[Spectral domain optical coherence tomography findings in patients with retinitis pigmentosa]

Background: Maculopathy is a common complication of retinitis pigmentosa [RP], and compromise the visual acuity of RP patients even in the less advanced stages

Aim: To report the morphological macular findings detected by spectral domain optical coherence tomography [SD-OCT] and to determine their prevalence in patients with retinitis pigmentosa [RP]

Methods: SD-OCT scans from 100 patients [196 eyes] affected by RP were reviewed

Results: We noted a normal macula appearance in 48.5%, macular edema in 14.5% and macular atrophy in 37%. Mean central macular thickness was 167.79 microns and we did not note any statistically significant correlation between visual acuity and foveal thickness. Visual acuity was statistically better in eyes with a larger number of hyper-reflective layers [p<0.001] and in eyes with photoreceptor inner/outer [IS/OS] segment junction distinct [p<0.001]. We have identified three types of tomographic macular edema: a cystoids macular edema in 6.8%, a tractional edema in 8.2% and mixed edema in 1%. We identified two tomographic types of macular atrophy: a central- foveal atrophy in 34 eyes [11.6%] and diffuse atrophy in 38 eyes [12.9%]. Epiretinal membrane was present in 24 eyes [8.2%]

Conclusions: The OCT contributes to the analysis of epidemiological and morphological of different macular involvement in RP. OCT has a prognostic value, which essentially depends on the morphology of the IS/OS line and number of hyper-reflective layers

Bilateral congenital agenesis of lacrimal glands in a Tunisian family

Background: Chronic corneal ulcers still pose etiological and therapeutic challenge. They are serious complications and often associated with poor functional prognosis

Aim: We report the case of a patient with bilateral and chronic corneal ulcer revealing a rare familial form of bilateral agenesis of the lacrimal gland

Cases report: A 39-year-old man was referred to our department for bilateralchronic and sterile ulcer. The tear break-up time was less than one second and the schirmer test detected no wetting in 5 minutes. He mentioned that lacrimation had been totally absent even when crying as was the case of his brother and his sister. Orbital echography showed absence of lacrimal gland. Orbital magnetic resonance imaging revealed absence of both lacrimal glands. Our patients were treated with permanent topical artificial tears. We performed also permanent occlusion of lower lachrymal poncti to preserve basic tear flow

Conclusion: Congenital lacrimal gland agenesis is rare. We report, to our knowledge, the first case of Tunisian family with three patients suffering from bilateral lacrimal gland agenesis and the first documented familiarly cases diagnosed in adulthood

[Ophthalmic artery occlusion with total ophtalmoplegia and anisocoria revealing cavernous sinus thrombosis]

Aim: To describe a case of ophthalmic artery occlusion associated with anisocoria and revealing a cavernous sinus thrombosis due to sinusitis

Observation: A 48-year-old man with a history of diabetes presented acutely with loss of vision and proptosis in the left eye. Ophthalmologic examination concluded in a left ophthalmic artery occlusion with anisocoria and total ophthalmoplgia. Cardiac assessment was normal. Magnetic resonance imaging [MRI] revealed left ophthalmic artery and internal carotid occlusions, left cavernous and transverse sinus thrombosis and sphenoid sinusitis. The patient underwent extensive haematological and medical assessment to search for embolic sources and disease causing thrombophilia. The patient recovered from the thrombosis episode, but sustained permanent blindness

Conclusion: Ophthalmic manifestations may be the only signs revealing cavernous sinus thrombosis which must be usually suspected. Visual prognostic was very poor

[Molecular exploration of the r91W [rPe65 gene] in Tunisian patients with early onset retinal Dystrophy and early onset retinis pigmentosa]

Background: Inherited retinal dystrophies are the major causes of blindness and visual impairment. Visual loss is due to neurosensory retinal and pigment epithelium cells degeneration. The most severe were Leber Congenital amaurosis [LCA], juvenile retinitis pigmentosa [RP] and early onset RP. The LCA and juvenile RP are called "Early Onset Retinal Dystrophy" [EORD]

Objective: Molecular exploration of the R91W [RPE65 gene] in Tunisian patients with Early Onset Retinal Dystrophy and early onset RP

Methods:All patients underwent a complete ophthalmological and a general examinations. The R91W exploration was performed by direct sequencing of exon 4 of the RPE65 gene and enzyme digestion

Results: Among 47 patients, 13 were from Nabeul. Twenty three had an EROD with a visual loss under the age of 2 years. Twenty four were with early onset RP and had these symptoms between the ages of 4 and 10 years. The best corrected visual acuity ranged from 2/10 to 1/60. Among the explored 94 chromosomes, the R91W [325C>T] allele was identified in heterozygous state in a sibling from Nabeul. The allele frequency was 2.12% [2/94]

Conclusion: All our patients had severe forms of RP with a decrease in visual acuity and a wide advanced retinal degeneration. The R91W mutation [325C>T] was not the major cause of EORD and early onset RP among Tunisian patients

[Epidemiologic study of hyperopia in schoolchildren in Tunisia]

To study the epidemiological profile and the degree of severity of hyperopia in Tunisia primary school and to assess its effect on school performance. A cross-sectional, descriptive survey was conducted among 6-14 aged Tunisian children attending primary urban and rural schools. A total of 6192 children were selected using stratified random cluster sampling. Cycloplegic refractive error was measured among all children with uncorrected visual acuity less than 9/10 or signs of astheniopia. Hyperopia was defined as spherical equivalent [SE] >/= 2.0 diopters [D]. We have also searched a possible relation between degree of severity of hyperopia and school performance. The prevalence of hyperopia was 2.61%. The spherical equivalent mean was + 3.73 +/- 0.94 D. The mean age was 9.67 +/- 0.44 years. This prevalence was 2.77% in boys and 2.47% in girls. 3.13% of students were living in urban areas and 1.42% in rural areas. The hyperopia rate decreased significantly with age [p = 0.021], but it was not significantly related to gender [p=0.54]. The difference in the prevalence of hyperopia between urban and rural areas was not statistically significant [p = 0.067]. There was no significant association between the degree of severity of hyperopia and school performance [p=0.41]. In our study, the prevalence of hyperopia among schoolage children in Tunisia was 2.61%.The identification of this refractive error and its correction as soon as possible would ensure these children better visual comfort and a better education

Optical coherence tomographic findings in Berlin's edema

To describe optical coherence tomography [OCT] findings in a patient with Berlin's edema following blunt ocular trauma. A 26-year-old man presented with acute loss of vision in his left eye following blunt trauma. He underwent a complete ophthalmologic examination and OCT. Fundus examination revealed abnormal yellow discoloration in the macula. OCT disclosed thickening of outer retinal structures and increased reflectivity in the area of photoreceptor outer segments with preservation of inner retinal architecture. Re-examination was conducted one month later at the time which OCT changes resolved leading to a surprisingly normal appearance. OCT can be a useful tool in the diagnosis and follow-up of eyes with Berlin's edema and may reveal ultrastructural macular changes

Does lowering hyperhomocysteinemia by folic acid beneficial for oculo-behcet's disease? a pilot study

To determine the effect of folic acid supplementation in Behset's disease [BD] patients with ocular involvement associated with hyperhomocysteinemia [Hhcys]. 19 BD patients, all with uveitis and/or retinal vasculitis associated with Hhcys [plasma hey > 15 /

toxocarose: Une pathologie sous-estimee. A propos de 9 cas

Toxocariasis or visceral larva migrans is a parasitosis due to the migration in the human organism of animal ascarid larvae. Its importance is under estimated and the reported Tunisian cases are rare. We report nine cases of toxocariasis, noted between January of 2000 to march of 2002, in the laboratory of parasitology mycology in la Rabta hospital. They were six children and three adults. The clinical forms are varied: ophthalmologic form [5 cases], general syndrome [1 case], oedema [1 case] and hypereosinophilia [2 cases], and confirmed serologically by the presence of anti toxocara canis antibody using ELISA test. Visceral larva migrans should be kept in mind to avoid severe forms such as ophthalmologic forms

Decollement de retine par trou maculaire: problemes therapeutiques

To compare the success rate and the visual improvement of different surgical techniques for treating 21 retinal detachments due to macular hole in highly myopic eyes. METHODS: twelve patients were treated by gas tamponade alone, 5 patients underwent vitrectomy with gas tamponade, 4 patients underwent vitrectomy with epiretinal membrane pealing and gas or oil silicone tamponade. fifty eight% of patients were successfully treated after gas tamponade alone, and 75% after vitrectomy, epiretinal membrane pealing and gas or silicone oil tamponade. After retreatment in 7 patients, the final reattachment rate was 80%. Visual acuity was inchanged in 12 cases, improved to 1/20 - 1/10 in 8 case and reached 3/10 in 1 case. A therapeutic scheme is suggested according to the type of retinal detachment, macular vitreoretinal traction and pigment epithelium and chorioretinal degeneration condition