Longitudinal follow-up of vision in a neuromyelitis optica cohort.

BACKGROUND: Neuromyelitis optica (NMO) is an inflammatory disease associated with optic neuritis and myelitis. Recently, several studies showed that optical coherence tomography (OCT) could be an interesting method for the evaluation of disease severity; however, to date there are no studies with a longitudinal follow-up of visual function in NMO. The aim of this study was to assess the ability of OCT to evaluate the progression of visual dysfunction in NMO. PATIENTS AND METHODS: A group of 30 NMO patients (thus, 60 eyes), comprised of 20 women and 10 men with a mean age of 43.7 +/- 12.3 years, were prospectively evaluated clinically and by a whole neuro-ophthalmological work-up, including: visual acuity (VA), fundoscopy, visual evoked potential (VEP), visual field (VF) and optical coherence tomography (OCT). All patients were tested at baseline (after a mean disease duration of 6.1 years) and after a mean time of follow-up of 18 months (range: 12-36 months). RESULTS: Mean VA was similar at the two evaluation times (0.77 +/- 0.36 versus 0.77 +/- 0.35). The mean VF defect decreased slightly, but the difference was not significant (-5.9 +/- 1.3 dB versus -5.3 +/- 1.3 dB). In contrast, the mean retinal thickness seen on OCT decreased from 87.4 +/- 23.3 µm to 79.7 +/- 22.4 µm (p = 0.006). These modifications were only observed in eyes with a past or a recent history of optic neuritis (-15.1 µm; p < 0.001) and not in eyes without any history of optic neuritis (-2.4 µm; not significant). Also, they occurred independently of the occurrence of relapses (n = 13) and especially optic neuritis episodes; however, the number of optic neuritis episodes was low (n = 5). CONCLUSION: OCT seems to be a more sensitive test than VA or VF for monitoring ophthalmological function in NMO and it seems to be helpful for the detection of infra-clinical episodes in patients with a past history of optic neuritis. Our results suggest that this easily performed technique should be used in the follow-up of NMO, but complementary studies are warranted to confirm its interest at an individual level.

Lateral elbow tendinopathy: surgery versus extracorporeal shock wave therapy.

Lateral elbow pain caused by tendinopathy - tendinosis - or tennis elbow is a highly prevalent problem. Unfortunately, no treatment method can guarantee clinical success. Inspired by the lithotripsy technique used for kidney stones, extracorporeal shock wave therapy (ESWT) has been introduced as an alternative to surgical treatment 25 years ago. In a randomized prospective study, we compared 15 patients with lateral elbow tendinopathy who were operated and 14 who underwent ESWT. Almost all patients had good or excellent outcomes according to the criteria by Verhaar. Subjective improvement was 57% for the ESWT group and 76% for the surgery group. No significant differences between both groups were found (p = 0.07). We therefore recommend considering non-invasive techniques such as ESWT treatment prior to surgery in tennis elbow.

[Benign intracranial hypertension: the role of medical treatment]. / Hypertension intracrânienne bénigne: place du traitement médical.

The goal of medical treatment in benign intracranial hypertension (BIH) is to treat intracranial hypertension symptoms as well as to preserve vision. Reducing the production rate of cerebrospinal fluid can be achieved using acetazolamide and/or furosemide (carbonic anhydrase inhibitors), although acetazolamide is the most effective drug. The use of steroids is debatable in BIH. This review focuses on the pathophysiology of these medications, followed by the report of a series of 16 pediatric patients suffering from BIH (1996-2006). BIH was idiopathic for eight children. Depletive lumbar punctures were effective, but this result was often transient. All children were treated with acetazolamide. Doses of acetazolamide (10-20mg/kg per day) must be given every 8h to respect its kinetics. This treatment has to be continued for at least several months and decreasing the dosage must be progressive. Hypokalemia is always prevented with oral potassium. There was only one true treatment failure requiring surgery. The authors therefore advise acetazolamide as a first-line treatment (combined with etiologic treatment, if available, in cases of nonidiopathic situations) in BIH.

[Principle of the useful field of view and normative data]. / Principes de réalisation du champ visuel attentionnel et élaboration de normes.

PURPOSE: The useful field of view is a test which takes into account the influence of patient attention during the evaluation of the visual field. This study aims to generate normative data for an adaptation of the useful field of view (UFOV) test. These normative data are essential to judge, in a clinical setting, whether patients' performance is normal or not across demographically similar peers, in order to advise whether or not to resume driving after a brain injury (traumatic brain injury, stroke or cerebral tumour). PATIENTS AND METHODS: This study examined demographic influences on an UFOV adaptation in a sample of 52 control participants (17 males and 35 females, aged 19 to 69) with no prior ophthalmologic or neurologic history. This adaptation used three visual attention tasks. In a simple task (ST), the participant had to detect, as fast as (s)he could, a single target in a visual display; in a double task (DT,) (s)he had to detect both a central and a lateral target in a double task with visual distractions present on the screen. The number of missed targets and the time needed to detect them are measured. RESULTS: Time to detect target was found to differ by gender and by age. Men and young people (from 19 to 29 years) are faster at detecting central and lateral targets. However, no demographic influence was observed on the number of missed targets. CONCLUSIONS: A normative table for this French UFOV adaptation is provided. This will allow clinicians to compare patient performance with similar peers and may help in identifying persons who would benefit from training on a driving simulator or having a road test with a driving-school.

[Fisher's one-and-one half syndrome. Involvement of the 6th cranial nerve nucleus and association with paralytic pontine exotropia]. / Syndrome un et demi de Fisher. Atteinte du noyau du VI associée à une exotropie pontine paralytique.

Total lateral paralysis in a case of "One and half" Fisher's syndrome accompanied by paralytic pontine exotropia is described. Oculographic investigation indicates involvement of the nucleus of the VIth cranial nerve. Paralytic pontine exotropia, may therefore be encountered where the VIth nucleus is involved.

[Refsum's disease. Ophthalmologic symptomatology dominated by tight bilateral miosis]. / Maladie de Refsum. Symptomatologie ophtalmologique dominée par un myosis bilatéral serré.

A case of Refsum's disease in a 62-year-old man, with an ophthalmologic symptomatology dominated by a tight bilateral miosis, is reported. The miosis mechanism in this disease is discussed. The clinical evolution has been stabilized by a diet poor in phytanic acid.

[11 cases of neuropathy induced by almitrine, of which one had optic neuropathy]. / Onze cas de neuropathie à l'almitrine, dont un avec neuropathie optique.

The only etiologic factor retained in 11 patients with sensory or sensory-motor neuropathy was almitrine therapy. In one patient there was in addition an optic neuropathy. The reduction in visual acuity in this patient coincided with the onset of the sensory-motor neuropathy of lower limbs after treatment with 100 mg/day of almitrine over a 2-year period. No other metabolic, inflammatory, toxic, vascular or immunologic cause was found. There was a moderate chronic respiratory insufficiency. Visual recuperation started one month after the arrest of almitrine treatment and was satisfactory 7 months later. The other 10 patients had neuropathy of limbs without visual disorders. Neuromuscular biopsy in one case showed lesions to be of the axonal type.

[Up-dated ophthalmological screening and follow-up management for long-term antimalarial treatment]. / Surveillance ophtalmologique de la prise des antipaludéens de synthèse au long cours: mise au point et conduite à tenir à partir de 2003.

The early detection of macular toxicity linked to long-term antimalarial treatment requires regular ophthalmological screening based on patients'classification based on their results compared to successive controls. Patients are classified as "low risk" with screening every 18 months if all of the following criteria are met: age under 65 years, no associated renal, hepatic or retinal disease, treatment for less than 5 years, dose less than or equal to 6,5mg/kg/d for hydroxychloroquine and 3mg/kg/d for chloroquine (for a lean patient's weight); "at risk, without fundus findings" with screening every 12 months if one of the following criteria is met: age over 65 years (at the start of or during treatment), antimalarial treatment for more than 5 years, daily dose higher than recommended, presence of renal and/or hepatic disease; "at risk, with fundus findings" with screening every 6 months if a retinal dysfunction has been detected and even if treatment is established or followed. Screening consists of an in-depth clinical examination and at least two complementary tests of macular function: color vision (desaturated-Panel-D15 test) and/or static macular perimetry (central 10 degrees) and/or macular electroretinography (pattern ERG/multifocal ERG). If any changes or anomalies are found between two successive check-ups, the state of the retina can be assessed by angiography and global retinal function by full-field-ERG and electro-oculogram (EOG). The progression from one check-up to the next decides whether a course of treatment will be followed.

[Pituitary radiotherapy. Current data and future prospects]. / Radiothérapie hypophysaire. Données actuelles et perspectives d'avenir.

Some technical improvements have allowed to minimize the frequency of severe complications following fractionated pituitary conventional radiotherapy, without altering its efficiency. "Conformational" radiotherapy is currently under development, aiming at the best fitting of the tumor borders to the irradiation zone, by the means of stereotactic imaging. More recently, radiosurgery has been proposed for pituitary adenomas. It consists in a single high radiation dose to the tumor, by the means of either cobalt minibeams (Gamma Unit) or photon beams from a linear particle accelerator. These techniques require the use of a stereotactic frame and precise 3D imaging in order to tightly superimpose the target volume to the reference isodose. They must not be viewed as an alternative to conventional radiotherapy. They can be applied only to small lesions (less than 20 mm in their maximal axis) which are distant (> 5 mm) from the optic chiasma and nerves. Their efficiency is similar to the one of fractionated conventional radiotherapy, with a shorter response time. In conclusion, radiotherapy can be used safely for pituitary adenomas. It remains however a second line treatment, when surgery has been incomplete and when a simple, effective and inexpensive medical treatment is not possible.

[Comparison of 2 techniques for evaluating static monocular cyclotorsion with central visual field and scanning laser ophthalmoscope]. / Comparaison de deux techniques d'évaluation de la cyclotorsion monoculaire statique: le champ visuel central et l'ophtalmoscope laser à balayage.

OBJECTIVE: To compare the angles of cyclotorsion measured by central campimetry and scanning laser ophthalmoscopy. METHODS: Both methods were applied to each eye of 44 healthy volunteers, aged between 22 and 55 years. The line passing through the fovea and the center of the papilla was drawn on images from the scanning laser ophthalmoscope (SLO); the line passing through the fixing point and the center of the blind spot was drawn on the charts of the central visual field (VF). Torsion was estimated by the angle between these lines and the horizontal. RESULTS: With the VF method, the excyclotorsion was 5.6+/-2.9 degrees on the right eye and 7.2+/-2.9 degrees on the left eye. With the SLO method, these values were 4.7+/-2.6 degrees and 6.8+/-2.5 degrees , respectively. The measures obtained with both methods correlated significantly, for the right eye and the left eye, as well as for the difference between them. CONCLUSION: Data were in good agreement with the literature. Though slightly greater, values obtained with the scanning laser ophthalmoscope were coherent with campimetric measures. The origin of the greater excyclotorsion of the left eye remains an open issue. This phenomenon must be kept in mind when looking for a pathological between-eye difference.

[Blindness following orbital reconstruction]. / Cécité au décours d'une réfection orbitaire.

A 20 year old patient who suffered from contusion of the optic nerve due to a complex craniofacial fracture, developed, after orbital reconstruction for sequelae of the fracture, loss of light perception which was transiently improved by drug treatment. The clinical and electrophysiological course suggest the presence of ischaemic optic neuropathy.

[Electroretinographic problems in the diagnosis of diseases of the cones and macula]. / Les problèmes électrorétinographiques du diagnostic des affections des cônes et de la macula.

From series of clinical cases, the authors expose how ERG is an essential element for the diagnosis of cone dysfunction with or without macular involvement. They show that to obtain an accurate diagnosis, precise proceedings must be chosen, using stimulation technics correctly selected. They study the advantage of focal or wide stimulations, of the level of the intensity of the stimulation and of the different colored filters. They propose a proceeding for adults examination. For young children, they discuss the advantages and limits of a particular proceeding.

[Congenital microphthalmos. Orbital and palpebral expansion]. / Microphtalmie congénitale. Expansion orbitaire et palpébrale.

Ocular atrophy in prime infancy leads to lack of orbital growth. Current treatment of plastic surgery in severe deformities is unsatisfactory, whereas tissue expanding techniques using intraorbital balloon are effective on orbital cavity growth. This procedure makes use of conjunctival shells or aesthetic ocular prosthesis easier, and allows an improved reconstruction. Description of implants and surgical technique of insertion used.

[Surgical treatment of micro-ophthalmic syndromes]. / Le traitement chirurgical des syndromes microphtalmiques.

The complex embryology of the oculo-orbito-palpebral region is responsible for a number of heterogeneous clinicopathological situations, associating variable proportions of the three components of the malformation: micro-anophthalmia, microblepharism, micro-orbitism. Application of the double principle of skin expansion for the eyelids and distraction of the callus for the orbit, as early as possible (first year of life), is possible by means of a device which consists of a combination of an intraorbital expansion balloon, an antireflux valve to avoid effective pressure losses in the balloon, and an injection site for progressive filling of the expansion balloon. The response to these treatments is excellent for cases of simple microphthalmia and micro-orbitism; in complex craniofacial malformations, it generally only partially resolves the problem, but provides a precious complement to the quality of the final repair.

[A protocol for contact lenses adaptation in aphakia and myopia in children; surveillance and follow-up]. / Protocole d'adaptation des lentilles de contact de l'aphakie et de la myopie chez l'enfant; surveillance et suivi.

The authors report their procedure of contact lens adaptation in child and particularly after traumatic cataract. Adaptation in the briefest time following cataract surgery is absolutely necessary in order to undertake jointly the orthoptic treatment of amblyopia.