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.

[Metastatic neoplasia in the optic nerve]. / Neuropathie optique métastatique.

INTRODUCTION: Ocular metastasis always involves the uveal tractus, especially the choroid. Papillary metastases have been exceptionally described, and represent only 5 percent of the ocular metastatic locations. We report in this observation a case of papillary metastasis in a patient treated for a metastatic adenocarcinoma. OBSERVATION: A 35-year-old woman was given chemotherapy for four months for metastatic adenocarcinoma involving the pleura and bones. She consulted for significant decline of visual acuity in the left eye associated with headache and vomiting. The fundus examination revealed a yellowish papillary lesion with edema associated with an inferior peripapillary serous retinal detachment. The fluorescein retinal angiography showed a choroidal lesion highly suggestive of choroidal metastasis. Cerebro-orbital CT scan revealed the presence of multiple cerebral metastases. The patient died four months after diagnosis of ocular metastasis and eleven months after diagnosis of adenocarcinoma. CONCLUSION: Presence of a papillary lesion suggests the possible diagnosis of papillary metastasis despite the lack of a history of neoplasia. Carcinomatosis tumors, especially breast and the lung carcinomas are the most frequent causes of papillary metastasis.

[Therapeutic results of 5-fluorouracil in multiple and unresectable facial carcinoma secondary to xeroderma pigmentosum]. / Résultats thérapeutiques du 5-fluorouracile dans les carcinomes multiples ou non resécables de la face secondaires au xeroderma pigmentosum (XP).

A prospective study was done to test the efficacy of 5-fluorouracil (topical and systemic) in multiple and unresectable histologically proven facial squamous cell carcinomas (SCC) secondary to XP. Twelve patients (7M/5F, mean age 19.8 years) with multiple facial SCC were treated between 1994 and 1997. 5-FU was used as a twice-a-day local application in the documented areas, by continuous infusion associated with cisplatin (2 patients) and short infusion combined with folic acid (3 patients). Evaluation was done by clinical examination every two months for topical therapy and after every cycle for systemic treatment. Median treatment duration was 12 months (2 to 36 months). Treatment was well tolerated excluding episodes of pruritus in the treated areas. We observed mainly superficial tumour regression followed by dryness and crusting. In 5 cases, we performed biopsies after treatment showing in one case an extensive fibrosis with absence of tumour. However in the remaining 4 cases, despite a superficial reduction of tumour and a reconstitution of the epidermis, viable and unmodified squamous cell carcinoma remained in the deeper dermis. In the 5 patients treated by systemic 5-FU, we observed 1 complete response and 3 partial responses. Despite a dissociation between a good cosmetic result and a relatively superficial effect, topical 5-FU represents a useful therapeutic option in multiple unresectable facial SCC in patients with XP. Systemic chemotherapy is recommended in the event of more extended or profound lesions.

[Retinal flecks in Alport's syndrome]. / Ponctuations rétiniennes et syndrome d'Alport.

UNLABELLED: Alport's syndrome is a familial disorder characterized by progressive renal failure, sensorineural hearing loss and ocular manifestations. CASE REPORT: The authors report a case of a 13-year-old child with Alport's syndrome associated with retinal flecks. CONCLUSION: Retinal flecks are the most frequent ocular manifestation in Alport's syndrome and are a considerable help to diagnosis. They are often associated with severe renal failure.

[Behçet disease in children. 3 Tunisian cases and review of the literature]. / La maladie de Behçet de l'enfant. A propos de 3 observations tunisiennes et revue de la littérature.

OBJECTIVE: To describe epidemiological, clinical and evolutive features of ophthalmological involvment of Behçet disease in children in tunisian patients. PATIENTS AND METHODS: In a retrospective study from 1990 to 1996, we collected three observations in children in 130 recorded cases of Behçet disease. Patients have been explored by a complete ophthalmologic staging and are treated and followed in our institution for theirs oculars problems. RESULTS: The three children, all males, aged from 12 to 13 years, represented 2.3% of all the Behçet disease diagnosed during the same period. Oral and/or genital aphtosis are present in all 3 cases and cutaneous or articular involvement is seen in 2 patients. Ocular Behçet disease involvement, bilateral in all the cases, is dominated by uveitis (posterior in 3 patients or anterior in 2) complicated by macular edema in 3 cases and cataract or pseudo-trou in 1 case. CONCLUSION: Behçet disease in children is characterized by the frequency of familial forms and articular involvement. The most characteristic ocular feature is represented by the posterior uveitis with a visual prognosis poor in short term. Specific criteria of Behçet disease is necessary for children for a early and best identification.

[Vermian agenesis: Report of a family and review of the literature]. / Agenesie vermienne: a propos d'une observation familiale et revue de la litterature.

Vermian agenesis constitute an heterogeneous group of clinical and neuroradiological entities with different prognosis. Authors report a kindred with vermian agenesis associated to characteristic facial dysmorphy and to mental retardation. After review of the literature, we found no previous description of such an association. We believe this is a new entity of familial vermian agenesis with autosomal recessive transmission.

[Patients' opinions about day cataract surgery in a general hospital]. / Opinion des patients sur l'hôpital de jour pour la chirurgie de la cataracte au sein d'un hôpital général.

OBJECTIVE: To evaluate the patient satisfaction as a performance indicator of quality of health care delivery in outpatient cataract surgery. PATIENTS AND METHODS: We performed a prospective study using a questionnaire containing 14 items (preoperative work-up, administrative formalities, local anesthesia..) evaluating all the phases of ambulatory surgery for cataract. RESULTS: We collect 75 responding patients and we observed 2/3 of relative satisfaction about outpatient cataract surgery. Negative opinion was in relation with the prolonged time required for preoperative work-up which is done outside the outpatient surgery structure. CONCLUSION: Advances in techniques of locoregional anesthesia and surgery permit today the frequent use of ambulatory treatment in cataract surgery. This method seems to be well accepted by patients. However the prolonged time used to do the preoperative work-up require in the future a centralisation for this procedure.

[Ambulatory cataract surgery]. / La chirurgie de la cataracte en ambulatoire.

UNLABELLED: The purpose of this study is to show the result of outpatient cataract surgery and its differences or advantages with inpatient cataract surgery. PATIENTS AND METHODS: The retrospective study concern 722 consecutives patients collected from June 1995 till May 1997; 388 underwent outpatient cataract surgery and 384 underwent inpatient cataract surgery. RESULTS: There were non significant difference between the two groups in type of cataract surgery. Immediate postoperative complications and final visual acuity did not show any significant difference in both groups. CONCLUSION: This analysis shows the great advantages of this simple surgical procedure such an increase in cataract operation leading to a decrease of patients in waiting list.

[Retinal vasculitis. Epidemiological, clinical and etiological features]. / 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.

[Optic nerve head analysis using the confocal scanning laser ophthalmoscope (CSLO) of big cups versus normal cups]. / Analyse de la tête du nerf optique par microscope confocal à balayage laser (CSLO) de larges excavations papillaires comparée aux normales.

PURPOSE: To comparatively evaluate the optic nerve head (ONH) using the confocal scanning laser ophthalmoscope (CSLO) in normal eye subjects (NE) versus big cup (BC) patients. MATERIALS AND METHODS: A total of 83 NEs (43 subjects) and 44 BC eyes (22 patients) were evaluated in this prospective study. The ONH was imaged using the CSLO (HRT-II; Heidelberg Engineering, Heidelberg, Germany). Disc area, cup area, rim area, rim volume (horizontal integrated rim volume), cup/disc ratio, and cup volume were evaluated. Additionally, cup depth and retinal nerve fiber layer thickness (RNFL th) and csa (RNFL csa) of the ONH were also measured. These ONH parameters were compared between normal subjects and eyes with a big cup. We used the t test for statistical analysis. RESULTS: The mean age was 46 and 44 years in the NE and BC groups, with a sex ratio of 1.26 and 0.69 (p=0.381), respectively. There was a significant difference in disc area (2.07+/-0.38, 2.73+/-0.45, p<0.01), cup area (0.52+/-0.8, 1.26+/-0.3, p<0.01), cup volume (0.14+/-0.14, 0.44+/-0.16, p<0.01), cup/disc ratio (0.24+/-0.1, 0.69+/-0.1, 0.46+/-0.06, p<0.01), Me cup disc (0.24+/-0.1, 0.37+/-0.1, p<0.01), rim volume (0.44+/-0.1, 0.34+/-0.09, p<0.01), rim area (1.56+/-0.27, 1.45+/-0.27, p=0.345), RNFL th (0.28+/-0.05, 0.23+/-0.05, p<0.001) and CSM-0.19+/-0.14,-0.08+/-0.06, p<0.001), RNFL csa (1.43+/-0.25, 1.37+/-0.29, p=0.849) in normal vs big cup eyes, respectively. DISCUSSION: There is correlation between the cup and disc areas. Parameters evaluating the retinal nerve fiber were comparable in the two groups, except the RNFL thickness, which was lower in the BC group. This may be explained by the larger surface of the optic disc in this group. CONCLUSION: HRT parameters might be part of the criteria favoring the physiologic character of big cups.

[Drusen in children: three case studies]. / Les druses papillaires de l'enfant: à propos de 3 cas.

We report three cases of optic disc drusen in children. The children were 5 months, 10 years, and 11 years old. Two of them were male. The optic disc drusen was unilateral in two cases and bilateral in one case. One child had a history of Down syndrome and another one a history of Alagille syndrome. The third child had no particular general history but he had unilateral high myopia with optic disc drusen in the same eye. Fundus examination showed pseudopapilledema in all three cases; the disc appeared elevated and its margins were blurred. Ultrasonography of the eye demonstrated optic disc drusen in the three cases. Optic disc calcification on CT scan was identified in only one case. In children, optic disc drusen are often buried, leading to pseudopapilledema appearance of the optic disc. Ultrasonography is highly sensitive in detecting optic disc drusen, making more expensive investigations unnecessary.

[Familial exudative vitreoretinopathy associated with persistence of hyaloid artery]. / 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.