Manual small incision cataract surgery in dense cataract: Morocco comparative study

BACKGROUND: The purpose of this study was to compare manual small incision cataract surgery (MSICS) with phacoemulsification and manual extracapsular extraction in terms of corneal edema, endothelial loss, and induced astigmatism. MATERIAL AND METHODS: A prospective study carried out in the ophthalmology department of the military hospital of Rabat in Morocco, including 15 eyes of 15 patients with brown cataracts. All patients were operated on by the same surgeon: 5 by phacoemulsification (PKE), 5 by manual extracapsular extraction (EEC) via corneal incision, and 5 by MSICS via tunneled sclero-corneal incision. Each patient underwent pre-, intra- and post-operative evaluation including: 1 — measurement of astigmatism before surgery and 3 months after (after removal of EEC threads); 2 — specular microscopy before and 3 months after surgery; 3 — clinical assessment of corneal edema before and at each follow-up: 1st and 7th day, 1st and 3rd month; 4 — evaluation of operating time. RESULTS: 9 men and 6 women were included. Mean age was 67 years. The mean axial length was 22.98mm. All surgeries were uneventful, and all patients were implanted in the capsular bag with a monofocal implant. Initial endothelial cell count was comparable in the 3 groups (p = 0.48). The endothelial loss was most significant in the PKE group (16%), followed by the EEC group (5.1%) and then the MSICS group (4.5%) (p < 0.01). The change in corneal astigmatism was most significant in the EEC group (2.1D), followed by the MSICS group (0.88 D), then the PKE group (0.65 D) (p = 0.01). In the PKE group, all patients showed moderate to severe corneal edema at 1st postoperative, and in 2 cases, the edema persisted at the 7th day and then regressed at the 1st and 3rd month. Only 2 cases of moderate edema at day 1 in the EEC group, and 1 case in the MSICS group, regressed at the 7th day. Phacoemulsification was the least time-consuming, with an average operating time of 13 minutes, compared with 28 minutes for MSICS and 34 minutes for EEC (p < 0.01). CONCLUSION: MSICS is a technique that resembles manual EEC, with a self-sealing tunneled scleral-corneal incision that avoids a full-thickness corneal incision and, consequently, sutures at the end of the procedure. It requires a learning curve. Our results concur with most of the data in the literature. MSICS is a safe technique, but it remains little used in cataract surgery. We believe that it should be preferred in patients with dense cataracts

Basal cell carcinoma of the medial canthus: resection and reconstruction by glabellar flap

The inner canthus is the site of aggressive basal cell carcinomas. The management of these tumors requires knowledge of the basic principles of reconstruction in reconstructive surgery. Surgical resection with exhaustive control of the excision margins should be performed. Even when the tumor is small, the need for healthy margins often results in a moderate to a large palpebral defect that cannot be repaired with direct sutures. The goal of reconstruction is to achieve a mobile eyelid, good corneal protection, and a good aesthetic result with acceptable donor site sequelae. In this manuscript, we describe a case of basal cell carcinoma of the medial canthus that underwent resection followed by reconstruction with a glabellar flap

A giant dermoid cyst of the orbit present in adulthood — a case report

Dermoid cysts are common orbital developmental tumors in childhood. They account for 3 to 9% of primary orbital tumors. They are considered to be congenital, but not all of them are diagnosed at birth. Dermoid cysts are benign choristomas that arise from sequestration of ectoderm along the lines of embryonic fusion of mesodermal processes destined to be bone. In most cases, the lesion is close to the zygomatic-frontal suture leading to a superotemporal subcutaneous mass in the eyebrow or eyelid. The intraorbital location is relatively rare and more prone to complications, particularly compressive. We report the case of a 41-year-old man with a large intraorbital tumor. The imaging aspects were evocative of an extraconal dermoid cyst. The tumor was resected through a transconjunctival route. Histopathologic examination confirmed the diagnosis of dermoid cyst

Quantitative assessment of optic disc photographs in normal and open-angle glaucoma patients

Background: The purpose of the study was to quantitively assess the optic nerve head (ONH) parameters from fundus photographs in normal and open-angle glaucoma patients and to compare them with those provided by spectral-domain optical coherence tomography (SD-OCT). Material and methods: This study compares 30 glaucomatous eyes to 30 healthy control eyes. One eye from each subject was randomly enrolled. From color photographs, different parameters were measured using image processing software (Adobe Photoshop CS6) after delimiting the boundaries of the optic disc and the excavation. The correlation between these measurements and those obtained by SD-OCT was evaluated. Results: Glaucomatous and normal patients groups were comparable in terms of age (p = 0.94), sex (p = 0.57), presence of diabetes (p = 0.52), hypertension (p = 0.40), and smoking (p = 0.67). The areas of the optic disc and the cup were significantly larger in glaucomatous patients (p = 0.004 and p < 0.001, respectively). The area of the neuroretinal rim was smaller in glaucomatous patients (p < 0.001). The vertical and horizontal cup-to-disc ratios were larger in glaucomatous patients (p < 0.001). The thicknesses of the rim in the four meridians were significantly reduced in the glaucoma group. The “ISNT” rule was fully respected in 87% of normal eyes and in only 2 cases (7%) of the glaucoma group (p < 0.001). There was an excellent correlation between different measurements obtained on photography and those provided by the SD-OCT. Pearson’s correlation coefficient was R = 0.95 (p <0.0001) for the optic disc area, R = 0.94 (p < 0.0001) for the rim area, and R = 0.98 (p < 0.0001) for the vertical cup-to-disc ratio. Conclusion: Color photography is very useful in the diagnosis and monitoring of glaucoma. The determination of normative values can further corroborate its interest in this indication. Despite the relatively high interobserver variability, ONH parameters obtained on photography showed excellent correlation with those measured by OCT

Œdème papillaire isolé révélant une sarcoïdose oculaire

La sarcoïdose est une granulomatose multisystémique d'étiologie inconnue, défini par la présence de granulomes épithélioïdes et gigantocellulaires, sans nécrose caséeuse. La sarcoïdose oculaire se manifeste essentiellement par une uvéite antérieure granulomateuse et bilatérale. L'atteinte postérieure au cours de la sarcoïdose oculaire est rare et se manifeste par des périphlébites ou une atteinte choroïdienne. L'œdème papillaire isolé au cours est un tableau atypique d'où la particularité de notre observation. L'atteinte postérieure est un élément de mauvais pronostic menaçant le pronostic visuel, une prise en charge rapide en collaboration avec les pneumologues par corticothérapie systémique permet d'améliorer le pronostic visuel et limiter les complications