Atypical Cogan's syndrome: A case report.

Cogan's syndrome is a rare autoimmune inflammatory disease, characterized by interstitial keratitis and audio-vestibular signs. The syndrome was first described in 1945 by David G. Cogan. Then, it was only in 1980 when Haynes et al. proposed diagnostic criteria for patients with other symptoms and was qualified as atypical form of Cogan's syndrome. Herein, we report a case of a 28-year-old woman with atypical Cogan's syndrome. The patient was treated with corticosteroids and received a cochlear implant.

[Forensic assessment of eye blasts in active military personal]. / Évaluation médicolégale des blasts oculaires chez le militaire actif.

BACKGROUND: Ocular blast injuries are defined as ocular damage caused by explosives. Within the military, they are considered work accidents resulting from military service, and they are therefore governed by the military disability pension system, which utilizes a specific scale. OBJECTIVES: To study the clinical presentation and course of ocular blast injuries. To describe the particularities of forensic expertise in military settings. METHODS: This was a retrospective study of 28 eyes of 15 military personnel with ocular blast injuries. A baseline ophthalmologic examination was performed to assess of all the eyes and the general lesions caused by the trauma. A military medicine expert opinion was obtained from the date of consolidation. The rates of permanent partial disability (PPD) and the aptitude or not for military activities were specified according to the specific scale of the military disability pension system. RESULTS: The mean age of the victims was 27.53 years. A mine explosion was the predominant cause of ocular damage. Trauma to the ocular adnexa occurred in 4 eyes. Anterior segment injuries were noted in 19 eyes, with a mean initial visual acuity of 1/10. Posterior segment lesions occurred in 14 eyes, with a mean initial visual acuity of 0.5/10. Ruptured globes occurred in 3 eyes of 2 patients. All the victims presented with systemic lesions in addition to ocular ones. The average PPD rate was approximately 58%. CONCLUSION: Regarding the particular clinical features of ocular blast injuries, military victims must be managed and fairly compensated according to specific regulations.

The effects of hyperbaric oxygen therapy on diabetic retinopathy: A preliminary study.

PURPOSE: The objective of this study was to prospectively assess the effect of hyperbaric oxygen therapy (HBOT) on diabetic retinopathy lesions and macular edema in patients undergoing the treatment for diabetic foot ulcers. METHODS: We compared two groups: a first group including 25 patients with non-proliferative diabetic retinopathy treated by HBOT for foot ulcers, and a second group (control group) composed of 25 patients with diabetic retinopathy who did not receive HBOT. The HBOT protocol performed for the patients in the first group was: 30 sessions of 90 minutes each at 2.5 ATA with a mean frequency of five sessions per week. All patients had an ophthalmological exam at baseline (visual acuity, intraocular pressure, fundus exam), fundus photography and an OCT exam. A follow-up exam was performed at the conclusion of the HBOT. RESULTS: Compared to the control group, patients treated with HBOT showed a regression or stabilization of diabetic retinopathy lesions and a decrease in central macular thickness (CMT). CONCLUSION: Hyperbaric oxygen therapy may improve diabetic retinopathy and diabetic macular edema. This therapy may serve as an adjunctive treatment in the management of retinal ischemia and capillary hyperpermeability in diabetic retinopathy.

[Solar retinopathy: optical coherence tomography findings]. / Retinopathie solaire: aspects en tomographie par coherence optique.

Through a case report, we discuss the clinical, angiographic aspects and the new information brought by the optical coherence tomography in the acute and chronic phase of the solar retinopathy.

[Risk factors for secondary cataract: a case-control study with multivariate analysis]. / Les facteurs de risque de la cataracte secondaire.

AIM: A retrospective case-control study was initiated to determine the risk factors for the development of posterior capsule opacification. SUBJECTS AND METHODS: 100 cases of patients with secondary cataract treated by YAG laser capsulotomy were compared with 100 controls (patients who had cataract surgery not complicated with a secondary cataract). The posterior capsule was examined by the biomicroscope. A 1-to-1 matched case-control study was designed by stratifying inclusions on the basis of age, sex, and delay. We studied the risk factors related to the patient, the primary cataract, the surgical technique, the surgeon's skill, and intraoperative and postoperative complications. All the lenses were biconvex and all-PMMA with the same design. Statistical analysis was done in 3 steps: a univariate analysis, then a bivariate analysis using chi-square and the Student tests and finally, we performed a multivariate analysis with a logistic regression. The significance level for type I error rate was fixed at 5%. RESULTS: The average age was 61.6 years. The mean delay was 32.7 months for cases and 34.5 months for controls. The bivariate analysis identified nine risk factors: corneal opacities (p=0.031), absence of a posterior chamber lens p=10(- 4)), the can opener anterior capsulotomy (p=0.003), ciliary sulcus fixation of the lens p=0.030), a large optic diameter of 7mm p=10(- 5)) and (t=0.002), poor intraoperative pupillary dilatation (p=0.003), a less experienced surgeon (p=3.10(- 4)), postoperative inflammation (p=0.021), and persistence of residual cortical material (p=0.002). The multivariate analysis selected five principal factors: absence of a posterior chamber lens, an optic diameter of 7mm, poor intraoperative pupillary dilatation, a less skilled surgeon, and persistence of cortical material. CONCLUSION: This case-control study reveals some of the risk factors previously identified and may contribute to the determination of methods for prevention of secondary cataract. The new intraocular lenses and pharmacological agents would lead to better results.

[Foveoschisis in highly myopic eyes: clinical and tomographic features]. / Le fovéoschisis du myope fort : signes cliniques et tomographiques

INTRODUCTION: Foveoschisis is a rare condition in highly myopic eyes, characterized by intra-retinal cleavage associated with abnormalities of the vitreous cortex and occasionally cortical retraction. The natural history of foveoschisis is unpredictable. The functional prognosis is often favorable after surgical treatment. MATERIALS AND METHODS: We report 7 cases of macular retinoschisis in highly myopic eyes. We describe the optical coherence tomographic features as well as associated signs. The correlation with visual acuity was assessed. RESULTS: Foveoschisis was undetected on clinical exam and visualized only on optical coherence tomography (OCT) in 4 cases. Mean central foveal thickness was 540 , mean visual acuity was 1/10­P10. The thicker the macula was, the worse was the visual acuity. The presenceor absence of serous retinal detachment did not affect visual acuity, whereas an epiretinal membrane or retraction of the vitreous cortex appeared to induce visual loss. CONCLUSION: OCT has been demonstrated to be particularly useful for the diagnosis of visual loss in the high myope, notably in the case of foveoschisis. Anatomic-functional correlations in high myopic foveoschisis are not yet well clarified. Posterior pole retinal detachment and macular hole are the most serious complications.

[Central serous chorioretinopathy: clinical-anatomic correlations]. / La choriorétinopathie séreuse centrale : corrélations anatomo-cliniques.

INTRODUCTION: Central serous chorioretinopathy (CSCR) is a retinal disease characterized by a serous retinal detachment (SRD) responsible for a macular syndrome in young patients, often in the context of stress. In our study, we aimed to describe through multimodal analysis the clinical, angiographic and tomographic characteristics of CSCR while identifying prognostic factors and highlighting functional-anatomic correlations. METHODS: We conducted a retrospective, descriptive and analytic study over a period of 6 years on 35 eyes of 34 patients with CSCR. The simultaneous analysis of clinical exams and imaging allowed for correlation between the anatomic lesions and visual function. RESULTS: A correlation was found between the leakage point on angiography and pigment epithelial detachments (PED) in 8 eyes (28.5%), and retinal pigment epithelial (RPE) irregularities in 6 eyes (21.4%) on optical coherence tomography (OCT). Factors associated with poor functional outcome were: poor initial visual acuity, greater subretinal fluid height (P=0.054), presence of highly reflective dots on OCT within the SRD (P<0.05) and the number of PED's (P=0.008). CONCLUSION: Although CRSC often a resolves spontaneously, the functional prognosis can be affected by macular sequellae. A comprehensive assessment of the anatomical lesions is essential to detect poor prognostic factors.

[Prognosis factors in diabetic macular edema: an OCT study]. / Facteurs de mauvais pronostic au cours des oedèmes maculaires diabétiques: apport de l'OCT.

INTRODUCTION: Macular edema is responsible for a significant degree of visual loss in diabetic patients. The prognosis factors in diabetic macular edema are varied and better documented by optical coherence tomography (OCT). We describe the patterns of diabetic macular edema demonstrated by OCT and correlate them with visual acuity. PATIENTS AND METHOD: A prospective study of 297 eyes with diabetic macular edema was conducted. An OTI/OCT exam was done for all eyes. The Fisher test was used to search for a correlation between visual acuity and each feature of diabetic macular edema (macular thickness, cystoid macular edema, central cyst, tractional component, and serous retinal detachment). RESULTS: Visual acuity varied from 1.3 log MAR to 0 log MAR. The mean visual acuity was 0.51 log MAR. The presence of central cyst on OCT scan was significantly associated with worse vision (p<0.0001). Increased retinal thickness in all patterns was significantly correlated with worse visual acuity (p<0.0001). The OCT patterns containing a tractional component and serous retinal detachment were also associated with visual loss (p<10(-6)). CONCLUSION: OCT is a very useful objective tool to describe, classify, and manage diabetic macular edema. It provides a better analysis of different prognosis factors and therefore can assist in determining a more suitable treatment for diabetic macular edema.