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Biomedical subjects

A Ladjimi

Publications and source records attributed to A Ladjimi.

At least 19 recordsLinked to original sources

Linear pattern of West Nile virus-associated chorioretinitis is related to retinal nerve fibres organization.

PURPOSE: To clarify the reason for the linear pattern of West Nile virus (WNV)-associated chorioretinitis. METHODS: The study included 12 patients (24 eyes) with WNV-associated chorioretinitis. All the patients underwent a complete ophthalmic evaluation, including dilated fundus examination, fundus photography, fluorescein angiography, and indocyanine green angiography. Characteristics of linear streaks, particularly their relationship to the course of retinal and choroidal vessels, and pattern of retinal nerve fibres, were analysed. RESULTS: All patients had bilateral multifocal chorioretinitis with linear clustering of chorioretinal lesions associated with a variable number of scattered lesions. Linear streaks, variable in number and length, originated from the optic disc or its vicinity in most cases. Their course in all cases appeared to closely follow the course of retinal nerve fibres, rather than that of retinal or choroidal vessels. CONCLUSIONS: Results of our study show that the linear pattern of WNV-associated chorioretinitis is related to retinal nerve fibres organization, suggesting a contiguous spread of WNV virus from central nerve system via the optic nerve fibres to the outer retina, retinal pigment epithelium, and choroid.

Adult↗

Pattern of uveitis in a referral centre in Tunisia, North Africa.

AIM: To analyse the pattern of uveitis in a referral centre in Tunisia, North Africa. METHODS: The study included 472 patients with uveitis examined at the Department of Ophthalmology of Monastir (Tunisia) from January 1992 to August 2003. All patients had a comprehensive ocular and systemic history, including an extensive review of medical systems. Complete ophthalmic examination was performed in all cases, including best-corrected Snellen visual acuity, slit-lamp examination, applanation tonometry, and dilated fundus examination with three-mirror lens. Standard diagnostic criteria were employed for all syndromes or entities of uveitis. RESULTS: The mean age at onset of uveitis was 34 years. The male-to-female ratio was 1:1.1. Uveitis was unilateral in 282 patients (59.7%) and bilateral in 190 patients (40.3%). Anterior uveitis was most common (166 patients; 35.2%), followed by posterior uveitis (133 patients; 28.2%), panuveitis (100 patients; 21.2%), and intermediate uveitis (73 patients; 15.5%). A specific diagnosis was found in 306 patients (64.8%). The most common cause of anterior uveitis was herpetic uveitis (56 patients; 33.7%). Toxoplasmosis was the most frequent cause of posterior uveitis (51 patients; 38.3%). Intermediate uveitis was most commonly idiopathic (63 patients; 86.3%). Behçet's disease was the most common cause of panuveitis (36 patients; 36%), followed by Vogt-Koyanagi-Harada (VKH) disease (15 patients; 15%). A total of 16 patients (3.4%) suffered from blindness, and 59 (12.5%) from uniocular blindness. CONCLUSIONS: In a hospital population in Tunisia, the most common causes of uveitis were Behçet's disease, herpes simplex infection, toxoplasmosis, and VKH disease.

Acute Disease↗

[Intravitreal injection of triamcinolone acetonide for the treatment of macular edema].

PURPOSE: To study the efficacy and safety of intravitreal injection of triamcinolone acetonide for the treatment of macular edema (ME). METHODS: Thirty-five eyes of 33 patients with ME were studied. The causes of ME included diabetes (24 eyes), postoperative ME (four eyes), intraocular inflammation (three eyes), retinal vein occlusion (three eyes), and Coats disease (one eye). All patients underwent a complete ophthalmic examination and fluorescein angiography before and after treatment. Treatment consisted of a single intravitreal injection of 2 or 4 mg of triamcinolone acetonide under subconjunctival anaesthesia. Mean follow-up time was 4 months (range, 1-10 months). RESULTS: Mean visual acuity before treatment was 20/200 (range, 20/400-20/70). Visual acuity improved by one line or more on the Snellen visual acuity chart in seven eyes (20%) and remained unchanged in nine eyes (25.7%). In the 19 remaining eyes, visual acuity improved slightly and remained less than 20/200. ME diminished or resolved completely in 32 eyes (91%). This improvement was seen in all eyes with diabetic ME, pseudophakic ME, or inflammatory ME. ME recurred in three eyes 3 months after injection of triamcinolone and in one eye 9 months after injection of triamcinolone. In one diabetic patient, retinal neovascularization associated with ME resolved as a consequence of intravitreal triamcinolone injection. Reversible ocular hypertension occurred in ten eyes (28.6%). No case of endophthalmitis was seen. CONCLUSION: Intravitreal injection of triamcinolone acetonide is an effective treatment of ME. Its best indications seem to be diabetic, pseudophakic and inflammatory ME. Randomized clinical trials are warranted to assess long-term efficacy and safety of this treatment modality of ME.

Adolescent↗

[Etiology of posterior uveitis and panuveitis at the Central University Hospital in Monastir].

The authors conducted a retrospective analysis of 245 patients with posterior uveitis or panuveitis in order to determine their etiologies and collect some epidemiological data. A specific diagnosis was made in 80.4%. Behcet's disease (22.4%), toxoplasmosis (22%), and Vogt-Koyanagi-Harada syndrome (9%) were the most common causes of posterior uveitis or panuveitis. No case of confirmed sarcoïdosis was found in our series.

Adult↗

[Werner's syndrome and endocrine disorders].

Werner's syndrome is a rare autosomal recessive disease caused by the mutation of DNA helicase gene (WRN), characterized by the premature onset of multiple age-related disorders and skin changes similar to those observed in scleroderma. Some endocrinologic and metabolic disorders have been described in patients with Werner's syndrome. We report one case in a 41-year-old man issuing from consanguineous parents, who presented for exploration of hypoglycemic episodes and sexual impotence. Werner's syndrome was diagnosed on the basis of his characteristic clinical appearance. Metabolic disorders were insulin-requiring diabetes and hypertriglyceridemia. Endocrinologic investigation revealed nodular goiter, sub clinical primary hypothyroidism, hypergonadotrophic hypogonadism,adrenal cortical hypofunction and GH deficiency. Pathology examination of the skin biopsy showed a scleroderma-like aspect. Finally, osteoporosis, atherosclerosis and sub-capsular cataract were associated. Thus, in Werner's syndrome metabolic and endocrinologic investigation is necessary in order to treat these disorders and improve the patient's prognosis and life.

Adrenal Insufficiency↗

[Compressive optic neuropathy caused by fibrous dysplasia].

We report a case of compressive optic neuropathy caused by fibrous dysplasia in a 28-year-old woman. The patient had no significant medical history. Her best-corrected visual acuity was 20/20 in the right eye and 20/400 in the left eye. There was an afferent pupillary defect in the left eye. Slit-lamp examination was unremarkable. Funduscopy showed a normal optic disc bilaterally and congenital hypertrophy of the retinal pigment epithelium in the right eye. Systemic evaluation disclosed facial asymmetry and mucocutaneous lentiginosis involving the face and the limbs. Goldmann visual field testing showed a cecocentral scotoma in the left eye. Imaging studies demonstrated extensive changes of craniofacial fibrous dysplasia involving the sphenoid bone, with compression of the left optic nerve by a cystic structure. Results of gastrointestinal fibroscopy were unremarkable. The patient was given systemic steroids. After 4 days of treatment, her visual acuity had improved to 20/40, with resolution of the afferent pupillary defect and visual field improvement. Debulking of the tumor was recommended, but the patient declined the procedure. She has remained stable over 13 months of follow-up. Compressive optic neuropathy should be considered as a leading cause of visual loss in patients with craniofacial fibrous dysplasia. Early diagnosis, close follow-up, and appropriate management are mandatory to improve or maintain the visual function in such patients.

Adult↗

[Posterior scleritis: six case reports].

PURPOSE: To study the clinical features, management guidelines, and the course of the disease in six patients with posterior scleritis. SUBJECTS AND METHODS: Six patients with posterior scleritis were enrolled in this retrospective study. All patients underwent a complete ophthalmic examination, fluorescein angiography, and B-scan ultrasonography. Systemic evaluation included physical examination and laboratory screening investigations. Medical management included systemic indomethacin (two cases), oral steroids (two cases), intravenous pulses of methylprednisolone followed by tapered oral steroids (two cases). One patient underwent immunosuppressive therapy (azathioprine) because of steroid dependence. RESULTS: The main presenting symptoms were pain (six cases) and decreased vision (four cases). Chorioretinal changes included chorioretinal folds (six cases), retinal folds (five cases), optic disc edema (five cases), serous retinal detachment (two cases), and a subretinal mass (one case). Ultrasonography disclosed sclerochoroidal thickening in all cases and retrobulbar edema in three cases. Systemic evaluation was unremarkable in five cases and revealed Behçet's disease in one case. All patients showed a good response to medical treatment. CONCLUSION: Posterior scleritis has protean manifestations and can be easily overlooked. This diagnosis must be considered in all inflammatory and painful ocular disorders with no obvious etiology. B-scan ultrasonography is the most useful diagnostic tool in such patients. The disease usually shows a good response to systemic anti-inflammatory therapy.

Administration, Oral↗

Retinal venous macroaneurysm associated with premacular hemorrhage.

To report an unusual association of a retinal venous macroaneurysm with premacular hemorrhage in a 50-year-old man, using a case report method. The patient exhibited a dense premacular hemorrhage in the left eye. Fluorescein angiography demonstrated that the source of bleeding was an isolated retinal venous macroaneurysm. The anterior surface of the hematoma was opened with an argon green laser, resulting in rapid clearing of the premacular hemorrhage and improvement in vision. Treatment of the retina surrounding the macroaneurysm to prevent recurrence of bleeding was ineffective to achieve occlusion of the lesion. No recurrent hemorrhage occurred during the observation period. Retinal venous macroaneurysm, a quite rare condition, may be complicated by premacular hemorrhage. Argon green laser may be useful in treating such hemorrhage. Hemorrhagic detachment of the internal limiting membrane or subhyaloid hemorrhage in the macula may occur after retinal vessel rupture with physical exertion (Valsalva retinopathy) or in retinal vascular diseases, such as proliferative diabetic retinopathy, and retinal arterial macroaneurysm. Arterial macroaneurysms are a common, well-described retinal vascular disorder. In contrast to retinal arterial macroaneurysms, retinal venous macroaneurysms are quite rare. In this article we describe a patient who presented with premacular hemorrhage that was caused by a retinal venous macroaneurysm. The hematoma and the macroaneurysm were treated with argon green laser.

Aneurysm↗

[Association of spheno-orbital dysplasia with plexiform neuroma in von Recklinghausen's neurofibromatosis].

We report a case of plexiform neurofibroma of the upper eyelid associated with spheno-orbital dysplasia in a 18-year-old woman with von Recklinghausen neurofibromatosis. Visual acuity was 20/40 in the right eye and 20/20 in the left. Plexiform neurofibroma involving the right upper eyelid was associated with mild ptosis and ipsilateral facial hypertrophy. Biomicroscopic examination showed lisch nodules. Funduscopic examination, visual field and neurologic examinations were normal. Café au lait spots involved the trunk with neck plexiform neurofibroma. Computed tomography disclosed spheno-orbital dysplasia. The patient's status remained unchanged at 6 months follow-up. Cranial features of von Recklinghausen neurofibromatosis are found in 3 to 7% of patients. In patients with plexiform neurofibroma of the eyelid the ophthalmologist should look for associated spheno-orbital dysplasia.

Adolescent↗

Sectorial choroidal ischemia associated with ipsilateral lacrimal gland tumor.

PURPOSE: To report the association of sectorial choroidal ischemia with ipsilateral tumor of the lacrimal gland. METHODS: Case report. In a 62-year-old man, a complete ophthalmologic examination, including fluorescein angiography and computed tomographic scans of the orbit, was performed. The patient underwent an en bloc excisional biopsy of the tumor. RESULTS: Fluorescein angiography of the left eye showed extensive sectorial choroidal ischemia superotemporal to the optic disk with macular involvement and associated chorioretinal folds. The patient was found to have a benign mixed tumor of the left lacrimal gland. CONCLUSION: The tumor of the lacrimal gland may have compressed choroidal vessels and short posterior ciliary arteries with subsequent sectorial choroidal ischemia.

Adenoma, Pleomorphic↗

[Post-traumatic anterior pituitary insufficiency. Apropos of 2 cases].

Post-trauma hypopituitarism is rare. The frequency of pituitary lesions observed at autopsy contrasts with small number of clinical cases. We report two cases in a 38 and a 25-year-old patients who developed hypopituitarism two years after severe craniofacial trauma followed by early onset but transitory poluria-polydypsia. Hormone explorations confirmed pituitary deficiency. Neuroradiological imaging, especially magnetic resonance imaging was normal with no intrasellar arachnoidocele.

Adult↗

[Remission of non-proliferative diabetic retinopathy following central retinal artery obstruction].

We report a case of central artery obstruction in a 55-year old man who had non proliferative diabetic retinopathy. Three years later, examination found no diabetic retinopathy in the eye that had central artery obstruction, and more advanced non proliferative diabetic retinopathy in the fellow eye. Pathogenic mechanisms for diabetic retinopathy regression after central artery occlusion could be the optic atrophy and ischemia of the inner retina associated to the decrease in retinal blood flow.

Diabetes Mellitus, Type 1↗

[Preventive treatment of retinal detachment of the contralateral eye. Results of 5 years follow-up of 109 eyes].

In 1987, we presented a study of 141 eyes treated prophylactically following retinal detachment in the fellow eye. A hundred and nine of these patients are reviewed with a minimum follow-up of five years. Only the evolution was studied, whether a peripheral retinal lesion was present or not at the time of prophylactic treatment. The examiner noted if new lesions had occurred, or if lesions present at the time of the first examination had developed: lattice degeneration or snail track developing into a retinal tear, hole or tear causing a retinal detachment, contained or not by laser treatment. Our study contained sixty two myopes. Fifty eyes had visible, dangerous lesions, and fifty nine a normal retina. Forty five circular barrages with four anterior radial rows returning to the ora serrata were performed, and sixty four barrages with tight anterior grids and a localised barrage of visible lesions. The results were judged on one criterion only: retinal detachment requiring emergency surgery. Only one retinal detachment occurred behind the barrage, caused by proliferative vitreoretinopathy due to multiple tears, and surgical results were good. Eight tears appeared in front of the barrage, five of these in healthy retina. Two very posterior tears behind the barrage were blocked with no problem by laser treatment. Four localised detachments occurred in front of the barrage, three of these without anterior grid treatment. The advantage of this is undeniable since out of sixty three cases treated in this way, only three tears were seen to be blocked by the laser shots, and one anterior localised detachment where the anterior grid was insufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Valsalva retinopathy induced by labour.

PURPOSE: To describe a patient with Valsalva retinopathy induced by labour. METHODS: Case report. RESULTS: A 29-year-old woman at her second pregnancy complained of a sudden loss of vision in her left eye during spontaneous labour. Visual acuity was reduced to counting fingers. Funduscopy revealed a large preretinal hemorrhage at the macula in the left eye. Three weeks after delivery, the hematoma was treated with Nd:YAG laser. Two weeks after treatment, visual acuity was 20/20 and the premacular hemorrhage had resolved. CONCLUSIONS: A rise in intra-abdominal pressure during labour may result in Valsalva retinopathy. Nd:YAG laser may be useful in treating such hemorrhage.

Adult↗