[Diabetic retinopathy in Lubumbashi]. / La rétinopathie diabétique à lubumbashi.

PURPOSE: To evaluate the frequency of diabetic retinopathy in Lubumbashi (Democratic Republic of Congo). METHODS: Descriptive survey including 369 diabetic patients examined in our department of Ophthalmology of Lubumbashi from May 2006 to March 2008. Rates of glycaemia and blood pressure were noted. All the patients had a complete ophthalmological examination including visual acuity measurement, anterior biomicroscopy, intraocular pressure and fundus examination after pupil dilation. RESULTS: At the time of ocular examination, the mean age of diabetic patients was 57 years (range 16 to 85) with a sex ratio of 1.2 males for 1 female. The frequency of type 1 diabetic patients was 28% and of type 2, 72%. High blood pressure was found in 42% of the patients. The frequency of diabetic patients (all forms included) was 13% and diabetes-induced blindness was 0.27%. In our study, the frequency of diabetic retinopathy increased with the patient's age and the duration of the diabetes. Diabetic retinopathy was more frequently found in adults. We did not find correlation between the level of glycaemia and the incidence of diabetic retinopathy. CONCLUSION: From our epidemiological study, diabetic retinopathy is a concern for adult public health. It requires organized screening and early treatment to prevent blindness of those diabetic patients.

[Treatment of age-related macular degeneration with intravitreous injections of bevacizumab (Avastin): short-term results]. / Traitement de la dégénérescence maculaire liée à l'âge par injections intravitréennes de bevacizumab (Avastin): résultats à court-terme.

PURPOSE: To analyse short term visual outcomes and macular morphologic changes associated with intravitreal injection of bevacizumab (Avastin) therapy for subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD) METHOD: Retrospective study of 59 eyes. Each included eye received 3 intravitreal injections of 1.25 mg bevacizumab at 4 to 6-week intervals. Mean follow-up was 5.5 months (range 3 to 9). Best-corrected visual acuity, ophthalmoscopic examination, optic coherence tomography and fluorescein or green indocyanin angiography were performed before and routinely after the treatment. RESULTS: A total of 160 injections were performed with a mean value of 2.7 (1-6) per eye. Visual acuity improved at least two lines in 17% (10 eyes), worsened at least two lines in 14% (8 eyes) and was stabilized in 69% (41 eyes). Among that last group of 41 eyes, a significative reduction of macular thickness was observed in more than 39% (12 eyes) and a subjective improvement with less metamorphopsia and better visual comfort was noticed in 24% (10 eyes). No intraocular or systemic adverse effects were observed except a self-limited iritis in two cases. CONCLUSION: Intravitreal bevacizumab therapy resulted in visual and morphologic improvements in a significant number of cases of advanced AMD with CNV. Randomized studies and longer follow-up are needed to confirm these preliminary results.

Acute visual field constriction in optic disc drusen: report of an unusual case.

We describe a case of an acute symptomatic and non-progressive visual field constriction in one eye of a 19-year-old female with optic disc drusen. The fellow eye showed slowly progressive visual field defects. A limited or retrolaminar infarction of the optic nerve head seems a plausible cause of the acute visual field loss. The slow progression in the fellow eye is most probably due to mechanical compression by the drusen. The case is documented with Humphrey perimetry during a follow-up of 11 years and with Color Doppler Imaging (CDI) of the optic nerve.

Late-onset renal failure in Senior-Loken syndrome.

We report on four patients, from three different families, with Senior-Loken syndrome (SLS). They were unusual in that they reached end-stage renal failure (ESRF) only during the fifth or sixth decade. SLS is an autosomal-recessive disorder defined by the association of nephronophthisis and retinal dystrophy. Affected individuals invariably progress to ESRF, usually before the age of 20 years. The diagnosis was based on typical clinical presentation and characteristic renal histology, that is, a picture of chronic interstitial nephritis with pronounced thickening and multilayering of tubular basement membranes. Deterioration of renal function was slow, leading to ESRF between the ages of 42 and 56 years. Retinal dystrophy, already symptomatic during childhood in two patients, led to severe visual impairment in all. In contrast with four cases of SLS recently reported in very young patients, the NPH1 gene (the main gene responsible for nephronophthisis) was not deleted in our two tested patients. We conclude that SLS should be considered in adults who suffer from both chronic interstitial nephropathy and retinal degeneration. Whether the SLS is a variant of nephronophthisis and whether early- and late-onset renal failure in SLS is accounted for by genetic or allelic heterogeneity remain to be determined.

Multiple arterial ectasias in patients with sarcoidosis and uveitis.

PURPOSE: To describe and evaluate the cause of a clinical entity characterized by bilateral intraocular inflammation, multiple arterial ectasias including beading, macroaneurysms, comma-like ectasias and kinking, with vasculitis, staining of the optic disk and multiple peripheral round punched-out hypopigmented chorioretinal scars in elderly patients. The formation and the course of the arterial ectasias is analyzed. METHODS: Seven patients with this syndrome were evaluated by clinical examination, fluorescein angiography, and systemic investigations. RESULTS: Three of the seven patients had a biopsy characteristic of sarcoidosis, two others showed positive bronchoalveolar lavage, as well as other analyses and tests suggesting sarcoidosis, and two showed other findings suggestive of sarcoidosis. The patients were all over 60 years of age and had arterial hypertension. In two patients, an arterial ectasia developed at the site of previous focal inflammation. The macroaneurysms either remained unchanged, became comma-like ectasias, arterial kinks, or completely vanished. CONCLUSION: Elderly patients with multiple arterial ectasias, uveitis, disk staining, and peripheral chorioretinitis should be thoroughly investigated for sarcoidosis. We suggest that sarcoidosis may cause some degree of arteritis, which may weaken the arterial wall, with resulting ectasia. Arterial hypertension may play a role in the formation of the ectasias by increasing the pressure on the arterial wall weakened by inflammation.

Diffuse retinal pigment epitheliopathy complicating systemic corticosteroid treatment.

AIMS/BACKGROUND: This study was undertaken to confirm the association between diffuse retinal pigment epitheliopathy (DRPE) and systemic corticosteroid therapy. This finding can be of help in determining an aetiological factor in DRPE and associated diseases. Corticosteroids may contribute to the development of leakage in the presence of a retinal pigment epitheliopathy or central serous chorioretinopathy. METHODS: Cases of DRPE were collected from the files of members of the European Fluorescein Angiography Club. There were 34 who developed their ophthalmic symptoms while being treated with corticosteroids. RESULTS: DRPE developed in 34 patients from 10 European eye clinics during systemic treatment with corticosteroids. Thirteen patients were treated with corticosteroids after allotransplantation, 21 other patients developed ocular symptoms while treated with steroids for serious systemic disorders. Symptoms occurred in some patients when the daily corticosteroid dosage was elevated, and the visual complaints ameliorated or even disappeared sometimes on discontinuation of the corticosteroid therapy. CONCLUSION: Corticosteroids can damage the retinal pigment epithelial barrier and predispose a patient to serous retinal detachment, whereas psychological stress may play a role in the development of central serous chorioretinopathy. A decrease of the daily corticosteroid dosage may help to diminish the visual symptoms.

Bilateral optic neuropathy associated with the crest variant of scleroderma.

We report a case of bilateral optic neuropathy associated with the CREST syndrome, a variant of scleroderma. Immunosuppressive therapy achieved significant improvement of the visual symptoms for two years. The pathophysiological mechanisms underlying this unique association remain unclear.

Sequential observation of fundus changes in patients with long standing membranoproliferative glomerulonephritis type II (MPGN type II).

Specific fundus changes have been reported in patients with membranoproliferative glomerulonephritis type II (MPGN type II). We studied the clinical course of this retinopathy in four patients who all had a long follow-up with several fundus examinations. Sequential observation was indicative of a slow progression of the retinopathy. Most eyes maintained in the chronic stages a nearly normal visual acuity, and a full visual field despite the existence of marked drusen and atrophic changes. The prognosis however must be somewhat guarded, since choroidal neovascularization developed in three eyes and caused bilateral severe visual loss in one patient.

[Trauma and imputability]. / Traumatisme et imputabilité.

The imputability of a bodily damage to a traumatism and the bond of causality are at the basis of the mission of the medical expert in the procedure that leads to indemnification in reparation of a suffered prejudice. The aim of this paper is to enumerate the bases on which the expert grounds to prove the imputability and the bond of causality. He will also insist on the final role of the jurist who, grounding his opinion on the elements of the expert appraisement, will establish the causality and hence the responsibility and the level of reparation.

[Proliferative diabetic retinopathy: laser photocoagulation treatment]. / Rétinopathie diabétique proliférante: traitement par photocoagulations au laser.

Laser panretinal photocoagulation has proven its efficacy in controlling proliferative diabetic retinopathy. It is unclear exactly how photocoagulation works: several mechanisms are evoked, involving the pigment epithelium, the photoreceptors and the retinal microvascularization. Indications for treatment and the way of carrying it out are reviewed. Possible complications related with photocoagulation can occur. Some advanced or complicated forms of proliferative diabetic retinopathy need alternative treatments like cryotherapy or vitreoretinal surgery.

[Herpetic retinal necrosis]. / Nécroses rétiniennes herpétiques.

Update on herpetic retinal necrosis, including cytomegalovirus retinitis.

[Posterior scleritis: apropos of 6 cases]. / Sclerite postérieure: à propos de 6 cas.

In a retrospective study of 6 patients (9 eyes) with posterior scleritis, we analyse the symptoms, the clinical signs and the ancillary tests of the disease. A decreased vision and an ocular or periocular pain are found in 8 cases of 9. Anterior involvement like redness is found in all the cases. In 7 eyes, we observe a diffuse or localized exudative retinal detachment. B-scan ultrasonography is the most helpful ancillary test, showing in all the examined eyes a scleral thickening. In 2 patients, we find a systemic disease associated with the posterior scleritis.

[Syphilitic uveitis. Apropos of 2 cases]. / Uvéite syphilitique. A propos de deux cas.

Report of two cases of syphilitic uveitis which presented vasculitis, papillitis, cystoid macular edema and large disturbance of the pigment epithelium. The superior value of the FTA-Abs test and of the cerebrospinal fluid analysis in the diagnosis of the disease is discussed. Treatment with high doses of Penicillin G for 10 to 15 days is recommended.

[Central serous choroiditis following renal transplantation]. / Choroïdite séreuse centrale après transplantation rénale.

Report of 5 cases of central serous choroidopathy (CSC) following kidney transplantation. The authors compare the clinical features, the fluorescein angiography, the color vision, the visual field and the electrophysiological tests of these 5 cases with 7 control patients. In the pathogenesis of the CSC, the authors briefly discuss about the risk factors associated with the transplantation.

[Recurrent corneal erosions: new manifestation of juvenile alport syndrome]. / Erosion cornéene récidivante: nouvelle manifestation du syndrome d'Alport juvenile.

A history of recurrent corneal erosion (RCE) in 3 brothers with juvenile X-linked Alport's syndrome (AS), whereas their 2 brothers without AS were unaffected, suggested a possible association between AS and RCE. A survey, among 39 patients with AS, revealed that 6 of them had suffered from RCE, supporting the association of the two conditions. RCE has to be considered as an additional ocular manifestation of AS, with a prevalence of 15 to 21%.

[Occlusion of the central retinal vein in young adults: risk factors and visual prognosis]. / Occlusion de la veine centrale de la rétine chez le jeune adulte: facteurs de risque et pronostic visuel.

Retrospective study of 15 cases of central retinal vein occlusion in young patients. A research for risk factors was performed. 4 patients had a systemic disease, and 6 had thrombophilic hematological conditions like blood hyperviscosity and increased platelet aggregation. No inflammatory disease was found. The visual prognosis was good in 7 out of 12 patients with a follow-up of more than 3 months. Chronic macular edema and neovascular glaucoma were responsible for the bad visual prognosis in 5 cases.

[Retinal occlusive vasculopathy and primary anti-phospholipid syndrome: when to evoke it?]. / Vasculopathie occlusive rétinienne et syndrome anti-phospholipide primaire: quand l'évoquer?

A severe case of retinal vascular occlusion in a 31 year old white female is reported. Its origin is attributed to the primary antiphospholipid syndrome. The diagnostic criteria and the treatment of the primary antiphospholipid syndrome are revised and discussed. When the etiology of a retinal vascular occlusion is not assessed by the initial work-up, especially if the initial presentation consists of a severe occlusive disease, antiphospholipid antibodies should be checked.

Successful photodynamic therapy combined with laser photocoagulation in three eyes with classic subfoveal choroidal neovascularisation affecting two patients with multifocal choroiditis: case reports.

Multifocal choroiditis (MC) is an idiopathic choroidal inflammatory disease affecting young subjects. Secondary choroidal--and often central--neovascularisation is a frequent complication leading to a poor visual prognosis. Photodynamic therapy (PDT) has now proven to be successful to treat classic subfoveal choroidal neovascularisation in age-related macular degeneration and in pathologic myopia. We describe the treatment applied to classic choroidal neovascularisation in two young women with MC, two eyes with subfoveal neovascular membrane and one eye in which new vessels encroach the foveal avascular zone. PDT has been useful in the three reported eyes, with stable or improved visual acuity. In two of them, it even made the membrane retract and become extrafoveal, allowing a secondary treatment using conventional laser.

[Radiotherapy treatment of subfoveal retinal neovascularization related to age]. / Traitement par radiothérapie des néo-vaisseaux sous-rétiniens rétrofovéolaires liés à l'âge.

Thirty-three patients who underwent low dose of radiation therapy for subfoveal choroidal membranes were studied after a mean follow-up of 16 months. The evaluated parameters were the visual outcome and the choroidal neovascularization evolution. In this study, the efficacy of low-dose radiation delivered to the macular region as an alternative treatment in subfoveal membrane was limited.