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Resume But Etablir le profil epidemio-clinique et tomographique des trous maculaires chez le sujet beninois. Patients et methodes Cette etude transversale a concerne les patients consecutifs recus pour exploration maculaire pendant la periode allant de janvier 2016 a aout 2017 au centre d’exploration de la retine Saint Antoine de Padoue Cotonou (Benin). Ont ete inclus tous les patients qui ont presente un trou maculaire et ayant eu un OCT maculaire. Pour definir les types de trou maculaire, nous avons utilise la nouvelle classification 2013 DUKER et analyse pour chaque cas : l’âge le sexe, les antecedents, l’œil atteint, l’œil adelphe, l’acuite visuelle, le type de trou, le diametre du trou, l’etat du cortex vitreen, l’œdeme des berges, l’epaisseur maculaire moyenne, l’existence de traction vitreo-maculaire, de membrane epi-maculaire, l’epaisseur de la choroide retrofoveolaire. Ont ete exclus tous les patients ayant presente un pseudo-trou maculaire ou un trou lamellaire. Resultats Pendant cette periode d’etude, 401 patients ont beneficie d’une procedure d’OCT maculaire au Centre d’exploration de la retine avec 22 patients ayant presente un trou maculaire, dont 15 femmes et 07 hommes soit un ratio de 2,14. L’âge moyen des patients etait de 61 ± 10 ans avec un âge median de 63 ans. Le diametre moyen des trous etait de 705 μm ± 232 μm. Aucun trou de petite taille n’a ete releve. L’epaisseur maculaire centrale moyenne est de 272 μm ± 39 μm. L’etat de l’œil adelphe a note dans 52,4 % des cas la presence d’une traction vitreo-maculaire. Le profil etiologique des TM a retrouve dans 72,7 % une origine primaire et une origine secondaire (diabetique et traumatique) respectivement dans 13,6 % et 9,09 %. Discussion La majorite des trous maculaires observes etaient de grands trous maculaires, ce qui pourrait s’expliquer par l’evolution progressive de ces trous maculaires et un depistage tardif. L’etat de l’œil adelphe avec plus de la moitie avec une traction, traduit le risque potentiel de bilateralisation. Conclusion Le trou maculaire est une pathologie de l’interface vitreo-maculaire observee dans notre contexte avec un profil de grand trou maculaire. A l’OCT, les donnees retrouvees restent comparables aux donnees de la litterature.

Resume Introduction L’injection intravitreenne (IVT) d’un medicament vise a obtenir une concentration elevee dans le segment posterieur. Nous avons mene une etude retrospective de notre pratique des IVT dans le but d’evaluer la securite de la technique et la tolerance a court et moyen terme et d’analyser les indications et les complications. Patients et methodes Cette etude retrospective analytique a porte sur des patients consecutifs traites par IVT pendant la periode allant de janvier 2015 a juin 2016 a la clinique ophtalmologique la Lumiere de Cotonou avec comme indicateur de securite base sur les incidents et/ou accidents au cours de la procedure d’IVT. Ont ete inclus tous les patients ayant eu une ou plusieurs IVT quelles que soient l’indication et la nature du produit injecte et qui ont beneficie d’un bilan ophtalmologique complet avant l’injection et ont ete suivis a une semaine (S1), 1 mois (M1) apres traitement. Resultats Pendant cette periode d’etude, nous avons realise 124 injections intravitreennes sur 49 patients en toute securite. Les indications ont ete dans 53,06 % les œdemes maculaires diabetiques et 26,53 % des œdemes maculaires avec occlusions veineuses. La principale complication observee est l’hypertonie oculaire dans 60 % principalement liee a l’IVT de Triamcinolone. Dans 51,02 %, la molecule utilisee est le Ranibizumab suivi du Bevacizumab 28,54 % et dans 20,40 % du Triamcinolone. Conclusion L’injection intravitreenne est une pratique courante dans notre activite avec une securite de realisation. Les indications sont multiples et l’hypertonie oculaire comme complication essentielle. La difficulte d’approvisionnement et de conservation des principales molecules (anti-VEGF) utilisees reste a resoudre.

To establish the epidemiological and tomographic profile of macular holes in the Beninese subject.This cross-sectional study included consecutive patients seen for macular testing during the period from January 2016 to August 2017 at the St. Anthony of Padua Retinal Testing Center in Cotonou (Benin). All patients who had a macular hole and macular OCT were included. To define macular hole types, we used the 2013 DUKER New Classification and analyzed for each case: age sex, history, involved eye, fellow eye, visual acuity, hole type, hole diameter, status of the vitreous cortex, edge edema, mean macular thickness, presence of vitreomacular traction, epimacular membrane, and retrofoveal choroidal thickness. Patients with a pseudo-macular hole or lamellar hole were excluded.During this study period, 401 patients underwent a macular OCT procedure at the Retinal Testing Center, with 22 patients having a macular hole, of which 15 women and 07 men for a sex ratio of 2.14 women to men. The mean age of the patients was 61±10 years, with a median age of 63 years. The mean diameter of the holes was 705μm±232μm. No small holes were found. The mean central macular thickness was 272μm±39μm. In 52.4% of cases, the condition of the felloweye indicated the presence of vitreomacular traction. The etiological profile of the macular hole found in 72.7% a primary origin, and a secondary origin (diabetic and traumatic) in 13.6% and 9.09% respectively.The majority of the macular holes observed were large macular holes, which could be explained by the progressive course of these macular holes as well as late detection. Over half of the fellow eyes showed vitreomacular traction, reflecting the potential risk of bilateralization.Macular hole is a pathology of the vitreomacular interface, tending to be large in our geographic context. On OCT, the data found remain comparable those reported in the literature.

Intravitreal injections of medication are designed to obtain a high concentration in the posterior segment. We conducted a retrospective study of our practice of intravitreal injections to assess safety of the technique and short- and medium-term tolerability, and to analyze indications and the complications.This analytic retrospective study focused on consecutive patients treated with intravitreal injections for the period of January 2015 to June 2016 in the "Lumière" ohthalmology clinic in Cotonou, with incidents or accidents during the injection procedure as a measure of safety. Included were all patients undergoing one or more intravitreal injections regardless of the type of product injected, who had undergone a complete ophthalmologic work-up prior to injection and who had been followed at one week (W1) and 1 month (M1) after treatment.During the study period, we safely performed 124 intravitreal injections on 49 patients. The indications were diabetic macular edema in 53.06% and macular edema due to vein occlusions in 26.53%. The main complication observed was ocular hypertension in 60%, mainly related to triamcinolone injection. In 51.02%, the drug used was Ranibizumab, followed by Bevacizumab in 28.54% and Triamcinolone in 20.40%.The main goal of intravitreal injection is to achieve instantly effective concentrations in the center of the globe. Intravitreal injection is a safe, feasible practice in our context. The male predominance observed in our series is explained by the low socio-economic status of women in our context as well as the economically difficult accessibility of important drugs such as anti-VEGF. Significant improvements in D7 and D30 visual acuity in our patients highlights the beneficial effects of the presence of the active molecule in the vitreous cavity for these indications.Intravitreal injection is a common practice in our context, which is being performed safely. The indications are many, and ocular hypertension is a significant complication. The difficulties in terms of supply and preservation of the main drugs used (anti-VEGF) remains to be resolved.

Resume Cette etude a ete initiee pour determiner l’evolution a cinq ans du risque cardiovasculaire chez les hypertendus traites. Il s’agit d’une etude retrospective descriptive sur une periode de neuf ans. Ont ete inclus les patients de race noire pris en charge pour HTA dans la periode de l’etude et qui ont un suivi d’au moins cinq ans. Le risque cardiovasculaire global (RCVA) a ete calcule a posteriori, pour les besoins de l’etude, a l’aide des tables de Framingham. Toutes les donnees ont ete recueillies apres la premiere evaluation puis actualisees aux echeances d’un, trois, cinq ans et a la derniere consultation pour les patients dont le suivi a excede cinq ans. Pour les 103 patients qui avaient des donnees completes l’âge moyen etait de 49,11 ± 8 ans et la sex-ratio de 2. Parmi eux 14 (13,6 %) sont decedes de complications cardiovasculaires. Parmi les 89 survivants le risque cardiovasculaire au debut etait tres eleve dans 10,1 %, eleve dans 49,4 %, modere dans 22,5 % et faible dans 18 %. L’evolution generale est caracterisee par une stabilite de la proportion du RCVA modere (20–23 %) et du RCVA eleve (43–50 %) mais une tres importante augmentation de la proportion du RCVA tres eleve (10 a 21 %) au detriment du RCVA faible (18 a 10 %). L’analyse de l’evolution individuelle revele une amelioration du RCVA chez 19 patients (21,3 %), une stabilite du RCVA chez 39 patients (43,8 %) et une aggravation chez 31 patients (34,8 %). Ces donnees se confirment dans une population elargie de 320 patients dont les donnees moins completes permettent une estimation du RCVA. Conclusion Le risque cardiovasculaire est difficile a evaluer. Il est mal controle a long terme.

Objectif Les auteurs ont voulu mettre en evidence les principales caracteristiques du tonus oculaire chez le Beninois, la frequence des hypertonies oculaires (HTO) et du glaucome primitif a angle ouvert (GPAO). Materiel et methodes Nous avons mene une etude retrospective dans une clinique privee d’Ophtalmologie de Cotonou du 1 er janvier au 30 juin 2001 (6 mois). Elle a concerne 4 159 patients âges de 20 ans et plus, chez qui le tonus oculairea ete mesure systematiquement dans le cadre du depistage du glaucome. Les parametres etudies etaient l’âge, le sexe et le tonus oculaire. Resultats Les patients ainsi recrutes etaient âges de 20 a 85 ans. La tranche d’âge de 41 a 50 ans etait la plus representee (30,1 %). 56,4 % de l’echantillon etaient des femmes. Les valeurs de tonus oculaire s’etalaient de 8 a 60 mmHg, dont plus de la moitie (52,3 %) etaient inferieures ou egales a 13 mmHg. Quel que soit le sexe, la repartition des tonus oculaires suivait approximativement une courbe en « cloche », avec un pic entre 11-13 mmHg. La frequence des HTO a ete de 3,8 % avec une predominance masculine et une augmentation reguliere avec l’âge. Parmi les cas d’HTO, 41,6 % etaient des HTO isolees et 58,4 % des GPAO averes. Seize pour cent des glaucomateux avaient moins de 40 ans, dont 25 % avaient moins de 30 ans. Conclusion De cette etude, il ressort une valeur basse entre 11-13 mmHg du pic moyen du tonus oculaire et la precocite d’apparition du glaucome chez leBeninois. Le depistage du glaucome doit donc etre institue des l’âge de 20 ans et meme plus tot.

This study was initiated to determine the progression of the cardiovascular risk (CR) in a 5-years period for those who went through high blood pressure treatment. It is a retrospective and descriptive study over a period of 9 years. Were included in that category, African patients treated in that period of time and who at least benefited from a 5-years medical care period. The total CR was calculated afterwards, for the needs for the study, using the tables of Framingham. All the data were collected after the first evaluation then brought up to date at the terms of 1, 3 and 5 years and with a last consultation for the patients whose medical care follow-up exceeded 5 years. For the 103 patients who had complete data, the average age was of 49.11±8 and the sex ratio of 2. Among them 14 (13.6%) died of cardiovascular complications. Among the 89 remaining patients, the CR at the beginning was very high in a proportion of 10.1%, high in 49.4%, moderated in 22.5% and weak in 18%. The general evolution is characterized by a stability of the proportion of the moderated CR (20 - 23%) and high CR (43 - 50%) but a very important increase in the proportion of the very high CR (10 to 21%) to the detriment of the weak CR (18 to 10%). The analysis of the individual evolution reveals an improvement of the CR among 19 patients (21.3%), its stability among 39 patients (43.8%) and a worsening among 31 patients (34.8%). These data are confirmed in a widened population of 321 patients of which the less complete data allow an estimate of the CR.The cardiovascular risk is difficult to evaluate. It is badly controlled in the long run.

Although cataracts cause 47% of global blindness, their epidemiologic impact in different countries is notoriously uneven and the world can be divided into two zones according to economic conditions. In advanced countries where care is good, cataracts account for only 5% of blindness while cataracts still account for 50% of blindness in developing countries. After a brief overview of historical, clinical and therapeutic aspects, this article updates epidemiological data on cataracts in the world. It also provides insight into political, socio-economic, and cultural factors adversely affecting care availability in developing countries thus making cataracts a major public health problem and an obstacle for development. Finally this article offers a few recommendations for reducing the backlog of cataracts in the world and for consolidating advances made over the last two decades thanks to experience gained in various National Blindness Prevention Programs (NBPP).

To describe the main characteristics of intraocular pressure (IOP) in Benin, the frequency of ocular hypertension (OHT) and primary open-angle glaucoma (POAG).A retrospective study was conducted in a private ophthalmological clinic in Cotonou, Benin, between January 1 and June 30, 2001. It involved 4159 patients aged 20 years and over in whom IOP was systematically measured within a glaucoma screening program. The parameters studied were age, sex, and IOP.The patients recruited were between 20 and 85 years old. The age group from 41 to 50 years was the largest (30.1%); 56.4% of the sample were women. IOP values ranged from 8 to 60 mmHg: 52.3% were lower or equal to 13 mmHg. For both sexes, IOP followed a Gaussian distribution, with a peak between 11 and 13 mmHg. OHT frequency was 3.8%, with a male predominance and a regular increase with age. Among the OHT cases, 41.6% were isolated OHT and 58.4% of the POAGs turned out. Of the glaucoma patients, 16% were less than 40 years old, 25% were under 30 years old.In this study, it was found that the IOP peak was low and glaucoma appeared prematurely in the Beninese population. Glaucoma screening must therefore be set up from the age of 20 years and even earlier.

Apert's syndrome is a type of acrocephalosyndactylia that is from part of the great group of craniofacial synostoses. It is characterized by craniofacial dysmorphia and syndactylia on hands and feet, which differentiates it from Crouzon's disease. It is a rare affection that is often transmitted through an autosome dominant mode, but sporadic cases exist. We report the case of a 15-year-old girl who presented characteristic clinical signs of Apert's syndrome with normal karyotype without parental consanguinity. The Ser 252 Trp mutation of the FGFR2 gene was found, confirming the molecular diagnosis. This study illustrates the severity of ocular and neurological problems of untreated Apert's syndrome. The presence of hemoglobinopathy (Hb AS) is also a mark of its originality.

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

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

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