[Rhegmatogenous retinal detachment: Topography of breaks and agreement with lincoff's rules]

PURPOSE

To study the topography of retinal breaks and their agreement with Lincoff's rules.

MATERIALS AND METHODS

We performed a retrospective descriptive study of patients with recent rhegmatogenous retinal detachments followed on the ophthalmology service of Abass Ndao Hospital from January 2006 through December 2016. Patients with no prior retinal treatment were included.

RESULTS

Over 11 years, we reviewed 97 patients with 107 eyes with retinal detachments. The mean age of our patients was 51.7 years, range 23-79 years. There were 69 male patients, for a male:female ratio of 2.46. Refraction revealed that 38.1% of patients were myopes. Fourteen percent (14%) of patients had experienced trauma to the eye with the detachment. The right eye was involved in 54.6% of patients. The onset was insidious in 54.6% of cases and sudden in 23.7% of cases. All patients had decreased visual acuity, associated with a scotoma in 26.8% of cases. Visual acuity was decreased to light perception through 7/10. In 64.9% of cases, Lincoff's rules were observed.

DISCUSSION

Lincoff's rules are still relevant for localization of the breaks in retinal detachments.

CONCLUSION

Diagnosis of a retinal detachment is an essential step, since it determines the treatment. Lincoff's rules still have a role in finding the retinal break in retinal detachments.

[Role of CT in diagnosis and monitoring of retinoblastoma in Senegal]

INTRODUCTION

Retinoblastoma is a malignant tumor of neuroepithelial origin, developed from young retinal cells, occurring in infants and young children. The goal of the study was to assess the role of CT in the diagnosis of retinoblastoma at the Aristide le Dantec Hospital in Dakar.

PATIENTS AND METHODS

This is an 11-year retrospective study of 160 patient records in the ophthalmology department and pediatric oncology unit of the same hospital.

RESULTS

One hundred and sixty (160) patients were recruited. The male:female ratio was 1.05. The mean age was 32.19 months. Leukocoria was the most common clinical sign, occurring in 105 cases (65.62 %). The retinoblastoma was intraocular in 97 cases (60.62 %). We saw 122 (76.25 %) unilateral and 3 (1.87 %) trilateral presentations. CT was performed in 150 children with 110 cases (73.33 %) of calcifications ; 62 cases (41.33 %) of optic nerve invasion ; 24 cases (16 %) of extraocular muscle invasion and 18 cases (12 %) endocranial extension. Associated tumors were found on CT: 2 cases of suprasellar mass and 1 case of pineoblastoma. In patients whose specimens were analyzed, histology showed 48.15 % optic nerve invasion, consistent with the CT findings.

DISCUSSION

CT has an important role in the diagnosis of retinoblastoma, despite its recent contraindication in bilateral and unilateral multinodular forms.

CONCLUSION

CT is a good alternative to MRI in the diagnosis of retinoblastoma in developing countries with limited technological resources.

[Ametropia among senegalese children in a hospital setting]

INTRODUCTION

Ametropia is common in children and cause strabismus and amblyopia. The goal was to establish its prevalence in a hospital setting among Senegalese children.

PATIENTS AND METHODS

This was a retrospective study of patients under 15 years of age with clear ocular media. The marital status, circumstances of discovery, and results of cycloplegic refraction were recorded.

RESULTS

Of 1506 children, 175 demonstrated ametropia. The mean age was 8 years, and the male : female ratio was 0.68. Family history of ametropia was present in 8.5 %. Decreased VA was present in 39.66 %, headache 10.06 %, and strabismus 4.47 %. Automated refraction in 109 patients and skiascopy in one patient showed 58.18 % cases of myopia, 18.18 % of hyperopia and 36.57 % of astigmatism.

DISCUSSION

The most common ametropia was myopia. Patients were referred for symptomatic ametropia.

CONCLUSION

Screening for ametropia might occur earlier if it is associated with pediatric monitoring in our regions.

[Giant retinal tears: Senegalese experience]

PURPOSE

To appreciate the epidemiological characteristics and to show the therapeutic aspects of the giant retinal tears.

PATIENTS AND METHODS

We conducted a retrospective study from January 2014 to June 2017 on subjects with giant retinal tears. Patients with media opacities limiting examination were excluded.

RESULTS

We identified 17 cases of giant retinal tears. The frequency of detachments related to a giant retinal tear was 17% compared to all retinal tears. The mean age was 50.75 years with a sex ratio (M/F) of 6.5. We found three cases of high myopia, one case of hyperopia and four trauma cases. All patients had a decrease in visual acuity. The average time to consultation was four weeks. The mean intraocular pressure was 8mmHg. The tear was found in the left eye in eight cases and in the right eye in five cases; two cases were bilateral. We performed intraocular surgery in five eyes and laser in four eyes. We achieved anatomical reattachment and functional improvement in all operated patients.

COMMENTS AND CONCLUSION

The prognosis of a giant retinal tear remains guarded, especially if patients are seen and treated late. Laser photocoagulation of giant tears remains effective, especially in cases of early diagnosis.

[Evaluation of mean macular thickness by optical coherence tomography (SD OCT) in black Senegalese subjects]

INTRODUCTION

Our goal was to evaluate the normal macular thickness in Blacks by OCT and to determine socio-demographic and clinical parameters which may influence it.

MATERIALS AND METHODS

This was a multicenter, prospective, descriptive study over 6 months. It included Black adults followed in the ophthalmology departments of Abass Ndao and Aristide-Le-Dantec hospitals in Dakar. Included subjects had corrected visual acuity of 10/10 (0 logMAR) and P2 (+0.1 logMAR), clear ocular media, and no retinal abnormalities. We used the Topcon 3D 2000 OCT to measure the central thicknesses of the cornea (CT) and of the macula (MT), and cup to disc ratio (C/D) in each eye. Socio-demographic, clinical and tomographic data were collected on a survey form and correlated to the MT. The analysis was carried out by the Epi info 7 software. We used the Chi² comparison test with a P value˂0.05.

RESULTS

One hundred and nine patients were included. The mean age was 27.39 years with a male/female ratio of 0.65. The subjects were emmetropic in 54.13% of cases. The mean CT was 519.97μm, the mean C/D was 0.23, and the mean MT was 264.35μm. The P-value (P) was greater than or equal to 0.1 for all the factors studied.

CONCLUSION

MT in our study was lower than that of Whites, and the various parameters studied did not demonstrate a statistically significant influence on MT.

[Perception of ocular blinding manifestations of sickle cell disease by practitioners in Dakar university hospital]

INTRODUCTION

In Senegal, 10% of the population are said to be carriers of hemoglobin S, the most widespread hemoglobinopathy in the world. It is responsible for potentially blinding ophthalmological manifestations. Few practitioners refer patients for ophthalmologic screening. The goal of our study was to assess the level of knowledge of practitioners of the blinding ocular lesions of sickle cell disease.

MATERIALS AND METHODS

A cross-sectional prospective study was carried out over five months. It included Dakar university hospital practitioners aside from ophthalmologists. On the survey form, each practitioner specified his or her specialty and responded to eight questions regarding sickle cell patients seen in consultation, knowledge of the blinding lesions related to the disease, and ocular monitoring for blinding systemic diseases. The practitioners were divided into three groups: department of medicine and medical specialties (group I), surgery and surgical specialties (group II), and biology and functional testing (group III). The descriptive analysis was done with the EPI-INFO software version 6.04.

RESULTS

The participation rate was 45.88%. Group I represented 45.29% of the sample, Group II 35.85% and Group III 18.86%. In all, 87.73% of practitioners saw sickle cell patients in consultation, 75.47% were aware of ocular involvement related to sickle cell disease, and 58.49% were aware of blinding lesions. 94.62% of practitioners saw sickle cell disease patients without systematically recommending ophthalmological consultation.

CONCLUSION

Practitioners' level of knowledge of the blinding ocular lesions of sickle cell disease is considered to be low.

[Rare causes of childhood leukocoria]

PURPOSE

The purpose was to record the causes of leukocoria among children under 10years of age and to determine the proportion of rare causes of leukocoria.

PATIENTS AND METHODS

This retrospective study was conducted over a period of ten years, from January 1, 2004 to December 31, 2013, in patients under 10years of age who were referred for leukocoria.

RESULTS

Leukocoria represented one of the ten reasons for consultation among children under 10years of age. The mean age of our patients was 42.5months. In 76 % of cases, the leukocoria patients were children under 6years of age. Male patients were affected more commonly, with a sex-ratio of 1.5. Patients coming from Dakar and its suburbs represented two thirds of the total. Bilateral involvement represented 53.7 % of the total. Cataracts were responsible for 74.3 % of cases, retinoblastoma 20.58 %, retinal detachment 0.96 %, retinopathy of prematurity 0.96 %, pupillary membrane persistence 0.96 %, persistent hyperplastic primary vitreous 0.64 %, endophthalmitis 0.64 %, optic nerve coloboma 0.32 %, iris heterochromia 0.32 % and ametropia 0.32 %.

DISCUSSION

The total percentage of rare causes was 5.12 % in our study, including one case of hyperopia. These etiologies, although rare, do exist.

CONCLUSION

Rare causes of leukocoria require special attention. The discovery of leukocoria necessitates rigorous etiological work-up. Ametropia must be a diagnosis of exclusion.

[Senegalese experience with acute viral conjunctivitis]

PURPOSE

To study the epidemiological and clinical aspects of acute enteroviral and adenoviral conjunctivitis.

PATIENTS AND METHODS

A prospective study was conducted between January 1st and October 31st, 2015, jointly between two Ophthalmology services and a virology laboratory, which identified 51 patients. Were included all patients who presented a painful red eye without loss of visual acuity associated with secretions,evolving for less than 4weeks RESULTS: The mean age was 32 years, and the sex ratio 1:1. Over half of our patients (61%) came from populous districts. A history of the virus "going around" was reported by 30 patients (59% of cases). Virological testing was positive in 35 patients (68.7% of cases). Over 90% of samples collected during the first week of clinical signs were positive.

CONCLUSION

Viral conjunctivitis is a contagious condition, the spread of which is favored by promiscuity. Adenovirus and enterovirus are the main causative agents. They are present on an endemic scale in Senegal; thus, the need for better epidemiological surveillance in order to limit spread.

[Isolated microspherophakia in a Senegalese family]

PURPOSE

To report the clinical investigation of isolated microspherophakia involving a Senegalese family in order to appreciate its functional impact.

OBSERVATIONS

This is a rural family comprised of 7 members. The sibship included three girls and two boys. One of the girls, who lived in a distant zone, was unable to be examined. Of all the examined members of the family, only the father was unaffected by the illness. There was no consanguinity. The general medical examination was normal. The best-corrected visual acuity (VA) for the girls was 2/10. For one of the boys, BCVA was 8/10 for both eyes, and for the other, BCVA was 10/10 for the right eye and 8/10 for the left eye. The mother's VA was 10/10 and P2 without correction. Myopia and astigmatism were present in the 4 children of the sibship. During the examination, we noted the presence of small crystalline lenses, which were very round and presented an abnormal visibility of the lens equator and zonular fibers. The diagnosis of microspherophakia was confirmed by measurement of the lens diameters by ultrasound biomicroscopy. Complications were present in the girls, including pupillary block glaucoma and amblyopia for the elder, and retinal degeneration and amblyopia for the younger daughter. The elder daughter was managed medically with glaucoma drops. The younger daughter received optical correction and a prophylactic Argon LASER treatment. The two boys received optical correction. No treatment was recommended for the mother.

CONCLUSION

Microspherophakia is a rare condition. Some serious complications can lead to amblyopia. A better multidisciplinary evaluation would allow for early detection and a better prognosis.

[Intratarsal triamcinolone acetonide injection for treatment of refractory chronic tropical endemic limboconjunctivitis (TELC): experience at Aristide-Le-Dantec university hospital in 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.

[Ocular lesions in melanodermia patients with chronic renal failure]

AIM

To describe the and the factors that influence their occurrence.

MATERIAL AND METHODS

A prospective study was performed over a year in the Ophthalmology clinic of Aristide le DANTEC Hospital, including 112 eyes of chronic renal failure patients followed up in the internal medicine unit of the same hospital. For each patient data of his follow up in the nephrology ward were recorded, even as the ophthalmological clinical examination which included colour test and angiography. All the lesions found were recorded on a questionnaire, seeking for any influence as far as age, sex, duration of signs, dialysis, and general complications were concerned. The analysis was performed using the 2005 Epi-info 6.0 software.

RESULTS

Sex ratio was 1.54. 70% were above 40 years old. Blindness was found on 44.6% of the eyes. There were 20.5% cases of eye lids oedema, 15.8% conjunctival calcifications, 26.8% cataracts, 3 cases of ocular hypertension, 7.1% corneal lesions. Hypertensive retinopathy was found on 75.9% of the cases, amongst 14.3% classified stage 3, and retinal oedema signs associated on 13.8%, arteriosclerosis on 14.3% of the cases. 88.1% had confirmed signs of dyschromatopsia. On angiography, there was evidence of chorioretinal lesions due to high blood pressure, including decrease of the choroidal blood flow, choroidal ischemic areas, and halo peripapillary oedema. Age was a risk factor for eye lid oedema. Corneal and conjunctival lesions, even as eye lid oedema and hypertensive retinopathy were more frequent on patients, sick for less than a year. High blood pressure was a risk factor for papillary lesions, hypertensive retinopathy, and dyschromatopsia. Corneal and conjunctival calcifications were found mostly on patients on dialysis, whereas they had less eye lid oedema, hypertensive retinopathy, and maculopathy.

CONCLUSION

Retinal lesion, especially due to high blood pressure is the most described. It permits to establish the prognostic of the disease. Patients on dialysis show a decrease of that retinopathy, but some sequels might persist which are invalidating, irreversible and may lead to blindness. This can be prevented by early screening of high blood pressure and an adequate treatment of chronic renal failure. Ophthalmologic examination remains a cheap and simple method to prevent the complications.