Imen Ksiaa

Pattern of Acute Retinal Necrosis in a Referral Center in Tunisia, North Africa

Abstract Purpose: To describe the pattern of acute retinal necrosis (ARN) syndrome in a referral center in Tunisia. Methods: Retrospective review of the charts of 12 patients (12 eyes). Results: Necrotizing retinitis involved >50% of the retina in 33.3% of eyes. Polymerase chain reaction on aqueous humor sample identified herpes simplex virus-1 in 4 eyes (33.3%) and varicella zoster virus in 3 eyes (25%), and was negative in 5 eyes (41.7%). All patients received intravenous acyclovir, followed by oral antivirals. Follow-up ranged from 6 to 16 months. Retinal detachment (RD) occurred in 3 eyes (25%), but no patient developed bilateral ARN. Final visual acuity was 20/200 or worse in 7 eyes (58.3%). Delay in diagnosis (p = 0.015), macular involvement (p = 0.045), development of RD (p = 0.018), and 25–50% of retinal involvement (p = 0.045) were associated with a worse visual outcome. Conclusion: ARN carries poor visual prognosis in Tunisia.

Infectious optic neuropathies: a clinical update

Different forms of optic neuropathy causing visual impairment of varying severity have been reported in association with a wide variety of infectious agents. Proper clinical diagnosis of any of these infectious conditions is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular findings. Diagnosis is confirmed by serologic testing and polymerase chain reaction in selected cases. Treatment of infectious optic neuropathies involves the use of specific anti-infectious drugs and corticosteroids to suppress the associated inflammatory reaction. The visual prognosis is generally good, but persistent severe vision loss with optic atrophy can occur. This review presents optic neuropathies caused by specific viral, bacterial, parasitic, and fungal diseases.

Retinal Pigment Epithelium Detachment in Acute Vogt–Koyanagi–Harada Disease: An Unusual Finding at Presentation

ABSTRACT Purpose: To report the cases of two patients who presented with acute Vogt–Koyanagi–Harada (VKH) disease and associated retinal pigment epithelium detachment (PED). Methods: 2 case reports. Case 1: A 22-year-old male patient complained of acute bilateral decrease in vision. Initial best corrected visual acuity (BCVA) was 20/63, OU. There was 1+ vitreous cells, OU, exudative retinal detachment (ERD) in the right eye (RE), and a macular deep yellow lesion suggestive of PED in the left eye (LE). Case 2: A 40-year-old female patient presented with bilateral vision blurring. BCVA was 20/40 in the RE and 20/32 in the LE. There was 1+ vitreous cells OU, bilateral optic disc swelling and retinal striae. Results: Multimodal imaging showed features of acute VKH disease with associated PED in the two patients. ERD and PED resolved under oral prednisone and cyclosporine in both cases. Conclusion: PED may rarely occur in acute VKH disease at presentation.

Rift Valley Fever

Rift Valley fever (RVF) is an emerging arthropod-borne zoonotic disease caused by RVF virus, which belongs to the Bunyaviridae family. RVF virus infection in humans usually causes a self-limiting acute and febrile illness but severe potentially lethal forms may develop. Macular or paramacular retinitis is the most common ocular complication of RVF. Other findings may include nongranulomatous anterior uveitis, retinal vasculitis, retinal hemorrhages, vitritis, and optic disc edema. Diagnosis is based on epidemiologic data, serologic testing and/or PCR. Ocular involvement is frequently associated with permanent visual loss. Treatment of RVF is entirely supportive and prevention is the mainstay of infection control.

Multimodal imaging in a case of bilateral outer retinitis associated with mumps infection

PurposeTo report the results of multimodal imaging of acute outer retinitis associated to mumps infection.MethodsA patient with mumps-associated outer retinitis evaluated by color fundus photography, spectral domain optical coherence tomography (SD-OCT), optical coherence tomography angiography, fundus autofluorescence (FAF), fluorescein angiography (FA), and indocyanine green angiography (ICGA).ResultsWe report a case of a 12-year-old boy who developed bilateral outer retinitis related to mumps. Ophthalmoscopy showed confluent areas of outer retinitis involving the posterior pole and the periphery with a centrifugal gyrate pattern. SD-OCT revealed a marked disorganization of the outer retinal layers with multiple highly reflective spicules. FA shows diffuse late hyperfluorescence with optic disk staining. ICGA shows macular and peripheral hyperfluorescent lesions with a geographical pattern in the late phases. The patient was treated with acyclovir and oral prednisone. Four weeks after presentation visual acuity remained unchanged, and retinal changes seen at the acute phase had resolved leading to extensive retinal atrophy and optic disk pallor. SD-OCT showed atrophy of the retinal pigment epithelial and outer retinal layers. FAF revealed scattered hyperautofluorescent lesions. Electrophysiology showed generalized retinal dysfunction.ConclusionsMumps infection should be considered in the differential diagnosis of bilateral necrotizing outer retinitis in children and young adults. A multimodal imaging approach may help distinguish mumps-associated retinitis from other causes of viral retinitis and facilitate appropriate management.

Multimodal imaging for the diagnosis of an atypical case of central serous chorioretinopathy

We report a case of a 52-year-old woman presented with atypical central serous chorioretinopathy (CSCR) that had been misdiagnosed as posterior uveitis and treated with systemic corticosteroids and immunosuppressive therapy, with subsequent severe chorioretinal damage. Diagnosis was straightened through multimodal imaging. Anatomical improvement was achieved after discontinuation of corticosteroids and intravitreal injection of bevacizumab. However, visual acuity remained severely impaired in one eye. Failure to differentiate atypical CSCR from inflammatory chorioretinal diseases may lead to severe and irreversible visual impairment. Multimodal imaging helps recognition of the atypical presentations of CSCR, avoiding misdiagnosis and inappropriate management.

Ocular Disease Associated with West Nile Virus Infection

Chorioretinal involvement, frequently asymptomatic and self-limited, is common in patients with West Nile virus (WNV) infection associated with neurologic illness. A bilateral multifocal chorioretinitis, with typical clinical and fluorescein angiographic features, is the most common finding, but numerous other ocular manifestations can occur. Diabetes mellitus appears to be a potential risk factor for developing severe neurologic disease and also severe chorioretinitis. The unique pattern of multifocal chorioretinitis can help establish an early diagnosis of the disease while serologic testing is pending. This might be of utmost importance in the near future for early initiation of promising drugs currently under investigation. Therefore, an ocular examination, including dilated fundus examination and fluorescein angiography in selected cases, should be part of the routine evaluation of patients with clinically suspected WNV infection. WNV infection should be considered in the differential diagnosis of multifocal chorioretinitis in patients living in or returning from specific endemic regions.