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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]

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 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]

Primary congenital glaucoma (PCG) is responsible for a significant proportion of childhood blindness in Tunisia. Early prevention based on genetic diagnosis is therefore required. This study sought to determine the frequency of CYP1B1 (cytochrome P450, family 1, subfamily B, polypeptide 1) mutations in 18 PCG patients, recruited from Central and Southern of Tunisia. Genomic DNA was extracted and the coding regions of CYP1B1 were analysed by direct sequencing. A phylogenetic network of CYP1B1 haplotypes was drawn using the median-joining algorithm. Sequence analysis revealed a 'tetra-allelic mutation' (two novel mutations, p.F231I and p.P437A in the homozygous state) in one patient. The healthy members of his family carried those variations on the same allele. Two previously described mutations p.G61E and c.535delG were also identified in the homozygous state in seven and two probands, respectively. Seven single-nucleotide polymorphisms were identified and used to generate haplotypes. Our results showed that the CYP1B1 mutations were present in 55% of Tunisian PCG patients' alleles. Haplotype analysis allowed us to define the proto-haplotype and to confirm historical migratory flows. Establishment of PCG genetic aetiology in Tunisia will improve genetic diagnosis and counselling. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study is to assess the frequency of HLA-B27 and HLA-B51 in healthy subjects from the center of Tunisia and to investigate their usefulness in the diagnosis of ankylosing spondylitis (AS) and Behçet's disease (BD), respectively. Microlymphocytotoxicity test was used to perform serologic HLA typing in a group of 124 healthy volunteers and a group of 365 patients suffering from clinical manifestations of AS and/or BD. HLA-B27 was found in 3.2% of healthy subjects and in 42.9% of patients with AS ( P < 0.00006). HLA-B51 is, however, found in 16.1% of healthy subjects and in 30.0% of patients with BD ( P > 0.05). Unlike HLA-B51, which seems to be as frequent in Tunisian patients with BD as in healthy subjects, HLA-B27 is more frequent in patients with AS than in controls. This highlights the usefulness of HLA-B27, rather than that of HLA-B51, in the diagnosis of the respective diseases. [ABSTRACT FROM AUTHOR]