[Case report of a severe corneoscleral burn caused by the phacoemulsification probe]. / A propos d'un cas de brûlure cornéo-sclérale grave par sonde de phacoémulsification.

We report a case in which a severe corneoscleral burn occurred during the first seconds of a phacoemulsification procedure. The procedure, a superior temporal corneal limbus incision on the right eye, was carried out on a 79-year-old woman presenting a cataract with an average lens density, who had no other risk factors for complications. In spite of a mild nucleus density and routine phacoemulsification equipment (PULSAR - OPTIKON 2000) with resterilizable parts, a severe corneal injury occurred with tissue shrinkage around the surgical wound. It led to an immediate severe astigmatism which only partially decreased in the following 7 months. We discuss the mechanism which may bring about this type of injury and the likely cause in this case. We also describe the primary sign ("lens milk") indicating that the procedure should immediately be stopped, and finally we suggest methods to reduce the incidence of such so-called "phacoburns".

[Dry eye]. / L'oeil sec.

As the term of "dry eye" is very common among people and physicians, the presumed definition of this entity is rather wrong. The simplistic triple equation: "dry eye = Sjögren's syndrome = artificial tears" belongs definitively to the past. This review is an attempt to demonstrate the complexity of the tear film regulation, the difficulties of an accurate diagnosis and finally the numerous therapeutic attitudes we can held for each sicca syndrome.

Successful surgical treatment of intraorbital arteriovenous malformations: case report.

OBJECTIVE AND IMPORTANCE: Cases of intraorbital arteriovenous malformations are rare, and their management presents a challenge for multidisciplinary teams. CLINICAL PRESENTATION: A 39-year-old woman developed a pulsating exophathalmos, visual loss, and ocular pain within 1 month, revealing the presence of intraorbital arteriovenous malformations. She underwent only surgical treatment. INTERVENTION: A fronto-orbital approach with removal of the orbital rim was performed. A CO2 laser facilitated all the surgical steps. CONCLUSION: Full recovery of vision and correction of the proptosis have been achieved, and postoperative magnetic resonance imaging and angiography confirmed the total removal of the malformations. The literature is reviewed regarding the management of such lesions. Surgery remains the treatment of choice. The role of embolization is discussed.

Identification of the T cell antigen receptor V beta gene products in labial salivary glands from patients with primary Sjögren's syndrome.

T lymphocytes are predominantly involved in the development of Sjögren's syndrome. Their repertoire has recently been claimed to be restricted. Analysis of T cell receptor V beta gene products within the labial salivary glands led us to identify V beta 2 and V beta 8. This study, using a new panel of anti-V beta product monoclonal antibodies and a tissue triple-staining technique, examined the distribution of V beta gene family products in activated as well as non-activated CD4+ or CD8+ T cells subsets in the salivary gland tissue of SS patients. Our results suggest that the V beta genes used by the T CD4+ or T CD8+ cells in situ are similar, irrespective of the activation status of these cells. T lymphocytes homing into exocrine tissues might thus be selected on the basis of their V beta repertoire rather than their activation state.

Selective expression of V beta families by T cells in the blood and salivary gland infiltrate of patients with primary Sjögren's syndrome.

OBJECTIVE: The T cell infiltration of the salivary gland of patients with Sjögren's syndrome (SS) has been implicated in the pathogenic process of the disease. We examined the representation of V beta subsets in the blood and salivary tissue of patients with SS. METHODS: Circulating T cells from 12 patients and paired samples of blood and labial salivary glands obtained from 8 patients were studied. A panel of monoclonal antibodies directed against the variable region of the T cell receptor was used to enumerate the cells expressing V beta families in the peripheral blood by flow cytometry, and in tissue sections by immunofluorescence. RESULTS: We found an increase of cells bearing V beta 2 family gene products in the circulation, and an increase in both V beta 2 and V beta 8 in the salivary gland infiltrate of patients with SS. No significant difference was noted between the 5 DR3+ patients and 7 DR3- patients studied with regard to the V beta families seen. CONCLUSION: Our data are consistent with a role for specific T cell families in the pathogenesis of SS.

Conjunctival epithelial cells from patients with Sjögren's syndrome inappropriately express major histocompatibility complex molecules, La(SSB) antigen, and heat-shock proteins.

The La(SSB) antigen has been detected within the cytoplasm and on the membrane of conjunctival cells (CC) from patients with Sjögren's syndrome, whereas it was weakly expressed in the nucleus of normal cells. The diseased CC were shown to overproduce major histocompatibility complex (MHC) class I antigens and express MHC class II antigens. Anti-heat-shock protein monoclonal antibody bound to the cell membrane in patients but not in normal controls.

Ocular surface lesions due to keratoconjunctivitis sicca: in primary Sjögren's syndrome.

Keratoconjunctivitis sicca is usually part of Sjögren's syndrome (SS) which is systemic disease. Ocular surface lesions are ascribed either to the reduction, or to to the low quality of tears. To address this question, ocular surface lesions were evaluated in 20 SS patients by the rose bengal test (RBT). The results were compared to those obtained in 20 normal volunteers and collated with the quality (estimated by the break-up-time) and the quantity of tears (estimated by the shirmer's I test and the level of lacrimal lactoferrin, LF). The RBT scores did not correlate with the shirmer's test results, neither did they with the break-up times. This is consistent with the view that Schirmer's I Test and break-up-time cannot make any distinction between patients from controls. In contrast, the RBT scores correlated well with the levels lacrimal LF and paralleled to serological abnormalities.

[Treatment of dry eye syndrome with lacrimal gel: a randomized multicenter study]. / Traitement de la sécheresse oculaire par gel lacrymal: étude multicentrique randomisée.

The appearance on the French market of a carbomer tear substitute, Gel-Larmes, an original galenic form, constitutes a real therapeutic progress in the treatment of dry eye syndrome. An open randomized multicentric trial was conducted comparing the tolerance and efficacy of Gel-Larmes with those of eye drops containing chondroitin sulphate. The statistical analysis evidences an inferior average number of daily instillations for Gel-Larmes, its better efficacy on the symptoms as well as on the objective criteria: biomicroscopic examination, break-up time, rose Bengal test. The tolerance of the product is excellent and 81% of the patients express their wish to pursue Gel-Larmes versus 54% for the reference product.

Salivary lactoferrin in primary Sjögren's syndrome.

Parotid salivary lactoferrin (LF) levels were measured in 26 patients with Sjögren's syndrome (SS), 19 patients with keratoconjunctivitis sicca (KCS) and 32 normal controls, by using a radial-immunodiffusion technique. The levels of LF were higher in SS than in KCS patients (23 +/- 21, 10 +/- 10, p less than 0.03) and in SS patients than in normals (7 +/- 6 micrograms/ml, p less than 0.001). There was some relationship of the LF level to the labial salivary gland histopathology grade.