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RÉSUMÉ
Introduction. Le glaucome primitif à angle ouvert (GPAO) progresse silencieusement et constitue une cause principale de cécité irréversible en Afrique subsaharienne, et le dépistage tardif aggrave les déficits visuels. À Yaoundé, où les patients consultent souvent à un stade avancé, notre étude détermine la sévérité des déficits périmétriques au diagnostic du GPAO chez les adultes de 20 ans et plus. Méthodologie. Nous avons conduit une étude transversale analytique rétrospective sur dix ans (2 janvier 2014 au 30 décembre 2024) à l'Hôpital Gynéco-Obstétrique et Pédiatrique (HGOPY), complétée par une collecte prospective sur six mois. Nous avons inclus les dossiers de patients ≥20 ans diagnostiqués avec GPAO et périmétrie automatisée (Octopus 311). Les variables englobaient l'âge, le sexe, les antécédents familiaux et médicaux (hypertension, diabète), l'acuité visuelle corrigée, la pression intraoculaire (PIO) ajustée, le rapport cup/disc (C/D) vertical et la déviation moyenne (MD) du champ visuel. Les déficits périmétriques suivaient la classification Hodapp-Parish-Anderson : légers (MD < -6 dB), modérés (-6 à -12 dB), sévères (> -12 dB). L'analyse univariée et multivariée utilisait SPSS 26.0 avec tests du chi²/Fisher (p<0,05). Résultats. Parmi 246 yeux de 123 patients (âge moyen 51 ± 15 ans ; sex-ratio 1,01), 56,1% avaient un antécédent familial de glaucome, 24,4% une hypertension et 8,9% un diabète. La PIO moyenne était de 20,4 ± 6,1 mmHg ; le C/D vertical moyen, 0,67 ± 0,18. Au diagnostic, 49,6% des yeux présentaient des déficits légers, 14,6% modérés et 37,4% sévères (52% modérés/sévères globalement). Le sexe masculin (OR 3,06 ; IC95 % 1,06-8,81 ; p=0,03) et l'hypertension (OR 2,95 ; IC95 % 1,05-8,27 ; p=0,03) s'associaient indépendamment à des déficits sévères. Conclusion. Plus de la moitié des patients arrivent au diagnostic avec des déficits périmétriques modérés à sévères, confirmant un dépistage tardif à Yaoundé. Les hommes et hypertendus risquent particulièrement des formes avancées. Des campagnes de dépistage ciblées chez ces groupes préserveraient la fonction visuelle et préviendraient la cécité au Cameroun.
ABSTRACT
Introduction. Primary open-angle glaucoma (POAG) progresses silently and ranks as a leading cause of irreversible blindness in sub-Saharan Africa, where late screening worsens visual field loss. At Yaoundé's Gynecology-Obstetrics and Pediatric Hospital (HGOPY) ophthalmology unit, patients often present at advanced stages. This study determines perimetric deficit severity at POAG diagnosis in adults aged 20 years and older. Methodology. We conducted a retrospective analytical cross-sectional study over ten years (January 2, 2014, to December 30, 2024) at HGOPY, with prospective data collection over six months. We included records of patients ≥20 years diagnosed with POAG and automated perimetry (Octopus 311). Variables included age, sex, family/medical history (hypertension, diabetes), corrected distance visual acuity, adjusted intraocular pressure (IOP), vertical cup/disc (C/D) ratio, and mean deviation (MD) on visual field. Perimetric deficits followed Hodapp-Parish-Anderson classification: mild (MD < -6 dB), moderate (-6 to -12 dB), severe (> -12 dB). Univariable and multivariable analyses used SPSS 26.0 with chi-square/Fisher tests (p<0.05). Results. Among 246 eyes from 123 patients (mean age 51 ± 15 years; sex ratio 1.01), 56.1% had family history of glaucoma, 24.4% hypertension, and 8.9% diabetes. Mean IOP was 20.4 ± 6.1 mmHg; mean vertical C/D ratio, 0.67 ± 0.18. At diagnosis, 49.6% of eyes showed mild deficits, 14.6% moderate, and 37.4% severe (52% moderate/severe overall). Male sex (OR 3.06; 95% CI 1.06-8.81; p=0.03) and hypertension (OR 2.95; 95% CI 1.05-8.27; p=0.03) independently associated with severe deficits. Conclusion. Over half of patients present with moderate-to-severe perimetric deficits at diagnosis, underscoring late detection in Yaoundé. Men and hypertensives face heightened risk of advanced disease. Targeted screening campaigns in these groups would preserve visual function and avert blindness in Cameroon.
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References
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- 2. World Health Organization (WHO). World Report on Vision. 2019.
- 3. Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014;311(18):1901‑11.
- 4. Flammer J, Orgül S, Costa VP, Orzalesi N, Krieglstein GK, Serra LM, et al. The impact of ocular blood flow in glaucoma. Prog Retin Eye Res. 2002;21(4):359‑93.
- 5. Quigley HA. Glaucoma. Lancet. 2011;377(9774):1367‑77.
- 6. Varma R, Lee PP, Goldberg I, Kotak S. An assessment of the health and economic burdens of glaucoma. Am J Ophthalmol. 2011;152(4):515‑22.
- 7. Boodhna T, Crabb DP. Disease severity in newly diagnosed glaucoma patients with visual field loss: trends from more than a decade of data. Ophthalmic Physiol Opt. 2015;35(2):225‑30.
- 8. Deva NC, Insull E, Gamble G, Danesh-Meyer HV. Risk factors for first presentation of glaucoma with significant visual field loss. Clin Exp Ophthalmol. 2008;36(3):217‑21.
- 9. King A, Azuara-Blanco A, Tuulonen A. Glaucoma. BMJ. 2013;346:f3518.
- 10. Abdull MM, Gilbert CC, Evans J. Primary open angle glaucoma in northern Nigeria: stage at presentation and acceptance of treatment. BMC Ophthalmology. 2015;15(1):111.
- 11. Kyari F, Abdull MM, Bastawrous A, Gilbert CE, Faal H. Epidemiology of glaucoma in sub-saharan Africa: prevalence, incidence and risk factors. Middle East Afr J Ophthalmol. 2013;20(2):111‑25.
- 12. Dohvoma VA, Mvogo SRE, Bidjogo M, Mvilongo CT, Akono ME, Nguena MB, et al. Clinical Characteristics of Patients Newly Diagnosed with Primary Open Angle Glaucoma at the Yaoundé Central Hospital-Cameroon. Journal of Ophthalmology and Research. Fortune Journals; 2020;3(1):1‑7.
- 13. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90(3):262‑7.
- 14. Leske MC, Heijl A, Hyman L, Bengtsson B, Dong L, Yang Z, et al. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology. 2007;114(11):1965‑72.
- 15. Wiggs JL, Pasquale LR. Genetics of glaucoma. Hum Mol Genet. 2017 ;26(R1):R21‑7.
- 16. Allingham RR, Liu Y, Rhee DJ. The genetics of primary open-angle glaucoma: a review. Exp Eye Res. 2009;88(4):837‑44.
- 17. Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004;363(9422):1711‑20.
- 18. Emre M, Orgül S, Gugleta K, Flammer J. Ocular blood flow alteration in glaucoma is related to systemic vascular dysregulation. Br J Ophthalmol. 2004;88(5):662‑6.
- 19. Enock ME, Omoti AE, Momoh RO. Glaucoma in a suburban tertiary care hospital in Nigeria. J Ophthalmic Vis Res. 2010;5(2):87‑91.
- 20. Kane R, Napo A, Kaba M, Russo Y, Toe Vital R, Bogoreh AR, et al. Etude du glaucome primitif a angle ouvert a l’institut d’Ophtalmologie Tropicale Africaine, Mali. Société médicale du Mali; 2017.
- 21. Bonnemaijer PWM, Lo Faro V, Sanyiwa AJ, Hassan HG, Cook C, GIGA study group, et al. Differences in clinical presentation of primary open-angle glaucoma between African and European populations. Acta Ophthalmol. 2021;99(7):e1118‑26.
- 22. Bonomi L, Marchini G, Marraffa M, Bernardi P, Morbio R, Varotto A. Vascular risk factors for primary open angle glaucoma: the Egna-Neumarkt Study. Ophthalmology. 2000;107(7):1287‑93.
- 23. Vajaranant TS, Pasquale LR. Estrogen deficiency accelerates aging of the optic nerve. Menopause. 2012;19(8):942‑7.
- 24. Shen L, Melles RB, Metlapally R, Barcellos L, Schaefer C, Risch N, et al. The Association of Refractive Error with Glaucoma in a Multiethnic Population. Ophthalmology. 2016;123(1):92‑101.
References
1. Tham Y-C, Li X, Wong TY, Quigley HA, Aung T, Cheng C-Y. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121(11):2081‑90.
2. World Health Organization (WHO). World Report on Vision. 2019.
3. Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014;311(18):1901‑11.
4. Flammer J, Orgül S, Costa VP, Orzalesi N, Krieglstein GK, Serra LM, et al. The impact of ocular blood flow in glaucoma. Prog Retin Eye Res. 2002;21(4):359‑93.
5. Quigley HA. Glaucoma. Lancet. 2011;377(9774):1367‑77.
6. Varma R, Lee PP, Goldberg I, Kotak S. An assessment of the health and economic burdens of glaucoma. Am J Ophthalmol. 2011;152(4):515‑22.
7. Boodhna T, Crabb DP. Disease severity in newly diagnosed glaucoma patients with visual field loss: trends from more than a decade of data. Ophthalmic Physiol Opt. 2015;35(2):225‑30.
8. Deva NC, Insull E, Gamble G, Danesh-Meyer HV. Risk factors for first presentation of glaucoma with significant visual field loss. Clin Exp Ophthalmol. 2008;36(3):217‑21.
9. King A, Azuara-Blanco A, Tuulonen A. Glaucoma. BMJ. 2013;346:f3518.
10. Abdull MM, Gilbert CC, Evans J. Primary open angle glaucoma in northern Nigeria: stage at presentation and acceptance of treatment. BMC Ophthalmology. 2015;15(1):111.
11. Kyari F, Abdull MM, Bastawrous A, Gilbert CE, Faal H. Epidemiology of glaucoma in sub-saharan Africa: prevalence, incidence and risk factors. Middle East Afr J Ophthalmol. 2013;20(2):111‑25.
12. Dohvoma VA, Mvogo SRE, Bidjogo M, Mvilongo CT, Akono ME, Nguena MB, et al. Clinical Characteristics of Patients Newly Diagnosed with Primary Open Angle Glaucoma at the Yaoundé Central Hospital-Cameroon. Journal of Ophthalmology and Research. Fortune Journals; 2020;3(1):1‑7.
13. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90(3):262‑7.
14. Leske MC, Heijl A, Hyman L, Bengtsson B, Dong L, Yang Z, et al. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology. 2007;114(11):1965‑72.
15. Wiggs JL, Pasquale LR. Genetics of glaucoma. Hum Mol Genet. 2017 ;26(R1):R21‑7.
16. Allingham RR, Liu Y, Rhee DJ. The genetics of primary open-angle glaucoma: a review. Exp Eye Res. 2009;88(4):837‑44.
17. Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004;363(9422):1711‑20.
18. Emre M, Orgül S, Gugleta K, Flammer J. Ocular blood flow alteration in glaucoma is related to systemic vascular dysregulation. Br J Ophthalmol. 2004;88(5):662‑6.
19. Enock ME, Omoti AE, Momoh RO. Glaucoma in a suburban tertiary care hospital in Nigeria. J Ophthalmic Vis Res. 2010;5(2):87‑91.
20. Kane R, Napo A, Kaba M, Russo Y, Toe Vital R, Bogoreh AR, et al. Etude du glaucome primitif a angle ouvert a l’institut d’Ophtalmologie Tropicale Africaine, Mali. Société médicale du Mali; 2017.
21. Bonnemaijer PWM, Lo Faro V, Sanyiwa AJ, Hassan HG, Cook C, GIGA study group, et al. Differences in clinical presentation of primary open-angle glaucoma between African and European populations. Acta Ophthalmol. 2021;99(7):e1118‑26.
22. Bonomi L, Marchini G, Marraffa M, Bernardi P, Morbio R, Varotto A. Vascular risk factors for primary open angle glaucoma: the Egna-Neumarkt Study. Ophthalmology. 2000;107(7):1287‑93.
23. Vajaranant TS, Pasquale LR. Estrogen deficiency accelerates aging of the optic nerve. Menopause. 2012;19(8):942‑7.
24. Shen L, Melles RB, Metlapally R, Barcellos L, Schaefer C, Risch N, et al. The Association of Refractive Error with Glaucoma in a Multiethnic Population. Ophthalmology. 2016;123(1):92‑101.