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

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

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

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