[Adenoid cystic carcinoma of the lacrimal gland in a 14-year-old girl]. / Carcinome adénoïde kystique de la glande lacrymale chez une enfant âgée de 14 ans.

The discovery of unilateral exophthalmia requires multidisciplinary care made all the more difficult in the case of a 14-year-old girl living in a tropical environment. The child, C.A., resident of the town of Djenné in Mali, was examined for nonpulsate, nonretractile, left lateral unilateral exophthalmia, painful upon palpation of a left upper-external mass under the orbital rim. The initial examination highlighted the existence of an intraorbital tumor with a moderate effect on visual function. In view of the slow and progressive development over 2 years, and with the assistance of an association, the child was transferred to a specialized medical structure where the tumorous nature was confirmed after surgical exeresis. The diagnosis was cylindroma, or adenoid cystic carcinoma. Neither chemotherapy nor radiation were used. At 15 months after surgery, the child showed no clinical sign of recurrence. Intraorbital tumors in children present diagnostic and therapeutic problems in countries with limited medical resources. Cylindromas or adenoid cystic carcinomas of the lachrymal gland are the second most common cause of epithelial tumors in this gland, which are characterized by a high degree of malignancy, a very high rate of recurrence, and a low survival rate at 5 years. In a tropical environment, diagnostic and therapeutic difficulties are compounded by limits to comprehensive care for the child.

[Extent of visual impairment in a population attending an ophthalmology center in Africa. Findings in 828 cases at the Tropical Ophthalmology Institute of Africa in Bamako, Mali]. / Importance du handicap visuel dans une population de consultants en ophtalmologie: a propos de 828 cas à l'Institut d'Ophtalmologie tropicale de l'Afrique de Bamako.

The purpose of this prospective observational study was to evaluate the extent of visual impairment in a socially and professionally active population attending the Tropical Ophthalmology Institute of Africa (IOTA). Thanks to high recruitment rate at the IOTA, which is the third reference eye centre, a total of 828 patients ranging from 18 and 50 years of age and consulting for the first time were included between February 1 and May 4, 2003. Each patient underwent a thorough ocular examination. Data were recorded using a dedicated study form. Most patients (40%) consulted for reduced visual acuity. Diagnosis determined organic disease in 75.6% of cases (626 patients) and ametropia (including presbyopia) in 18.5% (153 patients). In the remaining 6% of cases (49 patients), ophthalmic examination was normal. Bilateral blindness was observed in 5.8% of cases (48 patients). The main cause of bilateral blindness was cataract (19.2%). The third most common cause (14.6%) was ocular manifestations of HIV infection, confirming that the epidemiology of blindness is changing and that HIV/AIDS should be taken into account. Unilateral blindness accounted for 11.5% of cases (95 patients). The main causes of unilateral blindness were trauma (50.5%), infection (26%) and degenerative disease (18%). Low vision accounted for 8.5% of cases (70 patients). The main cause of low vision was ametropia. This is one of the few hospital-based studies on causes of blindness in West Africa. The major finding is the high prevalence of blinding ocular complications of HIV infection. Another important finding is the high incidence of low vision that is often disregarded in West Africa.

Drepanocytose et atteintes retiniennes : etude de 38 cas a l'Institut d'Ophtalmologie Tropicale de l'Afrique de Bamako (IOTA)

Evaluer les atteintes retiniennes au cours de la drepanocytose et etudier les liens avec les diff e rentes fo rmes genotypiques de l'affection chez les patients consultant a l'Institut d'Ophtalmologie Tropicale de l'Afrique (IOTA). Etude prospective de 12 mois chez 38 patients drepanocytaires diagnostiques comme porteurs du gene de l'hemoglobine S. L' atteinte retinienne a ete precisee par une angiographie nu m e risee realisee chez 31 patients. Sur les 38 patients inclus dans l'etude; 71cas etaient double heterozygote SC; 21simple hetero z y gote AS et 8homozygote SS. Soixante-huit pour cent des patients avaient une retinopathie drepanocytaire. La tranche d'age la plus atteinte par la proliferation neovasculaire etait celle de 26 a 35 ans. Les patients SC presentaient plus de retinopathies (19 patients soit 70) que le groupe des patients AS (30). Nous n'avons pas retrouve de retinopathies chez les 3 patients SS. Les neovaisseaux retiniens etaient la lesion la plus frequente sur les 27 yeux atteints. Cette etude confirme la frequence et la gravite des atteintes retiniennes de la drepanocytose en particulier au cours du double heterozygotisme SC chez le sujet jeune en milieu tropical africain. Le traitement de ces lesions est malheureusement trop peu access ible pour les patients d'Afrique sub-saharienne en dehors des grands centres de traitement. Un protocole de depistage et de prise en charge des atteintes retiniennes de ces patients jeunes et actifs permettrait de reduire les complications oculaires de la maladie et d'optimiser l'efficience visuelle des patients

Importance du handicap visuel dans une population de consultants en ophtalmologie: a propos de 828 cas l'Institut d'Ophtamologie tropicale de l'Afrique de Bamako

Cette etude se propose d'evaluer l'importance du handicap visuel a l'Institut d'Ophtalmologie Tropicale d'Afrique (IOTA) dans la population la plus active sur le plan economique et social. Il s'agit d'une enquete hospitaliere transve rsale sur deux mois; menee a l'IOTA; centre de 3e reference en ophtalmologie; qui a permis d'incl u re 828 patients ages de 18 a 50 ans; venus pour une premiere fois en consultation entre le 1er avril et le 4 mai 2003. Chaque patient a subi un examen ophtalmo-logique complet et les donnees ont ete recueillies sur un formulaire d'enquete. Huit cent vingt huit patients ont ete inclus dans l'etude. Le principal motif de consul-tation etait la baisse d'acuite visuelle pour 40d'entre eux. Le bilan diagnostic avait retrouve 626 cas (75;6) d'atteintes organiques et 153 cas (18;5) d'ametropies. L' examen oculaire etait normal pour 49 patients (6). La cecite binoculaire (48 cas) representait 5;8des cas. Les causes etaient dominees par la cataracte (29;2). Les manifestations oculaires VIH/SIDA representaient la 3e cause de cecite binoculaire avec 14;6cas; ce qui montre que le VIH/SIDA serait en train de modifier les donnees epidemiologiques de la cecite; une transition epidemiologique a prendre en conside-ration. La cecite monoculaire (95 cas) representait 11;5de l'ensemble des patients. Les traumatismes (50;5); les infections (26) les affections degeneratives (18) en etaient les principales causes. La basse vision (70 cas) representait 8;5cas. Les causes etaient dominees par les ametropies (23). Il y a peu d'enquetes en milieu hospitalier sur les causes de cecite. Le resultat le plus marquant de cette etude est la place importante prise par les complications oculaires de l'infection par le VIH. L' importance de la basse vision; souvent negligee en Afrique de l'Ouest; est a souligner

[Plea for a graft]. / Plaidoyer pour un greffon.

With the promulgation of the "Bioethics" laws in 1994 in France, the Etablissement français des Greffes was endowed with the task of defining the principles controlling human tissue grafts in France. These laws require a precise control of all material and human input involved in each step of the grafting process. Organ removal from human cadavers by the ophthalmologist, graft preservation, validation of organ banks and recipient grafting by the surgeon are some of the many steps which must follow precise rules of good practices. All those who participate in these activities from organ removal to recipient grafting must comply with these rules to obtain the necessary administrative authorization. As the "Bioethics" laws will be re-evaluated in 1999, now is the time to propose possible alternatives aimed at increasing organ procurement and shortening patient waiting lists.

[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.

[Xerophthalmia: current data]. / La xérophtalmie: données actuelles.

Xerophthalmia is a term covering a range of ophthalmologic manifestations due to vitamin A deficiency. This condition occurs in preschool children in tropical regions affected by protein-caloric malnutrition. Clinical manifestations of the disease have been summarized in the 1974 five-grade WHO classification. Clinical diagnosis was traditionally made using a slit lamp to detect the pathognomonic manifestations and consequences of corneal and conjunctival xerosis. Currently diagnosis is greatly facilitated by determination of plasma levels using a micromethod, especially the relative dose response (RDR) test, and by conjunctival impression cytology (CIC). CIC is a simple and reliable method which allows mass screening and thus more effective evaluation of the impact of xerophthalmia on public health in Africa. The relationship between xerophthalmia and measles is complex. Vitamin A deficiency promotes measles which can in turn hasten perforation of keratomalacia especially in undernourished children. Vitamin A has a beneficial effect on both xerophthamia and measles. Curative and prophylactic administration of vitamin A at doses recommended by the W.H.O. considerably reduces not only xerophthalmia-related morbidity but also child mortality in tropical areas.

[Unusual case of bilateral optic neuritis in Lyme neuroborreliosis]. / Un cas rare de névrite optique bilatérale dans une neuroborréliose de Lyme.

The most common manifestations of Lyme disease are neurologic and rheumatologic, but ophthalmologic lesions can also occur and may even be dominant. The authors describe a case of bilateral optic neuropathy associated with Lyme borreliosis that quickly led to near-total blindness. In addition to a loss in visual acuity and field bilateral papillary edema was documented by angiofluorography. A spectacular improvement was obtained under combined antimicrobial therapy using doxycycline and corticosteroid therapy. The patient rapidly recovered full vision. These observations are discussed within the context of Lyme disease with a review of other relevant ophthalmologic complications. The importance of careful interpretation of serology is emphasized.

[Harada's disease. Report of a case]. / La maladie de Harada. A propos d'un cas.

Harada's disease is a uveo-meningitis syndrome characterized by meningo-encephalic manifestations preceded by bilateral posterior uveal lesions. The etiology of Harada's disease is still unclear but it probably involves an auto-immune reaction to melanocytes. This mechanism would account for the high incidence of Harada's disease in dark-skinned patients. This report describes a case of Harada's disease that occurred in a 28-year-old woman from North Africa. Ophthalmologic manifestations were typical with regard to clinical features and course involving bilateral papillary edema followed by exsudative detachment of the retina and diffuse cicatricial epitheliopathy of the posterior poles. However neurologic signs were mild, the main finding being atypical headache, and this particularity delayed diagnosis. Limited cerebral involvement that did not coincide with ocular lesions explains the fact that a thorough search for posterior uveal involvement with the aforesaid features was necessary. Although it occurs mainly in dark-skinned Asians, Harada's disease deserves the attention of physicians practicing in tropical areas.