Atypical case of choroidal osteoma associated to polypoidal choroidal vasculopathy and preretinal neovascular membrane.

PURPOSE: To report a very rare and atypical case of an elderly Caucasian female patient who developed perilesional multiple polypoidal choroidal vasculopathy (PCV) as a probable complication of choroidal osteoma (CO), associated to preretinal neovascular membrane overlying the lesion. METHODS: Observational case report. CASE OBSERVATION: A 60-year-old Caucasian woman presented with blurred vision in her right eye (RE). Fundus examination revealed a round white-yellowish calcified deep lesion in the juxta-papillary superior area, measuring 4 disc-diameters, with well-defined scalloped margins and an irregular surface. B-scan ultrasonography and orbital tomography confirmed the diagnosis of choroidal osteoma (CO). Further investigation with multimodal imaging including infracyanine green angiography, fluorescein angiography, swept source optical coherence tomography and angiography highlighted the presence of multiple aneurysmal choroidal dilations around the CO, corresponding to PCV. We also noted the presence of a preretinal neovascular membrane overlying the CO. The patient was monitored with regular follow-up since no signs of activity were detected on multimodal imaging. CONCLUSION: Our case report represents an exceptional and atypical association between pre-retinal neovascularization, PCV and choroidal osteoma. While the mechanisms underlying the development of PCV and pre-retinal neovascularization in the setting of CO are not well understood, it is imperative for ophthalmologists to recognize this association as a potential cause of sudden vision loss in patients with CO, and to consider appropriate diagnostic and management strategies.

Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys.

PURPOSE: Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. METHODS: Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. RESULTS: Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. CONCLUSION: This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets.

Management of eyelids' primary malignancies.

Purpose: We report our experience in surgical management of primary malignant tumors of the eyelids. We have specified the various surgical techniques used, as well as functional and anatomical results.Patients and methods: A review of patients admitted for malignant tumor of the eyelids in the oculoplastic department of the Hedi Raies Institute of Ophthalmology from January 2012 to December 2021.Results: One hundred and twenty-three patients with malignant eyelid tumors were hospitalized. Surgical treatment involved 114 tumor lesions, which represents 95% of the cases. One hundred and eleven lesions (97.4%) had been operated by simple tumor resection. Safety margins were, respectively, 4 mm in 63.2% and from 5 to 6 mm in 34.2%. Extemporaneous histological examination was performed in three cases (2.6%). Reconstruction involved the anterior lamella (AL) in 92 cases (80.7%), the posterior lamella (PL) in 66 cases (57.9%), the medial canthus in 18 cases (15, 8%), and lateral canthus in 4 cases (3.5%). The excision was oncological in 85 cases (74.6%) and incomplete in 19 cases (16.7%). Tumor recurrence occurred in seven cases (6.1%), after an average delay of 36 months.Conclusion: The anatomical and functional features of the eyelids require a good reconstruction of the transfixion eyelid defect. Many reconstruction methods are available, allowing extensive and complex palpebral repairs. Oncologic prognosis is conditioned by the surgical quality.

[Orbital cellulitis: diagnostic, therapeutic and prognostic approach in a reference center in Tunis, Tunisia (a retrospective study of 109 cases)]. / Les cellulites orbitaires: approche diagnostique, thérapeutique et pronostique dans un centre de référence à Tunis, Tunisie (une étude rétrospective sur 109 cas).

Orbital cellulitis is a rare disease. Two anatomo-clinical forms can be distinguished: a preseptal "benign" form and a retroseptal "severe" form. The purpose of this study was to analyze the epidemiological, clinical, therapeutic and prognostic profile of orbital cellulitis in a third-line Hospital in Tunis, Tunisia. We conducted a retrospective study involving 109 patients hospitalized for orbital cellulitis. Two groups were distinguished: the retroseptal cellulitis group including 42 patients (38.5%) and the preseptal cellulitis group including 67 patients (61.5%). The average age of patients was 27.1 ± 34.8 years. The sex ratio M/F was 0.84 (45.9% of male patients). Acute sinusitis was the most frequently identified portal for retroseptal cellulitis entry (35.7%, n=15), while acute dacryocystitis was the most common cause of preseptal cellulitis (23.9%, n=16). Diabetes, non-functioning eye and prior use of non-steroidal anti-inflammatory drugs were associated with retroseptal cellulitis (p=0.007, p=0.022 and p=0.014 respectively). All patients received systemic antibiotic therapy. Ten patients (23.8%) of the retro-septal cellulitis group and 5 patients (7.46%) of the preseptal cellulitis group underwent surgery. Nine cases of blindness (8.2%), a case of septic shock and a case of death were reported. Poor prognostic factors were a time of consultation > 7 days (aOR = 4.277, 95% CI = 2.504-32.426, p = 0.006) and Chandler stage>III (aOR = 7.009, 95% CI = 1.69-51.839, p = 0.029). In developing countries and especially in Tunisia, orbital cellulitis can be sight threatening or even life-threatening. Early management could lead to a favorable outcome without sequelae.

Case report: Severe presentation of a syndromic congenital bilateral upper eyelids eversion.

INTRODUCTION: and importance: Congenital upper eyelid eversion (CUEE) is a rare congenital condition characterized by everted upper eyelids with prominent chemosis. The authors present the first case of concurrent upper eyelids eversion, umbilical hernia, and clubfeet. CASE PRESENTATION: A four-hour-old newborn male presented with bilateral red upper eyelids swelling. Ophthalmic examination revealed bilateral upper eyelids eversion and severe bilateral chemosis. The further pediatric evaluation showed a painless reducible umbilical hernia and clubfeet. Treatment of the eyelids eversion was conservative, combining topical steroids, antibiotics and lubricants. Chemosis reduced progressively. We obtained a complete resolution on day 21. We referred the neonate to the pediatric surgery, and orthopedic department for umbilical hernia and clubfeet management. CLINICAL DISCUSSION: Most infants with CUEE may show excellent anatomic and functional results with conservative treatment if managed timely and promptly. CONCLUSION: The innocuous appearance of CUEE must not prevent clinicians from investigating possible systemic associations and initiating appropriate treatment.

Does green tea extract enhance the anti-inflammatory effects of exercise on fat loss?

AIMS: Green tea extract (GTE) can exert antiobesity and anti-inflammatory effects. Our study determined whether the benefits of GTE are summative with exercise-induced changes in anthropometric indices, and the levels of inflammatory cytokines, adiponectin and irisin in inactive overweight women. METHODS: Thirty overweight female participants were randomized to 3 groups: endurance training + placebo (ET + P); endurance training + GTE (ET + GTE); and Control (no exercise) + placebo (Control, n = 10). The exercise intervention consisted of an 8-week endurance-training programme of 3 sessions per week (aerobics, aerobic circuit training, and fast walking or jogging at a moderate intensity of 40-59% of the heart rate reserve). The dose of GTE used was 500 mg/day in the form of a green tea capsule. RESULTS: Body weight, body mass index, waist to hip ratio and body fat percentage were decreased in both ET + P and ET + GTE interventions (P < .001 for both interventions). The reduction of anthropometric values in the ET + GTE group was significantly higher than ET + P interventions (P < .001). Both exercise interventions also significantly (P < .001) increased adiponectin (ET + GTE = 5.28 mg/mL [95% confidence interval {CI}, 4.48 to 6.08] and ET + P = 3.34 mg/mL [95% CI, 2.76 to 3.92]) and decreased high-sensitivity C-reactive protein (hs-CRP; ET + GTE = -0.95 mg/L [95% CI, -1.15 to -0.75] and ET + P = -0.35 mg/L [95% CI, -0.46 to -0.24]). Changes in adiponectin and hs-CRP were greater (P < .05) in ET + GTE compared to ET + P. There were no significant differences in irisin, interleukin-6 or tumour necrosis factor-α between the 3 groups (P > .05). CONCLUSIONS: GTE improves exercise-induced body composition by further decreasing exercise-induced changes in weight, body mass index, waist to hip ratio and body fat percentage. The combination of GTE and exercise also produced greater changes in anti-inflammatory (increases in adiponectin) and metabolic (decreases in hs-CRP) markers than exercise alone.

Effects of a six-week period of congested match play on plasma volume variations, hematological parameters, training workload and physical fitness in elite soccer players.

OBJECTIVES: The aims of this study were to investigate the effects of a six-week in-season period of soccer training and games (congested period) on plasma volume variations (PV), hematological parameters, and physical fitness in elite players. In addition, we analyzed relationships between training load, hematological parameters and players' physical fitness. METHODS: Eighteen elite players were evaluated before (T1) and after (T2) a six-week in-season period interspersed with 10 soccer matches. At T1 and T2, players performed the Yo-Yo intermittent recovery test level 1 (YYIR1), the repeated shuttle sprint ability test (RSSA), the countermovement jump test (CMJ), and the squat jump test (SJ). In addition, PV and hematological parameters (erythrocytes [M/mm3], hematocrit [%], hemoglobin [g/dl], mean corpuscular volume [fl], mean corpuscular hemoglobin content [pg], and mean hemoglobin concentration [%]) were assessed. Daily ratings of perceived exertion (RPE) were monitored in order to quantify the internal training load. RESULTS: From T1 to T2, significant performance declines were found for the YYIR1 (p<0.001, effect size [ES] = 0.5), RSSA (p<0.01, ES = 0.6) and SJ tests (p< 0.046, ES = 0.7). However, no significant changes were found for the CMJ (p = 0.86, ES = 0.1). Post-exercise, RSSA blood lactate (p<0.012, ES = 0.2) and PV (p<0.01, ES = 0.7) increased significantly from T1 to T2. A significant decrease was found from T1 to T2 for the erythrocyte value (p<0.002, ES = 0.5) and the hemoglobin concentration (p<0.018, ES = 0.8). The hematocrit percentage rate was also significantly lower (p<0.001, ES = 0.6) at T2. The mean corpuscular volume, mean corpuscular hemoglobin content and the mean hemoglobin content values were not statistically different from T1 to T2. No significant relationships were detected between training load parameters and percentage changes of hematological parameters. However, a significant relationship was observed between training load and changes in RSSA performance (r = -0.60; p<0.003). CONCLUSIONS: An intensive period of "congested match play" over 6 weeks significantly compromised players' physical fitness. These changes were not related to hematological parameters, even though significant alterations were detected for selected measures.

Postoperative Endophtalmities: therapeuthic results and Early vitrectomy.

BACKGROUND: Postoperative endophthalmitis is a public health issue due to its bad prognosis; its treatment is both surgical and medical. Classically, surgical treatment was done if visual acuity is limited to light perception only. AIM: To evaluate therapeutic results Of postoperative endophtalmitieS and to Compare therapeutics almost used intravitreal injection of antibiotics versus early vitrectomy. METHODS: It's a retrospective comparative study  includIng 120 cases of acute postoperative endophthalmitis hospitalized in a referral ophthalmology department between July 2007 and June 2013. A comparison was conducted between two groups of 24 and 94 patients; the first-line treatment was early vitrectomy for the first group and intravitreal antibiotic injection alone for the second group. RESULTS: The overall incidence rate was 0.38 %, Streptococcus and Staphylococcus Epidermidis where the most common bacterial strain (16 patients each). The treatment outcome was very favorable for 11 patients with final visual acuity  higher or equal to 2/10, the outcome was intermediate for 43 patients and poor for 66 patients because of final visual acuity lower than or equal to 1/20, loss of media transparency or anatomical or functional loss of the eye. The prognostic factors statistically correlated to treatment outcome where intense initial inflammation (p<0.001), high bacterial virulence (p=0.002), bacteria culture positive to Streptococcus (p=0.024), a defectuous operative incision (p= 0.012), age over 80 (p=0.022) and posterior capsule rupture (p=0.013). Early vitrectomy group (group1) achieved a higher percentage of good outcome (60% vs 41.5%,  p=0.098 ). CONCLUSION: Functional result is better in the Vitrectomy group than in the antibiotic intravitreal injections group whereas not Statically signifiant.

Mutation spectrum of RB1 gene in unilateral retinoblastoma cases from Tunisia and correlations with clinical features.

Retinoblastoma, an embryonic neoplasm of retinal origin, is the most common primary intraocular malignancy in children. Somatic inactivation of both alleles of the RB1 tumor suppressor gene in a retinal progenitor cell through diverse mechanisms including genetic and epigenetic modifications, is the crucial event in initiation of tumorigenesis in most cases of isolated unilateral retinoblastoma. We analyzed DNA from tumor tissue and from peripheral blood to determine the RB1 mutation status and seek correlations with clinical features of 37 unrelated cases of Tunisian origin with sporadic retinoblastoma. All cases were unilateral except one who presented with bilateral disease, in whom no germline coding sequence alteration was identified. A multi-step mutation scanning protocol identified bi-allelic inactivation of RB1 gene in 30 (81%) of the samples tested. A total of 7 novel mutations were identified. There were three tumors without any detectable mutation while a subset contained multiple mutations in RB1 gene. The latter group included tumors collected after treatment with chemotherapy. There were seven individuals with germline mutations and all presented with advanced stage of tumor. There was no difference in age of onset of RB based on the germline mutation status. Thus 20% of the individuals with sporadic unilateral RB in this series carried germline mutations and indicate the importance of genetic testing all children with sporadic retinoblastoma. These findings help to characterize the spectrum of mutations present in the Tunisian population and can improve genetic diagnosis of retinoblastoma.

[Epidemiological aspects of malignant melanoma of the uvea in Tunisia]. / Aspects épidémiologiques du melanoma malin de l'uvée en Tunisie.

BACKGROUND: to assess clinical factors that may influence the prognosis of malignant melanoma of the uvea METHODS: We conducted a retrospective study from January 1990 to December 2013, involving 80 patients suffering from malignant melanoma of the uvea. We determined the location, the size, the tumor thickness, the clinicopathological aspect, the degree of pigmentation of the uveal melanoma, and associated signs Results: Factors significantly associated with poor prognosis were: a tumor location (p = 0.01), the infiltrative or fungus aspect (p = 0.001), a diameter equal to or larger than 10 mm (p = 0.003), the thickness greater than or equal to 5 mm (p = 10-3), achromatic or hyperpigmented melanomas (p = 0.02) and retinal detachment (p = 10-3). CONCLUSION: Clinical prognostic factors are important to know because they determine the evolutionary profile and the metastatic potential of the uveal melanoma.

Multimodal imaging for the diagnosis of an atypical case of central serous chorioretinopathy.

We report a case of a 52-year-old woman presented with atypical central serous chorioretinopathy (CSCR) that had been misdiagnosed as posterior uveitis and treated with systemic corticosteroids and immunosuppressive therapy, with subsequent severe chorioretinal damage. Diagnosis was straightened through multimodal imaging. Anatomical improvement was achieved after discontinuation of corticosteroids and intravitreal injection of bevacizumab. However, visual acuity remained severely impaired in one eye. Failure to differentiate atypical CSCR from inflammatory chorioretinal diseases may lead to severe and irreversible visual impairment. Multimodal imaging helps recognition of the atypical presentations of CSCR, avoiding misdiagnosis and inappropriate management.

[Results of congenital cataract surgery using 2,2 microincision in children before the age of 5 years]. / Résultats de la chirurgie de la cataracte congénitale par micro-incision cornéenne de 2,2 chez les enfants de moins de 5 ans.

BACKGROUND: Thanks to the recent advances of the microsurgical techniques, the results of the congenital cataract surgery in children less than 5 years old have considerably improved. However, the age of implantation and the intraocular lens power calculation remain subjects of controversies. AIM: To evaluate the results of 2.2 mm micro-incision congenital cataract surgery in children less than five years old. METHODS: Forty seven consecutive eyes of 26 children who had dense congenital cataract surgery were included in this retrospective study. All children had had the same surgical procedure: anterior approach through 2.2 mm corneal tunnel, posterior capsulorhexis associated to anterior vitrectomy and a primary foldable intraocular lens implantation. The final evaluation was at the same time anatomical and functional depending on the children age. RESULTS: The median patient age of the children was of 23 months (6 to 54 months) and the sex ratio was 1.36 (15 boys / 11 girls). The cataract was bilateral in 77.7 % of the cases (21/27 children). The intraocular lens was implanted in the capsular bag in 93.6 % of the cases (44/47 eyes) and in the sulcus in 6.3 % of the cases (3/47 eyes). The postoperative complications were mild: inflammatory reaction limited to the anterior chamber in 17 % of the cases (8/47 eyes), opacification of the visual axis with a reproliferation of the epithelial cells behind the implant was observed in 4.25 % of the eyes (2/47 eyes). We noted no case of intraocular lens decentration or secondary glaucoma. The study of the refraction at last follow up showed a sphere average of 2.73 ± 1.21 diopters and mean astigmatism of 1.51 ± 0.82 diopters. The median best corrected distance visual acuity, evaluated in 12 children, was 5.2/10 ranging from 1/10 to 10/10. The amblyopia was also noted to 12/26 children (46.1 %). Among these children, 11/12 (91.6%) had a delay of surgery and 5/12 (41.6 %) had an unilateral cataract. CONCLUSION: Currently the anatomical prognosis of the congenital cataract surgery in children less than 5 years old is getting closer to that of the adult. However, the functional prognosis remains still unpredictable depending mainly on the deadline of surgery which remains very late in our series. Thanks to the improvement of the surgical techniques using microincision in cataract surgery and the new generation of foldable implants, the anatomical and functional prognosis of the congenital cataract have significantly improved.

[Keratomycosis in the area of Tunis: epidemiological data, diagnostic and therapeutic modalities]. / Les kératites fongiques dans la région de Tunis: caractéristiques épidémiologiques, modalités diagnostiques et thérapeutiques.

Fungal keratitis is a serious disease involving the visual prognosis. This pathology is not well known in Tunisia. The aim of our study is to determine epidemiological data and clinical and mycological characteristics of fungal keratitis in the area of Tunis (North of Tunisia) and discuss its therapeutic modalities. This is a retrospective study including 19 cases of fungal keratitis collected over a period of 11 years (January 1998-December 2008). The diagnosis of keratomycosis was based on clinical and mycological data. Mycological examination interested corneal scraping including direct examination and culture. The cases of fungal keratitis concerned 13 men and 6 women with a mean age of 48.7 years. The most common risk factors was corneal trauma (47.4%). The mean delay between the first ophthalmic signs and consultation was 17.7 days. Most frequently fungal isolated fungi were Candida albicans (6 cases), followed by Aspergillus spp (5 cases) and Fusarium spp (4 cases). All patients received topical and systemical antifungal therapy. The evolution was favourable in six cases. Three patients retained corneal scars. The surgery was necessary in 7 cases, consisting of a penetrating keratoplasty (5 cases), an enucleating (1 case) and amniotic membrane transplantation (1 case). In conclusion, despite the improvement of diagnosis and treatment of fungal keratitis, its prognosis remains pejorative. This prognosis depends on early diagnosis and choice of antifungal therapy.