R. Limaiem

Pediatric Penetrating Keratoplasty: Indications and Outcomes

PURPOSE This report evaluates patient characteristics, indications, and outcomes of pediatric keratoplasty, and identifies variables that help to predict poor surgical outcomes. METHODS We undertook a retrospective review of all cases in our department of primary penetrating keratoplasty performed in children 14 years of age or younger between January 2003 and December 2009. RESULTS Sixteen primary penetrating keratoplasties were performed during the study interval. Mean age was 11.2 years (3 to 14 years) and the gender ratio was 2. The mean duration of follow-up was 16 months (2 to 36 months).The surgical indications were acquired traumatic opacities in 6 cases, keratoconus in 5 cases, corneal perforation secondary to infectious keratitis in 3 cases, hereditary corneal dystrophy in 1 case, and acquired non-traumatic opacities secondary to congenital glaucoma in one case. The initial visual acuity was less than 1/20 in 68% of cases and the mean final visual acuity after 1 year was 2/10. The graft was clear in 52% of cases after 1 year of follow-up. Postoperative complications were graft failure (24%), ocular inflammation (5%), and ocular trauma (19%). CONCLUSION Penetrating keratoplasty in children has been documented to have a higher rate of graft failure and a worse visual prognosis than adult keratoplasty. Poor prognosis outcomes were especially caused by noncooperation of parents and postoperative ocular trauma.

Les abcès graves de la cornée : à propos de 100 cas

But Etudier les facteurs favorisants, les aspects cliniques, les elements du diagnostic microbiologique et discuter la conduite therapeutique et le pronostic des abces corneens graves. Patients et methodes Nous avons realise une etude retrospective des patients hospitalises dans le service B a l’institut Hedi Raies d’ophtalmologie (Tunis, Tunisie) pour abces grave de la cornee sur une periode allant d’aout 1996 a novembre 2004. Resultats Cent patients presentant un abces corneen ont ete hospitalises : 55 hommes et 45 femmes, âges de 11 ans a 87 ans. Les principaux facteurs predisposant retrouves etaient une pathologie de la surface oculaire (30 %), un traumatisme oculaire (28 %), une chirurgie oculaire (17 %), le port de lentilles de contact (8 %). Dans 9 % des cas, nous n’avons trouve aucun facteur de risque. La culture apres grattage corneen a ete positive dans 42 % des cas, identifiant des bacteries Gram- (48,6 %), des bacteries Gram− (29,7 %) et des mycoses (21,6 %). La majorite des patients (93 %) ont recu une antibiotherapie a large spectre, avec un succes therapeutique dans 53,8 % des cas. Les antifongiques par voie parenterale ont ete indiques dans 17 cas. Le recours a la chirurgie a ete necessaire dans 14 cas (25,8 %) : une keratoplastie therapeutique dans 5 cas et une keratoplastie a froid dans 9 cas. L’acuite visuelle finale a ete superieure ou egale a l’acuite visuelle initiale dans 81 cas. Une perte anatomique du globe a ete observee dans 8 cas : une evisceration dans 6 cas, et une enucleation dans 2 cas. Conclusion L’abces corneen est une pathologie grave et frequente pouvant entrainer la cecite. Seule une prise en charge precoce et adaptee aux resultats microbiologiques permet d’ameliorer le pronostic de laabces corneen.

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.

Y402H Polymorphism in Complement Factor H and Age-Related Macular Degeneration in the Tunisian Population

To evaluate a possible association between the complement factor H (CFH) Y402H polymorphism and susceptibility to age-related macular degeneration (AMD) in the Tunisian population, as well as the impact of the genotype distribution among different phenotypes and the response to treatment with intravitreal bevacizumab, exon 9 of CFH was analyzed for the Y402H polymorphism by direct sequencing in 135 healthy controls and 127 sporadic unrelated AMD patients classified into the following groups: 12 atrophic AMD (group G1), 115 exudative AMD (G2) and 10 AMD patients who had fibrovascular scarring (G3) that did not allow a precise grading of the phenotype. Seventy patients in G2 were treated with 1.25 mg intravitreal bevacizumab at 6-week intervals until choroidal neovascularization (CNV) was no longer active. The frequency of the CFH 402H allele was significantly higher in AMD patients than in controls (p = 2.62 × 10–16). However, subgroup analysis does not reveal any association between the variant allele H and phenotypes of AMD or CNV. Also, there was no significant difference in response to bevacizumab treatment according to Y402H CFH genotype (p = 0.59). A strong association of the 402H allele with susceptibility to AMD in the Tunisian population was confirmed; however, this variant does not appear to be involved in the clinical progression of this disease or in the postintravitreal bevacizumab response.

Bevacizumab Injection in Patients with Age-Related Macular Degeneration Associated with Poor Initial Visual Acuity

Purpose. To evaluate functional and anatomic effects of intravitreal bevacizumab in patients with neovascular AMD and initial low visual acuity. Methods. Retrospective case series of 38 eyes with neovascular AMD and initial visual acuity of 20/200 or less, treated with intravitreal bevacizumab injection. Results. Mean followup was 14.1 months ±  7.1 (range: 5 to 24 months). Mean logMAR vision at baseline was 1.38 logMAR ±  0.33, at 6 months was 1.14 logMAR ±  0.37 (P = 0.001) and at 12 months was 1.22 logMar ±  0.33 (P = 0.004). Mean baseline central retinal thickness was 431 μm ±  159.7 at 6 months was 293.43 μm  ±  122.79 (P = 10−4) and at 12 months was 293.1 μm  ±  130 (P = 0.004). Visual acuity improved in both patients with or without prior PDT treatment. Conclusions. Intravitreal bevacizumab injection may increase the chance of visual acuity gain in neovascular AMD even in cases with initial low visual acuity.

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.

712 Tumeur fibreuse solitaire de l’orbite ; une cause rare d’exophtalmie unilatérale : à propos d’une observation

Introduction Initialement decrite au niveau de la plevre, la tumeur fibreuse solitaire est une tumeur mesenchymateuse ubiquitaire exceptionnellement retrouvee dans l’orbite. Materiels et Methodes Cas clinique. Observation Nous presentons l’observation d’un patient âge de 38 ans ayant consulte pour une protrusion du globe oculaire gauche d’evolution tres rapide (deux semaines). L’examen de l’œil gauche a montre une exophtalmie de grade III indolore associee a un chemosis important, une keratite d’exposition avec un ulcere corneen de la moitie inferieure de la cornee, une limitation de la motilite oculaire et une acuite visuelle reduite a la perception lumineuse mal orientee. L’imagerie tomodensitometrique a montre une volumineuse formation intra-conique bien limitee spontanement dense prenant le contraste, englobant le nerf optique evoquant un meningiome ou une pseudotumeur inflammatoire de l’orbite. L’imagerie par resonnance magnetique nucleaire a mis en evidence cette volumineuse masse a double composante kystique et tissulaire, avec un iso signal el T1 et hypo-signal en T2, sans signe de specificite. L’examen anatomopathologique de la piece operatoire obtenue apres exenteration a permis de poser le diagnostic de tumeur fibreuse solitaire de l’orbite. Discussion Le diagnostic de tumeur fibreuse solitaire est anatomopathologique. Il s’agit d’une tumeur de nature mesenchymateuse avec une forte expression de l’antigene CD34 et de la vimentine en immunohistochimie. Conclusion La tumeur fibreuse solitaire de l’orbite est une tumeur rare habituellement benigne. Elle doit etre differenciee immuno-histo-chimiquement des autres types de tumeurs mesenchymateuses de l’orbite. Sa prise en charge repose sur l’exerese chirurgicale complete et un suivi clinique prolonge.

Retinal dystrophy and congenital glaucoma as major causes of vision loss in students attending two institutions for the visually disabled in Tunis city, Tunisia.

PURPOSE To assess vision loss, identify affected anatomical sites, determine etiologies and potentially avoidable causes in students attending two institutions for the visually disabled in Tunis city. METHODS A visit for a complete ophthalmological examination was performed. All students attending these schools were recruited in our study. The World Health Organisation Programme for the Prevention of Blindness (WHO/PBL) examination record for children was used. Data was analysed by the SPSS version 17 statistical software. RESULTS A total of 172 students were recruited with mean age of 11.9±3.3 years (between 6 and 18 years). One hundred and thirty-seven (79.6%) were under 16 years. The sex-ratio was 1.17. Ninety students (52.3%) had low vision and eighty-two (47.7%) were blind. We reported retina (29%), whole globe (29%), globe appears normal (11%) and optic nerve (9.8%) as the common sites of ocular abnormalities. Retinal dystrophy (22.7%) and congenital glaucoma (22.7%) were the most reported ocular diseases. The main etiologies were hereditary (54.1%) and unknown (30.8%). Consanguinity was reported in 108 students (62.8%), and fifty-five students (32%) had a positive family history. Overall, 50.5% (87/172) of ocular diseases were potentially treatable or preventable. CONCLUSION Retinal dystrophy and congenital glaucoma were the most common eye diseases. Heredity was the main etiology, and consanguinity was high. To decrease their incidence, awareness of the family members of the risks of consanguinous marriage and appropriate therapy for congenital glaucoma/cataract may significantly improve the childs visual prognosis.

Ocular lesions after bee sting of the cornea. A case report.

Bee stings of the cornea are rarely reported but can potentially cause serious ophthalmologic injuries. Locally, damage occurs through toxic and immunologic reactions and from the stinger retained in the cornea. Early recognition of the possible complications and appropriate treatment may help to prevent permanent loss of vision. Removal of a retained bee stinger remains controversial. We present a case of corneal bee sting with retained stinger apparatus and associated anterior uveitis and discuss the pathologic mechanisms of injury and evaluation of these uncommon presentations.

Lésions oculaires par piqûre d’abeille. À propos d’un cas

Introduction La piqure de cornee par abeille est un traumatisme rare. Les complications oculaires sont secondaires a l’action toxique ou immunologique du venin secrete par l’insecte ainsi que par la presence de l’aiguillon dans les tissus. Materiels et Methodes Cas clinique. Observation Nous presentons l’observation d’un patient âge de 25 ans ayant consulte pour douleurs oculaires droites intenses secondaires a une piqure de cornee par une abeille. L’examen initial avait montre une injection ciliaire, un œdeme corneen diffus, des plis de la descemet, une opacite corneenne peripherique localisee en regard de la porte d’entree et une acuite visuelle limitee au decompte des doigts. Le patient a beneficie d’une extraction du dard loge dans la cornee associee a un traitement medical par des steroides par voie locale et generale, des cicatrisants et des antibiotiques. L’evolution a ete marquee par la survenue d’une keratoconjonctivite mucopurulente a staphylococcus xylosus qui a bien evolue sous traitement antibiotique, une uveite anterieure avec des precipites retrocorneens et un debut d’opacification de la capsule posterieure du cristallin. Discussion Les blessures de la cornee dues a un dard d’abeille sont rares, mais elles peuvent entrainer des complications graves et dangereuses pouvant mettre en jeux le pronostic visuel. Conclusion La reconnaissance rapide des complications et un traitement approprie peuvent aider a prevenir une perte de vision par piqure d’abeille. L’extraction du dard retenu dans la cornee demeure sujette a controverse. Le meilleur traitement resta toutefois preventif par une bonne protection oculaire surtout chez les patients a risque.