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To present the efficacy of autologous neurosensory retinal transplantation in macular holes surgery with rhegmatogenous retinal detachment. Eleven eyes of 11 patients with rhegmatogenous retinal detachment associated to a large macular hole were enrolled between January 2019 and January 2021 in the Department A of the Hedi Rais Institute of Ophthalmology (Tunis, Tunisia). All patients underwent a 23 G pars plana vitrectomy. An autologous neurosensory retinal patch was placed inside the macular hole. Long-acting silicone tamponade was carried out. Clinical features of the macular area, best-corrected visual acuity (BCVA), fundus examination, and SD-OCT were recorded before surgery, at 1- and 3-month follow-up after surgery. The mean age of our population was 56.6 ± 10.33 years old, ranged from 45 to 76 years old. Final retinal reattachment was achieved clinically in all eyes. The Spectral domain-Optical Coherence Tomography (SD-OCT) follow-up showed the macular hole closure. The retinal patch was demonstrated by OCT at each control. BCVA improved from 1.52 ± 0.23 Logarithm of the Minimum Angle of Resolution (LogMAR) to 0.89 ± 0.16 LogMAR 3 months after surgery (p= 0.014). No adverse events were registered during the study. Autologous neurosensory retinal transplantation has been efficient to treat macular hole associated to rhegmatogenous retinal detachment. Further multicentric studies with a large number of patients are needed to establish the results of this technique in complex cases. [ABSTRACT FROM AUTHOR]

Purpose: To describe ocular manifestations of acute leukemia in a Tunisian cohort and to assess the associations between ophthalmic findings and epidemiological, clinical, and biological features of the disease. Methods: A prospective study included patients newly diagnosed with acute leukemia referred to our clinics between January 2019 and July 2020. All patients underwent a complete ophthalmic evaluation and spectral-domain optical coherence tomography (SD-OCT) at presentation, then every two months during one year. We defined two groups: Group 1 included patients with leukemic ophthalmopathy and group 2 included patients with normal ophthalmic examination. Results: Forty-six patients were enrolled. The mean age of patients was 32.1± 15.3 years. The sex ratio M/F was 1.55 (28 male patients and 18 females). Twenty-nine patients (63%) had acute myeloid leukemia (AML), and 17 (37%) had acute lymphoblastic leukemia (ALL). The average follow-up was 9.1 months (range: 3– 12 months). We observed ophthalmic manifestations in 28 patients (61%). Among them, 17 (61%) had vision-threatening complications. The posterior segment was the most common site of ocular involvement (82% of group1). Primary leukemic infiltration (Disc edema, ptosis, exophthalmos) was present in 13 eyes (14.1%). Twenty-seven eyes (29.3%) had secondary involvement lesions (Subconjunctival hemorrhage, periorbital ecchymosis, retinal/sub-hyaloid hemorrhage, dilated/tortuous veins). Twenty-one eyes (22.8%) showed other ocular manifestations which etiopathogenesis is not yet fully understood (White-centred hemorrhages, cotton-wool spots, serous retinal detachment, hemorrhagic pigment epithelial detachment). Leukemic retinopathy was significantly more frequent in adults (23/39 and 1/7 in adult and pediatric groups, respectively; p=0.003). Patients suffering from AML were more likely to have secondary ocular involvement (20/29 and 7/17 in AML and ALL patients, respectively; p=0.047). Retinal hemorrhages were statistically associated with anemia and thrombocytopenia (p=0.041 and p=0.034; respectively). Conclusion: Leukemic ophthalmopathy seems to be frequent and may lead to severe visual impairment. An ophthalmic assessment complemented with SD-OCT has paramount importance in all newly diagnosed acute leukemic patients. [ABSTRACT FROM AUTHOR]

To describe a case of outer retinitis with frosted branch angiitis associated with mumps infection treated with hyperbaric oxygen (HBO) therapy. Observational case report A four-year-old boy with bilateral blindness was diagnosed with necrotizing outer retinitis with frosted branch angiitis associated with serologically confirmed mumps virus infection. He was treated with HBO therapy. Visual acuity subsequently improved to 20/40 in the right eye and to 20/320 in the left eye. Sequential follow-up optical coherence tomography examinations showed progressive recovery of the outer retinal layers in the right eye. HBO therapy appears to be a feasible and safe treatment that might improve the anatomical and functional outcome in patients with mumps retinitis. [ABSTRACT FROM AUTHOR]

Intralenticular abscess is a very rare entity that has been described after penetrating trauma, intraocular surgery and metastatic spread. We report a case of intralenticular abscess treated surgically by phacoemulsification with good postoperative results. A 32-year-old patient presented with right eye redness and defective vision of 4 days following thorn injury. The visual acuity was limited to counting fingers. Anterior segment examination revealed healed lamellar corneal tear, 3+ cells in the anterior chamber, iris synechia and heterogeneous opacity of the crystalline lens. Vitreous and fundus were normal. Initially, we prescribed topic and systemic antimicrobial treatment. Lens extraction was performed 1 week later by phacoemulsification with primary intraocular lens implantation. The immediate postoperative recovery was uneventful. The visual acuity at last follow-up was 9/10. In the current case, lens extraction associated with systemic and local antimicrobial treatment allowed infection control and good visual outcome. [ABSTRACT FROM AUTHOR]

To report the case of a surgical-induced necrotizing scleritis (SINS) following vitreoretinal surgery for rhegmatogenous retinal detachment, successfully managed by superficial muscle temporal fascia grafting. An 18-year-old teenager, with a history of a 23G vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment of the left eye, presented with intense left ocular pain, decreased visual acuity to counting fingers and eye redness. Split lamp examination showed: Conjunctival infiltration with silicone oil, circumferential sclera thinning with ectasia of the underling uvea. The fundus examination showed an attached retina. Necrotizing scleritis was the retained diagnosis. SINS was the final diagnosis. An immunosuppressive therapy was started. Superficial muscle temporal fascia grafting was performed to cover the necrotizing sclera. The patient did well postoperatively without sclera thinning or ectasia and the fascia grafting still intact without retraction after 6 months of follow-up. This is the first case in the literature that used the superficial temporal muscle fascia as a graft for sclera reinforcement in SINS. We propose new support to reinforce the deficient sclera. This graft must be associated with prompt immunosuppressive therapy at high doses. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical manifestations of the persistence of the fetal vascular system and to show multimodal imaging findings in this disease. Methods: We presented two cases of persistent fetal vasculature. Thorough clinical examination and full multimodal imaging have been undertaken. Results: The first case is a 12‐year‐old girl who consulted for a visual impairment evolving for few years. Fundoscopy revealed a unilateral whitish vascular membrane attached to the optic disc towards the vitreous associated with retinal folds in interpapillomacular region as well as chorio‐retinal atrophy and nasal pigment migrations. B‐mode ultrasonography confirmed the presence of this membrane attached to the optic disc but does not reach the lens. Optical coherence tomography (OCT) showed a deficit of RNFL, especially in superotemporal and hyaloid condensation in the optic disc with macular folds. The second case is a 42‐year‐old patient who consulted for a presbyopia. Fundoscopy revealed membranous short band‐like lesion attached to the optic disc associated with retinal folds, better seen in the anerythral photograph which showed an alternation of grey and white bands. Conclusions: Multimodal imaging is of a paramount importance in diagnosing the fetal vascular system. It also allows the recognition of the form of this disease and thus the way to manage it. [ABSTRACT FROM AUTHOR]

Purpose: To present the vascular complications of traumatic acute retrobulbar haemorrhage and describe its management through a case report. Methods: A case report of a patient having an acute retrobulbar haemorrhage complicated with central retinal artery occlusion (CRAO). Results: A 50‐year‐old male patient exposed to blunt orbital trauma two hours prior was referred to the emergency with complaints of pain and loss of vision in the left eye. The negative light perception was noted in this eye. A tense hematoma, proptosis, ophthalmoplegia, and a non‐reactive pupil were also noted. Biomicroscopic examination, revealed corneal edema, subconjunctival haemorrhage, and chemosis. The fundus examination was not possible. Intraocular pressure (IOP) was 60 mmHg. The patient was diagnosed with acute retrobulbar haemorrhage. Computerized tomography was performed immediately showing a fracture of the left medial orbital wall and haemorrhage within the retrobulbar space. Intravenous mannitol and topical dorzolamide‐timolol associated with oral corticosteroid were administered. IOP decreased to 30 mmHg, but the patient's visual acuity did not improve. The fundus examination revealed a total CRAO confirmed by the fluorescein angiography and OCT‐A showing massive ischemic edema and occluded perimacular arterioles with interruption to the choroidal blood flow. OCT images demonstrated an increased reflectivity and thickness of the inner retina and subretinal fluid, which corresponds to the acute phase of CRAO. The time of surgical treatment was missed, and as a result, the patient missed their chance for visual recovery. Conclusions: Retrobulbar haemorrhage is a complication from ocular trauma that may cause permanent vision loss. Retrobulbar haemorrhage can potentially lead to dangerous increases in intraorbital pressure, a condition that is also described as orbital compartment syndrome. This increase in pressure is sufficient to cause vision loss, whether through direct compression of the optic nerve leading to optic neuropathy, a central retinal artery occlusion, or compression of the vessels that provide nutrition to the optic nerve. [ABSTRACT FROM AUTHOR]

Purpose: Arnold‐Chiari disease is a rare congenital malformation of the cerebellum. Symptoms are dominated by occipital headache, torticollis, and sometimes swallowing disorders. Regarding ophthalmological manifestations, convergence abnormalities, oculomotor paralysis and diplopia are the main clinical signs. We report two cases of ocular manifestations in Arnold Chiari type 1 syndrome. Methods: Two case reports and a literature review. Results: Case 1: A 40‐year‐old patient with no medical history presented an acute loss of vision in both eyes. On examination, the patient had a visual acuity limited to 5/63. Biomicroscopic examination of the anterior segment was without abnormalities. Fundus examination revealed a bilateral papillary edema. Visual field test showed a borderline diffuse loss in both eyes. Case 2: A 17‐year‐old patient with no medical history presented intermittent headaches and a progressive loss of vision in both eyes. On examination, the patient had a visual acuity limited to 5/80. Biomicroscopic examination of the anterior segment was without abnormalities. Fundus examination revealed atrophy not excavated in both eyes. Visual field test showed nasal and temporal scotomas in both eyes. Temporal, superior and inferior RNFL defects were detected in both eyes. A brain MRI revealed a Chiari type 1 malformation without associated hydrocephalus in both patients. Conclusions: Arnold Chiari type 1 malformation is an uncommon pathology. The discovery of ophthalmologic signs requires a neurosurgical intervention as soon as possible to stop progression towards the loss of visual function by optic atrophy. [ABSTRACT FROM AUTHOR]

Purpose: To describe current trends in therapeutic modalities to manage acute epidemic keratoconjunctivitis. Methods: We ran a descriptive study of 87 eyes of 61 patients diagnosed with acute epidemic keratoconjunctivitis confirmed by the presence of subepithelial infiltrates (SEIs) in the cornea. A clinical score based on a complete biomicroscopic examination, the measurement of visual acuity, the number of subepithelial infiltrates (SEIs), the break‐up‐time, and the value of the Schirmer type 1, has been established to evaluate symptoms. Results: The mean age of the study population was 36 ± 17 years‐old. The treatments taken in the acute phase were either prescribed by a general practitioner (10%) or an ophthalmologist (60%), or taken as self‐medication (30%). None of our patients has received nonsteroidal anti‐inflammatory eye drops. Antivirals including ganciclovir were taken by 40% of the study group, artificial tears in 81 eyes (93%), antiseptics in 21% of the cases, and local antibiotics in 46 eyes (53%). The mean clinical score was 4.2 ± 2.6. There was no significant difference in the final clinical score, visual acuity, number of SEIs, break‐up time and Schirmer's value between the groups who instilled ganciclovir, artificial tears, local antibiotics as well as the healing agents and those who did not. Visual acuity was better in patients who did not use antiseptic eye drops. Conclusions: The latest treatment recommended for the acute phase of epidemic keratoconjunctivitis are artificial tears with cold compresses, local povidone‐iodine and ganciclovir. Topical antibiotics are only used in confirmed bacterial superinfection. Our studied sample did not respond much to these recommendations. [ABSTRACT FROM AUTHOR]

To report the case of a surgical-induced necrotizing scleritis (SINS) following vitreoretinal surgery for rhegmatogenous retinal detachment, successfully managed by superficial muscle temporal fascia grafting. An 18-year-old teenager, with a history of a 23G vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment of the left eye, presented with intense left ocular pain, decreased visual acuity to counting fingers and eye redness. Split lamp examination showed: Conjunctival infiltration with silicone oil, circumferential sclera thinning with ectasia of the underling uvea. The fundus examination showed an attached retina. Necrotizing scleritis was the retained diagnosis. SINS was the final diagnosis. An immunosuppressive therapy was started. Superficial muscle temporal fascia grafting was performed to cover the necrotizing sclera. The patient did well postoperatively without sclera thinning or ectasia and the fascia grafting still intact without retraction after 6 months of follow-up. This is the first case in the literature that used the superficial temporal muscle fascia as a graft for sclera reinforcement in SINS. We propose new support to reinforce the deficient sclera. This graft must be associated with prompt immunosuppressive therapy at high doses., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Middle East African Journal of Ophthalmology.)