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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., (Copyright © 2018. Published by Elsevier Masson SAS.)

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., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate the type and frequency of the ocular lesions found in patients practicing artificial depigmentation., Patients and Method: We conducted a prospective study over 3 months involving 108 patients, of whom 72 underwent depigmentation, and 36 did not, representing the controls., Results: Among patients undergoing depigmentation, 100% were female, of whom 34.72% developed ocular lesions. Exogenous ochronosis lesions of the eyelid predominated (34.72%), followed by ocular ochronosis (25.81%). Cataract (19.35%) and glaucoma (6.45%) were the least frequent. Among the untreated, only 19.44% had ocular lesions. These included cataract (57.14%) and glaucoma (42.86%). Ocular lesions were more frequent in patients using products containing hydroquinone., Conclusion: Artificial depigmentation is responsible for ocular lesions of variable severity. Our study highlights the importance of the raising awareness amongst the general population of the complications of artificial depigmentation, particularly the ocular lesions., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: Cycloplegia allows for an objective refraction in children. Atropine is the gold standard but causes prolonged blurred vision. Cyclopentolate is less effective but less disabling. Tropicamide is a weak cycloplegic. The purpose of this study was to evaluate a cyclopentolate and tropicamide combination (CTA) versus atropine for refraction in black children., Materials and Methods: We performed a prospective study between October 2011 and July 2012 on all children seen in consultation. Objective refraction was performed after cycloplegia with cyclopentolate 0.5% combined with tropicamide 0.5%, and then after cycloplegia with atropine., Results: Thirty-three patients were recruited, 14 boys and 19 girls. The average age was 9.9 years. The mean age of the patients was 9.9 years. Astigmatism was found in 96.9% of cases. It was 1.34±1.32 diopters with CTA and 1.35±1.22 diopters with atropine. The mean axis was 98.15 and 99.8, respectively. Hyperopia and myopia were found in 39 and 27 eyes, respectively with ACT (average 1.73 and 5.37 diopters), and in 41 and 19 eyes with atropine (average 2.06 and 6.11 diopters)., Discussion: There is a good correlation of results with regards to cylindrical and spherical refractive error between the two protocols. Atropine is the best cycloplegic, however ACT provides reliable results., Conclusion: The cyclopentolate-tropicamide combination is satisfactory for routine cycloplegia in children., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

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., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

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., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

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.

Introduction: Our purpose was to evaluate the changes in the visual field (VF) after trabeculectomy and to indentify factors influencing variation for a better follow-up of patients with primitive open-angle glaucoma (POAG)., Material and Methods: We conducted a prospective study at the A. Le Dantec Hospital in Dakar, Senegal. Seventeen eyes of POAG patients were studied. The parameters noted for each patient were age, sex, affected eye, pre- and postoperative intra-ocular pressure (IOP), cup disk, sensitivity thresholds on pre- and postoperative perimetry, severity of glaucoma, and medication taken by the patient. Each patient had a frequency doubling technology (FDT) visual field examination before and the after surgery. None of them had an associated pathology that could cause VF troubles. The postoperative visual field was noted. All these parameters were correlated using the chi square test in order to determine factors influencing a threshold variation., Results: Our patients were new in 70.6% of cases, and the mean age was 45 years. The mean preoperative IOP was 25.7mmHg, 29.4% of the eyes had a cup disk up to 0.7. The VF showed severe glaucoma in 58.8%; 70.6% of eyes had only beta-blocker treatment. Peritomy with limbic hinge was performed in 88.2% of trabeculectomies. No surgical complication was noted. After trabeculectomy, the mean IOP was 14mmHg with a mean decrease of 42.8%. Before surgery, 94.1% of eyes had lower temporal quadrant involvement. For 94.1% of eyes, central vision was preserved. After surgery, progression was better in 18%, stable in 41%, and worse in 41% of cases. Of the factors studied, only age and graded follow-up time from surgery had a statistically significant influence on VF after trabeculectomy., Conclusion: Trabeculectomy was necessary in treatment of POAG, because of poor observance of medical treatment and severity of lesions at the time of diagnosis. The results (59% improvement or stability), in spite of the small sample size, argue in favor of this surgical treatment for some patients with POAG in our country.

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.

Purpose: Present a Senegalese experience of local anesthesia in children's ocular surgery., Patients and Methods: We conducted a retrospective study on 309 patients under 15 years of age, operated on in our department from June 1998 to December 2002. The type of anesthesia, general or local, was noted. The latter consisted in a retrobulbar and/or a peribulbar injection, with 4 ml of 50% of lidocaine 2% and bupivacaine mixture., Results: Local anesthesia was given to 38.8% of patients, who had a mean age of 11.51 years, with a sex ratio of 2.4. The mean age of patients operated on with general anesthesia was 4.6 years. No complications were noted in the local anesthesia group. One operation was postponed because of lack of cooperation. In this group of operated patients, 62.5% had a cataract surgery, 16.7% a corneal laceration suture, and 10.0% mutilating surgery., Comments: Because of our working conditions, local anesthesia, more than a choice, is almost obligatory. Our study shows that local anesthesia in children's ocular surgery has many advantages and few disadvantages. However, this study is limited because of a lack of information on the anesthesia and postoperative reactions. A prospective study based on a questionnaire completed by the anesthesiologist and the surgeon at the end of surgery will be necessary., Conclusion: Ocular surgery under local anesthesia is possible in children as young as 10 years of age. Good psychological preparation of the patient and the presence of the parents, from the consulting room to operating room, are required.

The diagnosis of allergic conjunctivis begins by a meticulous questioning emphasizing the existence of ocular itching, the way of evolution of the signs and allergic preceeding. The examination searchs after follicles and papillae of the conjunctiva who usually go with serous discharges, blepharitis and keratitis. So four clinical forms may be described the chronic conjunctivitis, the vernal kerato-conjunctivitis, the atopic conjunctivitis and the giganto-papillar conjunctivitis. For the treatment, all non specific signs of allergy must be eliminated, the focal infections also and allergic substance isolated. If evolution is worse, an antiallergic eye drop is given until the disappearance of all the physical signs. In the same time, steroids and anti H1 drugs must be avoided. In case of failure, the specialist in allergy will be helpful to exam the patient.

Fungal infection is rarely investigated in keratitis. The authors report five cases of fungal keratitis observed at the le Dantec University Teaching Hospital of Dakar, Senegal, involving two males and three females. Diagnosis was made by examination of smears and cultures of corneal scrapings revealing Candida albicans isolated in four patients and Acremonium strictium in another after 2 or 12 weeks of treatment with antibiotics, antivirals, or steroids. Povidone iodine 2.3% concentrated eye drop was used alone or with an azole for 4 a mean of weeks. All patients presented corneal scars. Fungal keratitis must be considered in presence of torpid corneal ulcer and corneal scraping must be systematically done. Topical povidone iodine alone or associated with azole may be an alternative fungal keratitis treatment in intertropical areas.

Aim: To show the etiological, clinical, and epidemiological aspects of orbital cellulitis at the ophthalmological clinic of A. le Dantec hospital., Patients and Method: This is a retrospective study conducted from January 1994 to October 2003. Sixty-eight patient records were used. We noted patients' civil status, past medical history, clinical and paraclinical examinations, treatment received before and at admission to the clinic, and progression., Results: The incidence of orbital cellulitis was 8.9 cases per year. The average age of patients was 18 years and the sex ratio 2.78 in favor of males. Patients were hospitalized for a mean of 11 days. The fever was often stopped at admission. All patients had violent retrobulbar pain, associated with inflammatory exophthalmos in 77.8% of cases, and ophthalmoplegia in 67.2%. Two cases of diplopia were noted; 57.5% had sinusitis. Streptococcus was the bacterium found most frequently. In hospital, all patients received three antibiotics (ampicillin, aminoglycoside, metronidazole) and prednisone. In 51.5% of the cases, surgical treatment was necessary. Progression was favorable in 55.88% of the cases. Three patients died and 18 cases of blindness were noted., Conclusion: Orbital cellulitis is a young people's disorder with serious complications. This medical emergency requires a combination of effective antibiotics and a corticosteroid. Treating the source of infections is essential to avoid recurrence. In our practice, these three drugs in association in first intention was beneficial without an antibiogram.

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.

Introduction: Compliance to medical treatment expresses the patient's perception of the disease and the treatment prescribed by the doctors. Lack of compliance endangers chronic glaucoma care, which explains the importance it has been given these last years. The objectives of this survey were to evaluate the compliance of adult patients suffering from primary open angle glaucoma to discover the influential factors., Materials and Methods: We conducted a survey at the ophthalmology clinic of Le Dantec Hospital from January 1997 to May 1998 among 31 adults being treated for primary open angle glaucoma. An indirect evaluation of the patients' compliance was made on the basis of a questionnaire after examination of their medical files. It was deemed good, average, or bad depending on: regularity of the patient's visits to the doctors, regularity of the treatment, respect of the doctor's prescription and the prescribed times for taking the medicine. The Chi square independence test was used to study the influence of the following factors: age, sex, residence, socioeconomic status, duration of symptom progression, level of instruction, counseling, and treatment., Results: The patients' mean age was 60.5 years. Compliance was deemed good for 29% of the total cases, average for 32.3%, and bad for 38.7%. Only factors such as the regular visits to the doctor, the regularity of the treatment, and respect of the doctor's prescription and the prescribed times for taking the medicine were found to be influential (p<0.05)., Conclusion: The medical treatment of primary open angle glaucoma, whether temporary or permanent, with a maximum of efficacy and a minimum of side-effects requires good compliance on the part of the patient. This compliance in turn requires a good doctor-patient relationship based on effective repeated counseling to educate patients, help them understand the disease, and act on the influential factors.

Purpose: Attempting to improve life expectancy among diabetics reveals degenerative complications, including diabetic retinopathy (DR) linked to microangiopathy. We assessed the incidence of diabetic retinopathy in its various forms amongst diabetics in Senegal., Patients and Methods: We carried out a survey between March and October 1998. The 51 patients surveyed had been affected for more than 5 years. They were divided into two groups: insulin-dependent diabetes (IDD) and non-insulin-dependent diabetes (NIDD). Patients were aged 17-71 and included 27 IDD and 24 NIDD. Each patient was given both a biological checkup (blood sugar level, HBA1c, creatininemy, triglycerides, cholesterol, albuminaria and urinary glucose) and an ophthalmological checkup with angiography in fluorescence., Results: Of the 51 patients studied, 26 presented a progression span of the disease of over 10 years. DR was detected in 62 eyes out of 102 (60.78%), with 37.25% of nonproliferating DR, 17.65% of preproliferating DR, and 5.88% of proliferating DR. Maculopathy was detected in 10 eyes (9.80%). Amongst the IDD patients, diabetic retinopathy accounted for 57.14% of diabetes, with a progression span of less than 10 years, compared to 84.62% for diabetes with a progression span of over 10 years. Amongst the NIDD patients, diabetic retinopathy accounted for 36.36% compared to 61.54%., Discussion: Through these results, a connection can be made between diabetic retinopathy, the progression span of diabetes, the type of diabetes, and the other microangiopathies. We noted a rise in retinopathy that increased with the age of diabetes patients and their IDD group., Conclusion: A multidisciplinary support of diabetes ensures early detection of diabetic retinopathy; hence the need for closer collaboration between the endocrinologist and the ophthalmologist.

Purpose: Retinal detachment is the main complication of peripheral retinal lesions in myopia but seems rare in black people. We analysed peripheral retinal changes in myopia in a black population., Material and Methods: This study was conducted by a single ophthalmologist. The tests included a refraction, a retinal biomicroscopy (with a Volk lens and a 3-mirror Goldmann lens) and an indirect ophthalmoscopy. The results were compared by a chi square test., Results: 50 people (100 eyes) were available for examination. The mean age was 28.21 years, the two extremes being at 11 and 54 years, with 68% females and 32% males. In 50 eyes the spheric equivalent was between -1 and -5.75 diopters (group I). In 50 eyes the spheric equivalent was greater than or equal to -6 diopters (group II). Snow was found in 16% of cases in group I and 34% of cases in group II (p = 0.0366). Tears were found in 2% of cases in group I and 12% of cases in group II (p = 0.116). Lattice degeneration was found only in group II., Conclusion: Retinal tear frequency was similar to the results of other authors. Comparative studies are necessary to evaluate the risk of retinal detachment in black populations.

Purpose: We report our experience with the Kansas technique of phakosection which eliminates or limits most complications of classic manual extracapsular extraction., Patients and Methods: This retrospective study included our first 80 patients undergoing surgery for mature cataract between May 1996 and May 1998 where we used the Kansas technique. We compared outcome with a group of 30 patients who underwent classic manual extracapsular extraction in a study performed in 1995 by the same surgeon in the same hospital., Results: Per- and post-operative complications were significantly lower with phakosection. Functional rehabilitation was quicker, better and provided better patient comfort., Discussion: Despite some difficulties encountered in a public hospital (viscoelastic excessively fluid and in small quantity, lack of suitable knives or reuse of sterilized disposable knives), we found that the Kansas technique is very well adapted to mature cataracts and our working conditions., Conclusion: Phakosection allowed us to give our patients with mature or very mature cataracts the benefit of small incisions. With a moderate increase in cost, this technique significantly reduced our per- and post-operative complication rates and gave quicker and better visual recovery. In our countries, this technique provides better care than phakoemulsification.

Purpose: Congenital cataract surgery can be performed by pars plana or limbal incision. We report our experience with scleral incision without ultrasounds in congenital cataract surgery., Material and Methods: Fifteen children with congenital cataract underwent surgery of both eyes (30 eyes). The zonular ciliaris and the lens anlage were normal in all cases. All procedures were performed by the same surgeon. A 3.2 mm scleral tunnel incision was made 2 mm from the limbus. Large capsulorhexis or capsulopuncture were performed after injection of a viscoelastic substance in the anterior chamber. After hydrodissection, the nucleus and cortex were aspirated. The wound was closed by apposition suture., Results: The mean age was 70.13 months (range 5 months to 130 months). Mean induced astimatism calculated with the Cravy method was 0.70 dipoters. A posterior capsular tear was observed in 1 case., Conclusion: Small scleral incision without ultrasounds has advantages. No expensive instruments are required and astimatism is not induced. The anterior chamber lies deep during the operation, protecting the endothelial cells and facilitating aspiration. Postoperative inflammation is minimal. The small scleral incision technique is useful in selected cases of congenital cataract.

Chemical and thermal ocular burns are emergencies in ophthalmology because of the blindness sequels they occur. All patients were included in a prospective study form during 18 months. 28 patients were admitted for ocular burns, representing an incidence of 5.21%. 13 of them had occupational ocular burns, 11 homely ocular burns and 4 public way injuries. 18 had chemical burns and 10 thermal burns, with a total of 44 eyes. The clinical observations was dominated by conjunctival lesions: 90.9%, corneal lesions: 79.5%, and plapebral lesions: 43.2%. 11 of them who had chemical burns, the ocular irrigation was made immediately after the accident, and all of them had antibiotic and cicatrizing treatment. The seriousness of ocular burns, the youngness of patients must instigate the authorities to improve the working conditions in the factories, and a better information in manipulation of dangerous chemical product.

Capsulopunture in cataract surgery doesn't allow insertion of intraocular lens in the capsular bag. Envelope technique is a easy way for this insertion. The goal of our study was to analyse the position of the intraocular lens in the capsular bag, after performing envelope technique in eyes suffering from "white" cataract. We realised on 25 eyes with "white" cataract, envelope technique. GALAND method (one superior linear capsulotomy) was realised in 15 cases and double linear capsulotomy (superior and inferior), was realised in 10 cases. The mean age of our patients was 55 years with two extremes (17 and 70 years). The mean visual acuity was 14/20. After verification, in 91.636% eyes, intraocular lenses were in the capsular bag. In 2 cases, we found a decentration. Envelope technique can lessen risks of capsular zip. It protects endothelium cells and is helpful for the insertion of the intraocular lens in the capsular bag. Envelope technique is well adapted to the surgery of "White" Cataract.

The aim of the study is to appreciate the prevalence of diabetic retinopathy among senegalese patients in analyzing age of diagnosis, duration of diabetes, plasma glucose and type of retinopathy. 129 diabetics followed and treated in the diabetic center of internal medicine clinic (Dakar University) were examined by 90 degrees Volk's lens. A determination of plasma c peptide and glucose concentration were performed. 55 (mean age 224. +/- 0.9 years) were insulino-dependent and 74 (mean age of 54.7 +/- 11.4 years) non insulinodependent. On average the duration of diabetes was 5.4 years +/- 5.4 for the former and 6.07 +/- 5.7 for the latter with respectively glucose plasma average 2.60 g/l +/- 0.7 and 1.7 g/l +/- 0.83. Retinopathy was found in 29 patients. So total prevalence was 22.48%, shared in 29.7% for non insulino-dependant and 12.7% for insulino-dependent. In 7 cases the retinopathy was proliferative and non proliferative in 22 cases essentially among non insulino-dependant diabetics. The diabetic retinopathy is one of handicaping complications of diabetics. Its prevalence is strongly linked to the duration of diabetes, glycaemic control and to other risk factors (genetics, glycosylated hemoglobin and high blood pressure).

Patients with IDDM often develop severe forms of retinopathy, supposed to be associated to risk factors such as hypertension, poor glycemic control and nephropathy. A controversial intervention of a genetic marker was evoked so as some diabetic patients have retinopathy in the absence of known risk factors. HLA-DR and DQ markers were compared in two groups of patients with IDDM respectively constituted of patients with and without severe retinopathy. HLA typing was carried out by polymerase chain reaction (PCR) and restriction fragments of length polymorphism (RFLP). DR9 (p < 10(-4); O.R. = 8.36) and DQA1*0301 (p < 0.05; O.R = 2.92) alleles were positively associated to diabetic retinopathy, at the opposite of DR3 (p < 10(-3); O.R: 0.01) and DQA1* (p < 10(-9); O.R = 0.15). Furthermore, among the genotypes previously considered as risk markers of IDDM in senegalese people, only DR4: DQA1*0301:DQB1*0302/DR9: DQA1*0301: DQB1*0201 was often observed in retinopathy.

Sickle hemoglobinopathies are frequent in black population. Double heterozygous SC gives less general symptoms but ocular complications are very common. Fluorescein angiography of 20 cases are reported. All the patients had hemoglobin electrophoresis showing double heterozygous SC. Clinical investigations included fundus examination and fluorescein angiography. Laser treatment or cryotherapy were realised regarding lesions features. Vascular retinal complications were found in 75% of cases, including vitreous hemorrhage (10% of cases). There was no correlation between fundus examination and fluorescein angiography. Fluorescein angiography is useful for early diagnosis and allows preventive laser treatment.

Retinal pigmented epithelium detachment is frequently associated to age related macular degeneration or others maculopathies. More rarely no cause can be found, particularly in young patients where it constitutes an entity named "Idiopathic serous detachment of the retinal pigmentary epithelium". We report such a case. We insist on the clinical and angiographical characteristics which allows a differentiation from the idiopathic central serous chorioretinopathy with which it can be confused. Last, it is important to point that for the time being no treatment can shorten the evolution.

In Senegal as well as others developing countries trachoma is a real public health problem. Entropion trichiasis is its most common and its most blinding complication. The authors made a retrospective study on 137 records of patients who underwent 199 surgical cures on a two years period. Epidemiologically, the average age is 49 years with a significative higher percentage of woman. Clinically, 51.5% of the patients had already complications, mostly on the cornea. The Trabut technique was the most used and its results was good in 82.4% cases. The authors underlined the duality of entropion trichiasis characterized by the ocular morbidity linked to the corneal damages and the simplicity of the surgical treatment which present definite advantages. Meanwhile they remind that the best treatment of the entropion trichiasis remains the prophylaxy of trachoma.

A rare case of the cryptophtalmos syndrome is presented. It's an atypical form according to François' classification. There are three types of cryptophtalmos. The problems of surgical management using several operations are underlined.

In a retrospective study on 10 years, the authors analyse epidemiological clinical and therapeutic aspects of congenital glaucoma. From 1979 to 1989, 58 cases of congenital glaucoma were found in children between 0 and 12 years, of which 53 bilateral and 5 unilateral cases (111 eyes). The frequency of 0.10% is considered high. According to studies carried out by Europeans, it is estimated between 0.01 and 0.024%. The authors stressed the important rate of consanguinity (46.5%) and masculine prevalence (74.1%). Disappointing therapeutic results and bad prognostic depend on the advanced cases of clinical forms found during the first consultation. The authors advocate preventive measures by genetic counsel and an early surgical treatment for best functional results.

During 20 months, 593 intracapsular cataract extractions have been studied, the authors founded 10 cases of ocular hypertension representing 1.68%. These eyes did not present any ocular pathology before and the intraocular pressure was normal before the operation. Among the 10 cases, 4 developed pupillary block. In 7 cases, the intraocular pressure was normalized within one month by local and general low pressure treatment, while 3 cases developed persistent ocular hypertension. The authors preconise to have a low pressure by premedication before surgery and to survey every day the intraocular pressure after intracapsular cataract extraction to prevent irreversible modifications of the optic nerve.

Intra capsular extraction is the most employed surgical technics for the treatment of senile cataract in developing countries. Nevertheless complications are usual, among them the pupillary block. The authors notified in 365 intra capsular cataract extractions, executed during 8 months, 4 cases of pupillary block occurred after operation without incident. The 3 cases had favorable evolution after an average of 4 days with medical treatment. 1 case had unfavorable evolution to aphakic glaucoma in spite of medical and surgical treatment. They point out in the necessity of strict post operative supervision and early treatment.

The authors report a case of bilateral essential iris atrophy syndrome in a twenty two years old man associated with unilateral cataract and glaucoma. They stress the rarity of the syndrome (first case in their section) and the uncommon bilateral case. The cataract unusually described in the syndrome would be directly linked to the important and durable ocular hypertension.

In this prospective study undertaken between november 1989 and december 1991, the authors report their observations of ocular lesions seen in a cohort of 67 AIDS patients hospitalised in the Infectious Diseases department CHU Fann Dakar. Ocular lesions were discovered in 52.23%. These lesions were observed in both HIV-1 and HIV-2 positive patients, however they were much more common in the former group (77.14%). Rétinal pathology was by far the most frequently observed (63%) and yet classic retinis was not discovered in our series. We feel that the ophtalmologist should play a key role in the routine care of AIDS patients especially in surveillance of retinal changes.

Two cases of expulsive haemorrhage consecutive to an operation of intumescent cataract responsible of major ocular overpressure (60 and 70 mmHg) are reported by the authors. No other risk factor has been found in our patients, one of 45 years old and the other 72 years old. First nor the operative wound suture neither the posterior sclerotomy were stitched, because of the inability to discover the site of choroidal haematoma with quat amount of blood in the operative field. The second reason was the use of an inadequate material of suture (vicryl 9/0). Finally both cases presented were eyes without any light perception. The final phase results in phtysis phenomena.

The authors reported a case of orbital congenital serous cyst with anophtalmos. It was a third type of Duke Elder classification. Although it looked sporadic, this malformation is hereditary and due to a disharmony between optic cup growth and differenciation. Ultrasonography and scanner could confirm the diagnosis and helped to discard orbital and eyelid angioma and meningocele. After excision, a prosthesis must be adapted in the orbit.

Intraocular pressure results and complications of trabeculectomy in Black African. The authors reported in 16 years 170 cases of trabeculectomy in Black African with open angle glaucoma. They observed excellent control of intraocular pressure (84% of normalisation at four years). This compared with others, shows that troubles are less important. All this advantages make that trabeculectomy is the best choice that authors advocate in surgical treatment of open angle glaucoma in our countries.

At the opposite of epibulbar dermoids (which are isolated or combined), dermoids of IDA MANN's second type are uncommon. The two cases reported had a big size and covered almost the cornea, without damage on the descemet's membrane, the endothelium and the other eyeball structures. This lesion is classified by the W.H.O. among choristomas. It's made of skin recovering fat which includes in different figures, hair follicle, eccrine and sweat glands. Total excision is the best treatment, but couls become complicated by cornea perforation. It could be followed in some cases by keratoplasty. Amblyopia could go with this malformation.

The report covers 27 cases of neuro-surgical exophthalmia treated at Dakar U.H.C. between 1970 and 1987. Unilateral forms are the most common (25 cases), usually discovered at the bulging stage. Exploration was undertaken by the usual means of X-ray without contrast, echography, arteriography, and fractioned, gaseous encephalography employed together in varying degrees. The main etiologies are tumours (70%), largely benign, and specific and non-specific inflammation (18.5%). Surgery was prescribed in 18 cases, including 11 orbitotomies--8 frontal and 3 fronto-temporal. Malformation syndromes, and above all very advanced pathologies challenged surgical skill in 9 of the cases. Generally speaking, post operational results are favourable, but 3 deaths are reported and one relapse. Tomodensitometry, modern anaesthetic and revival techniques, and the important collaboration between the ophthalmologist and the neuro-surgeon are all factors in successfully mastering neuro-surgical protrusions.

The authors report on the first case of Cortical Blindness in Senegal to be confirmed by sensorial electrophysiology (ERG and study of PEV). They stress the clinical aspects and the etiological factors dominated by infectious cerebral meningitis, particularly in sucklings.

The authors reported a case, a large orbital fibrous histiocytoma, in a 14 year old girl. They emphasize nosologic problems and histologic aspects of this benign tumor. Because of the localisation and the size of the tumor, a double anterior orbitotomy (superior and inferior) was necessary for complete renoval. Anatomic, functional and esthetic results were satisfactory.

Corticosteroids absorbed into the system, or, in particular, used locally, can lead to serious ocular complications often little understood by those who prescribe them. Among the three cases documented, the authors found one cortisone glaucoma, one cortisone cataract, and one associated glaucoma-cataract. General absorption occurred in one case, a nephrotic syndrome. The two other patients received corticosteroid ointment for chronic limbo-conjunctivitis, endemic in the tropics. Rigorous indication, respect for basic prescription laws, and regular supervision, particularly for long-term treatment, is necessary to prevent these iatrogenic accidents.