Functional blindness: Insurance fraud in a case report

The insurance fraud is a known phenomenon and old in rich countries. The problem is relatively new in black Africa. Thanks to the installation of private companies and the emergence of social security fund, this phenomenon tends to grow without having precise figures. These frauds often involve the  simulation of imaginary symptoms that primarily affect the five senses. The eye has a special place, its anatomical position easily exposed to work accident. Using simple clinical tests, the ophthalmologist must demonstrate that the patient with suspicion of visual loss is capable of normal vision and has no organic underlying deficit. This work aimed to report a case of  insurance fraud by simulating a unilateral blindness following a work accident

Traumatic ocular emergencies: the difficulties associated with their care at the university hospital of Brazzaville

Background: In black Africa, the severity of traumatic ocular emergencies (TOE) is increased by a lack of ophthalmologists and often inadequate or even the inexistence of surgical equipment.Objective: To make an inventory of the difficulties associated with the management of TOE at the ophthalmology department of the University Hospital of Brazzaville (UHB).Design: A retrospective study.Setting: The University Hospital of Brazzaville.Subjects: Records selected were those of patients seen for traumatic pathologies that could compromise the visual prognosis and require immediate surgical treatment. The patients seen for injuries of related structures of the eye were excluded. Types of lesion, consultation period, time of surgical treatment, clinical appearance of the eye and visual acuity (VA) at three months were analysed.Results: The frequency of TOE was 1.8%. The average age was 35 ± 4 years old. The average time for consultation and treatment were 35 ± 10 days and 74 ± 5.5 hours. These TOE were: corneoscleral rupture (63.2%), vitreoretinal iron foreign body (16.8%), retinal detachment (15%), and macula hole (5%). At three months 73.2% of eyes did not see the light, 19.2% had a VA waving from light perception and counting fingers, and for 7.6% the best VA did not exceed three out of ten.Conclusion: In the UHB, the rate of blindness associated with TOE is high. Training of ophthalmologists and adapted surgical equipment should be a priority.Background: In black Africa, the severity of traumatic ocular emergencies (TOE) isincreased by a lack of ophthalmologists and often inadequate or even the inexistenceof surgical equipment.Objective: To make an inventory of the difficulties associated with the management ofTOE at the ophthalmology department of the University Hospital of Brazzaville (UHB).Design: A retrospective study.Setting: The University Hospital of Brazzaville.Subjects: Records selected were those of patients seen for traumatic pathologies thatcould compromise the visual prognosis and require immediate surgical treatment.The patients seen for injuries of related structures of the eye were excluded. Types oflesion, consultation period, time of surgical treatment, clinical appearance of the eyeand visual acuity (VA) at three months were analysed.Results: The frequency of TOE was 1.8%. The average age was 35 ± 4 years old. Theaverage time for consultation and treatment were 35 ± 10 days and 74 ± 5.5 hours. TheseTOE were: corneoscleral rupture (63.2%), vitreoretinal iron foreign body (16.8%), retinaldetachment (15%), and macula hole (5%). At three months 73.2% of eyes did not seethe light, 19.2% had a VA waving from light perception and counting fingers, and for7.6% the best VA did not exceed three out of ten.Conclusion: In the UHB, the rate of blindness associated with TOE is high. Trainingof ophthalmologists and adapted surgical equipment should be a priority

Eye and rare genetic diseases: Case series and literature review

Genetic diseases are generally characterised by a multi visceral pathogenesis. Although orphan, these diseases interest many disciplines due to their clinical expression. Eye is sometimes part of the clinical polymorphism of some rare genetic diseases. Ocular signs are in some cases leading to the diagnosis of these pathologies. This work aimed to identify the records of patients seen for a rare genetic disease in our department. Five cases were selected: Bardt Biedl’s syndrome, Fraser’s syndrome, Leber Plus, Gilles de la Tourette’s syndrome, combination User’s syndrome - Von Recklinghausen's neurofibromatosis. The diagnosis was clinical, except a case of Leber Plus which required a biological analysis to confirm the mutation causing this disease. The ophthalmologist should have a general view of the patient's symptoms in order to diagnose

Periorbital cysticercosis: Case report

Cysticercosis is a larval cestodosis. It is due to the development in human body of the larval form of Taenia  solium, Cysticercus cellulosae. A person can be infected in two ways: by eating the infected pork, resulting in Taenia in the intestine (taeniasis) and excretion of infective eggs in faeces, secondly, by ingesting food or water contaminated with faeces containing eggs, resulting in the development of larval forms containing cysticerci of Taenia solium (cysticercosis). This Disease has a worldwide distribution, mainly related to poor hygiene. In Africa, several outbreaks are reported in south of the Sahara. The location of the larvae in the central nervous system (neurocysticercosis) represents the most severe form of this disease. At eye level, cysticercosis can occur either in the related structures (eyelids, conjunctiva, orbit), but these locations are rare, either in the eyeball more frequently. We report the first case of cysticercosis (periorbital cyst) diagnosed in the ophthalmology department of the University Hospital of Brazzaville (UHB) in a patient from Madagascar

Eye Munchausen’s Syndrome: Case Report

Munchausen’s syndrome is a psychiatric disorder characterised by a need to simulate a disease or trauma  self-mutilation, in order to attract attention or sympathy. Patients with this syndrome have multiple  operations scars after repeated hospitalisations for simulated diseases. The clinical expression is rich, multiple and varied depending on the mutilated organ. However, to date the literature has not reported a case of a serious eye infection self-induced as part of this syndrome. This observation has aimed to report a rare clinical aspect of this pathology, namely a corneal abscess due to repeated ocular instillation of infected urine drops

Marfan’s syndrome: case report and literature review

Marfan’s syndrome is a rare genetic disease, autosomal dominant. The most affected organs are eyes (myopia, subluxation of the lens); skeleton (hyperlaxity, arachnodactyly, scoliosis, dolichostenomelia) and cardiovascular system (aortic pathology). The severity of this disease is related to its cardiovascular damage. We proposed to carry out a review of the literature from the first case reported in the ophthalmology department of the University Hospital of Brazzaville

Eales’ Disease: Case report

Eales’ disease is a retinal vasculopathy of unknown origin. Ischaemic step associated retinal perivasculitis. Neovascularisation step after the previous one, characterised by vitreous haemorrhage in relation with retinal neo vessels. This observation presents the first reported case of this pathology in Brazzaville. A man of 32 was followed for more than five episodes of vitreous haemorrhage over three years. These episodes had an average duration of two months, inter-spersed with complete clinical silence period of variable duration. During crises, visual acuity was under 2/10, and then it went back up to 10/10 spontaneously. Successive tests were normal: blood count, serologies (syphilis, HIV, Lyme), blood tests (converting enzyme, angiotensin II, calcium), tuberculin skin test, fluorescein angiography (FA), chest x-ray. The last episode was unusual, by the depth of visual impairment (light perception), by the existence of retinal neovascularisation (sea fan aspect). The outcome was favorable after retinal photocoagulation and corticotherapy

Retinoblastoma: Assessing the Level of Knowledge of Tumour By Midwives in Brazzaville

Objective: To assess the level of knowledge of this tumour by midwives in two hospitals (Talangaï and Makélékélé) in Brazzaville.Design : An analytical cross-sectional study.Setting : Two maternity units (government hospitals) in the outskirts of BrazzavilleSubjects: One hundred midwives who responded to a questionnaire in the form of multiple-choice question  (MCQ). These midwives were randomly selected based on their availability to respond to questions. Each  midwife was seen once and had 30 minutes to answer three questions, define the retinoblastoma and recognise its two main early clinical signs (leucocoria, strabismus).Results: Forty percent were able to define the retinoblastoma. For 60% leucocoria was the only sign suspect of retinoblastoma, for 80% strabismus was the only sign of retinoblastoma, only 10% had associated  leucocoria and strabismus as two early signs of this cancer. Twelve percent had a score equal to 3/3, eight (8%) had a score equal to 2/3, and 80% had a score of less than or equal to 1/3.Conclusion: midwives in Brazzaville poorly understand the retinoblastoma. Training programmes should be tailored to effectively fight against mortality of this pathology

Ptosis linked to myasthenia: Case Report

Ptosis is the consequence of a general or an ophthalmologic pathology, whose etiological diagnosis and treatment can be complex. Eliminating life-threatening emergencies or chronic and severe diseases remain an obsession for the neurologist or the ophthalmologist. Autoimmune myasthenia gravis is a leading to evoke, especially when ptosis is fluctuating. In this disease, ptosis can be unilateral or bilateral, painless; variable during the day, aggravated by exertion, and it is frequently associated with diplopia. Ocular signs are indicative of the disease in half of the cases. We report a case of seropositive myasthenia (presence of acetylcholine receptor antibodies) in a 35 years old patient admitted for ptosis, and monitored for unexplained disorders of chewing for about a month

Wolfram syndrome: Case report

Wolfram syndrome is a rare neurodegenerative genetic disease, its prevalence is 1/700 000 cases. There are three known types. The first type is due to the mutation of WFS1 (4p16.1) gene. This results in the appearance in the first decade of life of diabetes mellitus type 1, diabetes insipidus, sensorineural hearing loss, bilateral optic atrophy and neurological damage signs. The second type is due to the mutation of CISD2 (4q24) gene. It differs from the first in the absence of diabetes insipidus. Types 1 and 2 are autosomal recessive. The third type or Wolfram-like syndrome is autosomal dominant, differs from the first two by the late onset of optic atrophy and diabetes mellitus type 1 (after adolescence) and hearing impairment is not always present. We report the first documented case of Wolfram syndrome at the University Hospital of Brazzaville in a nine year old girl