[Potential association of pseudoexfoliation syndrome (PEX) with age-related macular degeneration (ARMD)]. / Association potentielle entre le syndrome pseudo-exfoliatif (PEC) et la dégénérescence maculaire liée à l'âge (DMLA).

PURPOSE: Authors report an unexpected association between PEX and ARMD. It was an additional result of a study, that analysed possible systemic symptoms of pseudoexfoliation material in visceral organs. They reviewed literature data for both, concerning epidemiology and physiopathogeny. MATERIAL AND METHODS: We conducted an age-and sex matched study of 142 patients in Brittany, 71 PEX and 71 controls, 31 men and 40 women in the 2 groups. The statistical study was performed with Epi Info 6.0 software using the X2 of Mantel-Haenszel Test. RESULTS: Statistical positive relation was found between PEX and ARMD (p=0.02), both increasing with age. DISCUSSION AND CONCLUSION: Part of epidemiology seems to be similar in PEX and ARMD, especially environment role (particularly solar radiations), individual factors, and genetic predisposition. For the first time, in may 1999, a genetic localization of PEX was discovered on the chromosome II, and nearly of one loci of ARMD multiple localizations.

[Bilateral papilledema in young women: two case reports of benign intracranial hypertension?]. / OEdème papillaire bilatéral chez la femme jeune.

We report two cases of bilateral papilledema in young women. The first patient was 15 years old and had experienced headaches and vomiting for one month, but no visual loss. Cerebral tomodensitometry results were normal, but lumbar puncture showed increased pressure and normal biology. Benign intracranial hypertension was diagnosed. Recent treatment with minocycline for acne vulgaris was the only etiology. Papilledema was totally regressed at 6 weeks, after interruption of the antibiotic treatment. A prescription of acetazolamide was added for a short period of 10 days. The second patient, aged 29 years, presented bilateral papilledema with severe visual loss, with vision limited to light perception with mydriasis of the right eye. Lumbar puncture was not indicated because of a hypophyseal microadenoma revealed on MRI investigation. No other associated abnormalities were observed, in particular, no cerebral sinus thrombosis. Corticotherapy using prednisolone for 72 hours had no clinical effect. Fast visual recovery was obtained with intravenous acetazolamide therapy and was completely resolved at 2 months. Right visual field defects persisted. Minocycline and obesity are recognized as precipitating factors in pseudotumor cerebri syndrome. The literature advocates consideration of surgical treatment by optic nerve sheath fenestration if antiedematous treatment has no effect and the eye is nearly blind.

[Indomethacin (indocollyre) versus diclofenac (voltarene) for the control of pain following excimer photoablation]. / Indométhacine (Indocollyre) versus Diclofénac (Voltarène) sur la douleur post-photoablation excimer de surface.

PURPOSE: To compare effect of two topical non steroidal anti-inflammatory (NSAI) drugs: Indomethacin (Indocollyre)0.1 %, Chauvin Inc.) and Diclofenac (Voltaren 0.1%, Cibavision) on postoperative pain and epithelial regrowth following surface excimer photoablation. MATERIAL AND METHOD: Eighty-six excimer operated patients, were divided in two similar groups depending on the NSAI instilled postoperatively and for 3 days (4 drops daily). No patient was informed of any other available drug. Pain intensity was quantified between 1 and 10 according to an analog scale (reported from 1 to 10 hours, then 4 times a day during 7 days). Complementary medications and functional symptoms were also notified. Biomicroscopic evaluation using fluorescein test was performed to assess reepithelialization. RESULTS: In term of pain, no significative difference was observed between the two groups concerning intensity, associated medications, or numbers of days of discomfort. Controversially, retreated eyes might induce more pain than initial treatments. No delay in epithelial regrowth was noted and the difference between the two groups in functional complaints was no statistically significant. Pain appears to be not related to ablation depth. DISCUSSION- CONCLUSION: Our results are correlated to literature reported data. Introduction of NSAI constitutes a real advent in the care of excimer postoperative pain. Effect of indomethacin seems comparable to diclofenac effect, but might be of interest because of no anesthetic property that might guarantee of no delay in wound healing response.

[Mixed retinal thrombosis in a patient carrying prothrombin gene mutation in a homozygote state]. / Thrombose mixte rétinienne chez un patient porteur d'une mutation du gène de la prothrombine, à l'état homozygote.

We reported a case of a thrombosis of the retinal and central artery and vein in a 44-year-old patient, with high-grade T-cell lymphoma. Cardiovascular family history and a medical history of cerebral ischemia caused by in situ fibrinolysis, led to perform thorough hematologic and genetic examinations. These disclosed a prothrombin gene G 20210 a variant in a homozygous state. In a heterozygous state, this mutation leads to an increase in plasma prothrombin rate of the order of 30%. Therefore, it is considered to be a major risk factor for venous thrombotic disease. Otherwise, acute leukemia or non-Hodgkin's lymphoma may induce thrombosis of retinal artery and vein by means of an optic nerve infiltration, as well as beta-thalassemia, ocular trauma and retrobulbar anesthesia. Retinal central artery and vein are seldom both involved; whereas occlusions of their branches are more frequent.

Optic disc shape, corneal astigmatism, and amblyopia.

OBJECTIVE: The cornea and the optic disc form the anteroposterior opening of the sclera. This study evaluated whether an abnormal shape of the optic disc is associated with an abnormal configuration of the cornea measured as corneal astigmatism. DESIGN: The study design was a cross-sectional one. PARTICIPANTS: The study included 882 subjects (430 women, 452 men) with a mean age of 45.9 +/- 13.6 years (mean +/- standard deviation; range, 8-87 years) and a mean refractive error of -1.09 +/- 2.76 diopters (range, -21.0 diopters to +7.0 diopters). INTERVENTION: Corneal astigmatism was determined by keratometry, and the optic disc was analyzed morphometrically by planimetric evaluation of optic disc photographs. MAIN OUTCOME MEASURES: Corneal astigmatism, ratio of minimal-to-maximal disc diameter, and optic disc form factor were measured. RESULTS: The amount of corneal astigmatism was significantly (P < 0.001) correlated with an increasingly elongated optic disc shape. Corneal astigmatism was significantly (P < 0.01) higher in eyes with tilted discs. It was significantly (P = 0.006) smaller in eyes with an almost circular disc shape. Amblyopia was significantly (P < 0.05) associated with an elongated optic disc shape and high corneal astigmatism. The axis of corneal astigmatism was correlated with the orientation of the longest disc diameter. The optic disc was significantly (P < 0.05; chi-square test) more often horizontally oval in eyes with a steeper horizontal corneal meridian than in eyes with a steeper vertical corneal meridian. Correspondingly, the disc was significantly (P < 0.05) more often vertically oval in eyes with a steeper vertical corneal meridian than in eyes with a steeper horizontal corneal meridian. CONCLUSIONS: An abnormal optic disc shape is significantly correlated with corneal astigmatism. Especially in young children, if an abnormal optic disc shape is found on routine ophthalmoscopy, refractometry should be performed to rule out corneal astigmatism and to prevent amblyopia. The direction of the longest optic disc diameter can indicate the axis of corneal astigmatism.