Search

Copyright of Médecine et Santé Tropicales is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Ocular toxoplasmosis (OT) is the leading cause of infectious posterior uveitis in several areas worldwide. The combination of Trimethoprim/Sulfamethoxazole (TMP/SMX) has been presented as an attractive alternative to the "classic' treatment therapy (Pyrimethamine/Sulfadiazine)., Methods: A prospective study was carried out between February 2020 and September 2021 in 2 ophthalmic centers in Kinshasa. This study aimed to describe TMP/SMX treatment outcomes for OT in a cohort of immunocompetent Congolese patients., Results: 54 patients were included, with a mean age at presentation of 37.5 ± 13.6 years old and a Male-Female ratio of 1.45:1. Three patients (5.6%) presented a recurrence during the follow-up period. At the end of the follow-up, improvement in VA and resolution of inflammation concerned 75.9% and 77.5% of patients, respectively. Cataracts (3.7%), macular scars (3.7%), and vitreous opacities (3.7%) were the principal causes of non-improvement in VA. Treatment-related adverse events were present in 10 patients (18.5%); gastrointestinal (14.8%) and dermatological (3.7%) adverse events were the most frequent. Dermatological adverse events led to discontinuation of treatment., Conclusion: TMP/SMX regimen appears to be a safe and effective treatment for OT in Congolese patients. The low cost and the accessibility of the molecules make this regimen an option for treating OT in resource-limited countries., (© 2023. The Author(s).)

Purpose: To describe demographic data, clinical features, and serological profiles in a cohort of Congolese patients with ocular toxoplasmosis (OT)., Method: Cross-sectional study, carried out between March 2020 and July 2021 in two ophthalmic clinics in Kinshasa., Results: The study comprised 95 participants with OT. Fifty-three patients were male (55.8%). The mean age at presentation was 35.6 ± 14.1 years (range 8-69 years); 71 had active OT (74.7%), among them, 33 had primary OT (46.5%), and 38 had recurrences (53.5%). At presentation, 51 patients (53.7%) had visual impairment (VA < 6/18). Retinochoroidal lesions were located in the central retina in 60 patients (63.1%). Patients with primary OT tend to have higher IgG levels than those with recurrent OT ( P = .01)., Conclusion: We report the largest cohort of patients with OT in sub-Saharan Africa. In our setting, most patients had recurrent OT with multiple, extensive, and central retinochoroidal lesions.

Objective: To identify the risk factors associated with ocular toxoplasmosis (OT) in a cohort of Congolese patients with uveitis., Methods and Analysis: A cross-sectional study was conducted between March 2020 and July 2021 in two ophthalmic clinics in Kinshasa. Patients with a diagnosis of uveitis were enrolled in the study. Each patient underwent an interview, an ophthalmological examination and serology testing. Logistic regression was performed to identify risk factors for OT., Results: 212 patients were included in the study with a mean age at presentation of 42.1±15.9 years (limits: 8-74 years) and a sex ratio of 1.1:1. OT concerned 96 patients (45.3%). The age of the patients below 60 years (p=0.001, OR=9.75 CI 95% 2.51 to37.80)), the consumption of cat meat (p=0.01, OR=2.65 CI 95% 1.18 to 5.96)) and undercooked meat (p=0.044, OR=2.30 CI 95% 1.02 to 5.21)) and living in rural area (p=0.021, OR=11.4 (CI 95% 1.45 to 89.84])) were identified as risk factors for OT., Conclusion: OT affects more young people. It is associated with dietary habits. Informing and educating the population is necessary to avoid infection., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To present a narrative review about ocular toxoplasmosis epidemiology, disease burden and prevalent African parasitic strains., Methods: An initial search for MeSH terms was conducted with a posterior advanced search in two electronic databases. Full text reading was performed., Results: Animal African studies have identified Toxoplasma gondii type II, type III, Africa 1, and Africa 3 strains. Seroprevalence varies from 6.4% to 74.5%. Nevertheless, there is a scarcity of epidemiology and serotyping information about ocular toxoplasmosis. African studies have demonstrated that uveitis patients present high frequencies of ocular toxoplasmosis. There is a lack of studies describing specific clinical characteristics, which can be related, to environmental and socioeconomic factors, parasite serotype and genotype, and genetic susceptibility of the host., Conclusion: As Toxoplasma gondii has more virulent strains in the Southern hemisphere, it is relevant to determine African strain types and the correlation between the infecting strains and the clinical manifestations.

Background: The problem of access to medical information, particularly in low-income countries, has been under discussion for many years. Although a number of developments have occurred in the last decade (e.g., the open access (OA) movement and the website Sci-Hub), everyone agrees that these difficulties still persist very widely, mainly due to the fact that paywalls still limit access to approximately 75% of scholarly documents. In this study, we compare the accessibility of recent full text articles in the field of ophthalmology in 27 established institutions located worldwide., Methods: A total of 200 references from articles were retrieved using the PubMed database. Each article was individually checked for OA. Full texts of non-OA (i.e., "paywalled articles") were examined to determine whether they were available using institutional and Hinari access in each institution studied, using "alternative ways" (i.e., PubMed Central, ResearchGate, Google Scholar, and Online Reprint Request), and using the website Sci-Hub., Results: The number of full texts of "paywalled articles" available using institutional and Hinari access showed strong heterogeneity, scattered between 0% full texts to 94.8% (mean = 46.8%; SD = 31.5; median = 51.3%). We found that complementary use of "alternative ways" and Sci-Hub leads to 95.5% of full text "paywalled articles," and also divides by 14 the average extra costs needed to obtain all full texts on publishers' websites using pay-per-view., Conclusions: The scant number of available full text "paywalled articles" in most institutions studied encourages researchers in the field of ophthalmology to use Sci-Hub to search for scientific information. The scientific community and decision-makers must unite and strengthen their efforts to find solutions to improve access to scientific literature worldwide and avoid an implosion of the scientific publishing model. This study is not an endorsement for using Sci-Hub. The authors, their institutions, and publishers accept no responsibility on behalf of readers., Competing Interests: The authors declare that they have no competing interests., (© 2019 Boudry et al.)

Purpose: To determine the epidemiology and clinical pattern of Congolese patients with ocular toxoplasmosis., Patients and Methods: A retrospective study was conducted on records of patients with ocular toxoplasmosis examined in the Teaching Hospital of Kinshasa (DR Congo) from 2010 to 2012. Each patient underwent a complete ophthalmic examination. Sociodemographic data, clinical symptoms and signs, visual outcome, modality of treatment and type of complications were studied., Results: Thirty-five cases of ocular toxoplasmosis were diagnosed out of 18,144 patients, giving a frequency of 0.2 %. Eighteen men (51.4 %) were affected, with a sex ratio of 1.05. The mean age of the patients was 40.9±20 years (range: 10-72 years). The mean time until consultation was 10 months (range: 2 days-84 months). Ocular involvement was unilateral for 65.7 % of patients. Decreased visual acuity (77.1 %) and pain (7.1 %) were the main ocular complains. Chorioretinal lesions involved the central retina in 26 patients (74.3 %). Five patients (14.2 %) developed recurrences during follow-up. Complications affected 17 patients (48.6 %), with macular scarring (34.3 %) and cataract (17.1 %) being the most common. At the first consultation, 61.7 % of the affected eyes had visual impairment (VA<0.3). Visual impairment was associated with macular lesions (P<0.001, OR=3 [1.4-6.1]) and age greater than 45 years (P=0.002, OR=11 [2.2-53.6])., Conclusion: In our context, complications are common with ocular toxoplasmosis,s and they lead to visual impairment in the majority of patients., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objective: to determine the frequency of ocular manifestations in Congolese children aged 0 to 15 years infected with HIV/AIDS and to identify the predicted clinical and/or biological elements., Methods: This was a prospective, descriptive and cross-sectional study performed from November 2010 to April 2011 in five sanitary structures who take care of children infected with HIV/AIDS. During the period of study, one hundred children infected with VIH/AIDS were examined. Seventy- six (76%) of children were under highly active anti-retrovial therapy (HAART). The age of children ranged from 0,5 month to 15 years. Children underwent a routine ophthalmic examination which included measurement of visual acuity, inspection of the adnexa and cornea, slit-lamp examination and dilated ophthalmoscopy. The CD4 lymphocyte count was determined in 88 of them., Results: The frequency of ocular manifestations was 36%. The mean age of children was 8 years (SD: 4.01; range 0,5 month-15 years). The male female sex ratio was 0.8/1. Ocular complaints were present in 22 children (22%). Visual symptoms were most frequent in children with severe decrease of immunity. Of four children identified with a visual handicap, one (1.5%) had blindness and three (4.4%) had visual impairment. All of these four children had a CD4 lymphocyte count less than 15%. Among ocular manifestations, the adnexial manifestations were the most frequent with 18 cases (18%) followed by the posterior segment manifestations with 14 cases (14%) and the neuroophthalmic lesions with 5 cases (5%)., Conclusion: This study documented 36% of ocular manifestations; this frequency is comparable with the other African studies. Comparatively to studies conducted in other continents the frequency in African studies is high. This study also showed that the adnexial manifestations are the most frequent ocular findings and that the children with severe decrease of immunity are most exposed to visual troubles that can lead to blindness.

Objectives: To study the prevalence and risk markers of diabetes mellitus and intermediate hyperglycaemia (IH) in Kisantu, a semirural town in Bas-Congo province, The Democratic Republic of Congo., Design: A cross-sectional population-based survey., Settings: A modified WHO STEPwise strategy was used. Capillary glycaemia was measured for fasting plasma glucose and 2-h-postload glucose. Both WHO/IDF (International Diabetes Federation) 2006 and American Diabetes Association (ADA) 2003 diagnostic criteria for diabetes and IH were used., Participants: 1898 subjects aged ≥ 20 years., Results: Response rate was 93.7%. Complete data were available for 1759 subjects (86.9%). Crude and standardised (for Doll and UN population) prevalence of diabetes were 4.8% and 4.0-4.2%. Crude IH prevalence was 5.8% (WHO/IDF) and 14.2% (ADA). Independent risk markers for diabetes (p<0.01) were male (OR 2.5), age 50-69 years (OR 2.6), family history (OR 3.5), waist (OR 4.1) and alcohol consumption (OR 0.36). In receiver operating characteristic (ROC) analysis, prediction of diabetes was slightly better by waist than body mass index (BMI). IH defined according to WHO/IDF was associated with BMI (OR 2.6, p<0.001). IH defined according to ADA was associated (p<0.05) with waist (OR 1.4), education level (OR 1.6), BMI (OR 2.4) and physical activity (OR 0.7)., Conclusions: Current prevalence of diabetes in DR Congo exceeds IDF projections for 2030. The lower glucose threshold used by ADA almost triples impaired fasting glucose prevalence compared to WHO/IDF criteria. The high proportion of disorders of glycaemia made up by IH suggests the early stages of a diabetes epidemic.

Purpose: To evaluate the frequency of diabetic retinopathy in Lubumbashi (Democratic Republic of Congo)., Methods: Descriptive survey including 369 diabetic patients examined in our department of Ophthalmology of Lubumbashi from May 2006 to March 2008. Rates of glycaemia and blood pressure were noted. All the patients had a complete ophthalmological examination including visual acuity measurement, anterior biomicroscopy, intraocular pressure and fundus examination after pupil dilation., Results: At the time of ocular examination, the mean age of diabetic patients was 57 years (range 16 to 85) with a sex ratio of 1.2 males for 1 female. The frequency of type 1 diabetic patients was 28% and of type 2, 72%. High blood pressure was found in 42% of the patients. The frequency of diabetic patients (all forms included) was 13% and diabetes-induced blindness was 0.27%. In our study, the frequency of diabetic retinopathy increased with the patient's age and the duration of the diabetes. Diabetic retinopathy was more frequently found in adults. We did not find correlation between the level of glycaemia and the incidence of diabetic retinopathy., Conclusion: From our epidemiological study, diabetic retinopathy is a concern for adult public health. It requires organized screening and early treatment to prevent blindness of those diabetic patients.

A 34-year-old Lebanese man presented with photophobia, tearing, and reduced vision in the left eye, a few hours after being accidentally hit in the eye with a fingernail. The cornea in the left eye showed corneal defect . About three minutes after receiving topical fluorescein in this eye, the patient developed syncope and anaphylactic shock. After immediate reanimation, the patient regained consciousness. When specifically asked, he reported a three-month history of urticaria to the right side of his neck and nose. The possible pathophysiology involves an underlying IgE-mediated mechanism. Ophthalmologists should be aware of complications associated with topical fluorescein.

Purpose: To determine frequency and associated conditions of subconjunctival haemorrhage, Methods: A descriptive and cross-sectional study of all consecutive patients with traumatic and spontaneous subconjunctival haemorrhage (SCH) examined between 1999 and 2004 in a general practice of ophthalmology., Results: There were 58 (0.8%) patients with SCH (61 eyes) among 6843 consulting patients. They consisted of 34 (58.6%) women and 24 (41.4%) men, with a mean age (SD) of 30.7 years (16). Among the 58 patients with SCH, 30 (51.7%) had traumatic SCH and 28 (48.3%) had spontaneous SCH. In both populations of patients, females outnumbered males. The mean age was 35.5 and 26.4 years for patients with spontaneous and traumatic SCH, respectively (P = 0.04). Patients with spontaneous SCH presented earlier (< or = 3 days, P = 0.006) and complained of a red eye at a greater extent than patients with traumatic SCH (P = 0.02). There were no statistically significant differences between the patients with spontaneous and traumatic SCH with respect to gender (P = 0.75), eye involvement (P = 0.69), location of SCH (P = 0.23) and occupation of patients (P = 0.50). The condition was unilateral in 90% of eyes. Location of SCH was most found to be temporal (36.1%) or nasal (26.2%). In spontaneous SCH, no apparent associated condition was found in 64.3%. Hypertension (14.3%) was the most frequent associated condition. Other associated conditions were rare and included vomiting, sneezing, malaria, hypoglycaemia, sickle cell disease and delivery. In traumatic SCH, 67% injuries occurred at home., Conclusion: SCHs were seen in 0.8% of patients and occurred more frequently in women than in men in this study.

Objective: To determine the frequency and the causes of blindness and visual impairment among patients with diabetes mellitus from DR Congo., Methods: In this observational study of series, records of all consecutive patients with diabetes mellitus seen between April 1, 2004 and April 30, 2006 in the Division of Ophthalmology, University of Kinshasa, were retrospectively assessed and included. Eye examination including measurement of visual acuity, slit lamp examination, funduscopy and tonometry was performed in all patients. Fluorescein angiography was performed when needed. The World Health Organization criteria and the recommendations for the revision were used for blindness and visual impairment definitions., Results: During the study period, 299 patients with diabetes mellitus were examined, giving a frequency of 2% (299 out of 13401 patients). There were 194 males (65%) and 105 females (35%). Ages ranged from 21 to 88 years (mean age+/-SD, 58 years+/-10). The mean duration of diabetes mellitus was 7+/-8 years and its median duration was 4 years. Frequency of blindness and that of visual impairment were 12% and 24%, respectively. Causes of blindness were diabetic retinopathy (47%), cataract (33%), glaucoma (17%) and optic nerve atrophy (2.8%)., Conclusion: This study shows an unexpected higher frequency of blindness in diabetic patients when compared with previous African studies and those of other parts of the world. Blindness seemed to appear early in Congolese diabetic patients than in Caucasian diabetic patients. Diabetic Retinopathy remains the common cause of blindness among Congolese diabetic patients. Programmes must be drafted for prevention, early detection and treatment of blindness among diabetics.

Objective: To evaluate the efficacy of intralesional corticosteroid injection in the treatment of chalazia in black African patients., Methods: In a prospective study conducted between February 1999 and February 2000, 25 black African patients with chalazion (25 eyes, 29 chalazia), ranging in age from 15 to 54 years (mean age +/- SD, 30.6+/-9 years), were treated with intralesional triamcinolone (injection of 0.075 - 0.5 ml triamcinolone acetate at a 5-mg/ml concentration)., Results: Success was achieved in 18 (72%) of 25 patients [20 (74%) out of 27 eyes, 22 (76%) out of 29 chalazia)]. In 11 of 25 patients, two intralesional injections were necessary to obtain these results. Recurrence occurred in five eyes (five chalazia, 17%) after 5-6 weeks. During a mean +/- SD of 4.68 months (range, 3.5-12 months) of follow-up, no postinjection ocular complication occurred., Conclusion: Intralesional corticosteroid injection appears to be effective in managing chalazion in black African patients, as reported in previous studies in Caucasian patients. This treatment can be used when curettage is contraindicated.

Purpose: To determine frequencies of ocular emergencies and identify their nature., Design: Observational case series., Methods: In a retrospective study, the records of all 118 consecutive patients seen in emergency room during an eleven-month period were reviewed., Results: Ocular emergencies represented 4% of the 2917 new patients visiting the department of Ophthalmology during this time. There was a 2.1/1 male to female preponderance and a peak age of presentation between 11 and 30 years. The mean age was 26 years +/- 17. Ocular trauma (68 patients) accounted for over two-fourths (57.6%) of the total cases. Only 16% of patients presented within 48 hours. Fifty-one percent of injuries occurred to the left eye, 38% to the right, and 10% bilaterally. The commonest ocular injury problems were eyelid laceration (13 patients, 19.1%), post-traumatic iritis (12 patients, 17.6%), and corneal laceration and penetration (10 patients, 14.7%), accounting for 51% (35 patients) of the total. Home- and work-related ocular injuries accounted for 54% of all ocular injuries. Thirty-three percent of all ocular injuries were caused by assault and fight, and 15% were related to motor vehicle accident. For the non-traumatic ocular emergencies, the main aetiological factor was inflammation (18%)., Conclusion: Our study showed that males account for the majority of eye injuries and this class is more prone to assault-related injuries. In our country prevention strategies must take account of these.

Purpose: To report a case of unilateral corneal hydrops associated with vernal conjunctivitis as a presenting sign of keratoconus., Method: Case report. A 10-year-old girl with corneal hydrops of the left eye., Result: Visual acuity in the affected eye was hand motions and slit-lamp examination revealed a left keratoconic, ectasis, edematous cornea with mild vernal conjunctivitis., Conclusion: Hereditary and environmental factors may contribute to the etiology of keratoconus and corneal hydrops.

Objective: To report the relative frequency of the signs of presentation in Congolese children with retinoblastoma., Methods: A retrospective study was undertaken of all (29) patients with retinoblastoma examined between January 1995 and December 2000., Results: There were 19 (66%) boys and 10 (34%) girls. For all cases, mean age at diagnosis was 2.94 years +/- 1.6 (range, four months to six years). For bilateral cases, it was 1.12 year +/- 1.4 (range, two months to three years) whereas for unilateral cases it was 3.23 years +/- 1.5 (range, four months to six years) (P = 0.016). More than seven distinct signs were identified. Leukocoria was the most common presenting sign in 49% of diagnosed cases followed by proptosis (28%). Other signs were strabismus, red eye, anterior scleral staphyloma, hyphema and buphthalmia., Conclusion: Strabismus seemed to be uncommon whereas proptosis is important in our small series when compared to signs reported in the developed world.

Purpose: To study color vision in Congolese patients with tuberculosis receiving ethambutol therapy., Methods: A prospective, descriptive study of color vision test in patients with systemic tuberculosis receiving ethambutol was performed between April 1995 and January 1998 at the Department of Ophthalmology, University of Kinshasa. Color vision tests were assessed with pseudoisochromatic plates (the Ishihara Pseudo-isochromatic Plates), the AO-HRR (American Optical Handy Rand Rittler), the Bölle and Kastel anomaloscope, Farnsworth-Munsell test (the D-15 and the FM-100)., Results: There were 42 patients with a mean age of 33 years (range, 14 to 75 years). The color vision of all the patients was found to be normal as measured by the Ishihara pseudoisochromatic plates. One (2%) patient showed color vision defect (anarchic axis] with the OA-HRR test. Three (7%) of 42 patients displayed blue-yellow color axis or anarchic axis color vision test on the D-15 test. Fifteen (36%) of 42 patients had high total error scores at the Farnsworth-Munsell 100 test. The color axis was as follows: anarchic axis (13.1%), red-green-color and blue-yellow-color combined axis (13.1%), blue-yellow color axis (7.5%). Results of the Bölle and Kastel anomaloscope were normal in all patients., Conclusion: Our results confirm the importance of color vision examinations in the detection of the complications of ethambutol treatment.

Objective: The purpose of the study is to determine the frequency of ocular manifestations in Congolese children with homozygous sickle cell disease., Methods: Sixty-six children with homozygous sickle cell disease were examined for ocular abnormalities between March 1 and August 31, 1998. The ages of children ranged from two to 18 years. Routine ophthalmic examination included measurement of visual acuity, inspection of the adnexa and cornea, refraction, silt-lamp examination and dilated ophthalmoscopy., Results: Ocular abnormalities were found in 47 (71%) children of 66 subjects. Ophthalmologic abnormalities included conjunctival signs (32%), retinal vascular tortuosity (29%) and dilatation (26%), AV crossing (29%)., Conclusions: Ocular findings in this study were similar to those previously published in Africa, which showed a low frequency of retinal changes.

Background: On basis of clinical observation paediatricians in Kinshasa had the impression that children with homozygous sickle cell disease have a special face characterised by hypertelorism., Objective: The purpose of the study is to determine outer orbital, inner canthal and interpupillary distances as well as proptosis in children with sickle cell disease., Methods: These measurements were performed on 66 Congolese children with homozygous sickle cell disease, aged from 2 to 18 years. The measurements were performed with the Hertel exophthalmometer for the proptosis and the outer orbital distance, with the pupillometer model PD-2 meter for the interpupillary distance and with a ruler for the inner canthal distance. The results were compared with those of 95 healthy children of similar age., Results: All measurements were age related. In every age group the values for inner canthal distance were identical to those of healthy children, but the interpupillary, the outer orbital distances and the proptosis were significantly smaller., Conclusions: A slow growth of orbital tissue in children with homozygous sickle cell was suggested to explain the difference with healthy children. Other biometric studies comparing the orbital measurements with the rest of the body are needed to confirm or refute this hypothesis.

Purpose: To describe a patient with sudden onset of subconjunctival haemorrhage related to malaria., Methods: A case report., Results: The patient, who had a history of malaria, had bilateral subconjunctival haemorrhages. General examination showed no abnormality except malaria. All signs of conjunctival haemorrhages resolved later., Conclusion: Ocular malaria should be considered in the differential diagnosis of subconjunctival haemorrhages.

Purpose: To determine the clinical characteristics of conjunctival squamous cell carcinoma and conjunctival intraepithelial neoplasia in AIDS patients., Methods: A review of AIDS patients with biopsy-confirmed conjunctival squamous cell carcinoma and conjunctival intraepithelial neoplasia seen between 1994 and 1997., Results: Ten patients, aged from 25 to 46 years (average, 37.3 years) were seen. There were three men and seven women. The mean delay of diagnosis was 7 months. Of the 10 patients, three had squamous cell carcinoma of the conjunctiva and seven had conjunctival intraepithelial neoplasia. Both eyes were involved with equal frequency. Lesions involved the corneoscleral limbus and the conjunctiva in eight patients and the conjunctiva in two patients. Localization of lesions was temporal in six patients, nasal in three patients and inferior in one patient. All patients were treated by excision of the lesions. A recurrence was seen in two patients (during the follow-up of 6 months)., Conclusion: The conjunctival squamous cell carcinoma and intraepithelial neoplasia in AIDS patients in this study showed similar clinical characteristics as those reported in immunocompetent persons, but occurred in a younger age group and were more aggressive.

Purpose: To study the alterations of the trabecular meshwork of Belgian and Congolese patients with open angle glaucoma (OAG)., Methods: A trabeculectomy was performed in 27 OAG patients from Belgium and 24 from Congo; the trabecular specimens were fixed, embedded, stained, and studied by light microscopy. These specimens were compared with the trabecular meshworks from 5 Belgian non-glaucomatous eyes., Results: The mean number (+/- standard deviation) of trabecular cells per field was 69 (+/- 10) in Belgian normal eyes, 34 (+/- 17) in Belgian OAG patients, and 10 (+/- 6) in Congolese OAG patients. The trabecular meshwork was collapsed and Schlemm's canal was closed in the cases with a diminished number of cells. Pigmentation was present in 79% of the Congolese and in 35% of the Belgian specimens., Conclusion: The trabecular meshwork from OAG patients has a lower cellularity than normal, and the effect is much more pronounced in the trabecular meshwork from Congolese patients. This may be a possible explanation for the racial differences in OAG and the more severe forms of glaucoma in black people.

Objective: To determine frequencies of eye diseases and causes of blindness in this rural area., Method: During a one month period (February 1996), a study was carried out in three rural centers (Mbandaka, Iboko, Lukolela) in the South Western Equator, in the tropical equatorial forest area. A total of 700 patients were examined and ophthalmological examination included visual acuity, inspection of adnexa, refraction, slit-lamp examination, direct funduscopy and intraocular pressures., Results: Cataract and glaucoma were the major ocular diseases found. Among the patients 1/5 was legally blind, and common causes of blindness were: cataract (54%), glaucoma (30%), uveitis (6%), corneal disorder (5%), retinitis pigmentosa (3%), atrophy of eye (3%)., Conclusion: Cataract and glaucoma constituted a public health problem in this rural area of Zaïre.

Objective: To identify possible risk factors for open-angle glaucoma (OAG) among 260 black subjects in Kinshasa (Congo)., Methods: Between May 14, 1996 and June 14, 1996, 260 persons, aged 24-60 years old, working at a factory in Kinshasa, have been examined. Twenty-two patients with OAG and 238 controls were identified. Data were obtained through interviews and clinical examinations. OAG was defined by the presence of both optic disc damage and characteristic visual field defects., Results: The frequency of OAG was 8.5%. Associations were found with intraocular pressure greater than 21 mmHg (Odds ratio (OR) = 119.4, 95% confidence interval (CI), 17.62 to 4960.64), current cigarette smoking (OR = 2.77, 95% CI, 1.04 to 7.34) and Mongo ethnic subgroup (OR = 3.195, 95% CI, 0.93 to 9.57)., Conclusion: Mongo ethnic subgroup seemed to be another risk factor for OAG in Congo.

Objective: To determine frequencies of various types of glaucoma in an urban community of Congo., Methods: The records of 176 patients with the diagnosis of glaucoma examined between 1991 and 1995 at a non-university center were reviewed. A complete ophthalmological examination was performed in each patient including best visual acuity, refraction, slit-lamp examination, ophthalmology and intraocular pressure measurements. Gonioscopy and visual field examination were performed when needed., Results: The frequency distribution of the various subtypes of glaucoma was: open-angle glaucoma (72.2%), aphakic glaucoma (9%), uveitis glaucoma (6%), exfoliative glaucoma (3%), glaucoma secondary to ocular trauma (2.2%), cataract glaucoma (1.7%), normal tension glaucoma (1.7%), congenital glaucoma (1.7%), neovascular glaucoma (1.3%), pigmentary glaucoma (0.6%), corticosteroid-induced glaucoma (0.6%), and glaucoma associated with retinoblastoma (0.6%);, Conclusion: Despite the limitations inherent of a retrospective review of records, our study provides an indication of the prevalence of various types of glaucoma in a urban community of Congo. This study confirmed also the rarity of primary angle-closure glaucoma in the black.

Purpose: to determine frequencies of refractive errors in Zairian blacks and to investigate the influence of race upon refraction., Methods: we examined the records of all patients seen at the department of Ophthalmology from 1963 to 1972. Refraction was measured by objective (skiascopy) or subjective methods., Results: we found 4326 patients with ametropia, about 16% of the total. The records of 2594 Zairian patients with refractive errors were compared to those of 1417 non Zairian black patients and 315 Caucasian patients. The frequency of spherical refractive errors in Zairian black patients was 56%: (simple myopia: 33% myopia over 5 D: 1%, hypermetropia: 22%), astigmatism was seen in 44% (myopic astigmatism: 31% and hypermetropic astigmatism: 11%). The data of Zairian were similar to those of non-Zairian black patients. Spherical refractive errors in Caucasian patients were found in 46% of the patients (simple myopia: 19%, myopia over 5 D: 2%, hypermetropia: 25%). Astigmatismatic errors were seen in 54% (myopic astigmatism: 27%, hypermetropic astigmatism: 24%, mixed astigmatism: 3%). Hypermetropia increased with age in all groups, but slightly earlier in Zairian patients., Conclusion: Although the data of refractive errors did not show significant differences between Zairian and Caucasian patients, hypermetropic astigmatism seems to be less frequent and myopia more frequent among Zairian patients.

The purpose of this study was to establish in this first report the age standards of the Pelli-Robson contrast sensitivity in Zaïre. Contrast sensitivity using the Pelli-Robson chart was performed in 100 normal Zairian black subjects aged from 10 to 59 years and 36 patients (22 patients with open-angle glaucoma and 14 with optic nerve disease). Scores of normal subjects were age related (p < 0.05). The results of Zairian young subjects were similar to those found previously in young white subjects; scores for older subjects were lower when compared to those of whites. Scores of patients were lower than those of normals (p < 0.001). Contrast sensitivity using the Pelli-Robson chart can be useful in developing countries.

Purpose: to investigate, in the first report in Central Africa, the influence of tropical Mitomycin C on the recurrence rate and on the complications after surgical treatment for primary pterygium., Methods: Sixty-six patients with primary pterygia underwent excision of the lesion, leaving the sclera bare. Patients were randomized in two groups: in one group (36 eyes in 33 patients) 0.04% mitomycin C eye drops were used four times daily during two weeks or longer after surgery, the other group (41 eyes in 33 patients) underwent only surgery. The mean follow-up period was 6 months (range, one to 24 months)., Results: seven (19.4%) pterygia recurred in the group of eyes treated with topical 0.04% mitomycin C and 11 (26.8%) in the group of eyes treated without this drug. This difference was not significant (p > 0.05). Complications were observed in two (5.6%) eyes in group 1 and included conjunctival granuloma (one eye) and transient ocular hypertension. In group 2, complications were noted in four eyes (9.8%) and included conjunctival granulomas (three eyes) and symblepharon (one eye). Ocular hypertension could be due to instillation of mitomycin C. No group had significantly more complications., Conclusion: primary excision of pterygium with postoperative instillation of 0.04% mitomycin C had a higher rate of occurrence in this study than previously reported in Japan, in the USA and Europe.

Purpose: It is to establish the age norms of upper eyelid in the black subjects., Method: Measurements of upper eyelid, eyebrow height, crease height and the palpebral fissure were performed on 174 healthy Zairian subjects, without facial abnormalities. The subjects age-ranged from 1 to 60 years. There were 73 males (mean age +/- SD, 25.8 years +/- 15.6) and 101 females (mean age +/- SD, 24.8 years +/- 13.4). No statistically significant difference was found between the two sexes for mean age. Subjects were divided into five age groups: the first age group included subjects aged from 1 to 10 years, the second age group included subjects aged from 11 to 20 years, the third age group included subjects aged from 21 to 30 years, the fourth age group included subjects aged from 31 to 40 years, the fifth age group included subjects aged from 41 to 60 years. The measurements were performed with a ruler., Results: The mean eyebrow height measurements varied from 10.72 (group I) to 11.87 mm (group V) for the right eye, and from 10.76 mm (group I) to 11.74 mm (group V) for the left eye. Average pretarsal skin height ranged from 3.17 mm (group I) to 3.17 mm (group V) for the right eye and from 3.24 mm (group I) to 3.00 mm (group V) for the left eye. Average crease height measurements varied from 5.54 mm (group I) to 6.48 mm (group V) for the right eye, and from 5.57 mm (group I) to 6.78 mm (group V) for the left eye. The average palpebral fissure varied from 8.97 mm (group I) to 9.83 mm (group V) for the right eye and from 8.86 mm (group I) to 10.00 mm (group V) for the left eye. All measurements were aged related (p < 0.05)., Conclusion: Our results of upper eyelid crease height, eyebrow height, the amount of visible pretarsal skin and the amount of the palpebral fissure showed higher values than those published recently for caucasian subjects. The data obtained in this study showed racial difference and must be taken into account in interpretations of palpebral diseases and cosmetic surgery of the eyelid.

Objective: to determine the epidemiology of congenital eye malformations., Methods: the records of 1740 patients (1913 eyes) with congenital eye malformations seen from 1962 through 1992 were reviewed., Results: the prevalence rate of congenital eye malformations was 2.2%. Congenital cataract (38%), atresia of the naso-lacrimal duct (10%), congenital glaucoma (9%), congenital ptosis (8%), microphthalmos (8%), albinism of iris (8%), microcornea (7%) were the most frequent eye malformations. The common types of associated malformations included albinism, microcephaly, cardiopathy and anomalies of ears., Conclusion: the findings of this study were similar to those published in Europe and United States.

The purpose of this work was to establish in this first report the age standards of the Farnsworth-Munsell 100 hue in Zaire. The Farnsworth-Munsell 100 Hue test was performed in 132 normal subjects. All subjects were Zairian blacks aged from 20 to 49 years. The test was administered binocularly, once, to each subject. Subjects were divided in three age groups. The first age group had 35 subjects aged between 20 and 29 years, the second age group had 48 subjects aged between 30 and 39 years and the third 49 subjects aged between 40-49 years. The total error scores were 7.06 +/- 2.10 for the first age group, 9.03 +/- 1.80 for the second age group and 9.80 +/- 2 for the third age group. These results were aged related (r = 0.42, p inferior to 0.05). Scores of Zairian subjects in this study were higher when compared to those reported in Europe and U.S.A. Interpretation of results of the Farnsworth-Munsell 100 hue test must take in account this difference in ethnic origin.

In the developed countries, the great majority of operations for cataract are performed using the extracapsular cataract extraction (ECCE) and phacoemulsification generally combined with the implantation of an intraocular lens in the posterior chamber of the eye. However, in most developing countries, like Zaïre, the more widespread method is still intracapsular cataract extraction (ICCE). In a retrospective study, the results of the 33 first consecutive ECCE with or without IOL performed during six months (from January 1990 through June 1990) were reviewed. These results of ECCE were compared to those of patients who underwent ICCE (52 eyes) during the same period. The follow-up ranged from one month to 32 months with a mean of 7 months for the ECCE group and from one month to 24 months with a mean of 5 months for the ICCE group. The number of eyes that had peroperative complications was one (3%) for the ECCE and 14 (27%) for the ICCE. The number of eyes that had immediate postoperative complications was 12 (36%) for the ECCE and 20 (38%) for the ICCE. And the number of eyes that had later postoperative complications was 4 (9%) and 11 (22%) for respectively the ECCE and ICCE. The most important peroperative complication for the ECCE group was vitreous loss in 6% of the cases compared to 16% for the ICCE group. The most important immediate postoperative complication was striate keratitis (24%) in the ECCE group and striate keratitis (15%), iritis (12%), pupillary block (6%) in the ECCE group. The most important late complications were posterior capsule opacification (6%) for the ECCE and glaucoma (6%) for the ICCE. Of 33 eyes which underwent ECCE, 73% achieved a visual acuity of 0.5 or better. Of 52 eyes which underwent ICCE, 56% achieved a visual acuity of 0.5 or better. In this study, rates of complications were higher in ICCE and visual outcome was better in ECCE. This study shows that the ECCE with IOL implantation would be preferable than the ICCE in our country.