Predictibility of the efficacy of peripheral iridotomy in primary angle closure: Utility of UBM.

PURPOSE: To assess the utility of UBM in the management of primary angle closure (PAC) and assessing the predictability of peripheral iridotomy (PI) in re-opening the closed angle. DESIGN: Retrospective clinical study. SUBJECTS: Patients with suspicion of PAC. METHODS: This study obtained the consent of all patients and adhered to the Declaration of Helsinki. It was conducted in two ocular imaging centers and based on patients with suspected PAC. Each patient underwent UBM and Visante OCT at each visit, before and after PI when PAC was confirmed. MAIN OUTCOME MEASURE: Irido-corneal angle. RESULTS: Out of 202 eyes (101 patients) with a mean age of 62 years and 69.3% female predominance, we found 186 eyes with PAC. In most cases (77.4%), the iridocorneal angle was open after a single PI at the second visit, and only 14% eyes remained closed at the third visit, regardless of any additional treatment performed (complementary PI, iridoplasty, surgical lens extraction). Mechanisms involved in persistent angle closure after PI were: imperforate PI (45.2% of eyes), iris plateau syndrome (8.6% of eyes), significant lens vaulting (30.9% of eyes) and mixed mechanisms (2.3% of eyes). CONCLUSION: PI remains effective as a first-line treatment in most cases of PAC, even when associated with mechanisms other than pupillary block. Nevertheless, the PI must be completely patent, and UBM can help in understanding underlying mechanisms, hence guiding the treatment in these eyes.

[The eye and anorexia nervosa. A case report]. / Oeil et anorexie mentale. A propos d'un cas.

INTRODUCTION: Vitamin A deficiency occurs in the poor in developing countries and is one of the main causes of blindness by perforative corneal complications. It is a rare pathology in industrialized countries and it is associated with an absorption syndrome. The authors report the first case of hypovitaminosis A in a patient suffering from chronic and severe anorexia nervosa. CASE REPORT: The patient suffered from epiphora, photophobia, and hesperanopia. The ophthalmologic findings were keratoconjunctival xerosis with bilateral corneal ulcerations. The visual field showed a concentric bilateral restriction of isopters with tubular central vision, a similar aspect to retinitis pigmentosa. The ERG was modified with a b2 reduction and normal photopic and impaired scotopic responses. The fluorescein angiography was normal. The serum concentration of retinol confirmed the diagnosis of hypovitaminosis A. Corneoconjunctival improvement was obtained with vitamin supplementation, but no campimetric improvement was observed. DISCUSSION: The corneoconjunctival signs result from direct destruction of goblet cells, whereas the campimetric deficit is explained by a dysfunction of rod cells. Rhodopsin, necessary to the survival of the cell, cannot be renewed if retinol is not present, which causes a permanent bright light stimulation that is lethal for the photoreceptor. CONCLUSION: Vitamin A deficiency is rarely caused by psychiatric disease. Even if the main clinical finding is xerophthalmia with a high risk of keratomalacia, the visual prognosis can also be engaged by dysfunction of photoreceptors.

[Traumatic carotid-cavernous sinus fistula: a case study]. / Fistule carotido-caverneuse traumatique. A propos d'un cas.

The diagnosis of carotid-cavernous sinus fistula is based on clinical findings and must be confirmed and detailed by CT scan and arteriography. If the treatment, based on embolization, is not undertaken in the emergency room, visual complications or even death may result. We give an example of a direct post-traumatic carotid-cavernous sinus fistula, stressing its clinical characteristics (ophthalmoplegia) and treatment: the advantages of arteriography and of embolization methods (most often by detachable balloon or coils, through arteries or veins).