Hydrocephalus in toddlers: the place of shunts in sub-Sahara African countries.

PURPOSE: This study describes the epidemiological patterns of hydrocephalus in toddlers in our setting in order to determine the proportion of those who could benefit from endoscopic third ventriculostomy (ETV). METHODS: This prospective and descriptive study included all toddlers operated on for hydrocephalus from 1 March 2008 to 31 March 2010 at the Yaounde Central Hospital. RESULTS: Forty-six toddlers were included representing 72% of all hydrocephalus cases managed at the Neurosurgery Unit during the study period. The mean age was 6.9 ± 1.6 months. The delay before treatment varied from 5 days to 15.8 months (mean = 3.7 ± 0.5 months). The commonest clinical presentation was macrocrania (78.3%). Of the toddlers, 58.7% presented with a probable blindness (loss of ocular pursuit); dilated and non-reactive pupils were found in nine patients (19.6%). The diagnosis was based on transfontanellar echography (TFE), CT scan or combined TFE and CT scan. Identified aetiologies were aqueduct stenosis (28.7%), haemorrhage (18%), Dandy-Walker's syndrome (14.3%), meningitis (10.8%), myelomeningocele (10.8%), agenesis of Monro's foramen (3.6%), brain abscess (3.2%) and posterior fossa tumour (3.6%). No specific cause was found in 7% of cases. The treatment was ventriculoperitoneal shunting in 42 cases (91.3%) and ETV in two cases (4.3%). Infections (11.1%) and shunts' obstruction (5.4%) were the main complications. CONCLUSION: Cases of hydrocephalus in toddlers are frequent in our setting. Regardless of the patient's age, the most prevailing aetiologies (infections, haemorrhage, myelomeningocele) and technological conditions (neuroendoscope) are less favourable for ETV. The use of ETV in the treatment of hydrocephalus in sub-Saharan Africa is still marginal and needs to be encouraged in selected cases. The prevention of non-tumoral hydrocephalus is of critical importance.

[Prevalence and etiology of amblyopia of children in Yaoundé (Cameroon), aged 5-15 years]. / Prévalence et étiologies de l'amblyopie chez l'enfant camerounais de 5 à 15 ans à Yaoundé

PURPOSE: To determine the frequency of amblyopia and identify its causes in a population of children aged 5-15 years in Cameroon. SUBJECTS AND METHODS: This retrospective study examined the files of children aged 5-15 years seen in a private eye clinic in Yaounde from January 2008 through December 2010. The subjects underwent a complete ophthalmic examination including assessment of the best corrected visual acuity on a LogMAR chart, cycloplegic refraction measurements, and an orthoptic examination. The slit-lamp microscope and eye fundus examinations made it possible to rule out organic diseases. Statistical analysis was performed with Epi Info software, version 3.5.3, to analyze the the frequency and laterality of amblyopia according to age, sex, and refractive errors. RESULTS: Twenty-eight of the 314 patients studied had amblyopia, for a frequency of 8.9 % in the study population and 10.3 % in the subjects with ametropia (n = 271). The average age of children with amblyopia was 9.9 + / - 3 years. The frequency of amblyopia was higher among boys, but the difference was not statistically significant (p=0.3679). In order of frequency, the causes were refractive errors, for 93 % (26/28) of the children, and strabismus for 7 % (2/28). Astigmatism was the most frequent cause of ametropic amblyopia. Amblyopia had an anisometropic origin in 43 % (12/28) of cases. It was unilateral in 39.2 % (11/28) and bilateral in 61 % (17/28) of cases, severe in 18 %, moderate in 18 %, and mild in 64 %. CONCLUSION: Ten percent of the subjects in our series had amblyopia, mainly due to refractive errors. Amblyopia was most frequently bilateral and mild. A systematic ophthalmological examination in childhood could provide early detection and management of refractive errors that cause ocular morbidity.

Validation of Smartphone-Based Retinal Photography for Diabetic Retinopathy Screening.

BACKROUND AND OBJECTIVE: Screening for diabetic retinopathy (DR) is cost-effective when compared with disability loss for those who go blind in the absence of a screening program. We aimed to evaluate the sensitivity and specificity of a smartphone-based device for the screening and detection of DR. PATIENTS AND METHODS: A cross-sectional study of 220 patients with diabetes (440 eyes, all patients age 25 years or older) was completed. Tropicamide 0.5% was used for iris dilation followed by an indirect ophthalmoscopy using a 20-D lens. Retinal images were later obtained using a smartphone attached to an adaptable camera device. Retinal images permitted the visualization of the macular and papillary regions and were sent without compression via the internet to a retinal specialist for interpretation. Sensitivity and specificity were calculated for all cases and stages of DR. RESULTS: Using our standard examination method, the prevalence of DR and macular edema were 13.6% and 6.4%, respectively. With the smartphone-based retinal camera, the prevalence of DR and macular edema were 18.2% and 8.2%, respectively. Sensitivity and specificity for the detection of all stages of DR was 73.3% and 90.5%, respectively. For the detection of macular edema, sensitivity was 77.8%, and specificity was 95%. For severe nonproliferative DR (NPDR), sensitivity and specificity were 80% and 99%, respectively; for proliferative DR (PDR), they were both 100%. In the early stages of DR, specificity was 89.8% for mild NPDR and 97.1% for moderate NPDR. Sensitivity was 57.1% and 42.9%, respectively. CONCLUSION: Screening for DR using a smartphone-based retinal camera has a satisfactory specificity at all DR stages. Its sensitivity seems to be high only in the stages of DR necessitating a specific therapeutic decision (eg, macular edema, severe NPDR, and PDR). A smartphone-based retinal camera may be a useful device to screen for DR in resource-limited settings. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:S18-S22.].

Color vision deficiency among biomedical students: a cross-sectional study.

PURPOSE: To determine the prevalence of color vision deficiency (CVD) among first-cycle students of the Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I. PATIENTS AND METHODS: A cross-sectional descriptive study was carried out between October 1, 2015 and May 31, 2016. Distant visual acuity was measured and color vision test done for all consenting students. Ishihara's plates were used to test all the participants. Those who failed the test were tested with the Roth's 28 Hue test for confirmation of CVD and classification. RESULTS: A total of 303 students were included, among whom 155 were males (50.8%) and 148 were females (49.2%). The mean age was 20.2±2 years. Five students (1.6%) failed the Ishihara's plate testing. Roth's 28 Hue test confirmed CVD in 4 of those cases, giving a prevalence of 1.3%. There were equal numbers of protan and deutan CVD. CONCLUSION: Despite its low prevalence among first-cycle students of the Faculty of Medicine and Biomedical Sciences, CVD screening should be performed in order to raise awareness, which will go a long way to help orientate the choice of future specialty.

Ophthalmic Manifestations in Chronic Inflammatory Rheumatic Diseases at a Referral Hospital of Yaounde, Cameroon.

PURPOSE: To determine the profile of ophthalmic manifestations in chronic inflammatory rheumatic diseases (CIRD). METHODS: Observational study at the Yaounde Central Hospital and Innel Medical Centre (2004 to 2012). RESULTS: The study population (n = 36) consisted of 14 men and 22 women with average age of 47.9 ± 17.2 years. Cases of CIRD were rheumatoid arthritis (n = 16), systemic lupus erythematosus (n = 8), ankylosing spondylitis (n = 8), mixed connective tissue disease (n = 2), scleroderma (n = 1), and juvenile idiopathic arthritis (n = 1). Ophthalmic manifestations found in 22 (61.1%) patients were dry eye syndrome (n = 7), cataract (n = 6), anterior uveitis (n = 6), glaucoma (n = 4), and suspected maculopathy (n = 1). No association was found between steroids used and supcapsular cataract (p = 0.06) or glaucoma (p = 0.06). CONCLUSION: Ocular manifestations occurred in 61.1% of CIRD. Dry eye syndrome and anterior uveitis were commonly observed.

Ophthalmological findings in Cameroonian boxers.

BACKGROUND: The purpose of this prospective, noncomparative consecutive study was to examine active and retired amateur boxers in order to evaluate the nature and incidence of ocular pathologic conditions related to the boxing practice. RESULTS: A total of 35 boxers were included in this study. The mean age of the boxers was 28.09±7.57 years (range 18-52 years). Sixteen (45.7%) boxers had >5 years of boxing experience. Fifteen (42.85%) of the boxers reported wearing protective equipment in the bouts and sparring rounds. The number of bouts ranged from 3 to 103, with a median of 20 (interquartile range [IQR] =7-44). The percentages of wins varied from 25% to 100%, with a median of 68.29% (IQR =50.00-79.54). Most of the eye injuries recorded were minor injuries (66.66%), with subconjunctival hemorrhage being the most common (24.24%). Lid scars were the second most common lesion, accounting for 18.18% of all lesions. Sight-threatening eye lesions accounted for 33.34% of injuries and included cataracts (12.12%), lens dislocation (3.03%), pseudoexfoliation syndrome (3.03%), unilateral glaucoma (3.03%), retinal detachment (3.03%), vitreous opacity (6.06%), and lattice degeneration (3.03%). CONCLUSION: Boxing-related ocular traumas are common in Cameroon, and ocular surface lesions are the most common injury reported. Severe lesions are indications for premature retirement from boxing practice.

Malarial retinopathy in adult: a case report.

Although widely reported in children, the malarial retinopathy has rarely been described in adults. We observed a case in the department of ophthalmology at the pediatric and gynecology-obstetrics Yaoundé Hospital. The diagnosis revealing a decrease in visual acuity was confirmed by thorough ophthalmological and biological assessments. The basic treatment by quinine therapy was conclusive. The authors point out the need to consider this diagnosis in case of any decrease in visual acuity in febrile context for any adult living or recently having stayed in endemic areas.

Peters plus anomaly in a Cameroonian child: a case report.

BACKGROUND: Peters' anomaly (PA) is a rare form of anterior segment dysgenesis characterized by corneal opacity with varied degree of anterior chamber affection with associated defects in the posterior layers of the cornea. CASE PRESENTATION: We report the case of a 3-month-old male infant with bilateral corneal opacity since birth who was transferred from the pediatric unit for further ophthalmic care. He was diagnosed with PA with subsequent systemic-associated malformations including craniofacial defects and skeletal defects. He was managed minimally with topical mydriatics and antiglaucomatous drugs. CONCLUSION: PA is an inevitable cause of blindness in developing countries due to poor infrastructure and limited resources.

Indications for surgical removal of the eye in rural areas in cameroon.

OBJECTIVE: To determine the main clinical indications for surgical removal of the eye in rural areas in Cameroon. DESIGN: Retrospective non-comparative case series. PARTICIPANTS: A total of 253 patients presenting to the Manna eye clinic Nkongsamba who underwent destructive eye surgery (DES) between January 2006 and December 2010 were reviewed. MAIN OUTCOME MEASURE: Age, gender, occupation, prior medication, visual acuity, operation indications, and type of operation. RESULTS: There were 58.10% (n = 147) men and 41.90% (n = 106) women. Median age was 29 years (interquartile range: 14-69 years); age ranged from 10 to 88 years. A total of 67.19% (n = 170) of participants were farmers and lived in rural zones. In all, 79.05% (n = 200) confessed to have trying a medication before the presentation. Surgical indications included infective causes (perforated corneal ulcer 33.20% (n = 84) and endophthalmitis 18.20% (n = 46)), trauma 17.40% (n = 44), painful blind eyes 11.50% (n = 29), malignancy 10.70% (n = 27), and others 9.10% (n = 23). CONCLUSION: The most common causes of DES in this series could be avoided. Therefore, preventive measures including extensive health education of the public and traditional healers on the risks linked to the use of traditional medicines in ophthalmology and the late presentation of eye disease, quality control of the campaigns that offer free cataract operations in the country.

Prevalence of trachoma in the north region of Cameroon: results of a survey in 15 health districts.

BACKGROUND: To estimate the prevalence of trachoma in the North Region of Cameroon in order to facilitate the planning of trachoma control activities in this region, a survey was carried out in 2011 and 2012 in 15 health districts (HDs). METHODOLOGY: A cross-sectional, two-stage cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of Trachomatous Inflammation-Follicular (TF) and those aged 15 and over for the prevalence of Trachomatous Trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of HDs. The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma. PRINCIPAL FINDINGS: 30,562 children aged 1 to 9 years and 24,864 people aged 15 and above were examined. In children aged 1-9 years, the overall prevalence of TF was 4.2% (95% confidence intervals (CI): 4.0-4.5%). Three (3) of 15 HDs in the region showed TF prevalence of ≥ 10% (Poli, Rey Bouba, and Tcholliré). The overall TT prevalence was 0.25% (95% CI: 0.20-0.33%). There were estimated 1265 TT cases in the region. The prevalence of blindness was 0.01% (95% CI: 0.00-0.03%), low vision was 0.11% (95% CI: 0.07-0.17%), and corneal opacity was 0.22% (95% CI: 0.17-0.29%). CONCLUSIONS/SIGNIFICANCE: This survey provides baseline data for the planning of activities to control trachoma in the region. The overall prevalence of TF in the region is 4.2%, and that of TT is 0.2%; three HDs have a TF prevalence ≥ 10%. These three HDs are eligible for mass drug administration with azythromycin, along with the implementation of the "F" and "E" components of the SAFE strategy.

Prevalence of trachoma in the Far North region of Cameroon: results of a survey in 27 Health Districts.

BACKGROUND: Cameroon is known to be endemic with trachoma. To appreciate the burden of the disease and facilitate the national planning of trachoma control in the integrated control program for the neglected tropical diseases, an epidemiological mapping of trachoma was conducted in the Far North region in 2010-11. METHODOLOGY: A cross-sectional, cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of active trachoma and those aged 15 and over for the prevalence of trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of Health Districts (HDs). The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma. PRINCIPAL FINDINGS: 48,844 children aged 1 to 9 years and 41,533 people aged 15 and over were examined. In children aged 1-9 years, the overall prevalence of trachomatous inflammation-follicular (TF) was 11.2% (95% confidence intervals (CI): 11.0-11.5%). More girls were affected than boys (p = 0.003). Thirteen (13) of 27 HDs in the region showed TF prevalence of ≥10%. The overall TT prevalence was 1.0% (95% CI: 0.9-1.1%). There were estimated 17193 (95% CI: 12576-25860) TT cases in the region. The prevalence of blindness was 0.04% (95% CI: 0.03-0.07%) and visual impairment was 0.09% (95% CI: 0.07-0.13%). CONCLUSIONS/SIGNIFICANCE: The survey confirmed that trachoma is a public health problem in the Far North region with 13 HDs qualified for district-level mass drug administration with azithromycin. It provided a foundation for the national program to plan and implement the SAFE strategy in the region. Effort must be made to find resources to provide the surgical operations to the 17193 TT cases and prevent them from becoming blind.