N. Chaker

Intravitreal bevacizumab for the treatment of choroidal neovascularization secondary to angioid streaks: one year of follow‐up

Purpose:  To evaluate the efficacy and safety of intravitreal bevacizumab at one year follow‐up, for the treatment of choroidal neovascularization (CNV) associated with angioid streaks.

Les décollements de rétine rhegmatogènes bilatéraux simultanés. À propos de 7 observations

PURPOSE Simultaneous bilateral rhegmatogenous retinal detachments are rare. The purpose of our study was to examine the incidence, predictive factors, surgical results and prognosis of these retinal detachments. PATIENTS AND METHODS A retrospective analysis of the medical records of 468 consecutive patients, 7-89 years of age (mean, 45.7 years), undergoing surgery for rhegmatogenous retinal detachment between 1993 and 2000. RESULTS During this period, a total of 497 operations for rhegmatogenous retinal detachment were done. Thirty-two patients had bilateral rhegmatogenous retinal detachment. Simultaneous detachments were observed in seven patients (1.5%). In four cases, the diagnosis of retinal detachment was fortuitous. In fact, most patients presented with unilateral symptoms. The mean age (35 years) of patients suffering from simultaneous bilateral rhegmatogenous retinal detachment was younger than that of patients with unilateral or consecutive bilateral retinal detachments. Five patients were myopic. Multiple round retinal holes were the most frequent lesions responsible for retinal detachment. A preoperative proliferative vitreoretinopathy was found in 57% of cases. The retina was reattached in nine cases (81%). CONCLUSION Simultaneous bilateral rhegmatogenous retinal detachment is usually found in relatively young myopic patients with atrophic retinal holes. They are rare but severe because of their frequent association with preoperative proliferative vitreoretinopathy.But Les decollements de retine rhegmatogenes bilateraux simultanes sont rares. Le but de notre etude est d’etudier leur incidence, les facteurs favorisants leur survenue, leurs resultats operatoires et leur pronostic. Patients et methodes Il s’agit d’une etude retrospective portant sur des patients âges de 7 a 89 ans (45,7 ans) operes de decollements de retine rhegmatogenes durant la periode allant de 1993 a l’an 2000. Resultats Durant cette periode 497 interventions pour decollement de retine rhegmatogene ont ete pratiquees. Trente-deux patients avaient un decollement de retine rhegmatogene bilateral dont 7 (1,5 %) etaient simultanes. Dans 4 cas, la decouverte du decollement de retine rhegmatogene bilateral etait fortuite. En effet, la symptomatologie etait le plus souvent unilaterale. L’âge moyen (35 ans) des patients porteurs de decollements de retine rhegmatogenes bilateraux etait inferieur a celui des patients presentant un decollement de retine rhegmatogene unilateral ou bilateralise. Le plus souvent, les trous atrophiques etaient a l’origine du decollement de retine. En preoperatoire, la frequence de la proliferation vitreoretinienne etait de 57 %. La retine a ete reappliquee dans 9 cas sur 11 operes (81 %). Conclusion Les decollements de retine rhegmatogenes bilateraux surviennent le plus souvent chez des sujets jeunes, myopes, porteurs de lesions degeneratives de la peripherie retinienne a type de trous atrophiques. Ils sont rares mais graves car souvent associes a une proliferation vitreoretinienne.

Manifestations ophtalmologiques de la rubéole congénitale

Congenital rubella is a rare and serious disease including auditory neurological, cardiac, urinary, and ocular abnormalities. The eye complaints are often congenital cataract, congenital glaucoma, microphthalmia, and oculomotor disorders. We report the case of a 6-year-old girl presenting with a unilateral congenital cataract associated with congenital rubella. She was referred for complaints of high myopia in her right eye. She had a family history of cardiac and urogenital malformations, and presented deafness at birth. The ophthalmologic examination showed a microcornea and a unilateral dense congenital cataract in the right eye. B-scan ophthalmic ultrasound revealed a posterior microphthalmos. The anterior segment examination of the left eye was normal. Funduscopy revealed a salt-and-pepper appearance. Laboratory tests revealed a positive serology, confirming the congenital rubella. Given her complaints of loss of visual acuity in the right eye, the patient was operated on with a phacoaspiration implant in the capsular bag. The postoperative course was uneventful. The prevention of congenital rubella is based on routine vaccination of children. The association of cataract, congenital heart defects, and deafness must be systematically investigated as it may be more serious in association with systemic manifestations.

Herpes zoster ophthalmicus associated with abducens palsy

The extraocular muscle palsies associated with herpes zoster ophthalmicus (HZO) are transient, self-limiting conditions, usually seen in elderly patients. There are different treatment recommendations for paralytic complications, but prognosis has generally reported to be favorable. A 75-year-old male patient presented with diplopia. Clinical history revealed left facial vesicular eruptions and pain treated by oral aciclovir 1 week following symptom onset. On examination, we observed cicatricial lesions with crusts involving left hemiface, a limitation in abduction of the left eye, and a superficial punctuate keratitis (SPK) with decreased visual acuity (4/10). Examination of the right eye was unremarkable. Hess screen test confirmed left six nerve palsy.

Characteristics of Astigmatism in a Population of Tunisian School-Children.

Purpose: To evaluate the characteristics of astigmatism in a cross-sectional study of schoolchildren in Tunisia. Materials and Methods: A random cluster design was used to recruit children from primary schools across urban and rural settings in Tunisia, from 2008 to 2010. A total of 6192 students aged 6-14-years old were enrolled. All students whose uncorrected visual acuity was worse than 20/20 underwent a complete ophthalmic examination. Astigmatism was defined as the cylinder power of 0.75 diopter (D) or greater. Results: The prevalence of astigmatism was 6.67%. Mean cylinder power was - 1.89 ± 0.79D. The prevalence of astigmatism increased statistically significantly with age (P = 0.032). The prevalence of astigmatism was not significantly related to gender (P = 0.051). Of those with cylinder, 63.6%, 17.8%, and 18.6% schoolchildren had with with-the-rule, against-the-rule, and oblique astigmatism, respectively. ATR astigmatism was significantly higher in males (P = 0.033). There was no significant association between the student′s area of residence and astigmatism (P = 0.059). Conclusion: Comparisons with other studies show that the prevalence of astigmatism in Tunisia is higher than in some countries. The prevalence of astigmatism increased with age but not gender. The majority of schoolchildren had with-the-rule astigmatism.

Caractéristiques cliniques et angiographiques de la dystrophie cristalline de Bietti: À propos d’une patiente âgée de 8 ans

Introduction La dystrophie cristalline de Bietti est une degenerescence tapeto-retinienne caracterisee par la presence de petits cristaux refringents au niveau du limbe corneen et de la retine associes a une atrophie de l’epithelium pigmentaire retinien et a une sclerose des vaisseaux choroidiens. Nous rapportons le cas d’une dystrophie cristalline de Bietti survenue chez une fillette âgee de 8 ans. Observation Une fillette, âgee de 8 ans, issue d’un mariage consanguin, nous fut adressee pour un strabisme convergent intermittent. L’acuite visuelle etait reduite a 4/10 e a droite et a 3/10 e a gauche. L’examen biomicroscopique de la cornee au fort grossissement trouvait de petits cristaux refringents sous-epitheliaux prelimbiques bilateraux. L’examen du fond d’œil mit en evidence des alterations de l’epithelium pigmentaire maculaire avec de petits points refringents predominants au pole posterieur et a la moyenne peripherie. L’angiographie retinienne a la fluoresceine confirma les alterations de l’epithelium pigmentaire. L’angiographie au vert d’infracyanine montrait des plages d’atrophie choriocapillaire. Le champ visuel de Goldman trouvait un scotome paracentral bilateral. L’electroretinogramme montrait une reduction du nombre des photorecepteurs affectant aussi bien les cones que les bâtonnets. Discussion Les lesions ophtalmoscopiques dans la dystrophie cristalline de Bietti surviennent generalement entre 20 et 30 ans. La particularite de notre observation est leur apparition a un âge plus precoce (soit a l’âge de 8 ans). L’evolution se caracterise par l’extension centrifuge des lesions.INTRODUCTION Biettis crystalline corneoretinal dystrophy is a tapetoretinal degeneration, characterized by the presence of refringent crystals in the corneal limbus and the retina with sclerosis of choroidal vessels. We report the clinical and angiographic features of an 8-year-old girl affected with Biettis crystalline dystrophy. CASE REPORT This 8-year-old girl was a sporadic case, born of consanguineous parents. She was referred to our hospital for intermittent strabismus. Her visual acuity was 4/10 at the right eye and 3/10 at the left eye. Biomicroscopy revealed very fine crystals in the limbal area bilaterally. Mydriatic funduscopic examination showed bilateral macular pigment mottling and depigmentation, numerous tiny refractile yellow dots scattered throughout the posterior pole and the mid-periphery associated with diffuse retinal pigment epithelial atrophy and pigment accumulation. Fluorescein angiography revealed retinal pigmentary epithelium alterations. Indocyanine green (Infracyanin) angiography showed areas of choroidal atrophy. The electroretinogram noted a reduction in the number of both types of photoreceptors. COMMENTS Ophthalmological lesions normally occur between 20 and 30 years of age. The particularity of our case report is the manifestation of the disease at an earlier age (8 years). The progression is characterized by a centrifuge expansion of lesions.

Profil microbiologique des endophtalmies aiguës dans un centre de référence en Tunisie

PURPOSE To investigate the microbiological profile of acute postoperative endophthalmitis in a referral center in Tunisia and to assess the antibiotic sensitivity of the organisms. PATIENTS AND METHODS This is a retrospective study over a period of eleven years, conducted on patients hospitalized with acute infectious postoperative endophthalmitis. Cultures were performed on aqueous (93%) and vitreous specimens (68%) obtained at presentation. Each sample underwent direct examination, culture and antibiotic susceptibilities. RESULTS The number of acute postoperative endophthalmitis cases identified during the study period was 308. Organisms were found in 43% of samples (endophthalmitis was bacterial in 39.5%, fungal in 0.9% and polymicrobial in 2.6%). Cultures grew primarily Staphylococcus epidermidis in 31.4% of cases, Streptococcus pneumoniae in 22.7% of cases and Staphylococcus aureus in 12.7% of cases. Gram-positive cocci are more sensitive to vancomycin and Gram-negative bacilli are more susceptible to ofloxacin and ciprofloxacin. CONCLUSION In our study, microbiological samples were positive in 43% and coagulase-negative Gram-positive cocci are the most common organisms. However, antibiotic resistance has been increasing over the years.

Corps étranger intraoculaire révélé par une pseudo-uvéite

Le terme de pseudo-uvéites rassemble certaines affections oculaires bénignes ou malignes pouvant simuler une inflammation intraoculaire au stade tardif ou séquellaire et pouvant ainsi mettre en jeu le pronostic fonctionnel ou vital en cas de pathologie tumorale. Elles sont à différencier de l’uvéite où le mécanisme physiopathologique correspond à une véritable inflammation intraoculaire. Les pseudo-uvéites ont été retrouvées chez 5 % de l’ensemble des patients référés pour uvéite [1]. Nous rapportons le cas d’une patiente présentant un corps étranger intraoculaire (CEIO) révélé par une pseudo-uvéite.

Simultaneous SD-OCT and fundus autofluorescence imaging of the macula after successful repair of rhegmatogenous retinal detachment

Purpose To evaluate the ultrastructural changes in the macula after successful repair of rhegmatogenous retinal detachment (RRD) using spectral domain optical coherence tomography (sdOCT) and fundus autofluorescence (FAF) imaging Methods Simultaneous sdOCT (Topcon 2000 FA plus) and FAF imaging were performed with a system for FAF imaging using a fundus camera that included Spaide Autofluorescence filters available on IMAGEnet. Results 31 patients with macular-off RRD and 2 with macular-on RRD were recruited. Post operative visual acuity ranged from 20/400 to 20/20. SdOCT images were normal in 18 eyes (54.5%), revealed macular edema in 9 eyes (27.2%), macular hole in 2 eyes (6%), macular pucker in 3 eyes (9%), submacular fluid in 2 eyes (6%). Fundus autofluorescence imaging of the macula were normal in 13 eyes (39.3%).There were central abnormalities in 14 eyes. Patients with abnormal FAF were also associated with poor postoperative BCVA (p<0.001) Conclusion The present study demonstrates the ultrastructural changes assessed with simultaneous FAF and sdOCT and their relation with visual outcome

Hémangiome caverneux de l’apex orbitaire révélé par une neuropathie optique

Cavernous hemangioma is the most common primary vascular neoplasm. It typically occurs in middle-aged women, causing a progressive painless proptosis as the principal symptom. It exceptionally compresses the optic nerve. We report the case of a cavernous hemangioma revealed by optic neuropathy in a 33-year-old female.