Revue internationale du trachome et de pathologie oculaire tropicale et subtropicale et de sante publique : organe de la Ligue contre le trachome avec la collaboration de l'International Organization against Trachoma et des organisation...最新文献

The Bangladesh, earth of mud and water, is one of the most poor countries in the world. And it is a fact that the very special geographical, climatical and vital statistics are the victims of certain endemic diseases. For the most part, the diarrheoïcal diseases are prevailing. From the ophthalmologic point of view, avitaminosis A is the major risk factor during the childhood. However, as in many other countries, the prime cause of blindness is the cataract. This disease is surgically curable. The treatment is affected by the lack of surgeons and the big number of cases. An example of therapeutic strategy is presented by B.N.S.B.: Bangladesh National Society for the Blind.

The prevalence of pterygium was estimated in a Libyan village. There seems to be an association between pterygium and cicatricial trachoma, poor housing conditions and Herbert's Pits in this population.

The author reviews the current concepts of the pathogenesis, clinical course and treatment of pterygium. This neoplasm can be considered as to be a manifestation of a chronic irritative process caused by solar radiation and repeated microtrauma and, to a lesser degree, by other aetiological factors which are studied successively. The clinical course of the disease consists of two phases: a conjunctival phase and a corneal or true pterygial phase. The anatomical and clinical forms studied in a population of 2,350 subjects in an endemic region of pterygium (Central Sahara) appear to be closely related to the severity and the duration of exposure to predisposing factors. Prevention therefore constitutes the best treatment when it can be applied in highly endemic zones. The various preoperative and postoperative medical and physical treatment modalities (radiotherapy--beta therapy--cryotherapy--laser photocoagulation--antimitotic drugs--corticosteroids) are analysed together with the three main groups of surgical techniques: deviation--excision--lamellar keratoplasties. Medical and physical treatment modalities appear to be minimally effective in the primary treatment, but are valuable and essential adjuvants to surgical treatment. Surgery is the only treatment modality indicated in the corneal phase of the disease. Recurrence remains the major risk of this surgery which means that the surgical indications must be very carefully defined. Only a small number of techniques can be considered to be valid. Lamellar keratoplasties and their variants are indicated in the great majority of cases and have demonstrated their efficacy in the prevention of postoperative recurrences.

Ivermectine, MECTIZAN patented, is a new anti-parasitic product with wide spectrum, is an efficient microfiliar destructive, and is well tolerated by human being struck down by onchocercosis (filariasis which affects badly local populations in the endemic centres). The launching of a therapeutic mass campaign in North Cameroon in 1987, at an onchocercosis centre located in Sahel savanna (Vina Valley) provides more precise methodology to be used in the field and provides the analysis of the results already obtained; these results seem to be favourable both on parasitologic and ophthalmologic point of view. A new epoch begins, that way, mainly for ophthalmologists and also for all practitioners desirous to fight against onchocercosis which is both a gruesome scourge and a health problem in Black Africa.

Since 1973 and 1983's droughts, different studies have proved that xerophthalmia is a public health problem in Mauritania. With the collaboration of different N.G.O.'s, Mauritanian Health Ministry has elaborated a program against xerophthalmia. In this paper, the authors relate this fight since 1987; methods, limits and future.

This study, performed in Atar and Nouakchott, has tested a new proceeding for biological diagnostic of trachoma (Chlamydia trachomatis direct specimen test, SYVA Merieux microtrak), and has controlled the efficiency of different therapeutic schemes against trachoma. An experimental pattern for subsequent studies is proposed.

The authors set up an evaluation of the Prevention Program against Blindness in the Center and South areas of Tunisia. They point out an important improvement of the endemo-epidemiological situation, but, nevertheless, they stress the necessity of carrying on the measures of the campaign.

A survey on a representative sample of population showed that inflammatory trachoma is rare in Republic of Djibouti. However, it is significatively more frequent in rural surroundings (0.4%, standard rates) than in urban surroundings (0.4%, standard rates) where it affects particularly people recently coming from border countries. In rural surroundings the frequency changes according to the distances from capital (p = 0.01). On the contrary, cicatricial trachoma is more frequent in the city (16.4%) than in rural surroundings (8.2%--Standard rates). The blindnesses caused by trachoma are relatively rare (0.1%) when entropiontrichiasis appear especially in urban surroundings (0.7%) where people from Arab Peninsula are the most affected (p = 0.008). When comparing with the 1968 situation, we notice a perceptible decrease of the prevalence of trachoma and also the disappearing of ethnic differences which existed at that time concerning the illness active forms. This good evolution is probably due to the effects of several mass campaigns added to an improvement of accessibility to medical care.