Assumpta Lucienne Bella

Prevalence and causes of blindness at a tertiary hospital in Douala, Cameroon.

Purpose The aim of this study was to determine the prevalence and causes of bilateral and unilateral blindness in the town of Douala and its environs based on data from the ophthalmic unit of a tertiary hospital in Douala. Methods We conducted a retrospective epidemiological survey of consultations at the eye unit of the Douala General Hospital over the last 20 years (from January 1, 1990 to December 31, 2009). Results Out of the 1927 cases of blindness, 1000 were unilateral, corresponding to a hospital prevalence of 1.84% and 927 cases were bilateral, corresponding to a hospital prevalence of 1.71%. No statistically significant difference was noted between the two (P = 0.14). The leading causes of bilateral blindness were cataract (50.1%), glaucoma (19.7%), and diabetic retinopathy (7.8%) while the leading causes of unilateral blindness were cataract (40.4%), glaucoma (14.1%), and retinal detachment (9.1%). Cataract (51.2%), cortical blindness (16.3%), and congenital glaucoma (10%) were the leading causes of bilateral blindness in children aged less than 10 years. Conclusion Blindness remains a public health problem in the Douala region with a hospital prevalence which is relatively higher than the national estimate given by the National Blindness Control Program.

Indications for destructive eye surgeries at the Yaounde Gynaeco-Obstetric and Paediatric Hospital.

Objective: To determine the indications and rate of acceptance for destructive eye surgeries at the ophthalmology unit of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital. Methods: A retrospective consecutive case series in which the medical records of all patients consulting in this unit over a 9-year period (2002 to 2010) were reviewed. Records in which destructive surgery was recommended were retained. Information collected included demographic data, eye affected, clinical diagnosis, acceptance or refusal of surgery, and the outcome in those in whom surgery was performed. Results: A total of 48 patients had a recommendation for destructive eye surgery, of whom 30 (62.5%) were males and 18 (37.5%) were females. Mean age was 43.78 (SD = 28.11; range 1 month to 91 years). Children <10 years comprised 23.10%. The leading causes were endophthalmitis/panophthalmitis (47.9%), neoplasm (20.8%), and absolute glaucoma (14.6%). Surgery was done in 20 cases (41.7%). Evisceration was the most performed surgical procedure (50%), with endophthalmitis/panophthalmitis and neoplasm combined accounting for 65% of surgeries. Conclusion: The high rate of refusal is an indication of the psychological devastation undergone by patients or the families of children in whom eye removal is recommended. Awareness should be raised on preventive measures and the need to rapidly seek eye care.

Central corneal thickness in black Cameroonian ocular hypertensive and glaucomatous subjects.

Purpose 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.

Intraocular live male filarial Loa loa worm.

We report a case of Loa loa filariasis in an 8-month-old child who presented with a 3-month history of irritated acute red eye and insomnia. Examination revealed a living and active adult Loa loa worm in the anterior chamber of the left eye. The worm was extracted under general anesthetic.

Secondary cataract: an epidemiologic and clinical survey at the Yaounde Gynaeco-obstetric and Paediatric Hospital

Objective: To determine the incidence and risk factors of secondary cataract. Materials and methods: A retrospective study involving a review of medical records in the ophthalmology unit of the Yaoundé Gynaeco-obstetric and Paediatric Hospital in Yaoundé, Cameroon, was carried out. All patients who had cataract surgery between January 2006 and September 2010 were included. Variables included age, sex, past medical history, morphology of primary cataract, type of surgery, intraocular lens implantation, site of implantation, intra- and postoperative complications, and the time lapse for the presentation of secondary cataract. Both univariate and bivariate analyses were carried out. The χ2 test was used to compare proportions, and P-values <0.05 were considered statistically significant. Results: A total of 864 eyes of 718 patients had cataract surgery. Ninety-two eyes developed posterior capsule opacification, giving an incidence of 10.65%. The mean age of patients who developed secondary cataract was 52.3 ± 23.05 years, with a range of 4 years to 84 years. Secondary cataract was more frequent in the age group of 0–20 years. The time lapse for presentation of secondary cataract was 64.7 ± 9.53 days, with a range of 1 to 504 days. Risk factors for the development of secondary cataract were age (P = 0.000), sex (P = 0.011), cortical cataract (P = 0.000), and postoperative inflammation (P = 0.000). Conclusion: The incidence of secondary cataract, though high in this study, is lower than that reported in other studies.

Conservative Management in Congenital Bilateral Upper Eyelid Eversion

Aim. To report the case of congenital bilateral upper eyelid eversion with severe chemosis that was successfully managed conservatively. Report. The patient was a six-hour-old male neonate with bilateral congenital upper eyelid eversion and severe chemosis, following uneventful delivery. Conservative management consisted of the application of antibiotic ointment and padding the exposed conjunctiva with 5% hypertonic saline-soaked gauze. The eyelids reverted spontaneously on day 3 and the condition was completely resolved by the third week. Conclusion. Congenital upper lid eversion is usually a benign condition which responds well to conservative treatment. Creating awareness amongst healthcare professionals is essential.

Pattern of corneal pathologies in children seen at Yaounde Gynaeco-Obstetric and Paediatric Hospital, Cameroon.

Purpose To describe the different corneal pathologies and determine the prevalence of corneal blindness amongst children aged 0–15 years, seen at the ophthalmology unit of a tertiary hospital in Cameroon. Patients and methods The medical records of all patients who presented to the Ophthalmic Unit between 2002 and 2010 were reviewed, retrospectively. The records of children aged 0–15 years, presenting with corneal pathologies, were further reviewed. Data collected included age, sex, past medical history, initial visual acuity, type of corneal lesion, and visual acuity at last follow-up. Results Of the 7,922 children seen over the study period, 168 had corneal pathologies: a prevalence of 2.1%. Males were more affected than females (male to female ratio: 1.4:1; P = 0.008). The age range was from 2 weeks to 15 years (mean age: 7.1 years; standard deviation: 4.4 years). The leading etiologies were trauma (48.2%; n = 81) and infection (28.0%; n = 47). Amongst those with available follow-up data, visual impairment and blindness occurred in 50% of the cases (n = 12), with one case being bilateral. Conclusion Trauma is the most frequent cause of corneal blindness in children.

Analysis of central corneal thickness in black Cameroonian children

Correspondence: Andre Omgbwa Eballe Department of Ophthalmology, gynaeco-Obstetric and Pediatric hospital of Yaounde, PO Box 4362, Yaounde, Cameroon Tel +237 9965 4468 Fax +237 2221 2430 Email andyeballe@gmail.com Purpose: Our objective was to determine mean pediatric central corneal thickness (CCT) in black Cameroonian children, according to gender and age, using ultrasonic pachymetry. Materials and methods: A prospective, observational, consecutive case series in 102 children (204 eyes) aged 5–16 years was carried out from November 2009 to January 2010 at the Eye Unit of the Gynaeco-Obstetric and Paediatric Hospital in Yaounde, Cameroon. Descriptive and analytic statistics were performed for CCT measured by a hand-held ultrasonic pachymeter (Quantel Medical Inc, Clermont-Ferrand France, Model Pocket, Class II) according to demographic data. Results: The average CCT for both eyes in these children was 538.06 ± 38.03 μm. Average CCT was 541.41 ± 36.45 μm in boys and 536.15 ± 38.91 μm in girls, with no statistically significant difference between the two groups. There was also no statistically significant difference in CCT between the age groups, comprising Group 1 (5–7 years), Group 2 (8–10 years), Group 3 (11–13 years), and Group 4 (14–16 years). Conclusion: CCT has been suggested to be lower in black children than in Caucasian, Hispanic, and Japanese children. Nevertheless, our average CCT values were within the standard range, varying between 527 and 560 μm.

Prevalence and etiologies of visual handicaps in leprosy patients in the south of Cameroon

We report on a prospective study undertaken in April 2008, in 11 leper villages of the Southern Cameroon. Our aim was to determine the prevalence and the causes of bilateral blindness, low vision and unilateral blindness in the population of leprosy patients, irrespective of the clinical aspects of the illness. Results: Two hundred thirty-five known and newly diagnosed leprosy patients were examined. These patients included 149 cases (63.4%) of multibacillary leprosy and 86 cases (36.6%) of paucibacillary leprosy. There were 111 case of visual handicap, representing 47.2% of the population. These visual handicap cases were subdivided into 45 cases (19%) of bilateral blindness, 35 cases (15%) of unilateral blindness and 31 cases (13.2%) of low vision. Discussion: The prevalence of visual handicap among leprosy patients in Cameroon is too high. Causes in the majority of cases are age-related degenerative pathologies, and one third of cases are linked to the leprosy mycobacterium. Conclusion: Discovering a cure for ophthalmic pathologies is important in order to provide a better quality of life for this particular population.

Ophthalmic Manifestations in Chronic Inflammatory Rheumatic Diseases at a Referral Hospital of Yaounde, Cameroon.

ABSTRACT Purpose: To determine the profile of ophthalmic manifestations in chronic inflammatory rheumatic diseases (CIRD). Methods: Observational study at the Yaounde Central Hospital and Innel Medical Centre (2004 to 2012). Results: The study population (n = 36) consisted of 14 men and 22 women with average age of 47.9 ± 17.2 years. Cases of CIRD were rheumatoid arthritis (n = 16), systemic lupus erythematosus (n = 8), ankylosing spondylitis (n = 8), mixed connective tissue disease (n = 2), scleroderma (n = 1), and juvenile idiopathic arthritis (n = 1). Ophthalmic manifestations found in 22 (61.1%) patients were dry eye syndrome (n = 7), cataract (n = 6), anterior uveitis (n = 6), glaucoma (n = 4), and suspected maculopathy (n = 1). No association was found between steroids used and supcapsular cataract (p = 0.06) or glaucoma (p = 0.06). Conclusion: Ocular manifestations occurred in 61.1% of CIRD. Dry eye syndrome and anterior uveitis were commonly observed.