Introduction Cat scratch disease (CSD) is a ubiquitous infectious disease caused by a Gram-negative intracellular bacillus, Bartonella henselae. Neuroretinitis is a classical but rare manifestation of CSD. Case presentation A 20-year-old woman presented with a 5-day-history of reduced vision in the left eye (LE). Two weeks before eye symptoms, she complained from fever, fatigue and arthromyalgia which resolved spontaneously. In the LE, visual acuity (VA) was 7/10, fundus photography showed optic disc edema with macular exudates arranged in incomplete macular star. Serologic test for Bartonella henselae using indirect immunofluorescent assay (IFA) was highly positive (1:2560 UI/L) for immunoglobulin G (Ig G). The diagnosis of CSD associated neuroretinitis has been made and the patient was treated with doxycycline, rifampicin and oral prednisolone. Twelve months after the end of therapy, VA was 10/10, fundus photography and Macular OCT were normal. Discussion In CSD, neuroretinitis occurs 2–3 weeks after systemic symptoms. The clinical features of CSD are not specific hence the need for bacteriological diagnosis which is based mainly on serologic testing by the detection of Ig G and Ig M by IFA or ELISA. The treatment of CSD-associated neuroretinitis is not standardized. Antibiotics active against intracellular bacteria, with or without systemic corticosteroids, should be prescribed especially in severe cases. The outcome of Bartonella henslae neuroretinitis is usually favourable. Conclusion Despite rarely reported in Tunisia, CSD should be considered in patients with presence of typical neuroretinitis with macular star and of a history of contact with cats.

Introduction Optic nerve avulsion is a traumatic disinsertion of optic nerve fibres from the globe at the level of the lamina cribrosa. It is an uncommon and severe complication of blunt ocular trauma. Case presentation We report the case of a 15 years old male presented to the emergency department after being kicked by a horse. Initial ophthalmologic examination of the left eye (LE), exhibited eyelid hematoma, subconjunctival hemorrhage, VA was limited to light perception and there was a left relative afferent pupillary defect. Dilated fundus examination of the LE revealed an extensive vitreous and preretinal hemorrhage overlaying the optic disc and retina edema.The diagnosis of LE optic nerve head avulsion (ONA) was made. Five years after the accident, VA of LE detecting hand motion, fundus examination revealed a superior dragging of the optic disc, fibroglial scarring, retinal vessel narrowing and retinal epithelium hyperplasia. Clinical discussion In case of ONA, the avulsion can be missed initially due to vitreous and retinal hemorrhage overlaying the optic nerve, in such cases multimodal imaging can be a useful tool to the diagnosis and to evaluate associated ocular damage. Healing process of the avulsed optic nerve is characterized by the development of fibroglial proliferation. Visual outcome is poor and the final visual acuity range from light perception or no light perception in total ONA. Conclusion Optic head nerve avulsion is a rare and severe disease and initial diagnosis is challenging due to associated media opacities. The prognosis is poor and the injury leads to permanent visual impairment.

The authors report two cases of retinal artery macroaneurysm (RAM) complicated with subhyaloid hemorrhage. There are multiple cases about RAM that have been published; however, none of them present all the different treatments with its benefits and its limitations. Our study highlights all aspects of treatment. RAM is an uncommon pathology that affects generally elderly women with systemic vascular pathologies. It is often unilateral, and the patients stay mostly asymptomatic. Most cases of RAM regress without any treatment. A case of a 54-year-old male, with a medical history of hypertension who presented with an acute and unilateral decreased visual acuity (VA). Initial VA was limited to counting fingers at 1 m in the right eye (RE). The anterior segment was normal in both eyes. A fundus examination in the RE showed a large subhyaloid hemorrhage associated to retinal hemorrhage. Fluorescein angiography in the RE did not reveal any sign of macroaneurysm due to blockage of fluorescein by the hemorrhage. In the left eye, there was a hyperfluorescent paramacular lesion. Optical coherence tomography showed the hyperreflectivity of the subhyaloid hemorrhage and the underlying retinal layers could not be seen. Neodymium-doped yttrium aluminum garnet laser hyaloidotomy was performed for this patient to release the trapped hemorrhage into the vitreous, 3 weeks after initial loss of vision with a good visual outcome after the treatment. An 80-year-old woman, with medical history of rheumatoid arthritis who presented with an acute loss of vision in the RE. VA in the RE was 20/200. She had a nuclear cataract in both eyes. A fundus examination showed a subyaloid hemorrhage. Fluorescein angiography in the RE revealed a hyperfluorescent structure emanating from the superotemporal arcade of the artery compatible with a macroaneurysm. The patient was treated with three intravitreal antivascular endothelial growth factor injections with poor visual outcomes. Vision loss occurs with RAM complications. They mainly involve hemorrhages and macular exudations and are usually associated with poor visual recovery. There is no established treatment for RAM and its complications. There are many options, but the optimal therapy is still unknown.

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