Short-Term Total Tamponade with Perfluorocarbon Liquid and Silicone Oil in Complex Rhegmatogenous Retinal Detachment with Severe Proliferative Vitreoretinopathy.

Background: To evaluate retinal reattachment, visual functional results, and complications rates after total tamponade (TT) with perfluorocarbon liquid (PFCL) and silicone oil (SO) for 2 days followed by PFCL-SO exchange in complex retinal detachment (RD). Methods: Retrospective study including 52 consecutive eyes with complex RD and advanced proliferative vitreoretinopathy, who underwent vitrectomy with TT. Patients underwent first surgery by 25-Gauge vitrectomy and partial PFCL-SO exchange (approximately 60% PFCL 40% SO fill) followed by second surgery with extraction of the PFCL and complete SO fill. Results: After a mean follow-up period of 25.15 ± 6.6 months, the retina remained reattached in 48/52 eyes (92.3%) including 28 eyes (58.3%) without SO and 20 eyes (41.7%) with prolonged SO tamponade. Visual acuity improved in 45 eyes (86.6%) (P<0.001), remained stable in 4 eyes (7.7%) and decreased in 3 eyes (5.7%). Complications consisted in mild anterior chamber inflammation in 10 eyes, ocular hypertension in 12 eyes, and cataract in 10 eyes. Conclusion: Two-day TT with PFCL and SO may be considered in complex RD with advanced proliferative vitreoretinopathy especially in monocular patients. Further studies with longer follow-up period and retinal electrophysiologic assessment may be needed.

Fluffy white iris precipitates in Fuchs uveitis: a new sign for an old disease.

To describe particular iris precipitates in a series of five eyes from six patients with Fuchs uveitis (FU). Iris precipitates were noted by four independent examiners during routine physical examination of the angle by gonioscopy with Goldmann's three-mirror lens in patients with FU. The result was confirmed by examination, using the same method, of five other consecutive patients with FU and compared to 10 normal control eyes from five healthy individuals. Other causes of anterior uveitis were excluded. There were no iris precipitates in the healthy eyes. In eyes with FU, there were fluffy white iris precipitates, not visible by full-face examination or by classic slit-lamp examination. They were similar to keratic precipitates described in FU: starry, blurry and transparent with a tendency towards the white. Situated on the surface of the iris, they were visible only with the particular diffusion of the light from the gonioscopy's glass on the darkly pigmented iris of patients from North Africa. Fluffy white iris precipitates, seen in FU patients, appear to represent an additional clinical sign and may improve our diagnostic accuracy in this disease. Its visibility requires a specific technique during clinical examination. The validity of this new clinical sign based on this fact is yet to be determined.

Bilateral retinal pigment epithelium tears in acute Vogt-Koyanagi-Harada disease.

PURPOSE: To report an original case of retinal pigment epithelial (RPE) tears in acute Vogt-Koyanagi-Haradadisease. METHODS: Observational case report of a patient who presented with RPE tears in acute Vogt-Koyanagi-Harada disease, who underwent clinical examination, fluorescein and infracyanine green angiographies, and optical coherence tomography evaluation. RESULTS: A 42-year-old woman presented with bilateral serous retinal detachment related to Vogt-Koyanagi-Harada disease. Eight days after high-dose systemic corticosteroids, she developed bilateral RPE tears. At the 15-month follow-up, visual acuity was 20/20 in both eyes. CONCLUSION: The RPE tears are rarely observed in acute Vogt-Koyanagi-Harada disease. The RPE tears were likely caused by acute inflammation of the choroidal stroma.

Schwannoma of the eyelid: apropos of two cases.

Schwannoma, also referred to as neurilemmoma, is a benign tumor of peripheral nerve arising from Schwann cells that form the neural sheath. Schwannoma of ophthalmic interest is rare although it has been reported in relation with the orbit, and less frequently with the uveal tract and conjunctiva. Isolated eyelid schwannoma is extremely uncommon. Up until now, only eight cases have been reported in literature. Herein, we report two cases of eyelid schwannoma.

3-day treatment with azithromycin 1.5% eye drops versus 7-day treatment with tobramycin 0.3% for purulent bacterial conjunctivitis: multicentre, randomised and controlled trial in adults and children.

AIM: To compare the efficacy and safety of Azyter, azithromycin 1.5% eye drops, for 3 days with tobramycin 0.3% for 7 days to treat purulent bacterial conjunctivitis. METHODS: This was a multicentre, randomised, investigator-masked study including 1043 children and adults with purulent bacterial conjunctivitis. Patients received either azithromycin 1.5% twice-daily for 3 days or tobramycin 0.3%, 1 drop every two hours for 2 days, then four times daily for 5 days. Clinical signs were evaluated and cultures obtained at D0, D3 and D9 (where D refers to "day"). Primary variable was the clinical cure at the Test-of-Cure (TOC)-visit (D9+/-1), for patients with D0-positive cultures. The cure was defined as: bulbar conjunctival injection and discharge scores of 0. RESULTS: Among 471 patients with D0-positivity in the per protocol set, 87.8% of the azithromycin 1.5% group and 89.4% of the tobramycin group were clinically cured at the TOC-visit. Azithromycin was non-inferior to tobramycin for clinical and bacteriological cure. Clinical cure was significantly higher with azithromycin 1.5% at D3. The safety profile of azithromycin was satisfactory with a good patient and investigator's acceptability. CONCLUSIONS: Azithromycin 1.5% for 3 days was as effective and as safe as tobramycin for 7 days. Furthermore, more azithromycin than tobramycin patients presented an early clinical cure at Day 3. Due to its twice daily dosing regimen for 3 days, azithromycin represents a step forward in the management of purulent bacterial conjunctivitis, especially in children.

Immunohistochemical study of vascular endothelial growth factor (VEGF), tumor suppressor protein (p53) and intercellular adhesion molecule (ICAM-1) in the conjunctiva of diabetic patients.

The expression pattern of VEGF, p53 and ICAM-1 was studied in conjunctiva of diabetic patients with and without retinopathy. All patients underwent a complete ophthalmic examination, including retinal fluorescein angiography. Indirect immunoperoxidase method was performed on 20 eyes of 20 patients with type II diabetes without DR and on 5 eyes of 5 patients with PDR. A control study was performed on 6 normal conjunctiva undertaken during cataract surgery. Immunoreactivity of VEGF, p53 and ICAM-1 was found in epithelial, fibroblast and vascular endothelial cells. For the same duration of diabetes, a strong to moderate or weak immunoreactivity was observed in the conjunctiva of patients without retinopathy. In patients with PDR, the expression was strong for all these proteins. The immunoreactivity was correlated between VEGF, p53 and ICAM-1. In the normal conjunctiva, a weak to negative immunostaining was observed. The presence of these proteins in the conjunctiva of diabetic patients without retinopathy may add new data in the pathogenesis of diabetic retinopathy. Further studies are needed to confirm this hypothesis.

A homozygous splice mutation in the HSF4 gene is associated with an autosomal recessive congenital cataract.

PURPOSE: To map the locus and identify the gene causing autosomal recessive congenital cataracts in a large consanguineous Tunisian family. METHODS: DNA was extracted from blood samples from a large Tunisian family with an autosomal recessive, congenital, total white cataract. A genome-wide scan was performed with microsatellite markers. All exons and the splice sites of the HSF4 gene were sequenced in all members of the Tunisian family and in control individuals. RT-PCR was used to detect different transcripts of the HSF4 gene in the human lens. The transcripts were cloned in a TA cloning vector and sequenced. RESULTS: Two-point linkage analyses showed linkage to markers on 16q22 with a maximum lod score of 17.78 at theta = 0.01 with D16S3043. Haplotype analysis refined the critical region to a 1.8-cM (4.8-Mb) interval, flanked by D16S3031 and D16S3095. This region contains HSF4, some mutations of which cause the autosomal dominant Marner cataract. Sequencing of HSF4 showed a homozygous mutation in the 5' splice site of intron 12 (c.1327+4A-->G), which causes the skipping of exon 12. A more detailed study of the transcripts resulting from alternative splicing of the HSF4 gene in the lens is also reported, showing the major transcript HSF4b. CONCLUSIONS: This is the first report describing association of an autosomal recessive cataract with the HSF4 locus on 16q21-q22.1 and the first description of HSF4 splice variants in the lens showing that HSF4b is the major transcript.

[Penetrating keratoplasty in children]. / La greffe de cornéee chez l'enfant.

Penetrating keratoplasty in children is a high risk transplantation. Indications increased with improvement of surgical techniques and therapies. Our purpose is to study anatomic and functional results of penetrating keratoplasty in children. We report the results of a retrospective study including 23 penetrating keratoplasties (22 eyes) performed in 20 patients younger than 16 years old, between 1991 and 2000 at the department of ophthalmology at Charles Nicolle University Hospital-Tunis. Penetrating keratoplasty was performed for congenital dystrophies in 6 cases (17.3%), for acquired traumatic opacities in 4 cases (26%) and for non traumatic acquired opacities in 13 cases (56.7%). Non traumatic acquired opacities were keratoconus in 8 cases (61.5%), keratitis in 3 cases (23%) and graft rejection in 2 cases (15.5%). The mean follow-up was 41.8 months. Grafts remained clear in 20 cases (83.3%). Graft rejection occurred in 4 cases. Graft failure occurred in 3 cases (16.6%). Mean postoperative visual acuity was 3/10 (ranging from 1/20 to 7/10). Penetrating keratoplasty in children allows a satisfying anatomic success but a moderate visual improvement. Amblyopia is the major obstacle to success in children corneal grafting.

[Visual impairment in Tunisia]. / Le handicap visuel en Tunisie.

The purpose is to study visual impairment in Tunisia, its epidemiology, its etiologies and to present the major prevention measures. This study was conducted between 1992 and 1998. 1105 patients were examined in specialized outpatient clinic. Our group is composed from 712 men and et 393 women, aged 1 to 93 years. 435 patients were partially sighted and 670 were blind. Adults pathologies were dominated by acquired cataracts and adult glaucomas; diabetic retinopathy and age related macular degeneration are less frequent. Infectious ocular diseases are in constant decrease in Tunisia since 30 years. Prevention is fundamental and must be done each time it is possible. Visual reeducation should improve autonomy and familial and socio-economic reintegration of these visually impaired.

[Functional results of rhegmatogenous retinal and macular detachment]. / Les resultats fonctionnels du décollement de rétine rhégmatogène avec macula décollée.

The aim of our study is to evaluate the results of visual recovery after retinal detachment surgery with detached macula and to analyze factors that would influence these results. We carried out a retrospective study about 133 cases of reghmatogenous retinal detachment with detached macula. They were followed between 1990 and 1997 and had a primary classical surgery. The follow up was at least 6 months. The age of our patients varied from 9 to 79 years with an average of 43.8 years. Postoperatively, final visual acuity was equal or superior to 1/10 in 49.63% of cases. We analyzed the results of functional recovery according to the following factors: preoperative visual acuity, duration of detachment, patients history, area of detachment, break size, proliferative vitreoretinopathy stage and surgery factors (kind of buckling, subretinal fluid drainage and reoperations). We found a statistical significance between postoperative visual acuity and the following factors; preoperative visual acuity, duration and area of detachment, break size and proliferative vitreoretinopathy. It is essential to operate the patients with retinal detachment as early as possible in order to guarantee a better postoperative visual acuity. It is also important to incite patients with retinal detachment risk factors to consult in case of any ocular symptoms.

[Subretinal fluid drainage in rhegmatogenous retinal detachment]. / La ponction du liquide sous rétinien dans la chirurgie du decollement de rétine rhegmatogène.

Subretinal fluid drainage during retinal surgery is a tricky manoeuver that remains controversial. In this study, we carried out a comparative retrospective study about 265 cases with retinal detachment that had a primary episcleral surgery. We compared the results of the group operated with subretinal fluid drainage (199 cases) to the group without (66 cases). The complications met were retinal haemorrhages in 14 cases (7%) and retinal incarceration in one case (0.5%). Anatomical results were 91.45% in the group with drainage and 93.93% in the group without. There was no statistical difference between the two groups. The complications of the subretinal fluid drainage are extremely rare and have no repercussion if it is well checked. Subretinal fluid drainage remains the surgeon decision. It is achieved by most retinal surgeons (75%).