[Optical coherence tomography for surveillance of optic disc melanocytoma]. / Interêt de la tomographie en coherence optique dans la surveillance d'un melanocytome papillaire.

INTRODUCTION: Melanocytoma of the optic disc is a stable condition that unfrequently undergoes malignant transformation. CASE REPORT: We reported the case of a 42-year-old woman who presented with a pigmented tumoral lesion of the optic disc in her left eye. We described its characteristics in optical coherence tomography (OCT). CONCLUSION: Patients with pigmented tumors of the optic disc should have a periodic monitoring. OCT may be helpful in the difficult differential diagnosis between malignant and benign tumor and the monitoring of this lesion.

Capsulorhexis contraction syndrome despite capsular tension ring implantation.

A 35-year-old woman with zonular weakness in the left eye had phacoemulsification with inthe- bag implantation of an acrylic intraocular lens (IOL) and a capsular tension ring. 6 months postoperatively, the patient developed significant visual loss secondary to capsule shrinkage and contraction of the capsulorhexis opening, associated to a slight IOL decentration. Neodymium: YAG laser radial anterior capsulotomy and anterior capsulectomy were performed leading to visual acuity restoration.

[Bilateral pseudotumoral proptosis as presenting sign of orbital hyper-IgG4-related disease]. / Exophtalmie bilatérale pseudo-tumorale révélant un syndrome hyper-IgG4 orbitaire.

INTRODUCTION: Hyper-IgG4 syndrome is a rare cause of bilateral proptosis. It must always be considered after ruling out orbital lymphoma. CASE REPORT: We report a case of progressive bilateral proptosis for 4 years in a 34-year-old man. Orbital MRI showed an infiltrative process extending to the orbital fat, extraocular muscles and lacrimal glands. Lacrimal gland biopsy with immunohistochemical study showed a lymphoplasmocytic infiltrate rich in IgG4 and fibrosis. The diagnosis of orbital hyper-IgG4 syndrome was suggested. The patient responded well to systemic steroid treatment. DISCUSSION: Orbital hyper-IgG4 syndrome manifests most often as pseudo-tumoral bilateral proptosis. Elevated IgG4 levels are neither sensitive nor specific. Biopsy with immunohistochemical study is the key to diagnosis. Systemic steroid treatment is the gold standard, but recurrences may occur.

[Dome-shaped macula: appearance on ultrasound and optical coherence tomography]. / Macula en dôme : aspects échographique et tomographique.

INTRODUCTION: The purpose of our work is to demonstrate the role of optical coherence tomography and ocular ultrasound in the diagnosis of the dome-shaped macula in high myopia. OBSERVATION: We report the case of a patient with high myopia who presented with a decrease in visual acuity and metamorphopsia in the left eye. She underwent visual acuity measurement, biomicroscopic examination and measurement of axial length. B-mode ultrasound and optical coherence tomography showed a projection of the macula in the convexity of the myopic staphyloma confirming the diagnosis of dome-shaped macula. DISCUSSION AND CONCLUSION: Dome-shaped macula is a recently discovered entity, which may be responsible for a decrease in visual acuity in patients with high myopic posterior staphyloma. Ultrasound and optical coherence tomography are very helpful in making the diagnosis.

[Safety and efficacy of botulinum toxin in hemifacial spasm]. / Efficacité et tolérance de la toxine botulique dans l'hémispasme facial.

UNLABELLED: Given the failure of pharmacologic and surgical treatment in the management of hemifacial spasm, the use of botulinum toxin as first line therapy is interesting. PURPOSE: To evaluate the safety and efficacy of type A botulinum toxin in the treatment of hemifacial spasm. PATIENTS AND METHODS: We conducted a retrospective, descriptive and comparative study of 25 patients with hemifacial spasm followed in the ophthalmology department of Habib Thameur hospital in Tunis over the period from June 2003 to June 2009. All patients received injections of botulinum toxin type A (Botox). RESULTS: We carried out 168 Botulinum A toxin injections (Botox) with an average of 6.85 ± 4.32 injections per patient. Doses varied between 12.5 U and 28 U Botox. A good response to treatment was observed in 92% of patients with a satisfactory return to daily activities and work. Based on a subjective scale from 1 to 3, the average total functional benefit was 2.55 ± 0.56. Average total duration of therapeutic response was 9.35 ± 3.64 weeks. Local side effects observed were comparable to those described in the literature: ptosis (32.4%), diplopia (8.2%), drooping of the labial commissure (11.2%), lagophthalmos (21.3%), tearing (7%), dry eye (4%). No systemic complication was noted. CONCLUSION: Botulinum toxin type A provides effective short-term and medium-term results in the treatment of hemifacial spasm. It is well tolerated locally and systemically. This safety and efficacy make it a valuable therapeutic alternative in the management of hemifacial spasm.

[Corneal lesions in Kindler syndrome: a case report]. / Atteinte cornéenne au cours du syndrome de Kindler: à propos d'un cas.

INTRODUCTION: Kindler syndrome is a rare autosomal recessive genodermatosis belonging to the class of bullous poikiloderma. Corneal lesions are rare. We report a case of ocular lesions in this syndrome. OBSERVATION: We report the case of a 57-year-old patient followed since childhood in dermatology with the diagnosis of Kindler syndrome. He presented to the ophthalmology department with decreased vision. Ophthalmologic examination showed symblepharon, ectropion in both eyes, and corneal deformation. CONCLUSION: The role played by the abnormal protein in epithelial integrity suggests that ocular and more particularly corneal involvement is not rare in Kindler syndrome. In fact, it is less known by ophthalmologists and dermatologists are not aware of the ophthalmologic manifestations.

[Acquired ptosis in allergic blepharoconjunctivitis in children and adolescents]. / Le ptosis acquis dans la blépharoconjonctivite allergique chez l'enfant et l'adolescent.

Acquired ptosis is a common ophthalmologic problem. It is in the large majority of cases aponeurotic and occurs in the elderly as an involutional disorder or after ophthalmic surgery. In younger patients, it may occur after ocular trauma, periocular infection, contact lens wear, or palpebral edema. Allergic blepharoconjunctivitis is an unsuspected cause of acquired ptosis. Our study investigated patients (5 to 15 years old) with a history of allergic blepharoconjunctivitis and having a unilateral or bilateral ptosis. Physiopathological hypotheses are discussed. Management of acquired ptosis is presented.