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Ben Aoun S, Ksiaa I, Nefzi D, Khochtali S, Jelliti B, Abroug N, Khairallah M. SS OCT and OCT-A Findings in Convalescent Inactive Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2024; 32:407-414. [PMID: 37948509 DOI: 10.1080/09273948.2023.2274962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE This study aimed to determine predictive factors for low final visual acuity in patients with inactive Vogt-Koyanagi-Harada (VKH) disease using Swept-source OCT and OCT-angiography (OCT-A). METHODS We conducted a prospective longitudinal study, including 21 patients (42 eyes), who were followed up for the first 24 months after disease onset. Patients were included at the acute phase and subsequently treated. Sequential qualitative and quantitative changes in OCT and OCT-A were assessed. Analytical statistical methods were employed to determine predictive factors for final visual acuity. RESULTS Structural alterations including focal parafoveal outer nuclear layer atrophy, ellipsoid zone disruption, interdigitation zone disruption, and irregular and thickened retinal pigment epithelium line were observed in 57.1% of eyes at month 3, with no significant improvement over time. The presence of flow voids at months 6, 12, and 24 was significantly associated with low final visual acuity. Serous retnal detachment at presentation emerged as an independent risk factor for structural changes detected by SS-OCT during the first 2 years of the disease. Optic disc edema was predictive factor for both structural SS-OCT and OCT-A changes. CONCLUSION This study underscores the importance of monitoring flow voids to predict final visual acuity and highlights the impact of serous retinal detachment at presentation on structural changes in patients with inactive VKH disease.
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Affiliation(s)
- Safa Ben Aoun
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Dhouha Nefzi
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Bechir Jelliti
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Khairallah M, Khochtali S, Abroug N, Ksiaa I. Letter to the Editor: Comment on Fauquier A. et al. "Impact of Initial Management on Disease Evolution in Vogt-Koyanagi-Harada Syndrome: A Retrospective Cohort of 50 Patients". Ocul Immunol Inflamm 2024; 32:440-441. [PMID: 37369106 DOI: 10.1080/09273948.2023.2227259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Abstract
PURPOSE To provide an overview of pediatric pars planitis. METHODS Narrative literature review. RESULTS Pars planitis refers to the idiopathic subset of intermediate uveitis in which there is vitritis along with snowball or snowbank formation occurring in the absence of an associated infection or systemic disease. It is thought to be a T-cell mediated disease with a genetic predisposition. Pars planitis accounts for 5-26.7% of pediatric uveitis cases. Presentation is commonly bilateral but asymmetric, often with insidious onset of floaters and blurred vision. Although pars planitis is known to be a benign form of uveitis in most cases, severe complications secondary to chronic inflammation may arise, with cystoid macular edema being the most common cause of visual morbidity. Mild vitritis in the absence of symptoms, vision loss, or macular edema may be observed. Patients with severe vitritis and/or associated vision-threatening complications require prompt aggressive treatment. A stepladder approach including corticosteroids, immunosuppressive agents, anti‑tumor necrosis factor‑alpha and pars plana vitrectomy and/or laser photocoagulation is the most commonly used method for treatment of pars planitis. CONCLUSION Timely diagnosis and adequate treatment of pediatric pars planitis and associated complications are crucial in order to improve visual outcomes.
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Affiliation(s)
- Sana Khochtali
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Pinar Ozdal
- Service of Uveitis and Retinal Diseases, Ankara Ulucanlar Eye Research Hospital, Ankara, Turkiye
| | - Abdulrahman F AlBloushi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Wijdène Nabi
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
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Attia S, Al Baker Z, Ahmed N, Awadh B, Talas F, Khochtali S, Khairallah M. HLA B27-Related Uveitis Associated with Retinal Vasculitis, Optic Disc Neovascularization, and Vitreous Hemorrhage. Ocul Immunol Inflamm 2023:1-4. [PMID: 37890112 DOI: 10.1080/09273948.2023.2263556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Sonia Attia
- Ophthalmology Section, Ambulatory Care Center, Hamad Medical Corporation, Doha, Qatar
- Department of Ophthalmology, Fattouma Bourguiba, University Hospital, Faculty of Medecine, University of Monastir, Monastir, Tunisia
| | - Zamzam Al Baker
- Ophthalmology Section, Ambulatory Care Center, Hamad Medical Corporation, Doha, Qatar
| | - Nagi Ahmed
- Ophthalmology Section, Ambulatory Care Center, Hamad Medical Corporation, Doha, Qatar
| | - Bassem Awadh
- Rheumatology Section, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Firas Talas
- Ophthalmology Section, Ambulatory Care Center, Hamad Medical Corporation, Doha, Qatar
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba, University Hospital, Faculty of Medecine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba, University Hospital, Faculty of Medecine, University of Monastir, Monastir, Tunisia
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Nabi W, Ben Amor H, Zina S, Kadri A, Khochtali S, Abroug N, Ksiaa I, Khairallah M. Swept-source Optical Coherence Tomography Angiography in Active and Scarred Toxoplasmic Retinochoroiditis. Ocul Immunol Inflamm 2023; 31:1479-1485. [PMID: 35914295 DOI: 10.1080/09273948.2022.2097096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To describe optical coherence tomography angiography (OCTA) findings in eyes with active and scarred toxoplasmic retinochoroiditis. METHODS OCTA scans in active (25 eyes) and scarred (17 eyes) retinochoroiditis were retrospectively reviewed. RESULTS In active lesions, OCTA findings included a non-detectable flow signal area in retinal vascular plexuses and choriocapillaris in all 25 eyes (100%), an abnormal intraretinal vascular process in 2 eyes (8%), and an associated area of retinal flow deficit secondary to branch retinal artery occlusion in one eye (4%). In scarred lesions, OCTA findings included a flow deficit area in retinal vascular plexuses and choriocapillaris in all 17 eyes (100%), a visibility of larger deeper choroidal vessels at the level of choriocapillaris in 9 eyes (53%), and a well-defined intraretinal vascular network in one eye (5.9%). Peripapillary scars were associated on OCTA with wedge-shaped loss of radial peripapillary capillaries with corresponding localized retinal nerve fiber layer defect and visual field loss. CONCLUSION OCTA allows to non-invasively detect retinal and choroidal vascular changes in active and scarred toxoplasmic retinochoroiditis.
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Affiliation(s)
- Wijden Nabi
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Amal Kadri
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
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Ben Amor H, Krifa H, Mefteh M, Khairallah M, Njim L, Khochtali S, Khairallah M. Ocular tuberculosis presenting with a conjunctival granuloma. J Fr Ophtalmol 2023; 46:231-234. [PMID: 36725373 DOI: 10.1016/j.jfo.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/01/2022] [Indexed: 02/03/2023]
Abstract
An 18-year-old female patient was referred with complaints of tearing and redness in the left eye for 3 months after a mild ocular trauma with a turkey feather. She was treated with topical antibiotics and corticosteroids with no improvement. Slit-lamp examination of the left eye showed a vascularized lesion with a polypoidal appearance due to multiple contiguous micronodules on the temporal and inferior bulbar conjunctiva. Results of the anterior and posterior segment examination were unremarkable in both eyes. A biopsy specimen of the conjunctival mass showed multiple tuberculoid granulomas composed of epithelioid histiocytes with associated Langhan's type multinucleate giant cells and a necrotic nodule surrounded by histiocytes and giant cells. The Mantoux test was positive with induration of 15mm. The patient was prescribed antituberculosis therapy. Three months after treatment initiation, the conjunctival lesions had resolved. Mycobacterium tuberculosis should be considered in cases of unilateral chronic recalcitrant conjunctivitis. Biopsy of a conjunctival mass is of utmost importance to establish a definite diagnosis.
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Affiliation(s)
- H Ben Amor
- Service d'ophtalmologie, CHU de Fattouma-Bourguiba, faculté de médecine, université de Monastir, 5019 Monastir, Tunisia; Faculté de médecine, université de Monastir, Monastir, Tunisia.
| | - H Krifa
- Service d'ophtalmologie, CHU de Fattouma-Bourguiba, faculté de médecine, université de Monastir, 5019 Monastir, Tunisia
| | - M Mefteh
- Service d'ophtalmologie, CHU de Fattouma-Bourguiba, faculté de médecine, université de Monastir, 5019 Monastir, Tunisia
| | - M Khairallah
- Service d'ophtalmologie, CHU de Tahar Sfar, Mahdia, Tunisia; Faculté de médecine, université de Monastir, Monastir, Tunisia
| | - L Njim
- Faculté de médecine, université de Monastir, Monastir, Tunisia; Service d'anatomie & cytologie pathologiques, CHU de Fattouma-Bourguiba, faculté de médecine, université de Monastir, Monastir, Tunisia
| | - S Khochtali
- Service d'ophtalmologie, CHU de Fattouma-Bourguiba, faculté de médecine, université de Monastir, 5019 Monastir, Tunisia; Faculté de médecine, université de Monastir, Monastir, Tunisia
| | - M Khairallah
- Service d'ophtalmologie, CHU de Fattouma-Bourguiba, faculté de médecine, université de Monastir, 5019 Monastir, Tunisia; Faculté de médecine, université de Monastir, Monastir, Tunisia
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Abroug N, Khairallah M, Ksiaa I, Ben Amor H, Zina S, Attia S, Jelliti B, Khochtali S, Khairallah M. A Comparative Study between Occlusive and Non-occlusive Retinal Vasculitis: Data from a Referral Center in Tunisia, North Africa. Ocul Immunol Inflamm 2023; 31:97-104. [PMID: 34644223 DOI: 10.1080/09273948.2021.1986726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To compare clinical profile and visual outcomes of occlusive versus non-occlusive retinal vasculitis (RV). METHODS A retrospective comparative study. RESULTS 284 patients were enrolled, including 124 patients with occlusive RV (ORV) and 160 patients with non-occlusive RV (NORV). Patients with ORV were older (p ≤ 10-3), predominantly male (p ≤10-3), with less bilateral involvement (31.5% vs 53,4%; p ≤ 10-3). Infectious RV was more frequently diagnosed in the ORV group than in the NORV group (48.8% vs 32.9%, p = .006). Behçet disease and ocular tuberculosis were the leading causes of ORV. Idiopathic RV, Behçet disease, and sarcoidosis were the most common causes of NORV. Independent predictive factors of poor visual outcome were worse baseline visual acuity in both groups (p = .006 and p ≤ 10-3, respectively), and retinal hemorrhages (p = .048) and optic atrophy (p = .040) in the ORV group. CONCLUSION Occlusive and non-occlusive RV have distinctive clinical and etiological profile.
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Affiliation(s)
- Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Molka Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sonia Attia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Bechir Jelliti
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Abroug N, Nabi W, Amor HB, Ksiaa I, Khochtali S, Attia S, Jelliti B, Khairallah M. Rickettsial disease: An underestimated cause of posterior uveitis. Saudi J Ophthalmol 2022; 36:374-379. [PMID: 36618574 PMCID: PMC9811930 DOI: 10.4103/sjopt.sjopt_86_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/11/2022] [Indexed: 01/10/2023] Open
Abstract
Rickettsioses are worldwide distributed infectious disease caused by intracellular small Gram-negative bacteria transmitted to humans by the bite of contaminated arthropods, such as ticks. Systemic disease typically consists of a triad of high fever, headache, and skin rash. It usually has a self-limited course, but severe, life-threatening complications can sometimes occur. It may be clinically difficult to differentiate rickettsial diseases from other febrile illnesses. Rickettsial infection has been largely underestimated as a cause of infectious uveitis for long decades in the past. Conversely, recent data show that ocular involvement is much more common than previously thought, with retinitis, retinal vasculitis, and neuroretinitis being the most typical and frequent findings. Early clinical diagnosis of rickettsial disease, while awaiting laboratory test results, is essential for prompt initiation of appropriate antibiotic treatment to prevent systemic and ocular morbidity. The prevention remains the mainstay of rickettsial infection control.
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Affiliation(s)
- Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia,Address for correspondence: Dr. Nesrine Abroug, Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia. E-mail:
| | - Wejdene Nabi
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hager B. Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sonia Attia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Bechir Jelliti
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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El Mayel A, Amor HB, Sellem I, Mesfar R, Khochtali S, Ksiaa I, Khairallah M. Intermediate uveitis associated with Cogan's syndrome. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.0552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Amina El Mayel
- Ophthalmology Fattouma Bourguiba University Hospital Monastir Tunisia
| | - Hager Ben Amor
- Ophthalmology Fattouma Bourguiba University Hospital Monastir Tunisia
| | - Ilhem Sellem
- Ophthalmology Fattouma Bourguiba University Hospital Monastir Tunisia
| | - Rahma Mesfar
- Ophthalmology Fattouma Bourguiba University Hospital Monastir Tunisia
| | - Sana Khochtali
- Ophthalmology Fattouma Bourguiba University Hospital Monastir Tunisia
| | - Imen Ksiaa
- Ophthalmology Fattouma Bourguiba University Hospital Monastir Tunisia
| | - Moncef Khairallah
- Ophthalmology Fattouma Bourguiba University Hospital Monastir Tunisia
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Sayadi J, Gouider D, Henchiri M, Choura R, Boujelbene N, Abbes I, Khochtali S, Zghal I, Malek I, Khairallah M, Nacef L. Preoperative Intralesional Bevacizumab Injection in Primary Pterygium in Tunisian Patients: A Randomized Controlled Prospective Study. J Curr Ophthalmol 2022; 34:297-304. [PMID: 36644467 PMCID: PMC9832450 DOI: 10.4103/joco.joco_146_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/24/2022] [Accepted: 07/28/2022] [Indexed: 12/09/2022] Open
Abstract
Purpose To assess the efficacy and safety of a single preoperative intralesional bevacizumab injection as an adjuvant treatment before primary pterygium surgery. Methods We conducted a randomized controlled interventional study from January 2019 to December 2020. The study included a total of 60 patients (60 eyes) with primary pterygium. We defined two groups of 30 patients each. Group A received an intralesional injection of bevacizumab (Avastin), 1 month before surgery (lesion excision and conjunctival autograft). Group B (control) had only the surgical treatment. Patients were followed up 7 days (D7), 1 month (M1), 3 months (M3), and 6 months (M6) postoperatively. Pre-, per-, and postoperatively, photographs of the lesions were taken, as well as a histopathological examination. The main outcome measures were the change in functional discomfort following intralesional bevacizumab injection and pterygium recurrence. Recurrence was defined as fibrovascular tissue growth invading the cornea. Therapeutic success was defined as the absence of pterygium recurrence in M6. Results The mean age of the 60 patients was 54.17 ± 10.53. After bevacizumab injection, the preoperative functional discomfort score decreased significantly (P = 0.048). There was a significant improvement in grade and color intensity (P = 0.001). We noted no local nor systemic complications after intralesional injection of bevacizumab. After pterygium excision, the success rate was statistically higher in Group A (P = 0.047). There was no significant difference in either final best-corrected spectral visual acuity or astigmatism between the two groups. We noted a statistically significant association between recurrence and color intensity (P = 0.046), vascular density (P = 0.049), and the degree of elastic tissue degeneration (P = 0.040). Conclusion A single preoperative subconjunctival injection of bevacizumab 1 month before surgery decreases the vascularity of newly formed blood vessels and hence may reduce the recurrence rate.
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Affiliation(s)
- Jihene Sayadi
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Dhouha Gouider
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,Address for correspondence: Dhouha Gouider, Department A of Ophthalmology, Hedi Raies Institute, Faculty of Medicine, Beb Saadoun, Tunis, Tunisia. E-mail:
| | - Meher Henchiri
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Racem Choura
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nadia Boujelbene
- Department of Pathology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Imen Abbes
- Department of Pathology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, Monastir,Tunisia
| | - Imene Zghal
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ines Malek
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, Monastir,Tunisia
| | - Leila Nacef
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Nabi W, Khochtali S, Ben Amor H, Khairallah M, Abroug N, Khairallah M. IRVAN syndrome: A retrospective review of 9 cases from Tunisia. J Fr Ophtalmol 2022; 45:1012-1020. [DOI: 10.1016/j.jfo.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022]
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Ksiaa I, Khochtali S, Mefteh M, Ben Fredj M, Ben Amor H, Abroug N, Khairallah M. Distinguishing swept-source optical coherence tomography findings in active toxoplasmic retinochoroiditis. Eye (Lond) 2022; 36:1222-1230. [PMID: 34117384 PMCID: PMC9151801 DOI: 10.1038/s41433-021-01491-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/27/2021] [Accepted: 02/23/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To define the swept-source optical coherence tomography (SS-OCT) features which distinguish ocular toxoplasmosis (OT) from other forms of retinochoroiditis. METHODS This is a prospective diagnostic study enrolling 43 eyes of 43 patients with active toxoplasmic (TOXO) retinochoroiditis matched to 54 eyes (54 lesions) with non-TOXO retinochoroiditis evaluated by structural SS-OCT. RESULTS The finding of retinal hyper-reflective round deposits, sub-lesional choroidal thickening, and sub-lesional retinal pigment epithelium elevation were more likely to be found in TOXO lesions with a positive likelihood ratio of 45.2 (95% CI: 6.45-316.56), 23.86 (95% CI: 6.09-93.36), and 9.79 (95% CI: 4.22-22.7), respectively. The presence of each of these findings was associated with a high level for positive predictive value (PPV) (88.63-97.29), negative predictive value (NPV) (88.3-92.45), sensitivity (83.72-90.69), and specificity (90.74-98.14). Two-parameter model binary logistic regression suggested that sub-lesional retinal pigment epithelium elevation and sub-lesional choroidal thickening were significant predictors of the diagnosis of OT (Wald = 11.905, p < 0.001; Wald = 14.881, p < 0.001; respectively). By adding hyper-reflective round deposits along the posterior hyaloid or the retinal surface the model improved its performance with very good diagnostic accuracy with area under the curve (AUC) values of 0.96 (95% CI: 0.9-0.99) for two parameters model and 0.98 (95% CI: 0.93-0.99) for the three parameters model. CONCLUSIONS Our results show that three OCT findings including retinal hyper-reflective round deposits, sub-lesional choroidal thickening, and sub-lesional retinal pigment epithelium elevation are more likely to occur in OT patients as compared with non-OT patients.
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Affiliation(s)
- Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia.
| | - Sana Khochtali
- grid.411838.70000 0004 0593 5040Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Mossaab Mefteh
- grid.411838.70000 0004 0593 5040Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- grid.411838.70000 0004 0593 5040Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hajer Ben Amor
- grid.411838.70000 0004 0593 5040Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- grid.411838.70000 0004 0593 5040Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- grid.411838.70000 0004 0593 5040Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Khochtali S, Nabi W, Khairallah M. Comments on "Goyal M, Murthy SI and Annum S, Bilateral Multifocal Choroiditis following COVID-19 Vaccination". Ocul Immunol Inflamm 2022; 31:880. [PMID: 35442844 DOI: 10.1080/09273948.2022.2058557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The fundus photographs provided show deep yellowish lesions, multifocal exudative retinal detachments, and optic disc hyperemia in both eyes. Spectral domain optical coherence tomography scans shown demonstrate bilateral exudative retinal detachments involving the macula in the right eye. The exudative retinal detachment is characterized by the presence of subretinal fibrin and septa. The B-scan ultrasonography provided shows low- to medium-reflective choroidal thickening predominating around optic nerve head, in association with exudative retinal detachment in the right eye. All these findings are highly suggestive of acute Vogt-Koyanagi-Harada (VKH) disease rather than multifocal choroiditis.
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Affiliation(s)
- Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Wijden Nabi
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Khochtali S, Krifa H, Zina S, Khairallah M, Jelliti B, Abroug N, Khairallah M. Multimodal Imaging of Acute Foveolitis following COVID-19 Vaccination. Ocul Immunol Inflamm 2021; 30:1214-1217. [PMID: 34797736 DOI: 10.1080/09273948.2021.1993270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To report a case of unilateral acute foveolitis following COVID-19 vaccination. METHODS A case report. RESULTS A 24-year-old woman developed a sudden blurring of vision in the left eye (LE) 5 days after receiving the first dose of COVID-19 vaccine. Examination of the LE showed a visual acuity at 20/40, 2+ cells in the vitreous, and a small yellow-orange foveal subretinal lesion. Late-phase fluorescein angiography showed a mild diffuse retinal vascular leakage and a faint foveal hyperfluorescence. ICG angiography showed in the late-phase hypofluorescence of the centrofoveal lesion. OCT B-scan demonstrated a conical hyperreflective subfoveal lesion on the retinal pigment epithelium associated with disruption of the outer retinal layers. En-face OCT revealed granular hyperreflective specks mainly in the inner nuclear layer. Work-up results were unremarkable. The patient received oral prednisolone with subsequent full functional and anatomic recovery. CONCLUSION Foveolitis may rarely occur as a complication of COVID-19 vaccination.
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Affiliation(s)
- Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hamza Krifa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Molka Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Bechir Jelliti
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Abroug N, Khairallah M, Zina S, Ksiaa I, Amor HB, Attia S, Jelliti B, Khochtali S, Khairallah M. Ocular Manifestations of Emerging Arthropod-Borne Infectious Diseases. J Curr Ophthalmol 2021; 33:227-235. [PMID: 34765808 PMCID: PMC8579803 DOI: 10.4103/joco.joco_134_21] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/25/2021] [Accepted: 04/25/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose To review the clinical features, diagnosis, treatment modalities, and prognosis of arthropod-borne infectious diseases. Methods This is a narrative review on arthropod-borne infectious diseases including general and ophthalmological aspects of these infectious diseases. A comprehensive literature review between January 1983 and September 2020 was conducted in PubMed database. Epidemiology, clinical features, diagnosis, treatment, and prognosis of arthropod-borne infectious diseases were reviewed. Results Emergent and resurgent arthropod-borne infectious diseases are major causes of systemic morbidity and death that are expanding worldwide. Among them, bacterial and viral agents including rickettsial disease, West Nile virus, Dengue fever, Chikungunya, Rift valley fever, and Zika virus have been associated with an array of ocular manifestations. These include anterior uveitis, retinitis, chorioretinitis, retinal vasculitis, and optic nerve involvement. Proper clinical diagnosis of any of these infectious diseases is primarily based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular involvement. The diagnosis is confirmed by laboratory tests. Ocular involvement usually has a self-limited course, but it can result in persistent visual impairment. Doxycycline is the treatment of choice for rickettsial disease. There is currently no proven specific treatment for arboviral diseases. Prevention remains the mainstay for arthropod vector and zoonotic disease control. Conclusions Emerging arthropod vector-borne diseases should be considered in the differential diagnosis of uveitis, especially in patient living or with recent travel to endemic countries. Early clinical diagnosis, while laboratory testing is pending, is essential for proper management to prevent systemic and ocular morbidity.
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Affiliation(s)
- Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Molka Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sonia Attia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Bechir Jelliti
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Jomaa O, Ksiaa I, Khochtali S, Jguirim M, Khairallah M. P059 Etiological profile of childhood uveitis in a Tunisian population: a 12-year retrospective study. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab722.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Uveitis in children represents 10% of all cases of uveitis. It is a serious condition with an often-insidious onset and evolution, and has a negative impact on visual prognosis with a risk of amblyopia or even blindness. The etiologies are varied. the aim of this study is to describe the epidemiological, clinical, and etiological characteristics of childhood uveitis during a period of 12 years.
Methods
A descriptive retrospective study including 138 children (276 eyes) with uveitis, was conducted at the Ophthalmology Department of Fattouma Bourguiba University Hospital in Monastir Tunisia between 1 January 2006 and 31 December 2017.
Results
The patients average age was 10.2 ± 3,58. A female predominance was noted (sex ratio: 0.91). Uveitis was bilateral in 2/3 of cases and unilateral in 1/3 of cases. Vision loss was the most common reason for consultation (52.2%). The mean initial visual acuity was 3,3/10 ± 3,24. Intermediate uveitis was the most common anatomical form (42,02%), followed by anterior uveitis (28,26%), panuveitis (26,08%), and posterior uveitis (3,6%). The infectious origin was the most common aetiology, followed by uveitis related to general condition (13,72%), and uveitis in context of a specific ocular condition (12,3%). Uveitis was idiopathic in 79 patients (57.24%). Periocular injection of triamcinolone acetonide was performed in (29 patients, 21%). The use of immunosuppressives agents was noted in 38 patients (27,5%) (methotrexate: 23 patients, azathioprine: 16 patients, and ciclosporin: 10 patients). The use of intravitreous injections of bevacizumab was noted in 6 patients (4.33%). Anti TNF alpha treatment was used for 2 patients. Post-uveitic complications were noted in 84.3% of cases. They were dominated by cataract (31,88%) at the anterior segment level. Cystoid macular oedema (31,88%) and retinal serous detachment (15,9%) were the major complications in the posterior segment. Mean final visual acuity was 5.98/10 ± 3,54. It was <1/10 in 14 eyes.
Conclusion
In our study a female predominance was noted. Intermediate uveitis was the most common anatomical form. The infectious origin was preponderant. Post-uveitic complications was dominated at the anterior segment level by cataract and cystoid macular oedema at the posterior segment.
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Affiliation(s)
- O Jomaa
- Department of Ophthalmology, Faculty of Medicine of Monastir, Fattouma Bourguiba Hospital, Tunisia
| | - I Ksiaa
- Department of Ophthalmology, Faculty of Medicine of Monastir, Fattouma Bourguiba Hospital, Tunisia
| | - S Khochtali
- Department of Ophthalmology, Faculty of Medicine of Monastir, Fattouma Bourguiba Hospital, Tunisia
| | - M Jguirim
- Department of Ophthalmology, Faculty of Medicine of Monastir, Fattouma Bourguiba Hospital, Tunisia
| | - M Khairallah
- Department of Ophthalmology, Faculty of Medicine of Monastir, Fattouma Bourguiba Hospital, Tunisia
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17
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Zina S, Khairallah M, Ben Amor H, Ksiaa I, Hadhri R, Attia S, Khochtali S, Khairallah M. [Conjunctival granulomas leading to the diagnosis of systemic sarcoidosis]. J Fr Ophtalmol 2021; 45:e67-e69. [PMID: 34763957 DOI: 10.1016/j.jfo.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 10/19/2022]
Affiliation(s)
- S Zina
- Service d'ophtalmologie, faculté de médecine, hôpital universitaire Fattouma-Bourguiba, université de Monastir, avenue Farhat-Hached, 5000 Monastir, Tunisie
| | - M Khairallah
- Service d'ophtalmologie, faculté de médecine, hôpital universitaire Fattouma-Bourguiba, université de Monastir, avenue Farhat-Hached, 5000 Monastir, Tunisie.
| | - H Ben Amor
- Service d'ophtalmologie, faculté de médecine, hôpital universitaire Fattouma-Bourguiba, université de Monastir, avenue Farhat-Hached, 5000 Monastir, Tunisie
| | - I Ksiaa
- Service d'ophtalmologie, faculté de médecine, hôpital universitaire Fattouma-Bourguiba, université de Monastir, avenue Farhat-Hached, 5000 Monastir, Tunisie
| | - R Hadhri
- Service d'anatomopathologie, faculté de médecine, hôpital universitaire Fattouma-Bourguiba, université de Monastir, avenue Farhat-Hached, 5000 Monastir, Tunisie
| | - S Attia
- Service d'ophtalmologie, faculté de médecine, hôpital universitaire Fattouma-Bourguiba, université de Monastir, avenue Farhat-Hached, 5000 Monastir, Tunisie
| | - S Khochtali
- Service d'ophtalmologie, faculté de médecine, hôpital universitaire Fattouma-Bourguiba, université de Monastir, avenue Farhat-Hached, 5000 Monastir, Tunisie
| | - M Khairallah
- Service d'ophtalmologie, faculté de médecine, hôpital universitaire Fattouma-Bourguiba, université de Monastir, avenue Farhat-Hached, 5000 Monastir, Tunisie
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Abroug N, Zina S, Ksiaa I, Ben Amor H, Khochtali S, Khairallah M. Central retinal vein occlusion complicating retinal arteriovenous malformation. J Fr Ophtalmol 2021; 44:1476-1478. [PMID: 34474923 DOI: 10.1016/j.jfo.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/20/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022]
Affiliation(s)
- N Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia.
| | - S Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - I Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - H Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - S Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - M Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Khochtali S, Khairallah M, Meddeb S, Zina S, Khalifa M, Khairallah M. Ophthalmic involvement in Mycoplasma-induced rash and mucositis: A case report. J Fr Ophtalmol 2021; 45:e17-e19. [PMID: 34330551 DOI: 10.1016/j.jfo.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/03/2021] [Indexed: 11/19/2022]
Affiliation(s)
- S Khochtali
- Service d'ophtalmologie, hôpital universitaire Fattouma Bourguiba, avenue Farhat-Hached, 5000 Monastir, Tunisia; Université de Monastir, faculté de médecine de Monastir, avenue Avicenne, 5000 Monastir, Tunisia.
| | - M Khairallah
- Service d'ophtalmologie, hôpital universitaire Fattouma Bourguiba, avenue Farhat-Hached, 5000 Monastir, Tunisia; Université de Monastir, faculté de médecine de Monastir, avenue Avicenne, 5000 Monastir, Tunisia
| | - S Meddeb
- Hôpital régional de Msaken, avenue Taieb M'Hiri, 4070 M'Saken, Sousse, Tunisia
| | - S Zina
- Service d'ophtalmologie, hôpital universitaire Fattouma Bourguiba, avenue Farhat-Hached, 5000 Monastir, Tunisia; Université de Monastir, faculté de médecine de Monastir, avenue Avicenne, 5000 Monastir, Tunisia
| | - M Khalifa
- Service de pédiatrie, hôpital régional de Msaken, avenue Taieb M'Hiri, 4070 M'Saken, Sousse, Tunisia
| | - M Khairallah
- Service d'ophtalmologie, hôpital universitaire Fattouma Bourguiba, avenue Farhat-Hached, 5000 Monastir, Tunisia; Université de Monastir, faculté de médecine de Monastir, avenue Avicenne, 5000 Monastir, Tunisia
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Ksiaa I, Abroug N, Mahmoud A, Ben Amor H, Attia S, Khochtali S, Khairallah M. Hypopyon: Is-it Infective or Noninfective? Ocul Immunol Inflamm 2021; 29:817-829. [PMID: 34255602 DOI: 10.1080/09273948.2021.1922708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hypopyon usually corresponds to the sedimentation of white blood cells, and it signifies severe intraocular inflammation. This key clinical sign may occur in association with a wide variety of infectious, inflammatory, and neoplastic conditions that may be sight- and, occasionally, life-threatening. A careful history and thorough clinical examination are the cornerstones for orienting the differential diagnosis, identifying the causative agent, and initiating prompt and appropriate treatment. This review outlines the clinical characteristics and management of hypopyon in relation with the underlying causative infectious or noninfectious ocular or systemic diseases.
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Affiliation(s)
- Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Anis Mahmoud
- Department of Ophthalmology, Taher Sfar University Hospital of Mahdia, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sonia Attia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Zina S, Khochtali S, Sayadi S, Ksiaa I, Abroug N, Khairallah M. [Specular microscopy findings in active uveitis]. J Fr Ophtalmol 2021; 44:981-988. [PMID: 34172297 DOI: 10.1016/j.jfo.2020.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE To study the effect of ocular inflammation in active uveitis on the corneal endothelium. MATERIALS AND METHODS This is a prospective cross-sectional study involving 63 eyes of 38 patients with active newly-diagnosed uveitis. Eighty-four eyes of 42 non-uveitic subjects served as a control group. All patients underwent detailed ophthalmic examination, laser flare photometry, and non-contact specular microscopy. Eyes with uveitis had a follow-up visit at one month after initiation of treatment, including laser flare photometry and specular microscopy. RESULTS The mean age of the active uveitis patients was 33 (range: 9-67 years) with 21 men (55%) and 17 women (45%). For the uveitis patients at baseline, the mean flare value was 32ph/ms (range: 15-100ph/ms) with flare photometry value ≥50ph/ms in 13 eyes (21%) and<50ph/ms in 50 eyes (79%). At baseline, cell density (CD) of the uveitis patients was similar to CD in control eyes (p꞊0.16). The percent of hexagonality was significantly lower (p<0.0001), and the coefficient of variance (CV) (p<0.0001) and central corneal thickness (CCT) (p<0.0001) were significantly higher than in the control group. After one month, there was a significant decrease in flare photometry values (p<0.0001), with a mean flare value of 14.5ph/ms (range: 4-60ph/ms). In the active uveitis group, the overall results of specular microscopy did not significantly vary between the initial examination and the 1-month examination. For eyes with flare photometry value ≥50ph/ms at baseline, CD and hexagonal cell count significantly increased on the 1-month examination (p꞊0.01 and p꞊0.02 respectively), while CV and CCT decreased significantly at the one-month follow-up visit (p꞊0.007/p꞊0.03 respectively). For eyes with flare photometry value at baseline <50ph/ms, there was no significant differences in specular microscopy results between the initial examination and the 1-month examination. CONCLUSIONS In eyes with newly-diagnosed uveitis and active anterior chamber inflammation, specular microscopy shows transient qualitative abnormalities of the corneal endothelium that depend on the severity of the anterior chamber inflammation as measured by the laser flare meter.
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Affiliation(s)
- S Zina
- Service d'ophtalmologie, Hôpital universitaire Fattouma Bourguiba, Faculté de Médecine, Université de Monastir, 5019 Monastir, Tunisia.
| | - S Khochtali
- Service d'ophtalmologie, Hôpital universitaire Fattouma Bourguiba, Faculté de Médecine, Université de Monastir, 5019 Monastir, Tunisia.
| | - S Sayadi
- Service d'ophtalmologie, Hôpital universitaire Fattouma Bourguiba, Faculté de Médecine, Université de Monastir, 5019 Monastir, Tunisia.
| | - I Ksiaa
- Service d'ophtalmologie, Hôpital universitaire Fattouma Bourguiba, Faculté de Médecine, Université de Monastir, 5019 Monastir, Tunisia.
| | - N Abroug
- Service d'ophtalmologie, Hôpital universitaire Fattouma Bourguiba, Faculté de Médecine, Université de Monastir, 5019 Monastir, Tunisia.
| | - M Khairallah
- Service d'ophtalmologie, Hôpital universitaire Fattouma Bourguiba, Faculté de Médecine, Université de Monastir, 5019 Monastir, Tunisia.
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Zicarelli F, Azzolini C, Cornish E, Agarwal A, Khochtali S, Airaldi M, Khairallah M, Viola F, Staurenghi G, McCluskey P, Invernizzi A. OPTICAL COHERENCE TOMOGRAPHY FEATURES OF CHOROIDAL NEOVASCULARIZATION AND THEIR CORRELATION WITH AGE, GENDER, AND UNDERLYING DISEASE. Retina 2021; 41:1076-1083. [PMID: 33079791 DOI: 10.1097/iae.0000000000002984] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the influence of age, gender, and underlying disease on the optical coherence tomography (OCT) features of choroidal neovascularization (CNV) secondary to inflammation, myopia (mCNV), and age-related macular degeneration (AMD-CNV). METHODS Demographic and clinical data of eyes with treatment-naive inflammatory CNV, mCNV, and Type 2 AMD-CNV were collected. Optical coherence tomography images were reviewed to determine the presence of pitchfork sign, pigment epithelial detachment, subretinal fluid (SRF), intraretinal cysts, subretinal hyperreflective material, atrophy, and outer retinal disruption graded 1 to 4. The influence of demographics and underlying etiology on OCT signs was investigated. RESULTS One hundred and eighty-five eyes from 179 patients were enrolled. The mean [SD] age was 36 [±14.4], 62 [±18], and 77 [±8] for the inflammatory CNV, mCNV, and AMD-CNV, respectively (P < 0.001). Multiple linear regression showed that the presence of pitchfork sign was negatively associated with age (P < 0.0001), regardless of underlying disease. By contrast, the SRF, pigment epithelial detachment, intraretinal cysts, and the outer retinal disruption were all positively influenced by age, regardless of gender and underlying disease (all P < 0.01). Logistic regression showed that none of the OCT signs increased the likelihood for diagnosis of inflammatory CNV. By contrast, the absence of SRF was suggestive for mCNVs, and the presence of pigment epithelial detachment and SRF was suggestive for AMD-CNVs. CONCLUSION The age of the patient had a significant effect on the OCT appearance of the CNV, particularly the presence of a pitchfork sign, regardless of the underlying etiology. The absence of SRF was suggestive for a diagnosis of mCNVs. The presence of SRF and pigment epithelial detachment was suggestive for AMD-CNVs.
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Affiliation(s)
- Federico Zicarelli
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Claudia Azzolini
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa Cornish
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India ; and
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Matteo Airaldi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Francesco Viola
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Peter McCluskey
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
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Zina S, Khochtali S, Invernizzi A, Ksiaa I, Hager BA, Viola F, Abroug N, Khairallah M. Results of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy in Inflammatory Choroidal Neovascularization. J Curr Ophthalmol 2021; 33:68-74. [PMID: 34084960 PMCID: PMC8102949 DOI: 10.4103/joco.joco_128_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/08/2020] [Accepted: 08/01/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose: To report the visual outcomes of intravitreal (IVT) anti-vascular endothelial growth factor (anti-VEGF) in inflammatory choroidal neovascularization (iCNV). Methods: A retrospective study of 43 eyes of 38 patients with active choroidal neovascularization (CNV) related to ocular inflammatory disease, treated with IVT injections of anti-VEGF (bevacizumab, ranibizumab, or aflibercept), with or without associated systemic anti-inflammatory therapy, at Fattouma Bourguiba University Hospital, Monastir, Tunisia (24 eyes of 23 patients) and at Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (19 eyes of 15 patients) from January 1, 2013, to December 31, 2018. Results: The mean age was 35.5 ± 16.4 years. The sex ratio male:female was 0.27. Seventeen eyes (39.5%) of 17 patients (44.7%) had only anti-VEGF injections, and 26 eyes (60.5%) of 21 patients (45.3%) had anti-VEGF injections and associated systemic anti-inflammatory therapy. Bevacizumab was injected in 36 eyes (83.7%), ranibizumab in six eyes (14%), and aflibercept in one eye (2.3%). Mean follow-up was 20.3 ± 19.2 months (range, 6–106 months). Mean visual acuity improved from 0.8 ± 0.37 logMAR (approximate Snellen equivalent 20/125) to 0.51 ± 0.42 logMAR (approximate Snellen equivalent 20/63) (P < 0.001). Mean central macular thickness on optical coherence tomography decreased from 403.7 ± 121.9 to 293.7 ± 82.8 μm (P < 0.001). Mean gain of vision was 2.9 ± 3.1 lines. The mean number of injections was 2.5. Twenty eyes (46.5%) received a single injection. There were no side effects related to the IVT injections of anti-VEGF. Conclusions: CNV is a sight-threatening complication of uveitis. IVT anti-VEGF seems to be an effective and safe treatment for iCNV when inflammation is controlled.
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Affiliation(s)
- Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science "Luigi Sacco", Eye Clinic, Luigi Sacco Hospital, University of Milan, Milan, Italy.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Ben Amor Hager
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Francesco Viola
- Fondazione Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Abderrahim K, Zina S, Khairallah M, Ben Amor H, Khochtali S, Khairallah M. Abducens nerve palsy with associated retinal involvement secondary to rickettsia typhi infection. J Ophthalmic Inflamm Infect 2021; 11:9. [PMID: 33748920 PMCID: PMC7982369 DOI: 10.1186/s12348-021-00239-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To report a case of abducens nerve palsy with associated retinal involvement due to rickettsia typhi infection. MATERIAL AND METHODS A single case report documented with multimodal imaging. RESULTS A 18-year-old woman with a history of high-grade fever was initially diagnosed with typhoid fever and treated with fluoroquinolone. She presented with a 5-day history of diplopia and headaches. Her best-corrected visual acuity was 20/20 in both eyes. Ocular motility examination showed left lateral gaze restriction. Lancaster test confirmed the presence of left abducens palsy. Fundus examination showed optic disc swelling in both eyes associated with superotemporal retinal hemorrhage and a small retinal infiltrate with retinal hemorrhage in the nasal periphery in the left eye. Magnetic resonance imaging (MRI) of the brain and orbits showed no abnormalities. A diagnosis of rickettsial disease was suspected and the serologic test for Richettsia Typhi was positive. The patient was treated with doxycycline (100 mg every 12 h) for 15 days with complete recovery of the left lateral rectus motility and resolution of optic disc swelling, retinal hemorrhages, and retinal infiltrate. CONCLUSION Rickettsial disease should be considered in the differential diagnosis of abducens nerve palsy in any patient with unexplained fever from endemic area. Fundus examination may help establish an early diagnosis and to start an appropriate rickettsial treatment.
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Affiliation(s)
- Kaies Abderrahim
- Department of Ophthalmology, Medenine University Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 5019, Monastir, Tunisia
| | - Molka Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 5019, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 5019, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 5019, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 5019, Monastir, Tunisia.
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Gouider D, Khallouli A, Maalej A, Khochtali S, Khairallah M. Role of anterior segment optical coherence tomography in monitoring epidemic keratoconjunctivitis. J Curr Ophthalmol 2021; 33:408-412. [PMID: 35128186 PMCID: PMC8772485 DOI: 10.4103/joco.joco_218_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/08/2020] [Accepted: 06/20/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose: To describe, through anterior segment optical coherence tomography (AS-OCT) images, the different phases of epidemic keratoconjunctivitis (EKC) and show the impact of topical steroid on the course of this disease. Methods: A prospective observational study included 38 eyes (28 patients) with a presumed EKC complicated by subepithelial infiltrates (SEIs) and treated with topical fluorometholone. Slit-lamp examinations and serial AS-OCT were performed on days 7, 14, 30, 90, 180, and 210. The thickness of the whole cornea and thickness of the corneal epithelium were measured with AS-OCT and correlated to the clinical findings on slit-lamp examination in the different EKC phases. Results: In all patients, on day 7, the AS-OCT showed hyperreflective dots that were limited to the epithelial layers of the cornea and slightly rising above the epithelial surface, corresponding to the confluence of the punctuations of punctate epithelial keratitis. On day 14, a hyperreflective line in the Bowman's layer with intact epithelium was noted. On day 30, this hyperreflective band extended rapidly toward the anterior stroma, becoming thicker and more intense, corresponding to the SEI. They gradually decreased in number, intensity, and extent following treatment by topical steroids in 71.4% of the cases. Only two patients had persistent SEI. They were refractory to 3-month treatment by steroids. In these patients, who had persistent SEI, AS-OCT showed that the hyperreflective areas became well-defined, plaque-like lesions with sharp margins associated with disruption of Bowman's layer, localized epithelial thickening, stromal thinning, and a decrease in pachymetry. Conclusion: AS-OCT can be a valuable tool that provides a range of characteristic patterns of EKC and helps in monitoring it.
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Khairallah M, Khochtali S, Ksiaa I. Is There a True Neuroretinitis in Idiopathic Retinal Vasculitis, Aneurysms, and Neuroretinitis (IRVAN) Syndrome ? Ocul Immunol Inflamm 2020; 30:845-847. [PMID: 33331800 DOI: 10.1080/09273948.2020.1836234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose : To clarify whether a true neuroretinitis is part of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome.Methods : Critical literature review.Results : Neuroretinitis has been considered as a prominent feature of IRVAN syndrome. It has been described as late diffuse optic disc staining on fluorescein angiography. However, patients with IRVAN syndrome usually do not present with visual function alterations consistent with optic neuropathy or neuroretinitis. The typical stellate exudative maculopathy seen in IRVAN syndrome is primarily caused by leakage from retinal arteriolar aneurysms at or near the optic disc, and it could be misinterpreted as a feature of neuroretinitis.Conclusion : There is no clinical evidence of true neuroretinitis at any of the disease stages in patients with IRVAN syndrome. The acronym « IRVARE » (Idiopathic Retinal Vasculitis, Aneurysms, and Retinal Exudates) is proposed to better characterize this syndrome.
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Affiliation(s)
- Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Khochtali S, Tugal-Tutkun I, Fardeau C, Maestri F, Khairallah M. Multimodality Approach to the Diagnosis and Assessment of Uveitic Macular Edema. Ocul Immunol Inflamm 2020; 28:1212-1222. [DOI: 10.1080/09273948.2020.1797112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Christine Fardeau
- Ophthalmology Department, Reference Centre for Rare Diseases, Pitié-Salpétrière Hospital, University Paris VI, DHU Sight Restore, Paris, France
| | - Federico Maestri
- Ophthalmology Department, Reference Centre for Rare Diseases, Pitié-Salpétrière Hospital, University Paris VI, DHU Sight Restore, Paris, France
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Kammoun S, Khochtali S, Sehli M, Ben Amor S, Feki J, Khairallah M. Atypical multimodal imaging findings in a patient with multiple evanescent white dot syndrome. J Fr Ophtalmol 2020; 44:e115-e121. [PMID: 33162178 DOI: 10.1016/j.jfo.2020.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- S Kammoun
- Department of Ophthalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, El-Ferdaous avenue, 3029 Sfax, Tunisia
| | - S Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - M Sehli
- Department of Ophthalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, El-Ferdaous avenue, 3029 Sfax, Tunisia.
| | - S Ben Amor
- Department of Ophthalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, El-Ferdaous avenue, 3029 Sfax, Tunisia
| | - J Feki
- Department of Ophthalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, El-Ferdaous avenue, 3029 Sfax, Tunisia
| | - M Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Zina S, Ksiaa I, Abdelhedi C, Ben Amor H, Attia S, Khochtali S, Khairallah M. Multimodal imaging in IRVAN syndrome presenting with Branch Retinal Artery Occlusion. Eur J Ophthalmol 2020; 32:1120672120965492. [PMID: 33092394 DOI: 10.1177/1120672120965492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE To describe multimodal imaging findings in a patient with idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome presenting with branch retinal artery occlusion (BRAO). CASE DESCRIPTION A 33-year-old woman presented with acute BRAO in the right eye. A diagnosis of underlying IRVAN syndrome was made based on the presence of arteriolar aneurysms on the optic disc and along major arterioles and faint retinal hard exudates in both eyes. Eight months later, best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. The hard exudates had increased, and there were extensive areas of peripheral retinal capillary nonperfusion without new vessels. Optical coherence tomography (OCT) showed a localized retinal thinning corresponding to the prior BRAO. Fundus autofluorescence showed nodulo-linear periarterial hypoautofluorescence. OCT angiography (OCTA) showed localized ischemic changes, mainly involving the deep capillary plexus, corresponding to the area of resolved BRAO. It also clearly delineated the optic disc aneurysms. The patient received bilateral scatter laser photocoagulation directed to areas of peripheral capillary nonperfusion. Over a 6-month follow-up period, visual acuity remained unchanged, and there was no evidence of disease progression. CONCLUSION Multimodal imaging, including fundus autofluorescence, OCT, and OCTA can provide additional valuable information in the evaluation of IRVAN syndrome complicated with BRAO.
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Affiliation(s)
- Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Chiraz Abdelhedi
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sonia Attia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Ksiaa I, Ghachem M, Besbes H, Khochtali S, Chouchane S, Khairallah M. Swept-source OCT findings in shaken baby syndrome: case report. BMC Ophthalmol 2020; 20:396. [PMID: 33028244 PMCID: PMC7541327 DOI: 10.1186/s12886-020-01666-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/29/2020] [Indexed: 11/29/2022] Open
Abstract
Background Our purpose was to document the swept source optical coherence tomography (SSOCT) findings in a patient with Shaken baby syndrome (SBS). Case presentation SSOCT was obtained without sedation in a six-month-old girl with bilateral multilayered retinal hemorrhages due to SBS. It documented vitreoretinal interface abnormalities, including internal limiting membrane (ILM) detachment with retinal traction, in association with other specific changes in the inner and outer retinal layers. Six weeks later, retinal hemorrhages had substantially resolved, and there was optic disc pallor. OCT showed ILM reattachment with release of retinal traction and the development of severe diffuse retinal atrophy involving the fovea. Conclusions SS OCT can provide useful information in SBS, revealing a wide variety of vitreoretinal interface, inner, and outer retinal changes not detected by clinical examination. It also may have a prognostic value over follow-up.
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Affiliation(s)
- Imen Ksiaa
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Mohamed Ghachem
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Habib Besbes
- Department of Pediatrics, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Slaheddine Chouchane
- Department of Pediatrics, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.
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Khochtali S, Dridi T, Abroug N, Ksiaa I, Lupidi M, Khairallah M. Swept-Source Optical Coherence Tomography Angiography Shows Choriocapillaris Flow Reduction in Multiple Evanescent White Dot Syndrome. J Curr Ophthalmol 2020; 32:211-215. [PMID: 32671309 PMCID: PMC7337020 DOI: 10.4103/joco.joco_107_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/29/2019] [Accepted: 12/12/2019] [Indexed: 11/04/2022] Open
Abstract
Purpose To report two cases of typical multiple evanescent white dot syndrome (MEWDS), in which swept-source optical coherence tomography angiography (SS-OCTA) revealed transient areas of flow deficit at the level of the choriocapillaris. Methods The SS-OCTA images of two female patients with typical MEWDS were analyzed at the onset of the disease and during follow-up. Results The patients were aged 24 and 25 years, respectively. Previous medical history was unremarkable in both cases. The diagnosis of MEWDS was made on the basis of typical clinical findings and results of fundus autofluorescence, fluorescein angiography, and optical coherence tomography. At presentation, SS-OCTA showed a few small hypointense areas of flow deficit at the level of the choriocapillaris in both cases. During follow-up, SS-OCTA showed complete resolution of choriocapillaris flow voids. Conclusion Both our patients with typical acute MEWDS showed SS-OCTA multifocal small areas of flow reduction at the level of the choriocapillaris, with full recovery during the follow-up. This finding supports the hypothesis of transient, primary, or secondary choriocapillaris hypoperfusion in typical MEWDS.
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Affiliation(s)
- Sana Khochtali
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Tarek Dridi
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Marco Lupidi
- Section of Ophthalmology, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
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Abroug N, Lahdhiri M, Kechida M, Abdeljlil A, Khochtali S, Khairallah M. Panuveitis revealing Melkersson Rosenthal syndrome: a case report. Tunis Med 2020; 98:90-92. [PMID: 32395783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM To describe a case of panuveitis revealing Melkersson Rosenthal syndrome (MRS). CASE REPORT A 35-year-old female with a history of bilateral chronic idiopathic panuveitis was referred for work up. On examination, her visual acuity was 3/10 in the right eye and limited to hand motion in the left eye. Slit lamp examination revealed posterior synechiae and vitritis more severe in the left eye. Fundus examination showed bilateral vascular sheathing with no retinitis or choroiditis. Fluorescein angiography revealed bilateral occlusive retinal vasculitis. A careful questioning of the patient revealed the history of relapsing facial paralysis with palpebral edema. The work up ruled out an underlying infectious disease, especially ocular tuberculosis. Examination of the internist revealed a cheilitis and a fissured tongue. The diagnosis of MRS was made and the patient was treated with systemic corticosteroids and scatter laser treatment of retinal nonperfusion areas. CONCLUSION MRS is a rare disorder. Ocular involvement, especially uveitis, is uncommon. Clinicians should be aware of this syndrome to avoid misdiagnosis and extensive work up.
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Khairallah M, Khochtali S, Mahjoub A, Dridi T, Ksiaa I, Abroug N. Cytomegalovirus retinitis following corticosteroid overdose for Vogt-Koyanagi-Harada disease. Indian J Ophthalmol 2020; 68:2012-2014. [PMID: 32823462 PMCID: PMC7690477 DOI: 10.4103/ijo.ijo_628_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 33-year-old patient was diagnosed with acute Vogt-Koyanagi-Harada (VKH) disease and was prescribed prednisolone (1 mg/kg/day) and azathioprine (2.5 mg/kg/day). She mistakenly took an excessively high dose (4 mg/kg/day) of prednisolone for 14 days. The erroneous dose of corticosteroids was progressively corrected. Several weeks after initial presentation, the patient developed a polymerase chain reaction-proven bilateral cytomegalovirus retinitis, with extensive occlusive arteritis in the right eye. Systemic immunosuppressive therapy was temporarily discontinued and viral retinitis was successfully managed with systemic and intravitreal ganciclovir. Corticosteroids were reintroduced to control recurrent VKH disease. Final visual acuity was 20/1000 in the right eye and 20/50 in the left eye.
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Khochtali S, Abroug N, Megzari K, Gargouri MA, Ksiaa I, Ben Amor H, Saihi E, Khairallah M. Swept-source Optical Coherence Tomography Angiography Findings in Uveitic Cystoid Macular Edema. Ocul Immunol Inflamm 2019; 27:1211-1223. [DOI: 10.1080/09273948.2019.1672195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Kenza Megzari
- Department of Ophthalmology, Valenciennes Hospital Center, Valenciennes, France
| | | | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Emna Saihi
- Department of Ophthalmology, Valenciennes Hospital Center, Valenciennes, France
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Ksiaa I, Abroug N, Mahmoud A, Zina S, Hedayatfar A, Attia S, Khochtali S, Khairallah M. Update on Bartonella neuroretinitis. J Curr Ophthalmol 2019; 31:254-261. [PMID: 31528758 PMCID: PMC6742623 DOI: 10.1016/j.joco.2019.03.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/24/2019] [Accepted: 03/26/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To review the clinical features, diagnosis, treatment modalities, and prognosis of Bartonella-associated neuroretinitis. METHODS This is a narrative review on Bartonella-associated neuroretinitis including general and ophthalmological aspects of the disease. A comprehensive literature review between January 1950 and September 2018 was conducted in PubMed database. Epidemiology, clinical features, diagnosis, treatment, and prognosis of Bartonella neuroretinitis were reviewed. RESULTS Cat scratch disease (CSD) is a worldwide distributed systemic infectious disease caused by a bacterium, Bartonella henselae (B. henselae) which is usually transmitted to humans through contact with infected cats. Ocular manifestations of CSD are diverse, with neuroretinitis and superficial retinal infiltrates being the most common and typical manifestations. Neuroretinitis typically presents as optic disc edema with a partial or complete macular star in association with mild vitritis. Macular star may be absent at the initial presentation, becoming evident 1-2 weeks after the onset of optic disc edema. Diagnosis of CSD is confirmed by reliable laboratory tests. Neuroretinitis usually has a self-limited course. Antibiotic therapy is required for severe systemic disease and vision-threatening ocular involvement. The adjunctive use of oral corticosteroids may further improve the visual outcome. CONCLUSIONS The diagnosis of Bartonella-associated neuroretinitis is based on typical clinical findings and positive serology. The prognosis is usually favorable in immunocompetent individuals.
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Affiliation(s)
- Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Anis Mahmoud
- Department of Ophthalmology, Tahar Sfar University Hospital, Mahdia, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Alireza Hedayatfar
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Sonia Attia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Ksiaa I, Abroug N, Kechida M, Zina S, Jelliti B, Khochtali S, Attia S, Khairallah M. Œil et maladie de Behçet. J Fr Ophtalmol 2019; 42:626-641. [DOI: 10.1016/j.jfo.2018.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 09/03/2018] [Indexed: 12/30/2022]
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Abroug N, Zina S, Khairallah M, Ksiaa I, Kechida M, Ben Amor H, Khochtali S, Khairallah M. Diagnosing retinal vasculitis and its implications for treatment. Expert Review of Ophthalmology 2019. [DOI: 10.1080/17469899.2019.1613153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Molka Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Melek Kechida
- Internal Medicine Department, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Khochtali S, Kadri A, Bouabana A, Ben Amor H, Khairallah M, Zaouali S, Khairallah M. [Multimodal imaging in a case of drusen-like deposits associated with systemic lupus erythematosus]. J Fr Ophtalmol 2019; 42:e107-e110. [PMID: 30851970 DOI: 10.1016/j.jfo.2018.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 10/27/2022]
Affiliation(s)
- S Khochtali
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, Monastir, Tunisie.
| | - A Kadri
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, Monastir, Tunisie
| | - A Bouabana
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, Monastir, Tunisie
| | - H Ben Amor
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, Monastir, Tunisie
| | - M Khairallah
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, Monastir, Tunisie
| | - S Zaouali
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, Monastir, Tunisie
| | - M Khairallah
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, Monastir, Tunisie
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Abstract
PURPOSE To review the systemic and ocular manifestations of specific emergent viral infectious diseases relevant to the ophthalmologist with particular emphasis on anterior uveitis Methods: Review of literature. RESULTS Arboviral diseases are among the most important emergent and resurgent human infections, occurring mostly in tropical and subtropical zones, but appearing in virtually all regions of the world as a result of climate change, travel, and globalization. Arboviral infections are transmitted to humans by the bite of hematophagous arthropods, mainly mosquitoes. Systemic disease may range from asymptomatic to life-threatening. A wide variety of ocular manifestations, including uveitis, has been reported in association with these emerging viral diseases. Numerous viruses other than arboviruses also have been recently recognized as a potential cause of uveitis. CONCLUSIONS Proper clinical diagnosis of any emerging infectious disease is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular involvement. The diagnosis is usually confirmed by detection of virus-specific DNA or antivirus antibodies in serum.
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Affiliation(s)
- Moncef Khairallah
- a Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine , University of Monastir , Monastir , Tunisia
| | | | - Andre Curi
- c Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Diseases , Oswaldo Cruz Foundation , Rio de Janeiro , Brazil
| | - Sana Khochtali
- a Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine , University of Monastir , Monastir , Tunisia
| | - Emmett T Cunningham
- d Department of Ophthalmology , California Pacific Medical Center , San Francisco , CA , USA.,e Department of Ophthalmology , Stanford University School of Medicine , Stanford , CA , USA.,f UCSF School of Medicine , The Francis I. Proctor Foundation , San Francisco , CA , USA
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Hedayatfar A, Khochtali S, Khairallah M, Takeuchi M, El Asrar AA, Herbort CP. "Revised diagnostic criteria" for Vogt-Koyanagi-Harada disease fail to improve disease management. J Curr Ophthalmol 2018; 31:1-7. [PMID: 30899839 PMCID: PMC6407152 DOI: 10.1016/j.joco.2018.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/09/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Alireza Hedayatfar
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.,Department of Ophthalmology, Fattouma Bourghiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia.,Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan.,Department of Ophthalmology, and Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourghiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia.,Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan.,Department of Ophthalmology, and Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourghiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia.,Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan.,Department of Ophthalmology, and Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defence Medical College, Tokorozawa, Saitama, Japan.,Department of Ophthalmology, and Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Ahmed Abu El Asrar
- Department of Ophthalmology, and Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.,Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
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Khochtali S, Abroug N, Ksiaa I, Zina S, Attia S, Khairallah M. Atypical white dot syndrome with choriocapillaris ischemia in a patient with latent tuberculosis. J Ophthalmic Inflamm Infect 2018; 8:20. [PMID: 30392069 PMCID: PMC6215535 DOI: 10.1186/s12348-018-0162-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/24/2018] [Indexed: 11/28/2022] Open
Abstract
Background White dot syndromes (WDS) are a group of idiopathic multifocal inflammatory conditions that can be recognized and distinguished by lesion morphology, other specific clinical features, imaging findings, and disease course. Our purpose is to describe an atypical case of WDS with choriocapillaris ischemia shown by multimodal imaging including swept-source OCT angiography (OCTA) in a 30-year-old woman with latent tuberculosis. Findings At presentation, visual acuity in the left eye was 20/500. Clinical findings included macular granularity, diffuse outer retinal discoloration with satellite yellow-white dots, and disc margin blurring. Fluorescein angiography showed early confluent areas of choroidal hypofluorescence and late perifoveal punctate hyperfluorescence. There was choroidal hypofluorescence in a geographic configuration throughout the indocyanine green angiography sequence. OCTA showed confluent geographic areas of loss of signal in the choriocapillaris. Work-up revealed latent tuberculosis. The patient received corticosteroids and prophylactic anti-tubercular treatment. Nine months later, visual acuity had improved to 20/20, and there were some residual retinal pigment epithelium changes. Conclusion Atypical WDS associated with choriocapillaris hypoperfusion may show features of multiple evanescent white dot syndrome and acute posterior multifocal placoid pigment epitheliopathy melting together.
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Affiliation(s)
- Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sonia Attia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia.
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Khochtali S, Gargouri S, Zina S, Ksiaa I, Abroug N, Zaouali S, Jelliti B, Attia S, Khairallah M. Acute multifocal retinitis: a retrospective review of 35 cases. J Ophthalmic Inflamm Infect 2018; 8:18. [PMID: 30328571 PMCID: PMC6192942 DOI: 10.1186/s12348-018-0160-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/05/2018] [Indexed: 11/29/2022] Open
Abstract
Background Acute multifocal retinitis is a rare condition that has been considered to be often idiopathic. The purpose of this study was to analyze clinical features and causes of acute multifocal retinitis. Results This study is a retrospective review of the charts of 35 patients with acute multifocal retinitis. Patients with three or more retinal lesions in at least one eye, with at least one lesion of less than 500 μm in size were included. All patients had complete ophthalmological examination, fundus photography, and fluorescein angiography. Twelve patients (34.3%) had optical coherence tomography. An extensive work-up was performed including a detailed comprehensive medical history, examination by an internist and an infectious disease specialist, a chest X-ray, Mantoux test, and laboratory tests for syphilis, human immunodeficiency virus, Bartonella, and Rickettsia. Of the 35 patients, 25 (71.4%) had bilateral involvement and 10 (28.6%) had unilateral involvement (total number of eyes: 60). Mean best-corrected visual acuity (BCVA) was 20/25 (range, 20/1000–20/20). Retinal lesions ranged from 3 to more than 20 in number in at least 1 eye, and from 150 to 1500 μm in size. Associated findings included mild anterior chamber inflammation in 5 eyes (8.3%), mild vitritis in 46 eyes (76.7%), optic disc swelling in 9 eyes (15%), macular star in 4 eyes (6.7%), exudative retinal detachment in 6 eyes (10%), and branch retinal artery occlusion in 6 eyes (10%). Acute multifocal retinitis was found to be caused by Rickettsia conorii infection in 20 patients (57.1%), Rickettsia typhi infection in 4 patients (11.4%), cat-scratch disease in 8 patients (22.9%), and syphilis in 1 patient (2.9%). It was idiopathic in two patients (5.7%). Retinal lesions resolved without scarring in 3 to 12 weeks in all but three eyes (5%), in which residual retinal pigment epithelial changes were noted. Conclusion Rickettsial disease was the most common cause of acute multifocal retinitis. Other identified causes included cat-scratch disease and syphilis, and a very small subset of patients was diagnosed with idiopathic multifocal retinitis.
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Affiliation(s)
- Sana Khochtali
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Salma Gargouri
- Department of Ophthalmology, Faculty of Medicine, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Sonia Zaouali
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Bechir Jelliti
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Sonia Attia
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.
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Khochtali S, Daldoul N, Zina S, Kadri A, Ben Yahia S, Khairallah M. [Corneal involvement in tyrosinemia type II mimicking herpetic keratitis: Case report in an adult]. J Fr Ophtalmol 2018; 41:e315-e318. [PMID: 30126694 DOI: 10.1016/j.jfo.2017.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 11/19/2022]
Affiliation(s)
- S Khochtali
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, 5019 Monastir, Tunisie.
| | - N Daldoul
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, 5019 Monastir, Tunisie
| | - S Zina
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, 5019 Monastir, Tunisie
| | - A Kadri
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, 5019 Monastir, Tunisie
| | - S Ben Yahia
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, 5019 Monastir, Tunisie
| | - M Khairallah
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, 5019 Monastir, Tunisie
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Kechida M, Khochtali S, Benamor H, Zina S, Attia S, Khairallah M. Les sclérites : étiologies et modalités de prise en charge. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kechida M, Khochtali S, Zina S, Lahdhiri M, Zaouali S, Khairallah M. Pemphigoïde oculaire cicatricielle sévère : à propos de 5 cas. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Khochtali S, Ksiaa I, Megzari K, Khairallah M. Retinal Pigment Epithelium Detachment in Acute Vogt-Koyanagi-Harada Disease: An Unusual Finding at Presentation. Ocul Immunol Inflamm 2018. [PMID: 29513616 DOI: 10.1080/09273948.2018.1433304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: To report the cases of two patients who presented with acute Vogt-Koyanagi-Harada (VKH) disease and associated retinal pigment epithelium detachment (PED). Methods: 2 case reports. Case 1: A 22-year-old male patient complained of acute bilateral decrease in vision. Initial best corrected visual acuity (BCVA) was 20/63, OU. There was 1+ vitreous cells, OU, exudative retinal detachment (ERD) in the right eye (RE), and a macular deep yellow lesion suggestive of PED in the left eye (LE). Case 2: A 40-year-old female patient presented with bilateral vision blurring. BCVA was 20/40 in the RE and 20/32 in the LE. There was 1+ vitreous cells OU, bilateral optic disc swelling and retinal striae. Results: Multimodal imaging showed features of acute VKH disease with associated PED in the two patients. ERD and PED resolved under oral prednisone and cyclosporine in both cases. Conclusion: PED may rarely occur in acute VKH disease at presentation.
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Affiliation(s)
- Sana Khochtali
- a Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine , University of Monastir , Monastir , Tunisia
| | - Imen Ksiaa
- a Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine , University of Monastir , Monastir , Tunisia
| | - Kenza Megzari
- a Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine , University of Monastir , Monastir , Tunisia
| | - Moncef Khairallah
- a Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine , University of Monastir , Monastir , Tunisia
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Khochtali S, Salah Hani M, Ksiaa I, Zina S, Ben Yahia S, Jelliti B, Khairallah M. Crise de glaucome par fermeture de l’angle révélant une maladie inflammatoire du segment postérieur : à propos de 2 cas. J Fr Ophtalmol 2017; 40:e409-e412. [DOI: 10.1016/j.jfo.2017.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 11/26/2022]
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48
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Khochtali S, Zina S, Kechida M, Chakroun H, Bellassoued O, Jelliti B, Khairallah M. [Anterior uveitis as the presenting sign of chronic lymphocytic leukemia]. J Fr Ophtalmol 2017; 40:e337-e338. [PMID: 28992953 DOI: 10.1016/j.jfo.2017.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/13/2016] [Accepted: 04/03/2017] [Indexed: 10/18/2022]
Affiliation(s)
- S Khochtali
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, 5019 Monastir, Tunisie.
| | - S Zina
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, 5019 Monastir, Tunisie
| | - M Kechida
- Faculté de médecine, université de Monastir, 5019 Monastir, Tunisie; Service de médecine interne, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie
| | - H Chakroun
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, 5019 Monastir, Tunisie
| | - O Bellassoued
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, 5019 Monastir, Tunisie
| | - B Jelliti
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, 5019 Monastir, Tunisie
| | - M Khairallah
- Service d'ophtalmologie, hôpital universitaire Fattouma-Bourguiba, 5019 Monastir, Tunisie; Faculté de médecine, université de Monastir, 5019 Monastir, Tunisie
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Khairallah M, Khochtali S, Abroug N. The place of OCT-angiography in uveitis. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.02133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M. Khairallah
- Ophthalmology; Fattouma Bourguiba University Hospital; Monastir Tunisia
| | - S. Khochtali
- Ophthalmology; Fattouma Bourguiba University Hospital; Monastir Tunisia
| | - N. Abroug
- Ophthalmology; Fattouma Bourguiba University Hospital; Monastir Tunisia
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Khairallah M, Khochtali S, Mahmoud A, Ben Amor H. Tuberculosis. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.03533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Khairallah
- Ophthalmology; Fattouma Bourguiba University Hospital; Monastir Tunisia
| | - S. Khochtali
- Ophthalmology; Fattouma Bourguiba University Hospital; Monastir Tunisia
| | - A. Mahmoud
- Ophthalmology; Fattouma Bourguiba University Hospital; Monastir Tunisia
| | - H. Ben Amor
- Ophthalmology; Fattouma Bourguiba University Hospital; Monastir Tunisia
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