[Role of trypan blue in epiretinal membrane surgery]. / Intérêt du bleu trypan dans la chirurgie des membranes épirétiniennes.

INTRODUCTION: Idiopathic epiretinal membrane (ERM) results from detachment of the posterior hyaloid. Vitrectomy and peeling are the treatment of choice. Trypan blue 0.15% (TB) stains the epiretinal membrane and the internal limiting membrane (ILM), facilitating surgery and thus allowing selective and complete removal with less retinal damage. We conducted a study evaluating the advantages of selective staining associated with surgery, the incidence of postoperative damage, and the influence on final visual acuity. MATERIAL AND METHODS: Fourteen patients were operated on by the same surgeon, who carried out a complete vitrectomy, then fluid-air exchange for dye injection of undiluted 0.2 ml of Trypan blue 0.15% in front of the membrane, which was then easily distinguished from the area under the retina. Preoperative visual acuity, postoperative damage, as well as eye status at the end of follow-up are discussed. Transmission electron microscopy was used to determine if epiretinal membrane removal was complete and selective. Angiography was systematically used to study the state of retina before and after surgery. RESULTS: Preliminary results show that trypan blue is useful and facilitates complete removal of ERM and ILM. It may reduce long-term complications and recurrent membrane formation. Trypan blue is a staining agent that is quick and easy to use. It presents no short-term toxic effects. Functional results in 6 months show improvement of visual acuity and disappearance of metamorphopsia. CONCLUSION: Idiopathic epiretinal membrane surgery with tryptan blue staining is a better alternative than indocyanine green staining.

[Evaluation of trypan blue toxicity in idiopathic epiretinal membrane surgery with macular function test using multifocal electroretinography: seven prospective case studies]. / Evaluation de la toxicité du bleu trypan dans la chirurgie des membranes épirétiniennes idiopathiques en testant la fonction maculaire par l'électrorétinogramme multifocal. Etude prospective sur 7 cas.

INTRODUCTION: Idiopathic epiretinal membranes are considered the consequence of glial proliferation through a defect of the internal limiting membrane and can induce a functional macular syndrome associating mainly metamorphopsia and visual acuteness. Visual disturbance is not bound to the area and the degree of transparency of the membrane, but to distortion of external layers of the retina. Multifocal electroretinography (ERGm) can assess the macular area and retina extending 20 degrees. We used this tool to study macular function pre- and post-operatively with seven patients presenting idiopathic epiretinal membrane. PATIENT AND METHOD: All patients had successful vitrectomy, with 0.2 ml of 0.15% trypan blue (TB) staining to facilitate peeling. This stain is not toxic for the pigment epithelium but it becomes so for photoreceptors at doses exceeding 0.2%. We tried to estimate the echo of TB 0.15% on photoreceptors through this exam. An ERGm was done 1 week before the operation as well as 1 month and 4 months after on 14 eyes of seven patients with ERMs. RESULTS: Results show a pre-operative decrease in the electrical retinal response densities in the foveal, perifoveal and parafoveal areas. One month after operation, no significant difference was found compared to pre-operative results. However, at 4 months, an improvement of the retinal response density was observed. Retinal response densities in the macular area increased progressively after ERM surgery. CONCLUSION: The 0.15% TB facilitated ERM peeling and does not seem to present any retinal toxicity.

[Ultrastructural study of epiretinal membrane stained by trypan blue: 15 case reports]. / Etude ultrastructurale des membranes épirétiniennes idiopathiques colorées au bleu trypan.

INTRODUCTION: Idiopathic epiretinal membrane results from detachment of the posterior hyaloid and is believed to be related to naturally occurring defects in the internal limiting membrane (ILM) of the retina. Vitrectomy and peeling are the treatment of choice. Trypan blue 0.15% (TB) stains epiretinal membrane and internal limiting membrane. It allows selective and complete removal, facilitating surgery, with less retinal damage. An ultrastructural study was conducted showing ultrastructural features of idiopathic epiretinal membranes (ERM) and those of the internal limiting membrane and its connections with the retinal side. MATERIAL AND METHODS: After pars plana vitrectomy and induction of posterior vitreous detachment, 0.2 ml TB 0.15% was injected over the ERM in an air-filled eye. The stained tissue was peeled with intraocular forceps. Specimens were at once collected in 4% glutaraldehyde for a transmission electron microscopy study. RESULTS: TB may allow complete and easier ERM and ILM peeling. The staining does not present toxic effects. The major cellular contingent is represented by glial cells, participating actively in neocollagen synthesis. Their presence supports the hypothesis of a migratory movement of retinal cells toward the vitreoretinal side. CONCLUSION: The presence of an intact internal limiting membrane, the absence of optical fibers belonging to the under retina, and the absence of any sign of apoptosis make TB a useful staining agent for ERM and ILM peeling.

[Role of vitrectomy in patients with a decrease in visual acuity secondary to asteroid hyalosis]. / Indications de la vitrectomie chez les patients atteints d'une baisse d'acuité visuelle secondaire à une hyalopathie astéroïde.

PURPOSE: Asteroid hyalosis is a vitreous degeneration with calcium and phosphorus--lipid complexes in elderly patients with vascular risk factors or general disease such as diabetes mellitus. Synchysis scintillans is a complication of pathological eyes. Generally there are no symptoms. This study aims to evaluate the role of vitrectomy in patients with a decrease in visual acuity. CASE REPORTS: Pars plana vitrectomy was performed in three patients with visual acuity less than 1/10. The biomicroscope examination showed white and bright particles with rounded and variable shapes localized in the anterior vitreous, moving with the eye. The visualization of the fundus was difficult or impossible. On echography B, the vitreous was very dense with a complete posterior vitreous detachment. The vitrectomy was completed in one case by peeling an epiretinal membrane. Visual acuity was improved for two patients (6/10 or more) and stable for one patient with an atrophic DMLA. DISCUSSION AND CONCLUSION: These results were compared with studies in the literature: in spite of complications, vitrectomy can be indicated in patients with a substantial decrease in visual acuity. However, the result is conditioned by the macular status. Fluorescein angiography can, when it is possible, evaluate the fundus before surgery.

[Orbital extension of sinus plasmacytoma secondarily transforming into multiple myeloma: a case study]. / Extension orbitaire d'un plasmocytome sinusien secondairement transformé en myélome multiple. A propos d'un cas.

We report the case of a 39-year-old man who consulted for severe exophthalmia with diplopia associated with chronic sinusitis evolving over 6 months. A cervicofacial CT scan showed a tumoral mass invading the maxillary and ethmoidal left sinus and orbital cavity. A biopsy of the mass and general evaluation confirmed the diagnosis of extramedullary plasmocytoma. Secondarily it transformed into multiple myeloma. In light of this case of extramedullary plasmocytoma in a young subject, we discuss the clinical characteristics, ophthalmologic manifestations, and the various therapeutic modalities according to the stage of the disease and the ocular repercussions.

[Childhood Leber hereditary optic neuropathy. A case of a 6-year-old girl with loss of vision]. / Neuropathie optique de Leber de l'enfance. A propos d'un cas de baisse d'acuité visuelle chez une enfant de 6 ans.

Leber hereditary optic neuropathy, also known as hereditary optical atrophy, is passed on by the mother. It involves a papilledema and mostly affects young people. It is a mitochondrial DNA disease due to the mutation of the NADH dehydrogenase enzyme. Mutations are not sufficient to cause visual loss. Indeed, some individuals accommodate with mutations but do not express the disease. The heteroplasmic or homoplasmic character of the mutation among patients explains why they develop the disease or not even though they carry the mutation. Symptomatology starts with a central vision loss: a painless scotoma. The disease can progress either toward progressive vision loss, blindness, or spontaneous improvement. We report the rare case of a 6-year-old girl presenting a decline in central visual acuity. The genetic study revealed the presence of the G11778A primary mutation. The physiopathogenic mechanism, the genetic hypothesis of the female form, diagnostic means, and treatment options will be discussed.

[Toxoplasma gondii and necrotizing retinitis: a case report]. / Rétinite nécrosante à Toxoplasma gondii: à propos d'un cas.

Toxoplasmic retinochoroiditis is an important opportunistic retinal infection in immunodeficiency and elderly patients. The diagnosis of toxoplasmic retinochoroiditis is based primarily on characteristic ocular findings, with supportive serological evidence. It may present as diffuse necrotizing retinitis instead of a focal lesion. We report the original case of a 74-year-old woman who presented with blurred vision in her left eye lasting 3 months. In her medical history, the patient described a tuberculous infection evolving for some months, as well as agranulocytosis treated with Rifadine. Fundus examination revealed diffuse necrotizing retinitis, mainly at the nasal quadrant, with marked vitreitis in the left eye. Clinical recognition of atypical presentations is critical for timely antiparasitic drug therapy. This case initially was misdiagnosed as acute retinal necrosis syndrome. The correct diagnosis was confirmed by response to polymerase chain reaction studies of an intraocular specimen and histopathological analysis. The extensive necrotizing retinitis was nonhemorrhagic but associated with retinal detachment. Significant visual loss accompanied the infection. Toxoplasmosis should be considered as a cause of diffuse necrotizing retinitis in elderly and immunosuppressive patients. Older patients may be more susceptible to severe ocular Toxoplasma infections because of age-related decline in cell-mediated immunity and chronic underlying diseases.

[Atypical Cogan syndrome]. / Syndrome de Cogan atypique.

Atypical Cogan syndrome is a systemic vascular disease close to Cogan syndrome. It is characterized by different ocular manifestations associated with Ménière-like audiovestibulatory dysfunction with symptoms arising more than 2 years before or after the ocular abnormalities. We report the case of a 63-year-old woman whose ocular manifestations involved alternating scleritis, myositis and uveitis associated with audiovestibulatory signs, and the onset of ocular muscle and nerve palsies. In the light of this observation, we discuss the clinical characteristics, diagnostic means, differential diagnoses and therapeutic modalities of this syndrome.

[Endovascular treatment of sinus dural fistulas using vein catheterism]. / Traitement endovasculaire par voie veineuse des fistules durales du sinus caverneux.

PURPOSE: We report two techniques for treatment of dural arteriovenous fistulas using femoral vein catheterism and direct surgery via the superior ophthalmic vein. We will attempt to show the advantages of these new techniques instead of using the arterial pathway, which is currently the reference procedure. SUBJECTS AND METHOD: Mrs G, 75 years old was sent by her ophthalmologist because of a suspected orbital tumor. Visual acuity: right eye: 3/10, exophthalmia, chemosis, with no thrill or murmur. The fundus examination was normal. The ultrasound exam with color Doppler imaging showed an arterialization of the superior ophthalmic vein compatible with an arteriovenous sinus dural fistula. Angio-MRI revealed a large left cavernous sinus, confirming the diagnosis. Considering the type of the fistula and the weak physical condition of the patient, we decided to attempt an endovascular embolization with coil placement, using femoral vein catheterism. Exophthalmia regressed within days. The fistula remains sealed 1 year after the procedure. Mr D, 40 years old, showed a similar clinical aspect of sinus dural fistula. We attempted an embolization with the femoral vein, which failed. We decided to embolize the cavernous sinus via the direct surgical pathway of the superior ophthalmic vein. Coils were placed and the fistula was sealed. CONCLUSION: These clinical cases show two less invasive alternatives giving better results than arterial embolization, the reference method (Brooks 1930; Spearmann 1964; Parkinson 1965), endovascular trapping, or surgery.

[Limbal stem cell deficiency associated with KID syndrome, about a case]. / Insuffisance limbique bilatérale associée à un syndrome KID. A propos d'un cas.

We report the case of a 30-year-old woman with KID (keratitis ichthyosis deafness) syndrome consulting for massive corneal neovascularization. She had already undergone two unsuccessful penetrating keratoplasties in her left eye. Visual acuity was limited to no more than light perception because of the opacity and neovascularization of the graft. In the light of this case of limbal cell deficiency, we discuss the ophthalmologic manifestations of KID syndrome as well as its clinical characteristics, physiopathology, and mode of transmission.