Frequency, characteristics, and risk factors of late recurrence of retinal detachment.

PURPOSE: To evaluate the frequency, characteristics, causes, and risk factors of late recurrent retinal detachments (LRRD). METHODS: The authors retrospectively analyzed 445 eyes operated consecutively for rhegmatogenous retinal detachment between 1990 and 2003 by the same surgeon. Only eyes with complete reattachment after a minimum follow-up of 6 months were included. The authors defined LRRD as detachment occurring at least 6 months after a complete retinal reattachment. RESULTS: Nine eyes had a LRRD (2.02%). Mean age was 52.55 years. Six eyes had scleral buckle procedure and three eyes had vitrectomy silicone oil injection then silicone oil removal. LRRD occurred after an average period of 54 months. During follow-up two patients had a removal of extrusion of scleral buckling material. New or reopened breaks were associated with LRRD in all eyes. Endo-ocular surgery was carried out in seven eyes. The retinal reattachment was achieved in the seven eyes. Final visual acuity ranged from 20/400 to 20/60 after an average follow-up of 37.8 months. Relation between aphakic eyes (and more generally nonphakic eyes) and LRRD was close to significant value (p=0.05). LRRD was statistically independent (p>0.05) of myopia, preoperative pseudophakia, vitrectomy for initial detachment, scleral buckle removal, and cataract surgery after reattachment. CONCLUSIONS: LRRD were rare. Most of them were due to a retinal break. This break can be a new break, or reopened break especially after removal of scleral buckle material. Vitreous traction, at the vitreous base, seemed to be the cause of these breaks.

[Retinal vasculitis. Epidemiological, clinical and etiological features]. / Les vascularites rétiniennes: profils épidémiologiques, cliniques et étiologiques.

PURPOSE: To study the epidemiological and clinical features of noninfectious retinal vasculitis (NIRV). METHODS: We analyzed 128 consecutive patients with NIRV, collected over 15 years (1993-2007) in an ophthalmological reference university hospital in Tunis, Tunisia. Data were analyzed regarding associated systemic disease, ocular syndromes, anatomic features (type and topography of vessel and type of capillaropathy), age and sex. The results of the etiologic work-up were based on the Levy-Clarke and Perez classification. RESULTS: A total of 240 cases of NIRV (128 patients) were collected (mean age: 32; sex ratio: 2.6). It was bilateral in 93.7% of cases. The mean visual acuity (VA) was 20/50 (range: 20/800-20/20). NIRV was mainly venous (84.1%), diffuse (57%), with a mixed capillaropathy (40.2%). There were complications in 56.25% of the cases, mainly macular edema (48.1%), vascular occlusion (25.9%), optic atrophy (22.2%) and cataract (19.2%). NIRV was idiopathic in 15.6% of the cases, characterized by a predominance of young subjects (mean: 38 years old), males (sex ratio: 4), VA at 20/25, and edematous periphlebitis in 100% of cases. There were ocular disorders in 12.5% of the cases and systemic disease in 72% of the cases, with a predominance of Behçet disease (BD): 53.9% of all patients and 81% of systemic disease with predominant venous features. In 48.3% of cases, VA was less than 20/200, due to BD in 48% of the cases. CONCLUSION: In NIRV, the etiologic work-up is oriented on anatomic presentation, based on fluorescein retinal angiography, and requires an interdisciplinary approach. In young adults with retinal phlebitis, BD is suggested first.

[Congenital glaucoma: future of vision and pressure. Results of an 11-year study]. / Glaucome congénital : devenir visuel et pressionnel. Résultats d'une étude sur 11 ans.

AIM: To study the future of vision and IOP in congenital glaucoma. MATERIAL AND METHODS: We studied 33 eyes from 20 separate patients divided into two groups: group one consisted of 19 eyes with isolated trabeculodysgenesis and group two 14 eyes associated with Sturge-Weber-Krabbe syndrome, angiomatosis, or Peters syndrome. All patients underwent filtering surgery between 1995 and 2006. We studied a number of different forms of surgery; visual acuity after amblyopia treatment (> or =5/10, good; 4/10-2/10, average; < or =1/10, poor), objective refraction, and intraocular pressure (<16 mmHg, good; > or =16 mmHg, poor). RESULTS: We found that 54.8% of the patients had visual acuity 5/10 or greater and 44.2% between 4 and the ability to perceive light. Objective refraction was emmetropic in 19.4% (group 1, 60%; group 2, 40%), myopic in 53.8% (group 1, 28.5%; group 2, 71%), and hyperopic in 26.9% of cases (100%, group 1). All patients underwent surgery (45.5% deep sclerectomy and 54.5% trabeculectomy); 39.4% of the patients underwent more than one type of surgery (the number of operations is a prognosis factor for visual acuity). IOP was less than 19 mmHg in 87.9% of eyes. DISCUSSION: Visual acuity, refractive errors, and IOP depend on the type of congenital glaucoma. Isolated trabeculodysgenesis seems to give a better prognosis. CONCLUSION: If early diagnosis and treatment occur, visual acuity that is 5/10 or less can be expected for more than 50% of patients; therefore their visual future seems to be better.