Berlin nodules: About 3 cases.

INTRODUCTION: Granulomatous uveitis is mainly defined by the nature of keratic precipitates and iris nodules. Anterior chamber (AC) granulomas, also known as Berlin nodules (BN), are circumscribed granulomatous nodules that form in the iridocorneal angle (ICA) in response to intraocular inflammation. CASES DESCRIPTION: We present three representative cases of anterior uveitis with berlin nodules to insist on the clinical features of this entity. Case 1: A female adult was referred to our department for bilateral redness and gradual blurry vision. Slit-lamp examination of both eyes (OU) found a yellow-white nodular mass at 6 o'clock on the peripheral iris with irido-crystalline synechiae, vitreous haze and blurred fundus. Purified protein derivative skin test revealed an induration of 20 mm. A diagnosis of presumed ocular tuberculosis was made. The patient received antituberculosis drugs and steroids with good evolution. Case 2: An 11-year-old girl presented for redness and pain OU. Anterior segment examination showed circumciliary congestion, epithelial microcystic edema OU and pearly vascularized lesion against the cornea in the right eye. Fundus examination was unremarkable. A diagnosis of definite ocular sarcoidosis was made based on accessory salivary glands biopsy. The patient was treated with teroids and controlled twice a week. Case 3: A 26-year-old male presented with a redness and pain of the left eye. The slit-lamp examination showed fine keratic precipitates with pearly white nodules within the AC. Fundus examination showed a chorioretinal lesion and occlusive vasculitis. Chest CT was consistent with milliary tuberculosis. Adequate therapy was initiated with favorable outcome. CONCLUSION: BN can be associated with various ocular manifestations of several diseases. They may be the first manifestation of systemic conditions and seem to be well managed with topical steroids.

Qualitative and quantitative endothelium changes after cataract surgery: ultrasound phacoemulsification vs. nanolaser technique.

Purpose: The aim of this study was to evaluate corneal endothelial cell density and morphology, central corneal thickness, and best visual acuity using ultrasound (US) phacoemulsification or nanosecond laser technique. Setting: Department of ophthalmology, Nabeul, Tunisia. Design: Prospective cohort study. Methods: This study included eyes with nuclear cataracts with a density grade of 1, 2, 3, or 4 according to LOCS III, divided into two groups; group 1 had conventional US, and group 2 had nanosecond laser. The endothelial cell density (ECD), coefficient of variation (CoV) in cell size, percentage of hexagonal cells, central corneal thickness (CCT) and best visual acuity (VA) were evaluated during 24 months. Results: Seventy-four eyes had uneventful surgery, 40 in group 1, 34 in group 2. Three procedures in group 2 required conversion to standard phacoemulsification. The mean ECD decreased from 2616.4 ± 194.6 cells/mm2 in group 1 preoperatively to 2088.4 ± 229.9 after 2 years. In group 2, it decreased from 2611.8 ± 186.5 cells/mm2 to 2276.4 ± 163.8 after 2 years. The change was statistically significant in both groups. The decline of the mean ECD in group 2 was significantly less important than in group 1 (p = <10-2). The mean percentage of hexagonal cells was 45.18 ± 4.9 preoperatively and 43.5% ± 6.6 after 2 years in group 1. In group 2, it remained almost stable with 45.6 ± 5.1 and 45.4% ± 6.6 preoperatively and after 2 years, respectively. Preoperatively, the mean CoV was 0.39 ± 0.037 in group 1 and 0.38 ± 0.04 in group 2. After 2 years, it was 0.38 ± 0.04 and 0.37 ± 0.038 in group 1 and group 2, respectively. The changes of the mean CoV and the mean percentage of hexagonal cells were significant in both groups, but the difference between the groups was significant only during the six first months postoperatively. In preoperative, the mean corneal central thickness was 509.7 ± 19.5 in group 1 and 510.3 ± 20.4 in group 2. In both groups, the mean corneal thickness increased on D1 postoperatively to 550.9 in group 1, and 528.2 in group 2. The mean corneal thickness decreased more rapidly after 1 week in group 2, to find the initial values. Visual acuity improved from 0.76 Log Mar ± 0.5 at enrolment to 0.45 Log Mar ± 0.2, and 0.033 Log Mar ± 0.086 in group 1 at 1 day post-operative and after 24 months, respectively and from 0.58 Log Mar ± 0.28 to 0.2 Log Mar ± 0.09 and 0.035 Log Mar ± 0.083, respectively in group 2. There was no significant difference in VA at each follow-up between groups except for day 1. Conclusion: Our study showed lower corneal tissue trauma, and lower endothelial cell loss in the laser cataract surgery compared to phacoemulsification.Clinical trial registration: (https://classic.clinicaltrials.gov/ct2/show/NCT05886283), identifier NCT05886283.

Efficacy and Safety of Micropulse Transscleral Laser Therapy in Silicone Oil-induced Glaucoma.

PURPOSE: The purpose of this study was to assess the efficiency and safety of micropulse transscleral laser therapy (MP-TLT) in the management of silicone oil-induced glaucoma (SOG). METHODS: A prospective case series of 33 eyes with uncontrolled SOG was enrolled at the Department of Ophthalmology of Mohamed Taher Maamouri Hospital, Nabeul, Tunisia. Patients were treated with MP-TLT using the IRIDEX Cyclo G6 Glaucoma Laser System with the MicroPulse P3 fiberoptic handheld probe. Patients underwent complete ophthalmologic examination during the 12-month follow-up period. RESULTS: The study included 33 eyes of 33 patients. The mean age was 50.39 years old. We included patients with SOG. Silicone oil tamponade was indicated for complicated rhegmatogenous retinal detachment in 22 cases, diabetic tractional retinal detachment in 10 cases, and posttraumatic retinal detachment in 1 case. Silicone oil was already removed before the procedure in 23 eyes. Silicone oil tamponade duration varied between 3 and 26 months. Intraocular pressure (IOP) measurements at enrollment; days 1, 7, and 15; and months 1, 3, 6, and 12 was respectively 37.94±13.61, 19.03±10.98, 16.5±6.17, 19.45±9.73, 19.27±8.33, 19.39±9.52, 19.97±10.03, and 19.7±9.58 mm Hg. The percentage of IOP lowering was 45.38% at 6 months and 45% at 12 months. The success rate was 93.93% at 6 months, remaining stable at 12 months. No major side effects were observed, in particular, no phthisis bulbi nor prolonged inflammation. There was no difference in IOP lowering between patients with silicone oil or those after silicone oil removal ( P =0.99). CONCLUSIONS: MP-TLT was safe and effectively lowered IOP in uncontrolled SOG.

[Multimodal imaging in toxoplasmic external punctate retinitis: about a case]. / Imagerie multimodale dans la rétinite ponctuée externe toxoplasmique: à propos d'un cas.

Punctuate Outer Retinal Toxoplasmosis (PORT) is a rare variant of toxoplasma chorioretinitis. We report the case of a 21-year-old patient presenting with visual blur of the left eye (LE). The examination found a corrected visual acuity (VA) at 3/10th, a quit anterior segment and a 1+ vitreous haze. Fundus examination showed a suprafoveolar yellowish-white lesions associated to multiple peripheral atrophic and pigmented ones. Visual acuity of the right eye was 10/10th with a calm anterior segment. Fundus examination depicted an upper temporal cicatricial pigmented lesion. Multimodal imaging of LE objectified a PORT. The patient received antibiotic and corticosteroids with favorable clinical and functional outcome. Final VA reached 10/10 at day ten. This case illustrates the importance of multimodal imaging in the differentiation of PORT from the white dots syndrome and other unilateral retinitis.

Ophtalmoplegia complicating sino-orbital mucormycosis.

PURPOSE: To report a case of complete ophthalmoplegia and blindness in sino-orbital mucormycosis. CASE REPORT: A 68-year-old woman with history of diabetes and breast cancer presented with sudden onset of fever, orbital pain and blindness in the right eye. The patient was found to have no light perception, complete ophthalmoplegia, chemosis, corneal ulcer and optic nerve atrophy. In rhinologic examination, necrosis was noticed. Brain and orbit magnetic resonance imaging showed diffuse sinusitis with orbital involvement. The result of the clinical examination was reported as sino-orbitalmucormycosis. The diagnosis was confirmed by pathological specimens. The patient underwent extensive surgical debridement and systemic antifungal treatment. Despite treatment, visual acuity did not recover. CONCLUSION: The sino-orbital form of mucormycosis is a rare and insidious fungal infection. Ocular findings may range from orbital pain to ophtalmoplegia and blindness such as in our case. Black scar tissues seen on the nasal mucosa are pathognomonic. Delay in treatment due to late presentation and complications were major determinants in ocular prognosis and survival outcome.