[A new clinical entity: ascending solar iris degeneration. Report of 284 cases]. / Une nouvelle entité clinique : la dégénérescence irienne solaire ascendante. À propos de 284 cas.

The observation in a certain number of subjects of an atypical iris depigmentation led us to study this phenomenon. Therefore, the authors engaged in a prospective study of 398 subjects (100 cases in the city of Marrakesh, and 298 in the city of Dakhla). The geography, clinical signs and environmental factors were studied. Depigmentation was observed in 55% of the population of Marrakesh and 77% of the population of Dakhla. It is bilateral, symmetric, very progressive, always begins in the inferior one-third of the iris, and always spares the superior iris covered by the eyelid. By the time the depigmentation reaches the middle one-third, the inferior one-third also begins to demonstrate stromal atrophy: (26 cases). Of the 45 subjects with normal iris pigmentation, 31 cases spend more than 8 hours per day in the shade, and 26 cases constantly use some means of solar protection (sunglasses, caps, "Taraza", "Feroual"). Thus, this acquired iris depigmentation of an ascending nature, accompanied by an advanced stage involving primarily inferior iris atrophy, appears to be closely associated with exposure to the sun. Ascending solar iris degeneration, if we may refer to it as such, is a clinical entity never before reported in the literature. Now that we are faced with this new condition, numerous questions arise, to which future research must respond. Are there other factors in addition to sun exposure, which may lead to the depigmentation? Does this condition lead to further ocular pathology (due to the depigmentation and stromal atrophy)? Must solar protection be prescribed systematically for anyone at risk?

[Palpebral pilomatricoma simulating a chalazion in a young adult]. / Pilomatricome palpebral simulant un chalazion. A propos d'un cas chez un jeune adulte.

The pilomatricoma or epithelioma of Malherbe is a mummified benign and rare skin tumor. We report a rare case of palpebral pilomatricoma simulating a chalazion in a 26-year-old patient. This skin tumor is exceptional in adults. Its diagnosis is often missed preoperatively because of its great clinical polymorphism and is histopathologically based on the detection of mummified cells. Its surgical treatment will aim at a complete excision of the tumour in order to minimize the risks of recurrence.

[Childhood sarcoidosis: ophthalmological manifestations and diagnostic difficulties in two cases]. / La sarcoïdose chez l'enfant : manifestations ophtalmologiques et difficultés diagnostiques à propos de deux cas.

Sarcoidosis is a systemic expression of granuloma found in young adults, but which remains rare in children. Its incidence is underestimated because of the asymptomatic forms. Ocular involvement is present in 25% of the cases. The diagnosis is sometimes difficult and is based on clinical, radiological, and biological arguments and is confirmed by histopathological examination. The authors report the observations of two children, aged 5 and 10 years, discussing the diagnostic difficulty and most particularly, the differential diagnosis with tuberculosis, thereby illustrating the two forms of pediatric sarcoidosis.

[Endogenous postpartum panophthalmitis induced by sphingomonas paucimobili]. / Panophtalmie endogene postpartum a sphingomonas paucimobilis. A propos d'un cas.

Endogenous panophthalmitis is a rare eye disease with purulent necrosis of all the ocular structures. It is a rare but serious condition that occurs when bacteria cross the blood-ocular barrier and multiply within the eye. Although rare, endogenous panophthamitis is a potentially devastating intraocular infection resulting in a poor visual and anatomic prognosis. We present a 39-year-old woman, without any previous history, who developed a endogenous panophthalmitis in the left eye secondary to a puerperal endomyometritis secondary to infection with Sphingomonas paucimobilis. Despite systemic antibiotic therapy and intraocular injections, there was an evolution to purulent corneal melting.

[Giant apocrine hydrocystoma of the internal canthus]. / Hidrocystome apocrine géant du canthus interne.

Hydrocystoma is a benign tumor whose development involves the sudoriferous eccrine or apocrine glands. We report the case of a giant apocrine hydrocystoma in a 70-year-old female diabetic patient. The tumor's natural progression over 10 years and its volume caused significant functional and aesthetic damage. This article discusses the radiological, clinical, anatomopathological, and therapeutic aspects of this tumor. The case is original in the tumor's location, size, and its double visual and lachrymal functional involvement as well as its aesthetic damage.

[Congenital retinal macrovessel associated with central serous retinopathy]. / Macrovaisseau rétinien congénital associé à une choriorétinite séreuse centrale.

Retinal macrovessel is a rare disease. Since the first description in 1869 by Mauthner, fewer than 30 cases have been reported. We report a case of congenital retinal macrovessel in a 28-year-old patient with no pathological history. The patient consulted for functional macular syndrome (decreased visual acuity, central scotoma). In the right eye, the ophthalmologic examination found a visual acuity of ten over ten and serous detachment of the macular area. Examination of the left eye demonstrated the temporal vein crossing the macular area, without hemorrhage or exudates. Fluorescein angiography confirmed the diagnosis of bilateral central serous chorioretinitis with a congenital retinal macrovessel without leakage or arteriovenous anastomosis. Progression was marked by a disappearance of central serous retinopathy and visual recovery to ten over ten. In light of a literature review, we discuss the clinical classification of this disease and its developmental profile. The etiology of congenital retinal macrovessel is unknown. The diagnosis is clinical; its course is characterized by its stability. Its combination with central serous retinopathy is a fortuitous coincidence more than an individualized clinical form.

[Sneddon Syndrome and antiphospholipid antibodyies: an etiology of later al homonymous hemianopia]. / Syndrome de Sneddon et anticorps anti-phospholipides: une étiologie d'hémianopsie latérale homonyme.

Sneddon's syndrome is a particular and rare entity that mostly affects young women and whose diagnosis is based on the coexistence of a cuteaneous livedo and a cerebrovascular ischemic attack. It had be considered as being an expression of an occlusive vasculitis or of antiphospholipid antibody syndrome. We report the case of a 20-year-old female, who had developed a left homonymous hemianopia after ischemic encephalopathy. Visual field examination confirmed the presence of a complete left homonymous hemianopia. Cerebral Magnetic Resonance Imaging revealed right occipital cerebrovascular ischemic lesions. Sneddon's syndrome diagnosis was considered on the presence of cutaneous livedo reticularis and associated cerebral ischemic events. With medical treatment, a small functional improvement could be noticed but without net improvement in the visual field defect.

[Macular tuberculoma and optic neuritis: rare association with tuberculosis meningoencephalitis]. / Tuberculome maculaire et névrite optique : association rare au cours d'une méningo-encéphalite tuberculeuse.

INTRODUCTION: Tuberculosis is an endemic disease responsible for death and morbidity in developing countries. OBSERVATION: A 50-year-old man with no medical history was admitted to the emergency department for meningism associated with fever and confusion. The ophthalmic exam showed a decline in left visual acuity, reduced to light perception, VIth nerve left oculomotor paralysis, ocular fundus demonstrating a yellow tumor located on the posterior segment, measuring 1.5-2mm, papillomatous and prominent in the vitreous cavity. Fluorescein angiography showed a peritumoral choroiditis area, miliary tubercles of the choroid, and sectorial papillomatous edema. Color retinography unmasked inflamed posterior vitreous areas. Echography demonstrated a 4- to 5-mm oval hyperechogeneous and calcified tumor along with hyperechogeneous vitreous areas. Lumbar puncture showed lymphocytic meningitis associated with hyponatremia. The CT scan and MRI demonstrated optic neuritis. The antibiotic therapy was initiated and the outcome was favorable. CONCLUSION: This case report shows the importance of systematic ocular fundus in the presence of systemic tuberculosis and outlines the assessment of color retinography to unmask vitreous lesions. It shows the importance of radiological imaging in the semiological study of orbital and cerebral lesions.

[Hyperphosphatemia: an extremely rare cause of angioid streaks]. / L'hyperphosphatémie : une cause rarissime de stries angioïdes.

Angioid streaks are rare lesions of the fundus. They correspond to cracks in the Bruch membrane, which risk choroid neovessel emergence over time. We present the case of a 52-year-old diabetic patient who consulted for a macular syndrome of the left eye. The clinical examination revealed diffuse, bilateral nerve fibers with myelin, but particularly bilateral angioid streaks, complicated on the left by a juxtamacular choroid neovessel. The etiologic assessment revealed idiopathic hyperphosphatemia. We use this observation to discuss the originality of the case, the pathogenic assumption of its etiology, emphasizing the therapeutic difficulties.

[Orbital location of Kaposi's sarcoma]. / A propos d'une localisation orbitaire du sarcome de Kaposi.

Kaposi's sarcoma is a proliferative disease, probably induced by human herpes virus type 8 (HHV8). Its expression is cutaneous and visceral, with four clinical forms. An orbital location of Kaposi's sarcoma remains exceptional. In order to evaluate the epidemiological, clinical, and therapeutic objectives of this tumor location, we report a case of a 58-year-old patient hospitalized in the ophthalmology department for a surgically treated right orbital tumor.

[Peribulbar anesthesia: comparing 1% ropivacaine and a mixture of 0.5% bupivacaine--2% lidocaine]. / L'anesthésie péribulbaire: étude comparative entre la ropivacaïne 1% et l'association bupivacaïne 0,5%--lidocaïne 2%

PURPOSE: To compare the efficacy of 1% ropivacaine with a mixture of 0.5% bupivacaine and 2% lidocaine in peribulbar anesthesia for elective cataract surgery. MATERIAL AND METHODS: Prospective double-blinded study, enrolling 100 patients randomly assigned to two different groups. Group 1 received 9 ml of 1% ropivacaine and group 2 received 4.5 ml of 0.5% bupivacaine and 4.5 ml of 2% lidocaine. Both groups received 1 ml of hyaluronidase to reach a total volume of 10 ml. RESULTS AND CONCLUSION: No difference between the groups was noted during the study regarding not only onset time, but also the duration of anesthesia and perioperative analgesia. A greater incidence of pain on injection was significantly reported in group 2 (p<0.001). Patients in group 1 had less need for top-up injection and showed better ocular akinesia (p<0.01).