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.

Multimodal imaging in a case of a congenital retinal macrovessel associated with a retinal cavernous hemangioma: a case report.

BACKGROUND: To report the results of multimodal imaging in a case of a congenital retinal macrovessel associated with a retinal cavernous hemangioma. CASE PRESENTATION: A 52-year-old female patient presented with progressive vision loss in the right eye. BCVA was 8/20 in the right eye and 18/20 in the left eye. Fundus examination of the right eye showed an aberrant retinal macrovessel arising from the inferior temporal major vein. It crossed the foveal area and overstepped to the superior retina. A "brunch of grapes" shaped retinal lesions arised from the macrovessel. Fluorescein angiography showed saccular lesions that filled slowly during the venous phase and became brightly hyperfluorescent saccular caps. SS-OCT of the right eye revealed a highly back-scattering hyper-reflective vessel across the fovea with shadow effect and adhesions between the vitreous and the aberrant macrovessel. It also revealed hypo reflective saccules with hyperreflective borders located in the inner retina corresponding to the cavernous retinal hemangioma. Retinal pigment epithelium undulations and vascular dilations at the level of Haller's layer were observed in both eyes. Indocyanine green angiography revealed chroidal vascular dilatations in both eyes in the late phase. OCT-A showed the aberrant vessel emerging from the inferior temporal vein and splitting the foveal avascular zone horizontally. RCH appeared as small heterogeneous saccular flow areas associated with focal capillary hypo perfusion areas. Asymmetry and distorsion of the foveal avascular zone were also noticed. A diagnosis of retinal macrovessel associated with a retinal cavernous hemangioma was made. CONCLUSIONS: Congenital retinal macrovessels and retinal cavernous hemangioma are benign lesions. Their association is rare. Abnormal vascular development is likely to be responsible for their association. Swept source OCT and OCT angiography may be of a great contribution to better evaluate these retinal vascular disorders.

Ocular manifestations of crohn's disease.

INTRODUCTION: Ocular involvement in Crohn's disease is rare and polymorphic. AIM: To analyze the frequency and type of ocular manifestations during Crohn's disease as well as the risk factors for ocular involvement during this disease. METHODS: This is a prospective study of 52 patients (104 eyes) with Crohn's disease treated at the regional hospital of Nabeul between January 2016 and December 2016. Patients were divided into two groups: a group with ocular manifestations and a group without ocular manifestations. All the patients benefited from a complete ophthalmological examination. Fluorescein angiography and macular OCT were done in cases of posterior segment involvement. RESULTS: Patients with ocular manifestations were younger than those of group 2 without ocular manifestations with an average age of 34.5 years and 42 years, respectively. The colonic localization of the disease was found in 13 patients of group 1 (52%) and only in 2 patients of group 2 (7.4%). Extradigestive manifestations were noted in 12 patients of group 1 (48%) and 1 patient of group 2 (3.7%). For group 1, 60% of cases (15 patients) were in an active episode of inflammatory bowel disease versus 7.4% (2 patients) in group 2. Anterior uveitis was the most frequent ocular manifestation in our study, found in 29,3% of cases (12 patients). CONCLUSION: The ocular manifestations are more frequent in young people, during the inflammatory activity of the disease especially in colonic localization, during the first year of the follow-up of the disease and in the case of coexistence of articular or oral extra-intestinal manifestations.

Unilateral MALT conjunctival lymphoma: a case report.

INTRODUCTION: The conjunctival localization of MALT-type lymphoma is rare although it is the most common tumor of the ocular adnexa. OBSERVATION: We report a case of a 57 years old female patient who presented with a unilateral primitive MALT lymphoma, confined to the conjunctiva, she consulted for a protrusion of her left eye associated with a painless conjunctival lesion. Morphological and immunohistochemical analysis led to the diagnosis. CONCLUSION: Conjunctival MALT lymphoma is the most frequent tumor of ocular adnexa. It may be primary or secondary. Presentation is not specific, but the observation of a salmon colored conjunctival mass may lead to the diagnosis.

Orbital disorder revealing a lung cancer: a case report.

INTRODUCTION: Orbital metastases are rare and they are even rarer to be the first sign of the disease, which can lead to misdiagnosis and delay of management. OBSERVATION: Our patient consulted for a diplopia and a ptosis of the upper eyelid of the right eye since one month, without any other systemic symptoms. After ophthalmological examination and orbital tomography, the diagnosis of orbital metastasis was suspected. Lung cancer was revealed by thoracic tomography and confirmed by an anatomopahological examination. CONCLUSION: Because of the increased incidence of neoplasia, the diagnosis of orbital metastasis should be considered in any elderly patient who consults for symptomatology related to orbital involvement.

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.

Epidemiology of open globe injuries in cap bon: about 100 cases.

BACKGROUND: Open globe injuries are a major cause of permanent visual impairment and blindness. OBJECTIVES: In this retrospective study, we identify clinical characteristics and outcome of a series of open globe injuries. METHODS: Operating department records were reviewed to identify all patients who had undergone repair of an open globe injury from January 2006 to November 2013 at the department of ophtalmology in the university hospital of Nabeul in Tunisia. Case notes were examined to determine demographic data, mechanisms and location of injury. The Snellen visual acuity on presentation, initial clinical signs and the final visual acuity were, also, recorded. RESULTS: In total, 100 cases of open globe injury were identified. The mean age of the patients was 31.9 years. Eighty-two per cent (82%) of patients were male. Domestic accidents, assaults and accidents in the work place were the main etiologies of open globe injuries, representing respectively 30, 29 and 12% of cases. Twenty eight (28) patients had globe ruptures and 72 patients sustained globe lacerations. The injury was corneal in 60 cases, corneoscleral in 15 cases and scleral in 25 cases. An intraocular foreign body has been identified in 4 cases. The main complications were corneal opacity (43%) and posterior synechiae (28.6%). Final visual acuity of 5/10 or better was achieved in 24% of cases. It was ≤1/10 in 12 % of cases. CONCLUSION: Open globe injury is a serious accident that can cause significant functional impairment. Only the application of preventive measures can reduce the incidence of these accidents.

[Lofgren syndrome revealed by eyelid tumor]. / Syndrome de Löfgren revele par une tumeur palpebrale.

INTRODUCTION: The Lofgren syndrom is a particular variety of sarcoidose. The ocular attack is dominated in this syndrome by anterior uveitis. More rarely the eyelids and the orbitary structures are attached. PURPOSE: In this work, we report a Lofgren syndrome case revealed by eyelid tumor. OBSERVATION: It is about 42 year-old patient who consults for a right inferior eye-lid tumefaction developped for 2 months. The diagnosis of Lofgren syndrome was evoqued because of the association of fever, arthritis, erythema nodosum, tuberculin anergia, hypercalcinuria and mediastinal adenopathy at thoracic scan-tomography. The diagnosis was then confirmed by biopsy of palpebral tumor which showed multiple epithelioid and gigantocellular granuloma without caseous necrosis. CONCLUSION: The Lofgren syndrome is a multivisceral chronic affection. The eye and its annexes constitute frequent cibles of this affection for which they react by a diverse and rich symptomalogy and which can be presented by eye-lid tumors with orbital extension.