Micropulse diode laser therapy in refractory glaucoma.

Purpose: Description of safety and efficacy of micropulse Transscleral cyclophotocoagulation as a treatment option for refractory glaucoma. Methods: This is a prospective study including 39 eyes of 31 patients followed for refractory glaucoma, who benefited from transscleral cyclophotocoagulation using a microplused laser. The main indication for the procedure was increased ocular pressure refractory to quadritherapy in various types of glaucoma. The patients were treated using iridex Cyclo G6 laser with a Micropulse P3 infrared probe with a wavelength of 810 â€‹nm. The parameters for the procedure were a duration of 90 â€‹s per hemisphere with a power of 2000 mW and an energy of 180 â€‹J. Both the upper and lower hemispheres were treated in the same procedure, sparing the 3 o'clock and 9 o'clock meridians, and all the patients benefited from a single treatment session. The following parameters were evaluated: ocular pain and overall tolerance; visual acuity; and the evolution of IOP postoperatively up to 9 months. Results: The glaucoma subtypes treated are as follows: primary open-angle glaucoma (n â€‹= â€‹05), chronic angle-closure glaucoma (n â€‹= â€‹13), neovascular glaucoma (n â€‹= â€‹07), aphakic glaucoma (n â€‹= â€‹06), malignant glaucoma (n â€‹= â€‹04), post-traumatic angle recession (n â€‹= â€‹02), and inflammatory glaucoma (n â€‹= â€‹02). The mean pre-operative intraocular pressure was 42.3 â€‹± â€‹5.2 â€‹mmHg and the mean post-operative intraocular pressure at 9 months was 16.9 â€‹± â€‹1.9 â€‹mmHg. The reduction in IOP was 49.9%. The average number of intraocular pressure-lowering medications used prior to surgery was four, and the average number of medications used at the 9-month post-operative visit was 2.0 â€‹± â€‹1.2 (70.3% of patients were on dual therapy). The overall success rate was 60.5%. Conclusions: Micropulse transscleral cyclophotocoagulation appears to be a safe and efficient treatment for refractory glaucoma. Its indications should therefore be broadened and proposed early in various situations.

Management of a central corneal perforation in the emergency room: Tenon patch technique.

PURPOSE: Corneal perforations are defined as a solution of continuity in the cornea. Usually, these cases evolve to the formation of a corneal-iridial scar or require surgical intervention. The tenon patch graft represents a good alternative to other methods and has many advantages. OBSERVATION: A 63-year-old patient who had been followed for severe dry eyes due to rheumatoid arthritis for 10 years presented to the emergency room with a central corneal perforation, partially sealed by the iris, accompanied by significant corneal edema in the right eye. Given the clinical picture that had been developing for 5 days, we decided to perform a tenon patch graft on the perforation. At 4 weeks of follow-up, globe integrity was maintained with a well-placed tenon patch. No evidence of leakage in the Seidel test was noted. CONCLUSION: The tenon patch graft represents a good alternative in the management of corneal perforations and has many advantages, among which the feasibility in an emergency, allowing a corneal graft afterwards.

Terson syndrome: Two case reports.

PURPOSE: Vitreous or retinal hemorrhage occurring in association with subarachnoid hemorrhage (SAH) is known as Terson syndrome (TS). Its incidence is of the order of 10-50% after subarachnoid hemorrhage. We report two cases of TS with different clinical presentations, different managements, and a good final prognosis, which were managed at the Ibn Rochd hospital in Casablanca. OBSERVATIONS: We report two cases of TS. The first one occurred in a 55-year-old hypertensive man following a ruptured aneurysm of the internal carotid artery, revealed by a decrease in visual acuity concomitant with the neurological symptomatology. The evolution was favorable after specialized neurological management and spontaneous resorption of the intravitreal hemorrhage was obtained 3 months after the acute episode with good visual recovery. The second case was that of a 45-year-old man who presented with an intravitreal hemorrhage of the right eye, 24 h after severe head trauma responsible for a bifrontal extradural hematoma. The B-mode ocular ultrasound discovery of a retinal detachment with persistent hemorrhage led to the indication of a pars plana vitrectomy with retinal tamponade, which allowed visual rehabilitation without recurrence after 1 year. CONCLUSIONS: Ophthalmologic evaluation by specialized examination and radiology (ocular ultrasound, OCT) is necessary for all patients with TS because early diagnosis and treatment can prevent visual loss and associated complications. Treatment of TS can be conservative and based on periodic monitoring. A pars plana vitrectomy is considered in some cases.

Chronic unilateral anterior scleritis, think about a herpetic origin: A case report.

Scleritis is a very heterogeneous group of diseases responsible for ocular inflammation of varying severity, the evolution and prognosis of which depend on the etiology but also on the appropriate treatment. We report the case of a 15-year-old female patient, without any notable general history, followed in consultation for 3 months for a nodular scleritis not improving under usual treatments. She was reconsulted when her symptoms worsened and the examination revealed a minimal reaction of the anterior chamber, in addition to the nodular scleritis localized in the temporal region, with the notion of a vesicular eruption in the perioral region on the same side of the ocular involvement and preceding the ocular symptoms by one week, consistent with a cutaneous herpes. The patient was put on oral Aciclovir (800 mg, 3 times a day) with a clear improvement marked by a decrease in pain and redness, which improved again after the introduction of oral corticoids. The existence of an extraocular sign of herpes and the good response to antiviral treatment, thus confirming the herpetic etiology of this chronic nodular scleritis. Scleritis is caused by herpes in about 5% of cases. The clinical picture is either ophthalmic herpes zoster with associated scleritis (VZV), or diffuse anterior scleritis, unilateral in 80% of cases, related to herpes simplex. The diagnosis can be confirmed by local swabs, or more often by an antiviral therapeutic test.

Orbital varix: A rare case of unilateral exophthalmos, case report.

The etiologies of unilateral exophthalmos are multiple, rarely represented by an intra- or extra-conical vascular mass. Orbito-palpebral varixes are rare (2% of orbital masses) and represent a main cause of unilateral intermittent exophthalmos, often of an inflammatory nature. We report a Case of right orbito-palpebral varix in a 65-year-old adult, with no particular history, evolving for 2 years. The ophthalmological examination showed a right palpebral mass, extended to the right external canthus, with palpebral collateral circulation, moderate right ptosis with exophthalmos, non-axial, non-pulsatile, without thrill, painless, without complication, without visual deficit. A vascular mass was suspected and MRI revealed a right orbito-palpebral varix with temporal extension, confirmed by ANGIO-MRI. The latter also allowed to search for a cerebral venous malformation, an encephalocele or a bone defect, associated and also to eliminate differential diagnoses (tumor, arteriovenous fistula …). Color Doppler ultrasound in the proclive position confirmed the diagnosis of orbital varices. A preventive low-dose anticoagulant treatment was started to avoid thrombosis, with therapeutic abstention in the absence of complications. A rigorous monthly follow-up in consultation is ensured. Orbito-palpebral varices are characterized by an extensive posterior intra-orbital character, often during their evolution and imposes a strict surveillance. In Case of complication (thrombosis, hemorrhage, pain, compressive signs of the optic nerve), surgical removal or sclerosis of the varix can be envisaged with disappointing results (recurrence, hemorrhage).

De novo adenocarcinoma of the lacrimal gland: Case report.

Adenocarcinoma of the lacrimal gland is an epithelial malignancy with an incidence according to the literature of 5-7%. It is clinically revealed by an upper palpebral mass often associated with an inflammatory exophthalmos. It is a high-grade malignancy and there are no pathognomonic clinical or radiological signs. The Core 14G needle biopsy technique is now the simplest procedure to remove tissue from the mass to be analyzed. This allows a precise histological and immunohistochemical study, to establish a diagnosis of certainty and to institute a rapid and adequate therapeutic management in order to improve the prognosis. We report the case of a de novo lacrimal gland adenocarcinoma diagnosed in a 55-year-old patient. The patient presented with a subpalpebral mass, located in the superior-external angle of the globe, which was very inflammatory. The radiological work-up revealed a left intra-orbital tumor process, extra-conical, developed at the expense of the lacrimal gland, in contact with the external wall of the orbit with local cortical effractions. The anatomopathological examination of the specimen obtained by Core 14G needle biopsy, under local anesthesia and on an outpatient basis, was in favor of a moderately differentiated and infiltrating adenocarcinoma of the lacrimal gland. The extension workup did not reveal a metastatic focus. A total exenteration was performed with complementary postoperative radiotherapy. The patient was followed up after 2 years without recurrence.