[Ocular risk factors for progression of primary open angle glaucoma in the Tunisian population]. / Facteurs oculaires prédictifs de la progression du glaucome primitif à angle ouvert dans la population tunisienne.

PURPOSE: To evaluate intraocular pressure parameters and the role of other ocular risk factors in the progression of primary open angle glaucoma. PATIENTS AND METHODS: We performed a retrospective analysis of long-term glaucomatous progression in 140 patients (280 eyes) with primary open angle glaucoma (POAG) between 1998 and 2009. After analyzing their disease progression, the eyes of our patients were divided into two groups: group 1 (G1) consisted of eyes with worsening of their POAG, and group 2 (G2) consisted of the eyes that remained stable. The indicators of progression studied were factors associated with glaucomatous optic neuropathy, other ocular risk factors, and treatment-related risk factors. RESULTS: We found 188 eyes with stable visual fields (G2) and 92 eyes with glaucoma progression (G1), for a progression rate of 32.9%. Mean intraocular pressure (IOP) at diagnosis was statistically higher in the cases with progression, 22.78 mmHg vs. 19.9 mmHg for stable cases (P=0.03; OR=5.25). Higher final intraocular pressure (IOP) was also associated with progression (16.82 mmHg for G1 vs. 14.85 mmHg for G2; P=0.051). IOP less or equal to 12.75 mmHg was identified as the target pressure for our population. Progressed eyes also showed a statistically higher diurnal peak IOP (23.13 mmHg vs. 19.87 mmHg for G2; P=0.007). Long term IOP fluctuation was also predictive of progression (4.43 mmHg for G1 vs. 2.31 mmHg for G2; P=0.003). Eyes with initial visual field defect more than 8.2dB had 4.8 times the risk of progression (P=0.07). However, eyes diagnosed in an early glaucoma stage had four times the chance of maintaining a stable visual field (P=0.003). Statistically significant risk factors between the two groups also included: pseudoexfoliation (OR=2.84; P=0.05), cornea less than 505 µ (OR=10.89; P=0.005), topical beta blockers (P=0.003), and more than two topical medications (OR=3; P=0.003). CONCLUSION: It is currently known that IOP lowering contributes to glaucoma stabilization. However, this single criterion remains insufficient, as other, particularly ocular, factors have been implicated in glaucoma progression. Identification of these risk factors allows for a better therapeutic approach toward these patients, so as to preserve their vision and quality of life.

[Optical coherence tomography in Sjögren-Larsson Syndrome diagnosis]. / Apport de la tomographie en coherence optique dans le diagnostic du syndrome de Sjögren-Larsson.

PURPOSE: To study the clinical and the optical coherence tomography (OCT) features of crystalline_macular dystrophy in a 14-year-old man with Sjögren-Larsson syndrome (SLS). CASE REPORT: A 14-year-old man was hospitalized because of a severe hyperkeratosis, epilepsy, spastic paraplegia and mental retardation. The diagnosis of SLS was considered. A bilateral crystalline maculopathy was detected by fundus ophthalmoscopy. OCT showed bilateral focal perifoveal hyperreflectivities and microcystoid spaces. DISCUSSION-CONCLUSION: OCT features of the crystalline maculopathy could point at SLS in undiagnosed patients. It is a low cost and non invasive procedure that could be of value in elucidating the pathophysiological mechanisms of SLS.

[Unilateral panuveitis following intravesical therapy with bacille of Calmette et Guerin]. / Panuveite unilaterale apres instillations intravesicales du bacille de Calmette et Guerin.

Uveitis occuring after Mycobacterium bovis-bacille Calmette-Guerin (BCG) intravesical therapy for bladder carcinoma is rare. Only a few cases have been described. Its physiopathology is still unknown. Two mechanisms can be proposed at the origin of ocular inflammation: a local immune response or a direct choroidal mycobacterial infection as demonstrated by vitreous cultures. We report the case of 63-year-old man who presented with unilateral panuveitis after the fifth BCG intravesical instillation with no other systemic manifestations. There was no evidence for any other etiology for this uveitis. Loss of light perception occurred despite systemic antimycobacterial therapy and systemic prednisone therapy because of delayed diagnosis. This outlines the absolute need for a close ophthalmological monitoring of patients receiving a BCG therapy to allow an earlier diagnosis of this complication and appropriate treatment.