Effect of intravitreal injection of bevacizumab in treated and untreated eyes of Black African patients with polypoidal choroidal vasculopathy.

OBJECTIVE: To evaluate the response of polypoidal choroidal vasculopathy (PCV) in eyes treated with intravitreal bevacizumab (BVZ) and untreated fellow eyes in black Africans. METHODS: We studied 22 eyes (12 patients) divided into 12 treated and 10 untreated eyes from January 2017 to January 2020. Treated eyes received 1 monthly injection of BVZ 2.5mg for 3 months, with optional additional injections depending on the patient's course. Both groups of eyes were evaluated at presentation and then at 3, 6, 9, and 12 months after treatment. Outcome measures were visual acuity (VA) and ophthalmoscopic and OCT findings. RESULTS: The mean age of the patients was 66.3±5.6 years. In treated eyes, VA remained stable from 0.10±0.12 at baseline to 0.20±0.30 at month 12, P=0.84. VA was stable in 83.3% and improved in 16.7% of eyes. On OCT, 41.7% of eyes showed decreased and another 41.7% disappearance of subretinal fluid (SRF) at 12 months. Pigment epithelial detachment (PED) height decreased in 9 eyes (75.0%) but remained unchanged in 3 eyes (25%). In untreated eyes, no difference was observed between the baseline (0.53±0.42) and 12-month VA (0.58±0.40), P=0.82. VA improved in 2 eyes, decreased in one eye, and remained unchanged in 7 eyes. OCT lesions remained stable in 6 eyes. The PED enlarged in one eye but remained stable in 3 other eyes. CONCLUSION: Intravitreal injection of BVZ 2.5mg led to stabilization of VA, resorption of SRF, and reduction in the size of the PED in the majority of eyes with PCV but was ineffective on the polyps. The one-year prognosis in untreated eyes with PCV was favorable and marked by functional and structural stability.

[African programme for onchocerciasis control (APOC): entomological aspects of Onchocerca volvulus transmission by Simulium neavei in the Basin of Sankuru (Eastern Kasai, Democratic Republic of Congo)]. / Aspects entomologiques de la transmission d'Onchocerca volvulus par Simulium neavei dans le bassin du Sankuru (Kasaï oriental, République Démocratique du Congo).

As part of a study to evaluate the long-term impact of community-directed treatment with ivermectin (CDTI), baseline entomological data on the transmission of onchocerciasis in the forest zone of the Eastern Kasai Province were collected from July 1998 to January 1999. Species of the Simulium neavei complex were the only vectors found in the site during the study. Nuisance activity was low with a mean biting rate of only 32.5 bites/man/day. The mean parturity rate was 29.4%, the mean rate of infected females was 14.5% and the mean number of infective Onchocerca larvae per 1000 parous flies was 659. These findings clearly show that the S. neavei population at the study site has high vector capability and constitutes a large microfilarial reservoir. The entomological features found in the study area are consistent with a hyper-endemic zone.

[African Program for Onchocerciasis Control (APOC): Onchocerca volvulus transmission by Simulium damnosum s. l. in two regions of the Central African Republic]. / Programme africain de lutte contre l'onchocercose (APOC): transmission d'Onchocerca volvulus par Simulium damnosum s. l. dans deux régions de la République Centrafricaine.

Entomological baseline data were collected in the villages of Zinga and Boali-Falls in Central African Republic (CAR) in view of the long term impact assessment of community-directed treatment with ivermectin (CDTI). Morphological determinations revealed that flies caught in both sites belong to the sub-group Sou/Sq. In Boali, the nuisance was relatively high with biting rates averaging 243 bites/man/day, with a parous rate of 61.6% and a crude annual transmission potential (ATP) of 8,259 infective larvae/man/year; and the average number of infective larvae per 1,000 parous flies was 177. In Zinga, the mean biting rate was 191 bites/man/day, with a parous rate of 51.6%, a crude ATP of 3,422, and 86 infective larvae per 1,000 porous flies. In conclusion, the vectorial capacity and the entomological indices recorded are characteristic of high onchocerciasis transmission zones. However, some of the infective larvae found, maybe of animal origin, need identification to better determine the real level of endemicity.

[African Programme for Onchocerdasis Control (APOC): Onchocerca Simulium squamosum in two regions in the Republic of Cameroon]. / Programme africain de lutte contre l'onchocercose (APOC): intensité de la transmission d'Onchocerca volvulus par Simulium squamosum dans deux régions de la République du Cameroun.

In 1998, the African Programme for Onchocerciasis Control (APOC) decided to launch a long-term impact assessment of its operations. This paper reports the baseline entomological data collected throughout a whole year in two sites of Cameroon (Kahn and Bolo). The Simulium populations of the two study sites were characterized by parous rates of 7.2% and 33.5% respectively and infectivity by O. volvulus of 31 and 190 infective larvae per 1000 parous flies respectively The Annual Transmission Potentials (ATP) were respectively 523 and 9972 infective larvae per man and per year in Kahn and in Bolo. The Simulium populations studied in both sites, even though the ATP in Kahn is 19 times lower than that of Bolo, showed a pattern of an onchocerciasis hyperendemic zone in terms of vector capacities and entomological indices.

Uveitis in HIV-infected patients.

PURPOSE: To determine the prevalence of HIV infection and to find out the possible causes (associated conditions) of uveitis in HIV-infected patients. METHODS: We retrospectively analyzed the data of 581 patients with uveitis diagnosed over an 11-year period. All patients received a routine eye examination and most of them a general examination as well as complementary tests. RESULTS: The prevalence of HIV infection was 14.3% (89 patients). Anterior uveitis (62%) was the most frequent form, followed by posterior uveitis (22%), panuveitis (12%) and intermediate uveitis (4%). Associated conditions or causes were found in 88% of these 89 patients, the most frequent being Herpes zoster ophthalmicus (43%), tuberculosis (16%), CMV infection (12%) and toxoplasmosis (10%). CONCLUSIONS: In HIV-infected patients uveitis is frequently associated with opportunistic infections.

Neuro-ophthalmologic findings in konzo, an upper motor neuron disorder in Africa.

PURPOSE: To investigate the neuro-ophthalmological manifestations in konzo, a non-progressive symmetric spastic para/tetraparesis of acute onset associated with consumption of insufficiently processed bitter cassava roots combined with a low protein intake. METHODS: Twenty-one Congolese konzo patients underwent neuro-ophthalmological investigations including visual acuity testing, assessment of light pupillary reflexes, evaluation of ocular motility and deviation, direct ophthalmoscopy, and visual field perimetry. Objective refraction including retinoscopy and keratometry, and slit-lamp biomicroscopy were also done. RESULTS: Five patients had visual impairment, and 14 had temporal pallor of the optic disc. Fourteen presented visual field defects, the most frequent being concentric constriction and peripheral defects. Overall, 11 subjects had symptoms qualifying for the diagnosis of optic neuropathy. Two had spontaneous pendular nystagmus in primary position of gaze. Visual field defects and pallor of the optic discs were found in mild, moderate and severe forms of konzo. No correlation was found between the severity of the motor disability of konzo and the extent of visual field loss. CONCLUSIONS: Konzo was associated with optic neuropathy and a few patients had nystagmus. Although the etiopathogenesis of this optic neuropathy remains to be elucidated, the symmetry of the involvement suggests a toxic origin. We suggest that cyanide causes the neuro-ophthalmological damage in konzo. However, the optic neuropathy in konzo patients does not resemble the features of the epidemic optic neuropathy in Tanzania, Cuba or Nigeria, Leber's hereditary optic neuropathy, tobacco amblyopia or vitamin B deficiency.

[Association of malignant tumors of the conjunctiva and HIV infection in Kinshasa (D. R. Congo). First results]. / Assoziation von Bindehautneoplasien und HIV-Infektionen in Kinshasa (D. R. Kongo). Erste Ergebnisse.

BACKGROUND: Conjunctival carcinomas are tumors especially of the 6th/7th decades. They occur in Germany with a frequency of 1/20,000. For years it has been well known that in Africa the number of malignant tumors of the conjunctiva has been increasing. The reasons for that are not well known. HIV is a possible pathogenetic cofactor. METHOD: A histological examination of 34 specimens was performed in Rostock on conjunctival tumors removed at the Ophthalmologic Department of the University of Kinshasa in 2001. The study included 23 female and 11 male patients aged 20-75 years (mean 42). All patients underwent serological investigation for HIV infection. RESULTS: Of 34 patients 18 were HIV positive. Of the HIV-positive patients, six had a squamous cell carcinoma, seven a CIN (conjunctival intraepithelial neoplasia) I-III, and five a pinguecula. Of the HIV-negative patients, five showed a squamous cell carcinoma, eight a CIN I-III, one a pinguecula, one a sebaceous gland carcinoma, and one a papilloma. The average age of the HIV-positive patients with a squamous cell carcinoma was 41 years compared to the HIV-negative patients with 58 years. CONCLUSIONS: There was no difference in frequency of conjunctival intraepithelial neoplasia between HIV-positive or HIV-negative patients. HIV-positive patients with a squamous cell carcinoma were on average 17 years younger. UV radiation is the main risk factor and HIV infection is a possible carcinogenic cofactor. Investigations on additional viral infections as possible pathogenetic factors and on changed tumor suppressor genes are needed.

Reconstruction of orbital floor blow-out fractures with silicone implant.

AIM: To evaluate the outcome of orbital floor blow-out fractures treated surgically with silicone implant. METHODS: The patients were examined in a prospective study from October 1993 to December 1999. Over this period 11 patients were diagnosed as having orbital floor blow-out fractures. The study was restricted to those who were both treated surgically and followed-up at least three months after the discharge from hospital. Only six patients (five males and one female), ranging in age from 6 to 30 years, fulfilled the inclusion criteria. The fractures occurred during brawls in 3 patients, car accidents in 2 patients and child's play in 1 patient. The diagnosis was based on history, clinical grounds and coronal computed tomography. The surgical procedure was the same in all patients, using silicone implant to reconstruct the defects. The mean follow-up time after surgery was 4.8 months. RESULTS: The interval between injury and diagnosis ranged from 6 to 85 days (mean: 34.8 days). Limitation of vertical eye movements was present in all 6 patients, diplopia in 4 patients, enophthalmos in 3 patients and hypoesthesia in the distribution of the infraorbital nerve in 1 patient. The mean interval time between injury and surgery was 55.3 days and the majority of the patients (83%) had late repairs (> 14 days) after injury. Postoperatively, satisfactory results were obtained with regard to limitation of vertical eye movements, diplopia, enophthalmos and hypoesthesia. Only one patient had a persistent and partially reduced enophthalmos. Silicone implant was well tolerated in all 6 cases since complications such as infection, tissue reaction and extrusion were not observed. CONCLUSION: Satisfactory results may be obtained after late repair of orbital floor blow-out fractures. Silicone implant has the potential to be used successfully in orbital floor fractures.

[Solar retinopathy acquired after gazing at the sun during prayers]. / Rétinopathie solaire acquise durant des séances de prière.

The authors present the results of a study based on six persons who developed retinopathy after gazing at the sun during prayers. Risk factors were studied and the prognosis evaluated. The mean follow-up time was 82 days. Risk factors were present in all patients. The visual acuity was reduced in all patients at first presentation and total improvement was noted in four of them. Of all six patients, only one had his ocular fundus normalized. Amsler's grid testing revealed in all patients bilateral central scotomas which persisted in four of them. Fluorescein retinal angiography, which was found to be abnormal in all cases, became normal in only one case. However, all patients continued to complain of visual disability because of the persistence of photophobia, meta-morphopsia and scotomas. In conclusion, the prognosis of solar retinopathy is variable and the recovery of visual acuity does not necessarily imply the improvement of vision. Appropriate eye protection such as solar filters must be used when gazing at the sun to protect from retinal damage.

[Congenital malformations of the eyeball and its appendices in Zaire]. / Les malformations congénitales du globe oculaire et annexes au Zaïre.

OBJECTIVE: to determine the epidemiology of congenital eye malformations. METHODS: the records of 1740 patients (1913 eyes) with congenital eye malformations seen from 1962 through 1992 were reviewed. RESULTS: the prevalence rate of congenital eye malformations was 2.2%. Congenital cataract (38%), atresia of the naso-lacrimal duct (10%), congenital glaucoma (9%), congenital ptosis (8%), microphthalmos (8%), albinism of iris (8%), microcornea (7%) were the most frequent eye malformations. The common types of associated malformations included albinism, microcephaly, cardiopathy and anomalies of ears. CONCLUSION: the findings of this study were similar to those published in Europe and United States.

Ophthalmologic abnormalities in mentally retarded.

PURPOSE: To determine the prevalence and types of ophthalmologic abnormalities in mentally retarded subjects. METHODS: Seventy-three institutionalized mentally retarded subjects (41 boys and 32 girls) aged 5 to 19 years (mean: 11.5 years) were examined ophthalmologically during a three month period (from May to July 1999). The eye examination consisted of visual acuity testing (illiterate Snellen E-chart or acuity card procedures), pupillary reflex and motility evaluation, cover test for phoria and tropia, examination of adnexa and anterior segment (magnifying glass or slit-lamp biomicroscopy if indicated and possible), retinoscopy and direct ophthalmoscopy. All subjects were evaluated pediatrically, neurologically, psychologically and otorhinolaryngologically if indicated. RESULTS: Ophthalmologic abnormalities were found in 60.2% of the subjects. Eyelid abnormalities accounted for 21.7%, fundus abnormalities for 21.6%, refractive errors for 15% and ocular motility disorders for 13.6%. Taken separately, optic atrophy (16.4%) was the most frequent disorder, followed by refractive errors (15%), hypertelorism (12.3%), epicanthus (10.9%) and nystagmus (8.2%). Strabismus and mongoloid obliquity of lids were seen in 5.4% each other while ptosis was disclosed in 4.2% of cases. Visual acuity tested in 60 subjects revealed that 25 (41.6%) had visual impairment. Of all subjects 10.9% required corrective glasses while 9.6% needed corrective surgery for strabismus and ptosis. CONCLUSION: This study shows a high prevalence of ophthalmologic abnormalities in mentally retarded subjects. This is in agreement with the results of several other previous studies. It's therefore essential to screen mentally disabled subjects ophthalmologically.

[Orbital measurements in Zairian children. Inner canthal, outer orbital, inter-pupillary distances and proptosis]. / Mensurations orbitaires chez l'enfant zaïrois. Les distances intercanthale interne, interorbitaire externe, interpupillaire et la saillie oculaire.

Measurements of outer orbital distance, inner canthal distance and of interpupillary distance and proptosis were performed on 95 healthy Zairian subjects. The subjects were aged from 2 1/2 to 18 years. There were 47 boys (mean age +/- SD, 9.74 +/- 4.4 years) and 48 girls (mean age +/- SD, 9.07 +/- 4.1 years). No statistically significant difference was found between the two sexes for the mean age. Subjects were divided in four age groups: the first age group included children aged from 2 1/2 to 6 years (mean age +/- SD, 4.62 +/- 1.31 years), the second age group included children aged from 7 to 10 years (mean age, 8.32 +/- 1.22 years), the third included subjects aged from 11 to 14 years (mean age +/- SD, 12 +/- 1.06 years) and the fourth included subjects aged from 15 to 18 years (mean age +/- SD, 17 +/- 3 years). The measurements were performed with the Hertel exophthalmometer for the proptosis and the outer orbital distance, with the pupillometer model PD-2 meter for the interpupillary distance; with a ruler for the inner canthal distance. The mean +/- SD inner canthal was 27.4 +/- 2.7 mm for the first age group, 29.7 +/- 3.1 mm for the second age group, 30 +/- 2.4 mm for the third age group and 32.2 +/- 3.1 mm for the fourth age group. The mean +/- SD outer orbital was 100.0 +/- 4.4 mm for the first age group, 106.5 +/- 4.6 mm for the second age group, 111.7 +/- 6.8 mm for the third age group and 118.5 +/- 6.4 mm for the fourth age group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Malignant tumors of the eye and adnexa in Congo-Kinshasa]. / Les tumeurs malignes de l'oeil et des annexes au Congo-Kinshasa.

PURPOSE: To determine the frequency and to study anatomic and clinical features of malignant tumors of the eye and adnexa. METHODS: A retrospective (1962-1990) and prospective (1990-1992) study of 164 medical records of patients with histopathologic confirmation of malignant tumors of the eye and adnexa. All the patients received a conventional ophthalmological examination and underwent surgical biopsy. Histopathologic examinations were performed for a large part at the Department of Ophthalmology, University of Iowa and for a small part at the Department of Histopathology, University Hospital of Kinshasa. RESULTS: There were 99 (60%) male and 65 (40%) female for a sex ratio of 1.5: 1. The mean age of patients was 24.6 +/- 21.4 years. Epibulbar (35%) and intraocular (33%) tumors were the most frequent, followed by orbital tumors (20%). Epidermoid carcinoma and retinoblastoma were the most common histologic forms, representing respectively 33.5% and 31.7% of all malignant tumors of the eye and adnexa. They occurred especially in adults between 20 and 60 years for the first and in children below 5 years for the second. Metastatic tumors accounted for 9.7% of all cancers of the eye and adnexa. Kaposi's angiosarcoma was encountered in 3.6% of cases and in 3% it was associated with AIDS. Burkitt's lymphoma was seen in 3% of cases, basal cell carcinoma as well as in situ carcinoma in 2.4% of cases. Malignant lymphoma and adenocarcinoma both accounted for 1.8% of all cases of cancers of the eye and adnexa while adenoid cystic carcinoma, liposarcoma as well as rhabdomyosarcoma accounted for 1.2% of all cases. Other types of tumors were seen in very small proportion. CONCLUSION: Our results were similar to those of other studies in Africa and were different from those of European and American studies.

[Uveitis in patients with HIV infection]. / Uvéite chez les patients infectés par le VIH.

We carried out a retrospective analysis of 581 patients with uveitis seen over an 11-year period, to determine the prevalence of HIV infection in these patients and to look for associated diseases and the possible causes of uveitis in HIV-infected patients. All patients underwent routine eye examination and most also underwent a general examination and complementary tests. The prevalence of HIV infection was 14.3% (89 patients). Anterior uveitis (62%) was the most frequent, followed by posterior uveitis (22%), panuveitis (12%) and intermediate uveitis (4%). Associated conditions or causes were identified in 88% of the HIV-infected patients, with herpes zoster ophthalmicus the most frequent (43 %), followed by tuberculosis (16%), CMV infection (12%) and toxoplasmosis (10%). Thus, uveitis in HIV-infected patients is frequently associated with opportunistic infections.

Statistical evaluation of visual functions in dominant and recessive autosomal pigmentary retinopathy.

A statistical study of the progress of fundus lesions and functional loss in relation with age and with inheritance modus was performed in patients with pigmentary retinopathy. A three-way interaction was found between following parameters: inheritance modus, age and pigment anomalies of the fundus; inheritance modus, age and visual field; inheritance modus, age and ERG; inheritance modus, vision and ERG; inheritance modus, dark adaptation and visual field.

Refection of orbital floor blow-out fractures with silicone implant.

In a retrospective study, the authors present the results of the surgical treatment of 6 cases of orbital floor blow-out fractures with silicone implant. The diagnosis was based on history, clinical ground and coronal tomography. The surgical procedure was the same in all patients, using silicone implant. The mean follow-up time after surgery was 3 months. The mean interval time between injury and diagnosis was 34.8 days while that between injury and surgery was 55.3 days. The fractures occurred during brawls in 3 patients, car accidents in 2 patients and child's play in 1 patient. Limitation of vertical eye movements was presents in all patients, diplopia in 4 patients, enophthalmos in 3 patients and hypesthesia in the distribution of infraorbital nerve in 1 patient. Five patients hale late repairs (> 14 days) after surgery. Postoperatively, good results were obtained with regards to limitation of vertical eye movements, diplopia, enophthalmos and hypesthesia. Only one patient had a persistent and partially reduced enophthalmos. Silicone implant was well tolerated in all cases since complications such as infection, tissue reaction and extrusion were not observed. Excellent results may be obtained after late repair of orbital floor blow-out fractures. Silicone implant has the potential to be used successfully in orbital floor fractures.

Profile of eye lesions and vision loss: a cross-sectional study in Lusambo, a forest-savanna area hyperendemic for onchocerciasis in the Democratic Republic of Congo.

OBJECTIVE: To determine baseline data regarding eye lesions and vision loss in five villages of Lusambo, an onchocerciasis-hyperendemic forest-savanna area in the Democratic Republic of Congo (DRC), in preparation of mass ivermectin distribution. METHODS: Five villages were selected by simple randomization. Through a cross-sectional design, 750 subjects were examined ophthalmologically. The eye examination included acuity visual measurement, slit-lamp examination, ophthalmoscopy, intraocular pressure measurement, and visual field assessment by the Wu-Jones test. RESULTS: There was a high prevalence of onchocerciasis-related eye lesions compared with non-onchocercal lesions. Chorioretinitis (20%) was the most frequent disease, others were punctate keratitis and microfilariae in the anterior chamber in equal frequency (13.8%), white intraretinal deposits (10.4%) and iridocyclitis (8%). Vision loss was discovered in 8.5% of the subjects, of whom 0.5% had bilateral blindness, 2.2% had monocular blindness and 5.7% had visual impairment. Vision loss was mostly caused by onchocerciasis-related diseases, especially those affecting the anterior segment of the eye. CONCLUSION: Features of ocular onchocerciasis usually described in forest and savanna areas were both found in this forest-savanna zone of the DRC.