorbed into the system, or, in particular, used locally, can lead to serious ocular complications often little understood by those who prescribe them. Among the three cases documented, the authors found one cortisone glaucoma, one cortisone cataract, and one associated glaucoma-cataract. General absorption occurred in one case, a nephrotic syndrome. The two other patients received corticosteroid ointment for chronic limbo-conjunctivitis, endemic in the tropics. Rigorous indication, respect for basic prescription laws, and regular supervision, particularly for long-term treatment, is necessary to prevent these iatrogenic accidents.

[Neuro-surgical exophthalmias (retrospective study of 27 cases at the C.H.U. of Dakar)]. / Exophtalmies neuro-chirurgicales (etude rétrospective de 27 cas au C.H.U. de Dakar).

The report covers 27 cases of neuro-surgical exophthalmia treated at Dakar U.H.C. between 1970 and 1987. Unilateral forms are the most common (25 cases), usually discovered at the bulging stage. Exploration was undertaken by the usual means of X-ray without contrast, echography, arteriography, and fractioned, gaseous encephalography employed together in varying degrees. The main etiologies are tumours (70%), largely benign, and specific and non-specific inflammation (18.5%). Surgery was prescribed in 18 cases, including 11 orbitotomies--8 frontal and 3 fronto-temporal. Malformation syndromes, and above all very advanced pathologies challenged surgical skill in 9 of the cases. Generally speaking, post operational results are favourable, but 3 deaths are reported and one relapse. Tomodensitometry, modern anaesthetic and revival techniques, and the important collaboration between the ophthalmologist and the neuro-surgeon are all factors in successfully mastering neuro-surgical protrusions.

[Expulsive hemorrhage (report of 2 cases)]. / L'hémorragie expulsive (à propos de 2 cas).

Two cases of expulsive haemorrhage consecutive to an operation of intumescent cataract responsible of major ocular overpressure (60 and 70 mmHg) are reported by the authors. No other risk factor has been found in our patients, one of 45 years old and the other 72 years old. First nor the operative wound suture neither the posterior sclerotomy were stitched, because of the inability to discover the site of choroidal haematoma with quat amount of blood in the operative field. The second reason was the use of an inadequate material of suture (vicryl 9/0). Finally both cases presented were eyes without any light perception. The final phase results in phtysis phenomena.

[Cortical blindness: 1st Senegalese cases confirmed by sensory electrophysiology]. / Cécité corticale: premiers cas sénégalais confirmés par l'électrophysiologie sensorielle.

The authors report on the first case of Cortical Blindness in Senegal to be confirmed by sensorial electrophysiology (ERG and study of PEV). They stress the clinical aspects and the etiological factors dominated by infectious cerebral meningitis, particularly in sucklings.

[Pupillary blockage after intracapsular cataract extraction in the adult apropos of 4 cases]. / Le blocage pupillaire apres extraction intra capsulaire de la cataracte chez l'adulte à propos de 4 cas.

Intra capsular extraction is the most employed surgical technics for the treatment of senile cataract in developing countries. Nevertheless complications are usual, among them the pupillary block. The authors notified in 365 intra capsular cataract extractions, executed during 8 months, 4 cases of pupillary block occurred after operation without incident. The 3 cases had favorable evolution after an average of 4 days with medical treatment. 1 case had unfavorable evolution to aphakic glaucoma in spite of medical and surgical treatment. They point out in the necessity of strict post operative supervision and early treatment.

[HLA-markers and diabetic retinopathy in the Senegalese population]. / Marqueurs HLA et rétinopathie diabétique dans la population Sénégalaise.

Patients with IDDM often develop severe forms of retinopathy, supposed to be associated to risk factors such as hypertension, poor glycemic control and nephropathy. A controversial intervention of a genetic marker was evoked so as some diabetic patients have retinopathy in the absence of known risk factors. HLA-DR and DQ markers were compared in two groups of patients with IDDM respectively constituted of patients with and without severe retinopathy. HLA typing was carried out by polymerase chain reaction (PCR) and restriction fragments of length polymorphism (RFLP). DR9 (p < 10(-4); O.R. = 8.36) and DQA1*0301 (p < 0.05; O.R = 2.92) alleles were positively associated to diabetic retinopathy, at the opposite of DR3 (p < 10(-3); O.R: 0.01) and DQA1* (p < 10(-9); O.R = 0.15). Furthermore, among the genotypes previously considered as risk markers of IDDM in senegalese people, only DR4: DQA1*0301:DQB1*0302/DR9: DQA1*0301: DQB1*0201 was often observed in retinopathy.

[Ocular burns at the ophthalmologic clinic of the Central University Hospital of Le Dantec apropos of 28 patients]. / Les brûlures oculaires à la Clinique Ophtalmologique du CHU A. Le Dantec à propos de 28 malades.

Chemical and thermal ocular burns are emergencies in ophthalmology because of the blindness sequels they occur. All patients were included in a prospective study form during 18 months. 28 patients were admitted for ocular burns, representing an incidence of 5.21%. 13 of them had occupational ocular burns, 11 homely ocular burns and 4 public way injuries. 18 had chemical burns and 10 thermal burns, with a total of 44 eyes. The clinical observations was dominated by conjunctival lesions: 90.9%, corneal lesions: 79.5%, and plapebral lesions: 43.2%. 11 of them who had chemical burns, the ocular irrigation was made immediately after the accident, and all of them had antibiotic and cicatrizing treatment. The seriousness of ocular burns, the youngness of patients must instigate the authorities to improve the working conditions in the factories, and a better information in manipulation of dangerous chemical product.