[Efficacy of intravenous immunoglobulin in the treatment of Birdshot retinochoroiditis]. / Efficacité et tolérance des immunoglobulines intraveineuses dans le traitement de la rétinochoroïdopathie de type Birdshot.

AIM: To evaluate the efficacy of intravenous immunoglobulin (IVIg) in the treatment of Birdshot retinochoroiditis. PATIENTS AND METHODS: Eighteen patients were followed-up prospectively in a total number of 37 patients recorded. Inclusion criteria were birdshot retinochoroiditis (BRC) according to the criteria defined by Ryan et al., and a decrease in visual acuity (VA). Efficacy was assessed by measurements of visual acuity and a decrease in inflammation and macular edema on fluorescein angiograms. RESULTS: Sex ratio=1, mean age was 51 (range 29 to 72 years), HLA A29 was positive in 100% of the patients. VA at baseline was 0.6+/-2.4 (range 0.25 to 0.9). Angiography showed retinal vasculitis in 32 patients (86.48%) and cystoid macular edema in 16 patients (43.24%). IVIg was administered at a dosage of 0.4g/kg/d for 4 days then 0.6g/kg/d for 2 days every 4 weeks. Follow-up lasted a mean of 2.7+/-2.0 years (range, 4 months to 5.6 years). Visual acuity of 35 out of 66 eyes (53%) increased by 2.6+/-1.5 (range 1 to 5). In 19 eyes out of 66 (29%), VA remained stable and in 12 eyes out of 66 (18%), VA decreased by -1.8+/-0.8 (ranges-4 to -1). Inflammation on fluorescein angiography improved in 17 patients (81%) and cystoid macular edema decreased in 65% of the cases. Side effects were rare. Treatment was discontinued for side effects in only 3 patients. DISCUSSION: BRC is a chronique disease threatening vision. Treatments including systemic corticosteroids and cyclosporin A may result in severe long-term side effects. IVIg is well tolerated and may be therapeutic alternative for the treatment of BRC.

[Terrien's disease, apropos of 6 cases. Ultrastructural study]. / Maladie de Terrien, à propos de 6 observations. Etude ultrastructurale.

Terrien's disease is characterized by slowly progressive thinning of the pre-limbal cornea in middle-aged patients. It usually leads to peripheral ectasia with marked astigmatism. It is rarely accompagnied by inflammation and its cause is unknown. Very few histopathologic examinations have been published, in particular those using electron microscopy We present detailed results concerning 6 patients in whom perforating keratoplasty permitted histopathologic and electron microscopic examination. Clinical and histological features reveal marked degeneration of the peripheral corneal stroma, with lipid accumulation unaccompagnied by significant inflammatory cellular infiltration in each case. Of interest is the association in one patient with keratoconus. The generally accepted pathogenic theories are fully discussed. The wealth of electron microscopic data provides a complete review of stromal degenerative changes.

Terrien's disease: clinical and ultrastructural studies, five case reports.

Terrien's disease occurs in middle-aged patients and is characterised by an insidious thinning of the cornea near the limbus. In most cases, this results in a peripheral ectasia associated with a severe degree of astigmatism. Inflammatory signs are rarely observed in this marginal corneal degeneration which is of unknown aetiology. Electron and light microscopic studies have been performed on five specimens from penetrating keratoplasties. Anatomical and clinical correlations showed the marked marginal degenerations of the corneal stroma to be consistently associated with lipid deposits, but without inflammatory cell infiltrate. These changes are in agreement with previous reported pathological descriptions of Terrien's disease.

[Conjunctival capillaroscopy]. / Capillaroscopie conjonctivale.

Microcirculation is clearly visible and can be observed on the conjunctival mucosa by means of any microscope and notably with the slit lamp microscope of ophtalmologists. A glance at the conjunctival vessels may provide useful information on the quality of microcirculation generally and on the ischaemic or oedematous repercussions of lesions affecting the kidney, the brain and other organs. The vascular alterations detectable on the conjunctiva are described. The retina also may present with abnormalities of microcirculation. Their easy detection on the conjunctiva should lead to a more complete ophthalmic and systemic exploration.

Acute corneal edema in pellucid marginal degeneration or acute marginal keratoconus.

This article reports a case of bilateral corneal pellucid marginal degeneration. The right cornea had an acute hydrops. Both eyes underwent penetrating keratoplasty. A histopathological study of the corneal specimens was performed by light and electron microscopy. The histological changes observed on the right cornea showed breaks on Bowman's layer, edema and disorganization of the stromal collagen, and break of Descemet's membrane. The ultrastructural changes were similar to those observed in acute keratoconus, leading to the belief that these two corneal diseases are closely related.

[Unilateral progressive annular opacity of the cornea. Apropos of a case. Clinical, histological and ultrastructural study]. / Opacité annulaire progressive unilatérale de la cornée. A propos d'un cas. Etude clinique, histologique et ultrastructurale.

A case of unilateral corneal annular opacification with a slowly progressive thickening of the cornea is reported; clinical, optical and electron microscopic studies have made possible to eliminate oedematous pathological process. The central zone of the cornea was histologically within normal aspect. In the peripheral zone intracellular mucopolysaccharides (MPS) and lipids were found in the stroma. Their presence suggest a collagen degeneration, thus likely revealing a forgotten initial stromal pathology. Its consequence, the unilateral annular thickened opacified cornea, seemed to us confusing enough to be presented and discussed.

[Cyclosporin A eyedrops in the prevention of high-risk corneal graft rejection. II. Postoperative clinical results]. / Cyclosporine A collyre dans la prévention du rejet de greffe de cornée à haut risque. II. Résultats cliniques post-opératoires.

Twenty-four patients (25 eyes) presenting a high corneal rejection risk have been treated by an association of topical cyclosporine A (2% in castor oil) and Dexamethasone eyedrops 1% 48 h preoperatively, the posology was slowly degressive postoperatively. The mean follow-up is of 12 months. Results are 19 clear grafts among which 4 had a reversible reject reaction, 3 unreversible rejections with a totally cloudy graft (12%), 3 corneal graft oedema of nonimmunologic nature allowing a counting fingers vision. A control group of 25 patients with the same high risks of rejection treated only by topical corticosteroids followed up for the same mean time showed an obvious higher rate of failure (65%).

[Use of cyclosporin A eyedrops in the prevention of corneal graft rejection in man. I. Preoperative development of 4 eyes with metaherpetic keratitis]. / Usage de la cyclosporine A collyre dans la prévention du rejet de greffe de cornée chez l'homme. I. Evolution préopératoire de 4 yeux atteints de kératite métaherpétique.

Topical cyclosporine A (2%) has been used to prevent corneal graft rejection in high risk patients. The treatment was begun 48 h at least before surgery. 3 patients (4 eyes) suffering from metaherpetic keratitis were placed under this treatment for a long time due to the delay to obtain a corneal donor. Their observation while treated showed a remarkable slow-down of the inflammation both in conjunctivae and corneas. This confirms if necessary the role of T lymphocytes in metaherpetic corneal diseases and the clinical modulation effect of cyclosporine A on these T cells.

[Acanthamoeba keratitis. Clinical, histological and ultrastructural study]. / Kératite à Acanthamoeba. Etude clinique, histologique et ultrastructurale.

Acanthamoeba keratitis is a rare but very severe necrotizing stromal keratitis due to a non-parasitic free-living soil and freshwater amoeba. It affects more readily soft and hard lens wearers. It is often clinically mistaken for herpetic keratitis because of the similarity of the signs and the difficulty in performing the specific microbiological tests. This is the reason why the diagnosis is most often made at the time of penetrating keratoplasty and histological study of the buttons with special stains. Medical treatment is effective only when starting at the beginning of the disease.

[Keratomycosis and keratoplasty]. / Kératomycoses et kératoplastie.

Three cases of corneal perforation in keratomycosis are reported. In the first two cases the etiological diagnosis had been made from the anatomo-pathological examination of the excised corneal buttons. The mycotic origin in the third case was known before perforation from corneal cultures. Although the prognosis of this condition is usually poor, the post-keratoplasty evolution in the three cases was uncomplicated. The authors analyse the peculiarities of corneal mycotic abscess and discuss the appropriate diagnostic approach and management. Treatment must be performed before intraocular mycotic invasion occurs, because of the poor intraocular diffusion of antifungal agents. In this case, penetrating keratoplasty is not as dangerous as previously reported; and moreover, allows simultaneous treatment of the mycosis and the anatomical and functional repair of the cornea.