[Features of macular ganglion cell complex in normal black subject in Lomé]. / Caractéristiques du complexe de cellules ganglionnaires chez le sujet normal à Lomé.

PURPOSE: To determine the features of the macular ganglion cell complex and its correlations in normal black subjects in Lomé. MATERIALS AND METHODS: We conducted a descriptive, analytical, retrospective study over 32 months from November 2014 to June 2017. This study was based on records of healthy patients with normal IOP, optic discs and ganglion cell complexes (GCC). The 3D - OCT 2000 (Topcon Corporation, Tokyo, Japan) was used with standard image acquisition protocols. RNFL and the GCC parameters were analyzed. Univariate linear regression tests were used, with the Pearson correlation coefficient (r2) to assess correlations between the various parameters. RESULTS: A total of 277 eyes of 155 patients were examined - 146 right eyes and 131 left eyes. The mean age of the patients was 37.7±15.2 (5-60) years. The mean RNFL thickness was 108.3±7.1µm, 134.8±11.1µm in the lower quadrant, 128.3±13.8µm in the upper, 92.2±12.8µm in the nasal and 77.9±11.6µm in the temporal quadrant. There was 6% asymmetry in the macular fibers, with a mean thickness of 33.1±3.5µm superiorly and 35.3±3.8µm inferiorly. There was 2% asymmetry in the macular cells, with a mean thickness of 71.6±5.7µm superiorly and 70.5±5.2µm inferiorly. The macular GCC thickness showed 1% asymmetry, with a mean thickness of 105.0±7.1µm superiorly and 106.1±6.7µm inferiorly. The thickness of the superior macular GCC was strongly correlated with the inferior (r2=0.8; p <0.05). The thickness of the macular GCC was weakly correlated with age (r2=0.05; p =0.0003), gender (r2=0.01; p =0.2), optic nerve head surface area (r2=0.2; p < 0.05) and RNFL thickness (r2=0.15; p <0.05) CONCLUSION: The results of this study will help to establish a normative database for GCC parameters in normal black Africans.

[Accuracy of Optical Coherence Tomography versus Ultrasound in pachymetry]. / Fiabilité de la pachymétrie par OCT comparée à la pachymétrie par ultrasons.

PURPOSE: Measuring the central corneal thickness is an important step in the diagnosis and monitoring of glaucoma. Ultrasound pachymetry was the gold standard before the advent of OCT. The purpose of this study is to assess the reliability of OCT pachymetry compared to ultrasound pachymetry in black patients. PATIENTS AND METHODS: Pachymetry was performed as part of a glaucoma work-up. Ultrasonic pachymetry was measured using the Alcon Ocuscan by the same operator and OCT pachymetry using the Topcon 2000 OCT. The Student's t-test was used to compare means with statistical significance of 5%. The Pearson's correlation coefficient (r2) was used to measure correlations. RESULTS: One-hundred thirty-five right eyes and 135 left eyes, corresponding to 270 eyes of 135 patients, were examined. There was a female predominance (59 men/76 women), with a gender ratio of 0.78. The mean age was 42.3±17.3 [8-86] years. In the right eye, the mean OCT pachymetry was 522.4±36.8µ versus 528.2±37.9µ for ultrasonic pachymetry (P=1.00). In the left eye, the mean OCT pachymetry was 522.0±33.8µ versus 524.9±42.5µ for ultrasonic pachymetry (P=1.00). The overall mean OCT pachymetry was 522.2±35.2µ versus 526.5±40.2µ, with a non-significant difference (P=1.00). There was a strong correlation between ultrasonic pachymetry and OCT pachymetry (r2=0.83; P<0.05). On the other hand, there was a very low correlation between pachymetry and age (r2=0.09; P<0.05). Pachymetry decreased by 5µ per 10 years, corresponding to corneal thinning of 0.5µ per year. CONCLUSION: OCT pachymetry can be a reliable alternative to ultrasound pachymetry and could be performed at the same time as the OCT for glaucoma assessment.

[Association between consanguinity with the ocular congenital abnormalities in Togo]. / Association entre la consanguinité et les anomalies congénitales oculaires au Togo.

OBJECTIVES: To investigate the possibility of an association between parental consanguinity and the occurrence of congenital ocular abnormalities. MATERIALS AND METHODS: A retrospective cross-sectional study was carried out over 3 years, from January 2016 to December 2018, in the pediatric ophthalmology unit of the University Hospital Campus of Lomé (Togo). It included children with congenital ocular abnormalities. Age, gender, geographic origin (city or urban area, village or rural area), degree of consanguinity of parents and types of congenital ocular abnomalities were the variables of study. Odds Ratio (OR) and logistic regression were used to investigate the correlation between parental consanguinity and the occurrence of congenital ocular abnormalities. A P-value of<0.05 was considered statistically significant. RESULTS: Among the 103 patients with congenital ocular abnormalities, there were 60 (58.2%) males and 43 (41.8%) females. The mean age of the patients was 16 months, range 1 month-5 years. Patients born to consanguineous parents were 26.2% (27) of the total population. Of these 27 patients, 25 (92.6%) were born to second-cousin marriages and 24 (88.89%) came from a rural area. Parental consanguinity was correlated with developmental abnormalities of the globe (OR=37.50; 95% CI: [4.46-314.80]; r=3.62; P=0.00), sclerocornea (OR=13.04; 95% CI: [1.39-122.54]; r=2.57; P=0.02) and corneal dystrophy (OR=9.37; 95% CI: [0.93-94.36]; r=2.24; P=0.02). CONCLUSION: Our study suggests the existence of a correlation between parental consanguinity and the occurrence of congenital ocular abnormalities.

[Optic disc features on OCT in glaucomatous and normal black Africans]. / Caractéristiques de la papille chez les sujets glaucomateux et normaux à l'OCT dans une population Noire Africaine.

PURPOSE: To determine the correlations between the size of the optic disc and glaucomatous defects in black Africans. DESIGN: Retrospective observational study. METHODS: The study was conducted over a two-year period from November 2014 to October 2016, based on records of black Togolese patients who had undergone optic nerve head (ONH) OCT or ganglion cell complex OCT for assessment of glaucoma. The population was divided into 3 groups (I, II and III) depending on the size of the ONH. The ONH was considered small (Group I) if its size was less than the mean -1 SD, medium (Group II) if its size was within 1 SD of the mean, and large (Group III) if its size was greater than the mean+1 SD. Glaucomatous lesions were qualitatively identified on RNFL and or GCC. The ONH parameters were compared in the 3 groups. The Chi-square test was used to compare the percentages, and the t test to compare the means with statistical significance of 5%. The Pearson correlation coefficient (r2) was used to measure correlations. RESULTS: A total of 586 eyes of 298 patients were examined, 314 glaucomatous eyes and 272 healthy eyes. The mean age was 41.0±15.7 [6; 86] years. There were 159 men vs. 137 women, with a sex ratio of 1.2. The mean surface area of the ONH was 2.80±0.55mm2. Small ONH's (Group I) were defined as a surface area of less than 2.25mm2, medium-sized ONH's (Group II) as an area between 2.25 and 3.35mm2 and large ONH's (Group III) as an area greater than 3.35mm2. Small ONH's represented 14.7%, (86 eyes), medium-sized 68.6% (408 eyes) and large ONH's 16.8% (98 eyes). The mean surface area of the neuroretinal rim, cup, the cup-disc ratio and the RNFL thickness were statistically significant in the 3 groups. Similarly, all these parameters were significant in groups of glaucomatous or non-glaucomatous eyes, except for the surface area of the cup. The RNFL thickness was weakly correlated with the surface area of the ONH (r2=0.39), moderately correlated with the surface area of the neuroretinal rim (r2=0.57). The surface area of the ONH was strongly correlated with the surface area of the cup (r2=0.7). The neuroretinal rim surface area was strongly correlated with the cup-disc ratio (r2=0.66). CONCLUSION: The size of the ONH was correlated with the size of the cup, but it was not correlated to the surface area of the neuroretinal rim or the thickness of the nerve fibers. Analysis of the RNFL and GCC is essential for the diagnosis, especially in the case of large ONH's.

[Factors associated with the severity of acute ocular involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis in sub-Saharan Africa]. / Facteurs de risque associés à la sévérité de l'atteinte oculaire au stade aigu du syndrome de Stevens-Johnson et de la nécrolyse épidermique toxique en Afrique subsaharienne.

AIM: The purpose of this study was to identify risk factors associated with the severity of acute ocular involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) in sub-Saharan Africa. PATIENTS AND METHOD: A retrospective study was carried out at the dermatology department in collaboration with the ophthalmology department for SJS/TEN patients between January 2000 and December 2016 in Lomé (Togo). The severity of acute ocular involvement was evaluated using the Power classification, and the drug eruption score was assessed using de Bastuji-Garin classification. RESULTS: A total of 107 cases of SJS/TEN (84 cases of SJS, 20 cases of TEN and 3 cases of overlap syndrome) were analyzed. There were 71 women and 36 men, with an average age of 32.3±12.5 years (range: 5 to 75 years). Sulfonamides (37.4%) were the most commonly used drugs followed by nevirapine (22.4%). HIV serology was positive in 46 (58.2%) of the 79 patients tested. A total of 54 (50.5%) patients had acute ocular involvement, which was mild in 29.9% of patients, moderate in 13.1% and severe in 7.5%. In multivariate analysis, exposure to sulfadoxine was the sole factor associated with moderate or severe acute ocular involvement in SJS/TEN (adjusted odds ratio=3.3; 95% CI=[1.1; 10.2]). CONCLUSION: Exposure to sulfadoxine was identified in our study as a risk factor associated with the severity of acute ocular involvement in SJS/TEN. Multicenter studies should be conducted in sub-Saharan Africa to confirm this associated risk factor.

Epidemiological profile of patients with uveitis in Boko and Parakou, in northern Bénin.

To describe the epidemiology of uveitis in northern Bénin. This retrospective study carried out from records describing 10 years of uveitis care in 2 eye clinics in northern Bénin. The sample of 623 eyes with uveitis in 489 patients accounted for 1.0% of all consultations. A male predominance was observed with a sex-ratio of 1.5 (297 m/192 F). The patients' mean age was 35.7 ± 16.1 years, and the age range most often affected was 20-39 years. The uveitis was anterior in 32.3 %, posterior in 29.0 %, intermediate in 28.1% and total (panuveitis) in 10.6%. The cause was undetermined in 85.7 % of cases and identified in 14.3%, including toxoplasmosis in 47 cases (7.5%) and herpes zoster in 20 cases (3.2%). Outpatients accounted for all cases, and all received topical corticosteroids. Some complications were observed. Uveitis has a prevalence rate of 1% in northern Bénin. It caused blindness in 9.8% of affected eyes and impaired vision in 49.3%.

[OCT topographic characteristics of the optic nerve in patients clinically suspected to have large optic disc cupping in Togo]. / Les caractéristiques topographiques à l'OCT du disque optique chez des patients cliniquement suspects de grande excavation papillaire (GEP) au Togo.

PURPOSE: To describe topographic characteristics of optic discs clinically suspected of large cupping. MATERIALS AND METHODS: This is retrospective study conducted from the January 2 to December 31 on the OCT registry and data base of a private ophthalmologic center in Lomé (Togo). We included records of patients with large cupping - CDR (cup-to-disc ratio) ≥ 0.4 -clinically observed and having undergone OCT-optic disc analysis. RESULTS: Three hundred and thirty-five patients (619 eyes) were studied, with a mean age of 41.87 years±17.51 years [6 years and 80 years] and a sex-ratio of 1.01 with a slight female predominance. The mean clinical CDR was 0.51±0.126 [0.4 and 0.9] (95 % CI [0.503 to 0.531]). The clinical CDR was ≥ 0.7 in 7.75 % of cases. The mean neuroretinal rim area was 1.63±0.43 mm2 [0.34 and 2.85 mm2]. The mean cup area was 1.43±0.54 mm2 [0.13 and 4.29 mm2], and the mean cup volume 0.47±0.28 mm3 [0.01 and 1.72 mm3]. The mean global CDR on OCT was 0.46±0.13 [0.21 and 0.87], of which 30.85 % (191 cases) had CDR <0.4. The CDR on OCT was >0.7 in 40 (6.46 %) eyes vs. 48 (7.75 %) eyes on clinical examination. CONCLUSION: On the average, optics discs exhibit large size and large cup volume. Topographic evaluation of the optic disc by the means of OCT offers important data and gives way to etiological research of large cupping in the black African.

[Optic disc changes by optical coherence tomography in optic disc edema in Lomé]. / Modifications papillaires en tomographie par cohérence optique dans l'œdème papillaire à Lomé.

OBJECTIVE: To study the influence of optic disc edema (ODE) on the dimensions of the disc and the thickness of the retinal nerve fiber layer (RNFL) by optical coherence tomography (OCT) in Lomé. PATIENTS AND METHODS: This was a retrospective study which took place in a general ophthalmology office in the city. Twenty-six eyes were examined for ODE (cases) between January 2013 and May 2015, and 26 healthy eyes (control group) were considered in this study. The control group was recruited taking age into account with a variation not exceeding 5 years compared to the ODE cases. Topcon 3D-OCT 2000 software was used to analyze the disc and to measure the thickness of the peripapillary RNFL. The results were compared with software integrated into the OCT device, to the normal range of databases (normative basis) of RNFL thickness. The variables studied were age, gender, etiology of the edema, disc dimensions (optic disc surface area, vertical cup to disc ratio [CDR]), and the thickness of the peripapillary RNFL. Chi2 tests were used for comparison of proportions with a significance level less than or equal to 0.05. RESULTS: Twenty-six eyes of 16 patients with ODE (mean age 25.88±14.35years) and 26 eyes of 16 control group patients (mean age 25.73±15.90 years) were recruited. The ODE was caused by inflammatory optic neuropathies in 10 cases, malignant hypertension in 8 cases and intracranial hypertension in 8 cases. The surface area of the disc was 3.77±1.82mm2 for the ODE group vs. 2.74±0.57mm2 for the control group (P=0.009). The vertical CDR was 0.11±0.15 for the ODE group vs. 0.50±0.15 for the control group (P=0). The mean RNFL thickness was 117.12±18.30µm for the ODE group vs. 95.77±2.52µm for the control group (P=0.006). This study reveals an increase in RNFL in all quadrants (superior, P=0.027; inferior, P=0.007; nasal, P=0.026; temporal, P=0.032). Of the 26 ODE cases, we noted an increase beyond the normative base; superiorly (in 9 cases), inferiorly (in 12 cases), nasally (in 10 cases) and temporally (in 11 cases). CONCLUSION: The study of papillary changes with OCT in ODE has allowed us to note an increase in the surface area of the disc, a reduction of the vertical CDR, and an increase in the thickness of the average RNF in all quadrants.

Cataracts in rural areas in Togo: awareness and attitudes.

To assess the prevalence of senile cataracts and the awareness and attitudes of patients with them in a rural area in Togo. We conducted a 10-weeks cross-sectional ophthalmic screening in the prefecture of VO, 57 km from Lomé, which sought to include individuals aged 50 years and older living in the study area. All patients underwent a comprehensive ophthalmic examination. Of the 3111 patients expected, 767 came for the examination, for a participation rate of 24.6%. The sex ratio was 0.8, and the patients' mean age was 60.1 ± 8.7 years. The frequency of senile cataracts was 40.28%. Women had cataracts more often than men, with a sex ratio of 0.63. The frequency of unilateral blindness was 1.62% and 22% for bilateral blindness related to cataracts. Almost every participant (99.7%) knew the disease named cataract, but fewer than half (41.59%) knew its causes. Most patients (97.09%) accepted the idea of cataract surgery, but the lack of financial resources was a major barrier to it (64.72%). The frequency of senile cataracts is high in rural area. Decentralization of eye care is essential to give the right to sight to the population living in these areas.

[Compliance with medical treatment in primary open-angle glaucoma in Lomé]. / Observance du traitement médical dans le glaucome primitif à angle ouvert à Lomé.

OBJECTIVE: To assess the compliance rate among glaucoma patients with medical treatment, to investigate the factors influencing their attitude and survey their expectations vis-à-vis the doctor. PATIENTS AND METHODS: This is a prospective descriptive study conducted in four eye clinics in Lomé from January 2013 to July 2013. It included all glaucoma patients aged 40 years and above who have been under medical treatment for at least 6 months, with no history of surgical treatment of glaucoma. The evaluation was performed on the basis of a questionnaire. Compliance was rated good, fair or poor according to the regularity of treatment, compliance with the prescribed dosage and schedule of instillations, good instillation technique and compliance with follow-up visits. Patients consented to participate in the survey. RESULTS: A total of 107 patients responded to our questionnaire. There were 43 men and 64 women with a sex ratio (M/F) of 0.67. The mean age was 52.40±11.03 years. In total, 7.5% of patients were illiterate. Compliance rate was estimated good in 10.3% of cases, fair in 65.4% of cases, and poor in 24.3% of cases. Only the regularity of treatment, schedule adherence and good instillation technique, as well as compliance with monitoring visits were found as significant factors (P<0.05). Concerning patients' expectations vis-à-vis the doctor, 49.5% said they expected nothing from the doctor, 12.1% were hoping for advice and moral support, and 11.2% were hoping for the prescription of effective but less expensive eye drops. CONCLUSION: A good compliance rate was very low. The improvement of this compliance rate requires better information, education and communication for behavior change, and it also requires a higher quality of care and accessibility of anti-glaucoma drugs.

[Neurological manifestations of Gougerot and Sjögren disease: a Black African case]. / Les manifestations neurologiques du syndrome de Gougerot et Sjögren: à propos d'un cas en Afrique noire.

Primitive Gougerot-Sjögren syndrome (PGSS) is a systemic autoimmune exocrinopathy in which twenty percent of affected patients develop neurological manifestations. It has been little described in the Black African literature. We report a case of PGSS in a 64-year-old Black woman as revealed by neurological manifestations in an inflammatory context. Central neuropathy was present and the patient fulfilled at least four of the six Vitali American-European diagnostic criteria. There were abnormal aspects on the sylvian artery and hyperintense lesions of periventricular predominance. PGSS is a serious disease which we must consider when we encounter any unexplained neurological manifestations especially those associated with vasculitic lesions.