[Intravitreal anti-VEGF injections: The patient's experience]. / Injections intravitréennes d'anti-VEGF : ressenti du patient.

INTRODUCTION: Intravitreal anti-VEGF injections (IVI) represent a therapeutic revolution in the treatment of many retinal pathologies. Despite their safety and efficacy, some patients may experience significant discomfort and anxiety during the procedure. The goal of this study was to evaluate the experience of the patient receiving intravitreal anti-VEGF injections. METHODS: This was a prospective study to evaluate the experience of patients before, during and after intravitreal anti-VEGF injection. It included the evaluation of pain and fear by a visual analog scale from 0 to 10 (0 = absence of pain/fear). RESULTS: In total, 139 patients were included in our study, with a mean age of 57.5 ± 10.5 years. The pain assessment scores were higher during these steps of the procedure: insertion of the speculum, insertion of the needle and removal of the pre-cut drape. A feeling of fear was mainly expressed by the group of patients who had received fewer than three IVI. CONCLUSION: There is considerable variation in the patient experience during the various stages of the injection procedure and depending on the number of injections received. The use of a screw speculum, application of a cotton swab soaked in anesthetic, and application of the drape adhesive away from the eyebrow could improve the patient's tolerance and experience.

[Palpebral marginoplasty in the management of distichiasis: About 104 eyes]. / La marginoplastie palpébrale dans la prise en charge du distichiasis : à propos de 104 yeux.

Distichiasis is an anomaly of the of the eyelid margin characterized by the presence of a second row of eyelashes arising from the posterior lamella. It is a rare condition whose severity is related to corneal complications. There are two forms: congenital and acquired, the latter of which is the most frequent in our population, resulting mainly from chronic inflammation. There are several treatment modalities, the choice of which is up to the practitioner depending on the means at his or her disposal and the risk-benefit ratio. We report a series of 104 eyes (90 patients) undergoing surgery for distichiasis using the marginoplasty technique with labial mucosal autograft, collected between January 2000 and September 2021. The main indication was any distichiasis with more than seven lashes per eyelid. The mean age of the patients was 65.5 years. With a mean follow-up of over 24 months, a reduction in functional signs was noted in over 95% of cases. The success rate after marginoplasty with labial mucosal autograft alone was 82.7%. The recurrence rate was 17.3%, which patients underwent additional treatment by argon laser photoablation with very good final results (96% final success rate). Marginoplasty with labial mucosal autograft represents a technique of choice in distichiasis threatening the cornea, particularly in cases of distichiasis with a significant number of eyelashes to be treated.

[Argon laser trichiasis treatment: Technique, indications and results (report of 230 cases)]. / Traitement des cils trichiasiques au laser argon : technique, indications et résultats (à propos de 230 cas).

Trichiasis is a common misdirection of the eyelashes, creating a sharp point responsible for decreased vision, blepharospasm and corneal irritation. It may cause neurotrophic corneal disease leading to blindness. The etiology of trichiasis remains largely undetermined in our patient base. Treatment is based on pragmatic methods that take into account the ciliary ecosystem and the static and dynamic examination of the eyelids. For this, several therapeutic modalities exist: mechanical epilation, cryotherapy, surgery and electrolysis. Each of these techniques has its indications, advantages, and complications. Destruction of the lash follicles with argon laser has many advantages: it is an outpatient procedure, rapid, reproducible, well tolerated, and above all, effective in the long term. The aim of our study is to examine the advantages, technique, indications and results of argon laser trichiasis treatment. This was a retrospective study including 201 patients (230 eyelids) treated in our ophthalmology department over a period of 9years (from January 2011 to March 2020), all of whom were seen for various lash-related symptoms and treated with argon laser electrolysis. Results were considered satisfactory when no lash regrowth occurred within six months of the last laser session. Eighty-two percent of our patients (n=188) showed a good therapeutic response after the first session, 9% (n=21) needed an additional session, and only 6% of the patients (n=14) required a 3rd and/or 4th session, without resorting to surgery. The indications for this treatment should be limited to trichiasis of fewer than or equal to 7 per eyelid, without associated lid malposition (entropion), the treatment of which should be surgical and entirely different. Treatment of trichiasis with argon laser can be an alternative or complement to surgery. Results are excellent but require rigorous adherence to the technique and indications.

[Social media and its impact on ophthalmology training]. / Réseaux sociaux : quel impact sur la formation en ophtalmologie ?

For the past ten years or so, the emergence of social media has disrupted modes of communication and social interaction, in both the personal and professional arenas; it also plays a major role in medical education. The goal of our work is to assess the current degree of use of social media by ophthalmology residents and its effect on the learning process. Our results show that social media were used by all the residents interviewed; the mean time spent on social media was 3.08±1.98 hours per day, of which 1.08±1.014 minutes were devoted to education; over half of the residents use social media between one and two hours per day for medical education. YouTube is the most widely used social network for medical education, followed by Instagram and Facebook. Ninety-eight percent feel that social media can improve their training; 92% feel that social media may become increasingly more important in medical education.

[The effects of corneal cross-linking on intraocular pressure measurement in keratoconus]. / Les effets du cross-linking cornéen sur la mesure de pression intra-oculaire dans le kératocône.

Cross-linking (CXL) is a technique whose design aims to achieve a specific goal: to harden the corneal tissue of eyes with a progressive form of keratoconus. Other indications are being investigated, such as treatment of infectious keratitis and prevention of corneal ectasia post corneal ablative refractive surgery. Hardening the cornea means changing its biomechanical properties. The existence of true corneal hardening after CXL would inevitably result in an increase in measured intraocular pressure (IOP). This would have a considerable impact in the screening and follow-up of glaucoma patients who have undergone cross-linking because of the central role of IOP measurement in glaucomatous pathology.

[Necrotizing fasciitis caused by pseudomonas aeruginosa (an obervation)]. / Fasciite nécrosante à pseudomonas aeruginosa (à propos d' une observation).

Necrotizing fasciitis is an exceptional and severe form of subcutaneous gangrene which requires early diagnosis and emergency treatment. We report the case of a 24 year old woman presenting with necrotizing fasciitis after pansinusitis resistant to treatment. The germ detected was pseudomonas aeruginosa. The infection was controled with intensive care, antibiotics and surgical resection of necrotic tissues. The aim of this observation is to highlight the clinical characteristics of this disease, and to insist on the necessity to recognize the early symptoms and to start treatment as soon as possible.

[Role of Köllner-Hughes tarsoconjunctival flap in the reconstruction of large eyelid defects]. / Intérêt du lambeau tarsoconjonctival de Köllner-Hughes dans la reconstruction des larges défects palpébraux.

PURPOSE: To evaluate the aesthetic and functional results of the Köllner-Hughes tarsoconjonctival flap technique for large defects of over three-quarter of the lower eyelid. PATIENTS AND METHODS: A retrospective descriptive study of a series of 15 patients treated between January 2013 and December 2015. We included all patients who underwent reconstructive surgery for a tumor involving more than three-quarter of the lower eyelid and sparing the canthi. Reconstruction of the lower eyelid defect was performed using Köllner-Hughes technique. RESULTS: The mean age of our patients was 65.7±8 years. The sex ratio was 1.5 with male predominance. All patients had well-differentiated basal cell carcinoma of the lower eyelid. The average size of the eyelid defect induced by the surgery was 18±4mm. Release of the tarsoconjonctival flap was performed after a period of 8 to 10 weeks after the reconstructive surgery. After a mean follow-up of 12±6 months, the aesthetic and functional results were satisfactory in 86.7% of cases especially in terms of eyelid closure and protection of the ocular surface. Complications included erythema of the newly formed free edge in 26.7% of cases, keratinization and hypertrophy of the free edge in 20% of cases, the deformation of the upper free edge with an associated entropion in 20% of cases and lower eyelid retraction in 6.67% of cases. Ocular surface disease such assuperficial punctate keratitis or dry eye was found in 13.4% of cases. DISCUSSION: Several authors have chosen the Köllner-Hughes technique to treat increasingly wide eyelid defects with very satisfactory results. Eyelid reconstruction with the Köllner and Hughes technique is a very attractive procedure because it offers several advantages. It is a quick and easy technique that covers wide defects over three-quarter of the lower eyelid well with very satisfactory cosmetic results and without significantly increasing morbidity at the donor site. In combination with additional procedures, this technique can totally reconstruct the lower eyelid. Despite all its benefits, the Köllner-Hughes tarsoconjonctival flap has some minor drawbacks, such as the need for two surgeries spaced a few weeks apart to open the palpebral fissure; therefore it is contraindicated for one-eyed patients and children because of the risk of amblyopia. CONCLUSION: The tarsoconjonctival flap as initially described by Köllner and Hughes was indicated in the reconstruction of moderate and medium-sized defects of the lower eyelid. In our practice, we can extend the indications of this technique to much larger defects than three-quarter of the lower eyelid, while ensuring satisfactory aesthetic results and minimal complications.

[Anterior lamellar resection with lid margin split of the upper eyelid in the treatment of trachomatous entropion]. / Marginoplastie par recul de la lamelle antérieure dans le traitement de l'entropion trichiasis trachomateux de la paupière supérieure.

INTRODUCTION: The goal of this study is to assess functional and aesthetic results of anterior lamellar resection with lid margin splitting of the upper lid in the treatment of cicatricial trachomatous entropion. PATIENTS AND METHODS: Descriptive cross-sectional study of a series of 26 consecutive patients treated between January 2014 and December 2015. All patients were operated for cicatricial trachomatous entropion in our tertiary center using the technique of the anterior lamellar resection with lid margin splitting of the upper eyelid. All patients were followed for 6 to 12 months after surgery. The anatomical, functional and aesthetic results were evaluated six months after surgery. They were considered good if there was no recurrence of the entropion, no lashes in contact with the cornea and no associated eyelid complications. RESULTS: The mean age of the patients was 68.5±10 years with a male predominance (sex ratio=1.8). The average initial corrected visual acuity was 0.65±0.35 LogMAR, ranging from counting fingers at 1m to 6/10. Involvement was bilateral in 34.6% of cases. Correction of the cicatricial entropion was achieved in 24 patients (92.3% of cases) and full correction of misdirected lashes without any contact with the ocular surface was obtained in 23 patients (88.4% of cases). The lid margin was regular in 88.4% of cases. A significant improvement of the tear film and corneal surface was observed in 84.6% of patients. During the follow-up period, no cases of recurrent entropion were reported. DISCUSSION: Among the various surgical techniques, anterior lamellar resection with lid margin splitting is one that most respects the anatomy of the upper eyelid and allows precise intraoperative control of eyelid rotation and eversion of the misdirected lashes. Therefore, it reduces significantly the risk of recurrence and significantly enhances the aesthetic results of surgery. CONCLUSION: Anterior lamellar resection with lid margin splitting of the upper eyelid is a simple and effective technique that significantly improves the aesthetic result of cicatricial trachomatous entropion.

[Long-term results of phacoemulsification in pseudoexfoliation syndrome]. / Résultats à long terme de la phacoémulsification dans le syndrome pseudoexfoliatif.

INTRODUCTION: The prevalence of pseudoexfoliation syndrome is estimated at 8 % of all cataracts operated within our institution. The goal of our study was to describe the frequency of intraoperative and postoperative complications and long-term anatomical and functional results of phacoemulsification in pseudoexfoliation syndrome. PATIENTS AND METHODS: A retrospective observational study of a series including 103 patients (107 eyes) with cataract associated with pseudoexfoliation syndrome admitted between January 2010 and September 2014. All patients underwent phacoemulsification. RESULTS: The average age of our patients was 72.5±6 years. The average initial corrected visual acuity was 0.52±0.14LogMAR. The cataract was grade C3N3 in 58 % of cases. The pseudoexfoliation syndrome was bilateral in 69 % of cases. Pupillary dilatation was≤6mm in 54 % of cases. Among intraoperative complications, zonular dialysis was found in 1.8 % of cases. Posterior capsular rupture and vitreous loss was noted at 5.4 % of patients. The incidence of secondary cataract was 31.7 % at 12 months. The mean postoperative best corrected visual acuity was 0.13±0.15 LogMAR. DISCUSSION: The small pupil associated with high grade of the cataracts in our series explains the slightly higher frequency of intraoperative zonular dialysis. Cataract surgery by phacoemulsification allows for a statistically significant improvement in visual acuity (P<0.001). The incidence of secondary cataract, the main postoperative complication, is higher in our series compared to data in the literature. CONCLUSION: Pseudoexfoliation syndrome is common in our country. Functional results of phacoemulsification are very satisfactory, and secondary cataract is the main complication. A meticulous search for pseudoexfoliation is mandatory during the initial examination in order to reduce intraoperative complications. Careful removal of the cortex and systematic polishing of the lens capsule should limit the incidence of secondary cataracts.

[Squamous cell carcinoma of the eyelids. Review of 7 years of experience of the adult ophthalmology service of the Casablanca university medical center]. / Les carcinomes épidermoïdes des paupières. Bilan de 7ans d'expérience au service d'ophtalmologie adulte du CHU de Casablanca.

Malignant eyelid tumors generate considerable functional and aesthetic complications. Squamous cell carcinoma or squamous cell epithelioma (SCE) of the eyelids represents about 9% of all peri-ocular skin tumors. It is potentially lethal by orbital invasion or metastasis and characterized by clinical polymorphism and its ability to mimic other benign lesions of the eyelids, thus requiring early diagnosis and management. The goal of our work is to establish the epidemiological and clinical characteristics, treatment modalities and prognosis of SCE of the eyelids. This retrospective study was performed over a period of 7 years on 25 cases of SCE of the eyelids. The mean age was 62 years. The gender ratio was 1.77 with a male predominance. Twelve patients had precancerous lesions. Biopsy revealed squamous epithelioma SCE in 24 cases and a mixed carcinoma in one case. Surgical treatment was performed in 23 cases. Eyelid reconstruction was immediate in all cases. Radiation therapy (RTH) was carried out for additional 5 patients. The mean follow-up was 15 months. We noted 2 cases of recurrence; revision surgery was necessary in one case and radiotherapy in the other case. SCE is often diagnosed at advanced stages in our context because of the limited access to health care and the extreme clinic polymorphism. This explains the need for histological examination of any suspicious lesion. Prevention through photoprotection is essential.

[Non-traumatic corneal perforations: Therapeutic modalities]. / Perforations cornéennes non traumatiques : modalités thérapeutiques.

INTRODUCTION: The treatment of non-traumatic perforations of the cornea is a real challenge for the choice of surgical technique as well as for management of the causal pathology. The goal of our study is to determine the anatomical and functional results of the management of non-traumatic perforation of the cornea in the absence of ready access to a corneal graft. MATERIALS AND METHODS: This is a retrospective, non-comparative monocentric study of 23 consecutive cases diagnosed and treated between January 2011 and January 2013. We included 23 eyes with non-traumatic corneal perforation. Various surgical techniques were used depending on the size and location of the corneal perforation. RESULTS: The predominant etiology of the corneal perforations in our series was corneal abscess, found in 30.4% of cases (7 eyes). A conjunctival flap was performed in 43.5% of cases (10 eyes) followed by tarsorrhaphy in 21.7% of cases (5 eyes), autologous corneal patch in 17.4% of cases (4 eyes), amniotic membrane in 13% of cases (3 eyes) and finally cyanoacrylate glue in one case. Mean follow-up was 12.4 ± 2.1 months. Anatomical closure of the corneal perforation was achieved in 91.3% of cases (21 eyes), while the final visual acuity was not improved due to secondary opacities. DISCUSSION: The choice of surgical technique depends on the size of the corneal perforation, its location, its etiology and the resources available for emergencies. When amniotic membrane and corneal donor tissue are unavailable, conjunctival flap is an easy and effective technique, which is a good alternative to close corneal perforations less than 3mm. It improves ocular surface quality and prepares the eye for later penetrating keratoplasty. CONCLUSION: Conjunctival flap is a good technique that is still relevant today, especially in the absence of corneal donor tissue or amniotic membrane. The anatomical success rate is very satisfactory, but sometimes several interventions are needed to improve the visual prognosis.

[Treatment of congenital ptosis by frontalis suspension with monofilament polypropylene suture: results of a study of 21 cases]. / Traitement du ptosis congénital par suspension au muscle frontal par fil de polypropylène : résultats d'une étude de 21 cas.

INTRODUCTION: Frontalis suspension of the upper eyelid using suture in the treatment of congenital ptosis has long been considered a temporary solution when there is a risk of amblyopia. It helps to clear the visual axis pending further surgery after the age of 4 years. Polypropylene suture (Prolene(®)), which is an inert material with optimum scarring properties and tensile strength and good knot stability, has shown very encouraging functional and aesthetic results and low recurrence rates. MATERIAL AND METHODS: Retrospective descriptive study of a series of 21 patients, between January 2008 and December 2012, with severe congenital ptosis and poor or no function of the levator muscle of the upper eyelid. RESULTS: In our series, the recurrence rate of ptosis was 14.3% with a mean follow-up of 25.9 ± 10.8 months. We found 3 cases of under-correction, and one case of granulomatous inflammation with infection. DISCUSSION: The use of polypropylene suture seems to be a very good alternative to conventional materials for suspension, such as fascia lata, temporalis fascia and polytetrafluoroethylene (PTFE or Goretex(®)). The advantages of this technique are the ease of removal, low cost and lower associated morbidity. CONCLUSION: Eyelid suspension with polypropylene suture is an easy, rapid, reversible and inexpensive technique. The results in the short and medium terms are very encouraging, and we need longer follow-up to evaluate the long-term results.

[Pseudophakic retinal detachment: how to manage?]. / Décollement de rétine du pseudophaque : quelle prise en charge ?

INTRODUCTION: Retinal detachment, a common complication of cataract surgery, requires urgent surgical treatment. The external approach combining retinopexy with scleral buckling remains the gold standard in the surgical management of pseudophakic retinal detachment (RD) without marked proliferative vitreoretinopathy (PVR), although intraocular surgery is currently preferred by most of the authors. The purpose of this study is to compare the anatomical and functional results obtained with both techniques. PATIENTS AND METHODS: This study compares the results of two techniques for treating pseudophakic retinal detachment: external surgery (group I), and vitrectomy with internal tamponade (group II). Ab-externo surgery was performed in 24 patients (24 eyes), while 22 patients (22 eyes) underwent primary vitrectomy. In order to make both groups comparable, we excluded recurrences of RD, vitreous hemorrhage and other media opacities, giant tears and initial grade C PVR. Minimum follow-up was 12 months. Postoperative variables analyzed and compared were the rate of initial and final anatomical success, final visual acuity, and causes of failure of the initial surgery. RESULTS: The retina was reattached with a single operation in 21 eyes in group I (87.5%) and 19 eyes in group II (86.4%) (P=0.91). The causes of anatomical failure in both groups were proliferative vitreoretinopathy (4 cases) and secondary tears or tears not seen on initial examination (2 cases). For patients in group I, secondary surgery consisted of total vitrectomy with encircling buckle. Patients in group II underwent an additional vitrectomy (peeling of vitreoretinal proliferation, and silicone oil tamponade as necessary). After a mean follow-up of 12 months, the final examination noted a reattached retina in 23 eyes in group I (95.84%) and 21 eyes in group II (95.45%) (P=0.95). The final visual results were identical at comparable follow-up periods. Indeed, the final visual acuity was similar in the two groups with nearly 40% of patients having recovered visual acuity between 1/10 and 5/10 (P=0.98). CONCLUSION: With regard to surgical treatment of pseudophakic retinal detachment, vitrectomy with internal tamponade provides anatomical and functional results comparable to those obtained with external surgery.

[Use of bevacizumab in the treatment of complicated proliferative diabetic retinopathy]. / Utilisation du bévacizumab dans le traitement de la rétinopathie diabétique proliférative compliquée.

INTRODUCTION: Diabetes is the leading cause of neovascular vitreoretinal proliferation. Several recent publications have appeared showing the efficacy and safety of intravitreal bevacizumab (IVT) in proliferative or complicated diabetic retinopathy (PDR), but with no consensus on the injected dose. We report the results of its use as adjuvant intravitreal injection (IVT) prior to posterior vitrectomy in the setting of complicated PDR. The goal of our work is to evaluate the benefits of and try to establish a protocol for proper use of intravitreal bevacizumab prior to vitrectomy for complicated PDR, so as to incorporate it in the management of this disease. PATIENTS AND METHODS: A prospective comparative study of series of patients hospitalized for severe complicated PDR requiring vitrectomy was spread over one year, from January 2011 to December 2011. Included patients were divided into two groups: group A: receiving an injection preoperatively at a dose of 1.25mg, and group B, which received an injection of bevacizumab at a dose of 0.75mg (with a time to surgery of either less than 3 days, more than 6, or 3 to 6). We analyzed the epidemiological characteristics, data from the initial eye examination and intraoperative complications and follow-up after vitrectomy. RESULTS: Thirty-five patients were included. We noted no significant difference in epidemiological characteristics between group A and B. Sixty percent of patients underwent surgery after a period of three to six days post-IVT. The reduction of neovascularization, decreased risk of bleeding and the facilitation of membrane peeling during surgery were significantly similar between group A and B. No complication related to the molecule and no recurrence, including bleeding, were noted throughout follow-up in both groups. CONCLUSION: We opt for a systematic use of anti-VEGF, particularly bevacizumab prior to all vitrectomies for complicated PDR. A 0.75mg dose at an interval of 3 to 6 days seems to be a good compromise between the desired effect and possible complications that may arise.

[Contact lens related corneal ulcers: clinical, microbiological and therapeutic features]. / Abcès de cornée sur port de lentilles de contact : aspects cliniques, microbiologiques et thérapeutiques.

INTRODUCTION: Corneal ulcers in contact lens wearers are becoming more common, and can sometimes lead to severe complications. The purpose of this study is to define the epidemiological, clinical, microbiological and therapeutic considerations of these ulcers within the above context. PATIENTS AND METHODS: We conducted an uncontrolled, descriptive, retrospective study of 51 patients presenting with contact lens related corneal ulcers to the ophthalmology department of the August 20, 1953 Hospital in Casablanca between January 2009 and January 2012. RESULTS: The average age of our patients was 22 years, with a gender ratio of 7.5 female to male. General risk factors (diabetes and tuberculosis) were found in 17.5% of cases. The average length of hospital stay was 15 days. Of our patients, 58.8% wore cosmetic contact lenses and 41.18% wore therapeutic contact lenses. Mean duration prior to consultation was 5 days. The predominant clinical signs were eye pain and redness, with a decrease in visual acuity worse than 1/10 in 82.3% of patients. In 70.6% of cases, the ulcer was central. The average size was 4.3mm. An anterior chamber reaction was found in 47.1%. Corneal bacterial cultures were positive in 47.8%. Pathogens found were Staphylococcus aureus, Pseudomonas aeruginosa and Acanthamœba. Contact lens and solution cultures were positive in 73.6% of cases. Outcomes were favorable with local and systemic antibiotic treatment adapted to microbiological results in only 41.2% of cases. In the remaining patients, significant secondary opacities persisted. DISCUSSION: Cosmetic and therapeutic contact lens wear is a major cause of corneal ulcer. Delayed consultation results in severe sequelae with persistently decreased visual acuity. CONCLUSION: The ophthalmologist plays an important role in preventing complications of contact lens wear, through better hygiene instruction and follow-up of his or her patients.