[Results of congenital cataract surgery using 2,2 microincision in children before the age of 5 years]. / Résultats de la chirurgie de la cataracte congénitale par micro-incision cornéenne de 2,2 chez les enfants de moins de 5 ans.

BACKGROUND: Thanks to the recent advances of the microsurgical techniques, the results of the congenital cataract surgery in children less than 5 years old have considerably improved. However, the age of implantation and the intraocular lens power calculation remain subjects of controversies. AIM: To evaluate the results of 2.2 mm micro-incision congenital cataract surgery in children less than five years old. METHODS: Forty seven consecutive eyes of 26 children who had dense congenital cataract surgery were included in this retrospective study. All children had had the same surgical procedure: anterior approach through 2.2 mm corneal tunnel, posterior capsulorhexis associated to anterior vitrectomy and a primary foldable intraocular lens implantation. The final evaluation was at the same time anatomical and functional depending on the children age. RESULTS: The median patient age of the children was of 23 months (6 to 54 months) and the sex ratio was 1.36 (15 boys / 11 girls). The cataract was bilateral in 77.7 % of the cases (21/27 children). The intraocular lens was implanted in the capsular bag in 93.6 % of the cases (44/47 eyes) and in the sulcus in 6.3 % of the cases (3/47 eyes). The postoperative complications were mild: inflammatory reaction limited to the anterior chamber in 17 % of the cases (8/47 eyes), opacification of the visual axis with a reproliferation of the epithelial cells behind the implant was observed in 4.25 % of the eyes (2/47 eyes). We noted no case of intraocular lens decentration or secondary glaucoma. The study of the refraction at last follow up showed a sphere average of 2.73 ± 1.21 diopters and mean astigmatism of 1.51 ± 0.82 diopters. The median best corrected distance visual acuity, evaluated in 12 children, was 5.2/10 ranging from 1/10 to 10/10. The amblyopia was also noted to 12/26 children (46.1 %). Among these children, 11/12 (91.6%) had a delay of surgery and 5/12 (41.6 %) had an unilateral cataract. CONCLUSION: Currently the anatomical prognosis of the congenital cataract surgery in children less than 5 years old is getting closer to that of the adult. However, the functional prognosis remains still unpredictable depending mainly on the deadline of surgery which remains very late in our series. Thanks to the improvement of the surgical techniques using microincision in cataract surgery and the new generation of foldable implants, the anatomical and functional prognosis of the congenital cataract have significantly improved.

[Acanthamoeba keratitis: diagnosis to consider]. / La kératite amibienne: il faut y penser.

INTRODUCTION: Acanthamoeba keratitis is a rare but severe disease that can cause blindness. The objective of this study is to call attention to its severity and conditions of development and to emphasize the importance of early treatment. CASE REPORT: We report a case of a 27-year-old woman. After wearing soft contact lenses for a month, she consulted for redness, pain and poor visual acuity in her left eye. The ophthalmological examination showed an epithelial corneal abscess measuring 2 mm in diameter in the left eye and very tiny epithelial corneal abscesses in the right eye. Microscopic examination and culture of samples from the contact lenses and the contact lens solution found Acanthamoeba spp. Rapid anti-amoeba treatment led to disappearance of the corneal abscesses and improvement of her vision. CONCLUSION: This case confirmed that the prognosis of Acanthamoeba keratitis depends on rapid diagnosis and early treatment.

[Ocular manifestations of diabetes: 285 cases]. / Atteintes oculaires dans le diabète: à propos de 285 cas.

BACKGROUND: Diabetes is one of the principal cause of blindness in adults. The aim of the study is to evaluate the frequency of ocular complications and risk factors of diabetes. It's a multicentric prospective study on a representative sample of 285 diabetics. METHODS: We performed a general and an ophthalmologic exam for all patients with retinal angiography and appropriate laboratory tests. Chi 2, Fisher, Mann and Whitney tests were used as statistical methods. RESULTS: Diabetic retinopathy was observed in 45,2% of patients, cataract in 22%, glaucoma in 5%. Diabetic retinopathy frequency rises especially with duration of diabetes and bad glycaemic control. Blindness related to diabetic retinopathy was observed in 6,25% and visual deficiency in 12,5%. The authors compared their results with literature data. They emphasize on the great value of regular better glycaemic control and other associated metabolic disorders. CONCLUSION: We concluded that a regular ophthalmologic follow up is necessary for early diabetic retinopathy detection and treatment.

[Epidemiology of work-related eye injuries]. / Epidémiologie des accidents oculaires du travail.

BACKGROUND: Occupational injury represents 7,7 at 69,9% of the total ocular traumatisms. They can be a major source of visuel loss and blindness. The aim is to study the epidemiology of work-related ocular injuries: objects frequencies,works most exposed. METHODS: We performed a prospective study that interest 78 patients having a work-related ocular traumatism during a 4 months period. They were admitted at ocular emergeney All patients underwent an ophtalmologic examination completed with orbital radiography and echography. A medical and/or chirurgical appropriate treatment was institued. RESULTS: Occupationnal injury frequency was 9% of the whole ocular traumatisms in the same period. The mean age was 31 years. 55% of cases were under 30 years. 91% were male. Most exposed works were industrial and mecanical sectors In 70,5% of cases work-related eye injuries were caused by projectile objects. Most common lesion was corneal superficial foreign body (58%). Open globe injury was noted in 8%. 95% of patients had no eye protection at the time of the accident. 13% were blind or unilateral partially sighted (according to the OMS classification). CONCLUSION: The authors discussed the importance and different prevention strategies to prevent the risk of blindness and socio-economical cost of occupationnal accidents. There is a need for systematic periodic sensibilization to reduce these accidents and blindness.

[Association hyperlipidemia and retinal hard exudates in diabetic retinopathy]. / Association hyperlipémie et exsudats rétiniens dans la rétinopathie diabétique.

Diabetes mellitus is usually accompagned with dyslipidemia, which can be correlated with diabetic retinopathy (DR). The aim of the study is to determine the relation between DR and hyperlipidemia. We studied prospectively 64 diabetic patients classified into 2 groups: the first associated diabetics having dyslipidemia (n=34) and the second without dyslipidemia (n=30). The mean follow up was 11 months. We observed a high frequency of retinal hard exudates in diabetics with dyslipidemia in comparison with the second group (32% versus 10%). The control of dyslipidemia is recommended in diabetic patients.

[Aspects of outcome and therapy of edematous branch retinal vein occlusion]. / Aspects evolutifs et thérapeutiques des occlusions de branches veineuses rétiniennes oedémateuses.

The main cause of oedematous branch retinal vein occlusion (BRVO) vision loss is macular oedema persistence. We studied 18 patients having oedematous branch retinal vein occlusion. An ophthalmologic exam completed with angiography and etiologic assessment were performed. Argon Laser macular grid photocoagulation was performed in 11 eyes where macular oedema had persisted for over 3 months with visual acuity under 5/10. In 45% of cases, occlusion interests superotemporal vein. Atherosclerosis risk factors are found in 88% of cases. The course was spontaneously favourable in 39% of cases. Improvement of visual acuity was obtained in 36% of cases treated with laser photocoagulation. Oedematous branch retinal vein occlusion outcome is variable; it can be favourable if veino-veinous anastomosis develops rapidly, or unfavourable with macular edema persistence and decreased visual acuity. In the later case, grid macular phototcoagulation should be performed leading to macular edema regression. So, macular edema secondary to branch retinal vein occlusion can disappear spontaneously and needs laser treatment only if it persists.

[Indications and results of vitrectomy in Terson syndrome]. / Indications et resultats de la vitrectomie dans le syndrome de Terson.

Terson syndrome or vitreal hemorrhage associated with subdural hemorrhage is a rare condition. The goal of our work through a retrospective series of 3 cases (4 eyes) is to study clinical characteristics as well as adequate moment of surgery. All our patients had unilateral or bilateral visual impairement secondary to cerebral lesion. Ophtalmologic exam showed an intravitreal hemorrhage. Two of our patients were operated by vitrectomy, the third case had a spontaneous resorption of intravitreal hemorrhage and no surgery was performed. Functional prognosis depends on neuro-ophtalmologic sequellas. Ophtalmic exam is essential in cerebral hemorrhage. For intravitreal hemorrhage spontaneous resorption is frequent and vitrectomy must be delayed.

Telemedicine in the service of peace.

Ophthalmology is well suited to telemedicine, since optical and imaging devices provide the basis for virtually all ophthalmic patient evaluations. We established the Middle East Ophthalmology Network among ophthalmologists working in 10 major ophthalmology centres in Israel, Jordan, Morocco, the Palestinian Authority and Tunisia. The project offered some 50 physicians around the Middle East the opportunity to benefit from sharing clinical consultation for diagnosis and management decisions beyond physical and political boundaries. In the first year, over 100 consultations took place. The system overcame some of the constraints imposed by the uneven distribution of medical resources and expertise in the region, reduced professional isolation, encouraged more collaboration between physicians and offered peace dividends from cooperation between physicians across the political divide.