- [Show abstract] [Hide abstract] ABSTRACT: Occupational injury represents 7,7 at 69,9% of the total ocular traumatisms. They can be a major source of visuel loss and blindness. The aim is to study the epidemiology of work-related ocular injuries: objects frequencies,works most exposed. We performed a prospective study that interest 78 patients having a work-related ocular traumatism during a 4 months period. They were admitted at ocular emergeney All patients underwent an ophtalmologic examination completed with orbital radiography and echography. A medical and/or chirurgical appropriate treatment was institued. Occupationnal injury frequency was 9% of the whole ocular traumatisms in the same period. The mean age was 31 years. 55% of cases were under 30 years. 91% were male. Most exposed works were industrial and mecanical sectors In 70,5% of cases work-related eye injuries were caused by projectile objects. Most common lesion was corneal superficial foreign body (58%). Open globe injury was noted in 8%. 95% of patients had no eye protection at the time of the accident. 13% were blind or unilateral partially sighted (according to the OMS classification). The authors discussed the importance and different prevention strategies to prevent the risk of blindness and socio-economical cost of occupationnal accidents. There is a need for systematic periodic sensibilization to reduce these accidents and blindness.
- [Show abstract] [Hide abstract] ABSTRACT: Aims: to estimate the prevalence of visual impairment and blindness; to identify the major causes of visual impairment and blindness and to estimate their overall impact, particularly on cataracts. Methods: We used a population-based method. A cluster sample was selected, with the number of households randomly selected firm a community depending on the size of the population. Examinations and data collection were carried out using the procedures recommended by the WHO. Results: We included 3,981 individuals, 3,547 of whom were given a medical examination (89% participation). The structure of the sample differed from that of the Tunisian population, with people over the age of 60 years over represented in the sample. The crude prevalence of blindness was 1.2% (adjusted prevalence 0.8%) and that for bilateral visual impairment was 3% (adjusted prevalence 2%). There were 225,000 individuals with severely impaired vision, of whom 64,500 were blind (including 2,100 children under the age of 15 years) and 160,000 were visually impaired (including 8,700 children). Individuals over the age of 60 were eight times more likely to become blind and 6.7 times more likely to suffer visual impairment than those below the age of 60. Cataracts, particularly associated with aging, were the main cause of blindness (66%) and bilateral visual impairment (54.6%). Uncorrected aphakia accounted for a significant fraction of the visual deficiencies identified in this survey (6.4% of cases of blindness and 11.8% of cases of bilateral visual impairment). 1.7% of the individuals examined (135,000 people) had ocular surgery and 80,000 had undergone surgery for cataracts. Only 41% of those individuals who had cataracts had undergone surgery. The provision of cataract surgery was therefore inadequate. Conclusion: About 80% of the cases of blindness registered were preventable or treatable. The development of appropriate strategies for dealing with cataract blindness should significantly reduce the incidence of blindness.
- [Show abstract] [Hide abstract] ABSTRACT: Subretinal neovascularization (SRNV) were a severe disease which could threaten seriously visual function. They were often confined to the vicinity of the fovea and in spite of laser treatment recurrence and blindness were very frequent. Full ophtalmologic examination and fluorescein angiography were performed in thirty nine eyes of twenty seven patients with SRNV - SRNV were unilateral in fifteen cases. Laser treatment was achieved in 24% of cases. Age related macular degeneration (ARMD) and high myopia were the main etiology. Fluorescein angiography allowed to diagnosis of defined SRNV in 92% of cases: 52% at early stages and 40% at glial fibrosis scars. Occult SRNV were noted in the remain cases. 60 % of patients had legal blindness. The importance of early angiogrpahy and urgent laser treatment to avoid blindness are raised.
- [Show abstract] [Hide abstract] ABSTRACT: Chorioretinal toxoplasmosis can threaten visual function when located in the posterior pole. The aim of this study was to compare the advantages and disadvantage of combination of malocid-sulfadiazine and clindamycin subconjunctivally. Two groups of patients affected by unilateral chorioretinal toxoplasmosis were studied. The diagnosis was performed in 77% of cases on acqueous humor analysis. The first group of twenty-six patients was treated with a combination of malocid-sulfadiazine while the second group (seventeen patients) was treated with clindamycin subconjunctivally. Local and general corticosteroids were associated in all cases. Mean follow-up was 19 months in the first group and 16.5 months in the second. Visual acuity was increased in 88.5% of cases in the first group and in 94% of cases in the second group. Cicatrization obtained in both groups was comparably delayed 1.68 months for the first and 1.26 months for the second. Recurrences were rarely observed in the two groups: respectively 8% and 6% of cases. No local and general complication was noted. These findings suggest the advantages of subconjunctival clindamycin treatment due to the absence of general hematological toxicity.
Article: Ocular motor palsies in diabetics[Show abstract] [Hide abstract] ABSTRACT: Ocular motor palsies (OMP) in fifteen diabetic were studied. The common ocular motor nerve was affected in 60% of cases and the external oculomotor nerve in 33% of cases. Clinical features and risk factors of such nerve palsies were described. All cases achieved spontaneous total improvement after one to three months. However, such OMP were benign. A full neurological examination in any diabetic OMP to eliminate a central nerve disease is of major importance.
- [Show abstract] [Hide abstract] ABSTRACT: Retinal arterial occlusion (RAO) has local and general severity, so that it is important to found its aetiology. The authors reported three cases of unilateral retinal arterial occlusion, which occured in young patients between 28 to 34 old years. Clinical and angiographic features were described. Etiology investigation allowed to reveal a cardiopathy thus far unrecognized. The anticogulant therapy has avoided the bilateralisation. The importance of aetiology investigation to prevent bilateralisation and other severe vascular accident are raised.
- [Show abstract] [Hide abstract] ABSTRACT: We report the results of a randomized study concerning seventy two patients either with no diabetic retinopathy (DR) or with background retinopathy, among which thirty three were treated with aspirin® (250 mg per day). The assessment of treatment was based on the course of visual functions, visual acuity, color vision, automated central visual field and anatomic state: eye fundus, color photographs, angiography. After a 28.5 months follow-up, a significant reduction of color vision worsening was observed in all patients treated with aspirin. Similar results were observed for the course of visual field, but only in cases with no DR. However the reduction of anatomic worsening which was somewhat lower in treated patients did not reach statistical significance. The greater place of visual field and color vision in the screening and follow up of DR was discussed.
Article: The cornea of diabetics[Show abstract] [Hide abstract] ABSTRACT: The aim of the study is to investigate corneal sensitivity and the risk factors of corneal hypoesthaesia in diabetics. General examination and full ophthalmologic examination completed by exploration of corneal sensitivity were performed in one hundred thirty diabetic patients. Eleven per cent of patients showed microkystic oedema, whereas corneal hypoesthaesia was found in 45% of cases. Corneal hypoesthaesia was correlated with the duration and balance of diabetic mellitus, the age of patients and the presence of diabetic retinopathy. On the other hand, peripheral neuropathy was found in 88% of cases. Ophthalmologic examination of diabetics should not be limited to retina only but should also include the entire eye ball and especially the cornea in patients with high risk.
Article: [Choroid metastases][Show abstract] [Hide abstract] ABSTRACT: The aim of the present study is to investigate the clinical features and the risk factors characteristic of choroidal metastasis, which is known as the most common malignant neoplasm of the adult eye. A systematic ophthalmologic examination together with angiography and echography were performed in 106 patients with carcinoma. 10% of patients showed choroïdal metastasis. Breast and bronchogenic carcinoma were the most common primary tumor. 82% of cases died within a mean 6.5 months. Clinical, angiographic, echographic and histopathologic features of such metastasis were described. The importance of an early diagnosis of such metastasis are raised.
- [Show abstract] [Hide abstract] ABSTRACT: The aim of this study is to investigate the various tests which allow to detect and follow-up diabetic retinopathy (DR). Sixteen patients without DR or with background retinopathy underwent, once every six months: a full ophthalmologic investigation; a fluorescein angiography; a color vision test; a central visual field investigation. The impairment of angiography preceeded damage of eye fundus in 27% of cases. Deficiency of color vision and visual field were found in 57% of cases and in 35% respectively. These preceeded the appearance of angiographic DR in 50% of cases and 32% of cases respectively. The importance of such tools in the evolution of DR especially in young diabetics is discussed.
- [Show abstract] [Hide abstract] ABSTRACT: Endophthalmitis is a serious disease with multiple aetiologies. Its development seems to be dependent upon various risk factors. Among 99 cases of endophthalmitis, 79% were secondary to intraocular surgery especially cataract surgery and perforating ocular trauma. To identify risk factors of post-cataract surgery endophthalmitis, we performed a case-control study: 55 cases and 269 controls were used. Five risk factors were identified: duration of the operative procedure longer than 60 min, suture dehiscence, persistence of lens mass, traumatic cataract and left eye operated. The importance of prevention of endophthalmitis by avoiding such risk factors is raised.
Article: Diabetic retinopathy in children[Show abstract] [Hide abstract] ABSTRACT: Diabetic retinopathy (DR), a severe complication of diabetic microangiopathy, is a major cause of blindness in children. Among 235 patients with diabetes mellitus diagnosed before 18 years age (mean age: 17.5 years) 39% had DR. Background retinopathy was found in 21% of cases, pre proliferative or proliferative retinopathy in 15% of cases and macular edema in 3% of cases only. The risk factors of DR were the duration and the degree of imbalance of diabetes, age of patients at the diagnosis of diabetes and also at the time of ophtalmologic examination. Regularly well balanced diabetes and also an ophtalmologic follow up of diabetic children especially during the puberty are of major importance.