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.

Microbiologic profile of the mycosic absess on a reference center in Tunisia.

AIM: Given the increase in cases of fungal keratitis in recent years due to the inadvertent use of large -spectrum antibiotics and corticosteroids on the one hand and the emergence of contactology on the other hand, this study has was carried out in order to better understand the microbiological profile of fungal keratitis, particularly as a function of risk factors in a referral center in Tunisia. METHODS: We report a retrospective study of 43 patients (45eyes) hospitalized for fungal corneal abscess between January 2007 and December 2017. All patients benefited from corneal sampling by scraping the cornea with direct examination and culture. RESULTS: During the study period, 482 patients with corneal abscess were treated at the Ophthalmology Department of the Hédi Raies A Institute in Tunis. 45 eyes of 43 consecutive patients had keratomycosis (9.3%). The direct examination was positive in 71.1% of the cases and the culture in 73.3%. In 78.8% of the cases filaments were isolated: the fusarium being the most found species is in 39.4% of the patients particulary in cases of ocular trauma. Yeast species were more frequently found in surface pathology or local or general deficency. CONCLUSION:   It is important to guide the microbiological diagnosis of mycotic keratitis according to the clinical context, particularly in the case of negativity of the samples in order to establish a suitable treatment to improve the prognosis of this pathology, which represents one of the most difficult forms of infectious  keratitis to manage.

The interest of the OCT spectral Domain for the diagnosis of the acromatopsia.

AIM: the interest of the OCT spectral Domain for the diagnosis of the acromatopsia. CASE REPORT:   It's about 2 brothers consulting for low vision. The big brother, has a vision of 1/ 20 in two eyes. The anterior segment and the fundus examination were normals. The OCT SD shows a disappearance of the ellipsoid line in the macular region with an optic hole. The Global ERG has demonstrated flat plots in photopic component and normal in scotopic component. The ishihara test has showed an absence of the chromatic sense. The acromatopsia was the selected diagnosis.  The exam of the second brother showed a visual acuity limited 1/20 in the right eye and counting finger in the left eye, associated to photophobia and nystagmus. The OCT and global ERG gave the same results. CONCLUSION: The typical clinical picture with the ERG's data gave the diagnosis of the acromatopsia. An early diagnosis is necessary for a suitable life of the patient and genetic consulting. This paper demonstrated the importance of the OCT SD for the diagnosis when it's correclated to the clinic.

[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.

Results of vitrectomy in giant tear retinal detachments.

INTRODUCTION: Giant tear retinal detachments have long been recognized for their management difficulties and poor anatomical surgical prognosis. METHOD: Retrospective, descriptive study of 15 patients collected from IOHRT Department A. These patients were treated for rheumatogenic retinal detachment by giant tear. All patients underwent endocular vitreoretinal surgery. A visual acuity, FO and OCT check was performed at 7 days, 21 days, 45 days and 3 months, 6 months and 1 year postoperatively. RESULTS: Our study included 15 eyes from 15 patients with rheumatogenic giant tear retinal detachments. The average follow-up is 9 months. The average age of the patients was 45 years. Six patients were severely short-sighted; 30% of patients had stage C vitreous proliferations at diagnosis. Immediate postoperative anatomical reapplication was achieved in 85% of patients. After 1 year, anatomical reapplication was achieved in 100% of patients. The average visual acuity was 2/10. CONCLUSION: Surgery for rheumatogenic retinal detachment caused by a giant tear is a procedure that is still considered difficult with uncertain results. The progress of endocular surgery and tamponade methods has made it possible to revolutionize the prognosis of these detachments.

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.