[Epidemiological aspects of malignant melanoma of the uvea in Tunisia]

Background: to assess clinical factors that may influence the prognosis of malignant melanoma of the uvea

Methods:We conducted a retrospective study from January 1990 to December 2013, involving 80 patients suffering from malignant melanoma of the uvea. We determined the location, the size, the tumor thickness, the clinicopathological aspect, the degree of pigmentation of the uveal melanoma, and associated signs

Results: Factors significantly associated with poor prognosis were: a tumor location [p = 0.01], the infiltrative or fungus aspect [p = 0.001], a diameter equal to or larger than 10 mm [p = 0.003], the thickness greater than or equal to 5 mm [p = 10-3], achromatic or hyperpigmented melanomas [p = 0.02] and retinal detachment [p = 10-3]

Conclusion: Clinical prognostic factors are important to know because they determine the evolutionary profile and the metastatic potential of the uveal melanoma

Multimodal imaging for the diagnosis of an atypical case of central serous chorioretinopathy

We report a case of a 52-year-old woman presented with atypical central serous chorioretinopathy [CSCR] that had been misdiagnosed as posterior uveitis and treated with systemic corticosteroids and immunosuppressive therapy, with subsequent severe chorioretinal damage. Diagnosis was straightened through multimodal imaging. Anatomical improvement was achieved after discontinuation of corticosteroids and intravitreal injection of bevacizumab. However, visual acuity remained severely impaired in one eye. Failure to differentiate atypical CSCR from inflammatory chorioretinal diseases may lead to severe and irreversible visual impairment. Multimodal imaging helps recognition of the atypical presentations of CSCR, avoiding misdiagnosis and inappropriate management

[Results of congenital cataract surgery using 2,2 microincision in children before the age of 5 years]

Thanks to the recent advances of the microsurgical techniques, the results of the congenital cataract surgery in children less than 5 years old have considerably improved. However, the age of implantation and the intraocular lens power calculation remain subjects of controversies. To evaluate the results of 2.2 mm micro-incision congenital cataract surgery in children less than five years old. Forty seven consecutive eyes of 26 children who had dense congenital cataract surgery were included in this retrospective study. All children had had the same surgical procedure: anterior approach through 2.2 mm corneal tunnel, posterior capsulorhexis associated to anterior vitrectomy and a primary foldable intraocular lens implantation. The final evaluation was at the same time anatomical and functional depending on the children age. The median patient age of the children was of 23 months [6 to 54 months] and the sex ratio was 1.36 [15 boys / 11 girls]. The cataract was bilateral in 77.7 % of the cases [21/27 children]. The intraocular lens was implanted in the capsular bag in 93.6 % of the cases [44/47 eyes] and in the sulcus in 6.3 % of the cases [3/47 eyes]. The postoperative complications were mild: inflammatory reaction limited to the anterior chamber in 17 % of the cases [8/47 eyes], opacification of the visual axis with a reproliferation of the epithelial cells behind the implant was observed in 4.25 % of the eyes [2/47 eyes]. We noted no case of intraocular lens decentration or secondary glaucoma. The study of the refraction at last follow up showed a sphere average of 2.73 +/- 1.21 diopters and mean astigmatism of 1.51 +/- 0.82 diopters. The median best corrected distance visual acuity, evaluated in 12 children, was 5.2/10 ranging from 1/10 to 10/10. The amblyopia was also noted to 12/26 children [46.1 %]. Among these children, 11/12 [91.6%] had a delay of surgery and 5/12 [41.6 %] had an unilateral cataract. Currently the anatomical prognosis of the congenital cataract surgery in children less than 5 years old is getting closer to that of the adult. However, the functional prognosis remains still unpredictable depending mainly on the deadline of surgery which remains very late in our series. Thanks to the improvement of the surgical techniques using microincision in cataract surgery and the new generation of foldable implants, the anatomical and functional prognosis of the congenital cataract have significantly improved