A 24-year-old woman presented for routine clinical evaluation. Her best-corrected visual acuity was 20/20 and slit-lamp examination of the anterior segment was normal in both eyes. Fundus examination of the left eye revealed a hypopigmented lesion, one disc diameter temporal to the fovea, with a hyperpigmented tail extending temporally from the main lesion, consistent with a torpedo maculopathy. Fundus autofluorescence showed an hypoautofluorescence with hyperautofluorescent border. Swept-source optical coherence tomography (OCT) showed a normal inner retina and a degeneration of the outer retina without retinal cavitation. OCT angiography (OCT-A) of the choriocapillaris layer revealed reverse shadowing caused by the increased transmission from the atrophied outer retina and RPE within the torpedo lesion and attenuation of signal in the area of the temporal hyperpigmentation. The superficial capillary plexus was normal. This case includes a multimodal imaging with OCT-A of torpedo maculopathy in a Tunisian woman. Further reports are required to provide a better understanding of this rare condition.
INTRODUCTION: Adult-onset asthma and periocular xanthogranuloma (AAPOX) is a rare non-Langerhans cell histiocytic disorder. AIM: To describe the periocular clinical findings in a patient diagnosed with AAPOX, treated successfully by intralesional corticosteroids. CASE REPORT: A 40-year-old woman presented with bilateral eyelid swelling and adult-onset asthma. Initial examination revealed bilateral yellow-orange, elevated, indurated, and nonulcerated masses at the upper eyelids. The laboratory data showed high level of IgG. Periocular biopsy samples showed xanthoma cells positive for CD68 and Touton giant cells. The patient received 2 intralesional 40 mg of triamcinolone acetonide with a local control. No complications were noted. COMMENTARIES: AAPOX is characterized by a histiocytic proliferation associated to an adult-onset asthma, systemic lymphadenopathy, salivary gland enlargement and elevated serum levels of IgG. Treatment options vary with no current consensus. Intralesional corticosteroids have been rarely reported in controlling the signs and symptoms of adult-onset xanthogranulomatous disease. Surgery was successful but demonstrated recurrence. Methotrexate has been proposed to treat refractory cases or as a potential corticosteroid-sparing therapy. In this case, intralesional corticosteroid was an effective and safe treatment for eyelid adult xanthogranuloma.
Asthma , Orbital Diseases , Xanthomatosis , Adult , Female , Humans , Orbital Diseases/diagnosis , Granuloma/complications , Xanthomatosis/pathology , Asthma/complications , Asthma/drug therapy , Asthma/diagnosis , Adrenal Cortex Hormones/therapeutic use , Immunoglobulin G
INTRODUCTION: Cataract is a ubiquitous pathology. Its prevalence increases with age. Nowadays, cataract surgery is increasingly performed on an outpatient basis under locoregional anesthesia. In this context, sedation-analgesia is essential but not without risks. AIM: To evaluate the effectiveness of premedication with melatonin on intraoperative sedation-analgesia. METHODS: This is a prospective randomized double-blind study including patients proposed for scheduled cataract surgery by phacoemulsification under peribulbar anesthetic block. The participants will be randomized into two groups: group (M) will receive 05 tablets of melatonin (10mg sublingual) and group (P) will receive 05 tablets of Sucralose sublingually. Perioperative sedation-analgesia will be evaluated by the Ramsey score, the bisectral index, the simple verbal scale (EVS) and by the perioperative consumption of midazolam and alfentanyl. Secondary endpoints will be the degree of preoperative anxiety (Amsterdam Preoperative, Anxiety and Information Scale), the perioperative tonus of the eyeball, intraoperative nicardepine consumption and patients and surgeons satisfaction. A value of p <0.05 will be considered statistically significant. EXPECTED RESULTS: The administration of melatonin as a premedication for scheduled cataract surgery will allow a better quality of intraoperative sedationanalgesia, a reduction in the doses consumed of midazolam and alfentanyl, improves surgical conditions, leads to a decrease in ocular tone, and optimizes surgical safety conditions for the patient.
Cataract , Melatonin , Humans , Midazolam , Melatonin/therapeutic use , Double-Blind Method , Alfentanil , Prospective Studies , Premedication
INTRODUCTION: Diabetic retinopathy (DR) increases the risk of blindness by 25 times. Advanced researchs are justified for better management, leading to the role of Optical Coherence Tomography-Angiography (OCT-A), a new non-invasive imaging technique exploring retinal vascularization.Our purpose is to identify microvascular macular anomalies of DR on OCT-A with qualitative and quantitative evaluation of their impact on retinal vascularization. PATIENTS AND METHODS: This is a descriptive cross-sectional study where 120 eyes of 66 diabetic patients were enrolled. All patients were diabetic and went through OCT-A imaging. RESULTS: Microanevrysms were identified in both superficial capillary plexus (SCP) and deep capillary plexus (DCP) where they were more frequently visualized. Macular edema was present in 16,7% of cases in the SCP, and in 30% in DCP. Edema spaces were more frequently present in DCP (p < 0,05). Capillary nonperfusion areas were identified in 82,5% of cases in SCP and in 60% of cases in DCP. The main peri-foveal vascular density was 18,95 ± 5,37%. The main surface of foveal avascular zone (FAZ) in the SCP was 462,52 µm2 and was 555,04 ± 329,11 µm2 in the DCP where it was larger. CONCLUSION: OCT-A is a modern imaging tool that could be used for the diagnosis and monitoring of DR as well as the understanding of its pathophysiology.
BACKGROUND: Many studies suggest the existence of an alteration of the retinal hemoperfusion in primary open-angle glaucoma. The OCT-A is a novel technique that allows to provide information on retinal microcirculation in a non-invasive way, thus it represents a possible imaging target for the early diagnosis and follow-up of glaucoma. The aim of our work is to evaluate the contribution of vascular parameters provided by OCT-A and their diagnostic abilities in the different stages of primary open-angle glaucoma. METHOD: This is a prospective cross-sectional study involving 200 eyes of control subjects and 250 eyes of glaucomatous subjects divided into early glaucoma, moderate glaucoma and advanced glaucoma subgroups. They were assessed for MD, LV by visual field, RNFL and GCC thickness by SS-OCT papillary and macular vascular densities by SS-OCT A. RESULTS: OCT-A vessel densities determined in the optic nerve head, in the peripapillary and in the macular regions were significantly lower in glaucomatous eyes. Among the vascular parameters studied the whole image vascular density showed the best diagnostic ability in the discrimination between glaucomatous eyes and healthy eyes with an AUC of 0.949. Nevertheless, the diagnostic ability of vascular parameters remains lower than of the structural parameters RNFL (AUC: 0.981). A significant correlation was found between structural, functional and vascular parameters with r < 0.05. The quadratic non-linear model defines better the relationship between structural, vascular and functional damage in glaucoma. CONCLUSION: The OCT-A plays an important role in the early diagnosis and follow-up of PAOG. It also contributes to the understanding of some aspects of the vascular role in glaucoma.
INTRODUCTION: Dacryops is a rare benign cystic lesion of the lacrimal gland often developing in the palpebral gland. The exact etiology of dacryops remains unclear. Diagnosis could be suspected clinically and established histopathologically. Treatment is commonly surgical. PRESENTATION OF CASE: We report the case of a 75-year-old woman with past history of total conservative parotidectomy for a benign tumor 10 years ago. She presented to the Ophtalmology Department at Farhat Hached University Hospital of Sousse with a painful swelling of the left supero-external orbital angle. The patient underwent complete excision of the cyst using the conjunctival approach. Histopathological examination showed characteristic features of dacryops with foci of chronic inflammatory cell infiltrates. DISCUSSION: Dacryops is commonly seen in young adults or middle-aged individuals with a slight female preponderance. In some cases, cystic enlargement of dacryops can lead to mechanical ptosis, dystopia, limitation of extraocular movements, diplopia, and, in rare cases, blepharoptosis. However in this case, the patient was an elderly woman presenting a painless mass without ptosis. As in our case, excision using the conjunctival approach under microscope has excellent results without complications. Histopathological examination confirms the diagnosis and helps to rule out differential diagnoses. CONCLUSION: As reported in the present case, histopathological examination confirms clinically recognized or suspected dacryops. If untreated, dacryops may lead to ptosis, proptosis and/or dystopia. Complete excision of the cyst is often curative.
INTRODUCTION: Optic nerve avulsion is a traumatic disinsertion of optic nerve fibres from the globe at the level of the lamina cribrosa. It is an uncommon and severe complication of blunt ocular trauma. CASE PRESENTATION: We report the case of a 15 years old male presented to the emergency department after being kicked by a horse. Initial ophthalmologic examination of the left eye (LE), exhibited eyelid hematoma, subconjunctival hemorrhage, VA was limited to light perception and there was a left relative afferent pupillary defect. Dilated fundus examination of the LE revealed an extensive vitreous and preretinal hemorrhage overlaying the optic disc and retina edema.The diagnosis of LE optic nerve head avulsion (ONA) was made. Five years after the accident, VA of LE detecting hand motion, fundus examination revealed a superior dragging of the optic disc, fibroglial scarring, retinal vessel narrowing and retinal epithelium hyperplasia. CLINICAL DISCUSSION: In case of ONA, the avulsion can be missed initially due to vitreous and retinal hemorrhage overlaying the optic nerve, in such cases multimodal imaging can be a useful tool to the diagnosis and to evaluate associated ocular damage. Healing process of the avulsed optic nerve is characterized by the development of fibroglial proliferation. Visual outcome is poor and the final visual acuity range from light perception or no light perception in total ONA. CONCLUSION: Optic head nerve avulsion is a rare and severe disease and initial diagnosis is challenging due to associated media opacities. The prognosis is poor and the injury leads to permanent visual impairment.
AIM: To analyze microcirculatory abnormalities, central avascular area and capillary density in OCT-angiography in retinal venous occlusions (RVO). METHODS: This is a descriptive study of 35 patients (35 eyes) with RVO who consulted at the ophthalmology department of Farhat Hached Hospital in Sousse between January 2014 and July 2018. The diagnosis of retinal venous occlusion was established on clinical examination, fundus photography and fluorescein angiography. All patients underwent OCT-angiography and OCT B-scan. RESULTS: Our study includes a total of 35 patients (35 eyes). Of these patients, 20 (57.1%) had branch retinal vein occlusion and 15 (42.8%) had central retinal vein occlusion. The loss or rarefaction of the capillary plexus concerned the deep capillary plexus (DCP) more than the superficial one (SCP). This rarefaction was observed in 25 eyes (71.42%) in both DCP and SCP. The widening of the central avascular zone and the rupture of the peri-foveolar anastomotic mesh were better or as visible as fluorescein angiography. Vascular tortuosity was easy to analyze and was more evident in the SCP than the DCP. Twenty-six (74.28%) patients had vascular tortuosity in DCP and 30 patients (85.71%) had this vascular tortuosity in SCP. Capillary dilatation and microaneurysms were better visible in the DCP than the SCP. These vascular abnormalities were found in 26 cases (74.28%) in the DCP and in 17 cases (48.57%) in the SCP. CONCLUSIONS: OCT-A is a non-invasive examination that allows very precise analysis and follow-up of both macular edema and superficial and deep capillary plexus architecture during retinal vein occlusions.
Retinal Vein Occlusion , Fluorescein Angiography , Fundus Oculi , Humans , Microcirculation , Retinal Vein Occlusion/diagnosis , Retinal Vessels , Retrospective Studies , Tomography, Optical Coherence , Visual Acuity
AIM: To assess epidemiological, clinical and microbiological characteristics of patients presenting with a clinically diagnosed severe corneal abscess at the Farhat Hached Hospital Department of Ophthalmology (Sousse). METHODS: A retrospective, descriptive and anlalytic study of patients presenting severe corneal abscess was conducted over 5 years, from january 1st of 2013 to septembre 3Oth of 2017. The epidemiological, clinical and microbiological aspects, were analyzed. RESULTS: one hundred and one of of 100 patients were presented severe corneal abscess. The mean age was 54,1 ans years old. The mean delay for referral was 15,5days. The most frequent Risk factor was chronic keratopathy noted in 59% ofcases. Corneal trauma was noted in (30%) and use of contact lenses in (12%).Visual acuity was less than 1/10 in 72% of the patients. Bacteriological cultures isolated an organism in 39.9 % of cases. Coagulase-negative Staphylococcus (23,3%), Pseudomonas aeruginosa (16,7%), streptococcus (13,3%) were the most frequent species that have been found. CONCLUSION: A good preliminary analysis of the risk factors, the mode of infection, and the appropriate search for the incriminated germs, allow secondarily an adequate management of the severe corneal abscesses.
Eye Infections, Bacterial , Keratitis , Abscess/diagnosis , Abscess/epidemiology , Abscess/therapy , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/therapy , Humans , Keratitis/diagnosis , Keratitis/epidemiology , Keratitis/therapy , Pseudomonas aeruginosa , Retrospective Studies , Risk Factors
INTRODUCTION: Retinal vasoproliférative tumors (VPTs) have been reported as uncommon complications of intermediate Uveitis. CASE DESCRIPTION: A patient consulted for a gradually decreased vision in the right eye (RE). The examination of the RE found a corrected visual acuity at 20/100 with normal eye pressure measured. The anterior segment was deep and quiet and 2+ vitreous haze was found. Funduscopy showed a VPT. Retinal fluorescein angiography of the RE revealed macular cystoid edema also objectified by the Optical Coherence Tomography (OCT). Intermediate Uveitis was considered idiopathic. The patient received a cryoapplication and was put on oral corticosteroid therapy with improvement of visual acuity and a regress of both vitreous inflammation and cystoid macular edema. CONCLUSION: The association of a VPT with intermediate uveitis represents a real diagnostic and therapeutic challenge and imposes rigorous care and monitoring strategy combining internist and ophthalmologist.
PURPOSE: Ocular toxoplasmosis is the most common cause of infectious uveitis worldwide. The diagnosis of ocular toxoplasmosis is primarily clinical when it is a typical presentation.With an atypical presentation in the fundus, parasitological diagnosis is a decisive contribution, as well as multimodal imaging. The aim of this study was to investigate vitreal, retinal, and choroidal morphologic changes in active and scarred toxoplasmosis lesions using swept source optical coherence tomography. To our knowledge, it is the first study in Tunisia which describes with precision the retinochoroidal lesions caused by Toxoplasma Gondi by means of the optical coherence tomography (OCT). METHODS: A retrospective analysis of fifteen patients diagnosed with ocular toxoplasmosis was conducted. The patients were examined at ophthalmology service of Farhat Hached Hospital in Sousse Tunisia between January 2002 and December 2019. Complete ophthalmologic examination including best-corrected visual acuity, slit lamp biomicroscopy, dilated biomicroscopic and fundus examinations, colour fundus photography as well as fluorescein angiography and OCT were done at the initial visit and during follow-up. RESULT: In the acute phase, thickening, hyper-reflectivity of the neurosensory retina, posterior shading, bumping of the RPE, hyporeflectivity and thickening of choroid were found in 86,6% of patients. During follow-up, neurosensory retinal layers thinning and disorganization, interrupting ofthe ellipsoid zone (EZ), and RPE hyper reflective were noticed in 73% of patients. The choroid became thin and more hyperreflective in 73% of patients. Multiple hyperreflective dots in the vitreous cavity and posterior hyaloid thickening were demonstrated in the acute phase in 60% of patients, with complete resolution and detachment of the posterior hyaloid in the scarred lesions. CONCLUSION: The SS-OCT is an important adjunctive imaging modality in the diagnosis and follow-up of patients with ocular toxoplasmosis.
Our study aimed to describe the therapeutic management of moderate and severe dysthyroid orbitopathies and to evaluate the factors associated with optic neuropathy as well as the prognostic factors of poor visual outcome using a statistical analysis. We conducted a retrospective study of 22 patients presenting with moderate to severe dysthyroid orbitopathy in at least one eye and hospitalized in the Department of Ophthalmology at the University Hospital Farhat Hached, Sousse over the period from 1998 to 2015. Therapeutic indications were based on activity and severity criteria of the Eugogo (European Group On Graves' Orbitopathy) as well as on the assessment of prognostic factors of poor visual outcome. The average age of our patients was 40 years, with a slight male predominance (54.5%). 68.2% of patients were euthyroid, 18.2% had a history of smoking. The most significantly associated factor with neuropathy was a compression in the orbital apex (p = 0.03). Treatment was based on intravenous corticosteroid therapy and/or orbital decompression based on disease activity and severity. Overall evolution after treatment was marked by an improvement in inflammatory signs and by the reduction of exophthalmia. Visual prognosis was worse in elderly patients (p = 0.0001), male sex (p = 0.03) and treated by iratherapy (p = 0.04). Given the limits of a retrospective study, our results were generally consistent with the literature. The assessment and the management of dysthyroid orbitopathy are not well understood. Cohort, probably multicenter studies should be conducted to improve its management.
Exophthalmos/therapy , Graves Ophthalmopathy/therapy , Optic Nerve Diseases/therapy , Administration, Intravenous , Adrenal Cortex Hormones/administration & dosage , Adult , Age Factors , Aged , Decompression, Surgical/methods , Exophthalmos/etiology , Female , Humans , Male , Middle Aged , Optic Nerve Diseases/etiology , Prognosis , Retrospective Studies , Severity of Illness Index , Treatment Outcome , Tunisia
Choroideremia is a rare X-linked recessive, hereditary retinal pigment epithelial dystrophy, characterized by night blindness and progressive constriction of the visual fields leading to blindness in young adulthood. In this study, we reported three cases of choroideremia belonging to a Tunisian family. Patients complained of vision loss and night blindness. Fundus examination revealed diffused chorioretenal atrophy. In all cases, there was a visual field constriction and an undetectable electroretinography. Direct sequencing of the CHM gene detected a guanine to adenine transition (G>A) into the donor splice site of intron 1 leads to aberrantly spliced mRNA producing a premature stop codon and therefore functional loss of the CHM gene product, REP-1. The diagnosis should be considered in patients with a suitable family history and fundus findings.
Adaptor Proteins, Signal Transducing/genetics , Choroideremia/genetics , Mutation , Adolescent , Female , Humans , Male , Middle Aged , Pedigree , Tunisia
BACKGROUND: Amoeba of the genus Acanthamoeba are ubiquitous free-living protozoa encountered in water and soil. They frequently cause sight-threatening keratitis. AIM: Report of the three first cases diagnosed at the laboratory of Parasitology of Sousse Hospital, (Tunisia). CASE REPORT: Our study concerned three lens-wearing female patients, aged 17, 20 and 29 years respectively. The patients originate from central Tunisia and presented with unilateral (2 cases) or bilateral (one case) keratitis. Diagnosis was made by demonstrating Acanthamoeba trophozoites and/or cysts on direct examination and/or culture (in agar - Escherichia coli medium) of contact lenses and/or lenses' solution. Direct examination of corneal swabs was negative in three cases but culture was positive in one. The three patients were treated with hexamidine and neomycine eye-drops for three months. Treatment led to scarring of lesions with however sequellar opacities that was minor to moderate in two cases and consisted of a central leucoma with a poor visual outcome in the last case. CONCLUSION: The need for systematic research of amoeba in lenses wearing patients with keratitis is emphasized.
Acanthamoeba Keratitis/diagnosis , Acanthamoeba Keratitis/drug therapy , Adolescent , Adult , Anti-Infective Agents/therapeutic use , Contact Lenses , Female , Humans , Ophthalmic Solutions , Tunisia
