[Retinal artery occlusion and anterior ischemic optic neuropathy associated with factor V Leiden mutation: A case report]. / Occlusion de l'artère centrale de la rétine associée à une neuropathie optique ischémique antérieure secondaire à une mutation du facteur V Leiden : à propos d'un cas.

Factor V is a pro-coagulant cofactor required for the transformation of prothrombin into thrombin. Thrombin activates factor V, which is then deactivated by protein C. A mutation in factor V is responsible for the formation of factor V Leiden, resistant to activated protein C. The association of this mutation with venous thromboses has been established. Its association with arterial occlusions is still controversial. We report the case of a central retinal artery occlusion associated with a non-arteritic anterior optic neuropathy associated with a Leiden mutation of factor V (FVL). The presence of FVL has been associated with lack of reperfusion and rapid progression to neovascularization. It seems that FVL intervenes mainly during the reperfusion phase after the occurrence of arterial thrombosis.

Acanthamoeba keratitis: An emerging disease among microbial keratitis in the Cap Bon region of Tunisia.

INTRODUCTION: The aim of this study was to describe the prevalence of AK among microbial keratitis as well as their clinical features and to compare their risk factors to those of other infectious keratitis, over the last five years in a referral center in the region of Cap Bon, Tunisia, North Africa. METHODS: A retrospective review of the charts of 230 patients (230 eyes) diagnosed with presumed infectious keratitis between January 2011 and December 2016 at the department of ophthalmology of the university hospital of Nabeul in Tunisia. After a detailed ocular examination using standard technique, corneal scrapes were performed under aseptic conditions from each ulcer. Plates were incubated at 30 °C and screened daily for Amoeba. The treatment was adjusted according to the results of microbiological findings and the response of initial treatment. The mean follow up was 11.4 months (1 month-26 months). RESULTS: A total of 230 corneas were scraped. The prevalence of Acanthamoeba keratitis was 6% (14 cases of 230). All cases of Acanthamoeba keratitis with a history of contact lenses were diagnosed thanks to the test of Contact lenses, their cases or their storage solution, while their corneal scrapings were negative. The corneal scraping was positive for Acanthamoeba only in 4 cases of 14. Acanthamoeba was identified more in young patients (92.8%). Significantly, more patients (54 of 74; 73%) with fungal keratitis and Acanthamoeba keratitis (11 of14; 78.6%) were rural population The most cases of Acanthamoeba keratitis (10 of 14; 71.4%) used contact lenses. Ocular injury was identified in 4 cases of 14 AK (28,5%). Coexistent ocular disease was seen in seven cases of 14 (50%). Of the 230 microbial keratitis, an early diagnosis (≤30 days) was done in 200 cases (86.95%), while a late diagnosis (≥30 days) was made in 30 cases (13%). In AK, most cases (11 of 14; 78,5%) were diagnosed with a delay of more than 30 days. Slit-lamp examination showed stromal infiltrate in 12 cases (85,7%), hypopion in 2 cases (14,3%), immunitary ring in 2 cases (14,3%) and radial keratoneuritis in one case (7,1%). CONCLUSION: Contact lenses were identified as the main risk factor of Acanthamoeba keratitis in our study. The diagnosis of AK should be considered in case of atypical keratitis especially among CL wearers in the rural regions of CapBon where the rules of hygiene are not respected.

A 5-year retrospective review of fungal keratitis in the region of Cap Bon.

INTRODUCTION: Microbial keratitis is a serious ocular infection and a leading cause of morbidity and blindness worldwide. METHODS: A retrospective review of the charts of 30 patients (30 eyes) diagnosed with presumed or culture-proven fungal keratitis among 100 patients with infectious keratitis. All patients initially received hourly 0.5% Amphotericin B eye drops. Systemic antifungal agents consisted mainly of oral Fluconazole. After treatment, a healing time of less than 3 weeks from presentation was considered a good result. Mean follow up was 10.4 months. RESULTS: Risk factors for fungal keratitis included ocular trauma in 13 patients (43.3%). Stromal infiltration was seen in 100% of patients. Satellite lesions were noted in 6 eyes (20%) and an immune ring was noted in 3 cases (10%). The most commonly isolated agent was Fusarium in 9 eyes (50%), followed by Aspergillus in 6 eyes (33.3%), and Candida in 2 eyes (11.1%). At the end of follow up, final visual acuity varied from no light perception to 20/20. The significant predictors were initial visual acuity, size of infiltrate at presentation, male gender and advanced age. CONCLUSION: The key element in the diagnosis of mycotic keratitis is clinical suspicion on the part of the ophthalmologist. However, because of the potential serious complications, it is essential to identify the exact pathogen so as to initiate appropriate treatment in time and to thus improve the prognosis of this condition.

[Fundus autofluorescence. Has it a place in the management of diabetic macular edema?] / L'autofluorescence du fond d'œil. A-t-elle une place dans la prise en charge de l'œdème maculaire diabétique ?

PURPOSE: Analyze the characteristics of fundus autofluorescence of diabetic macular edema and study the association between these characteristics and visual function. PATIENTS AND METHODS: Our study included 18 patients (28 eyes) with clinically significant diabetic macular edema. All patients had a complete eye examination with a fundus autofluorescence imaging and optical coherence tomography. The central macular thickness and central macular volume were measured. The integrity of the inner segment-outer segment junction and the integrity of the external limiting membrane were also evaluated in the same area. RESULTS: Among the 28 eyes studied, 8 had normal autofluorescence. The remaining 20 eyes had abnormal autofluorescence: a hyper-cystoid autofluorescence in 5 eyes (25%), hyper-spot autofluorescence in 8 eyes (40%), and hypo-irregular autofluorescence in 5 eyes (25%). Best corrected visual acuity was significantly better in patients with normal autofluorescence and those with hyper-cystoid autofluorescence. There was no significant difference in central macular thickness (P=0.186) and central macular volume (P=0.191) between the four groups. CONCLUSION: The autofluorescence is a simple, fast, and non-invasive technique for the study of diabetic macular edema with good correlation to the visual function as well as to the extent of damage to the retina. It is, therefore, a possible alternative to other invasive imaging techniques in particular in the long term monitoring of diabetic macular edema.

[Obstructive sleep apnea syndrome. Is it a risk factor for diabetic retinopathy?]. / Le syndrome d'apnée de sommeil. Est-il un facteur de risque de rétinopathie diabétique ?

PURPOSE: The goal of our study was to evaluate the prevalence of diabetic retinopathy in type 2 diabetic patients with obstructive sleep apnea syndrome. PATIENTS AND METHODS: We performed a comparative study including 60 type 2 diabetics separated into 2 groups: a 1st group composed of 20 patients with obstructive sleep apnea syndrome and a 2nd group composed of 40 patients without this syndrome. The two groups were matched for age and length of diabetes. All patients underwent a complete ophthalmic examination. RESULTS: In both groups, the mean patient age was 59 years, the diabetes had been present for an average of 10 years, and the HbA1c was 10%. Diabetic retinopathy was diagnosed in 11 patients from the 1st group (55%) and 6 cases from the 2nd group (15%) (P=0.03). Non-proliferative and proliferative retinopathy were found in 7 cases (35%) and 4 cases (20%), respectively, in the 1st group and in 3 cases (7.5%) in the 2nd group for both types (P=0.03 and P=0.042, respectively). Diabetic macular edema was observed in 4 patients (20%) in the 1st group and 2 patients (5%) in the 2nd group (P=0.04). CONCLUSION: Obstructive sleep apnea syndrome is an independent risk factor for the appearance and aggravation of diabetic retinopathy. This underscores the importance of systematic screening for, and timely management of, sleep apnea.

[Epidemiology of open globe injuries in the Tunisian region of Cap Bon: Retrospective study of 100 cases]. / Épidémiologie des traumatismes oculaires à globe ouvert dans la région tunisienne du Cap Bon : étude rétrospective à propos de 100 cas.

PURPOSE: The goal of our study was to assess the epidemiological characteristics of ocular injuries in the Cap Bon region. PATIENTS AND METHODS: We retrospectively reviewed the records of 100 patients, hospitalized and treated in the department of ophthalmology at the Mohamed Taher Maamouri university medical center in Nabeul, Tunisia for an open globe injury between January 2006 and November 2013. The mean duration of follow-up was 15.9 months. RESULTS: The average age of the patients was 31.9 years. Domestic accidents accounted for 30% of cases of trauma, followed by violence (29%). The trauma was sharp in most cases (54%). The injury was penetrating in most cases (65.7%). The initial visual acuity was ≤ 1/10 in 69.8% of cases. The wound was isolated to the cornea in 59.7% of cases and scleral in 25% of cases. The most common associated ocular lesions were traumatic cataract (35%), followed by hyphema (32%). An intraocular foreign body was present in 4% of cases. At the final examination, 41.8% had a final visual acuity ≤ 1/10. CONCLUSION: Open globe injuries represent a real public health problem given their psychological and functional repercussions. The best treatment is preventative, involving better awareness in the family, school and work environment.

Immunohistochemical analysis of vascular endothelial growth factor (VEGF) and p53 expression in pterygium from Tunisian patients.

A pterygium is characterized by abnormal fibrovascular corneoconjunctival tissue. A number of investigations have attempted to elucidate this incompletely understood pathology. Since vascular endothelial growth factor (VEGF) and p53 are known to participate in tumor vascularization, our purpose was to study VEGF and p53 expression in active primary and recurrent pterygium from Tunisian patients. To this end, 15 cases of active primary pterygium and five cases of recurrent pterygium from Tunisia were studied by immunohistochemistry. Antibodies raised against VEGF and p53 were used to analyze the distribution and expression of these markers in pterygium and normal human conjunctiva were used as negative control. VEGF and p53 proteins were found in all cases of primary pterygium in epithelial, fibroblast and vascular endothelial cells. Active primary and recurrent pterygium have different patterns of expression. In primary pterygium, an important variability of p53 and VEGF expression was observed. However, in recurrent pterygium, p53 immunoreactivity was weak to moderate, whereas VEGF immunoreactivity was strong. In normal human conjunctiva, VEGF and p53 expression was weak to negative. The overexpression of VEGF in active primary and recurrent pterygium suggests that angiogenesis may play a role in pterygium pathogenesis and the expression of p53 in active primary pterygium, which might be associated with its mutated form, supports the hypothesis that actinic radiation may be involved in the genesis of pterygium. Thus, VEGF and p53 may be useful biomarkers for understanding the physiopathology of pterygium.

[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.

Immunohistochemical analysis of cellular adhesion molecules (ICAM-1, VCAM-1) and VEGF in fibrovascular membranes of patients with proliferative diabetic retinopathy: preliminary study.

PURPOSE: Diabetic fibrovascular membranes are the main pathological changes of proliferative diabetic retinopathy that can cause serious complications leading to blindness. Since the mechanism of fibrovascular membrane development is still unknown, the aim of our study was to identify potential biomarkers for this pathology. To this end, we analyzed the simultaneous expression of ICAM-1, VCAM-1 and VEGF within tissues of diabetic fibrovascular membranes. PATIENTS AND METHODS: Fibrovascular membranes were taken from nine diabetic patients with proliferative diabetic retinopathy. The fibrovascular membrane specimens were analyzed by immunohistochemistry to determine ICAM-1, VCAM-1 and VEGF expression. Controls were collected on nine normal conjunctivas removed during senile cataract surgery. RESULTS: Coexpression of ICAM-1, VCAM-1 and VEGF was found in most of the diabetic fibrovascular membranes studied. Thus, ICAM-1 was positive in eight of nine membranes (82%), VCAM-1 in seven of nine membranes (78%) and VEGF in all the membranes. CONCLUSIONS: The substantial overexpression of adhesion molecules ICAM-1, VCAM-1 and of VEGF suggests that these molecules might contribute to the development of fibrovascular membranes in patients with proliferative diabetic retinopathy, and that they could constitute suitable markers of this pathology.

Frequency, characteristics, and risk factors of late recurrence of retinal detachment.

PURPOSE: To evaluate the frequency, characteristics, causes, and risk factors of late recurrent retinal detachments (LRRD). METHODS: The authors retrospectively analyzed 445 eyes operated consecutively for rhegmatogenous retinal detachment between 1990 and 2003 by the same surgeon. Only eyes with complete reattachment after a minimum follow-up of 6 months were included. The authors defined LRRD as detachment occurring at least 6 months after a complete retinal reattachment. RESULTS: Nine eyes had a LRRD (2.02%). Mean age was 52.55 years. Six eyes had scleral buckle procedure and three eyes had vitrectomy silicone oil injection then silicone oil removal. LRRD occurred after an average period of 54 months. During follow-up two patients had a removal of extrusion of scleral buckling material. New or reopened breaks were associated with LRRD in all eyes. Endo-ocular surgery was carried out in seven eyes. The retinal reattachment was achieved in the seven eyes. Final visual acuity ranged from 20/400 to 20/60 after an average follow-up of 37.8 months. Relation between aphakic eyes (and more generally nonphakic eyes) and LRRD was close to significant value (p=0.05). LRRD was statistically independent (p>0.05) of myopia, preoperative pseudophakia, vitrectomy for initial detachment, scleral buckle removal, and cataract surgery after reattachment. CONCLUSIONS: LRRD were rare. Most of them were due to a retinal break. This break can be a new break, or reopened break especially after removal of scleral buckle material. Vitreous traction, at the vitreous base, seemed to be the cause of these breaks.