Autologous retinal graft for the management of large macular holes associated with retinal detachment.

To present the efficacy of autologous neurosensory retinal transplantation in macular holes surgery with rhegmatogenous retinal detachment. Eleven eyes of 11 patients with rhegmatogenous retinal detachment associated to a large macular hole were enrolled between January 2019 and January 2021 in the Department A of the Hedi Rais Institute of Ophthalmology (Tunis, Tunisia). All patients underwent a 23 G pars plana vitrectomy. An autologous neurosensory retinal patch was placed inside the macular hole. Long-acting silicone tamponade was carried out. Clinical features of the macular area, best-corrected visual acuity (BCVA), fundus examination, and SD-OCT were recorded before surgery, at 1- and 3-month follow-up after surgery. The mean age of our population was 56.6 ± 10.33 years old, ranged from 45 to 76 years old. Final retinal reattachment was achieved clinically in all eyes. The Spectral domain-Optical Coherence Tomography (SD-OCT) follow-up showed the macular hole closure. The retinal patch was demonstrated by OCT at each control. BCVA improved from 1.52 ± 0.23 Logarithm of the Minimum Angle of Resolution (LogMAR) to 0.89 ± 0.16 LogMAR 3 months after surgery (p= 0.014). No adverse events were registered during the study. Autologous neurosensory retinal transplantation has been efficient to treat macular hole associated to rhegmatogenous retinal detachment. Further multicentric studies with a large number of patients are needed to establish the results of this technique in complex cases.

Clinical Features and Outcomes of Congenital Cataract Surgery with Primary Intraocular Lens Implantation in a Tunisian Cohort.

Purpose: To describe the clinical features of congenital cataract (CC) in a Tunisian cohort and to assess the surgical outcomes of primary intraocular lens implantation in two groups based on the age at surgery. Methods: This study was a prospective analysis of children under 5 years with CC that were operated between January 2015 and 2020. The surgery consisted of phacoaspiration with posterior capsulorhexis and primary implantation. Group 1 comprised children operated at <2 years of age and Group 2 comprised children operated between 2 and 5 years. Peri and postoperative surgical events as well as refractive and visual outcomes were compared between both the groups. Results: Fifty-five (84 eyes) infants were enrolled. Group 1 included 30 (48 eyes) children and Group 2 included 25 (36 eyes) patients. The mean follow-up was 27.60 ± 19.89 months. The mean delay between the diagnosis and the cataract surgery was 11.97 ± 13.84 months. Of 14 (16.7%) eyes with postoperative visual axis opacification (VAO), 9 (10.7%) eyes required pars plana membranectomy. The VAO was not statistically associated with the age at surgery (P = 0.112), but significantly correlated with sulcus implantation (P = 0.037). The final mean visual acuity was 0.51 logMAR and comparable between both the groups (P = 0.871). Poor visual outcome was significantly associated with low age at presentation (<6 months; P = 0.039), delay between the diagnosis and time of surgery (P = 0.001), preoperative nystagmus (P = 0.02), and poor parental compliance to amblyopia treatment (P = 0.009). Conclusions: Primary implantation seems to be safe and efficient. VAO appears to become an avoidable occurrence owing to better surgical techniques. Amblyopia remains the biggest barrier to final visual outcome.

Cyclosporin A eye drop and subepithelial adenoviral keratoconjunctivitis infiltrates.

INTRODUCTION: The adenoviral keratoconjunctivitis infiltrates may be a source of significant visual impairment justifying the use of various therapeutic means. AIM: Evaluate the efficiency and safety of use of cyclosporine A 0,5% eye drop in the treatment of subepithelial infiltrates. METHODS: It was a prospective study of 37 eyes of 22 patients with adenoviral keratoconjunctivitis with subepithelial infiltrates treated with cyclosporine A 0,5% eye drop. Cyclosporine A 0,5% was prepared from the injectable form of cyclosporine (Sandimmun®) and artificial tears. The cyclosporine A 0,5% was first administered at 4 drops per day for 15 days, then at a rate of 2 drops per day for a variable period ranging from 15 days to 6 months. The use of this molecule has been motivated by the presence of a persistent dazzlement, by visual acuity under 6/10 or an astigmatism superior to 1 diopter. RESULTS: At the end of follow, dazzlement disappeared in all patients; the final average visual acuity was 8/10 and corneal astigmatism average was of 0.75 diopter. The slit lamp examination showed a marked decrease in the number and density of subepithelial infiltrates from the 15th day. A 29-year-old patient, however, presented some intercostal vesicles due to zonal recrudescence but with spontaneous and quick resolve in the same time of taking topical cyclosporine. No local complications were observed in our patients. The average follow-up was 13 months. CONCLUSION: Topical cyclosporine A is an effective and well-tolerated alternative to corticosteroids in the subepithelial infiltrates occurring as sequelae of adenoviral keratoconjunctivitis.

Choroidal neovascularization following argon laser photocoagulation for central serous chorioretinopathy.

INTRODUCTION: Choroidal neovascularization (CNV) is a rare complication after laser photocoagulation for central serous chorioretinopathy (CSCR).That's why , little is known about its management. Anti-VEGF therapy has emerged as the treatment of choice in patients with CNV. We report a case of a patient who developed iatrogenic CNV after having argon laser photocoagulation for a CSCR, treated with intravitreal injections of Bevacizumab. AIM: The goal of our paper is to show the efficacy and safety of the intravitreal injections of antiVEGF and discuss the alternative of argon laser photocoagulation to avoid complications. CASE PRESENTATION:   A 35-year-old pregnant woman diagnosed in August 2014 with an acute CSCR in the right eye. The patient was treated by a focal photocoagulation of the leakage point . In December 2015, she was complaining of metamorphopsia in the same eye .The BCVA was 10/10 in the right eye , and the funduscopic examination showed agrayish-white neovascular membrane, which corresponded to the area of the previous photocoagulation.The fluorescein angiography , OCT and the OCT angiography demonstrated the choroidal neovascular membrane .The patient received 3 intravitreal injections of Bevacizumab at monthly intervals in the right eye.The patient was followed-up at regular intervals and she became asymptomatic during three years. CONCLUSION: Choroidal neovascualrization may be an iatrogenic complication after argon photocoagulation in CSCR. Intravitreal injections of anti VEGF appear to be a promising treatment option for iatrogenic CNV due to photocoagulation.

Outcomes of transconjunctival 23-gauge vitrectomy for diabetic tractionnal retinal detachment.

INTRODUCTION: The transconjunctival 23-gauge vitrectomy without sutures (VTCSS) combines the advantages of the 20 and 25-gauge system. It currently represents the gold standard for the surgical management of vitreoretinal pathologies, especially in diabetic patients. AIM: Evaluate the anatomical and functional results of the VTCSS 23 gauge in diabetic tractionnal retinal detachment (DRT). METHODS: This is a retrospective study of patients undergoing vitrectomy 23 gauges from February 2015 to February 2017. Each patient a complete ophthalmological examination with collection of  pre operative peroperative and postoperative data. The vitrectomy was performed by 3 ways through the 23-gauge cannula system Results :We collected 52 eyes presenting a DRT. The average age of patients was 50.62 years old. The average glycated hemoglobin (HBA1C) was 9.3%. The average time to treatment was 76.92 days. The results were as follows: For anatomical results: anatomical success rate was 92.30%. Functionally: A significant improvement in mean AV from 1/80 to 1.25 / 10 after surgery (p = 0.022), a statistically significant correlation between the final postoperative VA and the management delay (p <0.001); significant correlation between preoperative VA and final postoperative VA (p <0.001). CONCLUSION: The VTCSS 23 gauge is an effective and safe surgery for DRT  surgery in diabetic patients with a gain in time and comfort for the patient.

Postoperative Endophtalmities: therapeuthic results and Early vitrectomy.

BACKGROUND: Postoperative endophthalmitis is a public health issue due to its bad prognosis; its treatment is both surgical and medical. Classically, surgical treatment was done if visual acuity is limited to light perception only. AIM: To evaluate therapeutic results Of postoperative endophtalmitieS and to Compare therapeutics almost used intravitreal injection of antibiotics versus early vitrectomy. METHODS: It's a retrospective comparative study  includIng 120 cases of acute postoperative endophthalmitis hospitalized in a referral ophthalmology department between July 2007 and June 2013. A comparison was conducted between two groups of 24 and 94 patients; the first-line treatment was early vitrectomy for the first group and intravitreal antibiotic injection alone for the second group. RESULTS: The overall incidence rate was 0.38 %, Streptococcus and Staphylococcus Epidermidis where the most common bacterial strain (16 patients each). The treatment outcome was very favorable for 11 patients with final visual acuity  higher or equal to 2/10, the outcome was intermediate for 43 patients and poor for 66 patients because of final visual acuity lower than or equal to 1/20, loss of media transparency or anatomical or functional loss of the eye. The prognostic factors statistically correlated to treatment outcome where intense initial inflammation (p<0.001), high bacterial virulence (p=0.002), bacteria culture positive to Streptococcus (p=0.024), a defectuous operative incision (p= 0.012), age over 80 (p=0.022) and posterior capsule rupture (p=0.013). Early vitrectomy group (group1) achieved a higher percentage of good outcome (60% vs 41.5%,  p=0.098 ). CONCLUSION: Functional result is better in the Vitrectomy group than in the antibiotic intravitreal injections group whereas not Statically signifiant.