[Compressive optic neuropathy secondary to a pituitary macroadenoma]. / Neuropathie optique compressive secondaire à un macroadénome hypophysaire.

INTRODUCTION: Pituitary adenoma is a common benign tumor representing 8 to 10% of intracranial mass lesions. The compressive optic neuropathy associated with a pituitary adenoma can be clinically indistinguishable from glaucomatous optic neuropathy. CASE REPORT: A 56-year-old man with no significant past medical history had noticed a rapid decrease in visual acuity for 6 months. Funduscopic examination revealed glaucoma-like bilateral, asymmetric optic cupping. Brain MRI examination revealed a pituitary tumor compressing the optic chiasm. CONCLUSION: The diagnosis of a compressive optic neuropathy associated with a pituitary adenoma can be difficult, since it often simulates chronic glaucoma. However, several features should alert the clinician to the possibility of a compressive optic neuropathy and prompt neuroimaging, in order to obtain earlier diagnosis and treatment.

[Safety and efficacy of botulinum toxin in hemifacial spasm]. / Efficacité et tolérance de la toxine botulique dans l'hémispasme facial.

UNLABELLED: Given the failure of pharmacologic and surgical treatment in the management of hemifacial spasm, the use of botulinum toxin as first line therapy is interesting. PURPOSE: To evaluate the safety and efficacy of type A botulinum toxin in the treatment of hemifacial spasm. PATIENTS AND METHODS: We conducted a retrospective, descriptive and comparative study of 25 patients with hemifacial spasm followed in the ophthalmology department of Habib Thameur hospital in Tunis over the period from June 2003 to June 2009. All patients received injections of botulinum toxin type A (Botox). RESULTS: We carried out 168 Botulinum A toxin injections (Botox) with an average of 6.85 ± 4.32 injections per patient. Doses varied between 12.5 U and 28 U Botox. A good response to treatment was observed in 92% of patients with a satisfactory return to daily activities and work. Based on a subjective scale from 1 to 3, the average total functional benefit was 2.55 ± 0.56. Average total duration of therapeutic response was 9.35 ± 3.64 weeks. Local side effects observed were comparable to those described in the literature: ptosis (32.4%), diplopia (8.2%), drooping of the labial commissure (11.2%), lagophthalmos (21.3%), tearing (7%), dry eye (4%). No systemic complication was noted. CONCLUSION: Botulinum toxin type A provides effective short-term and medium-term results in the treatment of hemifacial spasm. It is well tolerated locally and systemically. This safety and efficacy make it a valuable therapeutic alternative in the management of hemifacial spasm.

[Progression of diabetic retinopathy after cataract surgery by phacoemulsification]. / Évolution de la rétinopathie diabétique après chirurgie de la cataracte par phacoémulsification.

PURPOSE: To study the effect of cataract surgery by phacoemulsification and intraocular lens implantation on the progression of diabetic retinopathy (DR) using the nonoperated fellow eye as a control, by a retrospective comparative study. PATIENTS AND METHODS: We studied 46 diabetic patients who underwent monocular cataract surgery by phacoemulsification with implantation of an intraocular lens within the capsular bag, with the nonoperated fellow eye used as a control. In all cases, the fellow eye exhibited only a very mild cataract, allowing for visualization of the fundus. Preoperative and 1, 3, 6 and 12 months postoperative ophthalmic examination and fundus photographs, supplemented if necessary by retinal fluorescein angiography, were performed to assess DR using the Alfediam classification. Patients were followed for at least 1 year. RESULTS: Among the 46 patients, preoperative DR was absent in 40 patients, and six patients had bilateral, symmetric non-proliferate diabetic retinopathy (NPDR): mild in four patients, moderate in one patient and moderately severe in another patient. Thirty-five eyes (76%) had postoperative best corrected visual acuity of 8/10 or better. Progression of DR occurred at about 23.9% (11/46) in the operated eyes and 19.6% (9/46) in the nonoperated eyes. As compared by the MacNémar test, there was no significant difference between operated and nonoperated eyes (P=0.68). CONCLUSION: This study demonstrates that cataract surgery by phacoemulsification does not represent an apparent risk factor for progression of DR.

[Corneal lesions in Kindler syndrome: a case report]. / Atteinte cornéenne au cours du syndrome de Kindler: à propos d'un cas.

INTRODUCTION: Kindler syndrome is a rare autosomal recessive genodermatosis belonging to the class of bullous poikiloderma. Corneal lesions are rare. We report a case of ocular lesions in this syndrome. OBSERVATION: We report the case of a 57-year-old patient followed since childhood in dermatology with the diagnosis of Kindler syndrome. He presented to the ophthalmology department with decreased vision. Ophthalmologic examination showed symblepharon, ectropion in both eyes, and corneal deformation. CONCLUSION: The role played by the abnormal protein in epithelial integrity suggests that ocular and more particularly corneal involvement is not rare in Kindler syndrome. In fact, it is less known by ophthalmologists and dermatologists are not aware of the ophthalmologic manifestations.

[Acquired ptosis in allergic blepharoconjunctivitis in children and adolescents]. / Le ptosis acquis dans la blépharoconjonctivite allergique chez l'enfant et l'adolescent.

Acquired ptosis is a common ophthalmologic problem. It is in the large majority of cases aponeurotic and occurs in the elderly as an involutional disorder or after ophthalmic surgery. In younger patients, it may occur after ocular trauma, periocular infection, contact lens wear, or palpebral edema. Allergic blepharoconjunctivitis is an unsuspected cause of acquired ptosis. Our study investigated patients (5 to 15 years old) with a history of allergic blepharoconjunctivitis and having a unilateral or bilateral ptosis. Physiopathological hypotheses are discussed. Management of acquired ptosis is presented.

[Optical coherence tomography for surveillance of optic disc melanocytoma]. / Interêt de la tomographie en coherence optique dans la surveillance d'un melanocytome papillaire.

INTRODUCTION: Melanocytoma of the optic disc is a stable condition that unfrequently undergoes malignant transformation. CASE REPORT: We reported the case of a 42-year-old woman who presented with a pigmented tumoral lesion of the optic disc in her left eye. We described its characteristics in optical coherence tomography (OCT). CONCLUSION: Patients with pigmented tumors of the optic disc should have a periodic monitoring. OCT may be helpful in the difficult differential diagnosis between malignant and benign tumor and the monitoring of this lesion.

[Central retinal vein occlusion and internal carotid artery hypoplasia: a case report]. / Occlusion de la veine centrale de la rétine et hypoplasie de l'artère carotide interne: à propos d'un cas.

INTRODUCTION: Retinal vein occlusion is usually encountered in the elderly and is often associated with systemic vascular disease. It is rarer in young subjects and requires a serious etiological search to best adapt the treatment. OBSERVATION: We report the case of a central retinal vein occlusion (CRVO) in a 26-year-old patient who had no pathological history, discovered at a sudden decline of vision in the right eye, reduced to light perception. Fundus examination and retinal angiography showed an edematous CRVO. Radiologic imaging revealed a narrowing of the right carotid canal, probably congenital, and a reduction in the size of the right common carotid artery and internal carotid artery. Progression was favorable without treatment, and visual acuity improved to 8/10. CONCLUSION: The etiological investigation in retinal vein occlusion in young people must be exhaustive. The visual prognosis is variable and may depend on the etiology.

[Retinal vasculitis in Crohn's disease: a case report]. / Vascularites rétiniennes au cours d'une maladie de Crohn.

INTRODUCTION: Crohn's disease is a chronic inflammatory bowel disease. Numerous extra-intestinal complications can affect different organ in the body (kidneys, eyes...). Posterior ocular manifestation is rare and retinal vasculitis is exceptional. OBSERVATION: We present a case of a 55-year- old men in whom Crohn's disease was diagnosed in 1985 and considered severe treated by corticosteroid end then by immunosuppressive therapy. He lost his right eye few years ago. He presented a sudden loss of vision of the good eye. Physical examination found visual acuity reduced to light perception without sign of anterior inflammation. Ophthalmoscopic examination found different retinal vasculitis involving veins, papillitis, cystoid macular oedema; all these findings were confirmed by fluorescein angiography and OCT. Corticosteroid treatment with a dose of 1mg/Kg/day was instituted with precaution of use and a wide follow up with favourable evolution during 9 months. CONCLUSION: Retinal vasculitis is rare during Crohn's disease. It can be a severe ocular lesion and causes therapeutic and prognosis problems, especially in a patient with only one functional eye.

[Cortisone glaucoma: epidemiological, clinical, and therapeutic study]. / Glaucome cortisonique: étude épidémiologique, clinique et thérapeutique.

INTRODUCTION: Cortisone glaucoma is a secondary glaucoma induced by local or oral steroids used to treat chronic inflammatory diseases. PATIENTS AND METHODS: Retrospective study including 43 eyes of 23 patients (three patients were monophthalmos). We present epidemiological and clinical features with evaluation of functional damage (visual acuity, visual field), and therapeutic results with a follow-up period ranging from 2 to 10 years. RESULTS: Topical steroids were incriminated in 15 of 23 cases (self-medication), whereas general steroids (for chronic diseases) were used by eight patients. Visual function was seriously affected (visual acuity<1/10 in 23/43 eyes at the first visit with pronounced visual field abnormalities). Surgery was necessary in 16 of 43 eyes (deep sclerectomy with or without implant, trabeculectomy). DISCUSSION: Cortisone glaucoma is rather frequent in Tunisia where conjunctival allergy and self-medication are common. Young adults are concerned, making it a high surgical risk usually requiring surgical devices such as a T Flux implant. CONCLUSION: Cortisone glaucoma is a serious complication of steroid therapy that usually affects young adults. The disease is usually detected late, explaining the severe functional damage.

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

[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.

[Inferior branch retinal artery occlusion in a young adult revealing rheumatismal valvular disease]. / Oblitération de la branche inférieure de l'artère centrale de la rétine chez un adulte jeune révélatrice d'une valvulopathie rhumatismale.

INTRODUCTION: Inferior branch retinal artery occlusion is uncommon in young adults. Through a case report and data from the literature, we describe the clinical, fluorescein angiography, and progressive details of this disease. CASE REPORT: A 26-year-old man suddenly presented superior scotoma in the left eye. He underwent a full ophthalmologic examination, which showed visual acuity limited to 5/10 P4 and ischemia of the inferior retina at the fundus exam. Fluorescein angiography of the left eye revealed delayed filling of the inferior branch retinal artery. The ophthalmologic exam of the right eye was normal. RESULTS: The search for an etiologic explanation revealed double rheumatismal mitral and aortic valvular disease, which was referred to and treated in appropriate department. The condition has progressed slowly but favorably over 2 months, with visual acuity reaching 6/10 P3. DISCUSSION: Branch retinal artery occlusion commonly occurs in older adults. When it happens to the young adult, it may be dangerous and often reveals cardiac embolic disease, particularly rheumatismal valvular disease. CONCLUSION: Branch retinal artery occlusion in the young adult remains a rare and dangerous disease where the prognosis depends on the degree of artery repermeabilization and on the etiology of the thromboembolic disease.