[Treatment of postoperative cystoid macular edema (Irvine-Gass syndrome) with dexamethasone 0.7 mg intravitreal implant]. / Traitement de l'œdème maculaire postopératoire (syndrome d'Irvine-Gass) par implant intravitréen de dexaméthasone 700µg.

PURPOSE: To evaluate the efficacy of dexamethasone 0.7 mg intravitreal implant in patients with postoperative cystoid macular edema. MATERIALS AND METHODS: Fourteen patients' charts with postoperative cystoid macular edema were retrospectively reviewed. The main outcome measures were best-corrected visual acuity (BCVA) and mean central retinal thickness (CRT). RESULTS: Patients' mean age was 72.1 years old. Five patients were diabetic. All patients had previously been treated with non-steroidal anti-inflammatory drops. Four patients had received a previous treatment with intravitreal ranibizumab. The mean follow-up period was 8.7 months. Mean BCVA before intravitreal dexamethasone was 0.72 logMAR. After injection, it improved to 0.50 at month 1, was 0.47 at month 3, and 0.60 logMAR at month 12. The pre-injection mean CRT was 598 µm. It improved to 286 µm at month 1, 338 µm at month 3, and was 441 µm at month 12. Eight patients received 2 intravitreal injections of dexamethasone. Five patients presented with elevated intraocular pressure during follow-up, which was treated with drops. CONCLUSIONS: Intravitreal dexamethasone injection improved visual acuity and macular thickness at month 1 and month 3 in patients with postoperative cystoid macular edema. A second injection was necessary after a mean period of 5 months.

[Complications of silicone oil tamponade]. / Surveillance d'un tamponnement par huile de silicone.

Silicone oil tamponade is used for the management of complicated retinal detachment. Patients should be closely monitored as many complications may occur with intraocular silicone oil. Short-term complications include temporarily increased intraocular pressure and anterior segment inflammation. Long-term complications include cataract, emulsification, ocular hyper- or hypotension, keratopathy and retinal redetachment associated with proliferative vitreoretinopathy.

[Panuveitis associated with papillary carcinoma of the thyroid]. / Panuvéite bilatérale associée à un carcinome papillaire de la thyroïde.

Ocular involvement secondary to thyroid carcinomas is uncommon. Uveal metastasis may occur. More rarely, they can be responsible for paraneoplastic syndromes. We report the case of a 64-year-old woman who presented with a severe bilateral panuveitis with venous vasculitis associated with hyperthyroidism from a multinodular goiter, complicated by papillary carcinoma. Systemic steroid therapy was initiated; ocular symptoms resolved completely after total thyroidectomy. Other causes of panuveitis with venous vasculitis were ruled out. This is the first reported case of panuveitis associated with papillary thyroid carcinoma. The occurrence of the ocular symptoms with hyperthyroidism and their remission after surgery supports the possibility that this association may not be coincidental. A paraneoplastic phenomenon is suspected.

[Surgical management of a recurrent iris stromal cyst]. / Prise en charge chirurgicale d'un kyste du stroma irien récidivant.

INTRODUCTION: Cysts of the iris stroma may be congenital or acquired. They are rare tumors of the anterior segment. We describe the case of a 51-year-old patient presenting with a recurrent iris stromal cyst. OBSERVATION: The patient presented emergently for sudden recurrence of an iris stromal cyst with decreased visual acuity. He had already undergone needle aspiration and argon laser photocoagulation of the cyst 1 year previously. A Ultrasound BioMicroscopy (UBM) examination was performed to rule out any malignant tumor of the iris or ciliary body. Surgical treatment consisted of complete removal of the external layer of the cyst with Implantable Contact Lens (ICL) forceps after marsurpialization with scissors. The postoperative course was uneventful. CONCLUSION: Cysts of the iris stroma are rare benign tumors that pose problems due to their extension into the anterior chamber and recurrence.

[Vitreous body aging]. / Le vieillissement du vitré

The most important age-related changes in the vitreous are progressive liquefaction and posterior vitreous detachment (PVD). Optical coherence tomography enables better in vivo visualization of the vitreoretinal interface and has improved our understanding of the process of PVD, but knowledge of the biomicroscopic aspects of these vitreous anatomical modifications is required. The most common complications include retinal hemorrhage or vitreous hemorrhage, retinal breaks, and rhegmatogenous retinal detachment. Patients with symptomatic PVD require careful examination.

[Carotid-cavernous fistulas: Clinical features, management and differential diagnosis]. / Fistules carotidocaverneuses : présentation clinique, prise en charge et diagnostics différentiels.

Carotid-cavernous fistulas are abnormal communications between the carotid system and the cavernous sinus. Depending on their direct or indirect nature, they have different clinical manifestations and management. Are discussed in this paper: first the anatomy of the cavernous sinus, then clinical signs, diagnosis, management and differential diagnosis of carotid-cavernous fistulas.

[The other pigmented lesions]. / Les autres taches pigmentées.

Not all intraocular pigmented lesions are melanomas or nevi. In this article, we present what we classically consider to be the main pigmented stains other than melanomas and nevi and their possible forms of treatment. Regarding tumor-related stains, we describe melanocytomas, congenital hypertrophy or reactive hyperplasia of the retinal pigment epithelium, combined hamartoma of the retina and retinal pigment epithelium, and acquired vascular pseudotumors. Among the hemorrhage-related stains, we present pseudotumoral age-related macular degeneration, peripheral exudative and hemorrhagic chorioretinopathy, choroidal hematoma, and rupture of macroaneurysms.

[Surgery and additional protontherapy for treatment of invasive and recurrent squamous cell carcinomas: technique and preliminary results]. / Association chirurgie-protonthérapie dans le traitement des carcinomes invasifs et récidivants de la conjonctive: technique et résultats préliminaires.

INTRODUCTION: Invasive squamous cell carcinomas are uncommon neoplasias with high recurrence and mortality rates. The improvement of tumoral control requires additional treatments such as cryotherapy, topical chemotherapy, and radiotherapy. We present the technique and preliminary results of associating treatment with surgery and proton beam therapy for recurrent and invasive squamous cell carcinomas. MATERIALS AND METHODS: From June 2001 to September 2008, 15 patients were treated in our ocular oncologic center for squamous cell carcinomas either with recurrences or with invaded resection margins. The treatment combined new surgical resection with protontherapy. Specific improvements in proton beam therapy have been made at the Nice Cyclotron to adapt the treatment to conjunctival tumors. Proton beam carving consists in using a specific device to treat the thickness of the whole lesion site and the adjacent conjunctiva and to spare the surrounding healthy structures. RESULTS: Patients were staged according to the TNM classification of malignant tumors in T2: 3; T3: 5; T4: 7. Mean follow-up was 39.1 months (range, 6-90 months). Our 15 patients included 12 males and three females. Left eyes were involved in eight cases. The mean age at first consultation was 63.7 years (range, 46-80 years). In 13 cases (86.8%), the bulbar and limbic conjunctiva was involved, in five of these cases the cornea was invaded, and the anterior chamber was involved in one case. In one case, the tumor was located on bulbar conjunctiva near the caruncle (6.6%) and in one case in the fornix (6.6%). One patient died of another cancer after 48 months of follow-up. We obtained local tumor control for 13 patients (86.8%) and recurrences for two patients (13.2%). One of them has presented with cervical node metastases. These two patients who presented recurring and extensive tumors had had previous repeated surgeries in other centers. Moreover, proton beam therapy was performed more than 6 months after the initial treatment. Exenteration and enucleation had to be performed to treat these recurrences 6 and 24 months after proton beam therapy. The exentered patient has been lost to follow-up. No patients developed recurrences with additional proton beam therapy performed within 6 months after initial surgical resection. As for side effects, seven patients suffered from sicca syndrome, six needed cataract surgeries, three unesthetic dilatations of episclera vessels, two conjunctival postradiation dysplasias, two experienced eyelash loss, one stenosis of the lacrimal duct, and one glaucoma controlled by monotherapy. Conjunctiva and amniotic grafts had to be performed on one of the patients presenting with dysplasia. Due to the rarity and diversity of these cases, it is nearly impossible to carry out prospective and comparative studies. CONCLUSION: Traditional adjuvant treatments often failed to control recurring and invasive squamous cell carcinomas. We often ended up performing exenteration to control local recurrences. The preliminary results of the present study suggest that proton beam therapy may be considered as a good alternative to traditional treatments with acceptable side effects.

[Management of acute retinal necrosis syndrome with cystoid macular edema: a case report]. / Prise en charge du syndrome de nécrose rétinienne aiguë compliqué d'oedème maculaire cystoïde.

Acute retinal necrosis is a rare but devastating and rapidly progressive viral retinitis. We report the case of a healthy 46-year-old woman who presented bilateral acute retinal necrosis caused by varicella zoster virus (VZV). Intravenous and intravitreal antiviral therapy was given for 6 weeks and followed by oral therapy. After 3 months, the patient presented a bilateral macular edema which was treated first by laterobulbar injections of corticosteroids, then successfully by interferon alpha-2a. This clinical disease, which can cause major visual function impairment, must be known in order to treat it immediately.

[Macular holes that should not be operated]. / Ces trous maculaires qu'il vaut mieux ne pas opérer...

The prognosis for macular holes has greatly improved since the advent of vitrectomy. Most improve both anatomically and functionally with effective treatment. However, some situations challenge the indication for surgery: old holes, large holes, and holes associated with retinal pathology.

[A large intraocular foreign body]. / Corps étranger intra-oculaire de grande taille.

INTRODUCTION: Penetrating wounds to the eyeball with penetration of a foreign body at the posterior segment are often extremely serious for the eye. The equipment available to extract them can sometimes be inadequate. OBSERVATION: We report the case of a 38-year-old man hospitalized for a penetrating wound of the eyeball with a voluminous foreign body incarcerated in the retina. Because of the size of the foreign body it could not be extracted with the usual forceps. We describe the assembly put together during the intervention using an intramuscular needle and 7/0 virgin silk that allowed its extraction. CONCLUSION: This lasso provides a very effective, easy and nontraumatic grasp of voluminous foreign bodies in the vitreal cavity.

[Inferior retinal detachment with silicone oil tamponade]. / Le décollement de rétine inférieur sous silicone.

Silicone oil is a valuable surgical tool to treat severe retinal detachment (RD). However, following surgery, remaining RD or the appearance of inferior RD with silicone tamponade is a delicate situation. Anamnesis and careful examination should provide a suitable treatment. Silicon oil removal will be considered after treatment of this residual RD. The endocular approach may be required: dissection of vitreoretinal proliferation, phakoexeresis, or retinectomy, whereas complementary indentation, subretinal fluid puncture, and scleral shortening are external therapeutic methods. One of the frequent causes of these persistent RDs is the presence or the progression of a more or less large and extended anterior vitreoretinal proliferation, which will sometimes require extended silicon oil tamponade. Indeed, after a certain time has elapsed, the existence of a genuine retinal adhesion disease makes a durable reapplication without internal tamponade impossible.

[Topiramate and acute myopia with angle-closure glaucoma: case report and literature review]. / Topiramate et myopie avec crise aiguë de fermeture de l'angle irido-cornéen: cas clinique et revue de la littérature.

Topiramate, an antiepileptic medication, has been widely used since its recent indication for migraine prophylaxis. We report a case of bilateral angle-closure glaucoma and acute myopia in a 44-year-old woman on oral topiramate therapy initiation for migraine prophylaxis. Intraocular pressure was 31 mmHg right and 32 mmHg left, myopia was 4 diopters. Topiramate was interrupted and general and local hypotensive treatment begun and rapidly stopped after improvement. Iridotomy was also performed. Fifteen days later, complete resolution was observed on ophthalmologic examination: anterior chambers were deep, myopia fully regressed, intraocular pressure returned to normal, and the visual field was complete. This new case prompts discussion on current reports in the literature and French drug monitoring database cases in this context.

[Improved visualization of fundus with green-light ophthalmoscopy]. / Intérêt de l'examen biomicroscopique du fond d'oeil en lumière verte.

Monochromatic light accentuates details of different retinal layers because of its variable absorption and reflectance by structures both within and above these layers. Red-free light is little used, although it is an elementary method. Green-light ophthalmoscopy, with its short wavelength, enhances some fundus and vitreous structures and may make the examination of pathologic conditions (premacular pathology, vascular abnormalities, etc.) easier. Furthermore, it is often more comfortable for the patient.

[Floating membranes]. / Les membranes "flottantes."

INTRODUCTION: Floating membranes are epiretinal membranes that spontaneously detach from the retina and float in the vitreous cavity. PATIENTS AND METHOD: We studied a series of nine patients with a spontaneous separation of a premacular membrane. The majority of these detached membranes were secondary to vitreomacular traction syndrome. In four patients, the presence of peripheral retinal tears treated in the past by laser photocoagulation were found. None of the patients had complete vitreoretinal detachment before progressing to floating membranes. RESULTS: The separation of the membrane from the macular area occurred at the time of posterior vitreous detachment. The appearance of a bulky intravitreous floating body attached to the posterior vitreous cortex sometimes proved to be very awkward for vision, resulting in a vitrectomy in four patients for ablation of this large floating body. In five patients who were not operated, the presence of the membrane in the vitreous cavity was not responsible for significant functional disorders. DISCUSSION: The epimacular membranes concerned in this series were not very symptomatic before their detachment. They seemed to be integrated within the context of vitreomacular traction syndrome. The most invalidating cases that required surgery were those where the separation of the vitreous cortex remained incomplete, leaving an opaque membrane floating with a little mobility in front of the macular area (three out of four cases). CONCLUSION: The spontaneous detachment of a premacular membrane is an event that is quite seldom observed and generally follows the spontaneously favorable progression of vitreomacular traction syndrome.