[Central serous chorioretinopathy: clinical-anatomic correlations]. / La choriorétinopathie séreuse centrale : corrélations anatomo-cliniques.

INTRODUCTION: Central serous chorioretinopathy (CSCR) is a retinal disease characterized by a serous retinal detachment (SRD) responsible for a macular syndrome in young patients, often in the context of stress. In our study, we aimed to describe through multimodal analysis the clinical, angiographic and tomographic characteristics of CSCR while identifying prognostic factors and highlighting functional-anatomic correlations. METHODS: We conducted a retrospective, descriptive and analytic study over a period of 6 years on 35 eyes of 34 patients with CSCR. The simultaneous analysis of clinical exams and imaging allowed for correlation between the anatomic lesions and visual function. RESULTS: A correlation was found between the leakage point on angiography and pigment epithelial detachments (PED) in 8 eyes (28.5%), and retinal pigment epithelial (RPE) irregularities in 6 eyes (21.4%) on optical coherence tomography (OCT). Factors associated with poor functional outcome were: poor initial visual acuity, greater subretinal fluid height (P=0.054), presence of highly reflective dots on OCT within the SRD (P<0.05) and the number of PED's (P=0.008). CONCLUSION: Although CRSC often a resolves spontaneously, the functional prognosis can be affected by macular sequellae. A comprehensive assessment of the anatomical lesions is essential to detect poor prognostic factors.

[Foveoschisis in highly myopic eyes: clinical and tomographic features]. / Le fovéoschisis du myope fort : signes cliniques et tomographiques

INTRODUCTION: Foveoschisis is a rare condition in highly myopic eyes, characterized by intra-retinal cleavage associated with abnormalities of the vitreous cortex and occasionally cortical retraction. The natural history of foveoschisis is unpredictable. The functional prognosis is often favorable after surgical treatment. MATERIALS AND METHODS: We report 7 cases of macular retinoschisis in highly myopic eyes. We describe the optical coherence tomographic features as well as associated signs. The correlation with visual acuity was assessed. RESULTS: Foveoschisis was undetected on clinical exam and visualized only on optical coherence tomography (OCT) in 4 cases. Mean central foveal thickness was 540 , mean visual acuity was 1/10­P10. The thicker the macula was, the worse was the visual acuity. The presenceor absence of serous retinal detachment did not affect visual acuity, whereas an epiretinal membrane or retraction of the vitreous cortex appeared to induce visual loss. CONCLUSION: OCT has been demonstrated to be particularly useful for the diagnosis of visual loss in the high myope, notably in the case of foveoschisis. Anatomic-functional correlations in high myopic foveoschisis are not yet well clarified. Posterior pole retinal detachment and macular hole are the most serious complications.

[Multifocal choroidal ischemia in preeclampsia: report of two cases]. / Ischémie choroïdienne multifocale au cours de la toxémie gravidique : à propos de deux cas.

INTRODUCTION: Multifocal choroidal ischemia is a complication of severe hypertension, notably in preeclampsia. It is a rare phenomenon due to multiple choriocapillaris occlusions. CLINICAL OBSERVATIONS: We report the cases of two patients, age 28 and 32 years, 34 and 26 weeks since last menstrual period, respectively. The first had controlled preeclampsia under treatment. The second had developed Hemolysis, Elevated Liver enzymes, Low Platelet count (HELLP) syndrome complicated by in utero fetal death. Both patients reported visual loss. Comprehensive ophthalmological examination and fluorescein angiography confirmed the diagnosis of multifocal choroidal ischemia, in the acute stage in the first patient and cicatricial in the second. CONCLUSION: Acute choroidal ischemia is an ocular vascular syndrome which must be ruled out by systematic examination in any preeclamptic patient, so as to make the diagnosis and begin treatment early.

[Angioid streaks complicated by choroidal neovascularization secondary to pseudoxanthoma elasticum: diagnosis and treatment. Case report]. / Stries angioïdes compliquées de néovaisseaux choroïdiens révélant un pseudoxanthome élastique : diagnostic et stratégie thérapeutique. À propos d'un cas.

Angioid streaks represent linear breaks in Bruch's membrane secondary to a change in the elastic layer. They are often associated with pseudoxanthoma elasticum. We report the case of a 36-year-old man with no prior history who was seen for a macular problem in the left eye, eventually involving the right eye after 3 months. He was diagnosed with pseudoxanthoma elasticum, associated with angioid streaks, complicated by choroidal neovascularization in both eyes. He was treated with intravitreal ranibizumab injections (0.5 mg/0.05 mL). His course in the right eye was remarkable for stable improvement at 3 months after the final injection. In the left eye, after initial improvement, recurrence was noted 2.5 months after injection, with subfoveal progression of the choroidal neovascularisation, unresponsive to a fourth ranibizumab injection. Angioid streaks represent a degenerative retinal pathology of elastic tissue with the potential for ingrowth of choroidal neovascularization. Various therapeutic approaches such as photodynamic therapy or laser photocoagulation have been proposed, with variable and sometimes limited results. Intravitreal ranibizumab injections currently remain the best treatment and should be studied with a longer-term, larger series.

[Solar retinopathy: optical coherence tomography findings]. / Retinopathie solaire: aspects en tomographie par coherence optique.

Through a case report, we discuss the clinical, angiographic aspects and the new information brought by the optical coherence tomography in the acute and chronic phase of the solar retinopathy.

[The value of "Crozafon-De Laage punch" in combined phacoemulsification--trabeculectomy]. / Intérêt de la "pince de Crozafon-De Laage" dans les interventions combinées phacoémulsification--trabéculectomie.

PURPOSE: To assess the efficacy and safety of the "Crozafon-De Laage punch" during combined phacoemulsification-trabeculectomy interventions. METHODS: We conducted a retrospective Study of 75 eyes of 75 patients with cataract and open-angle glaucoma inadequately controlled by maximum medical and/or physical treatment. They underwent phacotrabeculectomy using the Crozafon-De Laage punch. We noted pre- and postoperative best visual acuity (VA) and intraocular pressure (IOP) as well as intra- and postoperative complications. RESULTS: After a mean follow-up of 24 months (range, 9-36), the functional results were satisfactory, with an average VA gain during the 1(st) postsurgical month of 5.8/10(e)+/-1.58 (compared to the preoperative VA). This gain in VA was steady with VA greater than 5/10(e) in 96% of our patients at 1 and 24 postoperative months. The mean IOP reduction was meaningful and steady: reduction of 8.2mm at the 9(th) postoperative month maintained to the 24(th) month. Ninety-five percent of our patients did not need medical treatment until the last follow-up; for the remaining 5%, IOP was controlled using a single agent. No intraoperative complications related to the use of the Crozafon-De Laage punch were noted. The postoperative complications were marked by the occurrence of a minimal and transient inflammatory reaction in 5.3% of cases; it was associated with a pseudoexfoliative syndrome in all cases. CONCLUSION: Phacotrabeculectomy using the Crozafon-De Laage punch provides better control of glaucoma, faster functional rehabilitation, and fewer complications associated with filtration surgery.

[Prognosis factors in diabetic macular edema: an OCT study]. / Facteurs de mauvais pronostic au cours des oedèmes maculaires diabétiques: apport de l'OCT.

INTRODUCTION: Macular edema is responsible for a significant degree of visual loss in diabetic patients. The prognosis factors in diabetic macular edema are varied and better documented by optical coherence tomography (OCT). We describe the patterns of diabetic macular edema demonstrated by OCT and correlate them with visual acuity. PATIENTS AND METHOD: A prospective study of 297 eyes with diabetic macular edema was conducted. An OTI/OCT exam was done for all eyes. The Fisher test was used to search for a correlation between visual acuity and each feature of diabetic macular edema (macular thickness, cystoid macular edema, central cyst, tractional component, and serous retinal detachment). RESULTS: Visual acuity varied from 1.3 log MAR to 0 log MAR. The mean visual acuity was 0.51 log MAR. The presence of central cyst on OCT scan was significantly associated with worse vision (p<0.0001). Increased retinal thickness in all patterns was significantly correlated with worse visual acuity (p<0.0001). The OCT patterns containing a tractional component and serous retinal detachment were also associated with visual loss (p<10(-6)). CONCLUSION: OCT is a very useful objective tool to describe, classify, and manage diabetic macular edema. It provides a better analysis of different prognosis factors and therefore can assist in determining a more suitable treatment for diabetic macular edema.

[Lateral gaze palsy and progressive scoliosis in 4 Tunisian families]. / Paralysie du regard latéral et scoliose progressive: à propos de 4 familles tunisiennes.

In 1975, Sharpe and Silversides described a neurological entity in a Chinese family. Clinical picture was characterized by paralysis of horizontal gaze, pendular nystagmus and progressive scoliosis. To date, 43 cases have been reported. The pathogenesis remains unclear. The Authors report four Tunisian families with 12 affected individuals. The age of patients ranges from 6 to 34 Years. All examined patients have complete lateral gaze palsy, pendular nystagmus and progressive scoliosis. Blood routine tests, cerebrospinal fluid (CSF), evoked potentials, electromyography (EMG), muscle biopsy, CT scan and cerebral MRI were normal. Autosomal recessive (AR) mode of inheritance is the most probable pattern.

[Risk factors for secondary cataract: a case-control study with multivariate analysis]. / Les facteurs de risque de la cataracte secondaire.

AIM: A retrospective case-control study was initiated to determine the risk factors for the development of posterior capsule opacification. SUBJECTS AND METHODS: 100 cases of patients with secondary cataract treated by YAG laser capsulotomy were compared with 100 controls (patients who had cataract surgery not complicated with a secondary cataract). The posterior capsule was examined by the biomicroscope. A 1-to-1 matched case-control study was designed by stratifying inclusions on the basis of age, sex, and delay. We studied the risk factors related to the patient, the primary cataract, the surgical technique, the surgeon's skill, and intraoperative and postoperative complications. All the lenses were biconvex and all-PMMA with the same design. Statistical analysis was done in 3 steps: a univariate analysis, then a bivariate analysis using chi-square and the Student tests and finally, we performed a multivariate analysis with a logistic regression. The significance level for type I error rate was fixed at 5%. RESULTS: The average age was 61.6 years. The mean delay was 32.7 months for cases and 34.5 months for controls. The bivariate analysis identified nine risk factors: corneal opacities (p=0.031), absence of a posterior chamber lens p=10(- 4)), the can opener anterior capsulotomy (p=0.003), ciliary sulcus fixation of the lens p=0.030), a large optic diameter of 7mm p=10(- 5)) and (t=0.002), poor intraoperative pupillary dilatation (p=0.003), a less experienced surgeon (p=3.10(- 4)), postoperative inflammation (p=0.021), and persistence of residual cortical material (p=0.002). The multivariate analysis selected five principal factors: absence of a posterior chamber lens, an optic diameter of 7mm, poor intraoperative pupillary dilatation, a less skilled surgeon, and persistence of cortical material. CONCLUSION: This case-control study reveals some of the risk factors previously identified and may contribute to the determination of methods for prevention of secondary cataract. The new intraocular lenses and pharmacological agents would lead to better results.

Effect of vitamin E supplementation in patients with ataxia with vitamin E deficiency.

Ataxia with vitamin E (Vit E) defciency (AVED) is an autosomal recessive disorder caused by mutations of the alpha tocopherol transfer protein gene. The Friedreich ataxia phenotype is the most frequent clinical presentation. In AVED patients, serum Vit E levels are very low in the absence of intestinal malabsorption. As Vit E is a major antioxidant agent, Vit E deficiency is supposed to be responsible for the pathological process. Twenty-four AVED patients were fully investigated (electromyography, nerve conduction velocity (NVC) studies, somatosensory evoked potentials, cerebral computed tomography scan, sural nerve biopsy, genetic studies) and supplemented with Vit E (800 mg daily) during a 1-year period. Clinical evaluation was mainly based on the Ataxia Rating Scale (ARS) for cerebellar ataxia assessment and serum Vit E levels were monitored. Serum Vit E levels normalized and ARS scores decreased moderately but significantly suggesting clinical improvement. Better results were noted with mean disease duration < or = 15 years. Reflexes remained abolished and posterior column disturbances unchanged. Vitamin E supplementation in AVED patients stabilizes the neurological signs and can lead to mild improvement of cerebellar ataxia, especially in early stages of the disease.

[Episcleral single injection anesthesia in the caruncle for cataract surgery: report of 350 cases]. / L'anesthésie épisclérale en injection unique à la caroncule dans la chirurgie de la cataracte: expérience de 350 cas.

Episcleral single injection anesthesia in the caruncle ovoïds the rare but potentially dangerous complications and incidents of classic local anesthesia. Excellent motor and sensory block is obtained with a single injection in the anatomic marks are well defined. We have practiced this technique since February 1999 for cataract surgery in 350 cases. The different surgical techniques used were manual extracapsular extraction in 52% of cases, phacosection through tunnel incision in 38%, and phacoemulsification in 10%. Our preliminary results show good acceptance of the episcleral anesthesia for both patients and surgeons. Because it is effective and safe, this anaesthtic technique may be an alternative to classic anesthetic techniques in all cases where topical anesthesia is not indicated.

Hemiparkinsonian syndrome due to a cerebral tumor infiltrating the substantia nigra.

Parkinsonism due to a cerebral tumor is rare and usually caused by an indirect effect of supratentorial tumors on nigrostriatal pathways rather than by direct involvement of the substantia nigra. Only three previous cases of midbrain infiltration causing Parkinsonism have been reported. We report the case of a young woman with a left tremo-akineto-rigid parkinsonian syndrome caused by a tumor of the brainstem infiltrating the right substantia nigra.

[Vermian agenesis: Report of a family and review of the literature]. / Agenesie vermienne: a propos d'une observation familiale et revue de la litterature.

Vermian agenesis constitute an heterogeneous group of clinical and neuroradiological entities with different prognosis. Authors report a kindred with vermian agenesis associated to characteristic facial dysmorphy and to mental retardation. After review of the literature, we found no previous description of such an association. We believe this is a new entity of familial vermian agenesis with autosomal recessive transmission.

[Occlusion of the central retinal vein in a 6-month pregnant woman]. / Occlusion du tronc de la veine centrale de la rétine chez une femme enceinte au 6e mois.

The authors report the case of 27-year old woman who was 6 months pregnant (second pregnancy, first parity) and presented an occlusion of the central retinal vein. The etiological investigation revealed impaired fibrinolysis after venous stasis. The clinical course including evolution and therapy was stressed. The role of pregnancy as a supplementary risk factor by haemorrheological mechanism was suggested.

[Intraepithelial carcinoma and invasive carcinoma of the sclero-corneal limbus. Anatomo-clinical study apropos of 20 cases]. / Carcinome intraépithélial et carcinome invasif du limbe scléro-cornéen. Etude anatomo-clinique à propos de 20 cas.

We report a retrospective multicentric study of 20 cases of sclero-corneal limbus tumours carcinome including 9 cases of Bowen's disease and 11 squamous cell carcinomas. These cases were observed over two 10 and 20-year periods in two pathology departments. Epidemiological, clinical, pathological and therapeutic data as well as the clinical course were studied and the results compared with a large review of the literature. The mean age of the patients was 38 years for Bowen's disease and 47 for carcinoma. Two young subjects, 5 and 22 years, had xeroderma pigmentosum and had Bowen's disease and an epidermoid microinvasive carcinoma, respectively. All of the patients with Bowen's disease were men and were more than 90% of the patients with carcinoma. Tumour size was greater in carcinomas (7 to 10 mm) than in Bowen's disease (1 to 5 mm). All tumours were unilateral. Clinical manifestations included irritative or inflammatory reactions in one-fourth of the patients with Bowen's disease and in one-third of those with carcinoma. Pathology examination revealed an intact basal membrane separating healthy tissue from Bowen's lesions which showed disrupted cell architecture mostly involving the medial layers of the epithelium in 37% of the cases. All of the lesions were treated by exeresis. No recurrence has been observed after a follow-up of 1 month to 2 years for Bowen's disease and 1 year (maximum) for squamous cell carcinomas.

[Ag-NORS and non-pigmented tumors of the sclerocorneal limbus. Apropos of 20 cases]. / Ag-NORS et tumeurs non pigmentées du limbe scléro-cornéen. A propos de 20 cas.

We studied nucleolar organizers (Ag-NORS) in 20 cases of ocular limbic tumours of which 7 were Bowen disease or intraepithelial carcinoma and 13 were invasive carcinomas. The NOR-Index, reflecting cellular activity, increased from intraepithelial carcinoma (3.97) to microinvasive (5.45) and invasive carcinoma (5.81). Results of Nor-Index, reflecting proliferation, was in agreement with other technics such as immuno-labelling with Ki67 and PCNA antibodies.

[Thoracic computed tomography data and cytology of the bronchoalveolar lavage fluid in an adult case of Niemann-Pick disease. The physiognomy of the disease in Tunisia]. / Manifestation tomodensitométrique thoracique et cytologie du liquide de lavage broncho-alvéolaire dans un cas adulte de maladie de Nieman-Pick. Physionomie de la maladie en Tunisie.

From a personal observation of a case of the chronic type-B form Niemann-Pick's disease in a 23 year old adult, the authors decided to review all the Tunisian published cases. They bring to light, in a review of the literature, the pulmonary disorder that occurs during this disease and discuss the contribution of computed tomography and the value of broncho-alveolar lavage as a method of diagnosis and prognosis in this disorder.