Retinal dystrophy and congenital glaucoma as major causes of vision loss in students attending two institutions for the visually disabled in Tunis city, Tunisia.

PURPOSE: To assess vision loss, identify affected anatomical sites, determine etiologies and potentially avoidable causes in students attending two institutions for the visually disabled in Tunis city. METHODS: A visit for a complete ophthalmological examination was performed. All students attending these schools were recruited in our study. The World Health Organisation Programme for the Prevention of Blindness (WHO/PBL) examination record for children was used. Data was analysed by the SPSS version 17 statistical software. RESULTS: A total of 172 students were recruited with mean age of 11.9±3.3 years (between 6 and 18 years). One hundred and thirty-seven (79.6%) were under 16 years. The sex-ratio was 1.17. Ninety students (52.3%) had low vision and eighty-two (47.7%) were blind. We reported retina (29%), whole globe (29%), globe appears normal (11%) and optic nerve (9.8%) as the common sites of ocular abnormalities. Retinal dystrophy (22.7%) and congenital glaucoma (22.7%) were the most reported ocular diseases. The main etiologies were hereditary (54.1%) and unknown (30.8%). Consanguinity was reported in 108 students (62.8%), and fifty-five students (32%) had a positive family history. Overall, 50.5% (87/172) of ocular diseases were potentially treatable or preventable. CONCLUSION: Retinal dystrophy and congenital glaucoma were the most common eye diseases. Heredity was the main etiology, and consanguinity was high. To decrease their incidence, awareness of the family members of the risks of consanguinous marriage and appropriate therapy for congenital glaucoma/cataract may significantly improve the child's visual prognosis.

[Ophthalmologic manifestations of congenital rubella]. / Manifestations ophtalmologiques de la rubéole congénitale.

Congenital rubella is a rare and serious disease including auditory neurological, cardiac, urinary, and ocular abnormalities. The eye complaints are often congenital cataract, congenital glaucoma, microphthalmia, and oculomotor disorders. We report the case of a 6-year-old girl presenting with a unilateral congenital cataract associated with congenital rubella. She was referred for complaints of high myopia in her right eye. She had a family history of cardiac and urogenital malformations, and presented deafness at birth. The ophthalmologic examination showed a microcornea and a unilateral dense congenital cataract in the right eye. B-scan ophthalmic ultrasound revealed a posterior microphthalmos. The anterior segment examination of the left eye was normal. Funduscopy revealed a salt-and-pepper appearance. Laboratory tests revealed a positive serology, confirming the congenital rubella. Given her complaints of loss of visual acuity in the right eye, the patient was operated on with a phacoaspiration implant in the capsular bag. The postoperative course was uneventful. The prevention of congenital rubella is based on routine vaccination of children. The association of cataract, congenital heart defects, and deafness must be systematically investigated as it may be more serious in association with systemic manifestations.

[Therapeutic penetrating keratoplasty in herpes infected eye]. / Les keratoplasties transfixiantes therapeutiques dans les atteintes oculaires d'origine herpetique.

PURPOSE: To report the clinical results, the postoperative course and the complications observed after therapeutic penetrating keratoplasty in herpetic keratitis. METHODS: Eleven eyes with herpetic keratitis (11 patients) that underwent therapeutic keratoplasty between September 2002 and September 2008 were included in this study. The eyes were evaluated retrospectively with respect to the anatomic success rate, the graft clarity, the visual prognosis and the postoperative complications. RESULTS: The mean follow-up was 13.7 months. Nine cases presented with corneal perforation and two cases with descemetocele. Anatomic repair was obtained in 11 eyes (100%). The graft transparency rate was 54.5%. A final visual acuity equal to or better than 1/10 was achieved in 45.45%. Major causes of failure of corneal graft included recurrent disease (n = 1), glaucoma (n = 1), graft rejection (n = 2) and early irreversible edema of the graft (n = 1). CONCLUSION: The prognosis of therapeutic penetrating keratoplasty in herpetic eye disease can only be improved with proper postoperative care and optimal management of immunologic and virologic complications.

[Severe microbial keratitis: report of 100 cases]. / Les abcès graves de la cornée: à propos de 100 cas.

PURPOSE: To study predisposing factors, clinical aspects, and microbiological diagnosis in severe microbial keratitis, and to discuss the therapy and visual outcome. MATERIAL: and methods: A prospective and retrospective study concerning patients presenting microbial keratitis hospitalized in department B of the Hedi Raies Ophthalmology Institute (Tunis, Tunisia), from August 1996 to November 2004. RESULTS: One hundred patients with microbial keratitis were hospitalized (45 females and 55 males; ranging in age from 11 to 87 years). The principal predisposing factors were ocular surface pathology (30%), ocular trauma (28%), prior ocular surgery (17%), and contact lens wear (8%). The corneal scraping culture was positive in 42% of cases, isolating Gram-positive bacteria (48.6%), Gram-negative bacteria (29.7%), and fungi (21.6%). The majority of our patients (93%) had broad-spectrum topical antibiotics with therapeutic success in 53.8% of cases. Systemic antifungal agents were indicated in 17 cases. Surgery was necessary in 25.8% of cases: therapeutic keratoplasty in five cases and deleted keratoplasty in nine cases. Final visual acuity was equal to or better than at admission in 81% of cases. Anatomic loss of the eye was observed in eight cases (evisceration, six cases; enucleation, two cases). CONCLUSION: microbial keratitis is a frequent and severe pathology that can lead to blindness. Only early and adapted management can improve the prognosis of severe microbial keratitis.

[Clinical and angiographic characteristics of Bietti's corneoretinal dystrophy: a case study of an 8-year-old girl]. / Caractéristiques cliniques et angiographiques de la dystrophie cristalline de Bietti: à propos d'une patiente âgée de 8 ans.

INTRODUCTION: Bietti's crystalline corneoretinal dystrophy is a tapetoretinal degeneration, characterized by the presence of refringent crystals in the corneal limbus and the retina with sclerosis of choroidal vessels. We report the clinical and angiographic features of an 8-year-old girl affected with Bietti's crystalline dystrophy. CASE REPORT: This 8-year-old girl was a sporadic case, born of consanguineous parents. She was referred to our hospital for intermittent strabismus. Her visual acuity was 4/10 at the right eye and 3/10 at the left eye. Biomicroscopy revealed very fine crystals in the limbal area bilaterally. Mydriatic funduscopic examination showed bilateral macular pigment mottling and depigmentation, numerous tiny refractile yellow dots scattered throughout the posterior pole and the mid-periphery associated with diffuse retinal pigment epithelial atrophy and pigment accumulation. Fluorescein angiography revealed retinal pigmentary epithelium alterations. Indocyanine green (Infracyanin) angiography showed areas of choroidal atrophy. The electroretinogram noted a reduction in the number of both types of photoreceptors. COMMENTS: Ophthalmological lesions normally occur between 20 and 30 years of age. The particularity of our case report is the manifestation of the disease at an earlier age (8 years). The progression is characterized by a centrifuge expansion of lesions.

[Treatment of subfoveal choroidal neovascularization in pathologic myopia with photodynamic therapy: outcomes at 1 and 2 years of follow-up]. / Traitement des néo-vaisseaux choroïdiens rétrofovéolaires du myope fort par photothérapie dynamique: résultats à 1 an et à 2 ans.

PURPOSE: To evaluate the visual outcome of photodynamic therapy with verteporfin in patients with subfoveal choroidal neovascularization (CNV) caused by pathologic myopia. METHODS: Retrospective and noncomparative analysis of 42 patients with CNV secondary to pathologic myopia recruited between September 2001 and 2003, who were treated with a standard regimen of photodynamic therapy with verteporfin. RESULTS: Forty-two patients were followed up for 12 months; 15 out of 42 completed 24 months of follow-up. Initial visual acuity ranged from 1/10 to 5/10 with a mean of 1.6/10. Twenty-five (56.7%) eyes had stable or improved visual acuity at 12 months with a mean of 2.5/10. In the group of patients who completed 24 months of follow-up, six eyes (39.9%) had stable or improved visual acuity with a mean of 1.6/10 at 1 year and 1.25/10 at 2 years. The average photodynamic therapy treatment required in 1 and 2 years were 1.5 and 2.1, respectively, and they are less than those reported by the Verteporfin in Photodynamic Therapy (VIP) study. CONCLUSION: Photodynamic therapy with verteporfin for subfoveal choroidal neovascularization caused by pathologic myopia maintained a visual benefit at 1 and 2 years.

[Inferior rhegmatogenous retinal detachments: clinical and therapeutic characteristics]. / Les décollements de rétine rhegmatogènes inférieurs: particularités cliniques et thérapeutiques.

PURPOSE: To determine the epidemiological and clinical factors involved in inferior rhegmatogenous retinal detachments and to propose a therapeutic plan. PATIENTS AND METHODS: A retrospective case note review of 173 patients (175 eyes), 11-89 years old, who had been operated on for inferior retinal detachment over a 13-year period between 1990 and 2003. RESULTS: The retinal reattachment rate after initial surgery was 79.5%, the final anatomical success rate was 81.5%. Scleral buckling surgery was used for the primary repair of rhegmatogenous retinal detachments in 111 cases and it was successful in 81 cases. Fifty-eight patients underwent vitrectomy with internal silicone oil tamponade. Anatomical success was obtained in 55 cases (94.8%) without recurrence. Endocular surgery allowed surgeons to find missed causal tear in 76% of cases. Mixed surgery was undertaken in four cases, with three good results. Visual acuity improved in 81% of cases, remained unchanged in 15% of cases, and deteriorated in 4% of cases. The mean final visual acuity ranged from 2.5 to 3/10, while it was only 1/20 before surgery. The mean improvement in visual acuity was 2.5 lines. The mean follow-up in our study was 13+/-11 months. CONCLUSION: Inferior retinal detachment usually occurred in young myopic or old pseudophakic subjects. These patients are characterized by the absence of tears. Vitrectomy in primary repair with inferior retinal detachment improves their anatomical and functional prognosis.

[Characteristics of retinal detachment following neodymium YAG laser posterior capsulotomy: clinical and therapeutic aspects]. / Les décollements de rétine rhegmatogènes post-capsulotomie postérieure au laser YAG: aspects cliniques et thérapeutiques.

PURPOSE: To study the clinical characteristics and the therapeutic results of retinal detachment following neodymium YAG laser posterior capsulotomy. MATERIAL AND METHODS: A retrospective study of 28 patients (28 eyes) operated in department B of the Hédi Rais Institute of Ophthalmology (Tunis, Tunisia) between march 1993 and january 2005 for retinal detachment following neodymium YAG laser posterior capsulotomy. We study the preoperative clinical characteristics of the retinal detachment and the anatomic and functionnal results. RESULTS: The mean age of the patients is 53.4 years. Fourteen patients are men and eleven have high myopia. Ten patients are aphakic and eighteen pseudophakic. The retinal detachment is total or subtotal in 19 eyes (67.9%). The macula is detached in 27 cases (96.4%). The retinal tears are posterior in 9 cases (paravascular retinal break or macular hole) and peripheral in fifteen cases. In 4 cases no tear is found. Vitreoretinal proliferation is advanced in 10 cases. Eleven patients underwent episcleral surgery and 17 endocular surgery. The final success rate is 89%. The postoperative visual acuity increases in 20 cases. It is superior to 1/10 in 14 cases. The minimum follow-up is 6 months. CONCLUSION: The retinal detachment after neodymium laser posterior capsulotomy is serious due to severe vitreoretinal proliferation wich influences the anatomic results.