[Contribution of break up time in the diagnosis and the treatment of dry eye syndrome in tropic area: about 234 patients in Abidjan]. / Contribution du break up time au diagnostic et à la prise en charge du syndrome sec oculaire en milieu tropical : à propos de 234 yeux à Abidjan.

INTRODUCTION: Dry eye disease (DED) can be evaluated clinically by the tear film break up time (BUT). There is a discrepancy between symptoms in relationship with dry eye disease and objectives measures of BUT. So we tried to evaluate the reliability of BUT in the diagnosis and treatment of this disease in black African people. METHODS: We carried out a prospective study of 6 months where melanoderms adults presenting subjective symptoms of dry eye disease according a questionnaire of 7 items were included. Then the measure of BUT is performed after ocular instillation of fluorescein eyedrop. This measured is done by recording the time elapsed from the last complete palpebral blink to the appearance of the first dry spot. Patients with subjective symptoms and time of BUT lower than 10seconds were called concordants (suffering really of DED). The discrepant group was represented by a BUT upper than 10seconds despite the fact that these patients answered positively to the questionnaire. RESULTS: This survey included 234 patients and the average age was 49.1 years. Sex-ratio was 0.68 and we noticed predominance of BUT between 5 and 10seconds in 42.3% of cases. Subjective symptoms were strengthened clinically by a BUT lower to 10seconds in 149 patients. Therefore, the reliability of BUT as clinic tool for the diagnosis after symptoms in relationship with DED was 63.7%. In the group of concordants, women were more likely than men to experience symptoms of DED (P=0.0005). Age upper than 50 years and computer usage were risk factors of DED (P<0.01). DISCUSSION: Dry eye disease is a multifactorial affection of tear and ocular surface frequently seen in female and people using computer and older than 50. The reliability of BUT near to 65% is a reason to perform this test in our daily practice. CONCLUSION: Tear BUT is a reliable clinical test which must be performed systematically to assess the diagnosis of DED in black African people.

[Selective laser trabeculoplasty in African blacks]. / Trabéculoplastie sélective chez le mélanoderme africain.

INTRODUCTION: The treatment of primary open angle glaucoma (POAG) is preferably medical. However, when medical therapy fails, alternative or complementary treatments may be considered. In this regard, selective laser trabeculoplasty is a widely popular procedural treatment whose accepted benefits have been very little studied in African blacks. The objective of this study was to assess the efficacy of selective laser trabeculoplasty on the reduction of intraocular pressure (IOP) in African blacks with POAG. METHODS: We conducted a retrospective study of black patients treated with selective laser trabeculoplasty between March 2010 and March 2011. All patients had POAG with trabecular meshwork accessible over 360°. The treatment protocol consisted of a 360°treatment in two sessions (180°/session) 15 days apart. Success was defined as decrease from the initial IOP≥3mm Hg without additional medications. RESULTS: We included 44 patients, corresponding to 82 eyes. The mean age of the patients was 55.94±11.66 years with extremes of 19 years and 76 years. The mean intraocular pressure before laser treatment (initial IOP) was 18.43±4.81mm Hg. After laser treatment, the mean pressure reduction was (i) 3.81mm Hg (20.67%) at 15 days ; (ii) 4.08mm Hg (22.14%) at 1 month; (iii) 4.45mm Hg (24.14%) at 3 months; and (iv) 4.95mm Hg (26.86%) at 6 months. The success rate after laser treatment was 67.60% at 15 days, 83.78% at 1 month, 72.09% at 3 months and 80.43% at 6 months. CONCLUSION: Selective laser trabeculoplasty is effective in African blacks. Its efficacy is comparable to that of a carbonic anhydrase inhibitor or even a prostaglandin. It could be a complementary or substitutive alternative to POAG medications in African blacks.

[Relationship between human immunodeficiency virus (HIV-AIDS) and conjunctival squamous cell carcinoma: A clinical epidemiological study of 26 cases in the ophthalmology department of the university hospital of Treichville-Abidjan (Abidjan-Côte d'Ivoire)]. / Relation entre le virus de l'immunodéficience acquis (VIH-sida) et Carcinome épidermoïde conjonctival (CEC) : étude épidémioclinique de 26 dossiers au service d'ophtalmologie du CHU de Treichville (Abidjan-Cote d'Ivoire).

PURPOSE: To describe the epidemiological and clinical parameters of conjunctival squamous cell carcinomas and their association with HIV-AIDS in the ophthalmology department of the university hospital of Treichville. PATIENTS ET METHODS: This is a prospective and descriptive cross sectional study carried out in the ophthalmology department of the university hospital of Treichville from July 2007 to June 2011. Twenty-six (26) patients who were selected presented with a tumor of the globe and/or adnexa. A CT scan was performed in advanced cases. Histopathological examination of the surgical specimen was performed in all cases. HIV serology was performed after informed consent. All patients were referred to the oncology department of the university hospital of Treichville where a unit of care for HIV-positive patients with malignant tumors is available. Statistical analysis was performed using the software program EPI info version 6.0. RESULTS: We note a slight predominance of female patients 15 (57.69%) vs. 11 (42.3%) male patients. The mean age was 42.32 years, and 13 patients (50%) were between 25 and 45 years of age. Intraorbital tumors were the most common reason for consultation, i.e. 38.46%. Seventeen patients (65.38%) had no particular history. Nine patients (34.61%) were already on antiretroviral treatment on admission. Three patients, i.e. 11.54%, had already had tumor biopsy and/or evisceration. The mean duration of the disease before consultation in ophthalmology was 14.28 months. Localized limbal conjunctival tumors were found in 11 cases (42.38%). Advanced tumors with regional or cerebral extension accounted for 34.61% of cases. Six patients (23.078%) were HIV negative vs. 20 (76.92%) HIV positive patients. CD4 lymphocyte typing was performed in 17 patients (85%), and 45% had a CD4 count below 200. Only five patients were able to receive neoadjuvant chemotherapy, but three of them died. The average length of follow-up was 29 months. COMMENT: This study allowed us to establish a statistically significant link between HIV positive status of patients and the occurrence of squamous cell carcinoma, (P=10(-4)), as well as the decline in CD4 count and disease progression (p=10(-3)). CONCLUSION: The poor prognosis of conjunctival carcinoma reflects the low socioeconomic status of patients, physician under-staffing in our health care facilities, the prohibitive cost of anticancer drugs and the link between this disease and HIV-AIDS.

[Cataracts related to the extended application of dermocorticosteroids. A study of 8 cases in Abidjan]. / Cataractes liées à l'application prolongée de dermocorticoïdes: étude de 8 cas à Abidjan.

INTRODUCTION: Cataract induced by corticosteroids is an entity, which has been well described for a relatively long time, but this eventuality caused by the cutaneous application of corticosteroids remains inadequately reported. The purpose of this study was to describe cataract as one of the complications of the misuse of cutaneous application of corticosteroids. MATERIALS AND METHODS: In eight patients seen for visual loss, bilateral cataract was discovered. The only probable etiology in these cases appeared to be the cutaneous application of corticosteroids. Indeed, the work-up and careful history performed did not uncover any other etiology. RESULTS: Eight patients, six women and two men, exhibited cataracts related to the application of topical corticosteroids. The age of the patients ranged between 39 and 45 years. The cataracts were bilateral and posterior subcapsular alone or combined. The period of use of corticosteroids ranged from 5 to 10 years. The products used consisted of a variety of chemicals including corticosteroids mainly in the form of traditionally manufactured soap, but also as ointment or other types of mixtures. CONCLUSION: Topical corticosteroids induce posterior subcapsular cataract. The mechanism of action is direct access to the eye without any hepatic-first pass effect on the corticosteroid in question. The increasingly frequent use of corticosteroids in African blacks for skin lightening raises concern regarding the risk of epidemic cataracts in young women attempting to lighten their skin to be beautiful. Increased public awareness should be undertaken to prevent this growing and harmful phenomenon.

[Central serous chorioretinopathy: a study of six cases observed in Abidjan between 2003 and 2005, suggesting a role played by the Ivorian political-military crisis]. / Choriorétinopathie séreuse centrale: étude de 6 cas observés à Abidjan entre 2003 et 2005, rôle évoqué de la crise ivoirienne.

OBJECTIVE: This study aimed to show that central serous chorioretinopathy is present in Ivory Coast and that the emotional and psychosocial context plays an important role in this disorder's pathogenesis. PATIENTS AND METHOD: The authors report six central serous chorioretinopathy cases based on angiographic diagnosis, five in Black African subjects and one in a European subject. These cases were observed over a period of 2 years during the Ivorian political-military crisis. RESULTS: In a center where angiography has been a current practice since 1999, up to 2002 479 angiographies were done without a single central serous chorioretinopathy case being diagnosed. After the beginning of the political-military crisis, six cases of central serous chorioretinopathy were observed out of 417 angiographies over a period of 2 years. All the patients were males, between 20 and 50 years old, five were Black Africans and one was a white European. Their professions varied (a contractor, a soldier, a business executive, for example). The angiography showed break points in ink spots in the majority of the cases, with one case showing multiple break points. All the patients were emotionally distraught because of the uncertainty of the political situation. CONCLUSION: This study confirms that central serous chorioretinopathy does indeed exist in the Black African subject, as it exists in the leucoderma subject without discrimination. This study emphasizes the anxiety and extreme emotional context as an initiating factor in the occurrence of central serous chorioretinopathy.

[Central corneal thickness and potential error in Goldmann applanation tonometry of the Black African patient suffering from primary open-angle glaucoma: 340 eyes surveyed]. / Epaisseur cornéenne centrale et erreur potentielle de la tonométrie à aplanation de Goldmann chez le patient noir africain atteint de glaucome primitif à angle ouvert. A propos de 340 yeux.

INTRODUCTION: Goldmann applanation tonometry is the reference method for measuring IOP. This tonometric model is influenced by corneal thickness, which varies according to race. Most studies have been conducted on Caucasian or Black American subjects. Studies on Black African subjects being rare, the goal of our study was to measure the central corneal thickness and its impact on Goldmann applanation tonometry on Black African subjects suffering from primary open-angle glaucoma (POAG). PATIENTS AND METHODS: Our retrospective study focused on POAG eyes. The central corneal thickness was measured using an ultrasonic pachymeter (Quentel Médical). RESULTS: 340 eyes from 170 patients made up the sample. The mean age of our patients was 44.4 +/- 12.7 years, with a mean central corneal thickness of 519.6 +/- 32.6 microm. Of our patients, 57.6% had a central corneal thickness less than 527 microm, 30.6% between 527 and 560 microm, and 11.8% had a central corneal thickness greater than 560 microm. DISCUSSION AND CONCLUSION: Compared to Black American and Caucasian subjects, the Black African glaucoma subject differs in the early age of glaucoma onset and the thinness of the cornea. Corneal thickness evaluation induces a potential error in IOP measurement on Black African glaucoma subjects. On the Black African subject, Goldmann tonometry is therefore affected by an error rate estimated at 69.4% (57.6% underevaluation and 11.8% overevaluation). Pachymetry is therefore a necessity for the Black African glaucoma patient requiring IOP adjustment.

[Ocular biometric values of the black African patient and theoretical consideration of the role of these values in various pathologies: analysis of 325 eyes]. / Valeurs biométriques de l'oeil du sujet africain de race noire et hypothèse du rôle dans certaines pathologies: à propos de 325 yeux.

INTRODUCTION: The international literature seldom refers to eye measurements of the black African patient. Therefore, the various patterns where biometry elements are used as constituents deserve reconsideration as they may not correspond to the eye of the black patient of our region. This study provides true measurements for the black African patient in Ivory Coast. It also establishes hypotheses by extrapolating the role of measurements in pathologies such as glaucoma. MATERIAL: and method: The study included 325 eyes of 217 male and female patients. All the patients underwent ocular keratometrics and echo biometrics to measure the depth of the anterior chamber, the width of the lens, and the total axial length with the ultrascan biometer using the contact method in A echometrics. RESULTS: The mean keratometry in women was significantly higher than in men (43.99 +/- 1.62 diopters vs 43.46 +/- 1.45 diopters). The anterior chamber was deeper in men (2.69 mm +/- 0.54 vs 2.53 mm +/- 0.48). The men's eyes were significantly longer, with an axial length of 23.26 mm +/- 1.07 vs 22.56 mm +/- 0.90. CONCLUSION: Significant biometric differences between men's and women's eyes, on the one hand, and between black African and white patients' eyes, on the other hand, can be observed. The reasons for these differences are several: they are natural, socioeconomic, and technical. If standard implant of a different power for black and white patients can be imagined, can we also infer that the biometrics of a black African patient predisposes him to a disorder such as glaucoma more than a white patient? Further in-depth studies could provide an answer to this question.

[Sickle cell beta-thalassemia leading to serious ischemic retinopathy: a study of 18 patients in Abidjan]. / Les bêtathalasso-drépanocytoses pourvoyeuses de rétinopathies ischémiques graves. A propos de 18 patients étudiés à Abidjan.

The authors in this study intended to demonstrate that S-beta thalassemia can lead to severe ocular hemorrhagic risks, as is true of the sickle cell form. Both forms are also comparable in terms of the risk of aseptic necrosis of the femoral head. Out of the 18 patients studied, 13 (72.2%) had sickle cell retinopathy. Three of 13 patients had already developed new vessels and risked intravitreous hemorrhage. The authors recommend that more vigilance be mounted for the detection of S-beta thalassemia so as to benefit from rigorous and systematic follow-up and early treatment. Retinal argon laser photocoagulation is only effective if a clear diagnosis is made early.

[Retinopathy as a sickle-cell trait: myth or reality?]. / La rétinopathie chez le porteur du trait drépanocytaire AS: mythe ou réalité?

INTRODUCTION: The retinopathy of sickle cell diseases is an ischemic retinopathy that occurs frequently in the major forms of HbSS and HbSC sickle cell diseases. The retinopathy of sickle trait HbAS has not been described extensively. PATIENTS AND METHODS: The aim of this study was to describe the retinal characteristics and thus gain better knowledge of sickle trait HbAS retinopathy. Seventy HbAS patients had a complete ocular examination including fluorescein angiography. RESULTS: Seventy percent of the patients had retinal lesions, with 49.3% non-vasoproliferative lesions, 22.7% prevasoproliferative lesions and 2.7% neovascular lesions. DISCUSSION AND CONCLUSION: Retinopathy is associated with the HbAS sickle cell trait, but it is less serious than in the major forms of sickle cell syndrome.

[Isolated palpebral tumor revealing Von Recklinghausen's neurofibromatosis: a case report]. / Tumeur palpébrale isolée révélatrice de la neurofibromatose de Von Recklinghausen.

INTRODUCTION: Von Recklinghausen's neurofibromatosis is the most frequent of phakomatoses. Its incidence is 1/2,500-3,000 births. It is inherited through a dominant autosomal mode with a strong prevalence and changing expression. Eye and skin signs are essential to diagnosis and this case provided a noteworthy example of a unilateral upper palpebral tumor revealing this disease. CLINICAL CASE: We report a case of a 6-year-old boy whose original clinical manifestation was a tumor on the upper eyelid of the right eye, present at birth. According to the anamnesis, this palpebral tumor gradually increased in size, causing a full ptosis. A biopsy exeresis of the tumor was carried out with an anatomicopathological study of the biopsy specimen, confirming the diagnosis. CONCLUSION: The anatomicopathological study of the biopsy specimen enabled diagnosis of a neurofibromatosis revealed by this isolated palpebral localization responsible for significant aesthetic and functional damage.

Oeil et medecine tradipraticienne: a propos d'un cas de traitement intempestif

La medecine traditionnelle a survecu a l'epreuve du developpement de la medecine moderne dans nos pays et gagne meme de plus en plus de terrain. Malheureusement cette medecine mal dosee et surtout mal maitrisee peut provoquer des complications graves. Nous rapportons ici un cas qui illustre bien la gravite de la situation. Il s'agit du cas d'une exophtalmie maligne apparue chez un homme de 42 ans souffrant de maladie de Basedow. Il a ete traite par application des produits traditionnels. Les consequences sont effroyables

Glaucome a pression normale: probleme diagnostique

Les auteurs rapportent une serie de glaucomes a pression normale et soulignent les problemes diagnostiques qu'ils soulevent

[Chronic gastritis and Helicobacter pylori infection on the Ivory Coast. A series of 277 symptomatic patients]. / Gastrite chronique et infection à Helicobacter pylori en Côte-d'Ivoire. Etude d'une série de 277 patients symptomatiques.

Only a few reports have established the importance of chronic gastritis and Helicobacter pylori infection in Africa. The aim of this study was to ascertain the prevalence of chronic gastritis and Helicobacter pylori infection in a symptomatic population in Abidjan, Côte-d'Ivoire. The study included 277 consecutive patients referred for gastroscopy. Two hundred nine patients complained of abdominal pain without gastroduodenal ulcer or cancer: 26 had a duodenal ulcer, 23 had a gastric ulcer, and 6 had gastric cancer. The remaining 14 patients underwent gastroscopy for various other reasons. Chronic gastritis was present in 89 percent of cases, of which 96 percent showed signs of activity. There were four cases of lymphocytic gastritis. Patients with antral chronic gastritis were older (39.43 +/- 14.3 years) than those with normal antral mucosa (33.7 +/- 12 years, P less than 0.05). Helicobacter pylori was present in 91.3 percent of cases, representing all patients with active chronic gastritis, and 60 percent of the patients with normal gastric mucosa. Chronic gastritis was present in 86 percent of patients with abdominal pain, in 100 percent of those with duodenal of gastric ulcer, and Helicobacter pylori were observed in 90, 100, and 91 percent of the same patient groups, respectively. This study demonstrates the high prevalence of chronic gastritis and the very high level of Helicobacter pylori infection in Ivorian patients complaining of various gastrointestinal symptoms. The usefulness and feasibility of therapeutic trials still have to be investigated.