[Profile of macular holes in Cotonou]. / Profil des trous maculaires à Cotonou.

PURPOSE: To establish the epidemiological and tomographic profile of macular holes in the Beninese subject. PATIENTS AND METHODS: This cross-sectional study included consecutive patients seen for macular testing during the period from January 2016 to August 2017 at the St. Anthony of Padua Retinal Testing Center in Cotonou (Benin). All patients who had a macular hole and macular OCT were included. To define macular hole types, we used the 2013 DUKER New Classification and analyzed for each case: age sex, history, involved eye, fellow eye, visual acuity, hole type, hole diameter, status of the vitreous cortex, edge edema, mean macular thickness, presence of vitreomacular traction, epimacular membrane, and retrofoveal choroidal thickness. Patients with a pseudo-macular hole or lamellar hole were excluded. RESULTS: During this study period, 401 patients underwent a macular OCT procedure at the Retinal Testing Center, with 22 patients having a macular hole, of which 15 women and 07 men for a sex ratio of 2.14 women to men. The mean age of the patients was 61±10 years, with a median age of 63 years. The mean diameter of the holes was 705µm±232µm. No small holes were found. The mean central macular thickness was 272µm±39µm. In 52.4% of cases, the condition of the felloweye indicated the presence of vitreomacular traction. The etiological profile of the macular hole found in 72.7% a primary origin, and a secondary origin (diabetic and traumatic) in 13.6% and 9.09% respectively. DISCUSSION: The majority of the macular holes observed were large macular holes, which could be explained by the progressive course of these macular holes as well as late detection. Over half of the fellow eyes showed vitreomacular traction, reflecting the potential risk of bilateralization. CONCLUSION: Macular hole is a pathology of the vitreomacular interface, tending to be large in our geographic context. On OCT, the data found remain comparable those reported in the literature.

[Tomographic appearance and etiologies of epimacular membranes in Cotonou]. / Aspects tomographiques et étiologiques des membranes épimaculaires à Cotonou.

PURPOSE: To study the tomographic appearance and etiologies of epimacular membranes in Cotonou. PATIENTS, MATERIALS AND METHODS: This was a descriptive, analytical study with retrospective data collection. It took place at the Cotonou Retinal Testing Center and included all patients who underwent macular OCT testing between January 1, 2016 and June 30, 2018. RESULTS: Of the 604 subjects examined, 32 patients (5.3%) exhibited an epimacular membrane. Epimacular membrane in combination with posterior vitreous detachment and contraction accounted for 44.74% of cases. 42.31% of the fellow eyes had developed a posterior vitreous detachment. The majority of the membranes were idiopathic. Proliferative diabetic retinopathy and posterior uveitis were the main risk factors for secondary membranes. CONCLUSION: Epimacular membrane is a potentially blinding condition. The risk of bilateral involvement is significant, and patient access to OCT remains a concern in developing countries.

[Evaluation of intravitreal injection practice patterns in Cotonou]. / Évaluation de la pratique de l'injection intravitréenne à Cotonou.

INTRODUCTION: Intravitreal injections of medication are designed to obtain a high concentration in the posterior segment. We conducted a retrospective study of our practice of intravitreal injections to assess safety of the technique and short- and medium-term tolerability, and to analyze indications and the complications. PATIENTS AND METHODS: This analytic retrospective study focused on consecutive patients treated with intravitreal injections for the period of January 2015 to June 2016 in the "Lumière" ohthalmology clinic in Cotonou, with incidents or accidents during the injection procedure as a measure of safety. Included were all patients undergoing one or more intravitreal injections regardless of the type of product injected, who had undergone a complete ophthalmologic work-up prior to injection and who had been followed at one week (W1) and 1 month (M1) after treatment. RESULTS: During the study period, we safely performed 124 intravitreal injections on 49 patients. The indications were diabetic macular edema in 53.06% and macular edema due to vein occlusions in 26.53%. The main complication observed was ocular hypertension in 60%, mainly related to triamcinolone injection. In 51.02%, the drug used was Ranibizumab, followed by Bevacizumab in 28.54% and Triamcinolone in 20.40%. DISCUSSION: The main goal of intravitreal injection is to achieve instantly effective concentrations in the center of the globe. Intravitreal injection is a safe, feasible practice in our context. The male predominance observed in our series is explained by the low socio-economic status of women in our context as well as the economically difficult accessibility of important drugs such as anti-VEGF. Significant improvements in D7 and D30 visual acuity in our patients highlights the beneficial effects of the presence of the active molecule in the vitreous cavity for these indications. CONCLUSION: Intravitreal injection is a common practice in our context, which is being performed safely. The indications are many, and ocular hypertension is a significant complication. The difficulties in terms of supply and preservation of the main drugs used (anti-VEGF) remains to be resolved.

[Socioeconomic aspects of the management of primary open angle glaucoma in Benin]. / Aspects socio-économiques de la prise en charge du glaucome primitif à angle ouvert au Bénin.

INTRODUCTION: The purpose of our study is to present the socioeconomic aspects of the management of primary open angle glaucoma in Benin. PATIENTS AND METHODS: The study was a multicentric descriptive, record review from January 1st, 2011 to June 30th, 2013 and prospective from May 1st to July 31st, 2013. It included patients over 15 years of age, and treated for a diagnosis of primary open angle glaucoma during the study period. RESULTS: Of 15,592 patients, 227 were diagnosed with glaucoma, for a 1.5% hospital prevalence with male predominance (64%). Medical treatment was the rule, with an average duration of 7.4 ± 7.4 months. A total of 10.6% of the patients were followed regularly. The average monthly cost of medications was 17.8 ± 10.8 euros. That of the consultations and diagnostic tests was an average of 79.5 ± 59.9 euros. The average cost of transportation to each visit was 1.6 euros. Stable glaucoma was more costly. A total of 17.6% of the patients were accompanied to visits for which the waiting time was always longer than one hour. The monthly average income of the patients was 187.7 euros. Loss of income associated with waiting was not evaluated. A total of 72.7% of the patients were self-insured, corresponding to 58.3% of their average monthly income. DISCUSSION: Patients cannot logically afford their medication. Practitioners should rely more on lower-cost surgical treatments.

[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.

[Ocular contusions at the Cotonou, Benin, National University Hospital. A series of 654 cases]. / Les contusions oculaires au centre national hospitalier universitaire de Cotonou, Bénin. À propos de 654 cas.

AIM: To specify the epidemiologic characteristics of ocular contusions, take an inventory of etiological factors, and study clinical aspects. PATIENTS AND METHODS: This study was a retrospective, descriptive and analytical study. We carried out an exhaustive recruitment among the consultations in the ophthalmologic department at the Cotonou National University Hospital from 1st January 2006 to 30 April 2009 of all the patients with the ocular diagnosis of contusion. RESULTS: Of 21,892 consultations, 654 cases were ocular contusions, i.e., a total prevalence of 3%. The prevalence among ocular injuries was 70.8%. The majority of the patients were between 16 and 45 years old (74.9%) and the mean age was 31.2±3.5 years. A clear male prevalence was observed (79.7%). The principal cause was road traffic accidents (58.6%). The lesions most frequently encountered were in the conjunctiva (64.9%) and eyelids (24.5%). Lesions of the anterior segment were infrequent (9.1%) and those of the posterior segment were rare (1.5%). CONCLUSION: Ocular contusions account for a large part of ocular injuries in the ophthalmologic department of Cotonou National University Hospital and result above all from road traffic accidents. It is important to reduce the frequency in taking essentially preventive measures.

[Influence of ethnic and eye condition on ultrasound A in ophthalmology at UHNC-HKM of Cotonou]. / Influence de l'ethnie et de l'etat oculaire sur l'echographie a en ophtalmologie au CNHU HKM de Cotonou.

PURPOSE: To study impact of sociocultural groups and ocular condition on biometric data at University and Hospital National Center of Cotonou PATIENTS AND METHODS: We conducted a descriptive cross-sectional study from 1st January to March 31, 2009 in the eye clinic at CNHU-HKM of Cotonou. It involved 116 patients aged over 16 years and Beninese nationality. RESULTS: The mean age was 48 years ± 15.7. The sex ratio was 0.78. The "fon" socio-cultural's group was the largest with 43.96%. The eye condition was normal in 79 cases (68.10%). Primary glaucoma with open angle (OAPG) and cataract were observed in respectively 18.10% and 13.79%. Biometrics eye was not influenced by the socio-cultural groups, or by the OAPG. In contrast, cataract induced increase in the lens's thickness and reducing the depth of anterior chamber. CONCLUSION: The lens plays a key role in changing the biometrics of the anterior segment.

[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.

[Not Available].

Refraction abnomalities are especially frequent with schoolchildren and constitute a frequent motive of medical advice. Authors trys to identify the most frequent refraction abnormalities and their epidemiological characteristics in daily practice at CNHUU-HKM. A retrospective study has been made on a period of 3 years at the ophthalmological clinic at CNHU-HKM (university and hospital national center-HKM) of Cotonou. This study was made on schoolchildren aged from six to fifteen years old who have experienced the automatic refractomety. From 1er January 2000 to 31 December 2002, 93 children, that is 9,2%, went to the surgery for refraction disorders. Patients from 31 to 15 years old were the most represented (63,44%) male sex is prevailing with a sex-ratio of 1,06. on the whole, myopia is the most frequent refractive abnormality with 72,04% distributed in simple myopia (32,26%) and astigmatism myopia (39,78%). Fermale sex people are the most concerned with myopia ; symptomatology from myopia (1 patient out of 3). Finally, myopia gets worse when people get older and is probably due to work intensity. Appears from this study that refraction abnormalities are curable discases; information, education and communication meetings are necessary to heightin public awareness.

[Not Available].

Treatment of detachment retinal is essentially surgical and making by external (scleral buckling) or internal (endocular chirurgy chirurgy) methid. Authors relate functional and anatomical result of retinal detachment in elderly's population. Retrospective study realized in ophthalmological clinic of University and Hospital Center of Tpirs; is concerning fifty-three patients mean aged of 76 years and treating to Irst January 1998 at 31 December 1999 by sclerall buckling in first intention. The authors have noticed one year after surgical treatment, an anatomical recuperation of 71,15 % (n=37) with 59,45 % of functional success superior to 4/10 degrees Seleral buckling can be also to considere as a valid treatment in case of retinal detachment trentment of clderly population.

[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.

[Analysis of implant position after envelope technique in "white" cataract surgery]. / Analyse de la position de l'implant après technique de l'enveloppe dans la chirurgie de la cataracte "blanche".

Capsulopunture in cataract surgery doesn't allow insertion of intraocular lens in the capsular bag. Envelope technique is a easy way for this insertion. The goal of our study was to analyse the position of the intraocular lens in the capsular bag, after performing envelope technique in eyes suffering from "white" cataract. We realised on 25 eyes with "white" cataract, envelope technique. GALAND method (one superior linear capsulotomy) was realised in 15 cases and double linear capsulotomy (superior and inferior), was realised in 10 cases. The mean age of our patients was 55 years with two extremes (17 and 70 years). The mean visual acuity was 14/20. After verification, in 91.636% eyes, intraocular lenses were in the capsular bag. In 2 cases, we found a decentration. Envelope technique can lessen risks of capsular zip. It protects endothelium cells and is helpful for the insertion of the intraocular lens in the capsular bag. Envelope technique is well adapted to the surgery of "White" Cataract.