[Visual loss after spine surgery. Imaging findings]. / Cécité compliquant une chirurgie du rachis. Apport de l'imagerie.

Postoperative visual loss is a rare but disastrous complication that can be observed after spinal surgery. We report the case of a 39-year-old woman involved in a traffic accident that caused trauma to the cervical spine causing right hemiplegia, who underwent a prolonged spinal operation in the prone position and complained of monocular blindness 1 day postoperatively. The ophthalmologic examination showed no involvement of the ocular globe. The orbitocerebral MRI showed definite diagnostic arguments for orbital vascular injury. The symptoms did not completely disappear after 1 year of treatment. We consider the potential etiological factors contributing to this unilateral postoperative visual loss and suggest strategies to reduce the incidence of this complication in spinal surgery.

[Cavernous hemangioma in the orbital apex revealed by optic neuropathy]. / Hémangiome caverneux de l'apex orbitaire révélé par une neuropathie optique.

Cavernous hemangioma is the most common primary vascular neoplasm. It typically occurs in middle-aged women, causing a progressive painless proptosis as the principal symptom. It exceptionally compresses the optic nerve. We report the case of a cavernous hemangioma revealed by optic neuropathy in a 33-year-old female.

[Corneal abscess presumed to be of bacterial origin]. / Les abcès cornéens présumés d'origine bactérienne.

AIM: To assess clinical, microbiological and therapeutical characteristics of patients presenting with a clinically diagnosed corneal abscess at the Nabeul Hospital Department of Ophthalmology (Tunisia). METHODS: A retrospective study of patients presenting corneal abscess was conducted over 6 years. The clinical aspects, the microbial isolation, the treatment, and the outcome were analyzed. RESULTS: sixty-one eyes of 61 patients were hospitalized from January 2000 to October 2006. The mean age was 59.2 years old. The mean delay for referral was 8.7 days. Risk factors were noted in 90% of cases: corneal trauma (24.6%), ocular surgery (19.7%) and chronic keratopathy (14.7%). Bacteriological cultures of corneal smears isolated an organism in 39.9% of cases. Coagulase-negative Staphylococcus (16.3%), streptococcus (13.1%), Pseudomonas aeruginosa (8.1%) were the most frequent species. Poor visual outcome was correlated with anterior chamber inflammation and initial low visual acuity. CONCLUSION: Corneal trauma was the most common risk factor of corneal abcess. Early diagnosis and prompt treatment are important for successful management of bacterial keratitis to avoid corneal vision loss.

[Iridocyclitis in a patient with Behçet's disease and a familial form of retinitis pigmentosa]. / Iridocyclite chez une patiente atteinte d'une maladie de Behçet et d'une forme familiale de rétinopathie pigmentaire.

INTRODUCTION: Iridocyclitis associated with retinitis pigmentosa is rarely described in the medical literature. We report an unusual case of this association. OBSERVATION: A 55-year-old woman with a history of Behçet's disease presented with acute red and painful eyes and moderately blurred vision. Ophthalmologic examination concluded in bilateral acute hypertensive uveitis. Funduscopy and fundus fluorescein angiogram showed retinitis pigmentosa. The same fundus changes were found in the patient's siblings. Recurrences were frequent and topical steroids were always successful. CONCLUSION: This case is particular in its association of anterior uveitis as the exclusive manifestation of ocular Behçet's disease and familial retinitis pigmentosa.

[Late recurrent retinal detachment after scleral buckling]. / Récidives tardives des décollements de rétine après chirurgie épisclérale.

PURPOSE: To analyze the physiopathologic mechanism, therapeutic modalities, and prognosis of late recurrent retinal detachment. METHODS: A retrospective study was conducted on late recurrent retinal detachment operated with episcleral surgery over a 15-year period. Ten patients were included in this study. RESULTS: Late recurrent retinal detachments occurred in 0.39% of all retinal detachments repaired by episcleral surgery over 15 years. Redetachment occurred 3-7 years after surgery, with etiologies including new retinal breaks (seven cases), reopening of old breaks (three cases), and removal of scleral explant (one case). Proliferative vitreoretinopathy (PVR) grade B was seen in three cases, grade C in six cases, and grade D in one case. After reoperation, the retina was reattached in nine cases. Three eyes were treated with scleral buckle, the others underwent vitreoretinal surgery. Failure occurred in one patient who had a very high level of vitreoretinal proliferation. CONCLUSION: Late recurrent retinal detachments are rare and vitreous base traction seems to be an important factor, although the associated PVR was probably a secondary factor. Treatment depends on PVR, with vitreoretinal surgery necessary in some cases. They usually have a good prognosis.

[Inferior rhegmatogenous retinal detachments: clinical and therapeutic characteristics]. / Les décollements de rétine rhegmatogènes inférieurs: particularités cliniques et thérapeutiques.

PURPOSE: To determine the epidemiological and clinical factors involved in inferior rhegmatogenous retinal detachments and to propose a therapeutic plan. PATIENTS AND METHODS: A retrospective case note review of 173 patients (175 eyes), 11-89 years old, who had been operated on for inferior retinal detachment over a 13-year period between 1990 and 2003. RESULTS: The retinal reattachment rate after initial surgery was 79.5%, the final anatomical success rate was 81.5%. Scleral buckling surgery was used for the primary repair of rhegmatogenous retinal detachments in 111 cases and it was successful in 81 cases. Fifty-eight patients underwent vitrectomy with internal silicone oil tamponade. Anatomical success was obtained in 55 cases (94.8%) without recurrence. Endocular surgery allowed surgeons to find missed causal tear in 76% of cases. Mixed surgery was undertaken in four cases, with three good results. Visual acuity improved in 81% of cases, remained unchanged in 15% of cases, and deteriorated in 4% of cases. The mean final visual acuity ranged from 2.5 to 3/10, while it was only 1/20 before surgery. The mean improvement in visual acuity was 2.5 lines. The mean follow-up in our study was 13+/-11 months. CONCLUSION: Inferior retinal detachment usually occurred in young myopic or old pseudophakic subjects. These patients are characterized by the absence of tears. Vitrectomy in primary repair with inferior retinal detachment improves their anatomical and functional prognosis.

[Characteristics of retinal detachment following neodymium YAG laser posterior capsulotomy: clinical and therapeutic aspects]. / Les décollements de rétine rhegmatogènes post-capsulotomie postérieure au laser YAG: aspects cliniques et thérapeutiques.

PURPOSE: To study the clinical characteristics and the therapeutic results of retinal detachment following neodymium YAG laser posterior capsulotomy. MATERIAL AND METHODS: A retrospective study of 28 patients (28 eyes) operated in department B of the Hédi Rais Institute of Ophthalmology (Tunis, Tunisia) between march 1993 and january 2005 for retinal detachment following neodymium YAG laser posterior capsulotomy. We study the preoperative clinical characteristics of the retinal detachment and the anatomic and functionnal results. RESULTS: The mean age of the patients is 53.4 years. Fourteen patients are men and eleven have high myopia. Ten patients are aphakic and eighteen pseudophakic. The retinal detachment is total or subtotal in 19 eyes (67.9%). The macula is detached in 27 cases (96.4%). The retinal tears are posterior in 9 cases (paravascular retinal break or macular hole) and peripheral in fifteen cases. In 4 cases no tear is found. Vitreoretinal proliferation is advanced in 10 cases. Eleven patients underwent episcleral surgery and 17 endocular surgery. The final success rate is 89%. The postoperative visual acuity increases in 20 cases. It is superior to 1/10 in 14 cases. The minimum follow-up is 6 months. CONCLUSION: The retinal detachment after neodymium laser posterior capsulotomy is serious due to severe vitreoretinal proliferation wich influences the anatomic results.

[Traumatic cataract: clinical and therapeutic aspects]. / Les cataractes traumatiques: aspects cliniques et therapeutiques.

PURPOSE: To assess clinical and therapeutic outcomes in traumatic cataracts. METHODS: Retrospective study of 20 cases of traumatic cataracts seen between 2001 and 2004. Mean age at diagnosis was 35 years (5-72 yr), 25% were infants. There were 11 women and 9 men. Extracapsular cataract extraction was performed in eighteen patients (90% of cases), 13 were implanted in posterior chamber, 3 having zonular rupture were implanted in anterior chamber. Two patients remained aphakic because of retinal lesions. Two patients with lens subluxation underwent intracapsular cataract extraction with anterior chamber implantation. The mean delay of surgery was 4 weeks. RESULTS: Overall satisfactory with 55% of final visual acuity more than 1/10. Visual acuity was better in implanted eyes, poorer in infants and after ocular perforation. Fibrinous uveitis was the common early postoperative complication especially in children. CONCLUSION: The majority of eyes with traumatic cataract could be safely rehabilitated after surgery and lensimplantation. In traumatic cataract, the vision can be severely threatened, preventive methods should be encouraged.