Prognostic factors for visual recovery after successful large macular hole surgery using the inverted flap technique.

PURPOSE: The goal of our study is to describe the functional results and preoperative factors predicting visual recovery after successful inverted flap technique and closure of large full-thickness macular holes (FTMH) and to evaluate the correlations between microstructural foveal changes and final visual acuity. METHODS: Retrospective, descriptive, analytical study including 80 eyes of 78 patients with large FTMH; operated by inverted flap technique with successful closure of the macular hole after surgery. All eyes underwent a full preoperative ophthalmic examination and macular B-scan SD-OCT. We performed the classic inverted flap technique for all patients. Postoperatively, all patients were examined at 7 days, 1, 3, 6, 9 and 12 months after surgery. SD-OCT was performed for all patients on each follow-up. Preoperatively, best-corrected visual acuity (BCVA), FTMH size and basal hole diameter were the main outcome measures. Postoperatively, BCVA, macular thickness, integrity of the external limiting membrane (ELM) and ellipsoid zone (EZ) were recorded. RESULTS: Mean age was 62±8.42 years with female predominance. Mean size of the FTMH was 692.59µm, and mean basal hole diameter was 1436.06µm. Mean BCVA improved from 1.06±0.491 LogMAR preoperatively to 0.52±0.32 at 9 months following surgery (P<0.001). At 9 months, the ELM was absent, partial or fully restored in 6.67, 10 and 83.33% respectively. The EZ was absent, partial or fully restored in 6.67, 33 and 63.33% respectively. ELM regeneration always preceded EZ regeneration at every point of follow-up. Final BCVA was statistically correlated with initial hole size (P=0.006, OR=1.056; CI [1.016-1.098]) and mean symptom duration prior to surgery (P=0.001. OR=0.987; CI [0.976-0.998]). Analysis of the ROC curve demonstrated that a hole diameter>478.5µm and symptom duration>5 weeks were correlated with non-improvement of visual acuity, with 81.3% sensibility and 18.7% specificity. CONCLUSION: We report tomographic microstructural foveal changes and functional results following successful large idiopathic FTMH surgery using the classic inverted flap technique. Preoperative parameters such as initial FTMH diameter and mean symptom duration prior to surgery are crucial prognostic factors influencing final visual results.

Impacts of several pollutants on the distribution of recent benthic foraminifera: the southern coast of Gulf of Gabes, Tunisia.

In addition to physicochemical methods, benthic foraminifera have become an essential tool for the assessment of polluted environments. The main objectives of the present work were to study the distribution of benthic foraminifera along the coastline of Skhira and Gabes (southern coast of Gulf of Gabes) and to predict the impact of pollution on these organisms. Thirty-one samples were studied and a polluted area was delimited by chemical analysis, where heavy metal, fluoride, phosphorus, nitrogen, and COT contents are very high. Thirty-four species of benthic foraminifera were identified and their response to pollution is very remarkable, in which their distribution shows barren area, corresponding to the highly polluted area. Away from the contaminated area, the density and the diversity of these organisms increase. Statistical analyses (principal component analysis (PCA)/FA and matrix correlation) show a possible control of these pollutants on biotic indices (with negative correlation), in addition to the presence of tolerant and sensitive species to pollution. A variety of test malformations were noticed especially in Ammonia beccarii, Peneroplis planatus, Sorites variabilis, and Adelosina pulchella. Unpolluted stations were dominated by species characteristic of shallow water environments with sandy sediment such Ammonia parkinsoniana, Triloculina trigonula, Quinqueloculina agglutinans, and P. planatus.

[Microbiological profile of endophthalmitis in a referral centre in Tunisia]. / Profil microbiologique des endophtalmies aiguës dans un centre de référence en Tunisie.

PURPOSE: To investigate the microbiological profile of acute postoperative endophthalmitis in a referral center in Tunisia and to assess the antibiotic sensitivity of the organisms. PATIENTS AND METHODS: This is a retrospective study over a period of eleven years, conducted on patients hospitalized with acute infectious postoperative endophthalmitis. Cultures were performed on aqueous (93%) and vitreous specimens (68%) obtained at presentation. Each sample underwent direct examination, culture and antibiotic susceptibilities. RESULTS: The number of acute postoperative endophthalmitis cases identified during the study period was 308. Organisms were found in 43% of samples (endophthalmitis was bacterial in 39.5%, fungal in 0.9% and polymicrobial in 2.6%). Cultures grew primarily Staphylococcus epidermidis in 31.4% of cases, Streptococcus pneumoniae in 22.7% of cases and Staphylococcus aureus in 12.7% of cases. Gram-positive cocci are more sensitive to vancomycin and Gram-negative bacilli are more susceptible to ofloxacin and ciprofloxacin. CONCLUSION: In our study, microbiological samples were positive in 43% and coagulase-negative Gram-positive cocci are the most common organisms. However, antibiotic resistance has been increasing over the years.

[Macula analysis by spectral domain OCT in rhegmatogenous retinal detachment surgery]. / Analyse de la macula par OCT spectral domain dans la chirurgie du décollement de rétine rhegmatogène.

INTRODUCTION: Despite surgical reattachment of retinal layers, postoperative functional outcomes after rhegmatogenous retinal detachment (RRD) may be limited. This can be explained by microstructural changes in the macula inherent to the pathology itself as well as the surgery. PURPOSE: To evaluate the various changes in the macula by OCT pre- and postoperatively, and correlate them with functional and clinical outcomes in patients with RRD. To establish pre- and postoperative prognostic factors. METHODS: This was a prospective study of 50 eyes of 50 patients operated for RDD. Each patient underwent a complete clinical examination and macular OCT using the Heidelberg Spectralis; preoperatively and then successively at 7 days, 1 month, 3 months and 6 months after RRD surgery. RESULTS: Preoperative tomographic results revealed an average height of submacular fluid of 742 ± 345 µm. Ninety-six percent of patients exhibited thickening of photoreceptor outer segments (PROS), 62% an outer layer undulation, 60% cystic cavities in the outer and/or inner nuclear layers (ONL, INL), 36% disruptions of the external limiting membrane (ELM) and 64% disruption of the IS/OS junction. Postoperatively, 24% of patients had persistent submacular fluid. The average thickness of the central fovea, the ONL, the IS/OS junction and the PROS were 172 ± 51.3 µm, 88.4 ± 30.9 µm, 11.36 ± 5.4 µm and 19.54 ± 13.1 µm respectively. Postoperative disruptions of the ELM, the IS/OS junction and Verhoeff's membrane (VM) were present in 24%, 60% and 82% of patients respectively. The preoperative tomographic risk factors for poor visual outcome were: submacular fluid height > 800 µm (P<0.001), disruptions of the MLE and/or IS/OS junction (P<0.001), as well as cystic cavities in the ENL and/or INL (P=0.002). Postoperative risk factors were: thinning of the fovea (≤ 250 µm), central fovea (≤ 160 µm), ONL (≤ 90 µm), IS/OS junction (≤ 10 µm) and PROS (≤ 18 µm) layers (P<0.001), as well as a discontinuous or absent appearance of the ELM (P<0.001), IS/OS junction (P<0.001) and VM (P=0.006). CONCLUSION: Spectral domain OCT allows detection of specific microscopic, quasi-histologic macular changes in rhegmatogenous retinal detachment. These anomalies could be predictive of final postoperative visual outcome.

[Viral retinitis following intravitreal triamcinolone injection]. / Rétinite virale secondaire à une injection intravitréenne de triamcinolone.

Necrotizing viral retinitis is associated with infection by the Herpes family of viruses, especially herpes simplex virus (HSV), varicella zoster virus (VZV) and occasionally cytomegalovirus (CMV). When the diagnosis is suspected clinically, antiviral therapy must be instituted immediately. We report the case of a patient presenting with necrotizing viral retinitis 3 months following intravitreal injection of triamcinolone acetonide for diabetic macular edema. Fluorescein angiography demonstrated a superior temporal occlusive vasculitis. A diagnostic anterior chamber paracentesis was performed to obtain deoxyribo-nucleic acid (DNA) for a polymerase chain reaction (PCR) test for viral retinitis. PCR was positive for CMV. The patient was placed on intravenous ganciclovir. CMV retinitis is exceedingly rare in immunocompetent patients; however, it remains the most common cause of posterior uveitis in immunocompromised patients. The incidence of this entity remains unknown. Local immunosuppression, the dose and the frequency of injections may explain the occurrence of this severe retinitis.

[Conjunctival limbal autograft versus simple excision with intra-operative mitomycin C in pterygium surgery: a comparative study]. / L'autogreffe conjonctivo-limbique versus l'exérèse simple avec mitomycine C dans la chirurgie du ptérygion : étude comparative.

PURPOSE: The purpose of our study is to evaluate the long-term anatomical and functional results of conjunctival-limbal autograft (AGCL) compared to simple excision with intraoperative mitomycin C. PATIENTS AND METHODS: We conducted a prospective comparative study of 60 eyes of 60 patients presenting with primary pterygium. These patients were divided into two groups, matched according to the age and the stage of the pterygium. Thirty eyes of 30 patients were treated with conjunctival limbal autograft (AGCL group), and 30 eyes of the other 30 patients were treated with simple excision with intraoperative mitomycin C (MMC group). Minimum follow-up was 24 months. RESULTS: The mean age of our patients was 50.6 and 51.3 years in the AGCL and MMC groups, respectively. A male predominance with male to female ratio of 1.5 was noted in both groups. We found more pterygium recurrences in the MMC group. Indeed, seven patients (23.3%) in the MMC group experienced a recurrence. In comparison, we found only a single recurrence (3.33%) in the AGCL group with a statistically significant difference (P=0.026). With regard to postoperative complications, we noted three inflammatory granulomas in the AGCL group (10%). In the MMC group, we observed two cases (6.66%) of delayed corneal healing with superficial punctate keratitis and epithelial defect and one case (3.33%) of symblepharon. There was no statistically significant difference in mean visual acuity gain between the two groups (AGCL: 1.76 lines; MMC: 2.82 lines; P=0.133). CONCLUSION: Pterygium surgery by excision with conjunctival limbal autograft is an effective technique offering a low rate of long-term recurrences and few complications.

[Full optical correction after cycloplegia in headache]. / Apport de la correction optique totale après cycloplégie dans les céphalées.

PURPOSE: To study the advantages of cycloplegia in the accurate assessment of refractive errors and to evaluate the impact of full optical correction in the course of headache. MATERIAL: and methods: A prospective study was carried out in 164 eyes of 82 patients with headache. Corrected visual acuity was 10/10 in all cases. Refraction was measured before and under cycloplegia by cyclopentolate with a CANON R 50 infrared autorefractometer. Full optical cycloplegic correction based on the value of refraction under cycloplegia was prescribed in all cases. Mean follow-up was 10 months. Statistical analyses were used: Student's t test, Pearson coefficient correlation, and Chi2. RESULTS: Under cycloplegia, hypermetropia was significantly the most frequent ametropia (67.1%, p<10(- 9)). The difference between the spherical equivalent, before and during cycloplegia, was highly significant (p<10(- 5)) at 0.79. Optical correction eliminated headaches in 76.5% of the cases. CONCLUSION: The authors conclude on the role of accommodation in headache onset and the need to continue cycloplegia until the age of 45. The importance of optical correction in alleviating headaches is underlined.

[Diabetes and the day hospital]. / Diabète et hopital de jour.

The day hospital is a relatively new way of hospitalization in Tunisia, the first experience beginning in 1985 to the National Institute of Nutrition. This hospitalization avoid the drawbacks of classic hospitalization (dependency, discomfort, separation) and boredom and present a lot of advantages of social command, humanitarian, psychological, medical and economical the cost of hospitalization is clearly reduced). This day hospitalization is beneficial in several pathologies notably the illness nutrition and metabolic diseases (diabetes, obesity, dyslipoproteinemia, hyperuricemia), where the patients continue to have a good physical activity and where the education médico sanitary and dietary hygiéno occupies a position of choice.

[Primary open-angle glaucoma and diabetes]. / Glaucome primitif à angle ouvert et diabète.

UNLABELLED: Open-angle glaucoma is most frequent in diabetics. Its evolution seems to be most severe although an equilibrated tonometry under glaucoma treatment in literature. AIM OF THE STUDY: comparison of evolution of glaucoma between diabetics and non diabetics. MATERIAL AND METHODS: A retrospective study of 72 glaucomatous patients diabetic and non diabetic was performed. A complete ophthalmologic examination with tonometry, funduscopy: sup disc measurement and automated perimetry was realised. Evolution was studied after chirurgical or medical treatment each four months with a mean follow up of 2 years. RESULTS: We observed that the evolution of Open-angle glaucoma in diabetics is significatively not different from non diabetics. CONCLUSION: Open-angle glaucoma evolution in diabetics is not more severe than general population.

[Quantitative topographic detection of keratoconus in the contralateral eye in clinically unilateral keratoconus. Apropos of 5 cases]. / Dépistage topographique quantitatif du kératocône sur les yeux adelphes de kératocônes cliniquement unilatéraux. Apropos de 5 cas.

BACKGROUND: Keratoconus is generally bilateral and follows an asymmetrical course. The goal of this study was to evaluate efficiency of the automated topographic screening indices on early keratoconus by examination of the fellow eyes of clinically unilateral keratoconus. PATIENTS AND METHOD: We examined the fellow eyes of 5 cases of clinically unilateral keratoconus by videokeratography using TMS-1 Computed Anatomy device, which incorporates the keratoconus screening indices from Rabinowitz (K and I-S values) and Klyce/Maeda (KPI value and other quantitative induces as OSI, DSI and CSI). RESULTS: One case (number 1) had keratoconus detected by both Rabinowitz and Klyce/Maeda indices. Two cases (number 2 and 3) had normal keratoconus screening indices. Two cases (number 4 and 5) had keratoconus detected by Rabinowitz I-S value, with a 0% KPI value. CONCLUSIONS: Rabinowitz indices are sensitive with a poor specificity. The Klyce/Maeda indices are less sensitive but more specific. Both methods may be useful for keratoconus detection. The results must always be analysed in relation to a clinical observation of both eyes and the course of the topographic changes.

[The cornea of diabetics]. / La cornée du diabétique.

PURPOSE: The aim of the study is to investigate corneal sensitivity and the risk factors of corneal hypoesthaesia in diabetics. METHODS: General examination and full ophthalmologic examination completed by exploration of corneal sensitivity were performed in one hundred thirty diabetic patients. RESULTS: Eleven per cent of patients showed microkystic oedema, whereas corneal hypoesthaesia was found in 45% of cases. Corneal hypoesthaesia was correlated with the duration and balance of diabetic mellitus, the age of patients and the presence of diabetic retinopathy. On the other hand, peripheral neuropathy was found in 88% of cases. CONCLUSION: Ophthalmologic examination of diabetics should not be limited to retina only but should also include the entire eye ball and especially the cornea in patients with high risk.