[Dome-shaped macula: appearance on ultrasound and optical coherence tomography]. / Macula en dôme : aspects échographique et tomographique.

INTRODUCTION: The purpose of our work is to demonstrate the role of optical coherence tomography and ocular ultrasound in the diagnosis of the dome-shaped macula in high myopia. OBSERVATION: We report the case of a patient with high myopia who presented with a decrease in visual acuity and metamorphopsia in the left eye. She underwent visual acuity measurement, biomicroscopic examination and measurement of axial length. B-mode ultrasound and optical coherence tomography showed a projection of the macula in the convexity of the myopic staphyloma confirming the diagnosis of dome-shaped macula. DISCUSSION AND CONCLUSION: Dome-shaped macula is a recently discovered entity, which may be responsible for a decrease in visual acuity in patients with high myopic posterior staphyloma. Ultrasound and optical coherence tomography are very helpful in making the diagnosis.

[Compressive optic neuropathy secondary to a pituitary macroadenoma]. / Neuropathie optique compressive secondaire à un macroadénome hypophysaire.

INTRODUCTION: Pituitary adenoma is a common benign tumor representing 8 to 10% of intracranial mass lesions. The compressive optic neuropathy associated with a pituitary adenoma can be clinically indistinguishable from glaucomatous optic neuropathy. CASE REPORT: A 56-year-old man with no significant past medical history had noticed a rapid decrease in visual acuity for 6 months. Funduscopic examination revealed glaucoma-like bilateral, asymmetric optic cupping. Brain MRI examination revealed a pituitary tumor compressing the optic chiasm. CONCLUSION: The diagnosis of a compressive optic neuropathy associated with a pituitary adenoma can be difficult, since it often simulates chronic glaucoma. However, several features should alert the clinician to the possibility of a compressive optic neuropathy and prompt neuroimaging, in order to obtain earlier diagnosis and treatment.

[Safety and efficacy of botulinum toxin in hemifacial spasm]. / Efficacité et tolérance de la toxine botulique dans l'hémispasme facial.

UNLABELLED: Given the failure of pharmacologic and surgical treatment in the management of hemifacial spasm, the use of botulinum toxin as first line therapy is interesting. PURPOSE: To evaluate the safety and efficacy of type A botulinum toxin in the treatment of hemifacial spasm. PATIENTS AND METHODS: We conducted a retrospective, descriptive and comparative study of 25 patients with hemifacial spasm followed in the ophthalmology department of Habib Thameur hospital in Tunis over the period from June 2003 to June 2009. All patients received injections of botulinum toxin type A (Botox). RESULTS: We carried out 168 Botulinum A toxin injections (Botox) with an average of 6.85 ± 4.32 injections per patient. Doses varied between 12.5 U and 28 U Botox. A good response to treatment was observed in 92% of patients with a satisfactory return to daily activities and work. Based on a subjective scale from 1 to 3, the average total functional benefit was 2.55 ± 0.56. Average total duration of therapeutic response was 9.35 ± 3.64 weeks. Local side effects observed were comparable to those described in the literature: ptosis (32.4%), diplopia (8.2%), drooping of the labial commissure (11.2%), lagophthalmos (21.3%), tearing (7%), dry eye (4%). No systemic complication was noted. CONCLUSION: Botulinum toxin type A provides effective short-term and medium-term results in the treatment of hemifacial spasm. It is well tolerated locally and systemically. This safety and efficacy make it a valuable therapeutic alternative in the management of hemifacial spasm.

[Progression of diabetic retinopathy after cataract surgery by phacoemulsification]. / Évolution de la rétinopathie diabétique après chirurgie de la cataracte par phacoémulsification.

PURPOSE: To study the effect of cataract surgery by phacoemulsification and intraocular lens implantation on the progression of diabetic retinopathy (DR) using the nonoperated fellow eye as a control, by a retrospective comparative study. PATIENTS AND METHODS: We studied 46 diabetic patients who underwent monocular cataract surgery by phacoemulsification with implantation of an intraocular lens within the capsular bag, with the nonoperated fellow eye used as a control. In all cases, the fellow eye exhibited only a very mild cataract, allowing for visualization of the fundus. Preoperative and 1, 3, 6 and 12 months postoperative ophthalmic examination and fundus photographs, supplemented if necessary by retinal fluorescein angiography, were performed to assess DR using the Alfediam classification. Patients were followed for at least 1 year. RESULTS: Among the 46 patients, preoperative DR was absent in 40 patients, and six patients had bilateral, symmetric non-proliferate diabetic retinopathy (NPDR): mild in four patients, moderate in one patient and moderately severe in another patient. Thirty-five eyes (76%) had postoperative best corrected visual acuity of 8/10 or better. Progression of DR occurred at about 23.9% (11/46) in the operated eyes and 19.6% (9/46) in the nonoperated eyes. As compared by the MacNémar test, there was no significant difference between operated and nonoperated eyes (P=0.68). CONCLUSION: This study demonstrates that cataract surgery by phacoemulsification does not represent an apparent risk factor for progression of DR.

[Corneal lesions in Kindler syndrome: a case report]. / Atteinte cornéenne au cours du syndrome de Kindler: à propos d'un cas.

INTRODUCTION: Kindler syndrome is a rare autosomal recessive genodermatosis belonging to the class of bullous poikiloderma. Corneal lesions are rare. We report a case of ocular lesions in this syndrome. OBSERVATION: We report the case of a 57-year-old patient followed since childhood in dermatology with the diagnosis of Kindler syndrome. He presented to the ophthalmology department with decreased vision. Ophthalmologic examination showed symblepharon, ectropion in both eyes, and corneal deformation. CONCLUSION: The role played by the abnormal protein in epithelial integrity suggests that ocular and more particularly corneal involvement is not rare in Kindler syndrome. In fact, it is less known by ophthalmologists and dermatologists are not aware of the ophthalmologic manifestations.

[Acquired ptosis in allergic blepharoconjunctivitis in children and adolescents]. / Le ptosis acquis dans la blépharoconjonctivite allergique chez l'enfant et l'adolescent.

Acquired ptosis is a common ophthalmologic problem. It is in the large majority of cases aponeurotic and occurs in the elderly as an involutional disorder or after ophthalmic surgery. In younger patients, it may occur after ocular trauma, periocular infection, contact lens wear, or palpebral edema. Allergic blepharoconjunctivitis is an unsuspected cause of acquired ptosis. Our study investigated patients (5 to 15 years old) with a history of allergic blepharoconjunctivitis and having a unilateral or bilateral ptosis. Physiopathological hypotheses are discussed. Management of acquired ptosis is presented.

Capsulorhexis contraction syndrome despite capsular tension ring implantation.

A 35-year-old woman with zonular weakness in the left eye had phacoemulsification with inthe- bag implantation of an acrylic intraocular lens (IOL) and a capsular tension ring. 6 months postoperatively, the patient developed significant visual loss secondary to capsule shrinkage and contraction of the capsulorhexis opening, associated to a slight IOL decentration. Neodymium: YAG laser radial anterior capsulotomy and anterior capsulectomy were performed leading to visual acuity restoration.

[Central retinal vein occlusion and internal carotid artery hypoplasia: a case report]. / Occlusion de la veine centrale de la rétine et hypoplasie de l'artère carotide interne: à propos d'un cas.

INTRODUCTION: Retinal vein occlusion is usually encountered in the elderly and is often associated with systemic vascular disease. It is rarer in young subjects and requires a serious etiological search to best adapt the treatment. OBSERVATION: We report the case of a central retinal vein occlusion (CRVO) in a 26-year-old patient who had no pathological history, discovered at a sudden decline of vision in the right eye, reduced to light perception. Fundus examination and retinal angiography showed an edematous CRVO. Radiologic imaging revealed a narrowing of the right carotid canal, probably congenital, and a reduction in the size of the right common carotid artery and internal carotid artery. Progression was favorable without treatment, and visual acuity improved to 8/10. CONCLUSION: The etiological investigation in retinal vein occlusion in young people must be exhaustive. The visual prognosis is variable and may depend on the etiology.

[Retinal vasculitis in Crohn's disease: a case report]. / Vascularites rétiniennes au cours d'une maladie de Crohn.

INTRODUCTION: Crohn's disease is a chronic inflammatory bowel disease. Numerous extra-intestinal complications can affect different organ in the body (kidneys, eyes...). Posterior ocular manifestation is rare and retinal vasculitis is exceptional. OBSERVATION: We present a case of a 55-year- old men in whom Crohn's disease was diagnosed in 1985 and considered severe treated by corticosteroid end then by immunosuppressive therapy. He lost his right eye few years ago. He presented a sudden loss of vision of the good eye. Physical examination found visual acuity reduced to light perception without sign of anterior inflammation. Ophthalmoscopic examination found different retinal vasculitis involving veins, papillitis, cystoid macular oedema; all these findings were confirmed by fluorescein angiography and OCT. Corticosteroid treatment with a dose of 1mg/Kg/day was instituted with precaution of use and a wide follow up with favourable evolution during 9 months. CONCLUSION: Retinal vasculitis is rare during Crohn's disease. It can be a severe ocular lesion and causes therapeutic and prognosis problems, especially in a patient with only one functional eye.

[Factors associated with graft reepithelialization after penetrating keratoplasty]. / Les facteurs intervenant dans la réépithélialisation cornéenne après kératoplastie transfixiante.

INTRODUCTION: To study graft reepithelialization time after penetrating keratoplasty and the factors influencing this reepithelialization. PATIENTS AND METHODS: In this retrospective study, 48 patients underwent penetrating keratoplasty (52 eyes) by the same surgeon between 1998 and 2006. Recipient pre- and postoperative variables, donor characteristics, and surgical variables were analyzed. Postoperative slit-lamp examination after fluorescein staining and graft reepithelialization time were recorded. Statistical analysis was done using SPSS version 11.5 (p<0.05). RESULTS: The average graft reepithelialization time was 8.02 +/- 6.87 days. Complete corneal epithelial healing was obtained in 2.2%, 38.3%, and 63% of patients in 1, 3, and 7 days, respectively. There was a statistical correlation between graft reepithelialization time and trephination size, death-to-storage time, and storage time (p<0.05). DISCUSSION: Postoperative epithelial defects are common after penetrating keratoplasty. Many factors influence this graft reepithelialization such as abnormal lid and surface dysfunction, recipient corneal epithelium, and surgical technique. A better understanding of these factors will prevent postoperative epithelial defects and complications.

[Nd:Yag laser treatment of anterior capsule contraction syndrome after phacoemulsification]. / Traitement au laser Nd:Yag du syndrome de contraction de la capsule antérieure après phacoémulsification.

INTRODUCTION: Anterior capsule contraction syndrome after phacoemulsification is rare and can compromise visual acuity. Nd:Yag laser capsulotomy is a good alternative in limited forms of contraction. OBSERVATIONS: We report four cases of anterior capsule contraction syndrome developed after a mean follow-up of 8 months after phacoemulsification and acrylic intraocular lens implantation. Nd:Yag laser capsulotomy was performed to help resolve the contraction and its symptoms. No relapses occurred during the follow-up. CONCLUSION: Nd:Yag laser capsulotomy is effective and safe in managing limited forms of anterior capsule contraction syndrome after phacoemulsification. Surgery is an alternative to Nd:Yag capsulotomy in severe cases.

[Trypan blue capsule staining for phacoemulsification in white cataract]. / Phacoémulsification des cataractes blanches en utilisant le bleu trypan.

OBJECTIVE: To study the results of phacoemulsification in eyes with white cataract using trypan blue for capsule staining. PATIENTS AND METHODS: Thirty patients who had white cataract were included in this prospective study. They had phacoemulsification and continuous curvilinear capsulorhexis using trypan blue. Intraoperative problems related to capsulorhexis and phacoemulsification as well as postoperative outcomes where analyzed. Postoperative examinations were done at 1 day, 1 week, and 1, 3, 6, and 12 months. The mean follow-up was 10 months. RESULTS: Complet capsulorhexis was achieved in 26 cases. Intraoperative complications included incomplet capsulorhexis in four cases (13.3%) and conversion to a conventional extraction technique in two cases. There were no cases of posterior capsular tear. Twenty-eight eyes (93.3%) had a final best corrected visual acuity at 8/10 or better. Postoperative complications included moderate transient corneal edema in six cases (20%) and iritis in three cases (10%). There were no complications related to the use of trypan blue. CONCLUSION: Phacoemulsification using trypan blue was safe and effective in managing white cataract and had a high success rate.

[Cortisone glaucoma: epidemiological, clinical, and therapeutic study]. / Glaucome cortisonique: étude épidémiologique, clinique et thérapeutique.

INTRODUCTION: Cortisone glaucoma is a secondary glaucoma induced by local or oral steroids used to treat chronic inflammatory diseases. PATIENTS AND METHODS: Retrospective study including 43 eyes of 23 patients (three patients were monophthalmos). We present epidemiological and clinical features with evaluation of functional damage (visual acuity, visual field), and therapeutic results with a follow-up period ranging from 2 to 10 years. RESULTS: Topical steroids were incriminated in 15 of 23 cases (self-medication), whereas general steroids (for chronic diseases) were used by eight patients. Visual function was seriously affected (visual acuity<1/10 in 23/43 eyes at the first visit with pronounced visual field abnormalities). Surgery was necessary in 16 of 43 eyes (deep sclerectomy with or without implant, trabeculectomy). DISCUSSION: Cortisone glaucoma is rather frequent in Tunisia where conjunctival allergy and self-medication are common. Young adults are concerned, making it a high surgical risk usually requiring surgical devices such as a T Flux implant. CONCLUSION: Cortisone glaucoma is a serious complication of steroid therapy that usually affects young adults. The disease is usually detected late, explaining the severe functional damage.

Manifestations ophtamologiques au cours du syndrome d'Apert : a propos d'un cas

Introduction : Parmi les craniostenoses; le syndrome d'Apert demande la collaboration de plusieurs specialistes; pour sauver ce qui peut l'etre de la fonction visuelle des patients et permettre un developpement cerebral le plus proche de la normale. Observation : Nous presentons le cas d'une jeune suivie et traitee depuis son jeune age pour un syndrome d'Apert. Elle a subi plusieurs interventions successives pour garder a un age assez avance une fonction visuelle appreciable a 3/10. Les modifications anato- miques ont ineluctablement influe sur l'etat visuel de la patiente avec une myopie forte; un astigmatisme relativement important et une atrophie papillaire partielle.Discussion : D'origine genetique; le syndrome d'Apert est du a une mutation allelique du recepteur 2 d'un facteur fibroblastique. Les signes de souffrance cerebrale sont inevitables; et l'atrophie optique relative represente la sequelle fonctionnelle principale. Conclusion : Une prise en charge de longue haleine est necessaire dans le syndrome d'Apert pour esperer sauver une fonction visuelle utile

[Etiopathogeny of intraocular pressure modifications in uveitis]. / Etiopathogénie des modifications de la pression intraoculaire au cours des uvéites.

Uveitic glaucoma is a secondary form of glaucoma. Treatment is essentially medical, based on antiglaucomatous medications and immunomodulatory therapy. Therefore, some patients may need filtrating surgery to control intraocular pressure. Understanding the cellular and biochemical modifications of aqueous humor that occur during intraocular inflammation and identification of anatomical modifications of the iridocorneal angle, trabecula, pupil, and ciliary body allow physicians to adapt management depending on the different clinical patterns of uveitic glaucoma. We propose a general review of the role of inflammatory mediators and etiopathogenic mechanisms involved in uveitic glaucoma.

[Deep sclerectomy for the management of uveitic glaucoma]. / Sclérectomie profonde non perforante dans le traitement du glaucome uvéitique.

PURPOSE: To report middle-term results of deep sclerectomy in uveitis patients with glaucoma who are resistant to medical therapy. PATIENTS AND METHODS: Eight eyes of eight patients (mean age, 56.9 years; range, 46-67 years) with uveitic glaucoma resistant to medical therapy underwent deep sclerectomy without antimetabolites between 1994 and 2001. All patients had their uveitis controlled before and after surgery by anti-inflammatory therapy. RESULTS: Mean follow-up was 42.2 months. Intraocular pressure was reduced from a mean preoperative value of 32.3 mmHg to a mean postoperative value of 15.2 (52.9% reduction). Success was obtained in seven eyes (87.5%). It was complete in four eyes (57.2%) and relative in three eyes (42.8%). Failure was noted in one eye (12.5%), controlled later by trabeculectomy. Antiglaucomatous medication was reduced from a mean of 2.9 medications preoperatively to 0.6 medications (79.3% reduction). Postoperative complications included one case of lens opacity and one case of hyphema. CONCLUSION: The low rate of surgical complications and the lack of failure risk factors except inflammation and long-term use of antiglaucomatous medication may explain the high success rate of deep sclerectomy in this study.

[Trabeculectomy for the management of uveitic glaucoma]. / La trabéculectomie dans la prise en charge du glaucome uvéitique.

PURPOSE: To report middle-term results of trabeculectomy in patients with uveitic glaucoma resistant to medical therapy. PATIENTS AND METHODS: Seventeen eyes of 14 patients with uveitic glaucoma resistant to medical therapy were treated by trabeculectomy without antimetabolites from 1994 to 2001. The patients'mean age was 48.1 years (range, 23-63 years). All had their uveitis controlled for at least 3 months before surgery by an anti-inflammatory therapy. RESULTS: Mean follow-up was 52.1 months. Success was obtained in 11 eyes (64.7%). It was complete in five eyes (45.5%) and relative in six eyes (54.5%). Failure was noted in six eyes (35.3%), which were treated with a second filtering surgery. Intraocular pressure was reduced from a mean preoperative value of 34.2 mmHg to a mean postoperative value of 18.6 (45.6% reduction). Antiglaucomatous medication was reduced from a mean of 2.8 medications preoperatively to 1.1 medications (60.7% reduction). Postoperative complications included three cases of lens opacity, two cases of hyphema, two cases of transitory hypotony, one case of flat anterior chamber, and one case of inflammation relapse. CONCLUSION: In the absence of failure risk factors except inflammation, trabeculectomy without antimetabolites can be successful in uveitic glaucoma not controlled by medical therapy, with good results even at the middle term.

[Bilateral retinal vascular occlusion during antiphospholipid antibody syndrome: a case report]. / Occlusion vasculaire rétinienne bilatérale au cours du syndrome des antiphospholipides. A propos d'un cas.

PURPOSE: Antiphospholipid syndrome is defined by the association of at least one clinical event (arterial and/or venous thrombosis, fetal loss) and antiphospholipid antibodies. It can be isolated or associated with systemic lupus disease. The purpose of this case report is to demonstrate that an ocular vascular event can reveal the disease and that its diagnosis is important because this disease generally affects young people and may endanger ocular and vital prognosis. OBSERVATION: We report the case of a 20-year-old female treated for systemic lupus erythematosus for 2 years, who stopped her medical treatment and presented a sudden bilateral loss of vision. Fundus examination and fluorescein angiography revealed severe bilateral retinal vascular occlusion. Antiphospholipid antibody syndrome was confirmed with the presence of anticardiolipin antibodies. With medical treatment, there was initially a small functional improvement and then a general degradation in 3 months, followed by the death of the patient secondary to severe pulmonary emboli. DISCUSSION AND CONCLUSION: Central retinal artery or vein occlusion in a young patient must suggest the diagnosis of antiphospholipid antibody syndrome. The bilateralism of vascular occlusion is considered a severe factor because of its consequence on functional ocular and vital prognosis, where it can sound the alarm to the extension of thrombotic events to other vessels in the body. Antiphospholipid syndrome must be studied in cases of severe retinal vascular occlusion in young patients. Its diagnosis is important because the risk of recurrent thrombotic events may endanger functional and vital prognosis.