The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries

Background

Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival.

Methods

We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models.

Findings

The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope).

Interpretation

This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.

Funding

Queen Elizabeth Diamond Jubilee Trust.

Women who have undergone female genital mutilation/cutting's perceptions and experiences with healthcare providers in Paris

Female genital mutilation/cutting (FGM/C) is a health and human rights issue and a dangerous form of gender-based violence. Given migratory flows from the countries in which it is practised, FGM/C concerns a substantial number of women living in Western countries. In this study, we looked at women who had undergone FGM/C experiences with French medical practitioners. We also discussed with them the desirability of screening for, and prevention of, FGM/C in international travel medicine centres. A qualitative approach was used to collect and analyse the data. Focus groups and semi-structured interviews were held with 26 women (24 participants in focus groups and 2 individual interviews). Transcriptions were coded and analysed thematically. All the participants came from sub-Saharan Africa. Their median age was 32.9 years. Persistent silence about FGM/C in the host society following immigration resulted in dissatisfaction with healthcare providers. Participants expected professionals to address the subject of FGM/C, feeling professionals should bring up the subject first so as to put women at ease. International travel medicine centres were discussed by some as a possible means of prevention.

[Invasive squamous cell carcinoma: about 2 cases]

Conjunctival tumors are common in tropical areas, where exposure to ultraviolet radiation is high and almost permanent. Malignant tumors are quite rare and the most represented is conjunctival squamous cell carcinoma. We report two cases of invasive squamous cell carcinoma of the conjunctiva received in the ophthalmology department of the Sominé Dolo hospital in Mopti, Mali. The patients were 25 and 51 years old, living in a rural desert area exposed to sunlight and dust. They presented with a mass developed in the area of the palpebral fissure, invading the cornea and preventing palpebral occlusion. The mass was raised, multi-lobulated, well circumscribed, pearly white in color and papillomatous in appearance with dilation of the feeder vessels. A wide surgical excision at 4 - 5 mm from the healthy tissue edges was performed with anatomopathological examination of the specimen, which confirmed a mature and invasive differentiated squamous cell carcinoma of the conjunctiva. The extension workup and HIV serology were negative. The evolution was favorable in the medium term without recurrence.

Symmetric and asymmetric shocked gas jets for laser-plasma experiments

Shocks in supersonic flows offer both high density and sharp density gradients that are used, for instance, for gradient injection in laser-plasma accelerators. We report on a parametric study of oblique shocks created by inserting a straight axisymmetric section at the end of a supersonic "de Laval" nozzle. The effect of different parameters, such as the throat diameter and straight section length on the shock position and density, is studied through computational fluid dynamics (CFD) simulations. Experimental characterizations of a shocked nozzle are compared to CFD simulations and found to be in good agreement. We then introduce a newly designed asymmetric shocked gas jet, where the straight section is only present on one lateral side of the nozzle, thus providing a gas profile well adapted for density transition injection. In this case, full-3D fluid simulations and experimental measurements are compared and show excellent agreement.

[Efficacy and tolerance of Latanoprost given as a first intention in the treatment of primitive open angle glaucoma in African melanoderm]

OBJECTIVE

To assess the reduction in IOP and ocular symptoms in patients newly diagnosed with POAG and treated with latanoprost as monotherapy.

PATIENTS AND METHOD

A multicentric, cross-sectional, descriptive study was conducted. We included adults newly diagnosed with POAG. All patients received one drop of preserved latanoprost 0.005% in each eye every night for 12 weeks. Changes in IOP and ophthalmic signs and symptoms were assessed during and at the end of treatment.

RESULTS

A total of 524 patients were included, with a participation rate of 93% at 12 weeks. The mean age was 52.79±17.33 years, and the sex ratio M/F was 1.39. At inclusion, the mean IOP was 21.68±9.72mmHg. After 2 weeks of treatment, the mean IOP was 15.49±5.81mmHg, for a reduction of 28.55%. After 12 weeks of treatment, the mean IOP was 13.16±3.54mmHg, for a reduction of 39.30%. The main symptom recorded was a gritty foreign body sensation, the frequency of which was 4.72% at W2 and 2.45% at W12. The main sign was hyperemia (4.33% at W2 and 1.84% at W12).

CONCLUSION

Latanoprost given as first-line monotherapy in POAG in blacks considerably reduces IOP. The incidence of side effects remains low; it is higher at the start of treatment.

Orbital migration of schistosome eggs: a case report

Background

Ocular damage, including damage to the conjunctiva, lacrimal gland, eyelids, and orbit, caused by Schistosoma haematobium is sporadic. We report a clinical case of orbital migration of schistosome eggs.

Case presentation

A 14-year-old boy of Malian nationality presented with a painless swelling of the upper right eyelid, which had been gradually increasing for approximately 3 months. Visual acuity was logMAR 0.10 and 0.00 in the right and left eye, respectively. External examination revealed a right palpebral mass, pushing the globe slightly downward and inward. Computed tomography revealed a mass of the right lacrimal gland. Total excision of the mass was performed by transpalpebral orbitotomy. Pathological examination revealed an inflammatory granulomatous infiltrate of the lacrimal gland consisting of lymphocytes, eosinophils, giant cells, epithelioid cell, histiocytes and calcified Schistosoma eggs with terminal spine.

Urine examination revealed eggs of S. haematobium. Praziquantel 40 mg/kg was administered to the patient. The hematuria stopped after 1 week. After 3 years of follow-up, no recurrence was noted.

Conclusions

The bilharzian granuloma of the lacrimal gland is an ectopic site of the parasite. In this case, the granuloma was cured by surgical excision followed by a course of Praziquantel.

[Eye traumatism during the COVID-19 sanitary crisis at Iota-teaching hospital]

INTRODUCTION

During the COVID-19 pandemic, we have witnessed a world-wide lock-down of the population. This government action combined with the application of social distancing should in principle reduce the frequency of occurrence of ocular injuries. The goal of our work is to try to understand the circumstances of the occurrence of ocular injuries at the IOTA Teaching Hospital during the lock-down period of the COVID-19 health crisis.

METHODOLOGY

This was a cross-sectional, descriptive study. The data were collected prospectively. Our study covered the period from March to May 2020. All consenting patients seen at the IOTA Teaching Hospital for ocular trauma regardless of gender, age, circumstances in which the trauma occurred or the nature of the injuries were included by non-probability sampling. Excluded from the study were patients who did not consent or who consulted for a non-traumatic ophthalmologic condition.

RESULTS

There were a total of 138 cases, of which 84 were male and 54 female, for a gender ratio of M/F=1.5. Children aged 0 to 5 years represented more than 3/4 (79.14%) of our sample. Trauma occurred in 45.83% of cases during leisure activities and 3.60% of cases involved domestic violence.

DISCUSSION

According to the authors, measures aimed at limiting public movement, particularly the curfews introduced by the Malian government to contain the spread of the COVID-19 pandemic, may actually result in trauma.

CONCLUSION

Raising public awareness of the social and psychological consequences of lock-down through audiovisual means might significantly reduce the frequency of these ocular traumas.

A systematic review and meta-analysis of the consequences of female genital mutilation on maternal and perinatal health outcomes in European and African countries

INTRODUCTION

Key knowledge gaps remain to improve reproductive health outcomes for millions of women living with female genital mutilation (FGM). We aimed to update previous reviews and quantify more rigorously maternal and perinatal complications related to FGM across different settings.

METHODS

In this systematic review and meta-analysis, we searched 15 electronic databases for studies published between 1 August 1995 and 15 March 2020, reporting on maternal and perinatal complications related to FGM. We included studies comparing women with and without FGM while accounting for confounders. Pooled relative risks (RR) were calculated, using fixed-effects and random-effects models, for a range of maternal and perinatal outcomes, adjusting for individual characteristics and according to delivery settings and study design.

RESULTS

We identified 106 unique references, assessed 72 full-text articles and included 11 studies. We found non-significant elevated risks of instrumental delivery, caesarean delivery, episiotomy, postpartum haemorrhage, perineal laceration, low Apgar score and miscarriage/stillbirth related to FGM. Heterogeneity was present for most outcomes when combining all studies but reduced in subgroup analyses. The risk of caesarean delivery was increased among primiparous women (1.79, 95% CI 1.04 to 3.07) such as the risk of episiotomy in European specialised settings for women with FGM (1.88, 1.14 to 3.09). In Africa, subgroup analyses revealed elevated risks of postpartum haemorrhage (2.59, 1.28 to 5.25). The most common reported type was FGM II. However, few studies provided stratified analyses by type of FGM, which did not allow an assessment of the impact of the severity of typology on studied outcomes.

CONCLUSION

This review suggests maternal and perinatal morbidity related to FGM vary by study design, context and by subgroup of women. Our study also draws attention to the complications that may extend to the postpartum period. This work contributes to shaping a reference framework for future research and clinical guidelines.

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND

The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe.

METHODS

A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries.

RESULTS

Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease.

CONCLUSIONS

Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral.

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance

Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.

Objectives

To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis.

Design, Setting, and Participants

A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017.

Main Outcomes and Measures

Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis.

Results

The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]).

Conclusions and Relevance

This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

[Evaluation of the quality of life of adult patients treated in low vision at the CHU-IOTA]

INTRODUCTION

Visual impairment is a handicap defined as any alteration of visual function responsible for a partial or total limitation of the activities of daily living (OMS, 2004). The objective of this study is to assess quality of life in patients before and after management of low vision.

PATIENTS AND METHODS

This was a mono-centric, transverse, analytical study over a period of 6 months. Our study population included all adult patients seen in ophthalmologic consultation and followed in the low vision unit with visual acuity less than 3/10 and greater than or equal to 1/20 in the best eye with best optical correction. The National Eye Institute's quality of life questionnaire, the NEF VFQ 25, was administered to patients on site prior to management and then a month later.

RESULTS

Low-vision management improved overall the dimensions of the quality of life questionnaire. Following the end-of-care assessment, the score for ocular pain was lowest (38.20), followed by the overall vision score (44.95) and near vision difficulty score (45.33).

DISCUSSION

Our sample population was distinguished by a cultural mix, with diversity of beliefs and lifestyles, and also by the relatively advanced age of the subjects constituting it. This can influence the individual's perception of him- or herself within his or her environment, modifying the patient's estimation of his or her condition and therefore his or her behavior.

CONCLUSION

Low-vision rehabilitation can improve the quality of life of visually impaired patients, particularly for near vision, activities of daily living and psychological health.

Head and neck cancer and occupational exposure to leather dust: results from the ICARE study, a French case-control study

BACKGROUND

Leather dust is an established carcinogen of the sinonasal cavities; however, evidence is lacking regarding its association with other head and neck cancers (HNC). To date, few studies have been conducted on the association between occupational leather dust exposure and the risk of oral, pharyngeal, and laryngeal cancers. The objective of this study was to investigate the association between the risk of HNC and occupational exposure to leather dust.

METHODS

Lifestyle habits and occupational history were collected for 2161 patients with squamous cell carcinoma of oral cavity, pharynx, and larynx, and 3555 controls, using a standardized questionnaire. Occupational exposure to leather dust was assessed using a job-exposure matrix. Odds ratios (OR) and 95% confidence intervals (CI) for HNC globally and by subsite were estimated using multivariate unconditional, and polytomous logistic regressions, respectively.

RESULTS

Cumulative lifetime exposure to leather dust < 6 mg/m³-years was associated with an increased risk of laryngeal cancer (OR = 2.26, 95% CI: 1.07-4.76); higher levels were not related to elevated risks of HNC. Some tasks performed and the use of some glues were associated with elevated, although non-significant, risks of HNC. No dose-response relationships were observed.

CONCLUSION

Our study did not provide enough evidence for an increased risk of HNC related to occupational exposure to leather dust. Further studies are needed to understand the risks of specific tasks in the leather industry.

[Assessment of quality of life in patients with primary open-angle glaucoma in urban areas]

INTRODUCTION

Quality of life is defined by the physical, emotional and social well-being of an individual. Primary Open Angle Glaucoma (POAG) is a blinding optic neuropathy, it can change the quality of life by its chronic and irreversible nature. The objective of this study was to evaluate the quality of life in patients with POAG in urban areas.

PATIENTS AND METHODS

this was a quantitative cross-sectional study with a descriptive aim over 3 months. Patients followed for POAG at CHU-IOTA with an age ≥ 18 years were included and submitted to the GlauQOL-17 questionnaire for data collection.

RESULTS

We collected 100 glaucomatous patients, the mean age of patients was 52 years with a standard deviation of 14.02. The extreme ages are 18 and 81 years old. There was a male predominance; (54%) with a sex ratio (M / F) of 1.7. The good visual acuities were majority (higher or equal to 3/10). Among our patients, 35% were at the stage of glaucoma starting at OD and 30% at the stage of moderate glaucoma at OG. Our patients had a poor quality of life score (score <50%) in the Anxiety and Driving dimensions. In patients younger than 70 years old, we had a poor anxiety score in all progressive stages of the disease. Scores of self-image dimensions, constraints, and management were greater than 60% in patients over 70 years of age.

CONCLUSION

Alteration of some of the domains studied was proportional to evolution of POAG. This degradation can have physical, psychological and social impacts on his patients.

Stable multi-GeV electron accelerator driven by waveform-controlled PW laser pulses

The achievable energy and the stability of accelerated electron beams have been the most critical issues in laser wakefield acceleration. As laser propagation, plasma wave formation and electron acceleration are highly nonlinear processes, the laser wakefield acceleration (LWFA) is extremely sensitive to initial experimental conditions. We propose a simple and elegant waveform control method for the LWFA process to enhance the performance of a laser electron accelerator by applying a fully optical and programmable technique to control the chirp of PW laser pulses. We found sensitive dependence of energy and stability of electron beams on the spectral phase of laser pulses and obtained stable 2-GeV electron beams from a 1-cm gas cell of helium. The waveform control technique for LWFA would prompt practical applications of centimeter-scale GeV-electron accelerators to a compact radiation sources in the x-ray and γ-ray regions.

Detailed Experimental Study of Ion Acceleration by Interaction of an Ultra-Short Intense Laser with an Underdense Plasma

Ion acceleration from intense (Iλ² > 10¹⁸ Wcm⁻² μm²) laser-plasma interaction is experimentally studied within a wide range of He gas densities. Focusing an ultrashort pulse (duration  ion plasma period) on a newly designed submillimetric gas jet system, enabled us to inhibit total evacuation of electrons from the central propagation channel reducing the radial ion acceleration associated with ponderomotive Coulomb explosion, a mechanism predominant in the long pulse scenario. New ion acceleration mechanism have been unveiled in this regime leading to non-Maxwellian quasi monoenergetic features in the ion energy spectra. The emitted nonthermal ion bunches show a new scaling of the ion peak energy with plasma density. The scaling identified in this new regime differs from previously reported studies.

Note: Real-time monitoring via second-harmonic interferometry of a flow gas cell for laser wakefield acceleration

The use of a gas cell as a target for laser wakefield acceleration (LWFA) offers the possibility to obtain stable and manageable laser-plasma interaction process, a mandatory condition for practical applications of this emerging technique, especially in multi-stage accelerators. In order to obtain full control of the gas particle number density in the interaction region, thus allowing for a long term stable and manageable LWFA, real-time monitoring is necessary. In fact, the ideal gas law cannot be used to estimate the particle density inside the flow cell based on the preset backing pressure and the room temperature because the gas flow depends on several factors like tubing, regulators, and valves in the gas supply system, as well as vacuum chamber volume and vacuum pump speed/throughput. Here, second-harmonic interferometry is applied to measure the particle number density inside a flow gas cell designed for LWFA. The results demonstrate that real-time monitoring is achieved and that using low backing pressure gas (<1 bar) and different cell orifice diameters (<2 mm) it is possible to finely tune the number density up to the 10(19) cm(-3) range well suited for LWFA.

Short intense laser pulse collapse in near-critical plasma

It is observed that the interaction of an intense ultrashort laser pulse with a near-critical gas jet results in the pulse collapse and the deposition of a significant fraction of the energy. This deposition happens in a small and well-localized volume in the rising part of the gas jet, where the electrons are efficiently accelerated and heated. A collisionless plasma expansion over ~ 150 μm at a subrelativistic velocity (~ c/3) has been optically monitored in time and space, and attributed to the quasistatic field ionization of the gas associated with the hot electron current. Numerical simulations in good agreement with the observations suggest the acceleration in the collapse region of relativistic electrons, along with the excitation of a sizable magnetic dipole that sustains the electron current over several picoseconds.

Anticorrelation between ion acceleration and nonlinear coherent structures from laser-underdense plasma interaction

In laser-plasma experiments, we observed that ion acceleration from the Coulomb explosion of the plasma channel bored by the laser is prevented when multiple plasma instabilities, such as filamentation and hosing, and nonlinear coherent structures (vortices or postsolitons) appear in the wake of an ultrashort laser pulse. The tailoring of the longitudinal plasma density ramp allows us to control the onset of these instabilities. We deduced that the laser pulse is depleted into these structures in our conditions, when a plasma at about 10% of the critical density exhibits a gradient on the order of 250 μm (Gaussian fit), thus hindering the acceleration. A promising experimental setup with a long pulse is demonstrated enabling the excitation of an isolated coherent structure for polarimetric measurements and, in further perspectives, parametric studies of ion plasma acceleration efficiency.

Development and characterization of very dense submillimetric gas jets for laser-plasma interaction

We report on the characterization of recently developed submillimetric He gas jets with peak density higher than 10(21) atoms/cm(3) from cylindrical and slightly conical nozzles of throat diameter of less than 400 μm. Helium gas at pressure 300-400 bar has been developed for this purpose to compensate the nozzle throat diameter reduction that affects the output mass flow rate. The fast-switching electro-valve enables to operate the jet safely for multi-stage vacuum pump assembly. Such gaseous thin targets are particularly suitable for laser-plasma interaction studies in the unexplored near-critical regime.

Dependence on pulse duration and foil thickness in high-contrast-laser proton acceleration

Experimental measurements of proton acceleration with high intensity and high-contrast short laser pulses have been carried out over an order of magnitude range in target thickness and laser pulse duration. The dependence of the maximum proton energy with these parameters is qualitatively supported by two-dimensional particle-in-cell simulations. They evidence that two regimes of proton acceleration can take place, depending on the ratio between the density gradient and the hot electron Debye length at the rear target surface. As this ratio can be affected by the target thickness, a complex interplay between pulse duration and target thickness is observed. Measurements and simulations support unexpected variations in the laser absorption and hot electron temperature with the pulse duration and laser intensity, for which density profile modification at the target front surface is the controlling parameter.

[Exophthalmia in children at the African Institute of Tropical Ophthalmology (AITO)]

INTRODUCTION

Exophthalmia is a rare entity. The purpose of this study was to ascertain epidemiological features, clinical aspects, and potential treatment modalities for exophthalmia in children at the University Teaching Hospital- African Institute of Tropical Ophthalmology (UTH-AITO).

PATIENTS AND METHOD

This prospective and descriptive study was carried out from July 2006 to June 2007 at the IOTA-UTH in collaboration with the pediatric hematology and oncology unit of the Gabriel Toure UTH. All patients between the ages of 0 to 15 years who presented unilateral or bilateral exophthalmia whether measurable or not were included. In all cases thorough clinical workup was performed and any appropriate additional examinations were ordered. All data were consigned to a questionnaire.

RESULTS

A total of 46 eyes in 38 children were included, i.e., unilateral right in 15 cases, unilateral left in 15 and bilateral in 8. Mean age was 9.6 years (range, 2 days to 15 years). The male-to-female sex ratio was 1.9:1. The incidence of exophthalmia was 0.3%. Exophthalmia was the reason for seeking medical advice in 68.4% of cases (26 children). Classification according to underlying pathology divided patients into four groups, i.e., inflammatory and/or infectious pathologies in 36.9% (14 cases), tumor pathologies in 31.6% (12 cases), trauma in 13.1% (5 cases) and undetermined in 18.4% (7 cases). A Hertel millimetric regression of exophthalmia was observed in 23.9% of cases (11 eyes) and a gain in visual lines of acuity was observed in 8.7% (4 eyes).

DISCUSSION

Given the normally low frequency of exophthalmia, observation of a 0.3% incidence at a third level reference center warrants alerting of health authorities. Etiological classification was comparable to Crawford's as described by Desjardins. Cellulites (50%) and retinoblastoma (33.3%) were the main causes of exophthalmia.

CONCLUSION

Since exophthalmia can cause loss of vision and even be life-threatening, early diagnosis and treatment is important particularly in children.