To describe the prevalence and the risk factors for the age related macular degeneration (AMD) in a Tunisian hospital population.A total of 2204 subjects 50 years of age and older were enrolled in a prospective study conducted between august 2004 and February 2009. Medical history was reviewed. Subjects underwent a complete ophthalmic examination, including best corrected visual acuity and slit lamp biomicroscopy with fundus examination. Fundus photography and fluorescein angiography were performed if clinical features of AMD were observed on fundus examination. Cases were classified in early and late stages of AMD.The prevalence of late AMD was higher than early AMD. Significant risk factors are age, male gender, smoking, excessive sunlight exposure and poor consumption of fish. Cardiovascular disease, diabetes and dyslipimia were not significantly associated to a high prevalence of AMD.AMD is a multifactorial disease. In our Tunisian hospital population, the prevalence of AMD was higher than in the Europeen population. It can be explained by genetic differences or risk factors. Age, cigarette smoking and sunlight exposure were associated with increasing prevalence of AMD in Tunisia.
Intumescent cataract with ocular hypertony is a medicosurgical emergency. The purpose of our study is to define the clinical and therapeutic particularities of these cataracts.This retrospective study includes 40 consecutive patients with angle closure secondary to intumescent cataract. All patients were examined between 1st January 1998 and 30 October 2000.The patient population consisted of 28 women (70%) and 12 men ranging in age from 59 to 88 years (mean age: 78 years). Preoperative visual acuity was negative in 17% of cases and limited to light perception in 83% of cases. Ocular pressure varied from 25 to 68 mmHg. Patients underwent surgery one to 23 days after diagnosis. Surgical techniques consisted in extracapsular cataract extraction with (35%) and without (65%) intraocular lens. Preoperative complications were: vitreous loss in 20% of cases and expulsive haemorrhage in 2 cases (5%). Postoperative visual acuity improved in 70% of cases. COMMENT AND CONCLUSION: Intumescent cataract with ocular overpressure gives therapeutic problems, which can be prevented by a preoperative hypotony. Functional results of this study encouraged us to operate the intumescent cataract even if visual acuity is bad.
We present a 52 years-old woman who developed acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with atypical features. APMPPE was unilateral and associated with serous retinal detachment and disc edema causing severe vision loss to 20/400. Oral corticosteroid therapy was prescribed with rapid resolution of lesions and visual improvement to 20/20. Clinical course and multimodal imaging in illustrating different features provide us clues for the definitive diagnosis.
To describe a case of ophthalmic artery occlusion associated with anisocoria and revealing a cavernous sinus thrombosis due to sinusitis. A 48-year-old man with a history of diabetes presented acutely with loss of vision and proptosis in the left eye. Ophthalmologic examination concluded in a left ophthalmic artery occlusion with anisocoria and total ophthalmoplgia. Cardiac assessment was normal. Magnetic resonance imaging (MRI) revealed left ophthalmic artery and internal carotid occlusions, left cavernous and transverse sinus thrombosis and sphenoid sinusitis. The patient underwent extensive haematological and medical assessment to search for embolic sources and disease causing thrombophilia. The patient recovered from the thrombosis episode, but sustained permanent blindness.Ophthalmic manifestations may be the only signs revealing cavernous sinus thrombosis which must be usually suspected. Visual prognostic was very poor.
To study the epidemiological profile and the degree of severity of hyperopia in Tunisia primary school and to assess its effect on school performance.A cross-sectional, descriptive survey was conducted among 6-14 aged Tunisian children attending primary urban and rural schools. A total of 6192 children were selected using stratified random cluster sampling. Cycloplegic refractive error was measured among all children with uncorrected visual acuity less than 9/10 or signs of astheniopia. Hyperopia was defined as spherical equivalent (SE) 2.0 diopters (D). We have also searched a possible relation between degree of severity of hyperopia and school performance.The prevalence of hyperopia was 2.61%. The spherical equivalent mean was + 3.73 ± 0.94 D. The mean age was 9.67 ± 0.44 years. This prevalence was 2.77% in boys and 2.47% in girls. 3.13% of students were living in urban areas and 1.42% in rural areas. The hyperopia rate decreased significantly with age (p = 0.021), but it was not significantly related to gender (p=0.54). The difference in the prevalence of hyperopia between urban and rural areas was not statistically significant (p = 0.067). There was no significant association between the degree of severity of hyperopia and school performance (p=0.41).In our study, the prevalence of hyperopia among schoolage children in Tunisia was 2.61%.The identification of this refractive error and its correction as soon as possible would ensure these children better visual comfort and a better education.