Central corneal thickness in black Cameroonian ocular hypertensive and glaucomatous subjects

Christelle Domngang Noche1, André Omgbwa Eballe2, Assumpta Lucienne Bella31Innel Medical Center, 2Faculty of Medicine, University of Douala, 3Faculty of Medicine and Biomedical Sciences, University of Yaoundé, CameroonPurpose: To evaluate central corneal thickness (CCT) in a black Cameroonian population of ocular hypertensive and glaucomatous subjects.Material and methods: This was a prospective study undertaken with an ultrasonic pachymeter from January 2009 to December 2009 in an eye clinic (INNEL Medical center) in Yaoundé, Cameroon.Results: One hundred subjects (200 eyes) were enrolled in the study. Sixty subjects were glaucomatous (primary open angle glaucoma, POAG group), and 40 ocular hypertensive (OHT group). The mean age of the sample was 52.60 ± 12.23 years. For the whole sample, CCT was 534.71 ± 37.95 µm in the right eye and 533.61 ± 37.67 µm in the left eye, with no statistically significant difference between the 2 eyes (P = 0.446). CCT in the POAG group was 526.30 ± 37.34 µm in the right eye and 524.90 ± 35.92 µm in the left eye. CCT in the OHT group was 547.32 ± 35.71 µm in the right eye and 546.67 ± 36.85 µm in the left eye. There was a statistically significant difference between CCT of the 2 groups (right eye: P = 0.013; left eye: P = 0.007).Conclusion: Mean CCT of ocular hypertensive subjects was thicker than CCT of glaucomatous ones in our Cameroonian sample. However, in both ocular hypertensive or glaucomatous patients, CCT of black Cameroonians is thinner than that reported in other studies in Caucasian populations.Keywords: central corneal thickness, ocular hypertension, glaucoma, black Cameroonia

Cataract surgery with intraocular lens implantation in children aged 5-15 in local anaesthesia: visual outcomes and complications

The aim of this study was to report feasibility, the visual outcomes and complications of pediatric cataract surgery with primary intraocular lens implantation in children aged 5 to15 years in local anesthesia. This retrospective interventional case series included 62 eyes from 50 children who underwent pediatrc cataract surgery with primary intraocular lens implantation at the Mana eye Clinic Nkongsamba between 2006 and 2015 Main outcome measures were: best-corrected post operative visual acuity, and intraoperative and postoperative complications. Mean age at surgery was 10.18 ± 3.21 years. Mean follow up length was 15.75 ± 3.36 weeks. Etiology included: 10 congenital cataracs (16.12%). 35 developmental cataracts (56.45%) and 17 traumatic cataracts (27.41%). The mean preoperative BCVA was logMAR 1.19 ± 0.33. (range 0.6-2.3). After cycloplegia refraction 2 weeks after surgery, the mean postoperative BCVA was log MAR 0.58 ± 0.88 ( range 0.5-1.8). The mean implanted IOL power was 22.01 ±3.16 D. IOL was succefuly implanted in 54 eyes (87.07%). Eight eyes (9.67%) were left aphakic. Increase in BCVA of 4 logMAR lines and above was recorded in 27 patients (43.55%). Intraoperative complications included: 4 posterior capsule holes with vitrous lost, 3 lenses subluxation and 1 case of iris dialyse. Late postoperative complications included: posterior capsular opacity which occurred in 16 patients, 3 posterior synechia, 2 retinal detachment. Peribulbar anaesthesia can be considered as a viable option in selected patients presenting developmental cataract undergoing cataract surgery in developing countries. Effort should be made to improve the early identification of congenital cataract and its early surgical intervention and prompt optical rehabilitation to prevent amblyopia.Pan African Medical Journal 2016; 2

Smartphone-Assisted Glaucoma Screening in Patients With Type 2 Diabetes: a Pilot Study

We aimed to determine true and false positives of glaucoma screening, relying solely on photos of the retina, taken with a smartphone. We performed a descriptive and analytical study on patients with type 2 diabetes at the National Obesity Centre, Yaoundé, Cameroon. Participating patients had retinal photography sessions using an iPhone 5s (iOS 10.3.3; Apple, Cupertino, CA) coupled to the Make in India Retinal Camera (MIIRetCam; MIIRetCam Inc., Coimbatore, TN, India). Obtained pictures of the retina were stored and transferred via the internet to an ophthalmologist to assess glaucoma. Selected patients were then invited to undergo a conventional ophthalmological examination to confirm the diagnosis. A total of 395 patients were screened, 39 (including 20 women) were diagnosed with suspicion of glaucoma based on retinal photos, a prevalence rate of 9.87%. The following signs were found; C/D ≥0.5 in 64.1% (25/39), asymmetric C/D >0.2 in 35.9% (14/39), papillary haemorrhage in 10.2% (4/39) and retinal nerve fibre deficiency in 2.5% (1/39). Only 14 of 39 patients with suspicion of glaucoma were examined, giving a lost-to-follow-up rate of 64.1%. Chronic open-angle glaucoma was confirmed in 8 patients (true positives) and absent in 6 patients (false positives). The prevalence of smartphone-detected glaucoma and lost-to-follow-up rates were high. So we need to improve this type of screening, with additional tests like transpalpebral applanation tonometer and the smartphone Frequency Doubling Technique visual field combined with better education of patients to increase their adherence to follow-up

Smartphone-Assisted Glaucoma Screening in Patients With Type 2 Diabetes: a Pilot Study

We aimed to determine true and false positives of glaucoma screening, relying solely on photos of the retina, taken with a smartphone. We performed a descriptive and analytical study on patients with type 2 diabetes at the National Obesity Centre, Yaoundé, Cameroon. Participating patients had retinal photography sessions using an iPhone 5s (iOS 10.3.3; Apple, Cupertino, CA) coupled to the Make in India Retinal Camera (MIIRetCam; MIIRetCam Inc., Coimbatore, TN, India). Obtained pictures of the retina were stored and transferred via the internet to an ophthalmologist to assess glaucoma. Selected patients were then invited to undergo a conventional ophthalmological examination to confirm the diagnosis. A total of 395 patients were screened, 39 (including 20 women) were diagnosed with suspicion of glaucoma based on retinal photos, a prevalence rate of 9.87%. The following signs were found; C/D ≥0.5 in 64.1% (25/39), asymmetric C/D >0.2 in 35.9% (14/39), papillary haemorrhage in 10.2% (4/39) and retinal nerve fibre deficiency in 2.5% (1/39). Only 14 of 39 patients with suspicion of glaucoma were examined, giving a lost-to-follow-up rate of 64.1%. Chronic open-angle glaucoma was confirmed in 8 patients (true positives) and absent in 6 patients (false positives). The prevalence of smartphone-detected glaucoma and lost-to-follow-up rates were high. So we need to improve this type of screening, with additional tests like transpalpebral applanation tonometer and the smartphone Frequency Doubling Technique visual field combined with better education of patients to increase their adherence to follow-up

Indications for Surgical Removal of the Eye in Rural Areas in Cameroon

Objective To determine the main clinical indications for surgical removal of the eye in rural areas in Cameroon. Design Retrospective non-comparative case series. Participants A total of 253 patients presenting to the Manna eye clinic Nkongsamba who underwent destructive eye surgery (DES) between January 2006 and December 2010 were reviewed. Main Outcome Measure Age, gender, occupation, prior medication, visual acuity, operation indications, and type of operation. Results There were 58.10% (n = 147) men and 41.90% (n = 106) women. Median age was 29 years (interquartile range: 14–69 years); age ranged from 10 to 88 years. A total of 67.19% (n = 170) of participants were farmers and lived in rural zones. In all, 79.05% (n = 200) confessed to have trying a medication before the presentation. Surgical indications included infective causes (perforated corneal ulcer 33.20% (n = 84) and endophthalmitis 18.20% (n = 46)), trauma 17.40% (n = 44), painful blind eyes 11.50% (n = 29), malignancy 10.70% (n = 27), and others 9.10% (n = 23). Conclusion The most common causes of DES in this series could be avoided. Therefore, preventive measures including extensive health education of the public and traditional healers on the risks linked to the use of traditional medicines in ophthalmology and the late presentation of eye disease, quality control of the campaigns that offer free cataract operations in the country

Uveal coloboma: about 3 cases at the University Teaching Hospital, Yaounde, Cameroon

Uveal coloboma is a rare eye malformation caused by failure of the optic fissure to close during the fifth to seventh weeks of foetal life. The risk of retinal detachment increases with age in colobomatous eyes. Preventive measures such as early detection of the retinal break , prophylactic laser photocoagulation along the coloboma margin, confer a significant benefit in reducing this risk of retinal detachment. Difficulties linked to the diagnosis and management of uveal colobomas in developing countries setting are presented in this study.Pan African Medical Journal 2016; 2

Modified Small Incision Cataract Surgery and Intraocular Lens Implantation in HIV Patients

Aim To describe a surgical technique suitable for cataract surgery in regions with a high prevalence of HIV infection. Methods We reviewed the medical records of 20 consecutive AIDS patients with cataract who underwent modified small-incision cataract surgery (mSICS) with posterior chamber lens implantation. Classic extracapsular cataract extraction (ECCE) was compared to mSICS. The number of potentially risky steps for contamination during surgery and duration of surgery were analyzed. A risky step was defined as any time when the surgeon had to use a sharp instrument. Student's paired t -test was carried out to compare continuous variables, and P -values <0.05 were considered statistically significant. Results Twenty patients were included in the study, 13 males (65%) and seven females (35%). The mean age was 46.3 ± 13.6 years (range 22–70 years). The number of potentially risky steps for contamination was significantly higher in the classical ECCE than in mSICS ( P < 0.001). The mean duration of cataract surgery with mSICS was significantly shorter as well ( P < 0.001). Conclusion Conversion to mSICS is essential in order to reduce accidental injuries during cataract surgery in sub-Saharan countries. Sharp instruments should be passed through a neutral zone to ensure that the surgeon and nurse do not touch the same instrument at the same time

Relationship between tropical endemic limbo-conjunctivitis and intestinal helminths in a population of Cameroonian children

Background: Tropical endemic limbo-conjunctivitis (TELC) is an allergic limbo-conjunctivitis, very common in children of tropical areas, and often characterized by ocular morbidity. Several studies were devoted to the study of the epidemiological and clinical aspects of TELC in Africa but in Cameroon, no study has ever been conducted on its association with intestinal helminths. The objective of our work was to investigate the association between TELC and intestinal helminths in pupils of Njombe–Cameroon. Methods: We conducted a cross-sectional study from January to September 2014. Random consecutive sampling was carried out. Selected pupils underwent a comprehensive eye examination, and their stool sample was examined using the KATO-KATZ technic to search for helminths eggs. Statistical tests were used for data analysis (p-value <0.05). Results: Two hundred and fifty-three students were enrolled. Thirty-six (14.2%) were affected by TELC. The average age of children with TELC was 9 ± 2 years (range: 4–13 years) with a male predominance (p = 0.001). Conjunctival hyperemia (88.9%) was the major clinical sign with a predominance of limbic clinical form (58.4%). The prevalence of intestinal helminths was 28.1% in the general population vs. 33.3% in participants with TELC. TELC was not associated with intestinal helminths. Conclusion: The prevalence of TELC (14.2%) is low in our study. Male sex was associated to TELC. The overall frequency of intestinal helminth infection was 28.1% and the one amongst patients with TELC was 33.3%. Despite the presence of intestinal helminth infection in our population, it was not associated with TELC

Aphakia Correction by Injection of Foldable Intra Ocular Lens in the Anterior Chamber

We assessed the outcomes of the use of anterior chamber foldable lens for unilateral aphakia correction at the University Teaching Hospital of Yaounde. In this retrospective, non-comparative, consecutive case series study, we reviewed the records of patients who underwent an operation for aphakia correction by the means of injection of an angular supported foldable lens between January 2009 and December 2011 in the University Teaching Hospital Yaounde. Student's paired t -test was carried out to compare preoperative and postoperative visual acuity (VA) and intraocular pressure (TOP). P -values less than 0.05 were considered statistically significant. Twenty-one patients were included in the study; twelve were male (57.1%) and nine were female (42.9%). The mean age was 55.38 ± 17.67 years (range 9–75 years). The mean follow-up duration was 5.95 ± 3.14 months (range 2–12 months). The mean logMAR visual acuity was 1.26 ± 0.46 pre-operatively and 0.78 ± 0.57 post-operatively ( P = 0.003). The change in intraocular pressure was not statistically significant. Complications included intraocular hypertension (over 21 mmHg) in 3 patients (14.3%) and macular edema, pupillar ovalization, and retinal detachment in one patient each. The results indicate that injection of an angular support foldable lens in the anterior chamber is a useful technique for the correction of aphakia in eyes without capsular support. More extended follow-up, however, and a larger series of patients are needed to ascertain the effectiveness and safety of this procedure