[Panuveitis following intravesical bacille Calmette-Guerin therapy]. / Pan-uvéite dans les suites d'instillations intravésicales de BCG (Bacille de Calmette et Guérin).

Uveitis occurring after bacille Calmette-Guerin (BCG) intravesical therapy for bladder carcinoma is rare: only nine cases have been described. In two previous reports, vitreous cultures proved Mycobacterium bovis presence. We describe the case of an 85-year-old woman who presented with bilateral panuveitis 2 months after the last BCG intravesical instillation, with no other systemic symptom. There was no evidence for any other etiology for this uveitis. She was given oral antibiotics that were effective against Mycobacterium species, oral steroids, and anti-inflammatory drops. Her ophthalmologic status dramatically improved. This case highlights that these patients may have a good visual outcome, as long as diagnosis and treatment are not delayed.

[Ciliary body melanomas. Survival and prognostic aspects after brachytherapy or proton therapy]. / Mélanomes uvéaux impliquant le corps ciliaire. Analyse de la survie après protonthérapie ou bêta-curiethérapie par ruthénium-106. A propos de 106 cas.

INTRODUCTION: Our main goals were to study the survival of patients with uveal melanomas involving the ciliary body 5 and 10 years after treatment and to review prognosis. MATERIAL AND METHODS: This study investigated 106 tumors (27 ciliary body melanomas and 79 choroidal-ciliary melanomas) of patients treated between June 1983 and April 1998. Seventy-two patients were treated with 106-ruthenium applicators and 34 were treated with proton therapy. Some large tumors or recurrences required a second treatment. The mean follow-up period was 91 months. RESULTS: The mean tumor sizes before treatment were 6,6mm for melanoma thickness and 10.3mm for mean largest basal melanoma diameters (LTD). Of the patients studied, 71% were still alive at 5 years, 35% had metastasis and 27.7% developed recurrences. Multivariate analysis showed that the risk factors for melanoma-related death were LTD greater than 13mm, presence of exudative retinal detachment, macroscopic iris root involvement at the time of diagnosis, and choroidal-ciliary location. DISCUSSION AND CONCLUSION: With 71% of patients still alive at 5 years, this review shows that melanomas involving the ciliary body do not seem less severe than more posterior uveal tumors. Because of size differences between ciliary body melanomas and choroidal-ciliary melanomas, we cannot come to the conclusion that choroidal-ciliary melanomas have a poorer prognosis than ciliary body melanomas. Largest tumor diameter over 13mm, presence of exudative retinal detachment, and macroscopic iris root involvement at the time of diagnosis are important risk factors for melanoma-related death, as shown by the multivariate analysis.

[Sarcoid granuloma simulating amelanotic melanoma of the iris: a case report]. / Granulome sarcoïdosique simulant un mélanome achromique de l'iris.

We report the case of a unilateral vascular iris tumor in a 24-year-old patient. Clinically, the iris lesion appeared similar to amelanotic melanoma. A systemic work-up (initial check-up), including an angiotensin-converting enzyme determination, provided the diagnosis of sarcoid granuloma. A biopsy confirmation was not needed. We concluded that iris granuloma can be the only ocular manifestation of sarcoidosis and this context is likely to be confused with amelanotic melanoma and metastatic carcinoma.

[Choroidal nevi associated with serous macular detachment]. / Décompensation exsudative anatomique et fonctionnelle de 12 naevi choroïdiens.

PURPOSE: To describe the aspect and progression of choroidal nevi associated with macular serous detachment and to analyze different treatments. MATERIAL: and methods: Twelve posterior choroidal nevi were associated with subretinal fluid. The fovea was detached in 11 cases. Tumor thickness was 2 mm or less. RESULTS: No treatment was given in 6 cases and spontaneous subretinal fluid regression was observed in 3 of these 6 cases. Success was also observed in 2 of 3 cases treated with corticotherapy, but subretinal fluid recurred. Gas injection was performed in 1 case and transpupillary thermotherapy in 2 others, all 3 with successful definitive drying of the nevus. Visual acuity decreased in 6 cases (in 3 untreated cases and in 3 cases treated with corticotherapy), remained stable in 3 cases, and increased in 3 cases (in 1 untreated case, in 1 gas injection case, and in 1 case after thermotherapy). Tumor growth was observed in 3 cases, on the average 2 years after diagnosis (25%). CONCLUSION: Subretinal fluid is rarely observed with choroidal nevi and its progression is variable. Various treatments in addition to observation such as corticotherapy, gas injection, transpupillary thermotherapy seem effective in stabilizing or improving visual function. Supervision is nevertheless needed to detect tumor growth that can be frequent in these nevi associated with subretinal fluid.

[Argon laser photocoagulation of circumscribed choroidal hemangiomas]. / Hémangiomes choroïdiens circonscrits traités par photocoagulation au laser Argon.

PURPOSE: Therapeutic retrospective results obtained after Argon laser photocoagulation of 17 circumscribed choroidal hemangiomas were analyzed. MATERIAL AND METHODS: Seventeen circumscribed choroidal hemangiomas associated with serous retinal detachment were analyzed. All patients were symptomatic but one. Duration of visual symptoms varied from 2 weeks to 3 years. Mean tumor thickness was 3,3mm (1 to 6,5mm). Mean tumor diameter was 6,5mm (2.5 to 15mm). Tumors were juxtapapillary in 9 cases (57%). The mean distance from the fovea was 1,5mm (0 to 3mm), and the fovea was pathological in all cases but two. The tumoral surface was covered by Argon laser spots with the central avascular area spared in the case of subfoveal hemangioma. In the case of subretinal fluid persistence 3 months later, 1 or more photocoagulation sessions were carried out. Follow-up was 27 months (6 to 156 months). RESULTS: Success (complete subretinal fluid resolution) was obtained in 82.4% with 1 or 2 laser photocoagulation sessions. Recurrence was observed in 4 cases (23.5%) but treated with success. Final visual acuity, related to the initial foveal condition, was >=0.5 in 23.5% of cases, and >=0.1 in 70.6% of cases. DISCUSSION: Anatomical and functional results were satisfactory considering initial foveal conditions. Irradiation (external beam irradiation, proton beam therapy, brachytherapy) has been used with success for several years. However, radiation-induced damage was described in addition to a few practical disadvantages. CONCLUSION: Argon laser photocoagulation was an effective noninvasive therapy for circumscribed choroidal hemangioma. It remains for us the reference method for treating this tumor.

[Double irradiation for macroscopic radioresistance or recurrence of melanomas of the posterior uvea: clinical, ballistic, therapeutic and prognostic aspects. Series of 19 cases among 462 patients]. / Double irradiation pour radiorésistance macroscopique ou récidive dans les mélanomes de l'uvée postérieure: aspects cliniques, ballistiques, thérapeutiques et pronostiques: A propos de 19 cas sur 462 patients.

We describe two comparative series of patients treated with double-dose betaraysbrachytherapy (106 Ruthenium) between 1983 and 1994, and double-dose proton beam therapy between 1991 and 1996. The indications for double-dose irradiation with the same radio-element corresponded to "macroscopically abnormal" situations: immediate and prolonged radioresistance, recurrence or secondary radioresistance. Thirteen cases are called series 1 (Ruthenium) and 6 cases are called series 2 (protons). The series 1 allows a more reliable study as far as follow-up is higher (5.8 to 7.5 years) than in series 2 where the follow-up is shorter (13.6 to 29 months). Although double-dose irradiation was macroscopically efficient in 11 out of 13 cases in series 1, and in 3 out of 6 cases in series 2 (stabilization or decrease of tumour height measured before the second therapeutic session), 2 patients are deceased and 1 has a metastatic disease in the group "recurrence" of Ruthenium serie. Another one has also a metastatic disease in the group "recurrence" of protons series. Nevertheless double-dose radiotherapy allows a complementary decrease or stabilization of tumour height after a first session. It also decreases the indications for enucleation if there is no severe anatomic complications, when a tumour does not regress or recurs after a first session of radiations.

[Postoperative proliferative vitreoretinopathy in rhegmatogenous retinal detachment associated with stage B preoperative proliferative vitreoretinopathy: comparative results of trans-scleral retinopexy with diode laser or trans-pupillary retinopexy with argon laser]. / PVR postopératoire dans le décollement rhegmatogène de la rétine associé à une PVR préopératoire stade B: résultats comparés de la rétinopexie transsclérale au laser à Diode et de la rétinopexie transpupillaire au laser à l'Argon.

PURPOSE: To compare the rate of severe postoperative PVR in primary rhegmatogenous retinal detachments (RD) associated with preoperative grade B PVR and managed either with transpupillary Argon laser photocoagulation or transscleral Diode laser photocoagulation. MATERIAL AND METHODS: We evaluated 72 primary rhegmatogenous retinal detachment associated with preoperative grade B PVR (retinal tears with curled posterior edges), referred before any failed attempt to reattach the retina. Eleven RD were due to giant tear. The retinopexy was performed using transpupillary Argon laser. photocoagulation in 46 eyes, and transscleral Diode laser photocoagulation in 26 eyes. Follow up was 6 to 30 months. Statistical analysis used Chi-square test, and variance analysis. RESULTS: The overall rate of postoperative PVR was 6.9% (5/72 eyes). The rate of postoperative PVR was 6.5% (3/46) in eyes managed with Argon laser photocoagulation and 7.7% (2/26) in eyes managed with Diode laser photocoagulation (p > 0.05). The rate of postoperative PVR in RD due to horseshoe tears was 5.4% (2/37) in eyes managed with Argon laser and 8.3% (2/24) in eyes treated with Diode laser (p > 0.05). The rate of postoperative PVR in giant tear was 11.1% (1/9) in eyes managed with Argon laser photocoagulation and 0% (0/2) in eyes managed with Diode laser photocoagulation (p > 0.05). CONCLUSION: In the present series the rate of postoperative PVR was not influenced by the method of photocoagulation (transpupillary Argon laser or transscleral Diode laser). Therefore each technique can be used as the retinopexy method in primary rhegmatogenous retinal detachment associated with preoperative grade B PVR.