[Etiologies of papilledema in Cameroonian hospitals]. / Etiologies des œdèmes papillaires en milieu hospitalier camerounais.

Introduction: papilledema refers to the swelling of the head of the optic nerve, a major sign of many local, locoregional or systemic pathologies that may involve patients' visual or vital prognosis. This condition represents a diagnostic and therapeutic emergency frequently encountered in our facilities. Therefore, it is deemed and opportune to identify the most common etiologies observed in Cameroonian hospitals. Method: we conducted a documentary and descriptive study of patients with papilledema presenting to the Ophthalmology Department of the Hospital of Instruction, Application and Reference of the Armed Forces of Yaoundé from 1st October 2013 to 31st December 2016. The variables under investigation included epidemiological data (age, sex), clinical data (functional signs, visual acuity, appearance of the papilla and associated signs according to the Hoyt and Beesten classification), complementary examinations performed (fluorescein angiography, visual field, biology, radiography, CT scan) and the etiological diagnosis. Epi-info 3.5.3 software was used for statistical analysis and the Chi-square test was performed at a 5% significance level (p < 5%). Results: during the study period, papilledema was found in 26 out of 5023 patients, reflecting a rate of 0.5%. The average age of patients was 32.7± 10.9 years, ranging from 7 to 79 years, for 13 women and 13 men. Papilledema was bilateral in 15 (57.7%) patients and unilateral in 11 (42.3%), or 41 affected eyes. The etiologies were 11 (42,3%) inflammatory optic neuropathies, 5 (19,2%) arterial hypertension, 4 (15,4%) central retinal vein occlusions, 3 (11,5%) eye contusions, 2 (7,7%) hydrocephalus and 1 case (3,9%) of cerebral malaria. Conclusion: inflammatory and vascular optic neuropathies were the most common etiologies of papilledema in our facilities.

Assessment of Systems and Services for Management of Diabetes and Diabetic Retinopathy in Cameroon.

AIM: To evaluate systems and services for management of diabetes and diabetic retinopathy. METHODOLOGY: The National Program for Blindness Control conducted a nationwide descriptive study from 1st February to 31st October 2016. Data was collected using WHO's:"Tool Assessment of Diabetic Retinopathy and Diabetes Management Systems" adapted to the context. Using direct interviews, all previously identified stakeholders, were involved from all levels of management and throughout the territory. The IBM version 20 software permitted analysis. RESULTS: Out of the 48 individuals selected, 46 agreed to participate in the survey. Four participants (8.7%) worked at the central level of the Ministry of Public Health, 2 (4.4%) were NGOs partners, 6 (13%) diabetic patients, and 34 (73.9%) health staff. According to the answers of participants, diabetes stands among priorities in the national health policy. Diabetic care services have been integrated into the National action plan for Chronic Non-Communicable Diseases, but a specific program for control of diabetes has not been created neither are national guidelines recommended by the Ministry available. Some health facilities provide care for diabetes and its complications. Modern technologies for evaluation and follow-up of diabetes of its complications are available only in tertiary level hospitals and in some private clinics. The cost of care obtained is the responsibility of the patients and families. CONCLUSION: The political will to manage diabetes and diabetic retinopathy is recognized by stakeholders and beneficiaries but not translated into an effective program. A suitable implementation strategy is necessary.

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.].

Epidémiologie et clinique des occlusions veineuses rétiniennes en milieu hospitalier camerounais

But. Décrire les caractéristiques épidémiologiques et cliniques des occlusions veineuses rétiniennes en milieu hospitalier camerounais. Patients et Méthodes. Cette étude transversale descriptive a porté sur 5055 dossiers de patients diabétiques examinés de Janvier 2010 à Décembre 2015 au Centre de Référence de Rétine pour la Prévention et de Prise en Charge de la Rétinopathie Diabétique de Yaoundé. Les variables étudiées incluaient l'œil atteint, la topographie des lésions, le type d'occlusion et les principaux facteurs de risque. Résultats. Soixante dix cas (72 yeux) d'occlusions veineuses rétiniennes ont été observés, soit une prévalence hospitalière de 1,38%. L'âge moyen des patients était de 61± 5,6 ans et le sex ratio de 1,33. L'œil droit était atteint dans 43 (62,26 %) cas. L'occlusion était de branche veineuse dans 44 (61,10 %) yeux et centrale dans 28 (38,88 %). Le type œdémateux prédominait avec 38 (54,90%) cas suivi de l'ischémique avec 27 (37,59 %) et du mixte avec 5 (7,48 %) cas. Les facteurs de risque étaient principalement l'hypertension artérielle avec 15 (21,42 %) cas, le diabète de type 2 avec 12 (17,14 %) et l'hypertonie avec 10 (14,28 %). Conclusion. Les occlusions veineuses rétiniennes sont fréquentes et devraient faire l'objet d'une recherche étiologique systématique pour chacun des cas dans notre milieu

La rétinopathie du prématuré en Centrafrique : résultats de l'examen du fond d'œil chez 88 nouveau-nés au complexe pédiatrique de Bangui

Introduction. Les auteurs ont examiné les prématurés au Complexe Pédiatrique de Bangui, dans le but d'évaluer les facteurs de risque de survenue de la rétinopathie du prématuré et les modalités de dépistage de cette maladie en Centrafrique. Patients et méthodes. Il s'agit d'une étude transversale prospective analytique de Janvier 2012 à Décembre 2014 à la Clinique Pédiatrique de Bangui. Tous les prématurés nés avant 32 semaines de gestation ou ayant un poids de naissance inférieur à 1500 grammes ont bénéficié d'un examen du fond d'œil à 5 semaines de vie. Le matériel utilisé était composé d'un ophtalmoscope binoculaire indirect Neitz, assorti d'une source d'alimentation électrique portative Zeiss/Opton, de deux lentilles d'examen 20 et 28 dioptries, d'un mydriatique (tropicamide®) et d'un anesthésique de contact. Les lésions observées ont été réparties selon la classification de Calgary. Résultats. 88 prématurés dont 39 garçons (44,3%) et 49 filles (55,7%) ont été étudiés. Leur âge gestationnel moyen était de 29,2 ±2,8 semaines et le poids de naissance moyen de 1205 ± 255 grammes. L'examen a été satisfaisant dans tous les cas. Le diagnostic de rétinopathie a été posé chez 29 (32,95%) prématurés, dont 12 garçons (41,4%) et 17 filles (58,6%), avec une atteinte bilatérale chez tous. 28 enfants sur 31 (90.3%) avaient des lésions minimes ou modérées et toutes ont régressé spontanément sans laisser de séquelle. Dix décès ont été enregistrés durant le suivi. Conclusion. L'ophtalmoscope binoculaire indirect est l'outil de choix pour le dépistage de la rétinopathie des prématurés et le tropicamide peut être utilisé sans effets indésirables pour obtenir une mydriase adéquate. Le poids de naissance et l'âge gestationnel sont deux facteurs de risque à considérer. Le risque semble être le même que l'enfant soit sous oxygène ou non

Eye malformations in Cameroonian children: a clinical survey.

SUMMARY: The aim of this work was to describe the clinical aspects of eye malformations observed at the ophthalmology unit of the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital. PATIENTS AND METHODS: We carried out a retrospective study of all malformations of the eye and its adnexae observed among children aged 0-5 years who were seen at the ophthalmology unit from January 2003 to December 2009. RESULTS: Out of the 2254 children who were examined, 150 (6.65%) presented eye malformations. The mean age was 14.40 ± 4 months. Eye malformations were diagnosed in 71.66% of cases during the first year of life. The most frequent malformations were congenital lacrimal duct obstruction (66.66%), congenital cataract (10.9%), congenital glaucoma (10.9%), microphthalmos (5.03%), and congenital ptosis (3.77%). CONCLUSION: Eye malformations among children can lead to visual impairment and are a cause for discomfort to children and parents. Therefore, systematic postnatal screening is recommended to enable early management.

Diabetic retinopathy at the Yaoundé Central Hospital in Cameroon: epidemiology and angiographic findings.

We carried out a cross-sectional analytical survey using data from patients who had done Fluorescein Angiography at the Yaounde Central Hospital Diabetic Retinopathy Prevention and Management Project between October 2007 and January 2010 to identify the risk factors, incidence and severity of different types of diabetic retinopathy. Data from 239 males (57.0%) and 180 females (43.0%) with diabetic retinopathy were included. Their mean age was 58.2 years. A majority of them were living with type II diabetes (96.2%). The mean duration of diabetes was 8.2 years. About sixty percent had both diabetes and hypertension. The average level of glycated haemoglobin was 9.72% (range 6-17.7%). Amongst the 419 patients with diabetic retinopathy, 292(69.7%) had non-proliferative diabetic retinopathy. One hundred and twelve (26.7%) of those with proliferative diabetic retinopathy had a formal indication for laser photocoagulation. Fifteen patients (3.6%) presented with complicated forms of proliferative diabetic retinopathy. Diabetic maculopathy was present in 30 patients (7.2%). Diabetic retinopathy is a frequent complication of diabetes in our setting which stems from inadequate emphasis on preventive measures. The technical requirements for managing some of the existing complications are still unavailable. Fluorescein Angiography is an important diagnostic tool which should be popularized.

Prevalence and causes of blindness at a tertiary hospital in Douala, Cameroon.

PURPOSE: The aim of this study was to determine the prevalence and causes of bilateral and unilateral blindness in the town of Douala and its environs based on data from the ophthalmic unit of a tertiary hospital in Douala. METHODS: We conducted a retrospective epidemiological survey of consultations at the eye unit of the Douala General Hospital over the last 20 years (from January 1, 1990 to December 31, 2009). RESULTS: Out of the 1927 cases of blindness, 1000 were unilateral, corresponding to a hospital prevalence of 1.84% and 927 cases were bilateral, corresponding to a hospital prevalence of 1.71%. No statistically significant difference was noted between the two (P = 0.14). The leading causes of bilateral blindness were cataract (50.1%), glaucoma (19.7%), and diabetic retinopathy (7.8%) while the leading causes of unilateral blindness were cataract (40.4%), glaucoma (14.1%), and retinal detachment (9.1%). Cataract (51.2%), cortical blindness (16.3%), and congenital glaucoma (10%) were the leading causes of bilateral blindness in children aged less than 10 years. CONCLUSION: Blindness remains a public health problem in the Douala region with a hospital prevalence which is relatively higher than the national estimate given by the National Blindness Control Program.

Indications for destructive eye surgeries at the Yaounde Gynaeco-Obstetric and Paediatric Hospital.

OBJECTIVE: To determine the indications and rate of acceptance for destructive eye surgeries at the ophthalmology unit of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital. METHODS: A retrospective consecutive case series in which the medical records of all patients consulting in this unit over a 9-year period (2002 to 2010) were reviewed. Records in which destructive surgery was recommended were retained. Information collected included demographic data, eye affected, clinical diagnosis, acceptance or refusal of surgery, and the outcome in those in whom surgery was performed. RESULTS: A total of 48 patients had a recommendation for destructive eye surgery, of whom 30 (62.5%) were males and 18 (37.5%) were females. Mean age was 43.78 (SD = 28.11; range 1 month to 91 years). Children <10 years comprised 23.10%. The leading causes were endophthalmitis/panophthalmitis (47.9%), neoplasm (20.8%), and absolute glaucoma (14.6%). Surgery was done in 20 cases (41.7%). Evisceration was the most performed surgical procedure (50%), with endophthalmitis/panophthalmitis and neoplasm combined accounting for 65% of surgeries. CONCLUSION: The high rate of refusal is an indication of the psychological devastation undergone by patients or the families of children in whom eye removal is recommended. Awareness should be raised on preventive measures and the need to rapidly seek eye care.

[Diabetic retinopathy in black Africans: an angiographic study]. / Rétinopathie diabétique du Noir africain : étude angiographique.

INTRODUCTION: Diabetes mellitus is an important public health issue worldwide. This retrospective and descriptive study took place at the diabetic retinopathy (DR) prevention and management project at the Central Hospital in Yaoundé between November 2007 and December 2008. Our aim was to analyse the characteristics of diabetic retinopathy in black Africans. MATERIALS AND METHOD: Our sample included all patients with diabetes, irrespective of age or insulin- dependence, with the results of at least fasting blood sugar test and fluorescein angiography imaging. The images were interpreted according to the Early Treatment of DR Study classification by one of the 3 project ophthalmologists. We used Epi-Info version 3.5.1 for the statistical analysis, comparing results with the Chi-square test (significance set at p < 0.05). RESULTS: Of 472 subjects with diabetes, 274 (58%) did not have DR, and 198 (42%, 393 eyes) did: 113 men (57%) and 85 women (43%). The mean age was 58.6 years with a mean duration of diabetes of 12.8 years. 128 subjects (64.7%) had non-proliferative DR (NPDR) in both eyes; 53 (26.8%) proliferative DR (PDR) in both eyes and 14 (7.1%) were discordant, with NPDR in one eye and PDR in the other. Macula edema was found in 21 angiographies (10.6%). In all, 6.9% of the subjects were blind. CONCLUSION: Fluorescein angiography is an invasive complementary examination that helps to diagnose retinal pathologies, to perform laser photocoagulation, and to assess its results. It cannot, however, replaced direct or indirect funduscopy with dilated pupil. Every patient with known diabetes must systematically undergo a complete ophthalmologic exam with funduscopy and angiography to prevent the onset or control existing DR.

Blindness and visual impairment in retinitis pigmentosa: a Cameroonian hospital-based study.

AIM: We performed a retrospective, analytical study in February 2010 on all retinitis pigmentosa cases seen during ophthalmologic consultation at the Gyneco-Obstetrics and Pediatric Hospital of Yaounde between March 2002 and December 2009 (82 months). The aim of this research was to determine the significance of blindness and visual impairment associated with retinitis pigmentosa in Cameroon. RESULTS: Forty cases were reported, corresponding to a hospital prevalence of 1.6/1000 (21 men and 19 women). The average age of the patients was 43.3 +/- 18 years, ranging between 6 and 74 years. Bilateral blindness and low vision was noted in 30% and 27.5% of patients, respectively. The average age of patients with low vision was 40.38 +/- 16.27 years and the average age of those with bilateral blindness was 51.08 +/- 15.79 years. Retinitis pigmentosa was bilateral in all cases and isolated (without any eye or general additional disease) in 67.5% of cases. CONCLUSION: Visual impairment is common and becomes even more severe with aging. Patients should be screened to enable them to benefit from management focusing on both appropriate treatment and genetic counseling.

Central corneal thickness and intraocular pressure in the Cameroonian nonglaucomatous population.

AIM: We performed a prospective, analytical study from 01 January to 31 March 2009 in the Ophthalmology Unit of the Gyneco-Obstetric and Pediatric Hospital of Yaounde, aiming to determine the profile of central corneal thickness (CCT) in the Cameroonian nonglaucomatous black population and its relationship with intraocular pressure (IOP). RESULTS AND DISCUSSION: Four hundred and eighty-five patients (970 eyes) meeting our inclusion criteria were selected for this study. The average CCT was 529.29 +/- 35.9 mum in the right eye (95% confidence interval [CI]: 526.09-532.49), 528.19 +/- 35.9 mum in the left eye (95% CI: 524.99-531.40) and 528.74 +/- 35.89 mum in both eyes (95% CI: 526.48-531.00), range 440 to 670 mum. The average IOP was 13.01 +/- 2.97 mmHg in both eyes (95% CI: 12.82-13.19). A rise in CCT by 100 mum was followed by an increase in IOP of about 2.8 mmHg (95% CI: 2.3-3.6) for both eyes taken together. Linear regression analysis showed that corneal thickness was negatively correlated with age and IOP was positively related with age. CONCLUSION: CCT in the Cameroonian nonglaucomatous black population was found to be lower compared with CCT values in Caucasian and Asian populations. On the basis of reference values ranging between 527 and 560 mum, an adjustment of IOP values by a correction factor is required for many Cameroonian patients. This will improve the diagnosis and follow-up of glaucoma by helping to detect true ocular hypertension.

Unilateral childhood blindness: a hospital-based study in Yaoundé, Cameroon.

INTRODUCTION: We performed an analytic and prospective study over a period of 12 months from January 2nd to December 31st, 2008, at the Gynaeco-Obstetric and Paediatric Hospital of Yaoundé, Cameroon. Our aim was to determine the prevalence and causes of unilateral blindness in school children aged 6 to 15 years. RESULTS: Among the 1,266 children aged 6 to 15 years who were recruited, 60 presented with unilateral blindness (4.7%): 42 boys (6.96%) and 18 girls (2.71%). The mean age was 10.15 +/- 3.4 years. In patients with unilateral blindness, 65% was due to ocular trauma. DISCUSSION: The hospital-based prevalence of unilateral blindness in children is relatively high and ocular trauma is the leading etiology. CONCLUSION: Unilateral blindness in school children is avoidable and its incidence could be markedly reduced by emphasizing an information strategy and education based on prevention of ocular trauma. Early management of nontraumatic diseases such as infantile glaucoma and some tumors could improve outcome and avoid blindness.

Intraocular live male filarial Loa loa worm.

We report a case of Loa loa filariasis in an 8-month-old child who presented with a 3-month history of irritated acute red eye and insomnia. Examination revealed a living and active adult Loa loa worm in the anterior chamber of the left eye. The worm was extracted under general anesthetic.