RESUMEN
INTRODUCTION: Behçet's disease is a systemic inflammatory disease. Ocular involvement is an important diagnostic criterion, and this disease may be associated with severe visual loss. PURPOSE: The goal of this study was to specify the epidemiological, clinical and therapeutic features of ocular involvement in patients with Behçet's disease and to identify risk factors for poor visual outcomes. METHODS: A retrospective study was performed in 93 patients diagnosed with ocular Behçet's disease over a period of 9 years. Epidemiological, clinical, and therapeutic data was obtained from medical records and analyzed retrospectively. Poor visual outcome was defined as visual acuity limited to light perception without projection or no light perception. RESULTS: The male:female ratio was 1.9. The mean age was 34.5 years. Ocular involvement was the presenting sign in 4%, bilateral in 61% and active in 68.8%. Uveitis was the most common presentation (57%), dominated by panuveitis, followed by retinal vasculitis (51.6%) and papilledema (10.7%). Maculopathy (26.8%) and cataract (18.2%) were the most common complications. Twenty patients (21.5%) had no light perception or light perception without projection. Treatment was based on corticosteroids in combination with immunosuppressive therapy (Azathioprine) in 55.9% of cases. Our study indicates a significant association of male gender and panuveitis with a poor visual outcome. CONCLUSION: Ocular involvement in Behçet's disease is frequent and serious, which may lead to blindness. Male gender and panuveitis were predictors of poor visual prognosis.
Asunto(s)
Síndrome de Behçet , Vasculitis Retiniana , Uveítis , Adulto , Síndrome de Behçet/complicaciones , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/epidemiología , Femenino , Humanos , Inmunosupresores/uso terapéutico , Masculino , Estudios Retrospectivos , Visión OcularRESUMEN
INTRODUCTION: There is uncertainty regarding the outcomes of glaucoma surgery for patients with advanced glaucoma, because it may be associated with the «wipe out¼ phenomenon. The aim of this study was to evaluate the outcome of surgical treatment in advanced glaucoma. METHODS: This retrospective study included 67eyes of 49 patients with end-stage glaucoma in which glaucoma surgery was carried out. The clinical records prior to and after surgery were reviewed. Follow up period was 14.4months. RESULTS: The mean age was 50.2years and the sex ratio was 0.75. All the patients had a tubular visual field with persistence of a central island. The mean value of the mean deviation on automated perimetry was 18.94dB±4.7. The mean intraocular pressure (IOP) before surgery was 27.16mmHg±8.9. Postoperatively the overall success rate was 93% (IOP <18mmHg with stable visual acuity). The mean IOP was 14.25mmHg±4.12 (P<.001). There was no significant change in the mean visual acuity. The mean value of the mean deviation was 18.83±4.69 (P=.07). No occurrence of wipe-out phenomenon was noted. The early postoperative complications were hypotony, hyphema and ocular hypertension and they were transient without causing any visual loss. Long term complications were late bleb fibrosis and progression of cataract. CONCLUSION: Glaucoma surgery had beneficial effects in the majority of patients with advanced glaucoma. Postoperative IOP was in general under control and visual acuity was preserved without any cases of wipe-out.
RESUMEN
We aimed to describe the epidemiological, etiological and clinical features, treatment and clinical course of sickle cell retinopathy in children and to determine the risk factors for serious involvement. METHODS: This was a retrospective study including all children diagnosed with sickle cell retinopathy. Epidemiological, clinical and therapeutic characteristics, as well as clinical course, were analysed retrospectively by chart review. Two groups were defined: Group 1 (Goldberg stage 1 and 2); Group 2 (Goldberg stage 3, 4 and 5). In order to identify factors independently associated with severe sickle cell retinopathy, we conducted a logistic regression analysis in descending order. RESULTS: The frequency of sickle cell retinopathy was 14.48%. Forty-two patients (84 eyes) were included; among them 23 boys and 19 girls, aged 10 to 17 with a mean age of 14±1.98 years. Twenty patients were of genotype SS, 11 patients of genotype SC, 8 Sß and 3 SO Arab. The three patients in group 2 were all of SS genotype. The majority of patients (32) had an HbF level of less than 15%. All our patients had sickle cell retinopathy distributed as follows: 62% at stage 1; 31% at stage 2; 5% at stage 3 and 2% at stage 4. Multivariate analysis revealed a single risk factor independently linked to severe involvement - an HbF level<15%. CONCLUSION: Retinopathy is a frequent complication of sickle cell disease which may lead to blindness. The HbF level is negatively correlated with severe involvement.
Asunto(s)
Anemia de Células Falciformes/epidemiología , Enfermedades de la Retina/epidemiología , Adolescente , Edad de Inicio , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/genética , Anemia de Células Falciformes/patología , Niño , Progresión de la Enfermedad , Femenino , Genotipo , Humanos , Masculino , Enfermedades de la Retina/etiología , Enfermedades de la Retina/genética , Enfermedades de la Retina/patología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
PURPOSE: The objectives of our study were to describe the ocular manifestations of Crohn's disease and to identify risk factors for ocular involvement. METHODS: We prospectively collected 71 cases of Crohn's disease. All patients underwent a complete ophthalmic examination. Two groups were identified according to the presence (group 1) or not (group 2) of ocular involvement related to Crohn's disease. Various parameters were compared between the 2 groups. RESULTS: The average age was 38±12 years. The M/F gender ratio was 1.7. Group 1 included 27 patients (38%). Among the ocular manifestations observed, we noted anterior uveitis in 10 cases (37%), scleritis in 2 cases (7.4%), episcleritis in 8 cases (29.6%), dry eye syndrome in 7 cases (25.9%), corneal infiltrates in 7 cases (25.9%), lid ulcer in one patient (3.7%), vein occlusion with capillary leakage in two patients (7.4%) and a serous retinal detachment in one patient (3.7%). Conjunctivitis was considered a coincidental ocular finding; it was seen in 8 cases (15 eyes). Colonic or ileocolic localisation and the activity of the bowel disease were identified as independent risk factors for ocular involvement in Crohn's disease (the adjusted odds ratios were 5.21 and 6.8, respectively). CONCLUSION: Ocular manifestations of Crohn's disease are polymorphic. Colonic or ileocolic localisation, as well as the activity of the bowel disease, have been identified as risk factors for ocular involvement.
Asunto(s)
Enfermedad de Crohn/complicaciones , Oftalmopatías/etiología , Adolescente , Adulto , Anciano , Enfermedad de Crohn/epidemiología , Síndromes de Ojo Seco/epidemiología , Síndromes de Ojo Seco/etiología , Oftalmopatías/epidemiología , Enfermedades de los Párpados/epidemiología , Enfermedades de los Párpados/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oclusión de la Vena Retiniana/epidemiología , Oclusión de la Vena Retiniana/etiología , Escleritis/epidemiología , Escleritis/etiología , Úlcera/epidemiología , Úlcera/etiología , Uveítis Anterior/epidemiología , Uveítis Anterior/etiología , Adulto JovenRESUMEN
The goal of this study was to describe the epidemiological, etiological, clinical and therapeutic features and clinical course of orbital cellulitis in children, and to assess the risk factors for retroseptal involvement. METHODS: This was a retrospective study including 60 children (67 eyes) diagnosed with orbital cellulitis. Two groups were defined according to the clinical form: pre- or retroseptal. RESULTS: We studied 29 cases (34 eyes) of preseptal cellulitis and 31 cases (33 eyes) of retroseptal cellulitis. The mean age was 4 years. The male: female ratio was 1.3. The prescription of anti-inflammatory drugs and antibiotics prior to hospitalization was noted in respectively four and 10 patients. Eyelid edema was the principal sign (100% of cases); exophthalmia was noted in 19 eyes, ptosis in 27 eyes and chemosis in 10 eyes. Oculomotor disorders were present in 4 eyes. The mean C-reactive protein level was 53.15±27mg/l in preseptal cellulitis and 92.09±21mg/l in the retro-septal cases. Orbital computed tomography was performed in 31 patients and MRI in 5 patients. The pathway of entry of the orbital infection was primarily from the sinuses (23 cases). All of our patients had received broad spectrum intravenous antibiotic therapy. Three children had a cavernous sinus thrombosis and had been treated with anticoagulant therapy. Surgical drainage was performed in five patients. The course was favorable and without sequelae for all the patients. Two independent risk factors for retroseptal involvement were identified: the prescription of anti-inflammatory drugs prior to hospitalization, and sinus involvement. CONCLUSION: Orbital cellulitis in children is a serious infection and requires close collaboration between the ophthalmologist, otolaryngologist, and pediatrician in order to be diagnosed and treated early so as to improve the prognosis for vision and life.
Asunto(s)
Celulitis Orbitaria , Sinusitis/etiología , Adolescente , Edad de Inicio , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Celulitis Orbitaria/diagnóstico , Celulitis Orbitaria/epidemiología , Celulitis Orbitaria/patología , Celulitis Orbitaria/terapia , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Sinusitis/epidemiología , Túnez/epidemiologíaRESUMEN
PURPOSE: Antiphospholipid syndrome is defined by the association of at least one clinical event (arterial and/or venous thrombosis, fetal loss) and antiphospholipid antibodies. It can be isolated or associated with systemic lupus disease. The purpose of this case report is to demonstrate that an ocular vascular event can reveal the disease and that its diagnosis is important because this disease generally affects young people and may endanger ocular and vital prognosis. OBSERVATION: We report the case of a 20-year-old female treated for systemic lupus erythematosus for 2 years, who stopped her medical treatment and presented a sudden bilateral loss of vision. Fundus examination and fluorescein angiography revealed severe bilateral retinal vascular occlusion. Antiphospholipid antibody syndrome was confirmed with the presence of anticardiolipin antibodies. With medical treatment, there was initially a small functional improvement and then a general degradation in 3 months, followed by the death of the patient secondary to severe pulmonary emboli. DISCUSSION AND CONCLUSION: Central retinal artery or vein occlusion in a young patient must suggest the diagnosis of antiphospholipid antibody syndrome. The bilateralism of vascular occlusion is considered a severe factor because of its consequence on functional ocular and vital prognosis, where it can sound the alarm to the extension of thrombotic events to other vessels in the body. Antiphospholipid syndrome must be studied in cases of severe retinal vascular occlusion in young patients. Its diagnosis is important because the risk of recurrent thrombotic events may endanger functional and vital prognosis.
Asunto(s)
Síndrome Antifosfolípido/complicaciones , Arteriopatías Oclusivas/diagnóstico , Lupus Eritematoso Sistémico/complicaciones , Enfermedades de la Retina/diagnóstico , Vasos Retinianos/patología , Adulto , Resultado Fatal , Femenino , Angiografía con Fluoresceína , Lateralidad Funcional , Humanos , Embolia Pulmonar , Arteria Retiniana , Vena Retiniana , Trastornos de la Visión/etiologíaRESUMEN
INTRODUCTION: Inferior branch retinal artery occlusion is uncommon in young adults. Through a case report and data from the literature, we describe the clinical, fluorescein angiography, and progressive details of this disease. CASE REPORT: A 26-year-old man suddenly presented superior scotoma in the left eye. He underwent a full ophthalmologic examination, which showed visual acuity limited to 5/10 P4 and ischemia of the inferior retina at the fundus exam. Fluorescein angiography of the left eye revealed delayed filling of the inferior branch retinal artery. The ophthalmologic exam of the right eye was normal. RESULTS: The search for an etiologic explanation revealed double rheumatismal mitral and aortic valvular disease, which was referred to and treated in appropriate department. The condition has progressed slowly but favorably over 2 months, with visual acuity reaching 6/10 P3. DISCUSSION: Branch retinal artery occlusion commonly occurs in older adults. When it happens to the young adult, it may be dangerous and often reveals cardiac embolic disease, particularly rheumatismal valvular disease. CONCLUSION: Branch retinal artery occlusion in the young adult remains a rare and dangerous disease where the prognosis depends on the degree of artery repermeabilization and on the etiology of the thromboembolic disease.
Asunto(s)
Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Mitral/diagnóstico , Oclusión de la Arteria Retiniana/etiología , Adulto , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Insuficiencia de la Válvula Aórtica/complicaciones , Insuficiencia de la Válvula Aórtica/tratamiento farmacológico , Angiografía con Fluoresceína , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/tratamiento farmacológico , Oclusión de la Arteria Retiniana/diagnóstico , Escotoma/etiología , Factores de Tiempo , Agudeza VisualRESUMEN
INTRODUCTION: Primary Sjögren's syndrome is frequently characterized by a sicca syndrome without associated connective tissue disease. Association with an optic neuropathy is uncommon. CASE REPORT: We report a case of optic neuropathy in a 59-year-old woman known to have primary Sjögren's syndrome confirmed clinically and histologically 2 years ago. She suddenly presented an initial bilateral visual loss. The ophthalmological exam noted a visual acuity of 1/10 in the right eye and limited to light perception in the left eye, with bilateral optic ischemic neuropathy more developed in the left eye. Fluorescein angiography showed, signs of ischemic neuropathy. The diagnosis of Horton disease was suspected, but subnormal blood velocity and a negative biopsy of the temporal artery confirmed the diagnosis of optic neuropathy associated with primary Sjögren's syndrome. General steroid therapy improved optic neuropathy in the right eye but was ineffective in the left eye. CONCLUSION: Optic neuropathy associated with Sjögren's syndrome is rare but must be considered the most common ophthalmological manifestation of the disease. Visual prognosis depends on the rapidity of diagnosis and therapy.
Asunto(s)
Enfermedades del Nervio Óptico/etiología , Síndrome de Sjögren/complicaciones , Antiinflamatorios/uso terapéutico , Biopsia , Velocidad del Flujo Sanguíneo , Diagnóstico Diferencial , Progresión de la Enfermedad , Femenino , Angiografía con Fluoresceína , Humanos , Persona de Mediana Edad , Oftalmoscopía , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/tratamiento farmacológico , Prednisona/uso terapéutico , Pronóstico , Índice de Severidad de la Enfermedad , Síndrome de Sjögren/diagnóstico , Resultado del Tratamiento , Agudeza Visual , Percepción VisualRESUMEN
INTRODUCTION: Epibulbar osseous choristoma is a congenital tumor consisting of normal tissue arising in an abnormal location. CARE REPORTS: We report two cases of epibulbar osseous choristoma discovered in 7- and 3-year-old girls. FIRST CASE: A calcified tumor was located regarding the temporal bulbar conjunctiva of the left eye. The rest of the ophthalmological examination was normal. Second case: During strabismus surgery, we unexpectedly discovered a white calcified mass located on the superior temporal part of the right eye. In both cases, a total excision was performed. Histopathological examination of the excised choristoma confirmed the diagnosis. DISCUSSION: Epibulbar osseous choristoma is a small unique nodule usually located on the superior temporal quadrant of the eye. Rarely reported in the literature, most cases are not recognized clinically and the diagnosis is essentially histopathological. CONCLUSION: Epibulbar osseous choristoma is a rare benign childhood tumor with an essentially histopathological diagnosis.
Asunto(s)
Huesos , Coristoma/diagnóstico , Oftalmopatías/diagnóstico , Niño , Preescolar , Coristoma/patología , Coristoma/cirugía , Oftalmopatías/patología , Oftalmopatías/cirugía , Femenino , Humanos , Resultado del TratamientoRESUMEN
We retrospectively analyzed 31 cases of dermoid cysts surgically treated between January 1992 and October 2000. Mean patient age was 18.9 years. The preseptal localization predominated, with 29 cases. Two cases of intraorbital localization required orbitotomy. The surgical result was excellent.
Asunto(s)
Quiste Dermoide/epidemiología , Adolescente , Adulto , Niño , Preescolar , Quiste Dermoide/patología , Quiste Dermoide/cirugía , Quiste Dermoide/terapia , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To report our experience in the therapeutic management of post-penetrating keratoplasty glaucoma. INTRODUCTION: Post-penetrating keratoplasty (PK) glaucoma is a true threat to visual prognosis. Therapeutic modalities are many, but the absence of a well-defined decision tree and the variable results of the various techniques renders management very difficult. PATIENTS AND METHODS: This is a retrospective study including 73 eyes of 71 patients undergoing a penetrating keratoplasty. Patients who developed post-operative ocular hypertension were treated first with eye drops. In the case of failure, surgical procedures were recommended including trabeculectomy or glaucoma drainage devices. The intraocular pressure (IOP) assessed with applanation tonometer, side effects and graft failure were monitored. RESULTS: The first medical treatment used for all patients was a betablocker, which allowed control of intraocular pressure in 80.6 % of eyes. Ahmed glaucoma valve was used in two cases with success and without graft failure. Trabeculectomy was necessary for five patients, three of whom developed immunological graft rejection within 6 to 9 months. We also observed that late ocular hypertension was statistically related to anatomic graft failure, independently of other preoperative factors. DISCUSSION AND CONCLUSION: Although hypotensive medication is still the first treatment for ocular hypertension after penetrating keratoplasty, a surgical procedure is sometimes required. Glaucoma drainage devices and trabeculectomy are widely practiced, leading to good outcomes, with the risk of rejection lower in cases involving mitomycin C. Cyclodestructive procedures should be reserved for surgical failures with significant visual loss.
Asunto(s)
Glaucoma/etiología , Glaucoma/terapia , Queratoplastia Penetrante/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hipertensión Ocular , Estudios RetrospectivosRESUMEN
UNLABELLED: Given the failure of pharmacologic and surgical treatment in the management of hemifacial spasm, the use of botulinum toxin as first line therapy is interesting. PURPOSE: To evaluate the safety and efficacy of type A botulinum toxin in the treatment of hemifacial spasm. PATIENTS AND METHODS: We conducted a retrospective, descriptive and comparative study of 25 patients with hemifacial spasm followed in the ophthalmology department of Habib Thameur hospital in Tunis over the period from June 2003 to June 2009. All patients received injections of botulinum toxin type A (Botox). RESULTS: We carried out 168 Botulinum A toxin injections (Botox) with an average of 6.85 ± 4.32 injections per patient. Doses varied between 12.5 U and 28 U Botox. A good response to treatment was observed in 92% of patients with a satisfactory return to daily activities and work. Based on a subjective scale from 1 to 3, the average total functional benefit was 2.55 ± 0.56. Average total duration of therapeutic response was 9.35 ± 3.64 weeks. Local side effects observed were comparable to those described in the literature: ptosis (32.4%), diplopia (8.2%), drooping of the labial commissure (11.2%), lagophthalmos (21.3%), tearing (7%), dry eye (4%). No systemic complication was noted. CONCLUSION: Botulinum toxin type A provides effective short-term and medium-term results in the treatment of hemifacial spasm. It is well tolerated locally and systemically. This safety and efficacy make it a valuable therapeutic alternative in the management of hemifacial spasm.
Asunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Espasmo Hemifacial/tratamiento farmacológico , Fármacos Neuromusculares/uso terapéutico , Anciano , Blefaroptosis/inducido químicamente , Toxinas Botulínicas Tipo A/administración & dosificación , Toxinas Botulínicas Tipo A/efectos adversos , Diplopía/inducido químicamente , Evaluación de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fármacos Neuromusculares/administración & dosificación , Fármacos Neuromusculares/efectos adversos , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate intraocular pressure parameters and the role of other ocular risk factors in the progression of primary open angle glaucoma. PATIENTS AND METHODS: We performed a retrospective analysis of long-term glaucomatous progression in 140 patients (280 eyes) with primary open angle glaucoma (POAG) between 1998 and 2009. After analyzing their disease progression, the eyes of our patients were divided into two groups: group 1 (G1) consisted of eyes with worsening of their POAG, and group 2 (G2) consisted of the eyes that remained stable. The indicators of progression studied were factors associated with glaucomatous optic neuropathy, other ocular risk factors, and treatment-related risk factors. RESULTS: We found 188 eyes with stable visual fields (G2) and 92 eyes with glaucoma progression (G1), for a progression rate of 32.9%. Mean intraocular pressure (IOP) at diagnosis was statistically higher in the cases with progression, 22.78 mmHg vs. 19.9 mmHg for stable cases (P=0.03; OR=5.25). Higher final intraocular pressure (IOP) was also associated with progression (16.82 mmHg for G1 vs. 14.85 mmHg for G2; P=0.051). IOP less or equal to 12.75 mmHg was identified as the target pressure for our population. Progressed eyes also showed a statistically higher diurnal peak IOP (23.13 mmHg vs. 19.87 mmHg for G2; P=0.007). Long term IOP fluctuation was also predictive of progression (4.43 mmHg for G1 vs. 2.31 mmHg for G2; P=0.003). Eyes with initial visual field defect more than 8.2dB had 4.8 times the risk of progression (P=0.07). However, eyes diagnosed in an early glaucoma stage had four times the chance of maintaining a stable visual field (P=0.003). Statistically significant risk factors between the two groups also included: pseudoexfoliation (OR=2.84; P=0.05), cornea less than 505 µ (OR=10.89; P=0.005), topical beta blockers (P=0.003), and more than two topical medications (OR=3; P=0.003). CONCLUSION: It is currently known that IOP lowering contributes to glaucoma stabilization. However, this single criterion remains insufficient, as other, particularly ocular, factors have been implicated in glaucoma progression. Identification of these risk factors allows for a better therapeutic approach toward these patients, so as to preserve their vision and quality of life.
Asunto(s)
Glaucoma de Ángulo Abierto/diagnóstico , Glaucoma de Ángulo Abierto/etiología , Adulto , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Glaucoma de Ángulo Abierto/epidemiología , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Población , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Tonometría Ocular , Túnez/epidemiologíaRESUMEN
Acquired ptosis is a common ophthalmologic problem. It is in the large majority of cases aponeurotic and occurs in the elderly as an involutional disorder or after ophthalmic surgery. In younger patients, it may occur after ocular trauma, periocular infection, contact lens wear, or palpebral edema. Allergic blepharoconjunctivitis is an unsuspected cause of acquired ptosis. Our study investigated patients (5 to 15 years old) with a history of allergic blepharoconjunctivitis and having a unilateral or bilateral ptosis. Physiopathological hypotheses are discussed. Management of acquired ptosis is presented.
Asunto(s)
Blefaroptosis/etiología , Blefaroptosis/terapia , Conjuntivitis Alérgica/complicaciones , Conjuntivitis Alérgica/terapia , Adolescente , Edad de Inicio , Blefaroptosis/diagnóstico , Blefaroptosis/epidemiología , Niño , Preescolar , Estudios de Cohortes , Conjuntivitis Alérgica/diagnóstico , Conjuntivitis Alérgica/epidemiología , Femenino , Humanos , Masculino , Procedimientos Quirúrgicos Oftalmológicos/estadística & datos numéricos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Túnez/epidemiologíaRESUMEN
Introducción Existe incertidumbre con respecto a los resultados de la cirugía de glaucoma para pacientes con glaucoma avanzado, ya que puede estar asociada con el fenómeno de «wipe out». El objetivo de este estudio fue evaluar el resultado del tratamiento quirúrgico en el glaucoma avanzado. Métodos Este estudio retrospectivo incluyó 67 ojos de 49 pacientes con glaucoma en etapa terminal en los que se realizó una cirugía de glaucoma. Se revisaron los registros clínicos antes y después de la cirugía. El período de seguimiento fue de 14,4meses. Resultados a edad media fue de 50,2años y la proporción de sexos fue de 0,75. Todos los pacientes tenían un campo visual tubular con persistencia de una isla central. El valor medio de la desviación media en perimetría automatizada fue de 18,94dB±4,7. La presión intraocular (PIO) media antes de la cirugía fue de 27,16mmHg±8,9 Después de la operación la tasa de éxito general fue del 93% (PIO <18mmHg con agudeza visual estable). La PIO media fue de 14,25mmHg±4,12 (p<0,001). No hubo cambios significativos en la agudeza visual media. El valor medio de la desviación media fue de 18,83±4,69 (p=0,07). No se observó ningún fenómeno de wipe out. Las complicaciones postoperatorias tempranas fueron hipotonía, hifema e hipertonía y fueron transitorias, sin causar pérdida visual. Las complicaciones a largo plazo fueron la fibrosis tardía de la ampolla de filtración y la progresión de la catarata. Conclusión La cirugía de glaucoma tuvo efectos beneficiosos en la mayoría de los pacientes con glaucoma avanzado. La PIO postoperatoria estuvo en general controlada y la agudeza visual se preservó sin ningún caso de wipe out (AU)
Introduction There is uncertainty regarding the outcomes of glaucoma surgery for patients with advanced glaucoma, because it may be associated with the «wipe out» phenomenon.The aim of this study was to evaluate the outcome of surgical treatment in advanced glaucoma. Methods This retrospective study included 67eyes of 49 patients with end-stage glaucoma in which glaucoma surgery was carried out. The clinical records prior to and after surgery were reviewed. Follow up period was 14.4months. Result The mean age was 50.2years and the sex ratio was 0.75. All the patients had a tubular visual field with persistence of a central island. The mean value of the mean deviation on automated perimetry was 18.94dB±4.7. The mean intraocular pressure (IOP) before surgery was 27.16mmHg±8.9. Postoperatively the overall success rate was 93% (IOP <18mmHg with stable visual acuity). The mean IOP was 14.25mmHg±4.12 (P<.001). There was no significant change in the mean visual acuity. The mean value of the mean deviation was 18.83±4.69 (P=.07). No occurrence of wipe-out phenomenon was noted. The early postoperative complications were hypotony, hyphema and ocular hypertension and they were transient without causing any visual loss. Long term complications were late bleb fibrosis and progression of cataract. Conclusion Glaucoma surgery had beneficial effects in the majority of patients with advanced glaucoma. Postoperative IOP was in general under control and visual acuity was preserved without any cases of wipe-out (AU)
Asunto(s)
Humanos , Trabeculectomía/métodos , Glaucoma/cirugía , Campos Visuales , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
INTRODUCTION: Crohn's disease is a chronic inflammatory bowel disease. Numerous extra-intestinal complications can affect different organ in the body (kidneys, eyes...). Posterior ocular manifestation is rare and retinal vasculitis is exceptional. OBSERVATION: We present a case of a 55-year- old men in whom Crohn's disease was diagnosed in 1985 and considered severe treated by corticosteroid end then by immunosuppressive therapy. He lost his right eye few years ago. He presented a sudden loss of vision of the good eye. Physical examination found visual acuity reduced to light perception without sign of anterior inflammation. Ophthalmoscopic examination found different retinal vasculitis involving veins, papillitis, cystoid macular oedema; all these findings were confirmed by fluorescein angiography and OCT. Corticosteroid treatment with a dose of 1mg/Kg/day was instituted with precaution of use and a wide follow up with favourable evolution during 9 months. CONCLUSION: Retinal vasculitis is rare during Crohn's disease. It can be a severe ocular lesion and causes therapeutic and prognosis problems, especially in a patient with only one functional eye.
Asunto(s)
Enfermedad de Crohn/complicaciones , Vasculitis Retiniana/etiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Cortisone glaucoma is a secondary glaucoma induced by local or oral steroids used to treat chronic inflammatory diseases. PATIENTS AND METHODS: Retrospective study including 43 eyes of 23 patients (three patients were monophthalmos). We present epidemiological and clinical features with evaluation of functional damage (visual acuity, visual field), and therapeutic results with a follow-up period ranging from 2 to 10 years. RESULTS: Topical steroids were incriminated in 15 of 23 cases (self-medication), whereas general steroids (for chronic diseases) were used by eight patients. Visual function was seriously affected (visual acuity<1/10 in 23/43 eyes at the first visit with pronounced visual field abnormalities). Surgery was necessary in 16 of 43 eyes (deep sclerectomy with or without implant, trabeculectomy). DISCUSSION: Cortisone glaucoma is rather frequent in Tunisia where conjunctival allergy and self-medication are common. Young adults are concerned, making it a high surgical risk usually requiring surgical devices such as a T Flux implant. CONCLUSION: Cortisone glaucoma is a serious complication of steroid therapy that usually affects young adults. The disease is usually detected late, explaining the severe functional damage.