K. Errais

Effect of pterygium surgery on corneal topography.

Purpose To evaluate the effect of successful pterygium surgery on corneal topography. Methods Computerized corneal topography was performed on 20 eyes with pterygium before and 3 months after successful excision and limbo-conjunctival autograft surgery. Corneal shape, corneal spherical power, simulated keratometric astigmatism, surface regularity index (SRI), and surface asymmetry index (SAI) were assessed before and after surgery. Pre- and postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and manifest refraction spherical equivalent (MRSE) were also evaluated. Results Changes in corneal shape were mainly a decrease in midline corneal flattening. Corneal spherical power was 41.65±3.29 diopters (D) (mean ± SD) preoperatively and 44.58±1.55 D postoperatively (p=0.04). Simulated keratometric astigmatism was 5.47±3.45 D preoperatively and 1.79±1.52 D postoperatively (p=0.0005). SRI was 1.39±0.93 preoperatively and 1.10±0.57 postoperatively (p=0.03). SAI was 1.17±1.09 preoperatively and 0.75±0.73 postoperatively (p=0.02). UCVA was 0.31±0.33 preoperatively and 0.52±0.32 postoperatively (p=0.04). BSCVA was 0.73±0.20 preoperatively and 0.89±0. 16 postoperatively (p=0.008). MRSE was −0.54±3.29 D preoperatively and −1.30±3.05 D postoperatively (p=0.45). Conclusions Corneal topographic changes caused by the pterygium are almost reversible after surgical treatment. Successful pterygium surgery significantly reduces topographic astigmatism, SRI, SAI, and corneal flattening. However, precise prediction of these refractive changes is not always accurate.

Frequency, characteristics, and risk factors of late recurrence of retinal detachment.

PURPOSE To evaluate the frequency, characteristics, causes, and risk factors of late recurrent retinal detachments (LRRD). METHODS The authors retrospectively analyzed 445 eyes operated consecutively for rhegmatogenous retinal detachment between 1990 and 2003 by the same surgeon. Only eyes with complete reattachment after a minimum follow-up of 6 months were included. The authors defined LRRD as detachment occurring at least 6 months after a complete retinal reattachment. RESULTS Nine eyes had a LRRD (2.02%). Mean age was 52.55 years. Six eyes had scleral buckle procedure and three eyes had vitrectomy silicone oil injection then silicone oil removal. LRRD occurred after an average period of 54 months. During follow-up two patients had a removal of extrusion of scleral buckling material. New or reopened breaks were associated with LRRD in all eyes. Endo-ocular surgery was carried out in seven eyes. The retinal reattachment was achieved in the seven eyes. Final visual acuity ranged from 20/400 to 20/60 after an average follow-up of 37.8 months. Relation between aphakic eyes (and more generally nonphakic eyes) and LRRD was close to significant value (p=0.05). LRRD was statistically independent (p>0.05) of myopia, preoperative pseudophakia, vitrectomy for initial detachment, scleral buckle removal, and cataract surgery after reattachment. CONCLUSIONS LRRD were rare. Most of them were due to a retinal break. This break can be a new break, or reopened break especially after removal of scleral buckle material. Vitreous traction, at the vitreous base, seemed to be the cause of these breaks.

Immunohistochemical study of vascular endothelial growth factor (VEGF), tumor suppressor protein (p53) and intercellular adhesion molecule (ICAM-1) in the conjunctiva of diabetic patients

SummaryThe expression pattern of VEGF, p53 and ICAM-1 was studied in conjunctiva of diabetic patients with and without retinopathy. All patients underwent a complete ophthalmic examination, including retinal fluorescein angiography. Indirect immunoperoxidase method was performed on 20 eyes of 20 patients with type II diabetes without DR and on 5 eyes of 5 patients with PDR. A control study was performed on 6 normal conjunctiva undertaken during cataract surgery. Immunoreactivity of VEGF, p53 and ICAM-1 was found in epithelial, fibroblast and vascular endothelial cells. For the same duration of diabetes, a strong to moderate or weak immunoreactivity was observed in the conjunctiva of patients without retinopathy. In patients with PDR, the expression was strong for all these proteins. The immunoreactivity was correlated between VEGF, p53 and ICAM-1. In the normal conjunctiva, a weak to negative immunostaining was observed. The presence of these proteins in the conjunctiva of diabetic patients without retinopathy may add new data in the pathogenesis of diabetic retinopathy. Further studies are needed to confirm this hypothesis.

Schwannoma of the eyelid: Apropos of two cases

Schwannoma, also referred to as neurilemmoma, is a benign tumor of peripheral nerve arising from Schwann cells that form the neural sheath. Schwannoma of ophthalmic interest is rare although it has been reported in relation with the orbit, and less frequently with the uveal tract and conjunctiva. Isolated eyelid schwannoma is extremely uncommon. Up until now, only eight cases have been reported in literature. Herein, we report two cases of eyelid schwannoma.

Les vascularites rétiniennes : profils épidémiologiques, cliniques et étiologiques

PURPOSE To study the epidemiological and clinical features of noninfectious retinal vasculitis (NIRV). METHODS We analyzed 128 consecutive patients with NIRV, collected over 15 years (1993-2007) in an ophthalmological reference university hospital in Tunis, Tunisia. Data were analyzed regarding associated systemic disease, ocular syndromes, anatomic features (type and topography of vessel and type of capillaropathy), age and sex. The results of the etiologic work-up were based on the Levy-Clarke and Perez classification. RESULTS A total of 240 cases of NIRV (128 patients) were collected (mean age: 32; sex ratio: 2.6). It was bilateral in 93.7% of cases. The mean visual acuity (VA) was 20/50 (range: 20/800-20/20). NIRV was mainly venous (84.1%), diffuse (57%), with a mixed capillaropathy (40.2%). There were complications in 56.25% of the cases, mainly macular edema (48.1%), vascular occlusion (25.9%), optic atrophy (22.2%) and cataract (19.2%). NIRV was idiopathic in 15.6% of the cases, characterized by a predominance of young subjects (mean: 38 years old), males (sex ratio: 4), VA at 20/25, and edematous periphlebitis in 100% of cases. There were ocular disorders in 12.5% of the cases and systemic disease in 72% of the cases, with a predominance of Behçet disease (BD): 53.9% of all patients and 81% of systemic disease with predominant venous features. In 48.3% of cases, VA was less than 20/200, due to BD in 48% of the cases. CONCLUSION In NIRV, the etiologic work-up is oriented on anatomic presentation, based on fluorescein retinal angiography, and requires an interdisciplinary approach. In young adults with retinal phlebitis, BD is suggested first.

Multimodal imaging of foveoschisis and macular pseudohole associated with gyrate atrophy: a family report

BackgroundTo report the results of multimodal imaging of a biochemically confirmed case of a family with gyrate atrophy (GA) associated with foveoschisis and macular pseudohole.Case presentationTwo sisters presented to us with progressive bilateral decreased vision. The 26-year old sister had a best corrected visual acuity (BCVA) of 20/32 in the right eye (RE) and 20/100 in the left eye (LE). Dilated fundus examination revealed multiple bilateral chorioretinal atrophy areas in the midperipheral and peripheral retina. Fluorescein angiography did not show any leak in the macular area. Swept-source optical coherence tomography (SS-OCT) showed increased central macular thickness in both eyes with foveoschisis. Optical coherence tomography angiography (OCTA) showed petaloid non-reflective areas and some perifoveal microvascular alterations similar to telangiectasias in the deep capillary complex. The 30-year-old sister had a BCVA of 20/20 in the RE and 20/32 in the LE. SS-OCT was normal in the RE and demonstrated a macular pseudohole with a fine epiretinal membrane in the LE. The persistent retinal tissue at the base of the pseudohole was disorganised. Blood tests showed hyperornithinemia in the 2 cases. Based on these observations, the patients were diagnosed with gyrate atrophy of the choroid and retina and were treated with a pyridoxine supplement and an arginine-restricted diet.ConclusionsFoveoschisis and macular pseudohole may be associated in GA, increasing the risk of rapid vision loss. OCTA is an interesting imaging tool that can help to better understand the pathophysiological mechanism of these macular involvements in GA.

Fluffy white iris precipitates in Fuchs uveitis: a new sign for an old disease

To describe particular iris precipitates in a series of five eyes from six patients with Fuchs uveitis (FU). Iris precipitates were noted by four independent examiners during routine physical examination of the angle by gonioscopy with Goldmann’s three-mirror lens in patients with FU. The result was confirmed by examination, using the same method, of five other consecutive patients with FU and compared to 10 normal control eyes from five healthy individuals. Other causes of anterior uveitis were excluded. There were no iris precipitates in the healthy eyes. In eyes with FU, there were fluffy white iris precipitates, not visible by full-face examination or by classic slit-lamp examination. They were similar to keratic precipitates described in FU: starry, blurry and transparent with a tendency towards the white. Situated on the surface of the iris, they were visible only with the particular diffusion of the light from the gonioscopy’s glass on the darkly pigmented iris of patients from North Africa. Fluffy white iris precipitates, seen in FU patients, appear to represent an additional clinical sign and may improve our diagnostic accuracy in this disease. Its visibility requires a specific technique during clinical examination. The validity of this new clinical sign based on this fact is yet to be determined.

612 Kérato-endothélite lupique bilatérale : à propos d’un cas

Introduction Le lupus erythemateux dissemine (LED) est une maladie autoimmune chronique a manifestation multi-systemique. L’atteinte oculaire est peu frequente. La kerato-endothelite est une des plus rares manifestations corneennes lupiques. Nous rapportons le cas d’une femme atteinte d’un LED presentant une kerato-endothelite bilaterale recidivante. Materiels et Methodes Patiente âgee de 38 ans qui a ete adressee du pour un flou visuel recent. Elle presente un LED qui a ete confirme selon les criteres de l’ARA. A l’examen opthalmologique initial l’acuite visuelle (AV) etait de 3/10 a l’œil droit et de 7/10 a l’œil gauche. A l’examen biomicroscopique, une hyperhemie conjonctivale diffuse bilaterale, des depots blancs grisâtres en placard stromaux profonds plus accentues du cote droit avec un œdeme stromal diffus bilateral ont ete observes. Le reste de l’examen ophtalmologique etait sans particularite. Le diagnostic d’endothelite lupique a ete retenu devant l’absence d’autres causes locales ou generales. Une bonne evolution sous corticotherapie topique, marquee par une amelioration de l’AV. Discussion Dans le lupus les manifestations oculaires sont rares, l’atteinte la plus commune etant celle du segment posterieur. Concernant le segment anterieur, l’endothelium est exceptionnellement touche. Dans la litterature, les cas d’endothelite lupique ont ete rarement decrits. Dans la majorite des cas, la corticotherapie locale a ete efficace. Conclusion Cette atteinte bien que rare pourrait constituer la premiere manifestation clinique du LED.

377 Correction de l’aphaquie de la cataracte congénitale par implant Artisan®

Introduction La correction de l’aphaquie dans la cataracte congenitale bilaterale operee repose sur l’implantation, primaire ou secondaire, en chambre posterieure. En cas d’absence de plan capsulaire posterieur, l’implantation ne peut etre realisee que par un implant fixe a la sclere ou un implant de chambre anterieure tel que les implants refractifs a fixation irienne (Artisan ® ). Materiels et Methodes Nous rapportons une etude regroupant 6 yeux de 4 patients aphaques, operes de cataracte congenitale bilaterale dans leur jeune âge et implantes secondairement par implant Artisan ® . Tous les patients presentaient un plan irien complet et un plan capsulaire incomplet. Le recul moyen est de 16 mois. Resultats L’âge moyen des patients est de 22 ans. La puissance moyenne de l’implant Artisan ® est de 17 dioptries. L’acuite visuelle moyenne pre-operatoire est de 2,4/10. L’acuite visuelle moyenne post-operatoire est de 5/10. La seule complication est la survenue d’un deplacement post-traumatique de l’implant Artisan ® , repositionne sans perte d’acuite visuelle. Discussion En cas d’absence de plan capsulaire posterieur chez l’aphaque secondaire a une cataracte congenitale operee, l’implantation en chamber anterieure par un implant Artisan ® constitue une alternative a la correction par lentille de contact ou aux implants fixes a la sclere. Elle permet la rehabilitation visuelle de ces jeunes patients. Les complications sont rares mais une surveillance a long terme s’impose. Conclusion La correction de l’aphaquie par implant Artisan ® est une technique simple et fiable, avec une bonne tolerance et d’excellents resultats fonctionnels.

Association d’une vitréo-rétinopathie familiale exsudative à une persistance de l’artère hyaloïdienne

Familial exudative vitreoretinopathy (FEVR) is a well-defined inherited disorder of retinal vessel development. Association of FEVR with other congenital ocular diseases has already been described. We report the first clinical case of FEVR associated with hyaloid artery persistence. An 18-year-old Tunisian woman and four members of her family (mother, two brothers, and sister) presented signs of FEVR. Examination of this patient also revealed functional hyaloid artery persistence in her right eye. These two disorders have many common aspects in their pathological process, in particular vascular endothelial growth factor expression, which can explain this association.Familial exudative vitreoretinopathy associated with persistence of hyaloid artery K. Errais, I. Ammous, R. Kamoun, I. Mili Boussen, R. Anene, R. Zhioua, A. Meddeb Ouertani Familial exudative vitreoretinopathy (FEVR) is a well-defined inherited disorder of retinal vessel development. Association of FEVR with other congenital ocular diseases has already been described. We report the first clinical case of FEVR associated with hyaloid artery persistence. An 18-year-old Tunisian woman and four members of her family (mother, two brothers, and sister) presented signs of FEVR. Examination of this patient also revealed functional hyaloid artery persistence in her right eye. These two disorders have many common aspects in their pathological process, in particular vascular endothelial growth factor expression, which can explain this association.