The outcome of surgical treatment in advanced glaucoma. / Evaluación de resultado del tratamiento quirúrgico en el glaucoma avanzado.

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.

[Ocular manifestations of Crohn's disease]. / Les manifestations oculaires au cours de la maladie de Crohn.

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.

[Acquired ptosis in allergic blepharoconjunctivitis in children and adolescents]. / Le ptosis acquis dans la blépharoconjonctivite allergique chez l'enfant et l'adolescent.

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.

[Retinal vasculitis in Crohn's disease: a case report]. / Vascularites rétiniennes au cours d'une maladie de Crohn.

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.

[Cortisone glaucoma: epidemiological, clinical, and therapeutic study]. / Glaucome cortisonique: étude épidémiologique, clinique et thérapeutique.

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.

[Etiopathogeny of intraocular pressure modifications in uveitis]. / Etiopathogénie des modifications de la pression intraoculaire au cours des uvéites.

Uveitic glaucoma is a secondary form of glaucoma. Treatment is essentially medical, based on antiglaucomatous medications and immunomodulatory therapy. Therefore, some patients may need filtrating surgery to control intraocular pressure. Understanding the cellular and biochemical modifications of aqueous humor that occur during intraocular inflammation and identification of anatomical modifications of the iridocorneal angle, trabecula, pupil, and ciliary body allow physicians to adapt management depending on the different clinical patterns of uveitic glaucoma. We propose a general review of the role of inflammatory mediators and etiopathogenic mechanisms involved in uveitic glaucoma.

[Trabeculectomy for the management of uveitic glaucoma]. / La trabéculectomie dans la prise en charge du glaucome uvéitique.

PURPOSE: To report middle-term results of trabeculectomy in patients with uveitic glaucoma resistant to medical therapy. PATIENTS AND METHODS: Seventeen eyes of 14 patients with uveitic glaucoma resistant to medical therapy were treated by trabeculectomy without antimetabolites from 1994 to 2001. The patients'mean age was 48.1 years (range, 23-63 years). All had their uveitis controlled for at least 3 months before surgery by an anti-inflammatory therapy. RESULTS: Mean follow-up was 52.1 months. Success was obtained in 11 eyes (64.7%). It was complete in five eyes (45.5%) and relative in six eyes (54.5%). Failure was noted in six eyes (35.3%), which were treated with a second filtering surgery. Intraocular pressure was reduced from a mean preoperative value of 34.2 mmHg to a mean postoperative value of 18.6 (45.6% reduction). Antiglaucomatous medication was reduced from a mean of 2.8 medications preoperatively to 1.1 medications (60.7% reduction). Postoperative complications included three cases of lens opacity, two cases of hyphema, two cases of transitory hypotony, one case of flat anterior chamber, and one case of inflammation relapse. CONCLUSION: In the absence of failure risk factors except inflammation, trabeculectomy without antimetabolites can be successful in uveitic glaucoma not controlled by medical therapy, with good results even at the middle term.

[Deep sclerectomy for the management of uveitic glaucoma]. / Sclérectomie profonde non perforante dans le traitement du glaucome uvéitique.

PURPOSE: To report middle-term results of deep sclerectomy in uveitis patients with glaucoma who are resistant to medical therapy. PATIENTS AND METHODS: Eight eyes of eight patients (mean age, 56.9 years; range, 46-67 years) with uveitic glaucoma resistant to medical therapy underwent deep sclerectomy without antimetabolites between 1994 and 2001. All patients had their uveitis controlled before and after surgery by anti-inflammatory therapy. RESULTS: Mean follow-up was 42.2 months. Intraocular pressure was reduced from a mean preoperative value of 32.3 mmHg to a mean postoperative value of 15.2 (52.9% reduction). Success was obtained in seven eyes (87.5%). It was complete in four eyes (57.2%) and relative in three eyes (42.8%). Failure was noted in one eye (12.5%), controlled later by trabeculectomy. Antiglaucomatous medication was reduced from a mean of 2.9 medications preoperatively to 0.6 medications (79.3% reduction). Postoperative complications included one case of lens opacity and one case of hyphema. CONCLUSION: The low rate of surgical complications and the lack of failure risk factors except inflammation and long-term use of antiglaucomatous medication may explain the high success rate of deep sclerectomy in this study.

[Bilateral optic neuropathy in a case of primary Gougerot Sjögren's syndrome]. / Une neuropathie optique bilatérale au cours du syndrome de Gougerot Sjögren primitif.

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.

[Dermoid cysts: epidemiological, clinical and pathological studies]. / Kystes dermoïdes: études épidémiologique, clinique et anatomopathologique.

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.

[Epibulbar osseous choristoma: two case reports]. / Ostéome épibulbaire: à propos de 2 cas.

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.