Zouheir Hafidi

Anterior Dislocation of the Lens

A 30-year-old man presented with sudden, painful vision impairment in his right eye 1 hour after vigorous exercise (long jump). He reported no direct ocular trauma.

Atypical Presentation of Ectopia Lentis in Homocystinuria

A 6-year-old boy presented with a history of intermittent strabismus since the age of 2 years. On examination, there was a bilateral displacement (ectopia) of the lense to the nasal and superior quadrants with a marked bilateral phacodonesis (tremulousness of the lens during eye movement) due to rupture of the zonular fibers in the inferotemporal quadrants holding the crystalline lens in place (Figure). General examination revealed a marfanoid morphotype with developmental delay, which was suggestive of a homocystinuria. This was confirmed by plasma and urine screening tests for homocysteine. The patient underwent bilateral phacophagia (surgical extraction of the lenses) and anterior vitrectomy. Iris fixated intraocular lenses were inplanted to manage the residual aphakia (absence of the crystalline lenses). Pyridoxine (vitamin B6) supplementation was started, along with a low-methionine and high-cysteine diet. Homocystinuria is an inborn error of methionine metabolism related to a deficiency of the cystathionine-bsynthetase, which converts homocysteine to cystathionine. Clinical features of this condition are related to the accumulation of the homocysteine and deficiency of cystine. The ocular manifestations are dominated by myopia and ectopia lentis. The latter is present in 90% of patients; it is an acquired and progressive abnormality. The suspensory system of the lens (zonula) contains high levels of cystine; thus, a deficiency of this component leads to an abnormal development of the zonular fibers, which alters the stability of the lens. This may lead, long-term, to a complete dislocation of the lens either to the anterior chamber or the vitreous, requiring a surgical extraction.

Cilioretinal artery and central retinal vein occlusion after sildenafil use

Its reported that sildenafil may cause non-arteritic anterior ischaemic optic neuropathy and transient changes in perception of colour hue or brightness.1 We report a case of cilioretinal artery and central retinal vein occlusion after sildenafil use. A previously healthy 40-year-old man, presented with acute visual loss of the left eye. He took one tablet of sildenafil (100 mg) for two consecutive days before the onset of symptoms. At examination the visual acuity was …

Acute fulminant endophthalmitis complicating traditional lens couching

A 76-year-old woman presented to the department of ophthalmology in February, 2014, with painful unilateral exophthalmos, 5 days after undergoing couching of the right cataractous lens by a traditional healer. The following day her eye had become red and painful with reduced vision. On examination visual acuity in the right eye was light perception, the intraocular pressure was high (45 mm Hg; normal 10–20 mm Hg), and there was proptosis and ophthalmoplegia. Biomicroscopic exam ination showed eyelid oedema, conjunctival injection, total chemosis, abundant purulent secretions, and a greenish hypopyon occupying the anterior chamber, typical of pseudomonas infection (fi gure). CT showed preseptal and retroseptal cellulitis, exophthalmos grade II, and a dislocated cataractous lens in the lower vitreous. We took vitreous and aqueous humour samples and gave one injection of intravitreal antibiotics (vancomycin 1 mg/0·1 mL and ceftazidime 2·25 mg/0·1 mL). We started systemic antibiotics (intravenous ceftriaxone 1 g twice daily and levofl oxacin 500 mg twice daily) and a systemic hypotonic (oral acetazolamide 250 mg twice daily). 48 h later we gave a second dose of intravitreal antibiotics and started methylprednisolone 40 mg twice daily for 5 days to reduce the infl ammation. Vitreous cultures grew Pseudomonas aeruginosa. By the seventh day the patient’s pain, eyelid oedema, and proptosis had resolved (fi gure), but she had a persistent vitreous opacity. We did pars plana vitrectomy and iris-claw intraocular lens on the posterior side of the iris to compensate for the refractive disorder caused by absence of the crystalline lens. At last follow-up in May, 2014, her best corrected visual acuity was 6/60 in the right eye and intraocular pressure had returned to normal (16 mm Hg). Lens couching is the oldest technique of cataract surgery. It was fi rst practised by the Assyrians of Hammurabi in the 17th century BC, and then by the Hindu surgeon Sushruta around 600 BC. It consists of traumatising the zonula through the sclera using a pen so the lens falls into the vitreous and releases the visual axis, allowing the patient to see the light. The visual outcome of this technique, unfortunately still prevalent in some parts of the world, is often poor. Its complications are retinal detachment, secondary glaucoma, hyphaema, uveitis, optic atrophy, and endophthalmitis.

Secondary hemorrhage in traumatic hyphema

A 40-year-old man presented with 3 h history of acute painful vision loss of his right eye. He reported a blunt trauma of the same eye 7 days prior to admission. At examination his visual acuity was reduced to light perception. Slit lamp examination revealed a multilayered hyphema (collection of blood in the anterior chamber). A layer of fresh blood (empty arrows) was noted over the darker clot (white arrows) in the anterior chamber (Figure 1). The intraocular pressure (IOP) was increased (40 mmgh).

Unilateral bullous exudative retinal detachment in Behcet's disease.

We report an unusual case of Behcet disease presenting with retinal vasculitis and unilateral exudative retinal detachment. A 24 years old man presented with 1 week history of acute vision loss of both eyes. He reported a 3 years history of recurrent oral and genital ulcerations, with arthralgia of wrists and ankles. The best correct visual acuity was 6/30 in the right eye and 6/24 in the left eye. Slit lamp examination showed bilateral mild inflammation in the anterior chamber and vitreous. Funduscopy revealed bilateral extensive perivascular sheathing with scattered yellowish retinal infiltrates and hemorrhages. In the right eye there was, in addition, a bullous exudative retinal detachment involving the superior and inferior quadrants of the temporal retina (a, white arrows). Fluoresce in angiography (b) showed late staining of the retinal vasculature with diffuse dye leakage in both eyes. In the right eye, late frames showed an evident fluorescein pooling in the subretinal space (black arrows). The patient received intravenous bolus of methylprednisolone (1 g daily / 3days) leading to prompt clinical improvement. Azathioprine was also started at a dose of 150 mg daily. Exudative retinal detachment is an uncommon finding in Behcets disease, and only few cases were reported in the medical literature. This entity could reflect the severity of the underlying disease. In addition the early set of the disease and male gender are usually associated with poor long term prognosis. This justifies our choice of giving azathioprine as an immunosuppressive therapy.

Unilateral multifocal choroidal ischemia revealing a giant cell arteritis: a case report.

Unilateral multifocal choroidal ischemia revealing a giant cell arteritis: a case report Zouheir Hafidi, Hanan Handor, Hamid Elmoussaif, Mina Laghmari, Abdelouahed Karmane, Samira Tachfouti, Rajae Daoudi Université Mohammed V Souissi, Service d’Ophtalmologie A de l’Hôpital des Spécialités, Centre Hospitalier Universitaire, Rabat, Maroc Corresponding author: Zouheir Hafidi, Université Mohammed V Souissi, Service d’Ophtalmologie A de l’Hôpital des Spécialités, Centre Hospitalier Universitaire, Rabat, Maroc

Limbal dermoid in Goldenhar syndrome

Le syndrome de Goldenhar ou dysplasie oculo-auriculo-vertebrale est un syndrome polymalformatif rare, en rapport avec une anomalie de developpement des premiers arcs branchiaux ; il est le plus souvent unilateral affectant les tissus mous et dans une moindre proportion le tissu osseux, associant de facon variable des malformations squelettiques, auditives et oculaires avec un retard mental. Son diagnostic est essentiellement clinique et relativement simple; l’atteinte ophtalmologique est assez caracteristique et representee par le dermoide du limbe, a cette anomalie peut s’ajouter un colobome de la paupiere, un syndrome de Duane et tres rarement une microphtalmie ou une anophtalmie. Nous rapportons l’observation d’un nourrisson âge de 2 annees de sexe masculin, adresse dans notre formation dans le cadre du bilan general d’un syndrome poly malformatif associant un retard psychomoteur, hypoplasie du pavillon de l’oreille gauche associe a des appendices pres auriculaires avec retrognathisme. L’examen ophtalmologique note une formation tumorale blanchâtre de l’œil gauche, de localisation limbique temporale inferieure avec un fin duvet a sa surface evoquant un dermoide du limbe, la refraction automatique n’a pas montre de vice refractif, le reste de l’examen ophtalmologique est sans aucune anomalie, notamment il n’y a pas de deviation oculaire a l’examen oculomoteur. Devant ce tableau clinique le diagnostic de syndrome de Goldenhar a ete retenu et l’abstention therapeutique sur le plan ophtalmologique a ete adoptee vu la benignite de la lesion, et l’absence de vice refractif qui pourrait etre a l’origine d’une amblyopie anisometropique, auquel cas l’excision chirurgicale devient imperative.

Branch retinal vein occlusion with sectoral cystoid macular edema in toxoplasmic chorioretinitis.

A 28 year-old man presented with sudden visual loss in his left eye. Best-corrected visual acuity was 20/20 in the right eye and 20/400 in the left eye. Fundus examination showed a whitish retinal lesion of the superotemporal quadrant involving the supero-temporal retinal vein branch with mild vitritis. Fluorescein angiography confirmed active retinochoroidal inflammation (black arrow) with delayed filling and tortuosity of the involved vein (white arrow); capillary dilatation was present within the affected drainage area (white arrowhead) with dye leakage in late frames, resulting in cystoid macular edema (black arrowhead) which was sectorial on macular OCT (optical coherence tomography) (star). Serological tests, after anterior chamber puncture, confirmed local production of specific anti toxoplasma antibodies. The patient was treated with clindamycin 150 mg four times a day and prednisolone 60 mg daily. After 6 weeks of antiparasitic therapy the lesion became inactive and visual acuity improved. Repeat fluorescein angiography and OCT demonstrated resorption of the macular edema.

Orbital hydatid cyst.

A 46-year-old man presented with unilateral proptosis of the right eye for 3 months. The patient was a shepherd and had contact with dogs. Visual acuity was 20/800 in the right eye and 20/25 in the left eye. Physical examination revealed an axile, irreducible and painless proptosis, without breath or thrill, associated with lower chemosis (Figure 1A, asterisk), lagophthalmos and exposure keratitis (Figure 1A, arrowheads). The CT scan showed a right intra conial hypodense mass measuring 42 mm × 29 mm, well limited, with sharp and spontaneously hyperdense edges (Figure 1B, asterisk). It pushes forward the eyeball, resulting in a grade III proptosis (figure 1B, arrows). Blood count …