[Phacoemulsification versus manual small incision cataract surgery: Anatomic and functional results]. / Phacoémulsification versus chirurgie de cataracte par mini incision manuelle : résultats anatomiques et fonctionnels.

PURPOSE: Prospective randomised study to compare the impact of phacoemusification (PHACO) and small incision cataract surgery (SICS) on endothelial structure (cell density and morphology) and refractive results (visual acuity, induced astigmatism). METHODS: Prospective study of 57 patients (63 eyes) over 20 months (May 2012-January 2014) undergoing surgery by 2 experienced surgeons. We included patients with senile or presenile cataracts, LOCS III class 2, 3 and 4. Patients were randomized into 2 groups based on their birth month (group 1: PHACO [33]; group 2: SICS [30]). All pre- intra- and postoperative data were collected prospectively. The minimum follow-up was 6 months. We used the SPSS 18.0 for statistical analysis. Statistical tests used included the test-t Student, the Anova test, the Mann-Witney non-parametric test and the Khi2 test. A threshold of significance was set at 0.05. RESULTS: The mean preoperative endothelial cell density was 2447.5±225 c/mm2 with no significant difference between the two groups (P=0.207). The mean percentage of hexagonality was 55.5±8.2% in groups 1 and 2. The most significant cell loss was during the first immediate postoperative period for both groups. At Day 15 postoperative, the decrease in cell loss was significant (P<0.001) with a mean loss of 312.9±208.9 c/mm2 (P<10-2). Postoperatively, the mean best-corrected visual acuity was 0.057 log MAR for all of our patients (P=0.170); no patient had an acuity ≤1/10. The mean astigmatism at the conclusion of follow-up was 1.08±0.42 D in group 1 and 1.51±0.55 D in group 2, with a significant difference (P=0.001). CONCLUSION: Both SICS and PHACO give excellent results, both anatomical and refractive. However, SICS appears to be more advantageous than PHACO in terms of speed, cost, and independence from technology, and appears to be better suited to dense cataracts and mass surgery.

A 5-year retrospective review of fungal keratitis in the region of Cap Bon.

INTRODUCTION: Microbial keratitis is a serious ocular infection and a leading cause of morbidity and blindness worldwide. METHODS: A retrospective review of the charts of 30 patients (30 eyes) diagnosed with presumed or culture-proven fungal keratitis among 100 patients with infectious keratitis. All patients initially received hourly 0.5% Amphotericin B eye drops. Systemic antifungal agents consisted mainly of oral Fluconazole. After treatment, a healing time of less than 3 weeks from presentation was considered a good result. Mean follow up was 10.4 months. RESULTS: Risk factors for fungal keratitis included ocular trauma in 13 patients (43.3%). Stromal infiltration was seen in 100% of patients. Satellite lesions were noted in 6 eyes (20%) and an immune ring was noted in 3 cases (10%). The most commonly isolated agent was Fusarium in 9 eyes (50%), followed by Aspergillus in 6 eyes (33.3%), and Candida in 2 eyes (11.1%). At the end of follow up, final visual acuity varied from no light perception to 20/20. The significant predictors were initial visual acuity, size of infiltrate at presentation, male gender and advanced age. CONCLUSION: The key element in the diagnosis of mycotic keratitis is clinical suspicion on the part of the ophthalmologist. However, because of the potential serious complications, it is essential to identify the exact pathogen so as to initiate appropriate treatment in time and to thus improve the prognosis of this condition.

[Fundus autofluorescence. Has it a place in the management of diabetic macular edema?] / L'autofluorescence du fond d'œil. A-t-elle une place dans la prise en charge de l'œdème maculaire diabétique ?

PURPOSE: Analyze the characteristics of fundus autofluorescence of diabetic macular edema and study the association between these characteristics and visual function. PATIENTS AND METHODS: Our study included 18 patients (28 eyes) with clinically significant diabetic macular edema. All patients had a complete eye examination with a fundus autofluorescence imaging and optical coherence tomography. The central macular thickness and central macular volume were measured. The integrity of the inner segment-outer segment junction and the integrity of the external limiting membrane were also evaluated in the same area. RESULTS: Among the 28 eyes studied, 8 had normal autofluorescence. The remaining 20 eyes had abnormal autofluorescence: a hyper-cystoid autofluorescence in 5 eyes (25%), hyper-spot autofluorescence in 8 eyes (40%), and hypo-irregular autofluorescence in 5 eyes (25%). Best corrected visual acuity was significantly better in patients with normal autofluorescence and those with hyper-cystoid autofluorescence. There was no significant difference in central macular thickness (P=0.186) and central macular volume (P=0.191) between the four groups. CONCLUSION: The autofluorescence is a simple, fast, and non-invasive technique for the study of diabetic macular edema with good correlation to the visual function as well as to the extent of damage to the retina. It is, therefore, a possible alternative to other invasive imaging techniques in particular in the long term monitoring of diabetic macular edema.

[Obstructive sleep apnea syndrome. Is it a risk factor for diabetic retinopathy?]. / Le syndrome d'apnée de sommeil. Est-il un facteur de risque de rétinopathie diabétique ?

PURPOSE: The goal of our study was to evaluate the prevalence of diabetic retinopathy in type 2 diabetic patients with obstructive sleep apnea syndrome. PATIENTS AND METHODS: We performed a comparative study including 60 type 2 diabetics separated into 2 groups: a 1st group composed of 20 patients with obstructive sleep apnea syndrome and a 2nd group composed of 40 patients without this syndrome. The two groups were matched for age and length of diabetes. All patients underwent a complete ophthalmic examination. RESULTS: In both groups, the mean patient age was 59 years, the diabetes had been present for an average of 10 years, and the HbA1c was 10%. Diabetic retinopathy was diagnosed in 11 patients from the 1st group (55%) and 6 cases from the 2nd group (15%) (P=0.03). Non-proliferative and proliferative retinopathy were found in 7 cases (35%) and 4 cases (20%), respectively, in the 1st group and in 3 cases (7.5%) in the 2nd group for both types (P=0.03 and P=0.042, respectively). Diabetic macular edema was observed in 4 patients (20%) in the 1st group and 2 patients (5%) in the 2nd group (P=0.04). CONCLUSION: Obstructive sleep apnea syndrome is an independent risk factor for the appearance and aggravation of diabetic retinopathy. This underscores the importance of systematic screening for, and timely management of, sleep apnea.