[Management of corneal neovascularization prior to corneal transplantation: Report of 112 cases]. / La prise en charge des néovaisseaux cornéens avant greffe de cornée : à propos de 112 cas.

INTRODUCTION: The avascular nature of the cornea results from a balance between angiogenic factors and anti-angiogenic factors. Under pathological conditions, this homeostasis can be disturbed, resulting in the onset of corneal neovascularization. The purpose of our study was to report our experience in the management of corneal neovascularization prior to keratoplasty. MATERIALS AND METHODS: This is a prospective study of 112 patients with corneal neovascularization and candidates for possible corneal transplant. RESULTS: The average age of patients was 38 years, ranging from 15 to 72 years. The etiologies of neovascularization were dominated by ocular trauma (26.8 %). In total, 48.33 % of patients had superficial neovascularization, 18.52 % moderately deep and 33.2 % deep neovascularization. All patients received topical corticosteroids, 29.4 % received subconjunctival injections of bevacizumab, and 22.32 % intrastromal bevacizumab injections. Clinical course was marked by a decrease in the percentage of corneal neovascularization compared to the total corneal surface area, from 45 % (between 16 and 82 %) to 28 % (between 0 and 69 %) at Day 120. There was no statistically significant improvement in visual acuity. DISCUSSION: Corneal neovascularization is a major risk factor for graft rejection; its management is crucial prior to every keratoplasty. CONCLUSION: Corneal neovascularization can lead to increased risk of graft rejection. Proper management increases the success rate of penetrating keratoplasty.

[Kearns-Sayre syndrome: a case report]. / Le syndrome de Kearns-Sayre: à propos d'un cas.

Kearns-Sayre syndrome (KSS), first described in 1958, is a multisystem disease defined by a characteristic triad of progressive external ophthalmoplegia, pigmentary retinopathy and atrioventricular block. These signs are frequently associated with increased cerebrospinal fluid protein level and cerebellar ataxia. This syndrome is caused by deletions in mitochondrial DNA, the age of onset is generally below 20, and the degree of severity differs between patients, as well as the prognosis, which may be fatal. The ocular manifestations include: bilateral ptosis, progressive external ophthalmoplegia and atypical pigmentary retinopathy. By way of this case report, the authors discuss the epidemiologic, clinical and therapeutic aspects of KSS, including the difficulty in managing ptosis in these cases.

[Vogt Koyanagi Harada syndrome in children: diagnosis and management]. / Le syndrome de Vogt Koyanagi Harada chez l'enfant: diagnostic et prise en charge.

Uveitis accounts for 5% to 10% of all cases of uveitis in children. Vogt-Koyanagi-Harada syndrome affects children very unfrequently. We report a case of a 14-year-old girl who presented with a bilateral uveitis with posterior predominance associated with an important serous retinal detachment and signs of meningeal irritation. No specific cause could be identified. The initial treatment consisted in administration of high dose steroids given in i.v. bolus at the dose of 10 mg/Kg/day then in oral steroids at the dose of 1 mg/Kg/day with slow tapering during 1 year. The evolution was marked by an excellent recuperation of the visual acuity, a total disappearance of the serous retinal detachment, the development of choroidal depigmentation and the occurrence of poliosis. This evolution was in favour of a Vogt-Koyanagi-Harada syndrome. The diagnosis of this syndrome is usually difficult to establish at its onset. Most often the evolution allows to correct and confirm the diagnosis. Megadoses of corticosteroid therapy and cytotoxic agents may be necessary. The visual prognosis may be poor in severe cases.

[Choroidal tuberculosis: reports of 3 cases]. / La tuberculose choroïdienne: à propos de 3 cas.

Tuberculosis is a chronic infection with a high incidence in Morocco. Ocular involvement is rare. We report three cases of choroidal tuberculosis. Case no 1: A 24-year-old female with tuberculous meningitis, multifocal choroiditis in the right eye and choroidal granuloma in the left eye. Case no 2: A 22-year-old female with multifocal tuberculosis. The ocular examination showed a choroidal granuloma. Case no 3: A 25-year-old male with HIV infection and miliary tuberculosis. Ocular involvement consisted in a choroidal granuloma. Ocular involvement in tuberculosis is uncommon. Choroidal granuloma is a characteristic manifestation.

[Bilateral Sturge-Weber-Krabbe syndrome. A case report]. / Syndrome de Sturge-Weber-Krabbe bilatéral et cécitant: à propos d'une observation.

Sturge-Weber-Krabbe syndrome is a rare congenital neuro-oculo-cutaneous disease, characterized by an unilateral facial vascular nevus which affects at least the first branch of the trigeminal nerve, associated with an ipsilateral leptomeningeal angioma and ipsilateral vascular lesions of the choroid sometimes leading to glaucoma. Variants of this classical presentation have been described in the literature, some of which have prognosis significance. We report an unusual case of an 11-year-old male with a serious bilateral glaucoma associated with a bilateral facial nevus flammeus and cerebral calcifications without neurological symptoms. Epidemiological, clinical, prognosis peculiarities and management of this syndrome are discussed.

[Orbital apex syndrome secondary to herpes zoster infection. A case report]. / Syndrome de l'apex orbitaire sur zona ophtalmique.

The orbital apex syndrome is defined by the association of visual loss, ophtalmoplegia, blepharoptosis, proptosis along with forehead and upper eyelid anesthesia. This syndrome is secondary to traumatism, malignancy or infection of orbital apex. Herpes zoster is an uncommon cause. We discuss the physiopathologic mechanism, evolution and management of this affection.

Management of a severe cranio-orbito-facial trauma with a dislocation of the globe into the maxillary sinus.

We report two cases of severe cranio-orbito-facial trauma associated with a dislocation of the globe into the maxillary sinus. Simultaneous surgical repositioning the globe in the orbit and reconstruction of the orbital floor defect with an autogenous bone was performed in the first case. Postoperatively, the globe was in a normal position with a moderately reduced motility. The patient's visual acuity was reduced to light perception while indirect ophthalmoscopy was normal. In the second case, no surgery could be attempted because the patient never regained consciousness and died 7 days after the trauma. Although the visual prognosis of such conditions is usually considered to be extremely poor, avoiding primary enucleation and deploying all efforts to preserve the eye, aims at helping the patient to recover psychologically from the trauma and allows to improve her/his cosmetic aspect.

[Primary palpebral tuberculosis (case report)]. / La tuberculose palpebrale primaire (a propos d'un cas).

Cutaneous tuberculosis is an uncommon disease and tuberculosis affecting the eyelid alone is even more rare. The clinical presentation is polymorphous which explains a diagnosis delay. Its treatment is based on antitubercular drugs chemotherapy. Authors report through an observation the case of a child with eyelid tuberculosis and discuss a difficult diagnosis, a physiopathogeny of eyelid tuberculosis, its diagnosis and treatment.

[Apert syndrome: a reported observation]. / Syndrome d'Apert: à propos d'une observation.

Apert syndrome is a type of acrocephalosyndactylia that belongs to the group of craniofacial synostoses. It is characterised by craniofacial dysmorphia and syndactyly of hands and feet. It is an uncommon affection that is often transmitted through an autosomal dominant mode, but sporadic cases are frequent. We report the case of a 2 months old baby brought by his parents to the paediatric emergencies for respiratory distress occurring within the framework of a polymalformative syndrome. The examination showed brachycephaly, bilateral exorbitism, syndactyly of the hands and feet and an anal fistula. Echocardiographic examination showed a cardiovascular malformation (interventricular communication), the whole suggestive of Apert syndrome. The child was admitted in intensive care during five days. He died following a respiratory infection. Through this observation the authors illustrate the clinical and evolutionary aspects as well as the therapeutic difficulties of this affection.

[Involvement of the optic nerve in the course of Behcet's disease (presentation of 148 cases)]. / Les atteintes du nerf optique au cours de la maladie de Behçet (a propos de 148 cas).

Behçet's disease is a multisystemic vascularitis of still unknown etiopathogeny. Among 400 cases of Behçet disease, 148 cases presented an optic nerve involvement during a period of eight years (1992-1999). The goal of this work is to contribute to the study of optic nerve involvement in Behçet's disease. The involvement is higher in males (64%) with median age of 27 years. The involvement of the optic nerve is noticed in 37% of cases. It's isolated in 7% of cases and occurs on average after 5 years of evolution of the disease. The diagnosis is based on the clinical examination, visual field, visual evoked potentials, retinal angiography and neuro-imaging (TDM and/or MRI). It can be an acute anterior neuropathy, stasis papilledema complicating a benign intracranial hypertension, neuroretinitis or retrobulbar optic neuropathy. The extraocular systemic manifestations were dominated by oral aphthosis (94%), genital aphthosis (70%), joint manifestations (40%) and central nervous system involvement (32.4%). The prognosis is reserved, 44% of patients having vision lower than 1/10 in spite of treatment. The authors insist on the therapeutic emergency that this involvement represents and the interest to consider it in all patients having an unexplained visual loss.

[Metastasis of medullar thyroid carcinoma (case report)]. / Métastase choroïdienne d'un carcinome de la thyroïde (à propos d'un cas).

We report the case of a 38 year-old man treated for medullar thyroid carcinoma in 1990. Nine years later, this patient developed metastases in the parotid, cervical nodes and bones, with a choroidal metastasis in the left eye one year later. Polychemotherapy was performed without good outcome.