[Juvenile glaucoma in Cameroon]. / Le glaucome juvénile au Cameroun.

AIM: To determine the prevalence and the visual morbidity of juvenile glaucoma in an urban black population. MATERIAL AND METHODS: A retrospective analysis of 1343 files of glaucomatous patients was carried out from January 1991 to December 2001 at the Douala General Hospital in Cameroon (Central Africa). Ninety four of them had juvenile glaucoma. Of the patients, 54 (57.4%) were males and 40 (42.6%) were females. Each subject underwent the following investigations: visual acuity, visual field testing, slit lamp examination, applanation tonometry, gonioscopy, and optic disc examination and photographies after mydriasis. RESULTS: The prevalence of juvenile glaucoma in our population was 0.4%. The mean patients age at diagnosis was 26 +/- 6.8 years (range, 10 to 35 years). Among them, 88.3% had a positive family history of glaucoma. The mean intraocular pressure at diagnosis was 28.2 +/- 9.3 mmHg (range: 14 to 56 mmHg). It was lower than 21 mmHg in 5.3% of the cases. The mean recorded cup/disc ratio at diagnosis was 0.7 +/- 0.3. It was equal to 1.0 in 25.6% of the cases. Gonioscopy showed that the angles were open, with no abnormal pigmentation, iris processes, or embryonic tissue. The prevalence of monocular and bilateral blindness was 3.2% and 33% respectively at the first examination. The affected eye was blind in 50% (6/12) of patients with unilateral juvenile glaucoma. The mean IOP of the treated 166 eyes with topical medications decreased from 28 +/- 8.7 mmHg (range: 15 to 56 mmHg) to 19.1 +/- 8 mmHg (range: 8 to 48 mmHg) after a follow-up period average 1.6 +/- 2.3 years (range: one month to 11 years). Trabeculectomy was required in 10 eyes. Follow-up period of surgery ranged from 1 to 8 years (mean 3.8 +/- 3.3 years). The mean IOP decreased from 30.8 +/- 14 mmHg (range: 17 to 54 mmHg) preoperatively to 15.7 +/- 4.6 mmHg (from 10 to 25 mmHg) postoperatively. CONCLUSION: This study confirms the high prevalence of juvenile glaucoma among black Cameroonian population. The screening, the treatment as well as the genetic studies of this glaucoma bump into strong economic contingencies in our regions. In the cases where topical medications were ineffective in controlling IOP, surgery was needed to obtain long-term pressure control.

[Post-traumatic glaucoma with irido-corneal angle injuries in Cameroon]. / Le glaucome post-traumatique a angle ouvert au Cameroun.

AIM: To study the particularities of late post-traumatic glaucoma with irido-corneal angle injuries in black Cameroonians. MATERIAL AND METHODS: Retrospective analysis of 1343 files of glaucomatous patients was carried out from January 1991 to December 2001 at the Douala General Hospital in Cameroon in Central Africa. Fifty seven of them had post-traumatic glaucoma. Of these 28 were secondary to irido-corneal angle injuries. RESULTS: The prevalence of post-traumatic glaucoma related to irido-corneal angle injuries in our population was 2.1%. The mean patients age was 45.9 +/- 18.3 years (range, 17 to 67 years). The time from injury to diagnosis ranged from 1 year 4 months to 7 years (median: 3.7 years). The follow-up period ranged from 3 months to 5 years 6 months, with a mean of 1.7 +/- 1.9 years. The prevalence of monocular blindness was 61.9% and 81% at the first and last examination respectively. The mean intraocular pressure was 36.9 +/- 13.8 mmHg (range: 22 and 66 mmHg) at the first examination and 24.3 +/- 13 mmHg (range: 12 and 29 mmHg) at the last examination. The mean recorded cup/disc ratio was 0.8 +/- 0.2. It was equal to 1.0 in 61.9% of cases. Irido-corneal angle recession was the most common lesion (61.9%) followed by iridodialysis (38.1%) and cyclodialysis (14.3%). Normalization of the intraocular pressure was achieved with medical treatment in 23.8% and with trabelectomy in 12.3% of the cases. Neovascular glaucoma was found in 4.8% of the cases. CONCLUSION: The treatment of secondary post-traumatic open angle glaucoma is disappointing. The patients are young, the disease is advanced, and the compliance and follow-up are poor. The prevention of post-traumatic glaucoma is based on the control of ocular trauma and the periodic follow-up of patients with and history of non perforating injury of the eye.

[Les amétropies statiques du noir camerounais]. / Static ametropias in black Cameroonian.

PURPOSE: We undertook this study with the aim to determine static ametropias of black Cameroonians as well as their clinical manifestations. It is a prospective study carried out in the Department of Ophthalmology of Douala General Hospital from January 1996 to December 1998. PATIENTS AND METHOD: During this period, all patients who fulfilled our criteria had a skiascopy done under cycloplegia. We thus examined 2,484 patients (4,968 eyes). 66.2% of them were female and 33.8% were male. RESULTS: In our series, hyperopia was found in 51% of the cases, hyperopic astigmatism in 27.5% of the cases, myopic astigmatism in 9.3% of cases, mixed astigmatism in 7.7% of cases and myopia in 4.5% of cases. Distribution of ametropias is influenced by age, not by sex or laterality. DISCUSSION AND CONCLUSION: Functional signs just have an indicative value; only objective refraction under cycloplegia can determine exactly the ametropia.

Ocular complications of leprosy in Cameroon.

PURPOSE: This study aimed to identify the main ocular complications of leprosy in Cameroon. PATIENTS AND METHODS: It is a prospective cross-sectional study which took place from July 1998 to January 1999 in five leprosaria in Cameroon. The ophthalmological examination of all patients was performed by the same team. RESULTS: Of the 218 patients examined, 60.1% were males and 39.9% females. 72.5% had a paucibacillary leprosy and 27.5% a multibacillary form. 77.5% of patients had at least one ocular lesion and 38.3% of eyes had visual acuity < or = 1/10. Madarosis and anterior uveitis were more frequent in multibacillary forms while lagophthalmos and cataract were so in paucibacillary forms. CONCLUSION: Ocular complications are frequent in leprosy in Cameroonians. It is a true public health problem and it is important to prevent these lesions by early diagnosis and adequate treatment.

[Uveitis: epidemiological aspects at the Hospital Laquintinie de Douala]. / Les uvéites: aspects épidémiologiques à l'hôpital Laquintinie de Douala

PURPOSE: This retrospective study was carried out to determine the epidemiological characteristics of uveitis in our country. PATIENTS AND METHODS: 38 patients, of 5,420 consulted, presented with uveitis (0.7%). 13 of them were female and 25 were male. Their ages ranged from 10 to 17 years (mean 33.9 years). RESULTS: The uveitis was unilateral in 81.6% of the cases, and the anterior form was found in 51.1% of the cases. An etiology was identified or suspected for 24 patients (63.1%), the most frequent being sinusitis (45.8%) and toxoplasmosis (29.2%). The treatment was generally effective (status improved in 72.2%), although 2 patients (3 eyes) lost their vision. DISCUSSION AND CONCLUSION: In spite of the low frequency of this disease, ophthalmologists are concerned about uveitis because of the difficulty of its etiological diagnosis and its ineluctable evolution, sometimes to blindness.

[Hereditary factors in strabismus]. / Les facteurs héréditaires dans le strabisme.

This retrospective study took place in the Ophthalmology Department of Douala General Hospital. The aim was to determine the importance of hereditary factors in a group of strabismic Cameroonians. In a series of 275 patients with strabismus, we found 79 familial cases (28.72%). Among them, 22.78% had more than one relative with squint and 75% had the same type of strabismus as their relative. There was no significant difference in the percentage of familial cases with regard to the type of strabismus, the sex, the mode of fixation and the impairment of ductions. As far as ametropias are concerned, only myopia showed a hereditary tendency in our series. The authors agree with the literature in that there is a significant hereditary component in the cause of strabismus, but its genetic sites are yet to be identified. There is strong hope in this direction with the decoding of the human genom and the advances in molecular biology. However, the study of familial cases is important since it allows high risk groups to be defined and screened. It thus makes it possible to successfully fight amblyopia through early detection and treatment.

[Autologous blood injections for treating hypotonies after trabeculectomy]. / Injections de sang autologue dans les hypotonies après la trabéculectomie.

The authors carried out a retrospective study in order to assess the efficacy of intrabled autologous blood injections after trabeculectomy. The indication for treatment was hypotony associated with overfiltration. Twelve eyes of 12 patients including seven men (58.3%) and five women (41.67 %) underwent from one to four (mean 1.7) subconjunctival injections. The age of the patients ranged from 31 to 66 years (mean 52.4 years). All the patients were diagnosed with open-angle glaucoma. Three eyes underwent trabeculectomy with mitomycine C, one with 5-fluorouracil and eight with no antimetabolite. The mean post-needling period was 12.3 months (ranging from 7 to 28 months). After intrabled blood injections, the average intraocular pressure increased from 2.7 1.2 mmHg (ranging from 0 to 6 mmHg) to 8.2 4.2 mmHg (ranging from 4 to 16 mmHg). The difference was statistically significant (P < 0.5). After treatment, the average visual acuity increased from 1.8/10 to 3.2/10. This difference was not statistically significant (P > 0.5). However, the procedure was ineffective in two patients (16.7%) as regards intraocular pressure and in seven patients (58.3%) as regards visual acuity. Hyphema, the most frequent complication (58.3% of our cases) is usually small, transient, and without sequelae. Although it may be delayed, it may be important and it induce intraocular hypertony (10% of our cases) or it may be associated with intravital blood.

[Ocular traumatism in children at Laquintinie Hospital, Douala (Cameroon)]. / Traumatologie oculo-orbitaire infantile à l'hôpital Laquintinie de Douala (Cameroun).

Pediatric ophthalmology is poorly developed in Cameroon. However, efforts are being made to collect data essential for the development of national strategies to combat blindness. We relate our experience, within this framework, at a large public hospital in Cameroon. We carried out a retrospective study covering the period from June 1993 to May 1998, studying the medical files of children under the age of 15 years with ocular traumatism. Data were collected from 144 files. The frequency of ocular/orbital injury was 7.8% and was the third most common condition, after ametropia and kerato-conjunctivitis, in this population. The mean age of the children was 7 years and 3 months and more boys (64%) than girls were affected. Ocular lesions were due to contusion in 83.3% of cases. The principal causes of the trauma were children's games (40.2%), and punishment by parents or teachers (23.7%). The ocular lesions were similar to those described in previous studies. Infection was rare, because the interval from trauma to consultation was very short. The functional prognosis was severe, with 24.3% of patients having final vision less than 1/10. We recommend that children should be informed about the dangers of violent games and that parents and teachers should be made aware of the dangers associated with brutality towards children. Finally, ophthalmologists should ensure that the injured eye is treated rapidly and carefully so as to minimize functional sequelae.

[Sensory heterotropias: epidemiological aspects at Douala General Hospital (Cameroon)]. / Les tropies sensorielles: aspects épidémiologiques à l'Hôpital général de Doula (Cameroun).

The aim of this retrospective study was to determine the epidemiological characteristics of the sensory heterotropia cases seen in the Opthamology Department of Douala General Hospital between November 1991 and November 1999. Sensory heterotropia accounted for 22.5% of the cases of strabismus reported. Onset was before the age of one year in 80.4% of cases and after the age of one year in 19.6% of cases. All cases of esotropia were apparent before the age of one year. Sensory heterotropia was associated with amblyopia in 89.3% of cases, with eccentric fixation in 78.6% of cases and with nystagmus in 53.6% of cases. Etiology was diverse, the most frequent causes being: albinism (19.6%), chorioretinal scars (16.1%), unilateral cataracts (16.1%), atrophy of the optic nerve (16.1%) and ametropia (8.9%). We recommend preventive measures for some etiologies.

[Visual problems in albinos: a hospital study carried out at the Douala General Hospital]. / Les troubles visuels de l'albinos. Etude hospitalière réalisée à l'Hôpital général de Douala.

We report here a clinical study investigating the main visual problems associated with albinism, with a view to determining the best treatment. We came across 42 cases of albinism during the course of this study, corresponding to a prevalence for albinism of 0.15%. One in ten albinos were of the yellow mutant type and more of the albinos were men than were women (sex ratio 1.21). The maximum visual acuity recorded was 3/10 and 40.47% of the patient had a best visual acuity score no higher than 1/10. Vision was best in the yellow mutants and it improved with age. We found that 33.33% of the albino patients had a squint and 35.71% had torticullis at primary fixation. In contrast to the results of previous studies, the most common ametropia was myopic astigmatism (61.9%). These findings have potential implications for the treatment of visual problems in albinos.

[Exotropia in black Cameroonians]. / Léxotropie chez le Noir camerounais.

We carried out this study to increase our knowledge and understanding of exotropia (divergent strabismus) in general, but particularly in black people, in whom it occurs more frequently. We carried out a prospective study in the department of ophthalmology of Douala General Hospital from November 1991 to June 1998. All patients underwent oculomotor examination and skiascopye. In a series of 225 consecutive strabismus cases, we identified 147 cases of exotropia (59.51%) in 67 male patients (45.58%) and 80 female patients (54.42%). In 59.86% of these cases, exotropia was evident before the age of one year and 59.19% had amblyopia. The mean age at first examination was 17.04 years (+/- 12.12 years). Hyperopia was the most common form of ametropia (59.86%) and 39 patients (26.53%) had parents, children or siblings who also had exotropia. We found that exotropia was the most common form of strabismus in black people in Cameroon and that it spontaneously progressed to amblyopia in a significant number of cases. We therefore recommend early, active treatment.

[Intraocular pressure in a young Cameroonian population]. / Etude de la pression intraoculaire dans une population de jeunes Camerounais.

Glaucoma is one of the major causes of blindness throughout the world; mostly because patients come to consultation late. We performed a prospective study of the intraocular pressure, fundus and perimetry in 307 young Cameroonians (20 to 39 years old). Glaucoma was found in 5.8% of cases. This study shows that the disease appears early in black people and must be detected in patients under 40 years old.

[Strabismus in Cameroon]. / Le strabisme au Cameroun.

PURPOSE: We undertook a study on strabismus in order to determine the characteristics of this disease in Cameroon. MATERIAL AND METHODS: A prospective study was carried out in the ophthalmological unit of the Douala General Hospital from November 1991 to October 1995. All patients were examined and followed regularly by the same team. RESULTS: We found 137 strabismus, which represent 1.22% of all patients with 51 esotropias (37.2%) and 86 exotropias (62.8%). The mean age was 13.61 years at the first consultation. 82.4% of convergent strabismus appeared before the age of one year against 67.4% of divergent strabismus. Moreover, amblyopia was found in 68.6% and 59.3% of cases respectively. CONCLUSION: As compared to European series, this study shows notably the great frequency of divergent squint in black africans and the fact that spontaneous evolution of the latter can lead to amblyopia in a large number of cases.

Pterygium: epidemiological, clinical and therapeutical aspects at the Douala General Hospital.

Authors report the results of a retrospective study of epidemiological, clinical and therapeutical aspects of pterygium carried at the ophthalmological service of the Douala General Hospital. During the period of the study, 167 patients with pterygium were registered, which means a prevalence of 1.10%. The mean age of the patients was 41.76 years with standard deviation of 10.89. The noticed that men were a little bit predominant as compared to women with respectively 54.8% and 45.2% of cases. The pterygium were in the nasal side in 93.66% of cases and bilateral forms represented 31.73% of cases. 67 eyes were operated by excision technic more often associated to conjunctival translation. The relapse rate at 6 months was 7.44%. Authors recommend: 1 degree)-not to operate small and non-evaluative pterygium 2 degrees)-to use a magnifying system and if possible the operatory microscope 3 degrees)-to institute systematically an early, intensive, prolonged but degressive corticotherapy after surgery. 4 degrees)-to prescribe tinted or photochromic glasses to patients.