Eye trauma in the workplace: about 110 cases.

AIM: To evaluate the epidemiological and clinical characteristics of occupational ocular trauma in order to determine prognostic factors of these eye accidents. METHODS: This is a cross-sectional study of 110 patients who were victims of occupational accidents that caused eye trauma. They were treated in Department A, Hédi Rais Ophthalmology Institute in Tunis, between March 2018 and March 2019. We collected information from the patients' files according to a standard form. The data collected were: patient demographics, circumstances of the accident, consultation time, clinical examination data and temporary disability. The data were entered and statistically analysed using SPSS 20.0 software. We used the "t-student" and the "chi-deux" as statistical tests. The significance level was set at 5%. RESULTS: We collected 120 eyes from 110 patients. The average age was 37 years with a male predominance. Almost half of the patients (45.4%) were construction workers.  In 34% of the cases, a metal object was responsible for the trauma. Projection of superficial foreign bodies was noted in 44.3% of cases and contusion in 34% of cases. The average visual acuity of the traumatised eye was 8/10 and depended on the nature of the trauma.  Palpebral ecchymosis (30.9%) and conjunctival hyperhaemia (48.5%) were the most common bio microscopic signs found. Eight cases of corneal wounds were noted, three cases of corneo-scleral wounds associated in 2 cases with an intra-ocular foreign body as well as three cases of bursting of the globe were noted. The risk factors of poor prognosis found were: male sex (p=0.042), the mechanism of the trauma: projection of a foreign body (p=0.0052) and the following occupations: bricklayer, mechanic and construction worker (p<0.0001). The average temporary disability caused by eye trauma was 5 days with a standard deviation of 6 days. CONCLUSION: Our study described the severity of eye injuries related to work-related accidents. The most important prognostic factors will be the male gender, the mechanism of the trauma and the occupation. These traumas represent a major public health problem. Prevention is the only way to improve the final prognosis.

Prognostic factors for visual recovery in idiopathic rhegmatogenous retinal detachment: a prospective study of 90 patients.

AIM: To determine the preoperative clinical and tomographic factors involved in the postoperative visual prognosis of macula-off rhegmatogenous retinal detachment. METHODS: We conducted a prospective analytical study of 90 eyes of 90 patients who suffered from macula-off rhegmatogenous retinal detachment and were treated in department "A" of "Hedi Raies Institute of Ophthalmology", Tunis. All the patients were examined prior and after the operation, with a thorough interrogation and complete ophthalmological examination. Also, we continued assessing their status for 6 months. We looked for the clinical factors predictive of postoperative visual recovery. The data collected was stored using Excel software and analyzed using SPSS version 18 for Windows (IBM Corp., Armonk, NY). For all statistical tests, the significance level was set at p=0.05. RESULTS: The mean preoperative visual acuity (VA) was 1.73 +/- 0.34 LogMAR. It was significantly correlated with management delay (p<0.001). Postoperative VA was 0.61 +/- 0.43 LogMAR. The various pre-operative clinical risk factors for poor final visual recovery (VA<5/10) were: preoperative VA ≥ 2 LogMAR, management delay > 15 days (p<0.01), proliferative vitreoretinopathy (PVR) stage C or greater (p=0.01), and number of detached retinal quadrants > 2 (p=0.05). Furthermore, we have found that the preoperative tomographic risk factors for poor visual recovery were: height of sub retinal fluid > 760µm (p < 0.001), disruption of the external limiting membrane and/or ellipsoid zone (p < 0.001), presence of cavitations in the external and/or internal nuclear layer (p = 0.002), and finally the absence of a thickening of the photoreceptor outer segments (p = 0.001). CONCLUSION: Predictive preoperative clinical factors in macula off RRD are mainly preoperative visual acuity, the management delay, number of quadrants reached and PVR stage. Mastering these factors builds a better understanding of the functional recovery after macula-off retinal detachment and helps advise the patients who will consequently be more involved in the management of this serious disease. Spectral domain OCT allows detection of specific microscopic macular changes. These anomalies could be predictive of final postoperative visual outcome.

Ruptured retinal macroaneurysm complicated by a retro hyaloidal hematoma: about a case and review of the literature.

A 45 years old patient consulted for a sudden decrease in visual acuity in the right eye. Ophthalmological examination gave visual acuity limited to luminous perceptions with a calm anterior segment, a transparent lens and at the fundus examination a dense, massive, two-level intra-retinal and retro hyaloidal pigeon nest hemorrhage with a fusiform whitish lesion on the path of the upper temporal artery. The suspected diagnosis was a complicated ruptured retinal macroaneurysm with massive retinal and retro hyaloidal hemorrhage. Fluorescein angiography confirmed the diagnosis. Our course of action was an emergency programmed evacuation vitrectomy with gas tamponade. The evolution was marked by a clear improvement in visual acuity. The rupture of retinal macroaneurysm is a frequent and serious accident. The complications of this rupture can threat the vision. Care is still being discussed. Randomized studies on large series are necessary to decide on the best therapy.

[Intraocular foreign body and endophthalmitis: risk factors and management]. / Corps étranger intraoculaire et endophtalmie: facteurs de risque et prise en charge.

This study aims to identify the risk factors for post-traumatic endophthalmitis (PTE) due to intraocular foreign body (IFB) in patients with penetrating injuries of the globe and to assess treatment outcomes. We conducted a descriptive, retrospective study of 60 patients hospitalized for penetrating wound due to intraocular foreign body at the Hedi Rais Institute of Ophthalmology, Tunis, over a period of 10 years. Our study involved the patients with penetrating ocular trauma due to intraocular foreign body associated with post-traumatic endophthalmitis. We also determined the clinical risk factors for endophthalmitis in these patients. We collected data from the medical records of 60 patients with penetrating injury due to intraocular foreign body. Clinical symptoms of endophthalmitis were reported in ten of these patients (16.66%). All IFBs were located in the posterior segment. Mean LogMAR visual acuity (VA) at baseline was 2.26. Final Mean LogMAR VA was 2.18. We found a statically significant correlation between the occurrence of endophthalmitis and the following factors: rural origin p=0.021, delays in removing IFB p=0.01, posterior location IFB p=0.012, capsule rupture p=0.022, associated retinal detachment p<0.0001. The identification of risk factors for post-traumatic endophthalmitis allow for better treatment adaptation and preventive measures of this complication to improve prognosis and quality of life.

Malignant glaucoma management: literature review.

Malignant glaucoma remains a challenging complications of ocular surgery. It has been reported to occur spontaneously or after any ophthalmic procedure, it is most commonly encountered after glaucoma surgery. The clinical diagnosis is made in the setting of a patent peripheral iridotomy and axial flattening of the anterior chamber. Intraocular pressure is usually elevated, but it may be normal in some cases. The exact etiology of this condition is not fully understood, several mechanisms have been proposed. This review discusses pathophysiology, differential diagnosis, imaging modalities, and current treatment strategies for this rare form of secondary glaucoma.