[Activities of the African Institute of Tropical Ophthalmology, 1990-1997]. / Activités de l'Institut d'Ophtalmologie Tropicale de l'Afrique, 1990-1997.

The African Institute of Tropical Ophthalmology (AITO) was founded in Bamako in 1953. It is part of a regional structure, The Organization for Cooperation and Coordination in the Control of Major Endemic Diseases (OCCCMED). AITO is a WHO collaborating center for the prevention of blindness and has four aims: the provision of eye care, training (ophthalmologists, cataract surgeons, specialist nurses, spectacle manufacturers), research (epidemiology, clinical and surgical) and assessment of public eye care as a function of the needs of the member states of OCCCMED. The European Regional Program for the Prevention of Blindness and an International Sight First Program Center are located at AITO. AITO is at the heart of a network dedicated to fighting blindness, and its activities extend beyond the borders of the OCCCMED.

[Training at the African Institute of Tropical Ophthalmology in Bamako]. / Formation à l'Institut d'Ophtalmologie Tropicale de l'Afrique de Bamako.

The African Institute of Tropical Ophthalmology (AITO) is an OCCCMED institute, founded in Bamako in 1953. The OCCCMED itself is based at Bobo Dioulasso (Burkina Faso). AITO is a WHO collaborating center for the prevention of blindness. Training is one of the main activities of the institute, along with eye care, research and assessment. The prevalence of blindness in sub-Saharan countries is about 1.2%, with blindness mostly caused by cataracts, trachoma, glaucoma and onchocercosis. The demand for eye care is high but there are currently too few trained personnel to satisfy that demand. Therefore, AITO's role in training eye-care professionals is particularly important. The institute trains ophthalmologists, specialist nurses, eye surgeons (who remove cataracts) and spectacle manufacturers. Training is carried out within the framework of the community and apprenticeship in the workplace. The student must attain specific targets, listed in a "competency passport" issued at the start of training. Clinical and surgical ophthalmology and general eye care are taught. Training costs and grants are mostly paid by the Lions Club International Sight First Program or by the French Overseas Development Ministry. Since 1991, AITO has trained to graduation: 18 ophthalmologists; 24 eye surgeons; 83 specialist nurses; 16 spectacle manufacturers.

[Future of ophthalmology nurses and physicians trained at the African Institute of Tropical Ophthalmology]. / Devenir des infirmiers et médecins ophtalmologistes formés à l'IOTA.

Six ophthalmologists and 24 specialist ophthalmology nurses from French-speaking African countries graduate from AITO each year. Their training focuses on the skills they will need to participate in the national programs to combat blindness. All the ophthalmologists (10) and specialist ophthalmology nurses (42) from Mali, Niger, Burkina Faso and Senegal, who graduated from AITO within the last ten years were interviewed. Eight of the ten ophthalmologists and all of the specialist nurses are currently working in national programs to combat blindness. The specialist nurses knew more about public eye health issues than about optics. The training given is appropriate for ophthalmology professionals working in these countries. The chief demand of both ophthalmologists and specialist nurses was that they should have continuous training and supervision.

[Synthesis of the blindness situation in the countries of the Organization for Cooperation and Coordination in the Control of Major Endemic Diseases]. / Synthèse de la situation en matière de cécité dans les paysde l'OCCGE.

The major causes of blindness in the OCCCMED states are cataracts, trachoma, glaucoma and oncocercosis. The prevalence of blindness is about 1.2% and there are about 880,000 blind individuals and 2,500,000 people with impaired vision. Cataracts were the cause of blindness in 440,000 people and the cause of visual impairment in 1,320,000 individuals. About 1,500,000 people were found to have oncocercosis, and about 24,000 were blind. The true rate of trachoma is unknown. Thirteen thousand cataracts are surgically removed in the region each year, the CSR (cataract surgery rate) being 210. In the last few years, national programs have been set up to combat blindness and equipment and training have been established. With a ratio of 1 ophthalmologist per 523,000 people, the WHO's objectives are becoming attainable.

[Strategies to control cataracts]. / Stratégies de lutte contre la cataracte.

Cataracts, often associated with aging (80%), are a major cause of blindness (more than 50% of cases of blindness in Africa), and for this reason, up to 80% of cases could be predicted or prevented. The socio-economic costs (care and loss of productivity) are increased by morbidity (blindness, impaired vision, congenital, complicated or infected cataracts). The biological determinants of cataracts account for the difficulties in developing and implementing effective preventive action. These epidemiological determinants (prevalence, incidence, increase in life expectancy) account for the size of the public health problem. The surgical removal of cataracts in Africa currently only deals with about 1% of the prevalence rate or 10% of the incidence. Cataracts are, however, easy to cure, resulting in great benefits to public health. The waiting list for cataract operations is very short because of social and cultural barriers which limit the acceptability and accessibility of treatment. Rather than formalizing the dogmatic choices of surgical techniques and structures (fixed, mobile, advanced?), we should promote all phases of treatment from active screening and the selection of cases for surgery to the follow-up of interventions and their impact. We should also increase public awareness, develop a system for the transfer of information that is effective and improve the cost-effectiveness and capacity of the region to provide high quality services on a large scale. We must promote patient satisfaction at all stages of treatment: its quality, its delivery and its low cost.

[Immune reactions in the eye]. / Les réactions immunitaires dans l'oeil.

The immunological status of the eye, like the one of the brain, is generally considered as an "immune privilege" site because of the presence of a strong blood-ocular barrier, the lack of lymphatic drainage and, last but not the least, the absence of professional antigen-presenting cells. This dogma is now challenged by recent studies indicating that presentation of endogenous (as in autoimmune uveitis) or exogenous (like in ocular cysticercosis) antigens occurs. The local immune response seems regulated by active immunosuppressive mechanisms, in order to limit the destructive effect of inflammatory reactions.

[Particularities in the immune response in ocular cysticercosis]. / Particularités de la réponse immune dans la cysticercose oculaire.

In addition to the unique physiological and immunological features of the eye, previously presented, some parasitic factors of recent knowledge are induced during ocular cysticercosis. A modulation of the immune response of the host, mediated by larval products (a soluble RNA-peptide, some metacestode surface sphingoglycolipids) seems to occur in vivo. These recent findings lead us to make a critical review of the antigenic profiles obtained by Enzyme-linked immunoelectrotransfer blot assay (EITB) on samples collected from malagasy patients.

[Intravitreous cysticercosis. Spontaneous course. Apropos of a case]. / La cysticercose intravitréenne. Evolution spontanée. A propos d'un cas.

We report a case of intravitreous cysticercosis in a 54-year-old woman from Madagascar. Since the patient refused surgical treatment, the lesion evolved toward blindness. The authors highlight the interest of surgical treatment and discuss the role of praziquantel which might increase local inflammatory reactions with subsequent severe damage.

[A survey of the prevalence and causes of eye disorders in primary school children in Antananarivo]. / Enquête sur la prévalence et les causes des affections oculaires chez les enfants des écoles primaires d'Antananarivo.

To assess the prevalence and causes of ocular abnormalities in children, we performed a cross-sectional survey with cluster sampling in Madagascar in Antananarivo primary schools in October 1994. Our other aim was to sensitize the sanitary authorities and the students of ophthalmology to the notion of public health ophthalmology in a country where a national blindness prevention program is being established. 1,081 children aged from 8 to 14 years (mean age 10.6 years) were examined. 51, or 4.7%, were diagnosed as having ocular abnormalities. These abnormalities were distributed as follows: 22 cases or 2% of the sample had refractive errors including 0.74% with myopia of less than 6 dioptrics, 0.18% with myopia of more than 6 dioptrics, 0.83% with hypermetropia of less than 6 dioptrics, and 0.28% with hypermetropia of more than 6 dioptrics; 15 cases or 1.4% of the sample had unilateral amblyopia including 0.9% with anisometropia, 0.37% with strabismus, and 0.09% with macular pathology; 8 cases or 0.74% of the sample had strabismus without amblyopia; and 6 cases or 0.57% of the sample had simple medical pathology. The results showed that 29 children were supposed to have an optic correction, including surgical treatment for 12 and medical treatment for 6. The same low frequencies of ocular abnormalities, mainly concerning refractive errors, were found in the literature. However, children suffering from important visual impairment do not attend school, and we cannot generalize the above results for the whole population.

[Ocular cysticercosis]. / La cysticercose oculaire.

Ocular cysticercosis results from development of Taenia solium larvae, Cysticercus cellulosae, in the eye. This condition is observed all over the world but is particularly common in developing countries. The eye, like nervous system and muscle tissue, is a prime location for parasitic development because of its rich vascularization. Intraorbital cysticercosis accounts for 75 to 85% of cases and if untreated leads to blindness. Intravitreal involvement is the most common followed by subretinal involvement. Involvement of other structures such as the camera aqueosa, iris, and crystalline lens is rare. Diagnosis of intraocular cysticercosis is straightforward when cysticerci are visible. Immunologic testing of aqueous humor using ELISA, western-blot, or immunodetection of circulating antigens can be useful diagnostic techniques in patients with opacification of the eye. Involvement of the orbit, palpebra, conjunctiva, and lacrimal glands is observed in 20 to 25% of cases. Diagnosis of adnexal involvement is facilitated by ultrasonography and CT-scan. Drug therapy for ocular manifestations of cysticercosis is ineffective and hastens progression of the disease by exacerbating the inflammatory response. Surgical treatment is the only alternative. Significant progress has been made thanks to new microsurgical vitreal and retinal procedures but these techniques are often unavailable in developing countries. The severity of ocular cysticercosis and poor management facilities in developing countries underlines the need for prevention by sanitary measures and health education.

[Management of postoperative endophthalmitis epidemics in tropical areas. Report of 24 cases seen at the Tropical Ophthalmology Institute of Africa]. / Conduite à tenir devant une épidémie d'endophtalmies post-opératoires en milieu tropical. A propos d'une série de 24 cas observés à l'Institut d'Ophtalmologie Tropicale de l'Afrique.

An epidemic of postoperative endophthalmitis occurred at the Tropical Ophthalmology Institute of Africa in September 1994. Due to the seriousness of this outbreak, a survey was undertaken to diagnose cases, trace the origin of contamination within the facilities and staff, and screen for the organism in patients with or without endophthalmitis. A total of 24 cases of endophthalmitis following 118 procedures involving the eyeball were found. There was no significant correlation between the occurrence of endophthalmitis and sex, age, type of surgery, surgeon, surgical assistant, operating room staff, postoperative complications, operating room, care providers, or type of hospitalisation. There was a significant correlation between the occurrence of endophthalmitis and the presence of secretions on the first bandage. Staphylococcus aureus was identified in 16 cases and in one patient hospitalized for an ulcer of the cornea. Staphylococcus aureus contamination was found in two fluids used for eye washing. We conclude that the probable cause of this epidemic was nosocomial infection and emphasize the importance of maintaining basic sterility measures despite the need to minimize costs in developing countries.

[The Institute of Tropical Ophthalmology of Africa]. / L'Institut d'Ophtalmologie Tropicale de l'Afrique.

The Tropical Ophthalmology Institute of Africa (TOIA) is an integral part of the OCCGE. Located in Bamako since 1953, the TOIA is operated jointly by the member states of the OCCGE, the French Cooperation Ministry, and the WHO for which it serves as a center for the prevention of blindness. In addition to providing eye care for the people of western Africa, the TOIA promotes clinical, epidemiologic, and surgical research and carries out health surveys in function of the needs of the member states of the OCCGE. The major purpose of the TOIA is to training doctors and ophthalmologic nurses as well as for cataract operators and eyeglasses technicians. At the center of a network dedicated to the fight against blindness, the range of action of the TOIA now reaches beyond the borders of the eight states in the OCCGE.

[Ocular cysticercosis (O.C.) in Madagascar (apropos of 6 cases)]. / La cysticercose oculaire (C.O.) à Madagascar (à propos de 6 cas).

Cysticercosis is due to cysticercus cellulosae and was know since a long time. Human is an intermediate occasional host by ingesting accidentally eggs of tenia. In Madagascar, neurocysticercosis are predominating (55%), occular localisations are not frequent (5%) and concerned particularly vitreous humour and retina. Diagnosis relies on serology: Elisa test, then Western Blot completed with research of circulating antibody and antigen in the acqueous humor by immocapture. Anatomopathologic test permits to confirm the diagnosis. Contribution of tomodensitometry is not conclusive therapeutic is summed up to a specific and symptomatic treatment with surgical extirpation when out means allow it.

[[Trabeculectomy in Madagascar. Retrospective study over 3 years]. / La trabéculectomie à Madagascar.Etude rétrospective sur 3 ans.

This study reports the results of the evolution of ocular pressure, glaucoma excavation and complications after trabeculectomy particularly cataracts observed in 47 cases of chronic glaucoma. Our chronic glaucomas are frequent in male with an average of age of 60,5 years. Normalisation of ocular tension has been obtained in 87.23% of cases. However in 10.53% of cases, an adjuvant medical treatment has been necessary. Ocular pressure figure raised up progressively after trabeculectomy to reach some limit from which it remains stable. The best ocular pressure control has been observed first in glaucoma with opened angle, then in post traumatic glaucoma. Visual acuteness was improved in 20.27% of cases. Trabeculectomy has involved a relief, a disparition of pain in all the cases. The main late complication observed is opacification of eye lens in patients aged more than 70 years old.

[Ophthalmologic manifestations of acquired immunodeficiency syndrome (AIDS) in central Africa]. / Manifestations ophtalmologiques du syndrome d'immunodépression acquise (SIDA) en Afrique centrale.

In central Africa, the authors have performed an ophthalmological examination of 77 adult patients (18-55 years) with AIDS: 33.7% had ocular abnormalities. Frequent manifestations included cotton-wool patches and retinal hemorrhages, while lacrymal hyposecretion, palpebral and conjunctival kaposi sarcoma, ocular palsy, ptosis, herpes zoster, papillar oedema, cytomegalovirus retinitis and periphlebitis were less frequent. The authors underline the necessity to perform an ocular examination for each patient with AIDS.