[Treatment of retinoblastoma: Senegalese experience]. / Thérapeutique du rétinoblastome: expérience sénégalaise.

INTRODUCTION: Retinoblastoma is a malignant tumor arising from retinal stem cells or retinoblasts. Its management has been well determined. The goal of this study is to report preliminary results obtained with combined chemotherapy and surgical treatment. PATIENTS AND METHODS: Our transverse prospective study includes retinoblastomas diagnosed and treated on our service from January 2006 to December 2010. Fundus examination under general anesthesia and radiological examination, orbital/brain CT or if unavailable, ultrasound, were systematically performed. MRI was able to be obtained in one case. The patients received 6 courses of chemotherapy (vincristin-carboplatin-etoposide or vincristin-cyclophosphamide), including 2 preoperative courses and 4 postoperative courses. A surgical procedure (enucleation or exenteration) supplemented the treatment, followed by histologic analysis of the specimen. External radiation therapy and conservative management were not available. RESULTS: Fifty-nine patients were treated. Median age at time of diagnosis was 9months (range 2months to 7years); the gender ratio was 1.18. Tumors were bilateral in 12 cases and unilateral in 47 cases, intraocular in 34 cases and extraocular in 25 cases. Optic nerve involvement was confirmed by histology in 12 cases. Twenty-one patients died from recurrence and/or metastatic disease, or during chemotherapy. Seven were lost to follow-up, and 31 have survived uneventfully. DISCUSSION: Improvement of mortality is still our major concern. Radiation therapy is essential in the presence of optic nerve involvement. CONCLUSION: Long-term survival will determine the efficacy of this form of management. The contribution of new therapeutic means will improve these results.

[Intratarsal triamcinolone acetonide injection for treatment of refractory chronic tropical endemic limboconjunctivitis (TELC): experience at Aristide-Le-Dantec university hospital in Dakar]. / Injection intratarsale de triamcinolone acétonide dans le traitement des formes graves de la limboconjonctivite chronique endémique des tropiques (LCET) : expérience du CHU Aristide-Le-Dantec de Dakar.

PURPOSE: To evaluate the efficacy of intratarsal triamcinolone acetonide (TA) injection versus dexamethasone ointment in the treatment of refractory chronic tropical endemic limboconjunctivitis (TELC). PATIENTS AND METHODS: This one-year prospective study enrolled 20 patients with refractory TELC. One millilitre containing 40 mg TA was injected intratarsally on the most affected eye and dexamethasone ointment applied in the fellow eye. Efficacy was judged by clinical criteria according to a specially designed scale for the study. Statistical analysis was carried out using Fisher's chi(2) test and Student's t test with comparisons of the means of paired samples. RESULTS: In both cases, symptoms improved in all patients, as early as the following day or week, and clinical signs improved from the second week through the first month after injection, with an effective dose of 1 mL TA and three weeks of dexamethasone, with no recurrence at three months. Efficacy of the ointment alone was less (33.3-75%) than that with injection (90.9-100%) and could only be maintained after the first month by repeated application. CONCLUSION: Intratarsal TA injection, relatively easy and well-tolerated by patients, may be a better alternative to dexamethasone ointment in the treatment of refractory TELC.

[Clinical and angiographical findings of age-related macular degeneration in Senegal. Preliminary results]. / Aspects cliniques et angiofluorographiques de la degenerescence maculaire liee a l'age au Senegal. Résultats préliminaires.

INTRODUCTION: Principal cause of legal blindness in industrialized countries, age-related macular degeneration (ARMD) have never been studied in West Africa. We report and analyse the clinical and angiographical characteristics of macular degeneration in our patients older than 50 years. MATERIAL AND METHODS: In this prospective study, we recruited during 13 months all patients presenting ARMD signs from our consultation department. Various clinic and angiography parameters were collected. The follow up varied between 6 and 20 months. RESULTS: The prevalence of this pathology was of 6.5 per 1000. Sex ratio was 0.36 and mean age 61.6 years (53 to 80 years). No familial history of ARMD was found. Three patients were more exposed to sun because of their profession, 9 had high blood pressure, 6 were hyperopes and 1 was smoking. A drop of visual acuity was noted in all cases but no metamorphopsies. Signs founded were miliar drusen (20 eyes), serous drusen (4 eyes), association of those two kinds (4 eyes) and retinal pigmented epithelium abnormalities (PE) (8 eyes) alone or associated with drusen. These signs were significant of age-related maculopathy (ARM). The fluorescein angiography confirmed the type of lesions and showed no signs of neovascularization. An aggravation of the pigment migration was noted in one case after 20 months. CONCLUSION: Age related macular degeneration doesn't seem frequent in our population of patients and shows essentially under its initial form of ARM even though facilitating factors seemed identical, excepted tobacco addiction, sun exposition and systemic hypertension. This study which short terms results we are presenting would need to be continue to give more precisions on those data.

[Aniridia: five case studies]. / L'aniridie: à propos de cinq observations.

INTRODUCTION: Aniridia, or congenital absence of the iris, is a rare and severe ocular abnormality. We report five cases diagnosed in our department over the last 5 years and describe our clinical findings and attitude. OBSERVATIONS: The patients were two adults and three children, 8-45 years old at the time of diagnosis. Visual acuity ranged from light perception to 20/50. Aniridia was associated with other abnormalities in four cases: lens ectopy in one case, ptosis in three cases, microcornea in one case, macular hypoplasia in three cases and a pterygium coli associated with a pectus excavatum in one case. All patients had complications: corneal dystrophy in three cases, lens opacities in five cases, elevated intraocular pressure (IOP) in two cases, severe amblyopia with nystagmus or strabismus in three cases. Only patients with glaucoma received IOP-lowering medications. IOP was normalized in both cases and regular controls were instituted for all the other patients. DISCUSSION: Management of aniridia is complex in our regions because patients often consult late, at a stage that involves complications and amblyopia. First-intention surgical treatment of glaucoma is not always justified. CONCLUSION: Only genetic counseling, a close follow-up after an early diagnosis and adapted surgical techniques can improve the visual prognosis of aniridia patients.