Postcoital visual loss due to valsalva retinopathy: A case report.

Valsalva retinopathy is a rare pathology presenting as a sudden and painless loss of vision affecting young subjects with no medical history. It is the result of an increase of intraocular venous pressure, leading to retrohyaloid haemorrhage. We describe here the clinical presentation of a retrohyaloid hemorrhage resulting from a valsalva mechanism following a sexual activity, in a 28-year-old patient treated by Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser hyaloidotomy with a visual recovery of 20/20 on 3 weeks follow-up. Valsalva retinopathy is a rare and an easy-to-diagnose pathology that is safely handled by Nd:YAG laser hyaloidotomy for a quick visual acuity recovery.

Kyrieleis arteritis associated with toxoplasmic retinochoroiditis: A case report.

-Kyrieleis arteritis is a rare manifestation in posterior uveitis-Kyrieleis arteritis is most frequently reported in ocular toxoplasmosis.-The pathogenesis still highly debated.-It is characterized by the presence of focal, segmental plaques or exudates within retinal arteries.-These plaques are usually reversible.-The prognosis is usually good.

Sterile endophthalmitis after intravitreal triamcinolone acetonide injection: A case report series.

Corticosteroids have proven their effectiveness in the treatment of cystoid macular edema. Especially after an intravitreal injection. Triamcinolone acetonide is the most commonly used in the treatment of macular edema. Noninfectious endophthalmitis is a form of endophthalmitis that can occur in the absence of a defined germ after an intravitreal injection of triamcinolone acetonide. We report here the case of three diabetic patients, who presented with visual blur, three days after an intra vitreal triamcinolone acetonide injection performed in the right eye. The vitreous inflammation resolved spontaneously in the first two cases after three weeks, and after four weeks for the third. The diagnosis of sterile endophthalmitis was made in view of the spontaneous resolution of the inflammation without the use of intravitreal injection of antibiotics and/or vitreoretinal surgery.

Acute posterior multifocal placoid pigment epitheliopathy associated with serous retinal detachment: A case report.

We report the occurrence of serous retinal detachment (SRD) in acute posterior multifocal placoid pigment epitheliopathy (APMPPE). A 22-year-old man with no general or ophthalmological pathological history presented with an acute and bilateral decreased visual acuity. There was no notion of recent flu or recent vaccination. There were anterior chamber cells and vitreous cells. Fundus revealed white-yellowish lesions, scattered on posterior pole and periphery, associated with SRD in both eyes. Fluorescein Angiography showed early hypofluorescence followed by late hyperfuorescence. Optical coherence tomography (OCT) showed hyperreflective bands of the outer nuclear layer and interruption of the ellipsoid zone associated with bilateral SRD. Repeat OCT revealed a spontaneous and complete regression of SRD in both eyes, and improvement of visual acuity after one week of evolution without any treatment. Serous retinal detachment is an uncommon manifestation of APMPPE. It is more suggestive of Vogt-Koyanagi-Harada disease (VKH), although angiographic features are typically observed in APMPPE. Moreover, spontaneous decrease of SRD within a few days is more in favor of APMPPE.

White-centered retinal hemorrhage revealing acute leukemia: A case report.

Retinal manifestations have been described as an inaugural manifestation of acute leukemia. Retinal hemorrhage, and in particular white-centered hemorrhages are among the most frequently observed signs. We report here the case of a 34-year-old Caucasian man with no medical history who presented to our emergency department with a decrease in visual acuity associated with asthenia. Ophthalmological examination revealed bilateral white-centered hemorrhages. The etiological assessment confirmed the diagnosis of acute myeloid leukemia. Whenever Roth spots are found in fundus examination, a complete ophthalmological examination along with a wide etiological investigation must be conducted.

Cat scratch disease neuroretinitis: A case report.

INTRODUCTION: Cat scratch disease (CSD) is a ubiquitous infectious disease caused by a Gram-negative intracellular bacillus, Bartonella henselae. Neuroretinitis is a classical but rare manifestation of CSD. CASE PRESENTATION: A 20-year-old woman presented with a 5-day-history of reduced vision in the left eye (LE). Two weeks before eye symptoms, she complained from fever, fatigue and arthromyalgia which resolved spontaneously. In the LE, visual acuity (VA) was 7/10, fundus photography showed optic disc edema with macular exudates arranged in incomplete macular star. Serologic test for Bartonella henselae using indirect immunofluorescent assay (IFA) was highly positive (1:2560 UI/L) for immunoglobulin G (Ig G). The diagnosis of CSD associated neuroretinitis has been made and the patient was treated with doxycycline, rifampicin and oral prednisolone. Twelve months after the end of therapy, VA was 10/10, fundus photography and Macular OCT were normal. DISCUSSION: In CSD, neuroretinitis occurs 2-3 weeks after systemic symptoms. The clinical features of CSD are not specific hence the need for bacteriological diagnosis which is based mainly on serologic testing by the detection of Ig G and Ig M by IFA or ELISA. The treatment of CSD-associated neuroretinitis is not standardized. Antibiotics active against intracellular bacteria, with or without systemic corticosteroids, should be prescribed especially in severe cases. The outcome of Bartonella henslae neuroretinitis is usually favourable. CONCLUSION: Despite rarely reported in Tunisia, CSD should be considered in patients with presence of typical neuroretinitis with macular star and of a history of contact with cats.

Optic nerve avulsion: Case report.

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.

Retinal vein occlusions: an OCT- Angiography analysis.

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.

Ocular manifestations of crohn's disease.

INTRODUCTION: Ocular involvement in Crohn's disease is rare and polymorphic. AIM: To analyze the frequency and type of ocular manifestations during Crohn's disease as well as the risk factors for ocular involvement during this disease. METHODS: This is a prospective study of 52 patients (104 eyes) with Crohn's disease treated at the regional hospital of Nabeul between January 2016 and December 2016. Patients were divided into two groups: a group with ocular manifestations and a group without ocular manifestations. All the patients benefited from a complete ophthalmological examination. Fluorescein angiography and macular OCT were done in cases of posterior segment involvement. RESULTS: Patients with ocular manifestations were younger than those of group 2 without ocular manifestations with an average age of 34.5 years and 42 years, respectively. The colonic localization of the disease was found in 13 patients of group 1 (52%) and only in 2 patients of group 2 (7.4%). Extradigestive manifestations were noted in 12 patients of group 1 (48%) and 1 patient of group 2 (3.7%). For group 1, 60% of cases (15 patients) were in an active episode of inflammatory bowel disease versus 7.4% (2 patients) in group 2. Anterior uveitis was the most frequent ocular manifestation in our study, found in 29,3% of cases (12 patients). CONCLUSION: The ocular manifestations are more frequent in young people, during the inflammatory activity of the disease especially in colonic localization, during the first year of the follow-up of the disease and in the case of coexistence of articular or oral extra-intestinal manifestations.

Orbital disorder revealing a lung cancer: a case report.

INTRODUCTION: Orbital metastases are rare and they are even rarer to be the first sign of the disease, which can lead to misdiagnosis and delay of management. OBSERVATION: Our patient consulted for a diplopia and a ptosis of the upper eyelid of the right eye since one month, without any other systemic symptoms. After ophthalmological examination and orbital tomography, the diagnosis of orbital metastasis was suspected. Lung cancer was revealed by thoracic tomography and confirmed by an anatomopahological examination. CONCLUSION: Because of the increased incidence of neoplasia, the diagnosis of orbital metastasis should be considered in any elderly patient who consults for symptomatology related to orbital involvement.

Ophtalmoplegia complicating sino-orbital mucormycosis.

PURPOSE: To report a case of complete ophthalmoplegia and blindness in sino-orbital mucormycosis. CASE REPORT: A 68-year-old woman with history of diabetes and breast cancer presented with sudden onset of fever, orbital pain and blindness in the right eye. The patient was found to have no light perception, complete ophthalmoplegia, chemosis, corneal ulcer and optic nerve atrophy. In rhinologic examination, necrosis was noticed. Brain and orbit magnetic resonance imaging showed diffuse sinusitis with orbital involvement. The result of the clinical examination was reported as sino-orbitalmucormycosis. The diagnosis was confirmed by pathological specimens. The patient underwent extensive surgical debridement and systemic antifungal treatment. Despite treatment, visual acuity did not recover. CONCLUSION: The sino-orbital form of mucormycosis is a rare and insidious fungal infection. Ocular findings may range from orbital pain to ophtalmoplegia and blindness such as in our case. Black scar tissues seen on the nasal mucosa are pathognomonic. Delay in treatment due to late presentation and complications were major determinants in ocular prognosis and survival outcome.