Encapsulated living worms due to periorbital dirofilariasis: detection with high-resolution sonography.

Sonography (US) is commonly required when a superficial lump appears. We present the case of a patient for whom US was highly suggestive of living worms causing a recurrent periorbital mass. After surgery, the final diagnosis was a nodule composed of dirofilariasis larva.

[Partially pigmented vitreous cyst]. / Kyste vitréen partiellement pigmenté.

Free-floating iris pigment epithelial cysts in the vitreous are very rare. We report the case of a partially pigmented cyst found on routine examination in the vitreous of a 51-year-old asymptomatic patient. Usually, non-pigmented cysts are derived from the hyaloid system. Pigmented cysts, however, are derived from the iris pigment epithelium. When they are not dislodged, these cysts can be confused with iris melanoma or primary stromal cysts. Treatment is usually unnecessary, unless they become symptomatic.

[Spontaneous peeling of the epimacular membrane after cryotherapy of retinal vasoproliferative tumors: report of a case]. / Decollement spontane d'une membrane epimaculaire apres cryotherapie de tumeurs retiniennes vasoproliferatives: a propos d'un cas.

Epimacular membranes when responsible for a significant loss of visual acuity, generally require treatment by vitrectomy and peeling of the membrane. We report the case of a spontaneous peeling of a macular pucker after cryotherapy of peripheral retinal vasoproliferative tumors. Review of the literature.

[Photodynamic therapy of circumscribed choroidal hemangiomas]. / Photothérapie dynamique des hémangiomes choroïdiens.

PURPOSE: To evaluate the safety and efficacy of photodynamic therapy in the management of symptomatic circumscribed choroidal hemangiomas (CCH) with exudative activity. PATIENTS AND METHODS: This prospective nonrandomized study included eight patients referred to us for management of CCH with exudative activity. PDT was applied by diode laser (689 nm) with a light dose of 100 J/cm2 and using verteporfin (6 mg/m2) IV bolus injection. The treatment spot diameter accurately corresponded to the tumor basal diameter (TBD). RESULTS: The mean tumor thickness before PDT was 3.3 mm (range, 2.7-7.5 mm) and the mean largest TBD was 6.1 mm (range, 5-12 mm). All patients were managed with a single PDT application. After a mean follow-up of 24.2 months (range, 17-29 months), all CCH (100%) showed regression of tumor thickness and complete resorption of the serous retinal fluid; 87.5% of the patients showed a flat tumor scar. All CCH showed overlying PDT-related retinal pigmented epithelium atrophic changes. No case of retinal vascular occlusion or recurrent leakage was documented. Five patients (62.5%) showed visual improvement, one (12.5%) retained stable vision and two (25%) developed worse vision due to chronic exudation-related RPE changes in one patient and preretinal fibrosis in another. CONCLUSION: PDT using verteporfin offers a safe and effective therapeutic option to manage CCH. Complete resorption of subretinal fluid is usually associated with visual improvement.

[Epidemiology of ocular and orbital lesions referred to an ocular oncology center]. / Epidémiologie des lésions oculaires et orbitaires adressées à un centre d'oncologie oculaire.

PURPOSE: To study the epidemiology of ocular and orbital lesions referred to an ocular oncology center. MATERIAL AND METHODS: Prospective study of ocular lesions referred between November 1997 and November 2002. RESULTS: A total of 1,257 lesions were recorded in 640 females and 617 males. The mean age at the initial visit was 52 years (range, 0 to 94 years). Patients more than 60 years old accounted for 46% of our series. The lesions were classified into four groups: intraocular lesions (69%), superficial layer lesions (18%), adnexal tissues lesions (7%) and orbital lesions (6%). The posterior uvea was the most frequent localization. The clinical diagnosis of 374 lesions (30%) was confirmed by histological examination. The most frequent tumors were retinoblastoma in children and teenagers, conjunctival nevus young adults, choroidal melanoma in slightly older patients and posterior choroidal nevus in elderly people. CONCLUSION: This study reviewed the epidemiological characteristics of ocular and orbital lesions referred to an ocular oncology center for their diagnosis, treatment and follow-up.

[Cat's cratch disease and Parinaud's oculoglandular syndrome]. / Maladie des griffes du chat et syndrome oculo-glandulaire de Parinaud.

By presenting this case report describing Parinaud's oculoglandular syndrome, we review the medical literature on its most frequent etiology: catscratch disease, a self-limited, systemic illness caused by a Gram-negative bacillus, Bartonella henselae, principally affecting children under 15 years of age. Typical symptoms include regional lymphadenopathy, fever, malaise, and fatigue, possibly with more severe complications such as splenomegaly, granulomatous hepatitis, and encephalopathy. Ocular manifestations may include follicular conjunctivitis, Parinaud's oculoglandular syndrome, neuroretinitis, optic neuritis, and chorioretinitis. Diagnosis is based on serologic tests, and when necessary, antimicrobial treatment can be considered.

[Treatment of intraocular melanoma: new concepts]. / Traitement du mélanome intraoculaire: nouveaux concepts.

The management of posterior uveal melanoma has evolved tremendously for the past decades and, more recently, there is a trend toward more focal conservative treatment. Transpupillary thermotherapy (TTT) with infrared diode laser (810 nm.) is the newest modality used as primary treatment or as complementary method to radiotherapy or surgical resection in very selected cases of choroidal melanoma. Plaque radiotherapy or charged-particle irradiation is particularly recommended for medium- or small-sized uveal melanoma not suitable to TTT or resection. Special custom-designed plaque radiotherapy (iodine-125) can be used for iris, ciliary body or juxta-paillary choroidal melanoma. The tumor control rate after plaque or charged-particle radiotherapy appears to be similar, but charged-particle irradiation may produce worse anterior segment complications than plaque radiotherapy. Stereotatic radiation therapy for choroidal melanomas may be effective in controlling tumor growth but the number of patients treated with the approach is too small to draw strong conclusions. Local tumor resection using trans-scleral resection is mainly suitable for selected iris, ciliary body, or anterior choroidal melanoma, particularly with smaller basal dimensions and greater thickness. Combined therapies (radiotherapy plus TTT, tumor resection plus TTT) appears to be more effective in decreasing the incidence of intraocular tumor recurrence. Enucleation is still performed for large uveal melanoma when there is no hope for useful vision. Based on the published ophthalmic literature, it seems that enucleation carries the same survival prognosis as each of the conservative treatment modalities.

[Transpupillary thermotherapy for treatment of choroidal melanomas]. / Thermothérapie transpupillaire dans le traitement du mélanome de la choroïde.

PURPOSE: To report the results of transpupillary thermotherapy (TTT) for selected posterior pole choroïdal melanomas. MATERIAL AND METHODS: Prospective study including 56 patients (mean age of 61 years) with choroidal melanoma treated with TTT. All treated tumors had either documented growth or clinical risk factors for future growth and for metastasis. The injection of infracyanine green (I CG) was randomized. RESULTS: The mean initial tumor basal diameter was 7.8 mm and tumor thickness was 3 mm. Twenty-seven tumors (48%) touched the optic disc and sixteen (29%) were under the fovea. Among these 56 patients with choroidal melanoma, 47 patients (84%) presented with primary choroidal melanoma. 9 tumors (16%) were late recurrences after conservative treatment. A mean of three treatment sessions was delivered. After a mean follow-up of 30 months, tumor regrowth was documented in 4 patients (7%) and the visual acuity was the same than the pretreatment acuity in 26 eyes (47%). The mean final thickness was 1.8 mm (percent reduction of tumor thickness was 39%). Intraocular complications included retinal fibrosis and/of retinal striae in 12 eyes (22%) and vascular occlusion in 14 eyes (25%). No statistical impact of ICG administration on the tumor regression was demonstrated. CONCLUSIONS: This series confirms the efficacy of transpupillary thermotherapy in the management of selected posterior pole choroïdal melanomas.

[Ocular manifestations of cancer]. / Manifestations oculaires des cancers.

Cancer may affect the eye and orbit as a direct result of metastatic neoplastic infiltration, compression, or circulating antibodies involving paraneoplastic retinal degeneration. A metastatic tumor to the uvea is the most common form of an intraocular metastatic process. The choroid is the most common site for uveal metastasis; metastases to the ciliary body, iris, retina, optic disk, and vitreous are rare. Approximately one-third of patients have no history of primary cancer at the time of ocular diagnosis. Breast and lung carcinomas for women and lung and gastrointestinal carcinomas for men most commonly metastasize to the eye and orbit. The short-term prognosis for vision is usually good after an individualized therapeutic approach (chemotherapy, hormonal therapy, external beam radiotherapy, or plaque radiotherapy), but the systemic prognosis is poor. The visual paraneoplastic syndromes encompass several distinct clinical and pathological entities including carcinoma-associated retinopathy (CAR), melanoma-associated retinopathy (MAR), and bilateral diffuse melanocytic uveal proliferation (BDUMP). The CAR syndrome affects photoreceptors, MAR is thought to affect bipolar cell function, and BDUMP targets the uveal tract. Identification of circulating antibodies against retinal proteins (recovering, 23-kDa retinal protein; 46-kDa and 60-kDa retinal proteins) serves to recognize the paraneoplastic nature of the patient's symptoms, which frequently develop before the cancer is diagnosed. Anecdotal therapeutic responses are described after systemic steroids, immunoglobulin injection, and plasmapheresis. Recognition of their visual symptoms and ocular findings should alert the ophthalmologist to the possibility of cancer and systemic evaluation should be pursued.

[Choroidal melanoma: current therapeutic approaches]. / Approches thérapeutiques actuelles du mélanome de la choroïde.

The management of posterior uveal melanoma has evolved tremendously over the past decades and more recently there has been a trend toward more focal conservative treatment. Transpupillary thermotherapy (TTT) with infrared diode laser (810nm) is the newest modality used as primary treatment or as a complement to radiotherapy or surgical resection in selected cases of choroidal melanoma. Plaque radiotherapy or charged-particle irradiation is particularly recommended for medium- or small-sized uveal melanoma not suitable to TTT or resection. Special custom-designed plaque radiotherapy (iodine-125) can be used for the iris and ciliary body, or in juxtapaillary choroidal melanoma. The tumor control rate after plaque or charged-particle radiotherapy appears to be similar but charged-particle irradiation may produce worse anterior-segment complications than plaque radiotherapy. Stereotactic radiation therapy for choroidal melanoma may be effective in controlling tumor growth, but the number of patients treated with this approach is too small to draw solid conclusions. Local tumor resection using trans-scleral resection is mainly suitable for selected iris, ciliary body, or anterior choroidal melanoma, particularly with smaller basal dimensions and greater thickness. Endoresection may preserve central vision or temporal field when radiotherapy would be expected to cause optic neuropathy. Longer follow-up is necessary to establish the efficacy of tumor control. Combined therapies (radiotherapy plus TTT or tumor resection plus TTT) appear to be more effective in decreasing the incidence of intraocular tumor recurrence. Enucleation is still performed for large uveal melanoma when there is no hope of regaining useful vision. Based on the published ophthalmology literature, it seems that enucleation carries the same survival prognosis as each of the conservative treatment modalities.

[Advantages of digital indocyanine green angiography for diagnosing choroidal tumors]. / Intérêt de l'angiographie numérisée au vert d'indocyanine dans le diagnostic des tumeurs choroïdiennes.

Indocyanine green angiography (ICG) is a well-known ancillary test for evaluation of choroidal tumors. The authors review the different images seen in choroidal nevus, melanoma, metastasis, hemangioma, osteoma, and vortex vein varix. ICG appears to be useful for the diagnosis of non pigmented choroidal tumors. In addition, ICG provides good information on the limits of pigmented tumors, particularly for the follow-up of a growing tumor and the choice of treatment.

Advances in imaging in oculoplastics.

Color Doppler imaging, computed tomography (CT) and magnetic resonance (MR) imaging are the most precious imaging tools for the clinician in the field of oculoplastics. Orbital and facial vasculature, with its dynamic changes and flow velocities seen in orbital varices, carotid-cavernous fistulas, and dural cavernous arteriovenous malformations, is best detected by Color Doppler imaging. Computed tomography remains the dominant imaging modality in the evaluation of orbital trauma. Helical CT axial scanning with multiplanar reconstruction and three-dimensional CT imaging are most helpful in assessing iatrogenic, traumatogenic, and teratogenic orbital abnormalities. Despite its poor histologic specificity, MR imaging provides superior soft tissue contrast, and contrast-enhanced MR imaging has an established role regarding soft tissue tumor infiltration. The greatest value of MR studies in the evaluation of orbital and palpebral tumors is that it has the capacity to show the precise relation between lesions and adjacent structures before the clinician contemplates a surgical approach. Finally, contrast-enhanced MR imaging proved to be a valuable vascularization indicator based upon the extent of relative enhancement within porous orbital implant in anophthalmic socket.

[Correlation between Goldmann and non-contact tonometry based on corneal thickness]. / Correlation entre tonometrie de Goldmann et tonometrie non-contact en fonction de l'epaisseur corneenne.

In this transversal study, we measure the intra ocular pressure by means of the Goldmann tonometer and a Non-Contact tonometer along with the central cornea thickness in 136 eyes of 73 patients. The statistical analysis of the collected data doesn't allow us to establish a correlation between the variation of the corneal thickness and the difference between the Goldmann tonometer and Non-Contact tonometer measures. The relative precision of the Non-Contact tonometer compared with the Goldmann tonometer doesn't seem influenced by the central cornea thickness.

[Transpupillary thermotherapy in the treatment of choroid melanoma]. / Thermothérapie transpupillaire dans le traitement du mélanome de la choroïde.

PURPOSE: To report the results of primary transpupillary thermotherapy (TTT) for selected posterior pole choroidal melanomas. MATERIAL AND METHODS: Prospective non randomized study including 34 patients with choroidal melanoma treated with TTT using near-infrared radiation (810 nm) delivered from the diode laser. All treated tumors had either documented growth or clinical risk factors for future growth and/or metastasis. The treatment was delivered using a specially modified infrared diode laser through a slit lamp adaptor. A contact lens was placed on the cornea to view the fundus and focus the laser beam. Treatment was initiated using a 60-second exposure and a low energy level at 300 mW with a 3.0 mm beam width. The energy was raised stepwise by 50 to 100 mW until the surface of the tumor develop a light grayish discoloration. The TTT sessions were delivered at 3-month intervals. RESULTS: Among these 34 patients with choroidal melanoma, 29 patients presented with primary choroidal melanoma. Five tumors (15%) were late recurrences after conservative treatment. The mean initial tumor basal diameter was 7.2 mm and tumor thickness was 2.9 mm. Seventeen tumors (50%) touched the optic disc and 10 (29%) were under the fovea. After a mean of three treatment sessions and 20 months of follow-up, the mean tumor thickness gradually decreased to 2.3 mm at month 3 and 2.0 mm at month 6 after the initial TTT. The percent reduction of tumor thickness was 20% at month 3 and 29% at month 6. The mean final thickness was 1.7 mm. Treatment was successful in 33 patients (97%). Tumor regrowth was documented in one patient (3%) and required plaque radiotherapy. After treatment, visual acuity was the same or better than the pretreatment visual acuity in 21 eyes (62%) and worse in 13 eyes (38%). Intraocular complications included retinal traction in 12 eyes (34%) and vascular occlusion in 3 eyes (9%). CONCLUSION: This series confirms the efficacy of transpupillary thermotherapy in the management of selected posterior pole choroidal melanomas. Longer follow-up is still required to assess late local recurrence and the impact on metastatic disease.

[Porous polyethylene (Medpor) orbital implant. Prospective study of 75 primary implantations]. / Implant orbitaire en polyéthylène poreux (Medpor). Etude prospective sur 75 implantations primaires.

PURPOSE: To examine the incidence of orbital complications in patients who underwent primary placement of a porous polyethylene implant (Medpor) after enucleation. MATERIAL AND METHOD: Prospective non randomized case series of 75 consecutive patients in whom a porous polyethylene (PP) spherical implant wrapped with homologous sclera was implanted after enucleation. RESULTS: The mean age at the time of enucleation was 42.7 years (range, 1.4 to 80 years). The histopathological diagnoses after enucleation included uveal melanoma in 28 patients, retinoblastoma in 11 patients, phthisis bulbi in 23 patients, neovascular glaucoma in 5 patients, endophthalmitis in 3 patients, ruptured traumatic globe in 2 patients, microphthalmos in two patients, and medulloepithelioma in one patient. Thirty-four patients (45%) had had prior ocular surgery. The prosthesis was fitted after a mean interval of 4.5 weeks (range, 3 to 10 weeks). After a mean follow-up of 20 months (range, 3 to 33 months), there was one case (1%) of conjunctival dehiscence with material exposure secondary to massive postoperative orbital hemorrhage 2 weeks after enucleation. There was no case of orbital cellulitis, implant extrusion, or significant inflammatory response. No PP implant was drilled for peg placement. DISCUSSION-CONCLUSIONS: The anteriorly wrapped porous polyethylene orbital (Medpor) sphere appears to be well tolerated by all age groups with no major complication in primary implantation after enucleation.

Postcontrast magnetic resonance imaging assessment of porous polyethylene orbital implant (Medpor).

OBJECTIVE: To evaluate the fibrovascular ingrowth progression within the porous polyethylene orbital implant (Medpor) with serial magnetic resonance imaging (MRI). DESIGN: Prospective, nonrandomized, comparative (self-controlled) trial. PARTICIPANTS: Ten patients who underwent enucleation and implantation of a 20-mm porous polyethylene implant wrapped with heterologous sclera. METHODS: Serial precontrast and postcontrast T1-weighted MRI were obtained at 1.5, 3, 6, and 12 months after implantation. The percentage area of enhancement was calculated by use of manual planimetric contouring unenhanced areas at the equator of each sphere on axial and coronal planes. RESULTS: All the implants showed enhancing areas as early as 1.5 months after enucleation. In 8 of the 10 patients, the areas of enhancement at the equator of the implant consistently showed similar centripetal progression primarily during the first 6 months after enucleation. The presence of fibrovascular tissue at the equator was associated in all cases with enhancing zones at the anterior portion of the implant. None of the implants showed diffuse complete enhancement after 12 months. Two patients failed to demonstrate further enhancement progression 1.5 months after implantation. No histopathologic study to equate with the MRI findings was performed in this series. CONCLUSIONS: Postcontrast magnetic resonance studies seem to be the best-suited imaging modality for assessing the fibrovascular tissue progression into porous polyethylene spheres after enucleation and for identifying patients in whom failure of vascularization occurs. Incomplete vascularization at the equator of the porous polyethylene sphere does not prove an absence of fibrovascular ingrowth in the anterior region. Prior ocular surgery and coexisting arterial hypertension may slow the progression of fibrovascular ingrowth.