Outbreak of keratomycosis attributable to Fusarium solani in the French West Indies.

PURPOSE: We report an unusual increase in the number of cases of keratomycosis attributable to Fusarium solani in contact lens wearers. DESIGN: Observational case series. METHODS: Between November 2005 and May 2006, 14 corneal abscesses were reported at the University Hospital Center of Fort-de-France. Twelve patients were contact lens wearers, and 10 used Bausch & Lomb (Rochester, New York, USA) ReNu with MoistureLoc. Corneal scrapings were collected for microbiological analyses. RESULTS: In six months, five abscesses attributable to Fusarium solani in contact lens wearers, using Bausch & Lomb ReNu with MoistureLoc as contact lens solution, were reported. CONCLUSIONS: This study reports an epidemic of keratomycosis attributable to Fusarium solani among contact lens wearers in the Caribbean, during the same timeframe as a similar epidemic in Asia and North America. We are unaware of previous report of this phenomenon and could find no reference to it in a computerized search utilizing MEDLINE.

Orbital and muscle involvement in multiple myeloma.

CASE REPORT: We report 2 cases of orbital plasmacytoma in patients with known multiple myeloma. Orbital spread with secondary maxillary sinus involvement is reported in the first case. Case 2 is the first report of immunoglobulin A kappa light chain multiple myeloma involving orbital recti muscles. Computed axial tomography and magnetic resonance imaging aided the diagnosis, confirmed with histopathologic studies. COMMENTS: Extraskeletal spread is rare and orbital involvement is exceedingly uncommon. From a review of the literature since 1972, we conclude that the immunoglobulin G type of multiple myeloma, whether lambda or kappa light chain, may be a risk factor for orbital involvement.

Occipital infarction revealed by quadranopsia following snakebite by Bothrops lanceolatus.

We report a case of snakebite in which envenomation was manifested through impairment of the visual field. The patient, a 46-year-old man, was bitten on the right thumb by Bothrops lanceolatus. Treatment with a specific equine antivenom (Bothrofav) was administered one hour after the bite. With the exception of fang marks, the results of a clinical examination, particularly the neurologic component, were normal. The day after the bite, the patient developed an inferior left lateral homonymous quadranopsia with macular epargne. T2 magnetic resonance imaging showed a right occipital infarction. His condition improved clinically and biologically. This observation of snakebite is the first in which envenomation was accompanied exclusively by an impairment of the visual field. Envenomation by B. lanceolatus is distinct in its incidence of significant thrombotic complications at a distance from the site of the bite.

Alkali ocular burns in Martinique (French West Indies) Evaluation of the use of an amphoteric solution as the rinsing product.

PRECIS: During the 4 years of this study, we noted 66 cases of alkali ocular burns, or approximately 16 cases per year, nearly half (45.5%) of which are due to an assault. For grade 1 and 2 burns the time elapsed to reepithelialization appears to be shorter when rinsed with Diphoterine* versus physiological solution. PURPOSE: Comparison of the effectiveness of two rinsing solutions for emergency use: a physiological solution and an amphoteric solution (Diphoterine*, Laboratories Prevor, Valmondois, France). Description of the clinical and progressive characteristics of alkali burns treated at the University Hospital Center of Fort de France in Martinique (French West Indies). DESIGN: Prospective consecutive observational case series and nonrandomized comparative study. PARTICIPANTS: Sixty-six patients were included. The total number of burned eyes is 104. Forty-eight eyes (46%) were rinsed with physiological solution and 56 eyes (54%) with Diphoterine*. METHODS: All patients benefited from an ocular rinse with 500ml of physiological solution or Diphoterine*, followed by a complete ophthalmologic exam. The ocular injuries were classified according to the Roper-Hall modification of the Hughes classification system. The same standardized therapeutic protocol was applied and adapted to the seriousness of the burn. MAIN OUTCOME MEASURES: Demographic data, time to corneal reepithelialization, final best corrected visual acuity and complications were analysed. RESULTS: Twenty-eight (42.4%) patients have a unilateral burn and 38 (57.6%) patients have bilateral burns. In decreasing order of frequency, the circumstances surrounding the injury are: assaults in 45.5% of cases (n=30), work-related accidents in 32% of cases (n=31), and domestic accidents in 23% of cases (n=15). For grade 1 and 2 burns the time elapsed to reepithelialization appears to be shorter when rinsed with Diphoterine* versus physiological solution (respectively): 1.9+/-1 days versus 11.1+/-1.4 days (p=10(-7)) and 5.6+/-4.9 days versus 10+/-9.2 days (p=0.02). For grade 3 and 4 burns, there are complications in 11 cases (11.6%): 8 corneal opacities and 3 perforations. CONCLUSIONS: This study is the first conducted in humans that takes into account the type of ocular rinse product used in the progressive follow-up study of injuries. The time elapsed to reepithelialization is shorter with Diphoterine* for grade 1 and 2 burns. There are not enough cases of grade 3 and 4 burns to make a conclusion. Diphoterine* seems very effective in terms of its mechanism of action and the experimental and clinical results.