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Aims/Purpose: To describe the pattern of acute retinal necrosis (ARN) in a referral centre in Tunisia, North Africa. Methods: The charts of 22 patients diagnosed with ARN from January 2006 to January 2023 were retrospectively reviewed. Results: The mean age at presentation was 39.2 (range, 12–70) years, sex ratio was 1.75. The mean diagnostic delay was 17.9 days (range 1–60). The mean visual acuity at presentation was 20/400. All patients presented with a mild to moderate anterior uveitis (100%) with granulomatous keratic precipitates in 18 eyes (81%) and ocular hypertension in 4 eyes (18%). Necrotizing retinitis involved >50% of the retina in 36.5%of eyes. Polymerase chain reaction on aqueous humour sample identified varicella zoster virus in 10 eyes (45%), herpes simplex virus‐1 in 4 eyes (18%) and was negative in 8 eyes (22%). All patients received intravenous acyclovir, followed by oral antivirals. Intravitreal injections of ganciclovir were administered in 12 eyes (54.5%). Follow‐up ranged from 1 month to 48 months. The mean final visual acuity was 20/200. Complications included retinal detachment (RD) (31.8%), macular oedema (18%), macular atrophy (22%), epimacular membrane (22%), cataract (27%), optic nerve atrophy (18%) and central retinal artery occlusion (4%). No patient developed bilateral ARN. Prophylactic laser was performed in 7 eyes (32%). RD was treated with pars plana vitrectomy and silicone oil injection in 7 eyes. Conclusions: ARN syndrome in Tunisia is most commonly caused by VZV. [ABSTRACT FROM AUTHOR]

Aims/Purpose: To investigate the size and shape of the foveal avascular zone (FAZ) after successful macula‐off rhegmatogenous retinal detachment (RRD) repair using swept source OCT angiography (SS OCTA). Methods: A prospective comparative cross‐sectional study including 21 eyes of 21 patients with macula‐off RRD that were successfully repaired. The size of the superficial FAZ was assessed by its area, length of perimeter, and Feret's diameter, and the shape by the circularity, axial ratio, roundness and solidity. The correlations between each parameter and the clinical and OCT findings were statistically determined. The unaffected fellow eyes were used as controls. Results: The mean initial BCVA was 1.92 ± 0.41 Log MAR (20/2000 Snellen's equivalent). The mean BCVA at OCTA acquisition (3 months) was 0.78 ± 0.39 Log MAR (20/100 Snellen's equivalent) (p < 0.001). FAZ was significantly larger (323.09 ± 129.03 μm2 vs. 245.27 ± 93.15 μm2; p = 0.038), with longer perimeter (2.31 ± 0.35 mm vs. 2.07 ± 0.31 mm; p = 0.048), and irregular shaped (mean circularity: 0.73 ± 0.72 vs. 0.78 ± 0.5; p = 0.019 and mean solidity: 0.90 ± 0.02 vs. 0.93 ± 0.02; p = 0.002) in operated eyes than in the control group. The average Feret's diameter was 0.77 ± 0.10 mm versus 0.71 ± 0.88 mm (p = 0.076). The average axial ratio was 1.25 ± 0.20 versus 1.22 ± 0.22 (p = 0.531), and the average roundness was 0.81 ± 0.11 versus 0.83 ± 0.11 (p = 0.531). Mean central foveal thickness (CFT) was significantly lower in operated eyes than in control eyes (178.23 ± 40.59 μm vs. 247.44 ± 38.2 μm (p < 0.001)). There was a significant inverse correlation between FAZ area and post‐operative outer nuclear layer thickness (r = −0.520, p = 0.016) and CFT (r = −0.571, p = 0.007) in operated eyes. There was no significant correlation between the post‐operative visual acuity and FAZ parameters. Conclusions: Enlargement and irregularities of FAZ after successful macula‐off RRD repair, as demonstrated by SS OCTA, might suggest an ischaemic macular damage caused by RRD that may affect post‐operative functional outcome. [ABSTRACT FROM AUTHOR]

Purpose: To describe clinical characteristics and etiological profile of uveitis presenting for the first time in the elderly and explain its therapeutic challenges and evolutive particularities. Methods: Retrospective review of 170 patients in the department of ophthalmology in Fattouma Bourguiba University Hospital, in the period between January 2007 and January 2021. Results: During the study, 221 eyes of 170 patients were affected by uveitis. The mean age was 59.32 ± 7.32 years and a female gender predominance was registered (61.1% were women). The most prevalent anatomical pattern was anterior uveitis (45/170; 26.4%) followed by panuveitis (33.5%). According to laterality, bilateral involvement (53.6%) was more registered. The majority of cases were chronic (67.2%), acute cases occurred in 31.7%, the rest of the cases (10%) were recurrent. Idiopathic uveitis was diagnosed in 21 cases (12.3%). A definitive or presumed specific aetiology was determined in most of our cases (87.7%), the most common specific aetiology in our case series was sarcoidosis (15.2%) followed by ocular Tuberculosis (12.9%), Herpes simplex virus anterior uveitis (10.5%), and chronic recurrent Vogt‐Koyanagi‐Harada disease (9.4%). An Infectious aetiology was established in 39.4% of the cases and noninfectious systemic autoimmune causes accounted for 24.1%. 53 eyes (16.2%) of 33 patients (19.4%) presented complications during the studied period. The most common ocular complication was uveitic cataract occurring in 38% of the cases. Conclusions: Epidemiological characteristics of uveitis in the elderly population is different from other age categories, which should influence the diagnostic approach in these patients. [ABSTRACT FROM AUTHOR]

Purpose: To describe clinical features and multimodal imaging findings in primary vitreoretinal lymphoma (PVRL). Methods: Medical records and imaging findings of 4 patients (4 eyes) diagnosed with PVRL were retrospectively reviewed. Detailed ophthalmic examination, fundus photography, fundus autofluorescence (FAF), fluorescein angiography (FA), optical coherence tomography (OCT) and OCT angiography (OCTA) were analysed in all patients. All patients underwent vitreous biopsy for diagnosis confirmation. Brain magnetic resonance imaging (MRI) was performed in all cases. Results: There were 2 women and 2 male patients with a mean age of 68.75 years. Visual blurring was the presenting symptom in all patients (100%). Clinical findings at presentation included vitritis in 4 eyes (100%), vitreous clumps in 2 eyes (50%), subretinal deposits in 3 eyes (75%) and exudative retinal detachment in one eye (25%). FAF showed granular hyperautofluorescence and hypoautofluorescence lesions in 3 eyes (75%) and blockage by mass lesion was seen in 1 eye. The most common pattern on FA was hypofluorescent lesions with a "leopard spot" appearance (75%). OCT revealed hyperreflective sub retinal lesions between retinal pigment epithelium and Bruch's membrane with an undulating shape (seasick sign) in 3 eyes (75%) and epiretinal membrane in one eye. OCTA showed areas of decreased signal on choriocapillaris slab in 2 eyes (50%). MRI of the globes and brain showed no abnormality in all cases. Vitreous cytology revealed atypical mononuclear cells consisting with the diagnosis of PVRL in all cases. The patients were referred to oncology unit. Conclusions: The diagnosis of PVRL is challenging. Multimodal imaging provides novel insights into features of PVRL. [ABSTRACT FROM AUTHOR]

Purpose: To describe the demographics and clinical characteristics of anterior scleritis associated with uveitis in a referral center in Tunisia. Methods: The charts of twenty patients (20 eyes) diagnosed with sclero‐uveitis at Fattouma Bourguiba University Hospital, Monastir, Tunisia, presented between January 2015 and April 2022, were retrospectively reviewed. Detailed ophthalmic examination and fundus photography were performed in all patients. Mean follow‐up period was 28.4 months. Patients with keratitis or posterior scleritis were excluded. Results: There were eight women and 12 males patients with a mean age of 34.8 years. All patients presented with ocular pain. Mean initial best‐corrected visual acuity (BCVA) was 20/80 (range, 20/2000–20/25).There was an associated anterior uveitis in 80% of cases and panuveitis in 20%. Clinical findings at presentation included nodular scleritis in five eyes (25%) and scleromalacia perforans in four eyes (20%). Idiopathic sclero‐uveitis accounted for almost 55%. Identified causes of sclerouveitis included rheumatoid arthritis in four eyes (20%), tuberculosis in three eyes (15%), granulomatosis with polyangiitis in two eyes (10%), sarcoidosis in one eye (5%) and then one case after mRNA 1273 vaccine (5%). Ocular complications included pupillary seclusion in 25% of cases and vision loss in 10% of patients. Mean final BCVA was 20/100 (range, 20/4000–20/32). Treatment modalities of non‐infectious scleritis included indomethacine in 14 patients (82.3%), systemic corticosteroid in seven patients (41.1%) and immunosuppressant or biological agent in five patients (29.4%). Conclusions: Our results provide useful information about the patterns and etiologies of sclerouveitis. The leading causes of sclerouveitis include mainly rheumatoid arthritis and tuberculosis. An infectious cause should be always ruled out. [ABSTRACT FROM AUTHOR]

Purpose: To describe a case of intermediate uveitis and optic neuritis associated with Cogan's syndrome. Methods: A case report. Results: A 29‐year‐old white Caucasian female was referred to our department for decreased vision in her left eye (LE). Previous medical history revealed relapsing intermediate uveitis and optic neuritis in the LE for 5 years and a sensio‐neural hearing loss a year earlier. On presentation, her ophthalmological examination revealed best corrected visual acuity in the LE of 6/60 with a relative afferent pupillary defect. Slit lamp examination revealed a clear cornea, 0.5+ cells in the anterior chamber and 3+ cells in the vitreous. Fundus examination showed an optic disc atrophy. Examination of the right eye was unremarkable. Examination by the internist revealed palmar erythematous lesions. Laboratory work‐up was negative for infectious diseases. Testing for antinuclear antibodies, antineutrophil cytoplasmic antibodies and rheumatoid factor were negative. The diagnosis of atypical Cogan's syndrome was made based on the association of atypical ophthalmological manifestations and typical audio‐vestibular manifestations. The patient was treated with oral prednisone and azathioprine. Conclusions: Optic neuritis may rarely be an ocular manifestation of Cogan's syndrome. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of Vogt‐Koyanagi‐Harada (VKH) disease following a serology‐confirmed bartonella henselae retinitis. Methods: A single case report. Results: A 41‐year‐old female patient presented with a central scotoma in her right eye (RE). Fundoscopic examination showed a focal retinitis with a macular star in the RE. Work‐up revealed positive bartonellosis serology. The patient was treated with oral azithromycine and oral steroids during 4 weeks with subsequent healing of the retinitis lesion. Three months after initial presentation, the patient complained of loss of vision in both eyes. Ophthalmological examination showed a best‐corrected visual acuity (BCVA) of 20/200 on both eyes, with a bilateral granulomatous panuveitis with bilateral multifocal exudative retinal detachment. Results of multimodal imaging were consistent with the diagnosis of acute VKH disease. Given the history of positive bartonellosis serology, the patient was treated with doxycycline (200 mg/day) for 6 weeks in association with intravenous methylprednisolone for 5 days followed by oral steroids and progressive tapering. At three‐month follow‐up, BCVA improved to 20/20 in both eyes associated with resolution of clinical and structural OCT changes. Conclusions: Our case suggests that bartonella henselae infection might be a non‐previously reported infectious trigger of VKH disease in genetically predisposed patients. Alternatively, bartonella henselae infection might manifest with panuveitis mimicking VKH disease. [ABSTRACT FROM AUTHOR]

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 nonocclusive 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 = 0.006). 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 = 0.006 and p ≤ 10‐3, respectively), and retinal haemorrhages (p = 0.048) and optic atrophy (p = 0.040) in the ORV group. Conclusions: Occlusive and non‐occlusive RV have distinctive clinical and etiological profile. References 1. Agarwal A, Karkhur S, Aggarwal K, Invernizzi A, Singh R, Dogra MR, et al. Epidemiology and clinical features of inflammatory retinal vascular occlusions: pooled data from two tertiary‐referral institutions: Inflammatory retinal vascular occlusion. Clin Experiment Ophthalmol. janv 2018;46(1):62–74. 2. Mir TA, Reddy AK, Burkholder BM, Walsh J, Shifera AS, Khan IR, et al. Clinical Features and Incidence Rates of Ocular Complications in Patients With Retinal Vasculitis. Am J Ophthalmol. juill 2017;179:171–8. [ABSTRACT FROM AUTHOR]

Purpose: To describe restoration of outer retinal layers on Swept‐Source OCT (SS OCT) in Vogt Koyanagi Harada (VKH) disease over a year after the disease onset. Methods: Prospective longitudinal study carried out at the department of Ophthalmology of Fattouma Bourguiba University Hospital of Monastir. Twenty‐one patients (42 eyes) were followed‐up for 12 months after the disease onset. The patients were included at the acute phase and subsequently treated. Sequential SS OCT changes were assessed. Results: Structural SS OCT changes occurred in 24 eyes (57.1%) on month 3 (M3), in 23 eyes (54.8%) on month 6 (M6), and in 19 eyes (45.2%) on month 12 (M12). They included external nuclear layer atrophy (14.3% on M3; 11.9% on M6; and 9.5% on M12); ellipsoid zone disruption (40.5% on M3; 38.1% on M6; and 33.3% on M12); interdigitation zone disruption (42.9% on M3; 40.5% on M6; and 33.3% on M12); and multifocal retinal pigment epithelium thickening (50% on M3; 45.2% on M6; and 31% on M12). No significant association between final visual acuity and external retinal layers alterations at any stage of the study was found. Stepwise analysis showed that the presence of serous retinal detachment at presentation was an independent factor for structural SS OCT changes on M3. Conclusions: After initial onset, SS OCT shows thinning of the outer nuclear layer, disruption of the ellipsoid and interdigitation zones, and multifocal retinal pigment epithelium thickening. Serous retinal detachment at presentation is an independent factor for structural SS OCT changes during the first year of the disease. [ABSTRACT FROM AUTHOR]

Purpose: To compare clinical findings and visual outcomes of vitreous haemorrhage (VH) associated with inflammatory ocular conditions between children and adults patients. Methods: Retrospective study including 46 patients (56 eyes) diagnosed with VH associated with inflammatory ocular conditions in Department of ophthalmology, Fattouma Bourguiba university hospital, Tunisia. Demographics, clinical findings, etiologies, treatment modalities, and visual outcomes were compared between adults and children. Mean follow‐up period was 18 months. Results: There were 10 children (12 eyes) and 36 adults (44 eyes) patients. Mean age was 9.5 years in the children group (six males and four females) and 35 years in the adult group (26 males and 10 females). Comparative study showed that VH in the paediatric group was associated with a significantly lower presenting visual acuity, more frequently vitritis and fern‐like capillaritis, whereas VH in the adult group were more associated with vascular sheathing and retinal haemorrhages. The main mechanism of bleeding was inflammatory optic disc neovessels (NV) in the children group (66.6%, p ≤ 0.001) and ischemic posterior segment NV in the adult group (81.8%, p ≤ 0.001). Idiopathic intermediate uveitis (40%) was the leading cause of VH in the children group. However, tuberculosis (41.7%), Behçet's (19.4%) disease and sarcoidosis (11.1%) were the most common etiologies in the adult group. The mean final visual acuity was significantly higher in the paediatric group (20/25) than the adult group (20/50) (p = 0.045). Conclusions: Inflammatory VH has a distinctive clinical and etiological profile between children and adults. References 1. Agarwal A, Karkhur S, Aggarwal K, Invernizzi A, Singh R, Dogra MR, et al. Epidemiology and clinical features of inflammatory retinal vascular occlusions: pooled data from two tertiary‐referral institutions: Inflammatory retinal vascular occlusion. Clin Experiment Ophthalmol. janv 2018;46(1):62–74. 2. Mir TA, Reddy AK, Burkholder BM, Walsh J, Shifera AS, Khan IR, et al. Clinical Features and Incidence Rates of Ocular Complications in Patients With Retinal Vasculitis. Am J Ophthalmol. juill 2017;179:171–8. [ABSTRACT FROM AUTHOR]

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 at Fattouma Bourguiba University Hospital, Monastir, Tunisia. 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 two 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 nine 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 fibre layer defect and visual field loss. Conclusions: OCTA allows to non‐invasively detect retinal and choroidal vascular changes in active and scarred toxoplasmic retinochoroiditis. References 1. Perez AL, Lozada RA, Emanuelli A, Oliver AL. Optical coherence tomography angiography findings in macular toxoplasma retinochoroiditis: A case report. Am J Ophthalmol Case Rep. 2020;19:100764. 2. Atas F, Kaya M, Toprak T, Akbulut Yagci B, Selver A, Saatci AO. Measurement of the active toxoplasma retinochoroiditis lesion size during the disease course with swept‐source optical coherence tomography angiography: A retrospective image analysis. Int Ophthalmol. 2021;41(12):4127–4135. [ABSTRACT FROM AUTHOR]