[Epidemiology and clinical pattern of ocular toxoplasmosis in Kinshasa]. / Profil clinique et épidémiologique de la toxoplasmose oculaire à Kinshasa.

PURPOSE: To determine the epidemiology and clinical pattern of Congolese patients with ocular toxoplasmosis. PATIENTS AND METHODS: A retrospective study was conducted on records of patients with ocular toxoplasmosis examined in the Teaching Hospital of Kinshasa (DR Congo) from 2010 to 2012. Each patient underwent a complete ophthalmic examination. Sociodemographic data, clinical symptoms and signs, visual outcome, modality of treatment and type of complications were studied. RESULTS: Thirty-five cases of ocular toxoplasmosis were diagnosed out of 18,144 patients, giving a frequency of 0.2 %. Eighteen men (51.4 %) were affected, with a sex ratio of 1.05. The mean age of the patients was 40.9±20 years (range: 10-72 years). The mean time until consultation was 10 months (range: 2 days-84 months). Ocular involvement was unilateral for 65.7 % of patients. Decreased visual acuity (77.1 %) and pain (7.1 %) were the main ocular complains. Chorioretinal lesions involved the central retina in 26 patients (74.3 %). Five patients (14.2 %) developed recurrences during follow-up. Complications affected 17 patients (48.6 %), with macular scarring (34.3 %) and cataract (17.1 %) being the most common. At the first consultation, 61.7 % of the affected eyes had visual impairment (VA<0.3). Visual impairment was associated with macular lesions (P<0.001, OR=3 [1.4-6.1]) and age greater than 45 years (P=0.002, OR=11 [2.2-53.6]). CONCLUSION: In our context, complications are common with ocular toxoplasmosis,s and they lead to visual impairment in the majority of patients.

Anterior uveitis as the first sign of human African trypanosomiasis: a case report.

We report the case of a 13-year-old girl who consulted for blurred vision, pain, and redness in her left eye. Ophthalmologic examination revealed chronic, hypertensive, and non-granulomatous anterior uveitis. The disease course was marked by a reversal of diurnal rhythm, with daytime sleepiness and behavioral disorders. A neuropsychiatric examination suggested human African trypanosomiasis (HAT), or sleeping sickness. The diagnosis was confirmed by the detection of Trypanosoma in the cerebrospinal fluid. The NECT regimen (nifurtimox-eflornithine combination therapy) was administered as medical treatment and resulted in the disappearance of all clinical signs. This observation suggests that the diagnosis of HAT can be considered in cases of anterior uveitis in individuals with a history of residence in or travel to an area endemic for it.

Frequency of prepapillary vascular loops in Congolese patients.

PURPOSE: To determine the frequency of prepapillary vascular loops in the population of Congolese patients. METHODS: We performed a retrospective cross-sectional and descriptive analysis of the data collected between January 2005 and August 2014 from patients diagnosed with prepapillary vascular loops, in an outpatient eye clinic, a general ophthalmology practice. RESULTS: Out of 16,016 patients seen during the study period, 24 patients (27 eyes) were diagnosed with prepapillary vascular loops, for a frequency of 0.15%. The mean age of the patients with prepapillary vascular loops was 37.8 years±14 (SD) (range, 18 to 60 years). Male were more frequently diagnosed with prepapillary vascular loops than female (62.5% vs 37.5%). Unilateral prepapillary vascular loops were found in 77.8% and bilateral in 22.2% of eyes. Most of PPLs were estimated to be arterial (88.9% of eyes) based on clinical observation alone, as fluorescein angiography was not systematically performed. Ophthalmoscopically, the vessels appeared as simple (44.6%) or took more serial turns (corkscew or spiral-shaped) (55.6%). The average length of PPLs was 1.02mm (range 0.6 to 1.5mm) with an orientation (an axis orientation) in the superior nasal sector (50%), inferior nasal sector (33%) and superior temporal sector (17%); and a mean axis of 143° relative to the horizontal. Refractive errors were found in 16 eyes (59.3%) and included simple myopia (4 eyes, 14.8%), myopic astigmatism (8 eyes, 29.6%), hyperopic astigmatism (one eye, 3.7%), hyperopia (3 eyes, 11.1%); One patient (one eye, 3.7%) with high hyperopia had anisometropia. Primary open angle glaucoma was found in 5 (18.5%) eyes; vascular tortuosity was seen in two (7.4%) eyes. No complication such as retinal arterial occlusion, vitreous hemorrhage, or any other complication was found. CONCLUSION: The frequency of 0.15% found in this study suggests that although rare, prepapillary vascular loops seem to be a bit more common in black people than in white and Asian people. An association between PPLs and refractive errors may be possible.

[Ocular manifestations of children living with HIV/AIDS in Kinshasa]. / Les manifestations oculaires chez l'enfant vivant avec le VIH/SIDA è kinshasa.

OBJECTIVE: to determine the frequency of ocular manifestations in Congolese children aged 0 to 15 years infected with HIV/AIDS and to identify the predicted clinical and/or biological elements. METHODS: This was a prospective, descriptive and cross-sectional study performed from November 2010 to April 2011 in five sanitary structures who take care of children infected with HIV/AIDS. During the period of study, one hundred children infected with VIH/AIDS were examined. Seventy- six (76%) of children were under highly active anti-retrovial therapy (HAART). The age of children ranged from 0,5 month to 15 years. Children underwent a routine ophthalmic examination which included measurement of visual acuity, inspection of the adnexa and cornea, slit-lamp examination and dilated ophthalmoscopy. The CD4 lymphocyte count was determined in 88 of them. RESULTS: The frequency of ocular manifestations was 36%. The mean age of children was 8 years (SD: 4.01; range 0,5 month-15 years). The male female sex ratio was 0.8/1. Ocular complaints were present in 22 children (22%). Visual symptoms were most frequent in children with severe decrease of immunity. Of four children identified with a visual handicap, one (1.5%) had blindness and three (4.4%) had visual impairment. All of these four children had a CD4 lymphocyte count less than 15%. Among ocular manifestations, the adnexial manifestations were the most frequent with 18 cases (18%) followed by the posterior segment manifestations with 14 cases (14%) and the neuroophthalmic lesions with 5 cases (5%). CONCLUSION: This study documented 36% of ocular manifestations; this frequency is comparable with the other African studies. Comparatively to studies conducted in other continents the frequency in African studies is high. This study also showed that the adnexial manifestations are the most frequent ocular findings and that the children with severe decrease of immunity are most exposed to visual troubles that can lead to blindness.

[Diabetic retinopathy in Lubumbashi]. / La rétinopathie diabétique à lubumbashi.

PURPOSE: To evaluate the frequency of diabetic retinopathy in Lubumbashi (Democratic Republic of Congo). METHODS: Descriptive survey including 369 diabetic patients examined in our department of Ophthalmology of Lubumbashi from May 2006 to March 2008. Rates of glycaemia and blood pressure were noted. All the patients had a complete ophthalmological examination including visual acuity measurement, anterior biomicroscopy, intraocular pressure and fundus examination after pupil dilation. RESULTS: At the time of ocular examination, the mean age of diabetic patients was 57 years (range 16 to 85) with a sex ratio of 1.2 males for 1 female. The frequency of type 1 diabetic patients was 28% and of type 2, 72%. High blood pressure was found in 42% of the patients. The frequency of diabetic patients (all forms included) was 13% and diabetes-induced blindness was 0.27%. In our study, the frequency of diabetic retinopathy increased with the patient's age and the duration of the diabetes. Diabetic retinopathy was more frequently found in adults. We did not find correlation between the level of glycaemia and the incidence of diabetic retinopathy. CONCLUSION: From our epidemiological study, diabetic retinopathy is a concern for adult public health. It requires organized screening and early treatment to prevent blindness of those diabetic patients.

Pseudoexfoliation syndrome in Congolese patients.

PURPOSE: To determine the frequency of pseudoexfoliation syndrome (PEX) in Congolese patients and its association with cataract and glaucoma. METHODS: We performed a cross-sectional and descriptive analysis of the data from patients diagnosed with PEX. Data were collected between February 2005 and June 2008 in a general practice of ophthalmology in Kinshasa. Patients aged 50 or above who attended the general practice of ophthalmology were included in the study. Each patient underwent complete ophthalmic evaluation, including visual acuity testing, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, and ophthalmoscopy. The diagnosis of PEX was based on presence of typical pseudoexfoliation material on the anterior lens surface and/or the pupillary margin in either or both eyes. RESULTS: Of 2142 patients seen during the study period, 37 (59 eyes) had PEX in either eye, for a frequency of 1.73%. The mean (±SD) age of the patients with PEX was 70.40 years±8 (range: 57-87 years). The frequency of PEX had a tendency to increase with age: 0.50% of patients aged 50-59 years had PEX, whereas 7.29% of those aged more or equal to 80 years were affected (P<0.0001), with a female predominance (2.18% of women versus 1.22% of men, P=0.035). PEX was bilateral in 22 (59.46%) of 37 patients (74.58% of eyes). Bilateral PEX was found more often in females (16 patients over 22, 72.72%) than in males (six patients over 15, 40%) (P=0.05). PEX was significantly associated with cataract (P=0.002) and glaucoma (P<0.001). CONCLUSION: Despite the limitations inherent in a clinic-based study, this investigation provides an indication of the frequency of PEX in Central Africa. This shows that Congolese patients have a low frequency of PEX (1.73%), inferior to that of black people in South Africa (12.1-16%). This study confirms that PEX is an age-related condition and is associated with cataract and glaucoma, as in other races.

Anaphylactic shock after fluorescein staining corneal abrasion. A case report.

A 34-year-old Lebanese man presented with photophobia, tearing, and reduced vision in the left eye, a few hours after being accidentally hit in the eye with a fingernail. The cornea in the left eye showed corneal defect . About three minutes after receiving topical fluorescein in this eye, the patient developed syncope and anaphylactic shock. After immediate reanimation, the patient regained consciousness. When specifically asked, he reported a three-month history of urticaria to the right side of his neck and nose. The possible pathophysiology involves an underlying IgE-mediated mechanism. Ophthalmologists should be aware of complications associated with topical fluorescein.

Epidemiology of traumatic and spontaneous subconjunctival haemorrhages in Congo.

PURPOSE: To determine frequency and associated conditions of subconjunctival haemorrhage METHODS: A descriptive and cross-sectional study of all consecutive patients with traumatic and spontaneous subconjunctival haemorrhage (SCH) examined between 1999 and 2004 in a general practice of ophthalmology. RESULTS: There were 58 (0.8%) patients with SCH (61 eyes) among 6843 consulting patients. They consisted of 34 (58.6%) women and 24 (41.4%) men, with a mean age (SD) of 30.7 years (16). Among the 58 patients with SCH, 30 (51.7%) had traumatic SCH and 28 (48.3%) had spontaneous SCH. In both populations of patients, females outnumbered males. The mean age was 35.5 and 26.4 years for patients with spontaneous and traumatic SCH, respectively (P = 0.04). Patients with spontaneous SCH presented earlier (< or = 3 days, P = 0.006) and complained of a red eye at a greater extent than patients with traumatic SCH (P = 0.02). There were no statistically significant differences between the patients with spontaneous and traumatic SCH with respect to gender (P = 0.75), eye involvement (P = 0.69), location of SCH (P = 0.23) and occupation of patients (P = 0.50). The condition was unilateral in 90% of eyes. Location of SCH was most found to be temporal (36.1%) or nasal (26.2%). In spontaneous SCH, no apparent associated condition was found in 64.3%. Hypertension (14.3%) was the most frequent associated condition. Other associated conditions were rare and included vomiting, sneezing, malaria, hypoglycaemia, sickle cell disease and delivery. In traumatic SCH, 67% injuries occurred at home. CONCLUSION: SCHs were seen in 0.8% of patients and occurred more frequently in women than in men in this study.

[Frequency and causes of blindness and poor vision in Congolese diabetic patients]. / Frequence et causes de la cecite et de la malvoyance chez les patients diabetiques Congolais.

OBJECTIVE: To determine the frequency and the causes of blindness and visual impairment among patients with diabetes mellitus from DR Congo. METHODS: In this observational study of series, records of all consecutive patients with diabetes mellitus seen between April 1, 2004 and April 30, 2006 in the Division of Ophthalmology, University of Kinshasa, were retrospectively assessed and included. Eye examination including measurement of visual acuity, slit lamp examination, funduscopy and tonometry was performed in all patients. Fluorescein angiography was performed when needed. The World Health Organization criteria and the recommendations for the revision were used for blindness and visual impairment definitions. RESULTS: During the study period, 299 patients with diabetes mellitus were examined, giving a frequency of 2% (299 out of 13401 patients). There were 194 males (65%) and 105 females (35%). Ages ranged from 21 to 88 years (mean age+/-SD, 58 years+/-10). The mean duration of diabetes mellitus was 7+/-8 years and its median duration was 4 years. Frequency of blindness and that of visual impairment were 12% and 24%, respectively. Causes of blindness were diabetic retinopathy (47%), cataract (33%), glaucoma (17%) and optic nerve atrophy (2.8%). CONCLUSION: This study shows an unexpected higher frequency of blindness in diabetic patients when compared with previous African studies and those of other parts of the world. Blindness seemed to appear early in Congolese diabetic patients than in Caucasian diabetic patients. Diabetic Retinopathy remains the common cause of blindness among Congolese diabetic patients. Programmes must be drafted for prevention, early detection and treatment of blindness among diabetics.

[Intralesional corticosteroid injection in the treatment of chalazion]. / Injection intra lésionnelle de corticoïde dans le traitement du chalazion.

OBJECTIVE: To evaluate the efficacy of intralesional corticosteroid injection in the treatment of chalazia in black African patients. METHODS: In a prospective study conducted between February 1999 and February 2000, 25 black African patients with chalazion (25 eyes, 29 chalazia), ranging in age from 15 to 54 years (mean age +/- SD, 30.6+/-9 years), were treated with intralesional triamcinolone (injection of 0.075 - 0.5 ml triamcinolone acetate at a 5-mg/ml concentration). RESULTS: Success was achieved in 18 (72%) of 25 patients [20 (74%) out of 27 eyes, 22 (76%) out of 29 chalazia)]. In 11 of 25 patients, two intralesional injections were necessary to obtain these results. Recurrence occurred in five eyes (five chalazia, 17%) after 5-6 weeks. During a mean +/- SD of 4.68 months (range, 3.5-12 months) of follow-up, no postinjection ocular complication occurred. CONCLUSION: Intralesional corticosteroid injection appears to be effective in managing chalazion in black African patients, as reported in previous studies in Caucasian patients. This treatment can be used when curettage is contraindicated.

Ocular emergencies in Kinshasa (Democratic Republic of Congo).

PURPOSE: To determine frequencies of ocular emergencies and identify their nature. DESIGN: Observational case series. METHODS: In a retrospective study, the records of all 118 consecutive patients seen in emergency room during an eleven-month period were reviewed. RESULTS: Ocular emergencies represented 4% of the 2917 new patients visiting the department of Ophthalmology during this time. There was a 2.1/1 male to female preponderance and a peak age of presentation between 11 and 30 years. The mean age was 26 years +/- 17. Ocular trauma (68 patients) accounted for over two-fourths (57.6%) of the total cases. Only 16% of patients presented within 48 hours. Fifty-one percent of injuries occurred to the left eye, 38% to the right, and 10% bilaterally. The commonest ocular injury problems were eyelid laceration (13 patients, 19.1%), post-traumatic iritis (12 patients, 17.6%), and corneal laceration and penetration (10 patients, 14.7%), accounting for 51% (35 patients) of the total. Home- and work-related ocular injuries accounted for 54% of all ocular injuries. Thirty-three percent of all ocular injuries were caused by assault and fight, and 15% were related to motor vehicle accident. For the non-traumatic ocular emergencies, the main aetiological factor was inflammation (18%). CONCLUSION: Our study showed that males account for the majority of eye injuries and this class is more prone to assault-related injuries. In our country prevention strategies must take account of these.

Color vision in 42 Congolese patients with tuberculosis receiving ethambutol treatment.

PURPOSE: To study color vision in Congolese patients with tuberculosis receiving ethambutol therapy. METHODS: A prospective, descriptive study of color vision test in patients with systemic tuberculosis receiving ethambutol was performed between April 1995 and January 1998 at the Department of Ophthalmology, University of Kinshasa. Color vision tests were assessed with pseudoisochromatic plates (the Ishihara Pseudo-isochromatic Plates), the AO-HRR (American Optical Handy Rand Rittler), the Bölle and Kastel anomaloscope, Farnsworth-Munsell test (the D-15 and the FM-100). RESULTS: There were 42 patients with a mean age of 33 years (range, 14 to 75 years). The color vision of all the patients was found to be normal as measured by the Ishihara pseudoisochromatic plates. One (2%) patient showed color vision defect (anarchic axis] with the OA-HRR test. Three (7%) of 42 patients displayed blue-yellow color axis or anarchic axis color vision test on the D-15 test. Fifteen (36%) of 42 patients had high total error scores at the Farnsworth-Munsell 100 test. The color axis was as follows: anarchic axis (13.1%), red-green-color and blue-yellow-color combined axis (13.1%), blue-yellow color axis (7.5%). Results of the Bölle and Kastel anomaloscope were normal in all patients. CONCLUSION: Our results confirm the importance of color vision examinations in the detection of the complications of ethambutol treatment.

Corneal hydrops associated with vernal conjunctivitis as a presenting sign of keratoconus in a Congolese child.

PURPOSE: To report a case of unilateral corneal hydrops associated with vernal conjunctivitis as a presenting sign of keratoconus. METHOD: Case report. A 10-year-old girl with corneal hydrops of the left eye. RESULT: Visual acuity in the affected eye was hand motions and slit-lamp examination revealed a left keratoconic, ectasis, edematous cornea with mild vernal conjunctivitis. CONCLUSION: Hereditary and environmental factors may contribute to the etiology of keratoconus and corneal hydrops.

Presenting signs of retinoblastoma in Congolese patients.

OBJECTIVE: To report the relative frequency of the signs of presentation in Congolese children with retinoblastoma. METHODS: A retrospective study was undertaken of all (29) patients with retinoblastoma examined between January 1995 and December 2000. RESULTS: There were 19 (66%) boys and 10 (34%) girls. For all cases, mean age at diagnosis was 2.94 years +/- 1.6 (range, four months to six years). For bilateral cases, it was 1.12 year +/- 1.4 (range, two months to three years) whereas for unilateral cases it was 3.23 years +/- 1.5 (range, four months to six years) (P = 0.016). More than seven distinct signs were identified. Leukocoria was the most common presenting sign in 49% of diagnosed cases followed by proptosis (28%). Other signs were strabismus, red eye, anterior scleral staphyloma, hyphema and buphthalmia. CONCLUSION: Strabismus seemed to be uncommon whereas proptosis is important in our small series when compared to signs reported in the developed world.

Ocular findings in children with homozygous sickle cell disease in the Democratic Republic of Congo.

OBJECTIVE: The purpose of the study is to determine the frequency of ocular manifestations in Congolese children with homozygous sickle cell disease. METHODS: Sixty-six children with homozygous sickle cell disease were examined for ocular abnormalities between March 1 and August 31, 1998. The ages of children ranged from two to 18 years. Routine ophthalmic examination included measurement of visual acuity, inspection of the adnexa and cornea, refraction, silt-lamp examination and dilated ophthalmoscopy. RESULTS: Ocular abnormalities were found in 47 (71%) children of 66 subjects. Ophthalmologic abnormalities included conjunctival signs (32%), retinal vascular tortuosity (29%) and dilatation (26%), AV crossing (29%). CONCLUSIONS: Ocular findings in this study were similar to those previously published in Africa, which showed a low frequency of retinal changes.

Outer orbital distance, inner canthal distance and interpupillary distance, proptosis in children with homozygous sickle cell disease.

BACKGROUND: On basis of clinical observation paediatricians in Kinshasa had the impression that children with homozygous sickle cell disease have a special face characterised by hypertelorism. OBJECTIVE: The purpose of the study is to determine outer orbital, inner canthal and interpupillary distances as well as proptosis in children with sickle cell disease. METHODS: These measurements were performed on 66 Congolese children with homozygous sickle cell disease, aged from 2 to 18 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 and with a ruler for the inner canthal distance. The results were compared with those of 95 healthy children of similar age. RESULTS: All measurements were age related. In every age group the values for inner canthal distance were identical to those of healthy children, but the interpupillary, the outer orbital distances and the proptosis were significantly smaller. CONCLUSIONS: A slow growth of orbital tissue in children with homozygous sickle cell was suggested to explain the difference with healthy children. Other biometric studies comparing the orbital measurements with the rest of the body are needed to confirm or refute this hypothesis.

Severe subconjunctival haemorrhage associated with malaria.

PURPOSE: To describe a patient with sudden onset of subconjunctival haemorrhage related to malaria. METHODS: A case report. RESULTS: The patient, who had a history of malaria, had bilateral subconjunctival haemorrhages. General examination showed no abnormality except malaria. All signs of conjunctival haemorrhages resolved later. CONCLUSION: Ocular malaria should be considered in the differential diagnosis of subconjunctival haemorrhages.