[Uveitic glaucoma in Behçet's disease: When everything gets complicated]

INTRODUCTION

Behçet's disease is a systemic disease of unknown etiology. Its ocular manifestations are multiple and polymorphic, with uveitis at the top of the list. Classically, uveitis in Behçet's disease does not cause elevation of intraocular pressure. However, this may be found in 10 to 20% of cases, secondary to trabeculitis, trabecular obstruction by inflammatory cells, anterior or posterior synechiae, or induced by prolonged use of corticosteroids. Its occurrence is a major complication, the management of which is especially delicate when glaucoma occurs. The purpose of this study was to study the factors predictive of glaucoma in Behçet's disease.

MATERIALS AND METHODS

This is a retrospective study of all the charts of patients consecutively hospitalized for Behçet's disease over a period of 8years in the ophthalmology A department of the specialty hospital of Rabat university medical center.

RESULTS

Fifty patients were treated for Behçet's disease during the study period. There were 41 men (82%), and 9 women (18%). Glaucoma was diagnosed in 11 patients (22%). The mean age of this subgroup was 31years, with a gender ratio of 6 women/5 men. The glaucoma was associated with anterior synechiae in 4 cases, primary open-angle glaucoma in 5 cases, neovascular glaucoma in 1 case and seclusio pupillae in 1 case. Therapeutically, all patients were on glaucoma eye drops, and five underwent filtering surgery. Statistically, on univariate analysis, ocular hypertension was observed particularly in patients with low initial visual acuity (less than 1/10) (P=0.001), with severe posterior segment involvement, especially retinal vasculitis (29% vs. 6%, P=0.04), macular edema (40% vs. 4%, P=0.001), and optic disc edema (50% vs. 15%, P=0.02). A high number of recurrences was also associated with glaucoma (1.0 vs. 3.0, P<0.0001). On multivariate analysis, low baseline visual acuity, presence of retinal vasculitis, and high number of recurrences were independent risk factors for ocular hypertension in our patients followed for Behçet's disease.

CONCLUSION

Glaucoma can complicate the management of Behçet's disease. This glaucoma will be more difficult to manage in this delicate pathological context. It requires special vigilance in patients with severe posterior segment inflammation, to institute effective management to avoid its potentially blinding complications.

[Bilateral primary pseudotumoral palpebral amyloidosis. A case report]

Ocular amyloidosis is infrequent, and the palpebral location is uncommon. It usually has a primary localized form, but can occur in systemic or familial amyloidosis. The diagnosis is mainly made by histopathology. Its treatment is surgical and the prognosis depends on clinical presentation and recurrences. We report the case of a 54-year-old woman with no medical history of the disease, who had bilateral isolated palpebral amyloidosis presenting as bilateral upper lid swelling with ptosis and corneal dystrophy. Diagnosis was confirmed by palpebral biopsy and the patient underwent excision of the involved lid tissue with reconstruction of the affected lid with cartilage autograft. Clinical progression showed improvement of the ptosis and the patient's comfort. Although rare, palpebral amyloidosis poses management problems, particularly in advanced cases, because of corneal complications and recurrence.

[Orbital ischemia syndrome after surgical intervention of the spine. A case report]

Uni- or bilateral blindness is an infrequent but severe complication after spinal surgery and typically occurs more frequently in elderly patients. The visual loss may be caused by ischemic optic neuropathy , central retinal artery or vein occlusion or cerebral stroke . It has often been attributed to various causes such as hemorrhagic shock, hypotension, coagulopathic disorders and embolism. However blindness as a surgical complication has rarely been described as a consequence of prolonged compression of the eye.

[Solitary eosinophilic granuloma of the orbit: a case report]

The authors report a case of eosinophilic granuloma involving the roof of the orbit in a 3-year-old girl. The clinical presentation and the imaging features suggested a malignant tumor and the final diagnosis was obtained by biopsy with histopathologic examination. Despite its alarming radiologic appearance, there was spontaneous healing of the eosinophilic granuloma.

Corps étranger intra-orbitaire végétal : à propos d’un cas

A 12-year-old child had left orbital trauma by wood. He consulted 4 months after for orbital cellulitis with cutaneous fistula. The CT scan showed the presence of a left orbital wood foreign body extended to the homolateral cavernous sinus and intracranial. Extraction of the wood fragment associated with an adapted antibiotic treatment led to clinical improvement without visual recovery. A situation of orbital trauma and secondary orbital inflammatory syndrome must raise the suspicion of a foreign body of the orbit and motivate emergency imaging for optimal management of the disorder.

Tumeur neuro-ectodermique primitive orbitaire avec extension endocrânienne

Primitive neuroectodermal tumor (PNET) of the orbit is rare. We present a case of a young patient with orbital PNET extending to the endo-crane and sinuses, which had been treated 10 years before with the diagnosis of rhabdomyosarcoma. The diagnosis was corrected with immunohistochemistry. Through this observation, we discuss the clinical aspects, the diagnosis difficulties, and the therapeutic options of this rare affection.

[Bilateral uveitis in relapsing polychondritis. A case report]

We report a rare ocular manifestation of relapsing polychondritis. A 28-year-old woman presented with a 5-year history of relapsing polychondritis with chondritis of the nose, ears and tracheobronchial system. The ocular symptoms were bilateral uveitis with macular involvement and papillaedema. Ocular manifestations of relapsing polychondritis occur in 60% of patients. Uveitis is a rare symptom, sometimes severe, which can lead to blindness. This case report with a literature review sheds light on the features of this disease.

Leucémie aiguë lymphoblastique T/Lymphome lymphoblastique orbitaire chez l’enfant

CASE

The authors report a case of an 6-year-old pediatric patient with a history of acute onset of proptosis of his right eye. He was admitted at hospital 6 months ago for proptosis concomitant with orbital trauma. Computed tomography scan demonstrated a mass involving the right orbit, right maxillary sinus, and zygoma with endocranial extension.

RESULTS

Incisional biopsy of the mass revealed after of histopathologic and immuno-histochemical evaluation a T-cell lymphoblastic lymphoma. Systemic examination and bone marrow aspirate show a acute lymphoblastic leukemia. The patient was treated with LMT96 Protocol. A complete Remission was observed after 13 months of follow up.

CONCLUSION

Primary T-cell lymphoblastic lymphoma of the orbit is a rare entity in any age group, but it is very rare in children. When tumors occurs in the orbit, it presents a challenging diagnosis problem, especially in pediatric patients.

[Purtscher's retinopathy with a favorable outcome after corticosteroids: case report]

Purtscher's retinopathy is a retinal vasculopathy most commonly caused by head or chest trauma. The most frequent signs include multiple areas of white ischemic infarcts and hemorrhages located in the posterior pole. Visual outcome in Purtscher's retinopathy is variable and there is no well defined treatment. We report a 8 year old child with sudden blurred vision in the right eye after head trauma. Ophthalmoscopy revealed multiple whitish patches and retinal hemorrhages predominant in the posterior pole. Megadoses of steroids were given with good visual response in the first three weeks, and child's vision recovered completely after four months despite initial severe symptomatology.

[Bilateral optic neuropathy from methanol intoxication. A case report]

Methanol poisoning generally occurs after voluntary or accidental ingestion and can be responsible for blindness by optic neuropathy. We describe two cases of methanol poisoning who developed bilateral optic atrophy despite a treatment combining corticosteroids and vitamin B. Through these observations we recall the physiopathology as well as the clinical and therapeutic aspects of this type of intoxication.

[Revealing dacryoadenitis inflammation as Wegener's granulomatosis]

INTRODUCTION

Wegener's granulomatosis is a necrotizing granulomatous vasculitis characterized by the involvement of the upper airways, lungs and kidneys.

CASE REPORT

A 39-year-old man presented with a 8-month history of proptosis of left eye. He had a history of recuring sinusitis and dyspnea. The diagnosis of Wegener's granulomotosis was confirmed by the nasal biopsy. A complete remission was achieved after treatment with corticosteroids, cyclophosphamide and trimethoprine sulfamethoxazole.

COMMENTS AND CONCLUSION

Wegener's granulomatosis is a multisystemic inflammatory disease of unknown origin. The classic diagnostic triad of this disease is necrotizing granuloma of the upper or lower respiratory tract, vasculitis and nephritis. The disease is usually fatal if untreated. However, early diagnosis and immunosuppressives such as cyclophosphamide can induce long term remission.

Maladie de Eales et allergie tuberculinique

The authors report the case of a 25-year-old woman who presented unilateral Eales disease associated with biologically confirmed pulmonary tuberculosis. The patient, from a family with a history of tuberculosis, showed a painless and abrupt decrease in visual acuity of the right eye with venous and arterial vasculitis. Fluorescein angiography confirmed the existence of peripheral ischemia and vascular abnormalities. The biological exam showed a positive PPD and the BK was isolated. Antibiotic and corticosteroid drugs were used in the treatment. The clinical, immunopathological and therapeutic aspects of this disease are discussed.

[Cutis laxa syndrome. Case report]

INTRODUCTION

Cutis laxa is a heterogeneous group of connective tissue disorders,characterized by loose skin and variable systemic involvement. The characteristic symptomatological pattern is resulting from paucity of elastic fibers.

CASE REPORT

A 4 year-old boy with a congenital cutis laxa was sent by his pediatrician for ophthalmic examination. His examination revealed an ectropion of the right lower lid and an entropion of the left lower lid. His general physical examination showed multiple visceral involvement, with inguino-scrotal hernia, multiple dental caries and severe pulmonary emphysema responsible for death two weeks after.

DISCUSSION

Cutis laxa is an extremely rare group of disorders. Congenital and acquired varieties have been described. The association of ocular anomalies has been described in the autosomal recessive form. Through this case report we shall discuss the ophthalmological signs of this disease as well as its clinical and genetic manifestation and its physiopathology.

[Retinal arterial macroaneurysm: spontaneous occlusion after rupture. In connection with a case]

INTRODUCTION

Retinal arterial macroaneurysms are ectatic modifications of the arterial wall. They are a relatively uncommon condition wich can threaten visual function by pre- or subretinal hemorrhage in case of rupture or by massive macular exudation.

OBSERVATION

We report a case of a 50 years old patient, without cardio-vascular history, who presented an arterial macroaneurysm complicated by premacular hemorrhage. Spontaneous evolution was aneurysm occlusion with complete hemorrhage regression and visual recovery.

COMMENTS AND CONCLUSION

Retinal macro-aneurysms are acquired malformations, often isolated and located in a temporal artery. Their evolution is unpredictable either towards spontaneous occlusion, occurrence of chronic exsudative retinopathy or hemorrhagic complications by fissuration or rupture of arterial wall. Through this observation, the authors discuss the evolution and therapeutic modalities of this affection.

[Association of choroidal coloboma, congenital hypertrophy of retinal pigmented epithelium and familial adenomatous polyposis: case report]

INTRODUCTION

The choroidal coloboma is a congenital malformation that results from an anomaly of the embryonic fissure. This anomaly is frequently associated to numerous ocular and systemic anomalies, but rarely to familial adenomatous polyposis.

CASE REPORT

We report a 12 years-old boy, who consulted for severe visual impairment of the right eye. The clinical examination revealed a coloboma of the iris and choroid and numerous lesions of congenital hypertrophy of the retinal pigmentary epithelium while exploration of the digestive tract revealed the presence of familial adenomatous polyposis.

DISCUSSION

We discuss the physiopathological mechanisms of this rare case, associating on one hand a coloboma of iris and choroid and on the other hand a congenital hypertrophy of the retinal pigment epithelium and a familial adenomatous polyposis. To the best of our knowledge this association has never been described before. We also emphasize the importance of an ophthalmologic examination for screening familial adenomatous polyposis in a subject at risk.

[Devic's neuromyelitis optica. A childhood case and review of the literature]

Neuromyelitis optical (NMO) or Devic's disease is an uncommon clinical syndrome associating unilateral or bilateral optic neuritis and transverse myelitis within about 8 weeks. Usually reported in adults, childhood cases constitute a distinctive clinical entity with good visual and neurological prognosis without long-term recurrence or sequelae. The pathogenesis is explained by autoimmune demyelinization triggered by a viral disease. Some authors suggest an infectious cause. The CT scan is usually negative while MRI shows nonspecific small foci in the white matter. Unlike multiple sclerosis, the main differential diagnosis, in NMO the cerebrospinal fluid may show pleocytosis with elevated protein level without an oligoclonal band. We report a case of neuromyelitis optica occurring in a 4-year-old child following a flu-like syndrome. Clinical outcome was favorable with a short course of high-dose corticosteroids.

[Sympathetic ophthalmia. Apropos of 5 cases]

PURPOSE

The objective of this study was to show the severity of sympathetic ophthalmia and the need for immunosuppressive treatment.

METHODS

The study included five cases of sympathetic ophthalmia following ocular injury in three cases and evisceration in two cases. The ocular lesions included total uveitis in all cases with papillary oedema in two cases. The treatment was based on corticosteroid therapy, with immunodepressants in four cases.

RESULTS

Functional prognosis was good in four cases, with final visual acuity between 3/10 and 10/10.

CONCLUSION

Immunosuppressive treatment must be used on all cases of sympathetic ophthalmia with the goal of improving visual prognosis.