[Impact of glaucoma medications and ocular surface disease on the quality of life of glaucoma patients in the district of Sousse (Tunisia)]. / Impact du traitement antiglaucomateux et de la pathologie de la surface oculaire sur la qualité de vie des patients glaucomateux dans la région de Sousse (Tunisie).

PURPOSE: To assess the impact of glaucoma treatment and ocular surface disease (OSD) on the vision-specific quality-of-life (VS-QoL) of glaucoma patients attending Farhat Hached university hospital Sousse-Tunisia. METHODS: This was a cross-sectional study enrolling one-hundred-twenty patients followed for primary open angle glaucoma. All patients successfully responded to the Arabic version of the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ 25). QoL was quantified in terms of scores (0-100) and correlated with the characteristics of glaucoma treatment and status of the ocular surface. RESULTS: One hundred and twenty patients were studied. The mean number of medications and instilled drops was 1.95 (1-4) and 2.69 (1-7) respectively. A total of 66.7% patients reported side effects of treatment. On examination, moderate or severe dry eye syndrome was identified in 90% of cases. A total of 16.7% of patients had superficial punctate keratopathy. The number of instilled drops per day, the use of brimonidine or oral carbonic anhydrase inhibitors, and the presence of OSD had a negative impact on the NEI-VFQ 25 scores. CONCLUSIONS: Glaucoma treatment and OSD are 2 factors potentially reducing the QoL of glaucoma patients, on which the ophthalmologist can act by optimizing treatment and regularly examining the ocular surface of glaucoma patients.

[Acute multifocal posterior placoid pigment epitheliopathy and central retinal vein occlusion: association in a sarcoidosis patient]. / Épithéliopathie en plaques et occlusion de la veine centrale de la rétine: une association au cours de la sarcoïdose.

Acute multifocal posterior placoid pigment epitheliopathy is a chorioretinal inflammatory disease characterized by whitish lesions with ill-defined margins, deep to the retina and concentrated in the posterior pole. We report the case of a 17-year-old man who presented with the typical findings of bilateral acute multifocal posterior placoid pigment epitheliopathy. He developed secondary central retinal vein occlusion in the right eye. Systemic manifestations and additional investigations resulted in a diagnosis of sarcoidosis.

[Ptosis associated with pachydermoperiostosis]. / Ptôsis associé à une pachydermopériostose.

INTRODUCTION: Pachydermoperiostosis or primary hypertrophic osteoarthropathy is a rare cause of ptosis. We report the case of a patient with pachydermoperiostosis and bilateral ptosis. The physiopathology and treatment of this ptosis are discussed. CASE REPORT: A 49-year-old patient was referred to our department with ptosis. He had pachydermia of the face, hands and the feet, digital clubbing and periostosis. Examination of the eyelids showed that palpebral apertures were reduced to less than 4mm bilaterally and that eyelids were markedly thickened. All theses features were consistent with the diagnosis of pachydermoperiostosis. Other secondary conditions were ruled out. Ptosis correction was performed by palpebral skin and orbicularis resection as well as tarsectomy. The aesthetic outcome was satisfactory. DISCUSSION: Pachydermoperiostosis is a rare inherited disease, characterized by pachydermia, digital clubbing and periotosis. Ptosis is the result of the palpebral hypertrophia. Excisions of skin, orbicularis muscle and tarsus often give good cosmetic outcomes. CONCLUSION: Pachydermoperiostosis is a rare cause of ptosis, which development is attributed to eyelid thickening. Surgical management has satisfactory cosmetic outcome.

[Senile scleral plaque associated with scleritis in a patient with rheumatoid arthritis]. / Plaque sclérale sénile associée à une sclérite chez un patient atteint d'une polyarthrite rhumatoïde.

Senile scleral plaque is an age-related, commonly asymptomatic hyaline degeneration of the sclera. We report a case of calcific scleral plaque associated with anterior scleritis in an elderly patient with rheumatoid arthritis. Response to anti-inflammatory treatment was favorable.

[Eyelid necrosis after injection of lidocaine with epinephrine]. / Nécrose cutanée palpébrale secondaire à une injection de xylocaïne adrénalinée.

Four patients (two women aged 50 and 67 years, a 36-year-old man, and a 5-year-old child) presented with necrosis of the eyelid after local anesthesia using 2% lidocaine with epinephrine. In three cases, the anesthesia was administered prior to suturing an eyelid laceration, and the necrosis involved the upper lid; in one case, the anesthesia was administered prior to temporal artery biopsy. Surgical debridement of the necrotic tissue was performed in all cases. Three patients developed a bacterial superinfection treated with systemic antibiotics with good results. Necrosis of the eyelid is a rare complication occurring after local anesthesia using lidocaine with epinephrine. Most dermatologists refrain from use of epinephrine with local anesthetics for digital blocks. Necrosis is due to prolonged vasoconstriction of arteries. It is observed especially commonly in patients at increased risk (arteritis, Raynaud's phenomenon and severe microvascular diseases). In the eyelid, few cases have been reported.

[Oculopalpebral and facial synkinesis associated with ptosis: epidemiological, clinical, and therapeutic features]. / Les syncinésies oculo-facio-palpébrales associées au ptosis : aspects épidémiologiques, cliniques et thérapeutiques.

Synkinetic movements of the upper eyelids may be noted in association with movements of either extraocular muscles or other muscles of the face. Patients with oculopalpebral or facial-palpebral synkinesis may also have ptosis of the involved eyelid. The clinical and therapeutic features of this association are specific. We mainly distinguish two forms of synkinetic movements, characterized either by the elevation of the ptotic eyelid such as in Marcus Gunn phenomenon and in the Fuchs sign or by the falling of the upper lid such as in Marin Amat syndrome. Many surgical techniques have been used to correct the blepharoptosis and the synkinetic movement. Levator resection is often advocated for correction of blepharoptosis with a mild degree of synkinesis. However, when the ptosis is major, eyelid lag is a possible outcome. For moderate or major synkinesis, bilateral frontalis suspension with disinsertion of the levator has been suggested. This procedure generally provides satisfactory cosmetic results.

Biological characterization and complete nucleotide sequence of a Tunisian isolate of Moroccan watermelon mosaic virus.

During a survey conducted in October 2005, cucurbit leaf samples showing virus-like symptoms were collected from the major cucurbit-growing areas in Tunisia. DAS-ELISA showed the presence of Moroccan watermelon mosaic virus (MWMV, Potyvirus), detected for the first time in Tunisia, in samples from the region of Cap Bon (Northern Tunisia). MWMV isolate TN05-76 (MWMV-Tn) was characterized biologically and its full-length genome sequence was established. MWMV-Tn was found to have biological properties similar to those reported for the MWMV type strain from Morocco. Phylogenetic analysis including the comparison of complete amino-acid sequences of 42 potyviruses confirmed that MWMV-Tn is related (65% amino-acid sequence identity) to Papaya ringspot virus (PRSV) isolates but is a member of a distinct virus species. Sequence analysis on parts of the CP gene of MWMV isolates from different geographical origins revealed some geographic structure of MWMV variability, with three different clusters: one cluster including isolates from the Mediterranean region, a second including isolates from western and central Africa, and a third one including isolates from the southern part of Africa. A significant correlation was observed between geographic and genetic distances between isolates. Isolates from countries in the Mediterranean region where MWMV has recently emerged (France, Spain, Portugal) have highly conserved sequences, suggesting that they may have a common and recent origin. MWMV from Sudan, a highly divergent variant, may be considered an evolutionary intermediate between MWMV and PRSV.