Prevalence and causes of visual impairment in diabetic patients in Tunisia, North Africa.

PURPOSE: To investigate the prevalence and causes of blindness and partial sight among a population of Tunisian diabetic patients. METHODS: A cross-sectional study of 2320 randomly identified patients with diabetes mellitus. Patient's characteristics as well as data from the last ophthalmic examination were reviewed. RESULTS: Of all patients examined, 60.2% were females and 39.8% were males. Mean age of patients was 54.5 years. Mean duration of diabetes was 7.6 years. Diabetic retinopathy (DR) was recorded in 26.3% of patients, and was proliferative in 3.4% of patients. The prevalence of visual impairment was 22.2%, with 4.4% patients legally blind and 17.8% partially sighted. Visual impairment was significantly associated with age ≥60 years (P<0.001), duration of diabetes >10 years (P<0.001), body mass index >25 (P=0.014), hypertension (P<0.001), heart disease (P<0.001), peripheral neuropathy (P=0.03), vegetative neuropathy (P=0.002), macroalbuminuria (P<0.001), cataract (P<0.001), DR (P<0.001), diabetic macular edema (P<0.001), open angle glaucoma (P<0.001), intravitreal hemorrhage (P<0.001), rubeosis iridis (P<0.001), neovascular glaucoma (P<0.001), and tractional retinal detachment (P<0.001). CONCLUSION: The current report is the largest study of DR in North African region. It provides a baseline data against which future progress can be assessed. Screening and treatment can greatly reduce the incidence of visual impairment due to diabetes.

[The eye and Behçet's disease]. / Œil et maladie de Behçet.

Behçet's disease (BD) is a systemic inflammatory disorder for which the underlying histopathology is an occlusive vasculitis. This disease is more common in the Mediterranean region, the middle east and the far east. It is characterized by oral and genital ulcerations, ocular inflammatory involvement, skin lesions, vascular involvement and numerous systemic manifestations that may affect mortality. The pathogenesis of the disease still remains poorly characterized, although infectious, genetic (HLA-B51 antigen polymorphism), and environmental factors have been implicated. Uveitis is by far the most common ocular manifestation of BD. It is an important diagnostic criterion and may be associated with severe visual loss. Management of both the patient's ocular and extra-ocular involvement requires close collaboration between the ophthalmologist and internist. Treatment of Behçet's uveitis has been better defined by the EULAR recommendations. It relies on azathioprine and systemic corticosteroids, the timely and more controlled institution of which has largely contributed to the improved visual prognosis. If the patient has severe eye disease, it is recommended that either cyclosporine A or infliximab be used in combination with azathioprine and corticosteroids; alternatively IFNα with or without corticosteroids may be used instead. The introduction of biological agents into the therapeutic armamentarium represents a significant advance in the treatment of severe refractory forms of the disease, compared to conventional treatment. A better understanding of the process of auto-immunity and the role of cytokines responsible for tissue damage in Behçet's disease and uveitides in general will allow new, more specific and effective therapeutic approaches to emerge in the near future.