Scleral contact lenses: Visual outcomes and tolerance. A prospective study about 98 eyes.

PURPOSE: To assess the improvement in visual acuity (VA), tolerance and quality of life of patients after scleral contact lens (SCL) fitting. MATERIAL AND METHODS: We carried out a prospective observational study conducted from April 2016 to August 2017. Patients fitted with SCL were included. For the purpose of this study, we analyzed VA and quality of life score (NEI-VFQ25) after 6 months of use. RESULTS: We identified 98 eyes of 56 patients; the major indication for SCL fitting was keratoconus in 64.3%; the other indications were post-penetrating keratoplasty, other irregular astigmatism, severe ametropia and ocular surface disease. The mean follow-up was 10.71 months. The mean daily wearing time was 9.89±1.63 hours. Best corrected Visual acuity "BCVA" (baseline 1.11±0.37 in the right eye and 1.13±0.42 LogMar in the left eye) improved to 0.19±0.20 and 0.23±0.38 LogMar respectively in the right and left eyes after SCL wear (P=0.000). The scores on the various subscales of the NEI-VFQ 25 questionnaire were significantly higher 6 months after SCL fitting, with a mean score of 87.28±9.87 with SCL versus 39.94±11.33 without these lenses (P=0.000). In our group, no complications related to the SCL wear occurred, except for the occurrence of "loose conjunctival tissue" at the inferior limbus in one patient. DISCUSSION: Our results complement those of several large series published on this subject. The best visual acuities were reported after correction of irregular astigmatism, in particular keratoconus. Therefore, SCL fitting has become an alternative or a precursor to penetrating keratoplasty in patients with advanced keratoconus. In the case of ocular surface disease, in addition to the improvement in VA, the comfort and recovery of the homeostasis of the ocular surface is greater, with fewer wearing complications. Hence, their inclusion in the therapeutic arsenal for severe ocular surface disease alongside the conventional treatment options. CONCLUSION: SCL have proven their efficacy and safety in the optical correction of irregular corneas and in the management of ocular surface problems. Additional studies are needed to compare the many lenses currently available and assess optimal fitting strategies for each type of scleral lens for easier fitting procedures and better wearing comfort.

[Treatment of choroidal noevascularization secondary to angioid streaks with bevacizumab and response: Experience of the ophthalmology department of Hassan II university hospital]. / Traitement par bévacizumab et évolution des néovaisseaux choroïdiens compliquant les stries angioïdes : expérience du service d'ophtalmologie du CHU Hassan II.

PURPOSE: To evaluate the efficacy of intravitreal bevacizumab in the treatment of choroidal neovascularization (CNV) secondary to angioid streaks. METHODS: We conducted a prospective study in the ophthalmology department of Hassan II university hospital in Fez, including 12 eyes of 7 patients with CNV associated with angioid streaks. We injected 8 eyes with bevacizumab 1.25mg; best corrected visual acuity (BCVA), fundus examination, fluorescein angiography and optical coherence tomography were performed and analyzed for all patients before and after treatment. The goal of the study was to determine the percentage of patients with stabilization or improvement in BCVA and decreased central macular thickness. RESULTS: Visual acuity on admission was <1/10 in 75% of patients. We injected 8 eyes with anti-VEGF, whereas abstention was appropriate for 4 eyes with disciform scarring. The average number of bevacizumab injections was 4.3±1.3 over a mean follow-up of 14.57 months±5.3. After treatment, BCVA was <1/10 in 12.5% of cases, between 1/10 and 5/10 in 50% of cases, and in 37.5% of patients, it was ≥5/10. Mean central macular thickness decreased from 424.25±137.03µm on admission to 255.75 microns±50.14 post-treatment (P=0.005). CONCLUSION: Intravitreal bevacizumab is a promising and effective treatment option for the management of CNV associated with angioid streaks, with the requirement however of early treatment and extended follow-up.

[Screening for diabetic retinopathy by non-mydriatic retinal camera in the region of Fez]. / Dépistage de la rétinopathie diabétique par un rétinographe non mydriatique dans la région de Fès.

PURPOSE: The goal of our study was to determine the benefits of screening by non-mydriatic retinal camera in the Fez region and to present the results of this screening. PATIENTS AND METHODS: We report a prospective study of 430 diabetic patients, or 860 eyes, compiled between December 2012 and June 2013 in the Dokkarat health center, "integrated referral center for management of diabetes and hypertension" in the region of Fez. All patients underwent an examination by non-mydriatic fundus camera, obtaining two digital images per eye. The photos are taken by a nurse and a general practitioner. Interpretation of the images was performed in the ophthalmology department of the Hassan II University Medical Center of Fez. RESULTS: A total of 430 patients were screened (78.4% female, 21.6% male). The mean age was 54.7 years (range, 10-80 years). The average duration of diabetes was 7.7 years (±5.9). Most patients had type 2 diabetes (94%). Insulin therapy was found in 35.3%. The mean HbA1c (obtained from 421 patients) was 8.21%. 38,8% of patients had never consulted an ophthalmologist before. The fundus photographs were not interpretable for at least one eye in 75 cases (17.4%). Among the interpretable images, the prevalence of diabetic retinopathy (DR) was 44.6%. Proliferative diabetic retinopathy was present in at least one eye in 2.5% and diabetic maculopathy in 32 cases (9%). After screening, 69% of patients with DR were seen by the ophthalmologist. CONCLUSION: These data confirm the benefits of screening by non-mydriatic retinal camera, because it helps reintegrate patients into the healthcare system and thus provides a real benefit in terms of public health and prevention of complications.

Hyphema revealing retinoblastoma in childhood. A case report.

We present a case dealing with an uncommon presentation of retinoblastoma. An 4-year-old boy presented to the ophthalmic department for a red painful eye following trauma. The examination showed decreased visual acuity, total hyphema and ocular hypertony. Ocular ultrasonography revealed an intraocular process. CT-scan of the orbit was consistent with a retinoblastoma. Treatment consisted of an enucleation and chemotherapy. This paper stresses the fact that presentation of retinoblastoma is not stereotypic. Every effort should be made to exclude a tumoral intraocular process in all cases of hyphema, even in cases of well documented ocular trauma.