Carcinome épidermoïde conjonctival au cours de l'infection au virus de l'immunodeficience humaine (VIH)

Le carcinome épidermoïde de la conjonctive est une tumeur maligne rare des cellules souches limbiques conjonctivales. Cependant, il représente la tumeur maligne la plus fréquente de la surface oculaire.Son évolution peut se faire vers l'orbite ou l'oeil et aboutir à la perte fonctionnelle du globe oculaire,en absence du traitement. Son traitement est essentiellement chirurgical mais les récidives sont fréquentes

Carcinome adenoïde kystique de la glande lacrymale

Le carcinome adénoïde kystique de la glande lacrymale est la tumeur maligne épithéliale d'agressivité locale et d'évolution lente. Cette tumeur se développe aux dépens des cellules glandulaires salivaires.Sa localisation orbitaire aux dépens des glandes lacrymales est exceptionnelle. Elle touche préférentiellement la jeune femme. Son traitement est essentiellement chirurgical. Les récidives sont fréquentes

[High intraocular pressure and open angle glaucoma]. / Hypertonie oculaire et glaucome primitif à angle ouvert.

PURPOSE: To study the correlation between high intraocular pressure and the primitive glaucoma with opened angle among beninese patients. METHOD: Our study was accomplished in the ophtalmological department of the university national hospital center of Cotonou. It was retrospective with descriptive and analytical aim and extended over a period of 3 years going from January 1st, 2007 till December 31st, 2009. It took into account all the patients' files having presented high intraocular pressure and to whom the search for primitive glaucoma with opened angle was carried out. RESULTS: Among 9406 patients received in consultation during the period of study, 129 (corresponding with 258 eyes) presented high intraocular pressure that is 1.37%. The age of the patients was included between 11 years and 82 years, with a medium age of 54.48 years ±13.94 years. Male subjects prevailed (57%), with a sex ratio of 1.3. All the patients (100%) consulted for visual decline by far, by near or both at the same time. A significant number of eyes (80 eyes - 31%) had a vision by far lower or equal with 3/10. The values of ocular pressure were included between 22 mmHg and 62 mmHg, with an average of 28.13 mmHg ±6.06 mmHg. The ratios cup/disc varied from 0.3 to 1 with a medium cup/disc of 0.46±0.34. The examination of the field of vision with the automatic perimeter showed deteriorations of glaucoma type in 170 eyes (65.89%). High ocular pressure, optic disc glaucoma excavation and visual field defects were associated in 58.13% of the cases with a coefficient of correlation (r) higher than 0.87. DISCUSSION: Although the high intraocular pressure does not allow to confirm the diagnosis of primitive glaucoma with opened angle, it constitutes an essential risk factor. CONCLUSION: We showed in this study that in 58.13% of the cases, there is a correlation between the high intraocular pressure and the primitive glaucoma with opened angle. Efforts must be made to sensitize our populations on the existence of this serious affection that is primitive glaucoma with opened angle and on its early tracking which begins with the measure of the eye pressure.

[Therapeutics of primary open-angle glaucoma in Cotonou: a series of 224 cases]. / Thérapeutique du glaucome primitif à angle ouvert à Cotonou : à propos de 224 cas.

AIMS: To determine POAG features and evaluate topical management in Cotonou, Benin, in order to suggest therapeutic diagrams adapted to local therapeutic conditions. PATIENTS AND METHOD: This was a retrospective, longitudinal study with cross-sectional collection of data from subjects with POAG who were admitted to the CNHU and Bethesda Hospital ophthalmologic center in Cotonou, Benin, from 1st January 2007 to 31st December 2008. RESULTS: Visual acuity higher than 6/10 improved from the first consultation (47.3% on the right and 43.8% on the left) to the second (62.5% on the right and 62.9% on the left). All the patients had received a topical treatment with predominance of monotherapy (59.4%) at the first consultation. Beta-blockers were the most frequently prescribed, alone or in association. They reduced IOP by 12.8% in the right eye and 14.6% in the left eye. The prostaglandins were responsible for 26.2% and 27.8% of IOP reduction in the right and left eyes, respectively. Whatever the therapeutic diagram, IOP decreased from one consultation to another (p<0.0001). The IOP was higher than 21 mm Hg in the majority of the cases at the first consultation (62.5% in right eye, 63.4% in the left eye) and lower than 21 mm Hg (75.9% in the right eye, 74.6% in the left eye) at the second. Dual therapy (t=72.2) was more effective than monotherapy (t=52.3). CONCLUSION: The search for therapeutic effectiveness and better treatment observance should bring physicians to more indications of surgery.

[Survey of medical treatment in primary open-angle glaucoma]. / Observance au traitement médical dans le glaucome primitif à angle ouvert.

PURPOSE: To survey patient understanding of primary open-angle glaucoma (POAG) and difficulties associated with medical treatment of POAG patients, to determine patient compliance rates with medical therapy, to study factors influencing compliance rates, and to formulate suggestions to improve patient compliance. PATIENTS AND METHODS: Our descriptive prospective study was carried out at the ophthalmology clinic of the Hubert K. Maga national university medical center and in the "La Lumière" ophthalmology clinic in Cotonou, from January 5 through April 25, 2009. The study included all glaucoma patients under medical treatment for at least 1 year with no surgical POAG intervention, seen in consultation during the study period, i.e. 120 patients. The following parameters were studied: whether the patient took or forgot to take his or her medication within the week preceding the survey, the patient's statement of whether or not voluntary interruption of antiglaucoma treatment occurred for more than 1 day, and the regularity of follow-up appointments with the doctor over the preceding 2 years. RESULTS: The median age of the patients was 56.5 ± 11.9years. A percentage of 90.8 of patients understood the chronic nature of POAG. A percentage of 91.7 knew that, in the absence of treatment, POAG can result in irreversible blindness. A percentage of 90 knew that medical treatment is intended to be lifelong. A percentage of 84.2 knew that the dosing schedule must be adhered to. The rate of total compliance was 53.3%. Only regularity of follow-up visits and adherence to dosing schedules were found as significant factors (P<0.05). CONCLUSION: Compliance is a dynamic variable which ophthalmologists need to evaluate throughout the follow-up of POAG patients, in order to reduce the prevalence of glaucoma blindness in Bénin.

[Detection of primary open-angle glaucoma at the National University Hospital Cotonou, Benin]. / Dépistage du glaucome primitif à angle ouvert au centre national hospitalier et universitaire de Cotonou, Bénin.

AIM: Describe the epidemiologic and clinical characteristics of POAG and evaluate hospital personnel's knowledge of the disease at the National University Hospital in Cotonou, Benin. PATIENTS AND METHOD: A transversal study was conducted over a period of 7 months on 689 employees over 20 years of age, divided into three professional categories A, B, and C. RESULTS: The rate of participation was 67 %. POAG was present in 5.5 % of the employees (n=38). The disease was known only by 21.0 % of employees (n=8). The average age of patients was 45.6+/-3.5 years, with a sex ratio of 3.2. Category C employees were the most affected. Vision was higher than 0.7 in 59,5 % at right eye and 57,9 % at left eye; the most frequent lesions of the visual field were nasal projection and Bjërrum scotoma. Intraocular pressure was higher than 21 mmHg in 63,2 % at right and 57,9 % at left eye with an average IOP of 21.5 mmHg on the left and 18.3 mmHg in the right eye. The average cup/disc was 0,5. DISCUSSION/CONCLUSION: POAG was unknown to most employees of the Cotonou National University Hospital; it affected young people and was more frequent in the low-income professional categories. Its prevention requires awareness and systematic monitoring of young people.

[A study of refractive errors in a primary school in Cotonou, Benin]. / Amétropies en milieu scolaire primaire à Cotonou (Bénin).

PURPOSE: Determine the epidemiologic aspects and the degree of severity of different refractive errors in primary schoolchildren. PATIENTS AND METHODS: A prospective and descriptive study was conducted from 1 December 2005 to 31 March 2006 on schoolchildren ranging from 4 to 16 years of age in a public primary school in Cotonou, Benin. The refraction was evaluated for any visual acuity lower than or equal to 0.7. RESULTS: The study included 1057 schoolchildren. The average age of the study population was 8.5+/-2.6 years with a slight predominance of females (51.8%). The prevalence of refractive error was 10.6% and astigmatism accounted for the most frequent refractive anomaly (91.9%). Myopia and the hyperopia were associated with astigmatism in 29.4% and 16.1% of the cases, respectively. The age bracket from 6 to 11 years accounted for the majority of refractive errors (75.9%), without age and sex being risk factors (p=0.811 and p=0.321, respectively). The average vision of the ametropic eye was 0.61, with a clear predominance of slight refractive errors (89.3%) and particularly of low-level simple astigmatism (45.5%). CONCLUSION: The relatively low prevalence of refractive error observed does not obviate the need for implementing actions to improve the ocular health of schoolchildren.

[Traumatic cataract at the Cotonou, hospital (Benin): epidemiological, clinical and therapeutic considerations]. / La cataracte traumatique au CNHU-HKM de Cotonou (Bénin): aspects épidémiologiques, cliniques et thérapeutiques.

OBJECTIVE: To determine the frequency of traumatic cataracts, to describe their epidemiological and clinical aspects, and to analyze the postoperative functional results. PATIENTS AND METHOD: We conducted a retrospective survey that covered the period from January 2000 to December 2003, during which 54 patients of all ages were treated for traumatic cataract. The epidemiological, clinical, and therapeutic parameters and the functional results were analyzed using the Epi info software, version 6. RESULTS: Traumatic cataracts accounted for 6.9% of all cataracts. The patients were aged from 3 to 59 years, with a mean age of 26.9+/-15.7 years; males were predominant (70.4%) with a ratio of 2.4. Schoolchildren were the most frequent (37%), followed by manual laborers (33.3%). The cataracts resulted from recreational accidents (37%), physical abuse (18.5%), fights (14.8%), and home accidents (13%). Total cataracts accounted for the majority of the cases (58.2%). Forty-three patients (78.2%) had unilateral blindness at the first consultation. Only 30 eyes out of 55 were operated (54.6%): 13 with simple extracapsular extraction and 15 with extracapsular extraction with implantation in the posterior chamber and two with extracapsular extraction with implantation in the anterior chamber. Ten eyes out of 30 (33.3%) presented intraoperative vitreous leakage. Only 11 eyes out of 15 recovered visual acuity corrected to 3/10 or better. DISCUSSION: Epidemiologically, the frequency of traumatic cataract doubled in 5 years, involving school-age boys most particularly. Unilateral cataracts are the rule. Anatomical and functional prognosis is worse for open injury. For different reasons, close to the half of the patients did not have surgery (44%). Among those that were treated surgically, few recovered corrected visual acuity better than 7/10. CONCLUSION: Traumatic cataract is an increasingly frequent condition, although in most cases unilateral. It poses the problem of childhood aphakia treatment.

[Congenital glaucoma at CNHU in Cotonou: a review of 27 cases]. / Le glaucome congenital au CNHU de Cotonou: a propos de 27 cas.

The authors presented the results of a retrospective study relating to 27 cases of congenital glaucoma indexed on the service of ophthalmology of CNHU at Cotonou over one 10 years period going from January 1, 1994 at December 31, 2003. Its frequency was 0.08%. The age at the time of the diagnosis varied from 1 day to 60 months, with a 8.1 months average. A male prevalence state noted (63%). The 27 children of our series belonged to 25 families of which 2 comprised each one 2 children reached. Consanguinity was found in 16% of the cases. The affection was bilateral in 25 cases (92.6%), that is to say on the whole 52 eyes reached. The pre-operative intraocular pression varied from 20 to 42 mmHg, with an average of 29.4 mm Hg +/- 6.5 mm Hg. The report ratio cup/disc went from 0.3 to 0.8 with an average of 0.6 +/- 0.2. On the 52 eyes reached, 43 were operated; all profited from a trabeculectomy. A pressional standardization was obtained in 65.2% of the cases after only one trabeculectomy with or without medical treatment. The authors insist to the preventive measures by a genetic counsel in the families with risk and also on a precocity of diagnosis and the surgical treatment.

Bilan des manifestations oculaires de la drepanocytose au CNHU-HKM de Cotounou

Introduction : Les manifestations oculaires representeraient 40des complications diverses de la drepanocytose et pourraient exposer a la cecite. Le but de notre travail est de determiner leur prevalence hospitaliere et de les decrire au plan clinique. Patients et Methodes : Nous avons realise une etude prospective du 15 mai 2006 au 14 mai 2007 a la clinique ophtalmologique du Centre National Hospitalier et Universitaire HKM de Cotonou. Ainsi 53 patients ont eu un examen ophtalmologique complet avec notamment une mesure de l'acuite visuelle; un examen du segment anterieur au biomicroscope; une mesure du tonus oculaire au tonometre a aplanation de Goldmann et un examen du fond d'oeil au verre a trois miroirs. Une angiographie a ete demandee en cas de lesions retiniennes. Resultats : La population; avec une predominance feminine de 54;7est constituee de 37 patients SS (69;8) et de 16 patients SC (30;2). L'age moyen est de 25;9 ans. 47;2des patients etaient des eleves ou etudiants. L'acuite visuelle etait superieure a 8/10eme dans 73;5et inferieure a 1/10eme dans 11;3. Les atteintes du segment anterieur etaient surtout conjonctivales avec 29 cas de subictere (54;7) et 25 cas de dilatation/tortuosites vasculaires (47;2) predominant dans la forme SS. Au niveau du segment posterieur; 63;2des yeux ont presente une atteinte retinienne (41 SS et 26 SC) ; la retinopathie etait proliferante surtout chez les SC avec 65;4et a predomine dans la tranche d'age de 10 a 24 ans. Discussion : Les manifestations conjonctivales seraient liees a l'hemolyse chronique et surviendraient surtout chez les patients SS. La frequence de l'atteinte retinienne pourrait etre sous estimee puisque l'angiographie fluoresceinique n'a pas ete systematique. Les formes proliferantes ont ete precoces et responsables de la baisse visuelle observee. Conclusion : Les atteintes oculaires sont frequentes au cours de la drepanocytose ; leur depistage passe par un examen ophtalmologique complet et angiographique regulier

[Intraocular pressure in the Benin: screening for primary open-angle glaucoma]. / Le tonus oculaire chez les Béninois: dépistage du glaucome primitif à angle ouvert.

PURPOSE: To describe the main characteristics of intraocular pressure (IOP) in Benin, the frequency of ocular hypertension (OHT) and primary open-angle glaucoma (POAG). MATERIAL AND METHODS: A retrospective study was conducted in a private ophthalmological clinic in Cotonou, Benin, between January 1 and June 30, 2001. It involved 4159 patients aged 20 years and over in whom IOP was systematically measured within a glaucoma screening program. The parameters studied were age, sex, and IOP. RESULTS: The patients recruited were between 20 and 85 years old. The age group from 41 to 50 years was the largest (30.1%); 56.4% of the sample were women. IOP values ranged from 8 to 60 mmHg: 52.3% were lower or equal to 13 mmHg. For both sexes, IOP followed a Gaussian distribution, with a peak between 11 and 13 mmHg. OHT frequency was 3.8%, with a male predominance and a regular increase with age. Among the OHT cases, 41.6% were isolated OHT and 58.4% of the POAGs turned out. Of the glaucoma patients, 16% were less than 40 years old, 25% were under 30 years old. CONCLUSION: In this study, it was found that the IOP peak was low and glaucoma appeared prematurely in the Beninese population. Glaucoma screening must therefore be set up from the age of 20 years and even earlier.

[Apert's syndrome: a case report]. / Le syndrome d'Apert: à propos d'une observation.

Apert's syndrome is a type of acrocephalosyndactylia that is from part of the great group of craniofacial synostoses. It is characterized by craniofacial dysmorphia and syndactylia on hands and feet, which differentiates it from Crouzon's disease. It is a rare affection that is often transmitted through an autosome dominant mode, but sporadic cases exist. We report the case of a 15-year-old girl who presented characteristic clinical signs of Apert's syndrome with normal karyotype without parental consanguinity. The Ser 252 Trp mutation of the FGFR2 gene was found, confirming the molecular diagnosis. This study illustrates the severity of ocular and neurological problems of untreated Apert's syndrome. The presence of hemoglobinopathy (Hb AS) is also a mark of its originality.

[A case of Waardenburg-Klein syndrome observed at the Cotonou NUHC]. / Un cas de syndrome de Waardenburg-Klein observé au C.N.H.U. de Cotonou.

Waardenburg-Klein syndrome is an "Oculo-dermato-auditif" dysplasia described in 1947 by Waardenburg and by Klein in 1950. Canthus dystopia and congenital deafness are the main symptoms. Three clinical types have been reported: type I: presents the full symptomatology; type II: without canthus dystopia; type III: presents not only the complete syndrome but also an orthro-osteomyodysplasia of the upper limbs. This clinical case in a small 3.5-year-old boy with congenital deafness, bilateral iris hypochromia and retina albinism without canthus dystopia was classed as type II Waardenburg-Klein syndrome. The patient had a second apparently fortuitous hereditary affection: hemoglobinopathy (Hb AS). But this seems to be fortuitous.