D. Sellami

Phtiriase ciliaire de l’enfant. Diagnostic et traitement

Introduction La phtiriase ciliaire est une blepharite a phtirius pubis. Il s’agit d’une ectoparasitose qui s’observe plus frequemment chez l’adulte. Une atteinte pubienne lui est habituellement associee. Elle est cependant rare chez l’enfant. Le but de cette etude est de rapporter quatre observations de phtiriase ciliaire infantile. Patients et methodes Quatre enfants se sont presentes pour prurit palpebral et rougeur oculaire. L’examen a la lampe a fente a permis de constater une irritation du bord libre palpebral et la presence de petits parasites solidement ancres le long des cils et des lentes accrochees a la base des cils. Une enquete au sein de l’entourage a ete menee et un examen parasitologique a ete realise. Resultats L’examen parasitologique a permis d’identifier les formes adultes et les lentes de phtirius. Les resultats de l’enquete au sein de l’entourage a permis de determiner la voie de contamination. Il s’agit d’une transmission par la literie. Une extraction du parasite a la pince est tentee, mais elle a ete tres douloureuse. Un traitement a base d’oxyde jaune de mercure 1 % a ete instaure chez deux patients, les deux autres ont ete traites par vaseline pommade en raison d’une irritation palpebrale tres importante. L’evolution a ete favorable chez tous les patients. Discussion Dans ce travail, nous discutons des modes de contamination de phtirus pubis chez l’enfant. En fait, la localisation ciliaire chez l’enfant est secondaire a une contamination au contact d’un adulte porteur de phtiriase pubienne. La transmission peut se faire suite a des sevices sexuels ou par le biais de vetements ou de literie infectes. Le diagnostic clinique de phtiriase ciliaire est confirme par l’examen parasitologique. Differentes therapeutiques ont ete proposees. Un traitement mecanique doit etre realise, mais il est rarement suffisant et il faut souvent l’associer a un traitement chimique (malathion a 1%, oxyde de mercure a 1 %, fluoresceine a 20 %…) ou physique (cryotherapie, laser argon). Conclusion La blepharite a phtirus pubis est de diagnostic facile et necessite la mise en route d’une enquete de l’entourage afin de detecter la source de contamination et de prevenir les reinfestations.

Lupus érythémateux discoïde et paupière. Une série de 9 patients

INTRODUCTION Discoid lupus erythematosus (DLE) is a chronic autoimmune skin disease that usually affects the sun-exposed skin. Palpebral involvement occurs uncommonly. MATERIAL AND METHOD The goal of our study was to present the clinical and therapeutic features of a series of nine patients with discoid lupus erythematosus with eyelid involvement. RESULTS Lesions of discoid lupus were more frequent in the lower eyelids (seven cases). The palpebral location was the only manifestation of the disease in a 34-year-old woman. In the other cases, cutaneous lesions of typical discoid lupus were noted. Seven patients responded to therapy with antimalarial drugs associated with local corticosteroids and photoprotection. DISCUSSION Eyelid lesions of discoid lupus erythematosus are rare. Involvement of the lower eyelids is more common. It is important to diagnose discoid lupus of the eyelids because misdiagnosis (isolated form) can delay treatment and cause deformities. The treatment is systemic antimalarial drugs, which have an excellent clinical response.Introduction Le lupus erythemateux discoide est une dermatose auto-immune touchant habituellement le visage et le cuir chevelu, la localisation palpebrale etant rare. Materiels et methodes Le but de ce travail etait d’illustrer les caracteristiques cliniques et therapeutiques de l’atteinte palpebrale du lupus discoide a travers une serie de 9 patients avec des localisations palpebrales de lupus discoide. Resultats Les lesions palpebrales etaient plus frequentes au niveau de la paupiere inferieure (7 cas). Chez une patiente âgee de 34 ans, l’atteinte palpebrale superieure etait l’unique manifestation de la maladie lupique. Dans les autres cas, la blepharite etait associee a des lesions typiques de lupus discoide a distance. Les antipaludeens de synthese indiques dans 7 cas ont ete efficaces associes a une corticotherapie locale et une photo protection. Discussion Les localisations palpebrales du lupus discoide sont rares. Ces lesions palpebrales sont plus frequentes au niveau de la paupiere inferieure. Il est important de diagnostiquer un lupus discoide au niveau d’une paupiere, une erreur diagnostique (formes isolees) etant cause d’un retard de traitement et de sequelles fonctionnelles parfois importantes. Les antipaludeens de synthese sont remarquablement efficaces.

Manifestations ophtalmologiques de la hyalinose cutanéo-muqueuse

Resume Introduction La hyalinose cutaneo-muqueuse (HCM) ou lipoproteinose d’Urbach-Wiethe est une affection rare a transmission autosomique recessive. Elle est caracterisee par un depot d’une substance hyaline au niveau de la peau et des muqueuses. Les manifestations ophtalmologiques sont frequentes pouvant conditionner le pronostic visuel. Observation Il s’agit d’une patiente âgee de 28 ans qui a eu des lesions vesiculo-bulleuses de la face evoluant vers des cicatrices varioliformes associees a un raucite de la voix. Elle avait une atteinte oculaire unilaterale gauche sous forme d’un depot hyalin limbique, irien et trabeculaire qui s’est complique d’une uveite, d’une cataracte et d’un glaucome ayant entraine la perte fonctionnelle de l’œil. L’etude histologique d’une biopsie cutanee concluait a une hyalinose cutaneo-muqueuse. Discussion L’atteinte palpebrale au cours de la hyalinose cutaneo-muqueuse est classique particulierement la blepharose moniliforme qui est pathognomonique. Ce cas se caracterisait par une atteinte intra-oculaire rare a type d’uveite. Par ailleurs, on peut trouver des depots corneo-conjonctivaux, trabeculaires ou au niveau de la membrane de Bruch. L’examen histologique des biopsies cutanee et/ou conjonctivale confirme le diagnostic. Les moyens therapeutiques sont assez limites.

Visual Loss Associated with Rickettsial Disease

Abstract Purpose: To characterize and analyze ocular involvement associated with visual loss in a cohort of patients with rickettsial disease. Methods: Retrospective study of 16 eyes of 14 patients. Results: Mean initial visual acuity (VA) was 20/63 (range, 20/800–20/25). White retinal lesions infiltrating inner retina was the most common finding occurring in 14 eyes (87.5%). It was associated with a serous retinal detachment (SRD), accurately detectable by optical coherence tomography, in 11 eyes (78.6%). Other findings included optic neuropathy in 7 eyes (43.75%), cystoid macular edema in 1 eye (6.25%), branch retinal artery occlusion in 1 eye (6.25%), and choroidal neovascularization in 1 eye (6.25%). Thirteen patients were treated with a 2-week course of oral doxycycline 200 mg/day. Mean final VA was 20/40. Conclusions: Inner retinitis, associated with mild vitritis and SRD, and optic neuropathy are the most common vision-threatening ocular manifestations of rickettsial disease.

Intérêt de l’huile de silicone dans la rétinopathie diabétique proliférante compliquée d’hémorragie intravitréenne

INTRODUCTION Vitreous hemorrhage is a frequent complication of proliferated diabetic retinopathy. Vitrectomy has vastly improved its prognosis. The purpose of this study was to evaluate the use of silicone oil in vitreal surgery in this indication. METHODS We present a retrospective study of 15 eyes that underwent vitrectomy and silicone oil injection for vitreal hemorrhage complicating proliferative diabetic retinopathy. For each patient, we noted the clinical and echographic features, the surgical procedure, and the postoperative outcome after a mean period of 20 months. RESULTS The indications for silicone injection were recurrent vitreal hemorrhage (seven eyes), aggressive fibrovascular proliferations (five eyes), and iatrogenic retinal breaks (three eyes). Anatomic success was noted in ten cases. Four patients had a hemorrhage reoccurrence after silicone oil removal and one patient developed neovascular glaucoma. Silicone cataract (seven eyes) and emulsification of silicone (one eye) were noted. DISCUSSION The use of silicone oil in vitreal surgery for complicated proliferated diabetic retinopathy contributes a hemostatic and plugging effect, but it still has a number of disadvantages such as the need to remove it and its own side effects. It can be beneficial in cases of rubeosis or recurrent hemorrhage. However, it is essentially indicated in recurrent hemorrhage in monophthalmos patients.

Automatic Skin Lesions Classification Using Ontology-Based Semantic Analysis of Optical Standard Images

Abstract This paper describes ontology-based semantic analysis of lesion images. We first present our ontology focusing on its main concepts, as well as the semantic annotation. Accordingly, the Bag-of-Words (BoW), modeling these concepts in skin lesion diagnosis, is inspired from experts in dermatology. These BoWs are modeled from the lesion images. Firstly, we extract low-level features describing the lesion shape, color and texture. Secondly, the BoWs are generated from these features using a machine learning classifier (SVM). An important step in semantic analysis is to define rules relating the different concepts. In our case, these rules are inspired from the score of the ABCD rule for decision making. Experimental results on a public database of 206 lesion images demonstrate that ontology offers a more efficient frame of analysis, where semantic relations between concepts can handle more knowledge of experts, and can be more appropriate for lesion severity classification with a good accuracy. Comparing to the previous works, our approach yields good sensitivity (97.4%) and accuracy (76.9%).

An efficient microcalcifications detection based on dual spatial/spectral processing

Microcalcifications are tiny deposits of calcium located in breast tissue. They appeared as very small highlighted regions in comparison with their surrounding tissue. Spatial non linear enhancement can be applied for microcalcification detection. However, efficiency of a such approach depends on breast density: in case of extreme breast density, the contrast between microcalcification’s details and their surrounding tissue is attenuated leading to a limitation of spatially based approaches. In that case, frequency analysis such as wavelet based analysis can be more relevant for dissociating microcalcifications. The main goal of Computer Aided Detection systems (CAD) is to detect breast cancer at an early stage for all breast density classes by using entropies to enhance and then detect microcalcification details. Accordingly, we combine our approach a spatial Automatic Non Linear Stretching (ANLS) and Shannon Entropy based Wavelet Coefficient Thresholding (SE_WCT). Validation of the proposed approach is done on the Mammographic Image Analysis Society (MIAS) database. The evaluation of the contrast is based on the Second-Derivative-Like measure of enhancement(SDME). Accordingly, it yields to a mean SDME of 78.8dB on the whole database. The performance metric for evaluating our proposed CAD is the Receiver Operating Characteristic(ROC) curve and the free-response ROC (FROC). An area under the ROC curve Az = 0.92 is obtained as well as 97.14 % of True Positives (TP) with 0,48 False positives per image (FP).

Early treatment with Nd-YAG laser for a premacular hemorrhage secondary to a retinal macroaneurysm

A 50-year-old man presented with a sudden, painless, visual loss in his left eye of 24 hours. His past ocular and medical histories were unremarkable and the accident was not preceded by a physical exertion. On examination, best corrected visual acuity was 20/20 in the right eye and 20/400 in the left eye. There was no afferent pupil defect and the anterior segment examination was unremarkable in both eyes. Dilated fundus examination of the left eye showed a large sedimented premacular hemorrhage beneath a transparent membrane covering most of the macula including the fovea. There was also a small ectasia of a macular branch of superotemporal vein located above the sedimented blood inside the area of the detached membrane (Fig. 1). Fundus examination of the right eye was normal.

High-level features for automatic skin lesions neural network based classification

Melanoma is the most dangerous form of skin cancer. It can be developed from pigmented cells of the skin and can grow and spread swiftly to other organs (metastasis). An early diagnosis increases the chance of cure. In the past three decades, the increase in the incidence of melanoma has given rise to more accurate methods of analysis. Feature extraction is a critical step in melanoma decision support systems. Early dermatoscopic rules (ABCD rule, 7-point checklist, Menzies method and CASH algorithm), used by experts are generally low level features. In this paper, we consider several dermatoscopic rules for automatic detection of melanoma in order to generate new high level features allowing semantic analysis. Such extracted features are based on shape characterization and color and texture features. A neural network classifier is used for decision making. Experimental results indicate that semantic analysis is a useful method for discrimination of melanocytic skin tumors with good accuracy. The proposed method yields a good sensitivity of 92% and a specificity of 95% on a database of 206 skin lesion images. A comparative study with recent previous works illustrates that our approach outperforms in terms of accuracy and specificity.

Néovaisseaux choroïdiens compliquant une maladie de Vogt-Koyanagi-Harada

But Nous rapportons deux cas de maladies de Vogt-Koyanagi-Harada (VKH) compliques de neovaisseaux choroidiens. Observations La premiere patiente, âgee de 12 ans, presenta une neovascularisation choroidienne apres 9 mois d′evolution de la maladie de VKH. L′aspect pseudo tumoral blanc grisâtre des neovaisseaux etait typique. La membrane neovasculaire etait maculaire superieure, extrafoveale, et entouree d′un decollement sereux retinien bulleux. L′angiographie fluoresceinique permit de visualiser l′etendue des zones de remaniement de l′epithelium pigmentaire au niveau des deux yeux. La seconde patiente, âgee de 18 ans, egalement suivie pour maladie de VKH, developpa des neovaisseaux choroidiens apres deux ans d′evolution. L′examen biomicroscopique mit en evidence un decollement sereux retinien entoure d′hemorragies et d′exsudats. L′angiographie en fluorescence montrait une membrane neovasculaire juxta papillaire. Une corticotherapie par voie generale fut instauree. Conclusion La maladie de VKH est une panuveite bilaterale qui peut se compliquer de neovaisseaux choroidiens dans 2,5 a 10 % des cas. Cette complication est responsable d′une baisse importante de la vision. Nous discutons dans ce travail des facteurs susceptibles de favoriser l′angiogenese et soulevons les difficultes therapeutiques de cette pathologie.