[Retinal detachment after Excimer laser (myopic LASIK or PRK). A retrospective multicentric study: 15 cases]. / Décollement de rétine post laser Excimer (Lasik/PKR myopique). Etude multicentrique rétrospective (15 cas).

INTRODUCTION: Refractive surgery by LASIK or photorefractive keratectomy (PRK) generaly aims at a myopic population that has a high probability of developing rhegmatogenous retinal detachment (RD). The authors report a multicenter study with 15 cases of RD appearing after refractive surgery by Excimer laser and discuss the role played by the techniques used. MATERIAL AND METHODS: Five centers fitted with nine Excimer laser devices took part in this study. Of 22,700 eyes undergoing refractive myopic surgery during the period 1994-2002, 15 eyes developed rhegmatogenous RD. The average age of the patients with RD was 37 years. The average myopia was 13.5 D. RD occurred a mean of 20 months after refractive laser. RESULTS: Fifteen eyes of 13 patients developed a rhegmatogenous RD, two of which were bilateral. Eight of these cases had LASIK surgery and six had photorefractive keratectomy; one of the latter patients was retreated with LASIK because of substantial regression after PRK. RD was total or subtotal in five eyes, partial superior with a temporal tear in six eyes, and nasal in three eyes. One case with inferior RD, two cases with giant retinal tear and one case with posterior tear were also repaired. Fourteen eyes were suitable for operation. The retina was reattached in 12 cases. Mean postoperative visual acuity was 7/10. DISCUSSION: The occurrence of rhegmatogenous RD in the myopic population is estimated at 2.2%. It is estimated at 0.1% in the emmetropic population. The Excimer laser, through its thermic effects, shock wave, traumatism undergone by the suction ring at the time of LASIK surgery, could increase this risk in myopic patients. A review of the literature cast doubt on the cause and effect hypothesis. Personal and multicenter studies (including ours) show that the frequency rate of rhegmatogenous RD after Excimer laser is equivalent and even lower than that estimated with an emmetropic population. The low percentage of RD after Excimer surgery found in the literature as well as in our study (<0.1%) may be explained by patient selection, the systematic monitoring of the peripheral fundus, and the prophylactic treatment of degenerative lesions by photocoagulation. In RD surgery, the cornea must be manipulated carefully, a case of flap dehiscence has been reported in the literature. CONCLUSION: Refractive surgery by LASIK or PRK for severe myopia increases the risk of RD. Systematically monitoring the peripheral fundus and preventive photocoagulation have mitigated its occurrence, and the risk incurred in the myopic population has fallen to the emmetropic population's rate. Nevertheless, candidates for LASIK or PRK surgery must be informed because severe myopia constitutes a non-negligible risk factor.

[Urgent penetrating keratoplasty in perforated infectious corneal ulcers]. / Kératoplastie transfixante à chaud dans les ulcères cornéens infectieux perforés.

PURPOSE: To evaluate anatomical and functional prognosis of urgent penetrating keratoplasty in perforated infectious corneal ulcers. METHODS: Seven eyes of seven patients had an urgent penetrating keratoplasty for perforated infectious corneal ulcers. Anatomical success was defined by eradication of infection and preservation of eye from enucleation and phthisis bulbi. Corneal graft survival was defined by the presence of a clear graft. RESULTS: The patients'mean age was 40.5 years. Four eyes had bacterial corneal ulcer and three eyes had herpetic corneal ulcer. Anatomical success was obtained in six eyes. The graft remained clear in two eyes. Graft rejection was noted in four eyes after a mean period of 4.5 months. Postoperative complications were ocular inflammation (one eye), ocular hypertension (three eyes), cataract (one eye), peripheral anterior synechiae (one1 eye), graft ectasia (one eye), bacterial infection (one eye) and recurrent herpetic keratitis (one eye). The mean follow-up period was 22 months, ranging from 9 to 32 months. CONCLUSION: Urgent penetrating keratoplasty can preserve eye integrity and eradication of the infectious process in a large part of perforated bacterial and herpetic corneal ulcers. Visual rehabilitation is often a secondary objective. Adapted antimicrobial treatment reduces graft reinfection and steroid treatment reduces the frequency of some complications, especially graft rejection.

[Prognosis of retinoblastoma. Report of 50 cases]. / Le pronostic du rétinoblastome. A propos de 50 cas.

PURPOSE: The aim of this study was to analyze the factors influencing the prognosis of retinoblastoma. MATERIALS AND METHODS: In 50 children with retinoblastoma, 69 eyes were reviewed. All patients had a full ophthalmic examination, a B-scan ultrasound, a computerized tomography scan and a pediatric examination. We performed enucleation in 47 eyes (with a histopathological study), external beam irradiation in 16 eyes, curitherapy in 4 eyes, cryotherapy in 3 eyes, and adjuvant chemotherapy in 7 cases. RESULTS: The global survival rate was 87.5%. The main aggravating factors were: the size of the tumor and the extraretinal involvement with extension within the chroid, the sclera, and the optic nerve. CONCLUSION: The prognosis of retinoblastoma mainly depends on the extraretinal invasion.

[Ocular contusions and giant retinal tears]. / Contusions oculaires et déchirures géantes.

PURPOSE: Analysis of the clinical and therapeutic results of giant retinal tears after ocular blunt trauma. PATIENTS AND METHODS: We performed a retrospective review of nine patients with giant retinal tears associated to retinal detachment after ocular blunt trauma. The traumatic giant retinal tear was a peripheral break of 90 degrees or greater. Seven patients had myopia. Primary management of retinal detachment included, scleral buckling and external drainage of subretinal fluid, in 2 cases. Vitrectomy with fluid-silicone oil exchange was used in 7 cases and perfluorodecalin in 3 cases. RESULTS: Our results indicate that myopia was the principal risk factor of blunt trauma retinal tears, which appear even when the contusion was not too violent or indirect. Successful results were not obtained with episcleral surgery alone (2 cases). With primar vitrectomy, the success rate was 57%. The overall success rate was 66.6% with an average acuity of 2/10. CONCLUSION: High myopia is the principal risk factor of giant retinal tear after blunt ocular trauma. The prognosis of this retinal detachment depends on the grade of proliferative vitreoretinopathy.

[Value of clindamycin in the treatment of ocular toxoplasmosis]. / Intérêt de la clindamycine dans le traitement de la toxoplasmose oculaire.

PURPOSE: Chorioretinal toxoplasmosis can threaten visual function when located in the posterior pole. The aim of this study was to compare the advantages and disadvantage of combination of malocid-sulfadiazine and clindamycin subconjunctivally. METHODS: Two groups of patients affected by unilateral chorioretinal toxoplasmosis were studied. The diagnosis was performed in 77% of cases on acqueous humor analysis. The first group of twenty-six patients was treated with a combination of malocid-sulfadiazine while the second group (seventeen patients) was treated with clindamycin subconjunctivally. Local and general corticosteroids were associated in all cases. Mean follow-up was 19 months in the first group and 16.5 months in the second. RESULTS: Visual acuity was increased in 88.5% of cases in the first group and in 94% of cases in the second group. Cicatrization obtained in both groups was comparably delayed 1.68 months for the first and 1.26 months for the second. Recurrences were rarely observed in the two groups: respectively 8% and 6% of cases. No local and general complication was noted. CONCLUSION: These findings suggest the advantages of subconjunctival clindamycin treatment due to the absence of general hematological toxicity.

[Retinal detachment and posterior lens luxation. Value of liquid perfluorocarbons]. / Décollement rétinien et luxation postérieure du cristallin. Intérêt des perfluorocarbones liquides.

PURPOSE: The purpose of this study is to review the benefits of perfluorocarbon liquids in the surgical treatment of retinal detachment with posterior lens dislocation. METHODS: Three cases of retinal detachment occurring in the presence of a posteriorly dislocated intraocular lens were managed with vitrectomy, fluid perfluorocarbon, scleral buckling and silicone oil injection. The dislocated lens were removed by anterior approach. RESULTS: In all cases a successful retinal reattachment was obtained after one or two surgical procedures.

[The cornea and synthetic antimalarials]. / Cornée et antipaludéens de synthèse.

The main targets of antimalarial ocular toxicity are the cornea, ciliary body and retina. In sixty patients treated with chloroquine (Nivaquine) 73% showed keratopathy. The clinical features and clinical course of this keratopathy and its relationship with retinopathy were described. In contrast with retinopathy, keratopathy is not contraindication to antimalarial treatment.

[Choroid metastases]. / Les métastases choroïdiennes.

PURPOSE: The aim of the present study is to investigate the clinical features and the risk factors characteristic of choroidal metastasis, which is known as the most common malignant neoplasm of the adult eye. METHODS: A systematic ophthalmologic examination together with angiography and echography were performed in 106 patients with carcinoma. RESULTS: 10% of patients showed choroïdal metastasis. Breast and bronchogenic carcinoma were the most common primary tumor. 82% of cases died within a mean 6.5 months. Clinical, angiographic, echographic and histopathologic features of such metastasis were described. CONCLUSIONS: The importance of an early diagnosis of such metastasis are raised.

[Methods for screening and surveillance of diabetic retinopathy]. / Moyens de dépistage et de surveillance de la rétinopathie diabétique.

PURPOSE: The aim of this study is to investigate the various tests which allow to detect and follow-up diabetic retinopathy (DR). METHODS: Sixteen patients without DR or with background retinopathy underwent, once every six months: a full ophthalmologic investigation; a fluorescein angiography; a color vision test; a central visual field investigation. RESULTS: The impairment of angiography preceeded damage of eye fundus in 27% of cases. Deficiency of color vision and visual field were found in 57% of cases and in 35% respectively. These preceeded the appearance of angiographic DR in 50% of cases and 32% of cases respectively. CONCLUSION: The importance of such tools in the evolution of DR especially in young diabetics is discussed.

[Developmental aspects of diabetic retinopathy during pregnancy]. / Aspects évolutifs de la rétinopathie diabétique pendant la grossesse.

The course of diabetic retinopathy (DR) was studied in 93 pregnant patients. Results were compared with data from 98 diabetic non pregnant women. Worsening of initial retinal lesions was observed in 16% of the pregnant group whereas only 6% of the control group showed a similar aggravation. The difference between the two groups was statistically significant (p < 0.05). Argon laser panretinal photocoagulation of pre-proliferative and proliferative DR resulted in no subsequent DR-induced complications. On the other hand, the risk of appearance of DR and/or its worsening during pregnancy depends on initial network but mostly on the duration of diabetes mellitus. In conclusion, regular ophthalmologic examination of diabetic patients especially during pregnancy seems crucial for the early screening of any worsening. Furthermore, the importance of pregnancy planning is emphasized.

[Senile cataract and trachoma in Tunisia]. / La cataracte sénile en Tunisie et trachome.

Senile cataract is the major cause of curable blindness in Tunisia (51%). Other factors than advanced age seem to play a role in senile cataract. The simultaneous of senile cataract with the trachoma makes the surgical operation problematic. In order to evaluate the frequency of such risk factors, we have realized a prospective study in two groups of patients recruited in 4 hospitals centers in Tunisia. The two groups of patients were homogenous regarding to age (more than 45 old year) sex and geographic origins. Cataract was present in the first group (287), but not in the second group (169) risk factors which were evidenced are: diabetes or abnormal glucose test tolerance, high systemic blood pressure, especially diastolic, low education and non professional occupation, family history of cataract. Evolutive trachoma was found in 5.1% of cases compared to only 0.6% in controls (p = 0.02). Trachoma sequela were found in the two groups. The importance of an evaluation of such risk factors in senile cataract is raised.

[Epidemiological profile of primary open-angle glaucoma in Tunisia]. / Profil épidémiologique du glaucome primitif a angle ouvert en Tunisie.

The main epidemiologic characteristics of primary angle glaucoma in Tunisia were studied in 5000 patients of Pr. AYED's external consultation at the National Institute of Ophthalmology. It appeared that POAG is a frequent and serious disease in Tunisia: a true problem of public health. The importance of the early diagnosis based essentially on a systematic intraocular pressure test together with the examination of optic disc and the visual field investigation using automated perimetry in suspected cases is discussed.

[Causes of blindness in Tunisian children]. / Les causes de cécité de l'enfant Tunisien.

Among 214 children living at Blindness Institute of Bir El Kassaa the causes of blindness were determined. Main causes were: congenital glaucoma, tapeto retinal degeneration and congenital cataract because of high prevalence of consanguinity. The importance of prevention based on genetic council is raised.