[Ocular manifestations of Crohn's disease]. / Les manifestations oculaires au cours de la maladie de Crohn.

PURPOSE: The objectives of our study were to describe the ocular manifestations of Crohn's disease and to identify risk factors for ocular involvement. METHODS: We prospectively collected 71 cases of Crohn's disease. All patients underwent a complete ophthalmic examination. Two groups were identified according to the presence (group 1) or not (group 2) of ocular involvement related to Crohn's disease. Various parameters were compared between the 2 groups. RESULTS: The average age was 38±12 years. The M/F gender ratio was 1.7. Group 1 included 27 patients (38%). Among the ocular manifestations observed, we noted anterior uveitis in 10 cases (37%), scleritis in 2 cases (7.4%), episcleritis in 8 cases (29.6%), dry eye syndrome in 7 cases (25.9%), corneal infiltrates in 7 cases (25.9%), lid ulcer in one patient (3.7%), vein occlusion with capillary leakage in two patients (7.4%) and a serous retinal detachment in one patient (3.7%). Conjunctivitis was considered a coincidental ocular finding; it was seen in 8 cases (15 eyes). Colonic or ileocolic localisation and the activity of the bowel disease were identified as independent risk factors for ocular involvement in Crohn's disease (the adjusted odds ratios were 5.21 and 6.8, respectively). CONCLUSION: Ocular manifestations of Crohn's disease are polymorphic. Colonic or ileocolic localisation, as well as the activity of the bowel disease, have been identified as risk factors for ocular involvement.

[Sickle cell retinopathy in children: Report of 42 cases]. / La rétinopathie drépanocytaire chez l'enfant : à propos de 42 cas.

We aimed to describe the epidemiological, etiological and clinical features, treatment and clinical course of sickle cell retinopathy in children and to determine the risk factors for serious involvement. METHODS: This was a retrospective study including all children diagnosed with sickle cell retinopathy. Epidemiological, clinical and therapeutic characteristics, as well as clinical course, were analysed retrospectively by chart review. Two groups were defined: Group 1 (Goldberg stage 1 and 2); Group 2 (Goldberg stage 3, 4 and 5). In order to identify factors independently associated with severe sickle cell retinopathy, we conducted a logistic regression analysis in descending order. RESULTS: The frequency of sickle cell retinopathy was 14.48%. Forty-two patients (84 eyes) were included; among them 23 boys and 19 girls, aged 10 to 17 with a mean age of 14±1.98 years. Twenty patients were of genotype SS, 11 patients of genotype SC, 8 Sß and 3 SO Arab. The three patients in group 2 were all of SS genotype. The majority of patients (32) had an HbF level of less than 15%. All our patients had sickle cell retinopathy distributed as follows: 62% at stage 1; 31% at stage 2; 5% at stage 3 and 2% at stage 4. Multivariate analysis revealed a single risk factor independently linked to severe involvement - an HbF level<15%. CONCLUSION: Retinopathy is a frequent complication of sickle cell disease which may lead to blindness. The HbF level is negatively correlated with severe involvement.

[Ophthalmic complications of nasosinus mucoceles]. / Complications ophtalmiques des mucocèles rhino-sinusiennes.

INTRODUCTION: A nasosinus mucocele is a pseudocystic process filled with mucus arising within the sinus. Despite its benign histology, potential ophthalimic risks are related to mass effect and expansion to the orbit by bone destruction with compression of optic nerves. PURPOSE: We describe mechanisms of ophthalimic involvement in patients with paranasal sinus mucoceles, radiological appearance, treatment and prognosis of this disease. MATERIALS AND METHODS: We report 5 cases of paranasal sinus mucocele with ophthalmic complications seen between January 2007 and December 2011 on the ENT and MFS service of La Rabta University hospital. RESULTS: The reason for consultation was: unilateral proptosis in 4 patients, diplopia in 2 patients and medial canthal swelling in 3 patients. Facial computed tomography showed a mucocele in the frontal sinus in two patients, in the ethmoid-frontal sinuses in two patients and in the ethmoid-maxillary sinuses in one patient. We found erosion of the orbital walls and displacement of the globe in all cases, extra-axial proptosis in one case, compression of the extraocular muscles in 4 cases and stretching of the optic nerve in three cases. All patients were treated initially with antibiotics then surgery. The postoperative course was uneventful with no recurrence. CONCLUSION: It is necessary to diagnose mucoceles as early as possible and plan surgical excision before growth of the mass irreversibly compromises visual function.

[Ocular risk factors for progression of primary open angle glaucoma in the Tunisian population]. / Facteurs oculaires prédictifs de la progression du glaucome primitif à angle ouvert dans la population tunisienne.

PURPOSE: To evaluate intraocular pressure parameters and the role of other ocular risk factors in the progression of primary open angle glaucoma. PATIENTS AND METHODS: We performed a retrospective analysis of long-term glaucomatous progression in 140 patients (280 eyes) with primary open angle glaucoma (POAG) between 1998 and 2009. After analyzing their disease progression, the eyes of our patients were divided into two groups: group 1 (G1) consisted of eyes with worsening of their POAG, and group 2 (G2) consisted of the eyes that remained stable. The indicators of progression studied were factors associated with glaucomatous optic neuropathy, other ocular risk factors, and treatment-related risk factors. RESULTS: We found 188 eyes with stable visual fields (G2) and 92 eyes with glaucoma progression (G1), for a progression rate of 32.9%. Mean intraocular pressure (IOP) at diagnosis was statistically higher in the cases with progression, 22.78 mmHg vs. 19.9 mmHg for stable cases (P=0.03; OR=5.25). Higher final intraocular pressure (IOP) was also associated with progression (16.82 mmHg for G1 vs. 14.85 mmHg for G2; P=0.051). IOP less or equal to 12.75 mmHg was identified as the target pressure for our population. Progressed eyes also showed a statistically higher diurnal peak IOP (23.13 mmHg vs. 19.87 mmHg for G2; P=0.007). Long term IOP fluctuation was also predictive of progression (4.43 mmHg for G1 vs. 2.31 mmHg for G2; P=0.003). Eyes with initial visual field defect more than 8.2dB had 4.8 times the risk of progression (P=0.07). However, eyes diagnosed in an early glaucoma stage had four times the chance of maintaining a stable visual field (P=0.003). Statistically significant risk factors between the two groups also included: pseudoexfoliation (OR=2.84; P=0.05), cornea less than 505 µ (OR=10.89; P=0.005), topical beta blockers (P=0.003), and more than two topical medications (OR=3; P=0.003). CONCLUSION: It is currently known that IOP lowering contributes to glaucoma stabilization. However, this single criterion remains insufficient, as other, particularly ocular, factors have been implicated in glaucoma progression. Identification of these risk factors allows for a better therapeutic approach toward these patients, so as to preserve their vision and quality of life.

[Optical coherence tomography in Sjögren-Larsson Syndrome diagnosis]. / Apport de la tomographie en coherence optique dans le diagnostic du syndrome de Sjögren-Larsson.

PURPOSE: To study the clinical and the optical coherence tomography (OCT) features of crystalline_macular dystrophy in a 14-year-old man with Sjögren-Larsson syndrome (SLS). CASE REPORT: A 14-year-old man was hospitalized because of a severe hyperkeratosis, epilepsy, spastic paraplegia and mental retardation. The diagnosis of SLS was considered. A bilateral crystalline maculopathy was detected by fundus ophthalmoscopy. OCT showed bilateral focal perifoveal hyperreflectivities and microcystoid spaces. DISCUSSION-CONCLUSION: OCT features of the crystalline maculopathy could point at SLS in undiagnosed patients. It is a low cost and non invasive procedure that could be of value in elucidating the pathophysiological mechanisms of SLS.

[Unilateral panuveitis following intravesical therapy with bacille of Calmette et Guerin]. / Panuveite unilaterale apres instillations intravesicales du bacille de Calmette et Guerin.

Uveitis occuring after Mycobacterium bovis-bacille Calmette-Guerin (BCG) intravesical therapy for bladder carcinoma is rare. Only a few cases have been described. Its physiopathology is still unknown. Two mechanisms can be proposed at the origin of ocular inflammation: a local immune response or a direct choroidal mycobacterial infection as demonstrated by vitreous cultures. We report the case of 63-year-old man who presented with unilateral panuveitis after the fifth BCG intravesical instillation with no other systemic manifestations. There was no evidence for any other etiology for this uveitis. Loss of light perception occurred despite systemic antimycobacterial therapy and systemic prednisone therapy because of delayed diagnosis. This outlines the absolute need for a close ophthalmological monitoring of patients receiving a BCG therapy to allow an earlier diagnosis of this complication and appropriate treatment.

[The occupational radiation-induced cataract in five industrial radiographers]. / La cataracte radio-induite professionnelle chez cinq radiographes industriels.

UNLABELLED: The industrial uses of ionizing radiation in Tunisia are expanding, especially in industry and most particularly in the nondestructive testing of welds. Thus workers operating in the non-destructive testing of welds may develop a radiation-induced cataract varying in time to onset depending on the dose. OBJECTIVES: To describe the characteristics of the radiation-induced cataract in patients exposed to ionizing radiation, determine the risk factors of radiation-induced cataracts. METHODS: This was an anamnestic, clinical, and environmental study of five cases of radiation-induced cataract in workers employed in non-destructive testing of welds. RESULTS: This series of five cases had a mean age of 30.2 years and 5.53 years of work experience, ranging from 14 months to 15 years. All the patients were male and industrial radiographers specialized in nondestructive testing of welds. The average duration of exposure to ionizing radiation was 5.53 years. None of the patients had worn protective gear such as eye goggles. The ophthalmic check-up for the five special industrial radiographers showed punctuate opacities in three cases, punctiform opacities in one eye in one case, and phacosclerosis with bilateral lens multiple crystalline stromal opacities in a case of micro-lens opacities in both eyes with opalescence of both eyes in one case. These cataracts had been declared as occupational diseases. CONCLUSION: The value of a specialized ophthalmologic surveillance among these workers and the early diagnosis of lens opacities must be emphasized.

[Cystic lymphangioma of the pancreas: an exceptional location]. / Lymphangiome kystique du pancréas : une localisation exceptionnelle.

Cystic lymphangioma of the pancreas is a rare benign vascular tumor. Its histogenesis is still hypothetical and preoperative diagnosis is difficult. We report a new case in a 14-year-old girl hospitalized for pain in the epigastrium and vomiting. Radiologic findings concluded in a cystic tumor of the head of the pancreas. The mass was completely excised. The pathological examination of the surgical specimen revealed cystic formations whose wall consisted of a squamous endothelial epithelium on a fibrous tissue and a few scattered lymphoid clusters, arguing in favor of a cystic lymphangioma.

[Blood groups and open-angle glaucoma in Tunisia]. / Groupes sanguins et glaucome primitif à angle ouvert.

PURPOSE: To determine whether blood groups are genetic markers for primary open angle glaucoma (POAG). METHODS: ABO, rhesus, and Kell and Duffy blood groups were analyzed in 114 POAG cases and in a control group of age- and sex-matched patients (96 cases). RESULTS: AB groups are significantly more frequent in POAG cases (10.5%) than in the control group (2%). However, no association was found between POAG and ABO, rhesus, and Kell and Duffy blood groups even when men and women were studied separately. CONCLUSION: AB blood groups seem to be genetic markers of POAG but further studies are needed to confirm this association.

[Management of hyperopia in children]. / Prise en charge de l'hypermétropie de l'enfant.

PURPOSE: To study the prevalence of hyperopia in school-aged children and to analyze the factors that increase the risk of squint or amblyopia in a retrospective study. METHODS: Three hundred eyes of 150 children with hyperopia who did not have anisometropia > or =1.5 D were selected. Complete ophthalmological examination was performed for all children. Hyperopia was defined when spherical equivalent was +0.5 D or greater. Amblyopia was screened and treated by patching therapy and then penalisation. Complete spectacle correction was achieved in children with high hyperopia (+3.5 D or greater) or in presence of squint or amblyopia. A statistical analysis compared the results using the Mann-Whitney test and the chi square test. RESULTS: The mean age was 9.5+/-2.7 years. Girls were statistically more represented than boys. The mean sphere measured overall was +2 D (+/-1.65). Severe hyperopia was detected in 19% of the children; it was latent in 35% of children. Strabismus was detected in 7% and was accommodative in 25%. Esotropia was the most prevalent deviation (72.8%). The prevalence of amblyopia was 12%. The mean sphere measured in amblyopic children was 5.66 D (+/-1.64 D). Initial depth of amblyopia was mild to moderate and 98% of the children achieved iso-acuity after patching therapy. The correlation between severe hyperopia, amblyopia, and squint was statistically significant. Indeed, the risk ratios of squint and amblyopia, 5.2 and 3.70, respectively, were significantly high in children with severe hypermetropia. Complete spectacle correction improved final visual acuity and reduced the angle deviation in accommodative esotropia. CONCLUSION: Children with hyperopia of +3.5 D or greater have an increased risk of amblyopia and squint that threatens their visual function. Hyperopic correction should be prescribed even if no strabismus or amblyopia is detected in order to prevent this risk. Screening programs should also be promoted to detect these children at an early age.

[Bilateral retinal vascular occlusion during antiphospholipid antibody syndrome: a case report]. / Occlusion vasculaire rétinienne bilatérale au cours du syndrome des antiphospholipides. A propos d'un cas.

PURPOSE: Antiphospholipid syndrome is defined by the association of at least one clinical event (arterial and/or venous thrombosis, fetal loss) and antiphospholipid antibodies. It can be isolated or associated with systemic lupus disease. The purpose of this case report is to demonstrate that an ocular vascular event can reveal the disease and that its diagnosis is important because this disease generally affects young people and may endanger ocular and vital prognosis. OBSERVATION: We report the case of a 20-year-old female treated for systemic lupus erythematosus for 2 years, who stopped her medical treatment and presented a sudden bilateral loss of vision. Fundus examination and fluorescein angiography revealed severe bilateral retinal vascular occlusion. Antiphospholipid antibody syndrome was confirmed with the presence of anticardiolipin antibodies. With medical treatment, there was initially a small functional improvement and then a general degradation in 3 months, followed by the death of the patient secondary to severe pulmonary emboli. DISCUSSION AND CONCLUSION: Central retinal artery or vein occlusion in a young patient must suggest the diagnosis of antiphospholipid antibody syndrome. The bilateralism of vascular occlusion is considered a severe factor because of its consequence on functional ocular and vital prognosis, where it can sound the alarm to the extension of thrombotic events to other vessels in the body. Antiphospholipid syndrome must be studied in cases of severe retinal vascular occlusion in young patients. Its diagnosis is important because the risk of recurrent thrombotic events may endanger functional and vital prognosis.

[Bilateral optic neuropathy in a case of primary Gougerot Sjögren's syndrome]. / Une neuropathie optique bilatérale au cours du syndrome de Gougerot Sjögren primitif.

INTRODUCTION: Primary Sjögren's syndrome is frequently characterized by a sicca syndrome without associated connective tissue disease. Association with an optic neuropathy is uncommon. CASE REPORT: We report a case of optic neuropathy in a 59-year-old woman known to have primary Sjögren's syndrome confirmed clinically and histologically 2 years ago. She suddenly presented an initial bilateral visual loss. The ophthalmological exam noted a visual acuity of 1/10 in the right eye and limited to light perception in the left eye, with bilateral optic ischemic neuropathy more developed in the left eye. Fluorescein angiography showed, signs of ischemic neuropathy. The diagnosis of Horton disease was suspected, but subnormal blood velocity and a negative biopsy of the temporal artery confirmed the diagnosis of optic neuropathy associated with primary Sjögren's syndrome. General steroid therapy improved optic neuropathy in the right eye but was ineffective in the left eye. CONCLUSION: Optic neuropathy associated with Sjögren's syndrome is rare but must be considered the most common ophthalmological manifestation of the disease. Visual prognosis depends on the rapidity of diagnosis and therapy.

[Epibulbar osseous choristoma: two case reports]. / Ostéome épibulbaire: à propos de 2 cas.

INTRODUCTION: Epibulbar osseous choristoma is a congenital tumor consisting of normal tissue arising in an abnormal location. CARE REPORTS: We report two cases of epibulbar osseous choristoma discovered in 7- and 3-year-old girls. FIRST CASE: A calcified tumor was located regarding the temporal bulbar conjunctiva of the left eye. The rest of the ophthalmological examination was normal. Second case: During strabismus surgery, we unexpectedly discovered a white calcified mass located on the superior temporal part of the right eye. In both cases, a total excision was performed. Histopathological examination of the excised choristoma confirmed the diagnosis. DISCUSSION: Epibulbar osseous choristoma is a small unique nodule usually located on the superior temporal quadrant of the eye. Rarely reported in the literature, most cases are not recognized clinically and the diagnosis is essentially histopathological. CONCLUSION: Epibulbar osseous choristoma is a rare benign childhood tumor with an essentially histopathological diagnosis.