Peripheral ulcerative keratitis (PUK) is a rare manifestation of rheumatoid arthritis (RA). The progressive thinning of the peripheral cornea is secondary to immune complex disease. It may lead to blindness and reflect the presence of an active, potentially vasculitis both locally and systemically. We report here a rare case of PUK revealed by a marginal keratitis. The diagnosis of unilateral PUK with anterior scleritis complicating RA was made. The diagnosis must be made quickly because of the risk of perforation, but also because it may be the presenting manifestation of a serious systemic disease. It should be treated as an emergent situation.

We report a case of hypopion uveitis as an immune ocular reaction to pulmonary tuberculosis. This uncommon condition shouldbe considered especially in endemies areas. Quantiferon-tuberculosis Gold may be helpful to salvage such eyes by starting an appropriate treatment.

Photokeratitis is a painful keratitis caused by exposure of insufficiently protected eyes to the ultraviolet (UV) rays. We talk about "arc eye" when photokeratitis is caused by UV rays emitted by electric arc during electric arc welding process. We here report the case of a 35-year old rider, with no previous medical-surgical history, who had looked at an electric arc for a few minutes while the doors of his building were welded. He had bilateral burning in his eyes associated with lacrimation, photophobia and blepharospasm. Clinical examination showed corrected visual acuity of 8/10 and 9/10, conjunctival hyperemia with punctate erosive keratitis limited to palpebral fissure after the use of fluorescein. Given patient's clinical picture, keratoconjunctivitis photoelectrica (arc eye) was diagnosed. Treatment was based on topical antibiotics, wetting agents as well as agents with healing properties. Outcome was marked by total disappearance of the signs with restoration of bilateral visual acuity (10/10). This study highlights the role of prevention using appropriate protection equipment.

The clinical evaluation of infectious keratitis takes place largely through biomicroscopic examination, which presents limitations in the evaluation of the depth of the infiltrate and the exact thickness of the cornea, whether edematous or thinned. In this study, we aim to quantify the human corneal inflammatory response in treated infectious keratitis by anterior segment optical coherence tomography (AS-OCT). Patients with infectious keratitis were recruited prospectively in the ophthalmology department of the military hospital of Rabat between November 2017 and May 2019. Over the study period, 32 patients were included. A standardized scanning protocol was used. The thickness of the infiltrate, when present, and corneal thickness in any area of thinning and any surrounding edematous areas were measured. The various thicknesses gradually decreased over the course of follow-up, providing objective evidence of therapeutic efficacy in the early stages. Improvement in corneal edema and thinning was faster in the early stage. AS-OCT scanning can be used along with slit lamp examination to quantify and objectively follow infectious keratitis.

Introduction: Macular edema is the main cause of decreased visual acuity following retinal vein occlusions. We propose to study at the macular level the changes of retinal layers in OCT. Material and method: This are a retrospective study of 43 patients with secondary macular edema to retinal vein occlusion (15 occlusions of the central vein and 28 venous occlusions). We analyzed the different modifications of the outer layers of the macula. Results:The nuclear layer appears irregular and of abnormal density.The cystoid cubicles disorganize the outer nuclear layers.The outer limiting is fragmented and disappears in places, and the interface outer segments / inner segments appear thickened hyperdense and irregular.In our study, only ECF is statistically significantly associated with a decrease in visual acuity. Discussion: Preliminary results of this study in agreement with what is currently admitted show retinal changes during venous occlusion of the retina. Conclusion:The high resolution of the SD-OCT allowed analyzing the changes in the reflectivity at the level of the retinal layers, evoking alterations in the normal structure of photoreceptors related to macular edema.The evolution of these modifications seems to be correlated with the visual prognosis.A longer-term prospective study would formalize this relationship between imaging and prognosis.

L’atteinte oculaire est l’une des nombreuses complications du diabète. La rétinopathie diabétique proliférante peut conduire à la cécité. L’objectif de notre travail a été d’étudier les aspects de la rétinopathie diabétique au fond d’œil chez les patients diabétiques à Bobo-Dioulasso en milieu hospitalier.Il s’est agi d’une étude prospective descriptive du 1er mars au 31 août 2014 chez les patients diabétiques du CHU Sourô Sanou. Nous avons utilisé la classification de la Société Francophone du diabète.Nous avons inclus 246 patients (487 yeux). La proportion de la rétinopathie diabétique (RD) était de 47,1 % et celle de la maculopathie diabétique (MD) de 8,9 %. La RD proliférante et la RD non proliférante sévère représentaient 3,3 % des yeux et la cécité était de 3 %. Parmi les diabétiques présentant une RD, 99,1 % étaient de type 2, avec un âge moyen de 55,75 ans (écart-type 11,04 ans), et un âge médian du diabète de 36 mois. Il y’avait un lien statistique significatif entre la RD et la durée d’évolution du diabète, l’antécédent de neuropathie, la présence de la protéinurie des 24 h, l’hypercréatininémie et aussi entre le taux de triglycérides et la MD.La RD affecte près de la moitié des diabétiques vus au CHUSS. Une prise en charge précoce et multidisciplinaire permettrait de la prévenir.Ocular damage is one of the numerous complications of diabetes. Proliferative diabetic retinopathy can result in blindness. The purpose of our work was to study the aspects of diabetic retinopathy on fundus examination in diabetic patients in Bobo-Dioulasso in a hospital environment.This is a descriptive, cross-sectional, prospective study from March 1st to August 31st 2014 of diabetic patients in the Sourô Sanou university hospital. We used the Francophone Diabetes Society's classification.We included 246 patients (487 eyes). The frequency of diabetic retinopathy (DR) was 47.1%, and the frequency of diabetic maculopathy 8.9%. Proliferative DR and severe Non-Proliferative DR represented 3.3% of eyes, and blindness occurred in 3%. Among diabetics with DR, the mean age was 55.75 years (standard deviation 11.04 years); the median duration of diabetes was 36 months, and 99.1% of the diabetic patients were categorized as type 2. There was a statistically significant association between diabetic retinopathy and duration of diabetes progression, history of neuropathy, presence of proteinuria on 24 hour urines, hypercreatininemia, and also between triglyceride levels and diabetic maculopathy.Diabetic retinopathy affects almost half of diabetic patients at the Sourô Sanou university hospital. An earlier, multidisciplinary management approach might prevent this.

Le traitement du glaucome primitif à angle ouvert (GPAO) est préférentiellement médical. Cependant en cas d’échec ou d’insuffisance de celui ci, des traitements alternatifs ou complémentaires peuvent être envisagés. La trabéculoplastie sélective dans cette approche est un traitement physique en plein essor et les avantages qui lui sont reconnus ont été très peu étudiés chez le sujet mélanoderme africain. L’objectif de cette étude était d’évaluer l’efficacité de la trabéculoplastie sélective sur la baisse de la pression intraoculaire (PIO) chez le sujet mélanoderme africain atteint de GPAO.Nous avons réalisé une étude rétrospective chez des patients mélanodermes traités par laser sélectif entre mars 2010 et mars 2011. Tous les patients présentaient un GPAO avec trabéculum accessible sur 360°. Le protocole thérapeutique a consisté en un traitement sur 360° en 2 séances (180°/séance) à 15 jours d’intervalle. Le succès était défini par une baisse de la PIO initiale ≥ 3 mm Hg sans traitement supplémentaire.Nous avons retenu 44 patients correspondant à 82 yeux. L’âge moyen des patients était de 55,94 ± 11,66 ans avec des extrêmes de 19 ans et 76 ans. La pression intraoculaire moyenne avant le traitement au laser (PIO initiale) était de 18,43 ± 4,18 mm Hg. Après traitement au laser, la réduction pressionnelle moyenne était de (i) 3,81 mm Hg (20,67 %) à 15 jours ; (ii) 4,08 mm Hg (22,14 %) à 1 mois ; (iii) 4,45 mm Hg (24,14 %) à 3 mois ; (iv) 4,95 mm Hg (26,86 %) à 6 mois. Le taux de succès après traitement au laser était de 67,60 % à 15 jours, 83,78 % à 1 mois, 72,09 % à 3 mois et 80,43 % à 6 mois.La trabéculoplastie sélective est efficace chez le mélanoderme africain. Son efficacité est comparable à celle d’un inhibiteur de l’anhydrase carbonique voire une prostaglandine. Elle pourrait être une alternative complémentaire ou substitutive du traitement du GPAO chez le mélanoderme africain.The treatment of primary open angle glaucoma (POAG) is preferably medical. However, when medical therapy fails, alternative or complementary treatments may be considered. In this regard, selective laser trabeculoplasty is a widely popular procedural treatment whose accepted benefits have been very little studied in African blacks. The objective of this study was to assess the efficacy of selective laser trabeculoplasty on the reduction of intraocular pressure (IOP) in African blacks with POAG.We conducted a retrospective study of black patients treated with selective laser trabeculoplasty between March 2010 and March 2011. All patients had POAG with trabecular meshwork accessible over 360°. The treatment protocol consisted of a 360°treatment in two sessions (180°/session) 15 days apart. Success was defined as decrease from the initial IOP ≥ 3 mm Hg without additional medications.We included 44 patients, corresponding to 82 eyes. The mean age of the patients was 55.94 ± 11.66 years with extremes of 19 years and 76 years. The mean intraocular pressure before laser treatment (initial IOP) was 18.43 ± 4.81 mm Hg. After laser treatment, the mean pressure reduction was (i) 3.81 mm Hg (20.67%) at 15 days ; (ii) 4.08 mm Hg (22.14%) at 1 month; (iii) 4.45 mm Hg (24.14%) at 3 months; and (iv) 4.95 mm Hg (26.86%) at 6 months. The success rate after laser treatment was 67.60% at 15 days, 83.78% at 1 month, 72.09% at 3 months and 80.43% at 6 months.Selective laser trabeculoplasty is effective in African blacks. Its efficacy is comparable to that of a carbonic anhydrase inhibitor or even a prostaglandin. It could be a complementary or substitutive alternative to POAG medications in African blacks.

Dissecting intramural hematoma of the esophagus (DIHE) is a rare condition in which intramural hemorrhage can lead to submucosal dissection of the esophageal wall. DIHE is generally considered a benign disease, and the only mortality associated with DIHE has been due to operative intervention or to the presence of another underlying, life-threatening condition. We report, however, a case of sudden death due to the spontaneous rupture of a DIHE that occurred in a 32-year-old woman, affected by neurofibromatosis type1. She was admitted to the local emergency room, presenting a 24-hour history of sudden onset, severe central chest and interscapular pain associated with dysphagia, odynophagia and vomiting. Her condition worsened and proved fatal within a 6-hour period. A complete autopsy was then conducted, showing a complete dissecting intramural hematoma with laceration of the third superior of the esophagus. We can hypothesize that abnormal variations of gastro-esophageal pressure during ingurgitation and during bolus movement could be predisposing factors in the pathogenesis of the dissection. On the other hand angular kyphoscoliosis deformity may have had play a role as precipitating factor while vomiting in the subject's medical history can then be interpreted as the likely activation phenomenon.

The Ota nevus or nevus fuscocaerulus ophtalmomaxillaris, recently named oculodermic melanocytosis, was described by the Japanese Ota in 1939. It consists of cutaneous hyperpigmentation in the territory of the first and second trigeminal branches, associated with ocular melanocytosis. This abnormal pigmentation is due to the aberrant migration of the cells of the neural crest, these cells being the embryological precursors of melanocytes. The sectoral form of the Ota nevi is rare.

To evaluate the long-term results of corneal collagen cross-linking (CXL) with epithelium removal in patients with progressive keratoconus.This retrospective study included 27 eyes of 18 patients who underwent CXL surgery for progressive keratoconus between April 2009 and March 2012. Best-corrected visual acuity (BCVA), manifest refraction spherical equivalent (SE), maximum keratometry reading (K max), mean of the minimum and maximum keratometry readings (mean-K), central corneal thickness (CCT), and anterior and posterior elevation at the apex preoperatively and year 1, 3 and 6 were evaluated and compared. P values < 0.05 were considered to be statistically significant.Mean BCVA was 0.35 ± 0.28 logMAR preoperatively and 0.23 ± 0.20 logMAR 6 years after the procedure (P = 0.01). Mean SE decreased from −4.3 ± 2.45 diopters (D) to −3.91 ± 2.12 D (P = 0.03). Mean K max decreased from 49.6 ± 3.2 D to 48.6 ± 2.8 D (P = 0.04), and mean-K decreased from 47.6 ± 2.5D to 46.9 ± 2.6 D (P = 0.04). CCT decreased insignificantly from 466.5 ± 32.1 μm to 465.4 ± 26.6 μm (P = 0.65). Mean anterior elevation at the apex decreased from 12.8 ± 7.9 to 12 ± 8.3 μm (P = 0.04), and posterior elevation decreased from 27.1 ± 17.4 μm to 26.8 ± 18.5 μm (P = 0.27). Mean-K, max-K, BCVA and CCT showed no change over the last 5 years. After the first year, no significant change was observed in BCVA, SE, max-K, mean-K and CCT, which were therefore considered stable. On the other hand, anterior and posterior elevation readings continued to decrease up to 6 years after CXL.Based on our 6-year results, CXL can halt progression of keratoconus and reduce the need for keratoplasty.L'objectif était d'évaluer les résultats à long terme du cross-linking du collagène cornéen (CXL) après enlèvement de l’épithélium dans le traitement du kératocône évolutif.Cette étude rétrospective a porté sur 27 yeux de 18 patients ayant subi une chirurgie CXL pour un kératocône évolutif entre avril 2009 et mars 2012. Les mesures pré- et postopératoires (année 1, 3 et 6) de la meilleure acuité visuelle corrigée (MAVC), de l’équivalent sphérique de réfraction manifeste (ES), de la valeur maximale de kératométrie (max-K), de la moyenne des valeurs de kératométrie minimale et maximale (mean-K), de l’épaisseur de la cornée centrale (ECC) et de l’élévation antérieure et postérieure à l’apex ont été évaluées et comparées.La MAVC moyenne était de 0,35 ± 0,28 logMAR à l’examen préopératoire et de 0,23 ± 0,20 logMAR à l’examen de 6 ans après la procédure (p = 0,01). L’ES moyenne a diminué de −4,3 ± 2,45 dioptres (D) à −3,91 ± 2,12 D (p = 0,03). La max-K moyenne a diminué de49,6 ± 3,2 D à 48,6 ± 2,8 D (p = 0,04) et la mean-K de 47,6 ± 2,5D à 46,9 ± 2,6 D (p = 0,04). Une diminution non significative de l’ECC a été observée de 466,5 ± 32,1 μm à 465,4 ± 26,6 μm (p = 0,65). L’élévation moyenne antérieure à l’apex a diminué de 12,8 ± 7,9 à 12,0 ± 8,3 μm (p = 0,04) et l’élévation postérieure de 27,1 ± 17,4 μm à 26,8 ± 18,5 μm (p = 0,27). Mean-K, max-K, MAVC et ECC n’ont montré aucun changement au cours des 5 dernières années. Après la première année, aucun changement significatif n’a été observé : cela peut être considéré comme une stabilisation en termes de MAVC, ES, max-K, mean-K et ECC. D’autre part, les valeurs d’élévation antérieure et postérieure ont continué à diminuer jusqu’à 6 ans après CXL.D’après nos résultats sur 6 ans, il semble que le CXL peut arrêter la progression du kératocône et peut réduire le besoin de kératoplastie.