[Intravitreal bevacizumab in AMD complicated by submacular hemorrhage]. / Injections intravitréennes de bevacizumab dans les hémorragies sous maculaires compliquant la DMLA.

PURPOSE: To evaluate functional and anatomic results of intravitreal bevacizumab as monotherapy at 12 and 24 months in patients with neovascular age-related macular degeneration (AMD) complicated by large submacular hemorrhage. METHODS: Retrospective analysis of a total of 21 patients (22 eyes) with large submacular hemorrhage secondary to age-related macular degeneration between May 2008 and December 2011. Patients were treated with three monthly intravitreal bevacizumab injections (1.25mg/0.05 mL) at a four to six week interval and then PRN. Retreatment was based on the presence of hemorrhage on fundus examination or signs of activity on optical coherence tomography. Changes from baseline best corrected visual acuity (BCVA) scores, central retinal thickness, volume of hemorrhage and number of injections were analyzed. RESULTS: The mean patient age was 72 years (range, 60-89 years). All patients completed at least 12 months of follow-up, and 17 patients fulfilled 24 months. The size of hemorrhage varied from 3 to 9 disc areas with a mean duration of 12.8 days. At baseline, mean initial BCVA was 20/400 (1.3 LogMAR) and improved to 20/160 at 12 months (P<0.001) and 20/164 at 24 months (P<0.001). Mean central retinal thickness decreased significantly from 550 µm to 255 µm at 24 months (P<0.001). The mean number of injections was 3.87 during the first 12 months. No case of recurrent bleeding was detected during the second year. CONCLUSION: Intravitreal bevacizumab may be a beneficial approach for the management of large submacular hemorrhage secondary to AMD.

[Role of SD-OCT in the diagnosis and prognosis of macular hypoplasia in nystagmus patients]. / Apport de l'OCT-SD maculaire dans le diagnostic et le pronostic de l'hypoplasie fovéolaire chez les patients ayant un nystagmus.

PURPOSE: To investigate whether spectral domain optical coherence tomography (SD-OCT) is helpful for the diagnosis and prognosis of foveal hypoplasia in patients with overt nystagmus. METHODS: A retrospective cross-sectional study was conducted in 48 patients with overt nystagmus. All patients underwent a complete ophthalmic examination including best corrected visual acuity, biomicroscopic and fundus examinations. Spectral domain optical coherence tomography was performed using 3D OCT-2000 FA PLUS Topcon, Tokyo, Japan, for the diagnosis and grading of foveal hypoplasia, using the Thomas classification, and its possible correlation with visual acuity. RESULTS: Foveal hypoplasia was diagnosed in 6 patients (12.5%). The mean age of the patients was 13.2 years (10-18 years). Mean visual acuity was 1.53/10 (0.87 LogMAR). Foveal hypoplasia was associated with aniridia in 2 patients, albinism in 3 patients and keratoconus in 1 case. On SD-OCT, foveal hypoplasia was grade 4 in 4 patients and grade 3 in 2 patients. Mean visual acuity was 2.55/10 in patients with grade 3 foveal hypoplasia and 1.22/10 in patients with grade 4 foveal hypoplasia, and the difference in visual acuity between the two groups was statistically significant (P<0.001). CONCLUSION: SD-OCT plays a double role in the diagnosis and prognosis of foveal hypoplasia in patients with nystagmus.

[Neuro-ophthalmic adverse effects of metronidazole treatment in children: Two case studies]. / Effets secondaires neuro-ophtalmologiques du traitement par métronidazole chez l'enfant : à propos de deux cas.

PURPOSE: To report the onset of neuro-ophthalmological adverse effects in two children treated with metronidazole for amoebic dysentery. OBSERVATIONS: A 6-year-old child and his 8-year-old sister presented with sudden bilateral vision loss and diplopia associated with intense headache and vomiting. The medical history revealed amoebic dysentery 3 weeks before treated orally with metronidazole for 2 weeks. The ophthalmic examination was similar in the two children and revealed visual acuity of 3/10 bilaterally, binocular diplopia, normal oculomotor function, quiet anterior segment, altered afferent pupil light reflex associated with normal fundus examination, and most particularly absence of optic disc edema. The kinetic visual field showed restriction of isopters and blind spot enlargement and the Lancaster test showed discrete paresis of the lateral rectus muscle of the left eye. Orbitocranial computed tomography and magnetic resonance imaging were normal and visual evoked potential results were compatible with optic neuropathy. Clinical progression consisted in spontaneous resolution of general symptoms, total regression of diplopia, improvement of visual acuity, and normalization of visual evoked potentials after treatment interruption. Regression of symptomatology after interruption of the treatment allowed us to retain the toxic origin. CONCLUSION: Metronidazole may have neuro-ophthalmological side effects. These complications are rare but can be severe and are reversible after treatment interruption. Regular follow-up is necessary in children receiving this treatment.

[SD-OCT contribution in congenital achromatopsia diagnosis (6 patients)]. / Contribution du SD-OCT de la macula dans le diagnostic de l'achromatopsie congénitale : à propos de 6 patients.

PURPOSE: Achromatopsia (ACH) is a congenital autosomal recessive cone disorder. The puspose is to describe particular SD-OCT macular images in ACH. METHODS: The study included 6 patients from 3 consanguineous Tunisian families with congenital nystagmus and amblyopia with ACH. All patients had clinical examination with fundus photography, autofluorescence, 100-Hue Color vision and the appearance and thickness of all retinal layers were evaluated by spectral-domain optical coherence tomography (SD-OCT). RESULTS: All patients had ACH. The feature was loss of inner- and outer-segments (IS/OS) with disruption of the ciliary layer on OCT and an appearance of partial-thickness hole in the outer macular retina. CONCLUSION: This feature seems to be characteristic of ACH. SD-OCT correlated to clinic signs help the diagnosis.

[Factors linked to foveoschisis in high myopia]. / Étude des facteurs associés au fovéoschisis dans la myopie forte.

PURPOSE: To investigate the factors linked to foveoschisis in high myopia. METHODS: Retrospective study of 113 patients (200 eyes) with high myopia was conducted between January 2010 and June 2012. Subjects underwent a complete ophthalmic examination, spectral domain optical coherence tomography (OCT TOPCON 2000) and ocular echography. RESULTS: Of the 200 eyes, 22 (11%) had foveoschisis on OCT examination. On the basis of univariate analysis, five variables were associated with the pathologic changes, including spherical equivalent over 10 diopters (P=0.044), axial length over 30 mm (P=0.0028), macular chorioretinal atrophy (P=0.0009), posterior staphyloma (P=0.0007) and vitreoretinal interface factors (P=0.0002). In the multivariate analysis, three factors were independently associated with foveoschisis in high myopia: axial length (adjusted OR, 16.7; IC 95% 1.4-219.7, P=0.036), macular chorioretinal atrophy (adjusted OR, 13.2; IC 95%, 1.3-133.1, P=0.044), and vitreoretinal interface factors (adjusted OR, 36.1; IC 95%, 3.5-376.9, P=0.002). CONCLUSIONS: In our study, axial length, macular chorioretinal atrophy, and vitreoretinal interface factors were independently associated foveoschisis in highly myopic eyes.

[Epidemiology of uveitis in the Tunis area]. / Profil épidémiologique des uvéites dans la région de Tunis.

PURPOSE: To identify the epidemiological characteristics and the most common etiologies of uveitis in the Tunis area. METHODS: Medical records for all uveitis patients seen from September 2003 through October 2009 were included. RESULTS: A total of 424 patients (596 eyes) were included. The mean age at onset of uveitis was 36 years, and the male-to-female ratio was 0.66. Uveitis was unilateral in 56.4%. Anterior uveitis was most common (48%), followed by panuveitis (33.6%), posterior uveitis (13.3%), and intermediate uveitis (5%). The most common causes were Behçet disease (14.7%), toxoplasmosis (10.2%), Vogt-Koyanagi-Harada (VKH) syndrome (3.7%) and sarcoidosis (3.3%). Retinal vasculitis was found in 20%. Behçet disease was the most common cause of chronic uveitis. The most common complications were cataract (21.6%), ocular hypertension (12%) and macular edema (5.6%). CONCLUSION: In our study, the most common causes of uveitis were Behçet disease, toxoplasmosis, VKH syndrome and sarcoidosis.

[Macular choroidal thickness assessment with SD-OCT in high myopia with or without choroidal neovascularization]. / Épaisseur choroïdienne fovéolaire au SD-OCT dans la myopie forte avec ou sans néovaisseaux choroïdiens.

PURPOSE: To measure macular choroidal thickness (CT) using spectral-domain optical coherence tomography (SD-OCT) in eyes with myopic macular choroidal neovascularization (CNV), and to compare choroidal thickness in these eyes with highly myopic eyes without CNV. PATIENTS AND METHODS: Sixty-four eyes with myopic CNV matched with 64 highly myopic eyes without CNV by age and axial length (AL) were examined between January 2010 and November 2011. OCT scans were performed with spectral-domain OCT (TOPCON OCT 2000). The reference position was changed from the vitreous to the choroid. OCT scan patterns consisted of seven sections; the subfoveal CT was measured manually between Bruch's membrane and the internal portion of the sclera in eyes with CNV and from the pigment epithelium to the scleral interface in eyes without CNV. RESULTS: In the subgroup with CNV, the mean subfoveal CT was 51.71 µm ± 17.35. A statistically significant negative correlation was found between CT and AL (r=-0.615, P=0.0001). Regression analysis demonstrated a decrease of 8.4 µm per mm of AL. In the subgroup without CNV, matched with the CNV subgroup by age (P=0.597), and AL (P=0.813), the mean subfoveal CT was 93.35 µm ± 34.81 µm. The difference between the two subgroups was statistically significant (P<10(-4)). DISCUSSION: Macular choroidal thickness is reduced in high myopia, especially when complicated by CNV. It has not yet been shown that choroidal thinning may be a risk factor for choroidal neovascularization, but our results may suggest that macular choroidal thinning may lead to hypoxic retinal changes resulting in secretion of VEGF and thus CNV. CONCLUSION: Macular choroidal thinning observed in high myopia with CNV. These findings may suggest that choroidal changes may play a role in the pathogenesis of choroidal neovascularization.

[Massive bilateral subconjunctival hemorrhage revealing acute lymphoblastic leukemia]. / Hémorragie sous-conjonctivale bilatérale massive révélatrice d'une leucémie aiguë lymphoblastique.

We report the case of 20-year-old patient who presented in emergency with bilateral massive, spontaneous subconjunctival hemorrhage. Clinical findings suggested a blood dyscrasia, which was confirmed by blood cell count. The patient was urgently referred to hematology where the diagnosis of acute lymphoblastic leukemia was made. This case highlights the importance of working up any unusual subconjunctival hemorrhage, as it may reveal, in certain cases, a severe life-threatening disease.

[Intravitreal bevacizumab injections versus verteporferin photodynamic therapy for macular choroidal neovascularization in high myopia: 24-month follow-up]. / Traitement des néovaisseaux choroïdiens maculaires du myope fort : injection intravitréenne de bevacizumab versus photothérapie dynamique à la vertéporfine à 24 mois.

PURPOSE: To compare the long-term safety and of intravitreal bevacizumab injections (IVB) and verteporferin photodynamic therapy (PDT) in the treatment of choroidal neovascularization (CNV) in high myopia. METHODS: Review of retrospectively collected data of 60 eyes of 60 patients with high myopic choroidal neovascularization treated either with standard PDT (PDT group; n=30) or IVB injections (IVB group; n=30). The two groups were compared at baseline, 3, 6,12 and 24 months. RESULTS: In the IVB group, mean best corrected visual acuity (BCVA) was significantly improved at 3 to 12 months; however, the significance was lost at 24 months. The PDT group showed an insignificant improvement at 3 and 6 months, then worsened at 12 and 24 months. Mean BCVA was better in the IVB group than the PDT group at 3, 6, 12 and 24 months. The decrease in mean central macular thickness was significantly higher in the IVB group than in the PDT group at 3, 6, 12 and 24 months. At 24 months, chorioretinal atrophy was noted in five eyes (16.6%) treated with IVB and in 22 eyes (73.3%) treated with PDT (P=2×10(-5)). CONCLUSION: IVB provides significantly better BCVA than PDT for high myopic CNV over the long-term.

[Management of rhegmatogenous retinal detachment with unseen breaks: about 50 cases]. / Prise en charge des decollements de retine rhegmatogenes sans dechirure visible: a propos de 50 cas.

PURPOSE: To evaluate the clinical and therapeutic characteristics of rhegmatogenous retinal detachment (RRD) with unseen retinal breaks. PATIENTS AND METHODS: Retrospective study 50 eyes (50 patients) with RRD with unseen retinal breaks in the pre and intraoperative examination. These patients were treated between 2005 and 2010 by vitrectomy or scleral buckling. Retinal breaks were meticulously sought by indentation of the vitreous base. The subretinal fluid was drained by a peripheral retinotomy when a vitrectomy was needed and puncture ab externo when a scleral buckling was performed. RESULTS: A retinal detachment with unseen retinal breaks accounted for 15% of all RRD operated during this 5-year duration period (2005 - 2010). The average age of our patients was 57 years.Ten were myopic (20%) and 27 (54%) pseudophakic, with inferior RRD in 60% of the cases cases while advanced vitreoretinal proliferation (PVR) greater or equal to stage C in was present in 72%. Primary vitrectomy was performed in 46 cases. Retinal reattachment rate was achieved after a single procedure in 41 eyes (82%). Among them, 40 were operated by vitrectomy and one eye by scleral buckling. The recurrence rate was significantly higher in patients operated by scleral buckling (75%) than by vitrectomy (15%). CONCLUSION: RRD with unseen retinal breaks are often seen inferiorly and have a chronic evolution (60%). They concern pseudophakic patients in the majority of the cases. Their poor prognosis and high recurrence rate also appear to be related to an advanced PVR (72%). The good results of primary vitrectomy should be confirmed by randomized studies, especially in phakic eyes.

[Prevalence and risk factors of age-related macular degeneration (AMD) in a Tunisian hospital population]. / Prévalence et facteurs de risque de la dégénérescence maculaire liée à l'âge (DMLA) dans une population hospitalière tunisienne.

PURPOSE: To describe the prevalence and the risk factors for the age related macular degeneration (AMD) in a Tunisian hospital population. PATIENTS AND METHODS: A total of 2204 subjects 50 years of age and older were enrolled in a prospective study conducted between august 2004 and February 2009. Medical history was reviewed. Subjects underwent a complete ophthalmic examination, including best corrected visual acuity and slit lamp biomicroscopy with fundus examination. Fundus photography and fluorescein angiography were performed if clinical features of AMD were observed on fundus examination. Cases were classified in early and late stages of AMD. RESULTS: The prevalence of late AMD was higher than early AMD. Significant risk factors are age, male gender, smoking, excessive sunlight exposure and poor consumption of fish. Cardiovascular disease, diabetes and dyslipimia were not significantly associated to a high prevalence of AMD. CONCLUSION: AMD is a multifactorial disease. In our Tunisian hospital population, the prevalence of AMD was higher than in the Europeen population. It can be explained by genetic differences or risk factors. Age, cigarette smoking and sunlight exposure were associated with increasing prevalence of AMD in Tunisia.

[Clinical characteristics and therapeutic challenges of retinal detachment in highly myopic eyes]. / Particularités cliniques et thérapeutiques du décollement de rétine du myope fort: à propos de 83 cas.

PURPOSE: To evaluate the clinical characteristics and therapeutic challenges of retinal detachment in highly myopic eyes. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 83 eyes in 79 patients with high myopia (> 6.00 diopters or axial length > or = 26.00 mm) who underwent surgery for retinal detachment between 2001 and 2008. The surgical approaches depended on the type and location of the retinal break, the degree of myopia, and the grade of PVR. RESULTS: The mean age of patients (48 men and 31 women) was 53.9 years. Refractive error ranged from - 10 D to - 25 D (mean was - 14.0 D). The mean follow-up was 19.4 months. Peripheral or equatorial retinal tears were present in 52 cases (62.6%), a macular hole in 14 cases (16.8%), a giant retinal tear in 6 cases (7.2%), and posterior paravascular retinal tears in 11 cases (13.2%). Single-surgery anatomic success was achieved in 65 cases (78.3%), with 17 cases after scleral buckle surgery and 46 cases after pars plana vitrectomy. Final anatomic success was achieved in 76 cases (91.5%). Per and postoperative hemorrhagic complications occurred in 16 cases (19.2%). CONCLUSION: Retinal detachment is a serious complication of high myopia. It often occurs in young patients. Treatment is difficult due to anatomical and clinical conditions.

[Nd:Yag laser treatment of anterior capsule contraction syndrome after phacoemulsification]. / Traitement au laser Nd:Yag du syndrome de contraction de la capsule antérieure après phacoémulsification.

INTRODUCTION: Anterior capsule contraction syndrome after phacoemulsification is rare and can compromise visual acuity. Nd:Yag laser capsulotomy is a good alternative in limited forms of contraction. OBSERVATIONS: We report four cases of anterior capsule contraction syndrome developed after a mean follow-up of 8 months after phacoemulsification and acrylic intraocular lens implantation. Nd:Yag laser capsulotomy was performed to help resolve the contraction and its symptoms. No relapses occurred during the follow-up. CONCLUSION: Nd:Yag laser capsulotomy is effective and safe in managing limited forms of anterior capsule contraction syndrome after phacoemulsification. Surgery is an alternative to Nd:Yag capsulotomy in severe cases.

Manifestations ophtamologiques au cours du syndrome d'Apert : a propos d'un cas

Introduction : Parmi les craniostenoses; le syndrome d'Apert demande la collaboration de plusieurs specialistes; pour sauver ce qui peut l'etre de la fonction visuelle des patients et permettre un developpement cerebral le plus proche de la normale. Observation : Nous presentons le cas d'une jeune suivie et traitee depuis son jeune age pour un syndrome d'Apert. Elle a subi plusieurs interventions successives pour garder a un age assez avance une fonction visuelle appreciable a 3/10. Les modifications anato- miques ont ineluctablement influe sur l'etat visuel de la patiente avec une myopie forte; un astigmatisme relativement important et une atrophie papillaire partielle.Discussion : D'origine genetique; le syndrome d'Apert est du a une mutation allelique du recepteur 2 d'un facteur fibroblastique. Les signes de souffrance cerebrale sont inevitables; et l'atrophie optique relative represente la sequelle fonctionnelle principale. Conclusion : Une prise en charge de longue haleine est necessaire dans le syndrome d'Apert pour esperer sauver une fonction visuelle utile