Scleral graft has been used in clinical situations including perforating eye trauma to treat traumatic scleral dehiscence. A 28-year-old male patient presented for a painful left eye following a firearm-related injury few hours ago. Visual acuity was limited to light perception with a 2 mm wide, oval-shaped inferior scleral gap. Due to the size of the scleral defect, we decided to perform a scleral autograft. The graft was fashioned from the inferonasal sclera, deposited over the recipient hole, and secured with 10–0 nylon sutures on the corneal and scleral sides of the surgical bed with favorable anatomical and refractive outcomes.

INTRODUCTION:Granulomatous uveitis is mainly defined by the nature of keratic precipitates and iris nodules. Anterior chamber (AC) granulomas, also known as Berlin nodules (BN), are circumscribed granulomatous nodules that form in the iridocorneal angle (ICA) in response to intraocular inflammation.CASES DESCRIPTION:We present three representative cases of anterior uveitis with berlin nodules to insist on the clinical features of this entity. Case 1: A female adult was referred to our department for bilateral redness and gradual blurry vision. Slit-lamp examination of both eyes (OU) found a yellow-white nodular mass at 6 o'clock on the peripheral iris with irido-crystalline synechiae, vitreous haze and blurred fundus. Purified protein derivative skin test revealed an induration of 20 mm. A diagnosis of presumed ocular tuberculosis was made. The patient received antituberculosis drugs and steroids with good evolution. Case 2: An 11-year-old girl presented for redness and pain OU. Anterior segment examination showed circumciliary congestion, epithelial microcystic edema OU and pearly vascularized lesion against the cornea in the right eye. Fundus examination was unremarkable. A diagnosis of definite ocular sarcoidosis was made based on accessory salivary glands biopsy. The patient was treated with teroids and controlled twice a week. Case 3: A 26-year-old male presented with a redness and pain of the left eye. The slit-lamp examination showed fine keratic precipitates with pearly white nodules within the AC. Fundus examination showed a chorioretinal lesion and occlusive vasculitis. Chest CT was consistent with milliary tuberculosis. Adequate therapy was initiated with favorable outcome.CONCLUSION:BN can be associated with various ocular manifestations of several diseases. They may be the first manifestation of systemic conditions and seem to be well managed with topical steroids.

The sural nerve is the autologous nerve used most commonly for grafting. However, recent studies indicate a high rate of complications and complaints after sural nerve removal. In this prospective study, we evaluated donor-site morbidity following full-length sural nerve harvesting on long-term follow-up.Fifty-one legs from 43 patients who underwent complete sural nerve harvesting for brachial plexus reconstruction were included in the study. After an average of 5 years, with a minimum postoperative follow-up of 12 months, sensory deficits in the leg and foot were analyzed using 2.0-g monofilaments. Regions of sensory deficit were marked with a skin marker and photographed. Over these regions of decreased sensation, we tested nociception using an eyebrow tweezer. Patients were also asked about pain, cold intolerance, pruritis, difficulties walking, and foot swelling.Regions most affected (84% of patients) were over the calcaneus and cuboid. However, in these regions, nociception was preserved. Regions of decreased sensation extended to the calf region in 11 of 51 legs. In 13 patients, we also observed regions of decreased sensation on the proximal leg. In five feet, the sensation was entirely preserved. No patient had any complaints about pain, cold intolerance, itchiness, difficulties walking, or foot swelling.Decreased sensation with nociception preserved was most common along the lateral side of the foot over the calcaneus and cuboid. Removing the entire sural nerve produced no long-term complaints of pain. Sural nerve use appears safe.Therapeutic II.

PurposeThe aim of this study was to evaluate corneal endothelial cell density and morphology, central corneal thickness, and best visual acuity using ultrasound (US) phacoemulsification or nanosecond laser technique.SettingDepartment of ophthalmology, Nabeul, Tunisia.DesignProspective cohort study.MethodsThis study included eyes with nuclear cataracts with a density grade of 1, 2, 3, or 4 according to LOCS III, divided into two groups; group 1 had conventional US, and group 2 had nanosecond laser. The endothelial cell density (ECD), coefficient of variation (CoV) in cell size, percentage of hexagonal cells, central corneal thickness (CCT) and best visual acuity (VA) were evaluated during 24 months.ResultsSeventy-four eyes had uneventful surgery, 40 in group 1, 34 in group 2. Three procedures in group 2 required conversion to standard phacoemulsification. The mean ECD decreased from 2616.4 ± 194.6 cells/mm2 in group 1 preoperatively to 2088.4 ± 229.9 after 2 years. In group 2, it decreased from 2611.8 ± 186.5 cells/mm2 to 2276.4 ± 163.8 after 2 years. The change was statistically significant in both groups. The decline of the mean ECD in group 2 was significantly less important than in group 1 (p = <10−2). The mean percentage of hexagonal cells was 45.18 ± 4.9 preoperatively and 43.5% ± 6.6 after 2 years in group 1. In group 2, it remained almost stable with 45.6 ± 5.1 and 45.4% ± 6.6 preoperatively and after 2 years, respectively. Preoperatively, the mean CoV was 0.39 ± 0.037 in group 1 and 0.38 ± 0.04 in group 2. After 2 years, it was 0.38 ± 0.04 and 0.37 ± 0.038 in group 1 and group 2, respectively. The changes of the mean CoV and the mean percentage of hexagonal cells were significant in both groups, but the difference between the groups was significant only during the six first months postoperatively. In preoperative, the mean corneal central thickness was 509.7 ± 19.5 in group 1 and 510.3 ± 20.4 in group 2. In both groups, the mean corneal thickness increased on D1 postoperatively to 550.9 in group 1, and 528.2 in group 2. The mean corneal thickness decreased more rapidly after 1 week in group 2, to find the initial values. Visual acuity improved from 0.76 Log Mar ± 0.5 at enrolment to 0.45 Log Mar ± 0.2, and 0.033 Log Mar ± 0.086 in group 1 at 1 day post-operative and after 24 months, respectively and from 0.58 Log Mar ± 0.28 to 0.2 Log Mar ± 0.09 and 0.035 Log Mar ± 0.083, respectively in group 2. There was no significant difference in VA at each follow-up between groups except for day 1.ConclusionOur study showed lower corneal tissue trauma, and lower endothelial cell loss in the laser cataract surgery compared to phacoemulsification.Clinical trial registration: (https://classic.clinicaltrials.gov/ct2/show/NCT05886283), identifier NCT05886283.

Toxic retinopathy due to antimalarial drugs is characterized by structural anomalies associated with severe, irreversible visual loss. The advantage of ophthalmologic monitoring is to detect these anomalies at an asymptomatic, preclinical stage, so that the recommended dose can be adjusted before the ophthalmologic manifestations appear.Cross-sectional study carried out in the ophthalmology department of Habib Bourguiba University Hospital, Sfax, between August 2016 and February 2018. All patients treated in the internal medicine department of Hedi Chaker University Hospital with synthetic antimalarial drugs for at least 1 year were included. A complete ophthalmologic examination and specialized retinal testing (fundus autofluorescence, 10-2 automated visual field and swept source OCT) were performed for all patients.Fifty-six patients treated with antimalarial drugs were analyzed. The main indication was systemic lupus erythematosus (80.3%). Fifty-three patients (94.64%) were treated with hydroxychloroquine, and 3 patients (5.4%) with chloroquine. Thirteen patients (23.2%) exhibited signs of retinal toxicity, with fundus autofluorescence alterations in 8% of cases, fundus anomalies in 12.5% of cases, 10-2 automated visual field defects in 16% of cases, and SS-OCT alterations in 23.2% of cases. We did not find a statistically significant association between retinal toxicity, weight, age, sex and renal insufficiency (p values of 0.8, 0.6, 0.66 and 0.7 respectively). Furthermore, the association between the cumulative dose and retinal toxicity was statistically significant (p = 0.02). The prevalence of toxic retinopathy was identified as 5% at 5 years, 25% at 10 years and 70% at 20 years.A better understanding of the risk factors for retinal toxicity is necessary when prescribing synthetic antimalarial drugs. Screening should be systematic. It should be based on a combination of functional and anatomic tests. The frequency of screening depends on the associated risk factors.La rétinopathie aux anti-paludéens de synthèse est caractérisée par des anomalies structurelles qui évoluent vers une perte visuelle sévère et irréversible. L’intérêt de la surveillance ophtalmologique est de dépister ces anomalies à un stade préclinique asymptomatique.Une étude transversale a été réalisée au service d’Ophtalmologie de CHU Habib Bourguiba, Sfax entre août 2016 et février 2018. Ont été inclus tous les patients suivis au service de Médecine interne du CHU Hédi Chaker, sous anti-paludéens de synthèse traités pendant une durée minimale de 1 an. Un examen ophtalmologique complet et des explorations rétiniennes spécialisées (clichés en autofluorescence, champ visuel automatique 10,2 et tomographie en cohérence optique) étaient réalisés pour tous les patients.Cinquante-six patients traités par des anti-paludéens de synthèse ont été analysés. La principale indication des anti-paludéens de synthèse était le lupus érythémateux systémique (80,3 %). Cinquante-trois patients (94,6 %) ont été traités par l’hydroxychloroquine et trois patients (5,4 %) par la chloroquine. Treize patients (23,2 %) ont présenté des signes de toxicité rétinienne : les clichés en autofluorescence étaient atteints dans 8 % des cas, le fond d’œil dans 12,5 % des cas, le champ visuel dans 16 % des cas et la tomographie en cohérence optique dans 23,2 % des cas. Aucune association statiquement significative n’a été trouvée entre la toxicité rétinienne, le poids, l’âge, le sexe et l’insuffisance rénale (valeurs de p respectives de 0,8 ; 0,6 ; 0,66 et 0,7). L’association entre la dose cumulative et la toxicité rétinienne était statiquement significative (p = 0,02). Le risque d’atteinte rétinienne serait de 5 % à 5 ans, 25 % à 10 ans et 70 % à 20 ans.Une connaissance des facteurs de risque de la toxicité rétinienne est nécessaire lors de la prescription des anti-paludéens de synthèse. Le rythme de dépistage dépend des facteurs de risque associés.

Microphthalmia, anophthalmia, and coloboma, fall under the MAC spectrum of ocular malformations. Congenital anophthalmia/microphthalmia is a rare developmental condition. It is due to the almost complete defect of the primary optic vesicle, which leads to an absent or very small eye within the orbit. The birth prevalence of these abnormalities is up to 3 per 10,000 births. The diagnosis is established upon clinical and imaging criteria. Genetic counselling might be challenging due to the wide range of involved genes. A full-term male newborn was referred to our department on the first day of life for ophthalmic examination. Medical history revealed a parental consanguinity. The patient was the third child for both parents. They had a six-year-old daughter with isolated bilateral severe microphthalmia (A,B) and a 4-year-old healthy son. Prenatal genetic analysis of both parents and the old daughter did not identify chromosomal abnormalities. Additionally, gestational-acquired infections, maternal vitamin A deficiency, X-rays or drugs exposure were excluded. Upon examination of the new born, we noticed a firmly closed eyes. The eyelid shape was normal. A gentle pose of the speculum revealed narrowed palpebral fissures and small conjunctival fornices. Both eyeballs, especially the left one, had a very reduced size. Conjunctiva and cornea were barely individualized. Adnexal tissues including the lacrimal canal were identified (C). Further systemic evaluation including transfontanellar and abdominal ultrasound, as well as neurological and urological assessments ruled out associated anomalies. Computed tomography scan of the orbits confirmed the diagnosis of severe bilateral microphthalmia. Rudimentary optic nerves were detected. Extra ocular muscles were within normal limits (D).

BACKGROUND AND OBJECTIVE: To describe the multimodal imaging characteristics associated with punctate outer retinal toxoplasmosis (PORT). PATIENTS AND METHODS: Multicenter, retrospective, observational case series of three patients who presented with PORT. Multimodal imaging was reviewed including optical coherence tomography (OCT), fundus autofluorescence, optical coherence tomography angiography, and conventional dye-based angiography. RESULTS: Patient ages ranged from 13 years to 55 years. Each patient had multiple white, punctate outer retinal lesions in the affected eye at initial diagnosis. OCT showed both inner and outer retinal changes, including disruption of the ellipsoid and interdigitation zones and retinal pigment epithelium/Bruch's membrane complex, as well as punctate, preretinal, hyperreflective lesions at the vitreoretinal interface, which regressed with treatment. CONCLUSION: Multimodal imaging is useful in diagnosing and monitoring treatment response in PORT, an uncommon presentation of ocular toxoplasmosis that must be differentiated from white dot syndromes or other causes of unilateral retinitis. [ Ophthalmic Surg Lasers Imaging Retina . 2019;50:281–287.]

Myelinated retinal nerve fiber layer is rare. It is estimated to occur in 0.5% to 1% of the population and is often detected on routine examination without symptoms. It consists of white or gray-white well-demarcated patches on the outermost surface of the retina that obscure the underlying retinal vessels. It can be associated with axial myopia, amblyopia, and strabismus. A 12-year-old girl with normal development presented with ocular deviation of the right eye. There was no past medical or ocular history. Automatic refraction found in the right eye -9 DP and -1 DP in the left eye. The best Visual acuity was 20/600 in the right eye and 20/20 in the left one. Slit lamp examination of the right eye (A) revealed two vast whitish zones extending from the papilla towards the temporal sector sparing the posterior pole. These lesions covered the temporal vessels with fuzzy and scalloped boundaries. Fundus examination of the left eye was without abnormalities (B). Scan of Optical coherence tomography showed isolated hyper reflectivity of the fiber optic layer, an abnormality of the vitreoretinal interface with posterior shadow cone effect (C).

BACKGROUND:Ocular blast injuries are defined as ocular damage caused by explosives. Within the military, they are considered work accidents resulting from military service, and they are therefore governed by the military disability pension system, which utilizes a specific scale. OBJECTIVES:To study the clinical presentation and course of ocular blast injuries. To describe the particularities of forensic expertise in military settings. METHODS:This was a retrospective study of 28 eyes of 15 military personnel with ocular blast injuries. A baseline ophthalmologic examination was performed to assess of all the eyes and the general lesions caused by the trauma. A military medicine expert opinion was obtained from the date of consolidation. The rates of permanent partial disability (PPD) and the aptitude or not for military activities were specified according to the specific scale of the military disability pension system. RESULTS:The mean age of the victims was 27.53 years. A mine explosion was the predominant cause of ocular damage. Trauma to the ocular adnexa occurred in 4 eyes. Anterior segment injuries were noted in 19 eyes, with a mean initial visual acuity of 1/10. Posterior segment lesions occurred in 14 eyes, with a mean initial visual acuity of 0.5/10. Ruptured globes occurred in 3 eyes of 2 patients. All the victims presented with systemic lesions in addition to ocular ones. The average PPD rate was approximately 58%. CONCLUSION:Regarding the particular clinical features of ocular blast injuries, military victims must be managed and fairly compensated according to specific regulations.

Punctuate Outer Retinal Toxoplasmosis (PORT) is a rare variant of toxoplasma chorioretinitis. We report the case of a 21-year-old patient presenting with visual blur of the left eye (LE). The examination found a corrected visual acuity (VA) at 3/10, a quit anterior segment and a 1+ vitreous haze. Fundus examination showed a suprafoveolar yellowish-white lesions associated to multiple peripheral atrophic and pigmented ones. Visual acuity of the right eye was 10/10 with a calm anterior segment. Fundus examination depicted an upper temporal cicatricial pigmented lesion. Multimodal imaging of LE objectified a PORT. The patient received antibiotic and corticosteroids with favorable clinical and functional outcome. Final VA reached 10/10 at day ten. This case illustrates the importance of multimodal imaging in the differentiation of PORT from the white dots syndrome and other unilateral retinitis.

La toxoplasmose ponctuée de la rétine externe (RPE) est une variante rare de la choriorétinite toxoplasmique. Nous rapportons le cas d´une patiente de 21 ans se présentant pour un flou visuel de l´œil gauche (OG). L´examen trouvait une acuité visuelle corrigée (AVc) à 3/10e, un segment antérieur calme et un Tyndall vitréen à 1 croix. L´examen du fond de l´œil (FO) a montré un foyer blanc-jaunâtre supra-fovéolaire et de multiples lésions atropho-pigmentaires périphériques. L´AVc de l´œil adelphie était à 10/10ème avec un segment antérieur calme et au FO un foyer atropho-pigmentaire cicatriciel temporal supérieur. L´imagerie multimodale de l´OG a conclu à une RPE toxoplasmique. L´évolution sous traitement antibiotique et corticoïdes était favorable avec une AV finale à 10/10 à 10 jours. Ce cas illustre l´importance de l´imagerie multimodale dans la différenciation de la RPE toxoplasmique du syndrome des taches blanches et les autres causes de rétinites unilatérales.

lntralenticular abscess is a very rare entity that has been described after penetrating trauma, intraocular surgery and metastatic spread. We report a case of intralenticular abscess treated surgically by phacoemulsification with good postoperative results. A 32-year-old patient presented with right eye redness and defective vision of 4 days following thorn injury. The visual acuity was limited to counting fingers. Anterior segment examination revealed healed lamellar corneal tear, 3+ cells in the anterior chamber, iris synechia and heterogeneous opacity of the crystalline lens. Vitreous and fundus were normal. Initially, we prescribed topic and systemic antimicrobial treatment. Lens extraction was performed 1 week later by phacoemulsification with primary intraocular lens implantation. The immediate postoperative recovery was uneventful. The visual acuity at last follow-up was 9/10. In the current case, lens extraction associated with systemic and local antimicrobial treatment allowed infection control and good visual outcome.