[Bilateral simultaneous central retinal artery occlusion revealing giant cell arteritis]. / Occlusion bilaterale et simultanee de l'artere centrale de la retine revelatrice d'une maladie de Horton.

AIM: To point out the importance of the early diagnosis of giant cell arteritis (GCA) (Horton's disease). MATERIALS AND METHODS: a case report of a sudden bilateral blindness that had revealed GCA. CASE REPORT: A 68-year old female patient with a history of elevated blood pressure and diabetes mellitus type 2, was examined in emergency for a right painful headache developed one week previously. In ophthalmological examination, her BCVA was 0.9 and P2 in both eyes. Diagnosis of Horton's disease was not initially done in spite of elevated erythrocytes sedimentation rate (ESR) at 30 mm, protein C reactive (CRP) at 19 mg/l. The patient consulted seven weeks later in emergency for a sudden bilateral blindness associated with severe headache, recent asthenia, and limping of the lower jaw. At that time, visual acuity was reduced to light perception in both eyes whereas ophthalmoscopy revealed a bilateral central retinal artery occlusion (CRAO). ESR was 74 mm and CRP 233 mg/I. Temporal artery biopsy confirmed the diagnosis of GCA. The patient was treated with systemic steroids without visual recovery. CONCLUSION: This case outlines the importance of the early diagnosis of GCA in order to make possible to start treatment before the occurrence of irreversible complications.

Insulin sensitivity, adjusted beta-cell function and adiponectinaemia among lean drug-naive schizophrenic patients treated with atypical antipsychotic drugs: a nine-month prospective study.

Atypical antipsychotic drugs (AADs) induce weight gain and truncal adiposity, and even the metabolic syndrome (MetS), which may progress to IFG/IGT or DM. AAD effects in lean schizophrenic patients without MetS have not been documented, especially in terms of weight gain and changes in insulin sensitivity (S), beta-cell function (beta) and adiponectinaemia. We prospectively determined the effects of nine-month therapy with AADs on anthropometrics, metabolism and adiponectinaemia, including homoeostasis model assessment (HOMA) modelling of S, beta and betaxS (hyperbolic product, assessing individual beta adjusted for S). We analyzed 36 schizophrenic subjects (M/F: 24/12; Caucasian: n=23, North African: n=12, South Asian: n=1) aged 35+/- years (mean+/-one S.D.) free of MetS (NCEP-ATPIII), of whom 19 study completers were evaluated following AAD treatment. S, beta, betaxS and adiponectin were measured at zero, three and nine months. At nine months, BMI had risen from 22+/-2 to 25+/-2kg/m(2) (P<0.001) and waist circumference from 85+/-8 to 91+/-11cm (P<0.001), while adiponectin decreased from 10.4+/-5.1 to 7.4+/-3.8mug/mL (P<0.001). Blood pressure and lipids were unaffected. S decreased from 138+/-49 to 110+/-58% (P=0.006) and beta increased from 83+/-24 to 100+/-40% (P=0.034). As a result, betaxS decreased from 106+/-19 to 91+/-27% (P=0.015). Fasting glycaemia rose from 89+/-5 to 96+/-9mg/dL (P=0.007). On study completion, 21% had IFG. Long-term use of AADs in lean, drug-naive, schizophrenics initially free of MetS induced weight gain and truncal fat accumulation associated with decreases in adiponectin and hyperbolic product, explaining the increased fasting glycaemia and impaired fasting glucose seen in predisposed individuals.

Vancomycin prophylaxis and intraocular contamination during cataract surgery.

PURPOSE: To investigate the effect of vancomycin added to the intraocular irrigation solution to prevent anterior chamber contamination during phacoemulsification. SETTING: Centre Hospitalier, Villeneuve-Saint-Georges, France. METHODS: A group of 372 patients having cataract extraction by phacoemulsification was divided into two consecutive, nonrandomized groups. The first group (n = 190) was a control; there was no antibiotic in the irrigation solution. The second group (n = 182) received vancomycin in the irrigation solution. Intraocular fluid was aspirated at the end of surgery and injected into a blood culture bottle to evaluate bacterial contamination of the anterior chamber. RESULTS: There was no between-group difference in bacterial intraocular contamination. Eight samples in the first group were contaminated and nine in the second group. All contaminants were gram-positive vancomycin-sensitive organisms. CONCLUSIONS: Adding vancomycin to the intraocular irrigation solution during cataract surgery had no effect on the occurrence of intraocular contamination as evaluated by anterior chamber taps.

[Rules and regulations concerning contact lens-related infection]. / Lentilles de contact et risques infectieux, aspects réglementaires.

Contact lens-related infectious keratitis is a potentially sight-threatening complication. Bacterial keratitis, mostly due to Gram-negative bacteria, is associated with poor lens hygiene, overnight wear, and contaminated lens care solutions. Contamination of the lens storage case may cause fungal keratitis. Acanthamoeba infection is related to the use of tap water or swimming while wearing soft lenses. Viruses are of less concern among contact lens wearers. Possible transmission of Creutzfeldt-Jakob disease by multi-patient trial lenses must be taken in account. To minimize these risk factors, regulations are applied at various levels: CE marking of contact lenses and care products as they are medical devices; contact lens fitting only by health care professionals; distribution of contact lenses by opticians and lens care solutions by opticians and pharmacists; hygienic management of trial lenses following official recommendations. Contact lens-related keratitis must be reported to health care Authorities.

[Factors influencing early post surgical ocular hypertension after phacoemulsification]. / Les facteurs de l'hypertonie oculaire précoce après phacoémulsification.

PURPOSE: To evaluate factors influencing early post surgical ocular hypertension after phacoemulsification. METHODS: Records were collected for patients who had uncomplicated phacoemulsification with IOL implantation in the bag. Aspiration of the viscoelastic was performed at the conclusion of surgery. Patients with previous ocular surgery, high myopia, or glaucoma were excluded. Intraocular pressures were measured at six hours (+/-2) postoperatively. Following factors were analysed RESULTS: 26% of the patients had an ocular pressure equal or higher than 21 mmHg. Among the factors we analysed, pilocarpine injection was the only one to produce significant decrease in postoperative ocular pressure. COMMENTS: The acute postoperative IOP increase following phacoemulsification is presumably the result of trabecular obstruction by viscoelastic material. However it can occur despite meticulous evacuation of viscoelastic, which could be dependent upon the material's viscosity, and IOL material and design. Postoperative ocular hypertension is not related to ultrasonic duration. Intracameral injection of pilocarpine significantly reduces the incidence of postoperative intraocular pressure increase. CONCLUSION: Early postoperative ocular hypertension can be observed with different kinds of viscoelastics and IOL. Meticulous evacuation of viscoelastic from anterior chamber, although necessary does not always prevent this early complication. Intracameral injection of pilocarpine can reduce its incidence.

[Bacterial contamination: epidemiology in cataract surgery]. / Epidémiologie de la contamination bactérienne oculaire en chirurgie de la cataracte.

PURPOSE: To evaluate anterior chamber (AC) bacterial contamination at the end of cataract surgery in a large series of patients, to determine the influence of operative technique on ocular contamination. METHODS: Retrospective study of 2,624 patients undergoing cataract extraction, 354 extracapsular cataract extraction (ECCE) and 2,270 phacoemulsification. Anterior chamber aspirates were performed on completion of surgery for microbiological studies. RESULTS: One hundred and thirty two patients (5%) had culture-positive anterior chamber aspirates. Coagulase-negative Staphylococcus, Propionibacterium sp. and Corynebacterium sp. were the most commonly isolated organisms. The AC contamination rates during ECCE (5.6%) and phacoemulsification (4.7%) were not statistically different. There was a statistically significantly higher risk of AC contamination in eyes receiving an intraocular lens (IOL) with polypropylene haptics (9.9%) than in eyes receiving the same IOL with polymethylmethacrylate haptics (4.4%). CONCLUSION: Surgical technique had no statistically significant effect on ocular contamination. Polypropylene haptics IOLs were associated with a higher risk of bacterial contamination.

[Torpid endophthalmitis in pseudophakia: diagnostic and therapeutic difficulties. Apropos of 4 cases]. / Endophtalmies torpides chez le pseudophake: difficultés diagnostiques et thérapeutiques. A propos de 4 cas.

The authors report four cases of chronic endophthalmitis following extracapsular cataract extraction with intraocular lens implantation in the posterior chamber. The first attack of intraocular inflammation occurred in the form of recurrent iridocyclitis two to six months after surgery. The first attack usually responded well to local corticosteroids. After many relapses of inflammation, increasingly resistant to medical treatment, a severe attack occurred leading to the decision to treat such endophthalmitis surgically: endocular fluid aspiration, vitrectomy, intraocular injection of antibiotics combined with systemic antibiotics and corticosteroids. It may be very difficult to prove the infectious origin of torpid endophthalmitis. Growing bacteria from endocular fluid aspirates is much more difficult than in acute endophthalmitis. No organisms were found in this series by this method, despite the fact that fluid aspiration was often performed many times in these 4 cases. A bacterium was identified in 3 cases, twice on the implant itself and once after culture of an iridectomy specimen. Intraocular antibiotic injections resulted in the complete recovery of one patient. Following failure of standard treatment, intraocular lens explantation resulted in the disappearance of infectious inflammatory signs in 3 cases. The treatment of chronic endophthalmitis is governed by the same rules as acute endophthalmitis but is not always as successful. Intraocular lens removal is often the only solution and confirms the pathogenic hypothesis that slime production by organisms, their adherence to the intraocular lens and their quiescent state make them less vulnerable to antibiotics and host defences.

[Intraocular contamination during cataract surgery according to surgical technique and type of implant]. / Contamination intra-oculaire au cours de la chirurgie de la cataracte selon la technique et l'implant utilisés.

PURPOSE: To determine wether the cataract extraction method and intraocular lens material affect bacterial contamination of the eye during surgery. METHODS: This retrospective study evaluated microbial contamination of the anterior chamber fluid in three group of patients. Group 1: extracapsular extraction and PMMA lens (354 cases). Group 2: phacoemulsification and PMMA lens (474 cases). Group 3: phacoemulsification and silicone lens with PMMA haptic (264 cases). RESULTS: Microbial contamination rate was in group 1: 5.65%, in group 2: 4.75%, and in group 3: 4.54%. The difference was not statistically significant (chi: 0.321). All contaminants were Gram positive. CONCLUSION: Bacterial contamination rate of the anterior chamber is similar during extracapsular extraction and phacoemulsification, and is not modified when using PMMA or silicone lens.

[Capsulorhexis staining by trypan bleu in mature cataract surgery]. / Utilisation du bleu trypan pour la réalisation du capsulorhexis dans la chirurgie de la cataracte blanche.

BACKGROUND: Capsulorrhexis may be hazardous in the absence of the red fundus reflex. Anterior capsule trypan blue staining enabled to perform the capsulorrhexis and safe phacoemulsification. MATERIAL AND METHODS: Twenty patients with mature cataract were enrolled in the study and opereted on after injection of trypan blue in the anterior chamber. RESULTS: Circular capsulorrhexis was performed in all cases followed by phacoemulsification and in-the-bag IOL implantation. In two cases hard nuclei required a manual extracapsular technique. No operative complications, and no residual of coloration was noted the day after the operation. With a follow-up of 2 to 12 months, no complications appeared (cornea, capsulorrhexis, IOP). CONCLUSION: In mature cataracts, with no red fundus reflex, capsulorrhexis can be done by anterior capsule staining.

[Bacteriological study of the intraocular fluid at the end of cataract surgery]. / Etude bactériologique du liquide intra-oculaire en fin d'intervention de cataracte.

The authors studied bacterial contamination of the anterior chamber during extracapsular cataract extraction with intraocular lens implantation. A first study was conducted to determine the rate of contamination of anterior chamber aspirates, before surgery, in 46 patients undergoing cataract extraction. A second study concerned 200 patients undergoing extracapsular extraction with posterior chamber lens. Anterior chamber fluid was aspirated at the end of surgery, and inoculated into blood culture bottles. Bacteriological results were positive in 11 cases, and were compared with conjunctival smears. The way in which aqueous humor was aspirated and inoculated is described. The bacteriological method was tested with a small inoculum of bacteria. Bacteriological study of intraocular fluid at the end of cataract surgery might be useful in the diagnosis and treatment of postoperative endophthalmitis.

[Interleukin-6 and other cytokines in the aqueous humor in uveitis and endophthalmitis]. / Interleukine-6 et autres cytokines dans l'humeur aqueuse au cours d'uvéites et d'endophtalmies.

We studied aqueous humour and serum level of 4 cytokines during uveitis and endophthalmitis: Interleukin 6, Gamma interferon, tumor necrosis factor and Granulocyte-macrophage colony stimulating factor. High levels of IL-6 were found in aqueous humour during ocular inflammation and infection. This elevation of IL-6 level was more constant and more important in the endophthalmitis group (mean level 2.992 pg/ml) than in the uveitis group (mean level 1.480 pg/ml). During endophthalmitis no evident relation was found between IL-6 level and clinical course or aspect, or bacteriological results of anterior chamber tapes. In the uveitis group, no relation was found between IL-6 level and clinical aspect or aetiology.

[Spontaneous clearing of the cornea with detachment of Descemets membrane]. / Décollement de la membrane de Descemet d'évolution spontanément favorable.

UNLABELLED: Detachment of Descemet's membrane (DM) is a rare complication of cataract and glaucoma surgery. Although permanent corneal edema is the usual outcome of a large detachment, spontaneous clearing of the cornea may occur. CASE REPORT: A 55-year-old man underwent trabeculectomy in 1991 under local anesthesia. One day later the cornea was edematous, with a large superior DM detachment curling inward in the anterior chamber, limited by a thin blood pigmented line. Two months after cornea had cleared, and remained clear for ten years, with 20/20 visual acuity and intraocular pressure of 14mmHg. DISCUSSION: Small detachments of DM after surgery are not rare and usually reattach spontaneously. However, extensive detachment results in overlying corneal edema and may require surgical reapposition. In our case, the cornea cleared spontaneously in the absence of DM repositionning, as denuded corneal stroma may be covered by newly regenerated DM. Before any surgical repair of DM detachment, one should consider spontaneous clearing of the cornea as a possible outcome.

[Hereditary hyperferritinemia syndrome and cataract]. / Syndrome héréditaire d'hyperferritinémie et cataracte.

UNLABELLED: Hereditary hyperferritinemia cataract is a recently described autosomal dominant syndrome, characterized by bilateral cataracts and elevated level of serum ferritin. PATIENTS: Three members of a family were investigated for cataract and hyperferritinemia. A 30-year-old woman had elevated serum ferritin levels and bilateral cataracts. She was treated for hemochromatosis, but serum iron and transferrin saturation were normal. Her two sons, nine and five years old, also had a high ferritin level and bilateral cataracts. RESULTS: The ferritin level was 1200 micrograms/L in the woman's serum, and respectively, 974 and 965 micrograms/L in the two boys' serum. The mother had a visual acuity of 8/10 in the right eye and 5/10 in the left eye. The cataract comprised fine crystalline cortical opacities, extending axially. The two sons had 7 to 8/10 in both eyes. No other ophthalmic abnormality was noted. These patients were heterozygous for a 16 bp deletion on the L-ferritin gene. DISCUSSION: Ferritin is an iron storage ubiquitous protein present in every cell. In hyperferritinemia cataract syndrome, serum iron and transferrin saturation are normal, and the elevated serum ferritin level is the consequence of an autosomal dominant disorder. The cataract is made up of the accumulation of small opacities disposed radially and more numerous on the outside edges, with relatively good visual acuity. The size of the cataract seems to be correlated to the serum ferritin level. In hemochromatosis, hyperferritinemia is related to increased iron stores and is not associated with cataracts.

[Eye injuries due to pellet guns. Apropos of 7 cases]. / Traumatismes oculaires par armes à grenaille. A propos de 7 cas.

The authors expose a series of seven cases of ocular trauma due to pellet guns. First, they describe the different kinds of lesions, their treatment, and their development. Then, they study the prognostic points, the mechanism of the secondary complications, and the therapeutic conduct to adopt in front of this type of perforating injuries with non-magnetic intraocular foreign body. They insist on the severity of this type of ocular trauma, and on the necessity of a modification of the law concerning pellet guns.