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Abstract
RÉSUMÉ
INTRODUCTION: Le glaucome néovasculaire (GNV) est lié à une néovascularisation de l’angle iridocornéen secondaire à une hypoxie prolongée de la rétine. Dans les pays occidentaux, son traitement est bien codifié et le pronostic est bien meilleur qu’à Brazzaville où le GNV se termine souvent par une énucléation suite à une phtise hyperalgique ou à un éclatement spontané de l’œil.
OBJECTIF: Énumérer les principales étiologies du GNV et discuter des difficultés liées à sa prise en charge à Brazzaville.
MATÉRIELS ET MÉTHODES: Étude transversale, multicentrique (CHU/Brazzaville, Clinique Médicale de Brazzaville), réalisée sur une période de 7 ans sur la base de dossiers de patients vus pour un GNV. Le GNV était défini par l’association d’une rubéose irienne et d’un tonus oculaire supérieure à 21 mm Hg. Les paramètres suivant étaient analysés: motifs de consultation, présentations cliniques, étiologies et traitements.
RÉSULTATS : 25 dossiers ont été retenus (correspondant à 30 yeux souffrant de GNV). La douleur oculaire était le principal motif de consultation (92%, 23/25 patients). La cornée était opaque avec gonoscopie et fond d’oeil impossibles dans 83,33% des cas (25/30 yeux). Les étiologies étaient: diabète sucré (88%, 22/25 patients), occlusion de la veine centrale de la rétine (12%, 3/25 patients). Perdus de vue 7/25 patients correspondant à 7/30 yeux. Le traitement consistait en énucléation (69,56%, 16/23 yeux), photocoagulation rétinienne (21,74%, 5/23 yeux), et injection rétrobulbaire de Chlorpromazine (8,70%, 2/23 yeux).
CONCLUSION: Le diabète sucré est la principale étiologie du GNV à Brazzaville. Le manque de moyens techniques et les consultations tardives n’offrent que peu d’alternative thérapeutique à l’énucléation qui reste largement malheureusement utilisée.
ABSTRACT
INTRODUCTION: Neovascular glaucoma is (NVG) related to neovascularization of iricorneal angle due to prolonged hypoxia in the retina. Treatment is well codified in western countries, but in Brazzaville neovascular glaucoma often ends by enucleation following hyperalgic ocular phtisis or spontaneous bursting of the eye.
OBJECTIVE: To report the main causes of NVG and discuss challenges related to its management in Brazzaville.
MATERIALS AND METHODS: Cross-sectional, multicenter study (CHU / Brazzaville, Clinique Medicale de Brazzaville), conducted over a period of 7 years on the basis of patient records seen for NVG. NVG was defined by the combination of iris rubeosis and an intraocular pressure more than 21 mmHg. The following parameters were analyzed: reasons of consultation, clinical presentations, etiologies and treatments.
RESULTS: 25 cases were recruited (corresponding to 30 eyes suffering from NVG). Eye pain was the main reason for consultation (92%, 23/25 patients). The cornea was opaque with no possibility to realise gonoscopie and ocular fundus in 83.33% of cases (25/30 eyes). The etiologies were: diabetes mellitus (88%, 22/25 patients), central retinal vein occlusion (12%, 3/25 patients). Patients lost 7/25 patients corresponding to 7/30 eyes. Treatment was: enucleation (69.56%, 16/23 eyes), retinal photocoagulation (21.74%, 5/23 eyes), retrobulbar injection of chlorpromazine (8. 70%, 2/23 eyes).
CONCLUSION: Diabetes mellitus is the main etiology of NVG in Brazzaville. The lack of medical equipment and the important delay of consultations offer few therapeutic alternatives to enucleation.
Article Details
References
- Ajvazi H, Lutaj P. Clinical impact in the management of neovascular glaucoma. Rom J Ophthalmol. 2015;59(3):154- 8.
- Havens SJ, Gulati V. Neovascular Glaucoma. Dev Ophthalmol. 2016;55:196- 204.
- Kahloun R, Jelliti B, Zaouali S, Attia S, Ben Yahia S, Resnikoff S et al. Prevalence and causes of visual impairment in diabetic patients in Tunisia, North Africa. Eye (Lond). 2014;28(8):986- 91.
- Hayreh SS. Noevascular glaucoma. Prog Retin Eye Res. 2007;26:470 - 485
- Aref AA.Current management of glaucoma and vascular occlusive disease. Curr Opin Ophthalmol. 2016;27(2):140- 5.
- Ashaye A, Ashaolu O, Komolafe O, Ajayi BG, Olawoye O, Olusanya B et al. Prevalence and types of glaucoma among an indigenous African population in southwestern Nigeria. Invest Ophthalmol Vis Sci. 2013;54(12):7410- 6.
- Uhumwangho OM, Oronsaye D. Retinal Vein Occlusion in Benin City, Nigeria. Niger J Surg. 2016;22(1):17- 20.
- Kaimbo DK, Kabongo BK, Missotten L Ocular complications in diabetes mellitus in Zaire. Bull Soc Belge Ophtalmol. 1995;255:107- 13.
- Ashaye AO, Adeoti CO. Neovascular glaucoma in a Nigerian African population. East Afr Med J 2006.;83(10):559- 64.
- Kaimbo Wa Kaimbo D, Missotten L. Glaucoma in Congo. Bull Soc Belge Ophtalmol. 1997;267:21 -6.
- Ellong A, Mvogo CE, Bella-Hiag AL, Mouney EN, Ngosso A, Litumbe CN. Prevalence of glaucomas in a Black Cameroonian population. Sante. 2006;16(2):83- 8.
- Fiore C, Lupidi G, Santoni G. Retrobulbar injection of chlorpromazine in the absolute glaucoma. J Fr Ophtalmol. 1980;3(6-7):397- 9.
- Lu Q, Zou C, Cao H, Zhao M, Yu S, Qiu Q et al. Preoperative intravitreal injection of ranibizumab for patients with severe proliferative diabetic retinopathy contributes to a decreased risk of postoperative neovascular glaucoma. Acta Ophthalmol. 2016. [Epub ahead of print].
- Frezzotti P, Menicacci C, Bagaglia SA, Mittica P, Toto F, Motolese I. Management of intraocular pressure elevation during hemodialysis of neovascular glaucoma: a case report. BMC Ophthalmol. 2016;16(1):23.
- Olmos LC, Sayed MS, Lee RK. Reply to 'Comment on: Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab'. Eye (Lond). 2016 [Epub ahead of print].
- Seymenoğlu RG, Ulusoy MO, Başer EF. Safety and efficacy of panretinal photocoagulation in patients with high-risk proliferative diabetic retinopathy using pattern scan laser versus conventional YAG laser. Kaohsiung J Med Sci. 2016;32(1):22-6.
- Tang M, Fu Y, Wang Y, Zheng Z, Fan Y, Sun X et al. Efficacy of intravitreal ranibizumab combined with Ahmed glaucoma valve implantation for the treatment ofneovascular glaucoma. BMC Ophthalmol. 2016;16(1):7.
References
Ajvazi H, Lutaj P. Clinical impact in the management of neovascular glaucoma. Rom J Ophthalmol. 2015;59(3):154- 8.
Havens SJ, Gulati V. Neovascular Glaucoma. Dev Ophthalmol. 2016;55:196- 204.
Kahloun R, Jelliti B, Zaouali S, Attia S, Ben Yahia S, Resnikoff S et al. Prevalence and causes of visual impairment in diabetic patients in Tunisia, North Africa. Eye (Lond). 2014;28(8):986- 91.
Hayreh SS. Noevascular glaucoma. Prog Retin Eye Res. 2007;26:470 - 485
Aref AA.Current management of glaucoma and vascular occlusive disease. Curr Opin Ophthalmol. 2016;27(2):140- 5.
Ashaye A, Ashaolu O, Komolafe O, Ajayi BG, Olawoye O, Olusanya B et al. Prevalence and types of glaucoma among an indigenous African population in southwestern Nigeria. Invest Ophthalmol Vis Sci. 2013;54(12):7410- 6.
Uhumwangho OM, Oronsaye D. Retinal Vein Occlusion in Benin City, Nigeria. Niger J Surg. 2016;22(1):17- 20.
Kaimbo DK, Kabongo BK, Missotten L Ocular complications in diabetes mellitus in Zaire. Bull Soc Belge Ophtalmol. 1995;255:107- 13.
Ashaye AO, Adeoti CO. Neovascular glaucoma in a Nigerian African population. East Afr Med J 2006.;83(10):559- 64.
Kaimbo Wa Kaimbo D, Missotten L. Glaucoma in Congo. Bull Soc Belge Ophtalmol. 1997;267:21 -6.
Ellong A, Mvogo CE, Bella-Hiag AL, Mouney EN, Ngosso A, Litumbe CN. Prevalence of glaucomas in a Black Cameroonian population. Sante. 2006;16(2):83- 8.
Fiore C, Lupidi G, Santoni G. Retrobulbar injection of chlorpromazine in the absolute glaucoma. J Fr Ophtalmol. 1980;3(6-7):397- 9.
Lu Q, Zou C, Cao H, Zhao M, Yu S, Qiu Q et al. Preoperative intravitreal injection of ranibizumab for patients with severe proliferative diabetic retinopathy contributes to a decreased risk of postoperative neovascular glaucoma. Acta Ophthalmol. 2016. [Epub ahead of print].
Frezzotti P, Menicacci C, Bagaglia SA, Mittica P, Toto F, Motolese I. Management of intraocular pressure elevation during hemodialysis of neovascular glaucoma: a case report. BMC Ophthalmol. 2016;16(1):23.
Olmos LC, Sayed MS, Lee RK. Reply to 'Comment on: Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab'. Eye (Lond). 2016 [Epub ahead of print].
Seymenoğlu RG, Ulusoy MO, Başer EF. Safety and efficacy of panretinal photocoagulation in patients with high-risk proliferative diabetic retinopathy using pattern scan laser versus conventional YAG laser. Kaohsiung J Med Sci. 2016;32(1):22-6.
Tang M, Fu Y, Wang Y, Zheng Z, Fan Y, Sun X et al. Efficacy of intravitreal ranibizumab combined with Ahmed glaucoma valve implantation for the treatment ofneovascular glaucoma. BMC Ophthalmol. 2016;16(1):7.