Nidain Maneh

Myasthénie juvénile oculaire en Afrique Subsaharienne: cas de deux sœurs germaines issues d’un mariage consanguin au Togo

Myasthenia gravis is a rare acquired autoimmune pathology causing neuromuscular transmission impairment. Juvenile onset of myasthenia gravis is often characterized by ocular involvement. We report two cases of ocular juvenile myasthenia gravis (JMG) in two siblings. They were two young girls, XA and XB, aged 11 and 9 years, of Malian origin, residing in Togo, born from first-degree of consanguinity presenting to Ophthalmology due to progressive decrease in visual acuity. XA showed visual acuity 8/10 on both eyes while XB showed improvement in visual acuity from 3/10 to 7/10 using a pinhole occluder, suggesting ametropia. XA had a 2-year history of bilateral ptosis lifting the upper eyelid of 7 mm, while XB had a 3-year history of bilateral ptosis with no lifting of the upper eyelid. Ice pack test was strongly positive in both patients. They had Cogans lid twitch with paresis of the oculomotor nerve without diplopia. The dosage of acetylcholine receptor autoantibodies was normal. The diagnosis of JMG associated with ametropia was suspected. Ametropia was corrected by glasses and a specific treatment with pyridostigmine was initiated, but both patients were lost to follow-up. Autoimmune myasthenia gravis with inaugural ophthalmologic manifestation is rare but it can occur among children living in sub-Saharan Africa. Studies should be conducted to establish the features of this disease.

Facteurs de risque du décollement de rétine au Togo

Introduction Retinal detachment poses management problems in developing countries due to the shortage of technical equipment. Prevention passes through knowledge and elimination of risk factors. This study aimed to identify the risk factors for retinal detachment in people living in Togo. Methods We conducted a retrospective and descriptive study in the Department of Ophthalmology at the Chu-Campus and in an ophthalmology office in Lomé from 2 January 2011 to 31 December 2015. The medical records of patients with retinal detachment were included in the study. The diagnosis of retinal detachment was confirmed based on funduscopic exam or ocular ultrasound. Results in total, 116 eyes of 100 patients had retinal detachment of whom 40 in the RE, 44 in the LE and 16 bilaterally. The average age of patients was 46.65 ± 16.46 years [07 years; 87 years], with a male predominance and with a sex-ratio = 0.32 (W/M). Diabetic patients accounted for 17% and patients with sickle cell disease accounted for 16%. Myopic patients accounted for 5%, pseudophakic patients accounted for 17.2% and aphakic patients accounted for 3.4%. Four patients had retinal tear (14.28% of rhegmatogenous detachment) including 2 superotemporal tears, 1 inferior nasal tear and 1 inferior temporala tear. 35 eyes (52.2%) had total retinal detachment while 24 eyes (35.8%) had partial retinal detachment. Twenty eyes had vitreoretinal proliferations, 5 eyes had itreous hemorrhage and 6 eyes had hyalite. Diabetes and sickle cell disease were the risk factors for tractional RD (p=0.006 and p=0.0003) while cataract surgery was the risk factor for rhegmatogenous RD (p=0.0097). Conclusion Diabetes, sickle cell anemia and eye surgery were the major risk factors for RD. A better management of these pathologies and ophthalmologists mastery of cataract surgery may prevent retinal detachment.

Descriptive Epidemiology of Cancers in Togo from 2009 to 2016

Background: Cancer is a global public health problem. According to World Report on Cancer in 2000, developing countries are becoming increasingly affected. Methods: This retrospective and descriptive 8-year study of all histological confirmed cancers was conducted using data from the anatomical pathology laboratory registry of Togo’s only laboratory. The parameters were frequency, site and histological type as well as age and gender. Results: We found 1,738 cancers in patients aged from 4 months to 109 years (mean, 50.4 ± 4. The sex ratio (M/F) was 1.3. The most frequent localizations of the cancers were the prostate (10.3%) followed by the breast (9.9%), the stomach (8.4%) and the cervix (7.2%). In women, the median age was 47.4 ± 2.9 years, and the most common cancers were breast cancer (21.2%), followed by cervical cancer (16.3%). In men, the median age was 53.2 ± 7.3 years and the most frequent cancers were prostate cancer (18.5%), non-Hodgkin’s lymphoma (13.2%) and stomach cancer (10.7%). In children, Burkitt’s lymphoma (41.8%), retinoblastoma (11.6%) and nephroblastoma (9.6%) were the most important cancers. Conclusion: Cancers are frequent in Togo, those of the prostate, breast and cervix being most important with a worse prognosis. Emphasis should be placed on early detection and diagnosis.

Prise en charge et résultats fonctionnels des cataractes traumatiques dans la région centrale du Togo

INTRODUCTION Traumatic cataract is a serious condition because it can cause partial or total vision loss. Our study aims to assess the postoperative functional outcomes of patients undergoing surgery for traumatic cataract in the Central region of Togo. METHODS We conducted a retrospective study based on the analysis of medical records of patients who underwent surgical treatment for traumatic cataract in hospital based and outreach eye care services between 1 January 2009 and 30 June 2011. RESULTS Out of a total of 1086 cases with cataract undergoing surgery during this period, 131 (12.06%) had traumatic cataract. The average age was 30.01 ± 16.61 years, ranging betrween 5 and 70 years, 85% of patients underwent implantation with good or average success rates of 66% after correction in the first postoperative day (according to WHO classification). At two months follow up, 85% of patients had visual acuity above 3/10. CONCLUSION Despite micro-ophthalmic surgery advances, access to traumatic cataract surgery remains difficult for both the patient and the practitioner, especially in developing countries. For these reasons priority must be given to ocular trauma prevention.

Complications retiniennes d’une thrombocytemie essentielle

La thrombocytémie essentielle (TE) est un désordre myéloprolifératif chronique s’accompagnant d’une thrombocytose importante et de complications hémorragiques ou thrombotiques pouvant être veineuses mais également artérielles [1]. La prépondérance féminine est fréquemment observée. L’âge moyen de diagnostic de la TE est de 60 ans et la maladie est rare chez les enfants [2]. Ces complications vasculaires peuvent toucher la vision et surtout la microcirculation rétinienne avec le risque d’une perte de la fonction visuelle.