[Compressive optic neuropathy secondary to a pituitary macroadenoma]. / Neuropathie optique compressive secondaire à un macroadénome hypophysaire.

INTRODUCTION: Pituitary adenoma is a common benign tumor representing 8 to 10% of intracranial mass lesions. The compressive optic neuropathy associated with a pituitary adenoma can be clinically indistinguishable from glaucomatous optic neuropathy. CASE REPORT: A 56-year-old man with no significant past medical history had noticed a rapid decrease in visual acuity for 6 months. Funduscopic examination revealed glaucoma-like bilateral, asymmetric optic cupping. Brain MRI examination revealed a pituitary tumor compressing the optic chiasm. CONCLUSION: The diagnosis of a compressive optic neuropathy associated with a pituitary adenoma can be difficult, since it often simulates chronic glaucoma. However, several features should alert the clinician to the possibility of a compressive optic neuropathy and prompt neuroimaging, in order to obtain earlier diagnosis and treatment.

[Progression of diabetic retinopathy after cataract surgery by phacoemulsification]. / Évolution de la rétinopathie diabétique après chirurgie de la cataracte par phacoémulsification.

PURPOSE: To study the effect of cataract surgery by phacoemulsification and intraocular lens implantation on the progression of diabetic retinopathy (DR) using the nonoperated fellow eye as a control, by a retrospective comparative study. PATIENTS AND METHODS: We studied 46 diabetic patients who underwent monocular cataract surgery by phacoemulsification with implantation of an intraocular lens within the capsular bag, with the nonoperated fellow eye used as a control. In all cases, the fellow eye exhibited only a very mild cataract, allowing for visualization of the fundus. Preoperative and 1, 3, 6 and 12 months postoperative ophthalmic examination and fundus photographs, supplemented if necessary by retinal fluorescein angiography, were performed to assess DR using the Alfediam classification. Patients were followed for at least 1 year. RESULTS: Among the 46 patients, preoperative DR was absent in 40 patients, and six patients had bilateral, symmetric non-proliferate diabetic retinopathy (NPDR): mild in four patients, moderate in one patient and moderately severe in another patient. Thirty-five eyes (76%) had postoperative best corrected visual acuity of 8/10 or better. Progression of DR occurred at about 23.9% (11/46) in the operated eyes and 19.6% (9/46) in the nonoperated eyes. As compared by the MacNémar test, there was no significant difference between operated and nonoperated eyes (P=0.68). CONCLUSION: This study demonstrates that cataract surgery by phacoemulsification does not represent an apparent risk factor for progression of DR.

[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.

[Nd:Yag laser treatment of anterior capsule contraction syndrome after phacoemulsification]. / Traitement au laser Nd:Yag du syndrome de contraction de la capsule antérieure après phacoémulsification.

INTRODUCTION: Anterior capsule contraction syndrome after phacoemulsification is rare and can compromise visual acuity. Nd:Yag laser capsulotomy is a good alternative in limited forms of contraction. OBSERVATIONS: We report four cases of anterior capsule contraction syndrome developed after a mean follow-up of 8 months after phacoemulsification and acrylic intraocular lens implantation. Nd:Yag laser capsulotomy was performed to help resolve the contraction and its symptoms. No relapses occurred during the follow-up. CONCLUSION: Nd:Yag laser capsulotomy is effective and safe in managing limited forms of anterior capsule contraction syndrome after phacoemulsification. Surgery is an alternative to Nd:Yag capsulotomy in severe cases.

[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.

[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.

[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.

[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.

[Palpebral capillary hemangioma and amblyopia. Apropos of 2 cases]. / Hémangiome capillaire palpébral et amblyopie. A propos de 2 cas.

Periorbital capillary hemangiomas of childhood can produce visual axis occlusion and anisometropia, resulting in amblyopia. We report our experience performing surgical resection of periorbital capillary hemangiomas. Partial resection of hemangiomas was performed in two infants under five months of age, and permitted clearing of the visual axis. This immediate effect is necessary to prevent amblyopia. Surgical resection should be considered a treatment option for managing periorbital capillary hemangiomas which threaten vision.

Improvement of microcirculation abnormalities in sickle cell patients upon buflomedil treatment.

The efficacy of the vasoactive compound buflomedil on previously described microcirculation abnormalities observed in sickle cell disease (SCD) was investigated using bulbar conjunctival angioscopy (BCA) and laser doppler flux metering. Eleven sickle cell disease patients at steady state were studied in a double-blind randomized parallel-versus-placebo study (5 patients were given placebo and 6 patients received 600 mg buflomedil per day for 21 days after a washout period of 15 days). The blood flux score measured by BCA improved, indicating reduced entrapment of sickle red blood cells. There was a striking improvement of reactive alterations of vasomotion in the buflomedil group, particularly in postocclusive reactive hyperemia; the half return time was also significantly reduced. These results encourage further studies with buflomedil to investigate long-term effects of this compound in SCD, potential prevention of acute vaso-occlusive events, and degenerative complications.

[Therapeutic efficiency of iodine 131 in autonomous thyroid adenoma and toxic multinodular goiter. Apropos of 59 cases]. / Efficacité thérapeutique de l'iode 131 dans l'adénome thyroïdien autonome et le goitre multinodulaire toxique. A propos de 59 cas.

Our study dealt with 81 patients treated by iodine 131 for autonomous goiter. We have followed 59 patients during about a year. The global therapeutic efficiency is of 73% and the risk of hypothyroidism is very weak. The administration of a high activity (greater than 15 mCi) of iodine allows to get a faster recovery, a better therapeutic efficiency and permits to reduce the number of cures (therefore, to reduce the irradiation of the patient), nevertheless, the risk of hypothyroidism is very slight. The advantages of metabolic radiotherapy (low cost, facility of administration, efficiency) make it preferable to surgery, above all with patients that are more than 40 years old, for whom the radiation risk is practically null (hereditary diseases, cancer).