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Purpose: To evaluate the clinical and therapeutic characteristics of rhegmatogenous retinal detachment (RRD) with unseen retinal breaks., Patients and Methods: Retrospective study 50 eyes (50 patients) with RRD with unseen retinal breaks in the pre and intraoperative examination. These patients were treated between 2005 and 2010 by vitrectomy or scleral buckling. Retinal breaks were meticulously sought by indentation of the vitreous base. The subretinal fluid was drained by a peripheral retinotomy when a vitrectomy was needed and puncture ab externo when a scleral buckling was performed., Results: A retinal detachment with unseen retinal breaks accounted for 15% of all RRD operated during this 5-year duration period (2005 - 2010). The average age of our patients was 57 years.Ten were myopic (20%) and 27 (54%) pseudophakic, with inferior RRD in 60% of the cases cases while advanced vitreoretinal proliferation (PVR) greater or equal to stage C in was present in 72%. Primary vitrectomy was performed in 46 cases. Retinal reattachment rate was achieved after a single procedure in 41 eyes (82%). Among them, 40 were operated by vitrectomy and one eye by scleral buckling. The recurrence rate was significantly higher in patients operated by scleral buckling (75%) than by vitrectomy (15%)., Conclusion: RRD with unseen retinal breaks are often seen inferiorly and have a chronic evolution (60%). They concern pseudophakic patients in the majority of the cases. Their poor prognosis and high recurrence rate also appear to be related to an advanced PVR (72%). The good results of primary vitrectomy should be confirmed by randomized studies, especially in phakic eyes.

Purpose: To evaluate the clinical characteristics and therapeutic challenges of retinal detachment in highly myopic eyes., Patients and Methods: We retrospectively reviewed the medical records of 83 eyes in 79 patients with high myopia (> 6.00 diopters or axial length > or = 26.00 mm) who underwent surgery for retinal detachment between 2001 and 2008. The surgical approaches depended on the type and location of the retinal break, the degree of myopia, and the grade of PVR., Results: The mean age of patients (48 men and 31 women) was 53.9 years. Refractive error ranged from - 10 D to - 25 D (mean was - 14.0 D). The mean follow-up was 19.4 months. Peripheral or equatorial retinal tears were present in 52 cases (62.6%), a macular hole in 14 cases (16.8%), a giant retinal tear in 6 cases (7.2%), and posterior paravascular retinal tears in 11 cases (13.2%). Single-surgery anatomic success was achieved in 65 cases (78.3%), with 17 cases after scleral buckle surgery and 46 cases after pars plana vitrectomy. Final anatomic success was achieved in 76 cases (91.5%). Per and postoperative hemorrhagic complications occurred in 16 cases (19.2%)., Conclusion: Retinal detachment is a serious complication of high myopia. It often occurs in young patients. Treatment is difficult due to anatomical and clinical conditions.

Purpose: To describe the prevalence and the risk factors for the age related macular degeneration (AMD) in a Tunisian hospital population., Patients and Methods: A total of 2204 subjects 50 years of age and older were enrolled in a prospective study conducted between august 2004 and February 2009. Medical history was reviewed. Subjects underwent a complete ophthalmic examination, including best corrected visual acuity and slit lamp biomicroscopy with fundus examination. Fundus photography and fluorescein angiography were performed if clinical features of AMD were observed on fundus examination. Cases were classified in early and late stages of AMD., Results: The prevalence of late AMD was higher than early AMD. Significant risk factors are age, male gender, smoking, excessive sunlight exposure and poor consumption of fish. Cardiovascular disease, diabetes and dyslipimia were not significantly associated to a high prevalence of AMD., Conclusion: AMD is a multifactorial disease. In our Tunisian hospital population, the prevalence of AMD was higher than in the Europeen population. It can be explained by genetic differences or risk factors. Age, cigarette smoking and sunlight exposure were associated with increasing prevalence of AMD in Tunisia.

Purpose: To report the clinical results, the postoperative course and the complications observed after therapeutic penetrating keratoplasty in herpetic keratitis., Methods: Eleven eyes with herpetic keratitis (11 patients) that underwent therapeutic keratoplasty between September 2002 and September 2008 were included in this study. The eyes were evaluated retrospectively with respect to the anatomic success rate, the graft clarity, the visual prognosis and the postoperative complications., Results: The mean follow-up was 13.7 months. Nine cases presented with corneal perforation and two cases with descemetocele. Anatomic repair was obtained in 11 eyes (100%). The graft transparency rate was 54.5%. A final visual acuity equal to or better than 1/10 was achieved in 45.45%. Major causes of failure of corneal graft included recurrent disease (n = 1), glaucoma (n = 1), graft rejection (n = 2) and early irreversible edema of the graft (n = 1)., Conclusion: The prognosis of therapeutic penetrating keratoplasty in herpetic eye disease can only be improved with proper postoperative care and optimal management of immunologic and virologic complications.

Orbital cellulitis with endophthalmitis is an extremely uncommon complication following ocular surgery. We report the case of 38 year-old man who developed orbital cellulitis and endophthalmitis after extracapsular extraction and posterior chamber implant placement for cataract secondary to radiotherapy. Phacoextraction was performed under general anaesthesia and was uneventful. Three days postoperatively, the patient was examined for a reduced visual acuity and lid swelling in the operated eye. Ocular examination has shown signs of endophthalmitis and orbital cellulitis, which was confirmed by a computed tomographic scan. Bacteriology cultures were positive for a Streptococcus pneumoniae. The ocular infection evolved towards phthisis bulbi with no light perception 45 days after surgery. Enucleation with orbital implant was performed.

Purpose: To study the clinical characteristics and the therapeutic results of retinal detachment following neodymium YAG laser posterior capsulotomy., Material and Methods: A retrospective study of 28 patients (28 eyes) operated in department B of the Hédi Rais Institute of Ophthalmology (Tunis, Tunisia) between march 1993 and january 2005 for retinal detachment following neodymium YAG laser posterior capsulotomy. We study the preoperative clinical characteristics of the retinal detachment and the anatomic and functionnal results., Results: The mean age of the patients is 53.4 years. Fourteen patients are men and eleven have high myopia. Ten patients are aphakic and eighteen pseudophakic. The retinal detachment is total or subtotal in 19 eyes (67.9%). The macula is detached in 27 cases (96.4%). The retinal tears are posterior in 9 cases (paravascular retinal break or macular hole) and peripheral in fifteen cases. In 4 cases no tear is found. Vitreoretinal proliferation is advanced in 10 cases. Eleven patients underwent episcleral surgery and 17 endocular surgery. The final success rate is 89%. The postoperative visual acuity increases in 20 cases. It is superior to 1/10 in 14 cases. The minimum follow-up is 6 months., Conclusion: The retinal detachment after neodymium laser posterior capsulotomy is serious due to severe vitreoretinal proliferation wich influences the anatomic results.

Purpose: To evaluate a new technique of local anesthesia namely caruncular anesthesia (subtenon anesthesia by single injection at the inner canthus of the eye) in vitreoretinal surgery., Patients and Methods: We carried out a prospective study from June 2002 to May 2004. We performed 140 consecutive vitreoretinal procedures that lasted less than two hours: 56% were endovitreal, 36% were episcleral and 8% were combined., Results: The delay for anesthesia onset was 6 min (average time). We obtained a complete akinesia score in 83% of cases. Our reinjection rate was 11%. Sedative supplementation was given peroperatively in 11% of the cases. Surgeon satisfaction was complete in 78% of the cases, and patients satisfaction was complete in 84% of the cases. No complications were observed during the study., Conclusion: Caruncular injection as local anesthesia is an interesting technique for vitreoretinal surgery. Subtenon anesthesia is an interesting efficacious and secure technique that can be used during long and painful interventions with satisfactory results.

Purpose: To assess clinical and therapeutic outcomes in traumatic cataracts., Methods: Retrospective study of 20 cases of traumatic cataracts seen between 2001 and 2004. Mean age at diagnosis was 35 years (5-72 yr), 25% were infants. There were 11 women and 9 men. Extracapsular cataract extraction was performed in eighteen patients (90% of cases), 13 were implanted in posterior chamber, 3 having zonular rupture were implanted in anterior chamber. Two patients remained aphakic because of retinal lesions. Two patients with lens subluxation underwent intracapsular cataract extraction with anterior chamber implantation. The mean delay of surgery was 4 weeks., Results: Overall satisfactory with 55% of final visual acuity more than 1/10. Visual acuity was better in implanted eyes, poorer in infants and after ocular perforation. Fibrinous uveitis was the common early postoperative complication especially in children., Conclusion: The majority of eyes with traumatic cataract could be safely rehabilitated after surgery and lensimplantation. In traumatic cataract, the vision can be severely threatened, preventive methods should be encouraged.

Iris cysts are rare in children. They might be primary or secondary. Their treatment depends on their type and clinical evolution. The purpose of our study is to discuss the etiologies and therapeutic modalities of iris cysts.

Introduction: Intumescent cataract with ocular hypertony is a medicosurgical emergency. The purpose of our study is to define the clinical and therapeutic particularities of these cataracts., Material and Methods: This retrospective study includes 40 consecutive patients with angle closure secondary to intumescent cataract. All patients were examined between 1st January 1998 and 30 October 2000., Results: The patient population consisted of 28 women (70%) and 12 men ranging in age from 59 to 88 years (mean age: 78 years). Preoperative visual acuity was negative in 17% of cases and limited to light perception in 83% of cases. Ocular pressure varied from 25 to 68 mmHg. Patients underwent surgery one to 23 days after diagnosis. Surgical techniques consisted in extracapsular cataract extraction with (35%) and without (65%) intraocular lens. Preoperative complications were: vitreous loss in 20% of cases and expulsive haemorrhage in 2 cases (5%). Postoperative visual acuity improved in 70% of cases. COMMENT AND CONCLUSION: Intumescent cataract with ocular overpressure gives therapeutic problems, which can be prevented by a preoperative hypotony. Functional results of this study encouraged us to operate the intumescent cataract even if visual acuity is bad.