Determinants of the Ophthalmological Follow-Up of Sickle Cell Patients at the National Center of Research and Care for Sickle Cell Patients in Lome-Togo

Objectives: To assess the factors influencing the ophthalmological follow-up of sickle cell patients in Togo. Materials and Methods: The national center of research and care for sickle cell patients (CNRSD) served as study setting. It was a descriptive and analytical study by interview over a three-month period from December 01, 2020 to March 02, 2021. Was included in the study, any patient with sickle cell disease genotype SS or SC, age ≥ 17 years, regularly followed at the CNRSD and having accepted the interview by a survey sheet. Excluded were patients with sickle cell trait genotype AS or AC or with a disability that prevented them from being interviewed. Results: Two hundred and fifty (250) patients with sickle cell disease were interviewed. The mean age was 29.1 years ± 11.12 years [17 years;67 years] and the sex ratio = 0.52. Nine patients over ten (9/10) attended at least secondary school. The jobless represented 25.60% of the total population followed respectively by students and laborers in 20.40% and 16% of cases. Twenty-four percent (24%) of patients were followed up in ophthalmology department. Statistically, there was no significant relationship between level of education (p = 0.4083), occupation (p = 0.6441) and knowledge of the ocular complications of sickle cell disease. Statistically, there was a significant relationship between knowledge of the ocular complications of sickle cell disease and compliance with ophthalmological follow-up (p = 0.0009). Conclusion: The knowledge of eye disorders related to sickle cell disease by patients with sickle cell disease improves their ophthalmological follow-up. Greater awareness on eye disorders related to sickle cell disease by medical staff towards patients with sickle cell disease would improve ophthalmological follow-up. .

Pathogenesis, prevention, diagnosis and management of retinal vein occlusion

Retinal vein occlusion(RVO) is the second vascular retinal cause of visual loss and defined by the occlusion of a retinal vein. It is divided into branch retinal vein occlusion or central retinal vein occlusion, depending on the location of occlusion. RVO has severe medical, financial and social implications on the patients. The diagnosis of the disease is easier nowadays with the use of spectral domain optical coherence tomography and fluorescein angiography. The treatment options for RVO have changed dramatically over the past few years with the introduction of the intravitreal injections of dexamethasone(Ozurdex), bevacizumab(Avastin), ranibizumab(Lucentis) and aflibercept(EYLEA), along with the panretinal laser photocoagulation, abandoning former treatment modalities and surgical solution. This manuscript is a review of current literature about RVO with emphasize on the pathophysiology, risk factors and prevention, diagnosis and sub-group categorization and treatments including medical and surgical. Since no official guidelines are available for the treatment of RVO patients, and considering the latest developments in the treatment options, and the variety of follow-up and treatment modalities, this manuscript aims to provide tools and knowledge to guide the physician in treating RVO patients, based on the latest publications from the literature and on several of the patients characteristics.

Direct Cost of Primary Open Angle Glaucoma Management

Background: There are few studies on the cost of glaucoma management in developing country, especially in Togo, there are no data on the cost of POAG management. Aims: To determine the annual direct cost of the management of POAG, to evaluate the annual economic weight of the management of POAG and to determine the factors associated with the annual economic weight of the management. Methods: We conducted a retrospective and descriptive study over a period of 12 months from January 1 to December 31, 2019 based on the records of patients followed for POAG in AFIA Eye Clinic in Lomé-Togo. The annual direct cost was defined by the sum of the costs of consultations, explorations and treatments. We defined the direct cost per patient and per year and related to the average annual income. It was said to be catastrophic at 20% or more of the estimated annual income. Chi 2 and Fisher tested the comparison of proportions. We conducted univariate and multivariate logistic regression to search correlations. Results: During the study period, 150 patient records were included. The average age was 47.24 ± 17.09 years and the sex ratio was 0.82. The cost of the diagnosis was 112.18 ± 22.26 €. The average cost of consultations was 19.46 ± 11.35 € and that of explorations was 92.71 ± 10.91 €. The annual cost of treatment per patient was 165.52 ± 110.16 €. The annual global direct cost of POAG management per patient was 277.69 ± 132.42 €. Compared to the annual income of 1166.29 €, the economic weight of the glaucoma management was 23.8%. This direct cost was catastrophic for 32.1% of patients in the study (44/150 of people with no care). Compared to the guaranteed inter-professional minimum wage (SMIG) of 640.30 €, the economic direct cost weight was 43.3%. Risk factors significantly associated with the direct cost were age over 40 (OR = 1.05 and p = 0.032), liberal profession (OR = 4.72 and p = 0.04), the absence of health insurance (OR = 6.68 and p = 0.017) and the use carbonic anhydrase inhibitors (OR = 7.4 and p = 0.012) and prostaglandin analogues (OR of 38.2 and p Conclusion: This first study on the direct cost of POAG management in Lomé showed that the economic burden glaucoma represents for the patient, his family and society. The data from this study will allow health decision-makers to adopt strategies to mitigate the effects of glaucoma on the economy.

Progression of Primary Open Angle Glaucoma on Optical Coherence Tomography of the Optic Nerve Head

Aims: To describe the progression of Primary open angle glaucoma (POAG) on Optical Coherence Tomography (OCT) of the optic nerve head and retinal nerve fiber layers (RNFL). Method: We conducted a descriptive retrospective study from January 1, 2015 to December 31, 2019, a period of 5 years from the files of patients followed for POAG and having carried out at least two OCT examinations of the optic nerve head (ONH), one automated visual field and Intraocular pression (IOP). The variables studied were: age, sex, mean IOP, glaucoma stage, progression of ONH parameters, and progression of RNFL parameters. Results: During the period, 112 eyes of 56 patients were included. The mean age was 48.96 ± 16.57 [12 - 83] years with a sex-ratio of 1.33 (32 M/27 F). The mean IOP was 21 ± 4.54 [10 - 36] mm Hg. According to the mean deviation (MD) of the visual field, 98 eyes or 87.5% were stage 1 of POAG, 10 eyes or 8.9% at stage 2 and 4 eyes or 3.6% at stage 3. The mean time between the 1st and 2nd OCT examination was 28.91 ± 11.07 [6 - 56] months, corresponding to an average of 2.18 OCT per patient in 5 years of follow-up. There was an average increase of 6.2% of the Cup area and an increase in the vertical Cup/Disc ratio of 1.79% per year. The thinning average of neuro-retinal ring area was 1.64% per year. The RNFL thickness had decreased on average by 4.28 μ or 0.93% per year. The lower quadrant had the highest fiber loss with 1.08% per year followed by the upper quadrant with a loss of 1.05% per year. Conclusion: OCT of the ONH and RNFL proves to be an essential tool in the follow-up of POAG. A subsequent study taking into account the OCT of the macular ganglion complex will enable to study its contribution in the follow-up of glaucomatous patients in the same population.

AB047.Quebec database of clinical data and biological material for research on uveal melanoma

Background:Sharing biological material and clinical data from patients with uveal melanoma.Methods:Uveal melanoma is the most common intraocular malignancy in the adult population.Because uveal melanoma is primarily a sporadic cancer and familial cases are rare,it is difficult to prevent or detect it.Despite effective treatment of ocular tumors,more than 50%of patients develop incurable liver metastases mainly in the 5-10 years following the detection of the primary tumor.This cancer is relatively rare and the obtained biopsies are very small.About 20 samples are taken each year in Quebec.This provincial infrastructure is made of biological material from donors with uveal melanoma and a large clinical database.Collected tumor biopsies are used for culturing cell lines and the creation of a DNA/RNA library used for genomic and genetic studies.Results:This infrastructure plays an important role in the achievement of various research programs for a better understanding of genetic and environmental factors involved in the development of melanoma and the spread of metastasis.It allows collaboration with other researchers at a provincial,national and international level in order to make progress in basic and clinical research on uveal melanoma.Conclusions:The biological material and clinical data of this infrastructure are available upon request to VHRN members whose research project was approved by the ethics committee of the institution.

Optical coherence tomography angiography at the acute phase of optic disc edema

Background:The differential diagnosis of optic disc edema at the acute phase can be challenging.OCT angiography(OCTA)is a new technology allowing the visualization of the peripapillary vascular network and optic disc capillaries.The peripapillary network alterations of glaucoma and chronic non-arteritic anterior ischemic optic neuropathy(NAION)were reported.However,no OCTA studies on acute optic disc edema from various causes.The aim of this project was to use OCTA to demonstrate the vascular changes the optic nerve head of various types of optic disc edema at the acute phase.Methods:In this retrospective study,patients with non-arteritic anterior ischemic optic neuropathy(NAION),papillitis or papilledema were recruited.Each patient was imaged using the AngioPlex^(TM)CIRRUS^(TM)HD-OCT device(model 5000,Carl Zeiss Meditec,Inc.,Dublin,USA)with a scanning area of 6×6 mm^(2) centered on the optic disc.A morphological analysis of the peripapillary network was performed.For some patients with unilateral optic disc edema,a quantitative analysis was performed using a swept-source OCT-A system(PLEX®Elite 9000,Carl Zeiss Meditec,Inc.,Dublin,USA).Vessel perfusion density and flux index of the peripapillary area were calculated.Results:Eight eyes with NAION(4 patients),12 eyes with papillitis(6 patients)and 25 eyes with papilledema(13 patients)were imaged.The apparent disappearance or moderate pattern alteration of the peripapillary capillary vessels were observed in patients with NAION or papillitis,respectively.For papilledema,the capillaries at the surface of the optic disc were dilated and tortuous,but no peripapillary network pattern changes were observed.The quantitative analysis did not show any difference of peripapillary network between NAION and healthy eyes.For papillitis,the flux index was higher in inflammatory eyes compared to the healthy eyes in average(p=0.03).Conclusion:At the acute phase,the morphological analysis of OCT-A appeared to be more useful than the quantification analysis,facilitating the differentiation between the three kinds of ONH edema:ischemic,inflammatory and papilledema.