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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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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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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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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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6
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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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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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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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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, Kechida M, Zina S, Lahdhiri M, Abroug N, Khairallah M. Acute lymphoblastic leukemia relapse presenting as retinal vasculitis. Clin Case Rep 2020; 8:1467-1471. [PMID: 32884776 PMCID: PMC7455396 DOI: 10.1002/ccr3.2895] [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: 01/08/2020] [Revised: 04/01/2020] [Accepted: 04/05/2020] [Indexed: 11/08/2022] Open
Abstract
Retinal vasculitis may occur as an isolated manifestation of acute lymphoblastic leukemia (ALL) relapse and precede central nervous involvement. Therefore, a high index of suspicion and repeated ocular and neurological evaluations are essential for early diagnosis and prompt appropriate treatment to save life and sight.
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Affiliation(s)
- Imen Ksiaa
- Department of OphthalmologyFaculty of MedicineFattouma Bourguiba University HospitalUniversity of MonastirMonastirTunisia
| | - Melek Kechida
- Department of Internal Medicine and EndocrinolgyFaculty of MedicineFattouma Bourguiba University HospitalUniversity of MonastirMonastirTunisia
| | - Sourour Zina
- Department of OphthalmologyFaculty of MedicineFattouma Bourguiba University HospitalUniversity of MonastirMonastirTunisia
| | - Marouane Lahdhiri
- Department of OphthalmologyFaculty of MedicineFattouma Bourguiba University HospitalUniversity of MonastirMonastirTunisia
| | - Nesrine Abroug
- Department of OphthalmologyFaculty of MedicineFattouma Bourguiba University HospitalUniversity of MonastirMonastirTunisia
| | - Moncef Khairallah
- Department of OphthalmologyFaculty of MedicineFattouma Bourguiba University HospitalUniversity of MonastirMonastirTunisia
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Migaou A, Ben Saad A, Joobeur S, Ben Abdeljelil N, Zina S, Cheikh Mhammed S, Rouatbi N, Fahem N. Choroidal metastasis as the initial presentation of lung adenocarcinoma: A case report. Respir Med Case Rep 2020; 29:100992. [PMID: 31956477 PMCID: PMC6957837 DOI: 10.1016/j.rmcr.2019.100992] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/26/2019] [Accepted: 12/26/2019] [Indexed: 11/19/2022] Open
Abstract
Clinical reports of symptomatic choroidal metastasis as the initial presentation of lung cancer are rare. Here, we report such a presentation in a female patient of non small cell lung cancer. She presented with loss of vision in her left eye. On further analyses, the patient was diagnosed with a lung adenocarcinoma.
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Affiliation(s)
- Asma Migaou
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
- Corresponding author.
| | - Ahmed Ben Saad
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Sameh Joobeur
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | | | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | | | - Naceur Rouatbi
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Nesrine Fahem
- Pulmonology Department, Fattouma Bourguiba Hospital, 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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15
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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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Abroug N, Ksiaa I, Nefzi D, Zina S, Nabi W, Khairallah M. Carotid artery dissection following dental extraction revealed by ischaemic optic neuropathy. Tunis Med 2019; 97:153-156. [PMID: 31535709] [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: 06/10/2023]
Abstract
AIM To describe a case of posterior ischemic optic neuropathy (PION) revealing carotid arterial dissection occurring after ipsilateral tooth extraction. CASE REPORT A 56-year-old patient referred for sudden loss of vision of the left eye (LE) since 3 weeks. Initial visual acuity was 10/10 in the right eye (RE) and limited to light perception in the LE. Ophthalmological examination was without abnormalities in the RE. A relative afferent pupillary defect was noted in the LE. Fundus examination of the LE revealed a papillary pallor, without excavation. Fluorescein angiography revealed no abnormalities in both eyes, including normal choroidal filling. The diagnosis of left PION was retained. A careful questioning of the patient revealed the history of tooth extraction under intra-oral local anesthesia one day before the vision loss. Investigational work up revealed a dissection of the left internal carotid artery. CONCLUSION Dissection of the internal carotid artery is a rare but possible cause of PION. Ocular involvement may be the only manifestation. Clinicians should be aware of such manifestation especially in case of particular context of micro-trauma, such as dental procedures, and look for an underlying cause that may be potentially fatal.
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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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22
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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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23
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Mahmoud A, Abid F, Ksiaa I, Zina S, Messaoud R, Khairallah M. Bilateral acute angle-closure glaucoma following tramadol subcutaneous administration. BMC Ophthalmol 2018; 18:50. [PMID: 29454329 PMCID: PMC5816554 DOI: 10.1186/s12886-018-0715-4] [Citation(s) in RCA: 3] [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: 08/31/2017] [Accepted: 02/12/2018] [Indexed: 11/21/2022] Open
Abstract
Background To report a case of bilateral acute angle closure-glaucoma following the use of subcutaneous Tramadol. Case presentation A 42-year-old healthy man with unremarkable past medical and ocular history, was admitted to the Orthopedic Department for surgical treatment of a bilateral open fracture of the femur following a road accident. Three hoursafterTramadolsubcutaneous injection, the patient complained of a bilateral acute painful visual loss with persistent vomiting. An ocular examination showed bilateral acute angle-closure-glaucoma. The patient was treated with topical anti-glaucoma therapy and intravenous Mannitol 20%.After resolution of ocular hypertension attack, NdYag laser peripheral iridotomy was performed on both eyes. After a follow-up period of 7 days visual acuity improved to 20/20 in both eyes and intraocular pressure returned to normal levels. Conclusions This case highlights the risk of developing bilateral acute angle-closure glaucoma after Tramadol administration. Keywords Angle closure glaucomaMydriasisTramadolAnterior segment OCT
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Affiliation(s)
- Anis Mahmoud
- Department of Ophthalmology, Tahar Sfar University Hospital, Mahdia; Faculty of Medicine, University of Monastir, Monastir, Tunisia.
| | - Fatma Abid
- Department of Ophthalmology, Tahar Sfar University Hospital, Mahdia; 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
| | - Riadh Messaoud
- Department of Ophthalmology, Tahar Sfar University Hospital, Mahdia; 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, 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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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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Ben Abderrahim K, Zina S, Khairallah M, Ksiaa I, Jelliti B, Khairallah M. Optical coherence tomography angiography in occlusive retinal vasculitis. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.01183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
| | - S. Zina
- Department of Ophthalmology; Fattouma Bourguiba University Hospital; Monastir Tunisia
| | - M. Khairallah
- Department of Ophthalmology; Fattouma Bourguiba University Hospital; Monastir Tunisia
| | - I. Ksiaa
- Department of Ophthalmology; Fattouma Bourguiba University Hospital; Monastir Tunisia
| | - B. Jelliti
- Department of Ophthalmology; Fattouma Bourguiba University Hospital; Monastir Tunisia
| | - M. Khairallah
- Department of Ophthalmology; Fattouma Bourguiba University Hospital; Monastir Tunisia
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Kahloun R, Ben Amor H, Ksiaa I, Zina S, Jelliti B, Ben Yahia S, Khairallah M. Multimodal imaging in a case of bilateral outer retinitis associated with mumps infection. Int Ophthalmol 2016; 38:339-343. [PMID: 28028739 DOI: 10.1007/s10792-016-0417-y] [Citation(s) in RCA: 2] [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: 12/07/2016] [Accepted: 12/11/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the results of multimodal imaging of acute outer retinitis associated to mumps infection. METHODS A patient with mumps-associated outer retinitis evaluated by color fundus photography, spectral domain optical coherence tomography (SD-OCT), optical coherence tomography angiography, fundus autofluorescence (FAF), fluorescein angiography (FA), and indocyanine green angiography (ICGA). RESULTS We report a case of a 12-year-old boy who developed bilateral outer retinitis related to mumps. Ophthalmoscopy showed confluent areas of outer retinitis involving the posterior pole and the periphery with a centrifugal gyrate pattern. SD-OCT revealed a marked disorganization of the outer retinal layers with multiple highly reflective spicules. FA shows diffuse late hyperfluorescence with optic disk staining. ICGA shows macular and peripheral hyperfluorescent lesions with a geographical pattern in the late phases. The patient was treated with acyclovir and oral prednisone. Four weeks after presentation visual acuity remained unchanged, and retinal changes seen at the acute phase had resolved leading to extensive retinal atrophy and optic disk pallor. SD-OCT showed atrophy of the retinal pigment epithelial and outer retinal layers. FAF revealed scattered hyperautofluorescent lesions. Electrophysiology showed generalized retinal dysfunction. CONCLUSIONS Mumps infection should be considered in the differential diagnosis of bilateral necrotizing outer retinitis in children and young adults. A multimodal imaging approach may help distinguish mumps-associated retinitis from other causes of viral retinitis and facilitate appropriate management.
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Affiliation(s)
- Rim Kahloun
- 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
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 5019, Monastir, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 5019, Monastir, Tunisia
| | - Bechir Jelliti
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 5019, Monastir, Tunisia
| | - Salim Ben Yahia
- 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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Kechida M, Khochtali S, Zina S, Ben Nasr M, Klii R, Hammami S, Khochtali I, Khairallah M. Les sclérites : un motif de collaboration entre internistes et ophtalmologistes. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.249] [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: 11/30/2022]
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