Abnormal brain function in photophobic patients with dry eye disease: An fMRI study.

BACKGROUND AND OBJECTIVES: Photophobia, a frequent and disabling symptom observed in various neurological conditions and eye diseases, is thought to involve maladaptive brain functioning. We assessed this hypothesis, using functional magnetic resonance imaging (fMRI) in photophobic patients with minimal-to-severe dry eye disease (DED), as compared to healthy controls. METHODS: This prospective, monocentric, comparative, cohort study included eleven photophobic DED patients compared to eight controls. Photophobic patients had a complete evaluation of DED to exclude any other cause of photophobia. All participants were scanned with fMRI under intermittent light stimulation with a LED lamp (27s. ON, 27 s. OFF), and cerebral activations were studied with univariate contrasts between the ON and OFF conditions, and with functional connectivity methods. RESULTS: Firstly, stimulation activated the occipital cortex more strongly in patients than in controls. Moreover, stimulation deactivated the superior temporal cortex in patients less than in controls. Secondly, functional connectivity analysis showed that light stimulation induced lesser decoupling between the occipital cortex and the salience and visual networks in patients than in controls. DISCUSSION: The current data shows that DED patients with photophobia have maladaptive brain anomalies. There is hyperactivity in the cortical visual system, associated with abnormal functional interactions, both within the visual cortex, and between visual areas and salience control mechanisms. Such anomalies show similarities with other conditions such as tinnitus, hyperacusis, and neuropathic pain. Those findings support novel neurally oriented methods for the care of patients with photophobia.

Evaluation of retinal nerve fiber layer thickness measured by optical coherence tomography in Moroccan patients with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by focal inflammatory infiltrates, demyelinating lesions and axonal injury. The purpose of the study was to evaluate the retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT) in Moroccan patients with MS and to assess the relationship between RNFL thickness and disease duration, Expanded Disability Status Scale (EDSS) score, visual acuity and automated visual field indices. MATERIALS AND METHODS: Thirty-one patients with definite MS and thirty-one disease-free controls were enrolled in the study. After neurologic consultation, ophthalmologic examination including visual acuity, automated visual field testing and OCT were performed. RESULTS: Significant differences between both groups were observed in OCT parameters (total, temporal and macular ganglion cell layer) with lower thickness in the MS group. In patients without a history of optic neuritis, there were statistically significant inverse correlations between total RNFL thickness and disease duration, neurologic disability evaluated by the EDSS, logMAR visual acuity and automated visual field indices. CONCLUSIONS: OCT seems to be a reproducible test to detect axonal loss of ganglion cells in MS. Further and larger longitudinal prospective studies would be valuable to assess the evolution over time of the RNFL measurements in Moroccan MS patients.

[Risk factors for failure of scleral buckling in rhegmatogenous retinal detachment. A Moroccan series]. / Facteurs d'échec de la chirurgie épisclérale dans le décollement de rétine rhegmatogène. À propos d'une série marocaine.

PURPOSE: To evaluate risk factors for failure of scleral buckling in rhegmatogenous retinal detachment (RRD) in an adult Moroccan population. METHODS: A retrospective study of 432 eyes of 422 patients undergoing scleral buckling (SB) for primary RRD between 2001 and 2009 was carried out. Statistical analysis of risk factors for failure was performed using binary logistic regression. RESULTS: Mean patient age was 43 ± 15 years, and 45.4% were myopic. The median recurrence was at 10 months. The final failure rate was 22.5%. Univariate analysis shows that significant risk factors for failure were extent of RRD ≥ 3 quadrants (P<0.001), advanced PVR (P<0.001) and worsening PVR postoperatively (P<0.001). In the multivariate model, the only significant risk factor for failure was the worsening postoperative PVR (P<0.001). CONCLUSIONS: Our findings suggest that worsening of PVR after surgery is the major risk factor for failure of SB in RRD. Thus, it is necessary to recognize the risk factors contributing to PVR and to plan the most appropriate, earliest and least traumatic surgical treatment of RRD.

[Retrobulbar optic neuropathy secondary to an undifferentiated carcinoma of the sphenoid sinus]. / Neuropathie optique rétrobulbaire révélant un carcinome indifférencié du sinus sphénoïdal.

Undifferentiated carcinoma of the paranasal sinuses is a rare malignant tumor, characterized by rapid growth, local/regional invasion, metastatic potential and poor prognosis despite aggressive treatment. Clinically, this tumor may manifest as episodes of epistaxis, headache or ophthalmic signs, particularly oculomotor nerve palsies, optic atrophy or even proptosis in the case of orbital extension. We report the case of a patient admitted with a left retrobulbar optic neuropathy, which led to a diagnosis of undifferentiated carcinoma of the sphenoid sinus.

[Double prepapillary arterial loop and arterial occlusion]. / Boucle vasculaire prépapillaire bilatérale compliquée d'une occlusion artérielle.

The prepapillary vascular loops are rare congenital vascular anomalies. Often unilateral and asymptomatic, they may be complicated by ischemic events by twisting or thrombosis of the loop. We report a rare case of double prepapillary arterial loop complicated by left retinal ischemia due to thrombosis of the loop.

[Solitary retinal astrocytic hamartoma simulating retinoblastoma]. / Hamartome astrocytaire isolé simulant un rétinoblastome.

Retinal astrocytic hamartoma and retinoblastoma may be very similar clinically and their differentiation in atypical cases can be difficult, even with the use of ultrasonography and computed tomography. In such cases, a close follow-up is recommended before enucleation. This paper reviews the case of a 18 month old girl who presented with a solitary retinal astrocytoma of the right eye, without any other physical or ocular disorder. The initial presentation simulated a retinoblastoma; nevertheless atypical patterns as yellow calcifications and the lack of tortuous and dilated feeding blood vessels were present. Ophthalmoscopic and ultrasound regular evaluation did not reveal any change after one year follow-up. Additional investigations performed in order to exclude tuberous sclerosis (neurological and dermatological examination, CT-scans) showed no other organ involvement, which ruled out a phakomatosis. The clinical appearance and course of astrocytic hamartomas, its differential diagnosis from other retinal tumors, especially retinoblastoma, and its association with tuberous sclerosis are discussed.

[Inflammatory pseudotumor of the lacrimal gland. Apropos of 2 cases]. / Les pseudo-tumeurs inflammatoires de la glande lacrymale. A propos de 2 cas.

BACKGROUND: Inflammatory pseudotumors of the orbit are relatively common accounting for 12 to 15% of all orbital diseases. Lacrimal gland location is exceptional. CASE REPORTS: We report 2 patients aged 30 and 25 years who underwent surgery for an isodense tumor of the lacrimal gland. Immunohistochemistry revealed an inflammatory pseudotumoral process. Both patients are recurrence-free 2 years follow-up. DISCUSSION: Inflammatory pseudotumors of the orbit, particularly those located in the lacrimal gland still raise unresolved questions concerning the pathogenesis, diagnosis and treatment. CONCLUSION: Lacrimal gland localizations of inflammatory pseudotumors must be recognized due to difficulties in diagnosis and therapeutic management.

[Retinal vasculitis]. / Les vascularites retiniennes.

PURPOSE: The purpose of this study is to determine aetiologies of vasculitis of retina in Morocco. MATERIAL AND METHODS: This is a retrospective study on 108 cases of vasculitis of retina admitted in the ophthalmology department, for a 5-year period (1987-1993). Our patients had a complete ophthalmological examination : fluorescine angiography, colour vision, general examination and biological study. RESULTS: Many aetiologies have been found, predominantly Behcet's disease. The neovascularization of retina which complicates the vasculitis was detected in 30 % of our patients. A laser photocoagulation was performed on these cases, sometimes a vitrectomy was necessary when a haemorrhage of vitreous body occurred, complicating the neo-vessels of retina. The therapeutics received by our patients was based on the corticotherapy. An immunosuppression treatment was prescribed in most cases of Behcet's disease and in severe vasculitis. Outcome after treatment has been satisfactory, but many patients relapse very frequently, mainly those with Behcet's disease. CONCLUSION: Causes of vascular retinitis are variable, most of them are due to Behcet's disease.

[Severe toxic optic neuropathies caused by isoniazid. Apropos of 3 cases]. / Neuropathies optiques toxiques graves induites par l'isoniazide. A propos de trois cas.

Three cases of isoniazid-induced toxic optic neuropathy are reported. These severe forms of the disease lead in all cases to bilateral blindness despite drug withdrawal. The epidemiological, clinical and therapeutic aspects of the disease are discussed. Further emphasis is placed on the importance of systematic screening of patients at risk using regular ophthalmological examinations before and after treatment.

[Value of ultrasonography in persistent hyperplastic primary vitreous body. Apropos of 4 cases]. / Intérêt de l'échographie dans la persistance et l'hyperplasie du vitré primitif. A propos de 4 cas.

The authors report 4 patients with complicated persistent hyperplastic primary vitreous. The complications observed are cataract (2 eyes) and retinal detachment (2 eyes). The affection is bilateral in two cases and unilateral in the two other cases. After a short embryologic vitreous recall, the authors present clinical and paraclinical aspects of the condition. The authors focus on the importance of echographic data.