[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.

[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.

[Optic disk neovascularization in fungal endophthalmitis]. / Néovascularisation prépapillaire au cours d'une endophtalmie fongique présumée chez une toxicomane.

A case of optic disk neovascularization is reported in a 30-year-old female heroin addict with suspected fungal endophthalmitis treated with an intravitreal injection of amphotericin B and fluconazole (200mg/day). Membrane healing was characterized by densification and contraction leading to tractional retinal detachment; excision by vitrectomy was required. Electron microscopy analysis of the membrane removed the tenth month revealed a poorly vascularized fibrous tissue infiltrated by chronic inflammatory cells. Visual improvement was poor owing to a postoperative macular disorder and a full-thickness retinal scar.

[Retinal detachment due to macular holes in highly myopic eyes. Prognostic factors]. / Décollement de rétine par trou maculaire du myope fort. Evaluation des critères pronostiques.

PURPOSE: To evaluate the prognostic value of axial length and epiretinal membrane (ERM) separation during vitrectomy for retinal detachment due to macular hole in high myopia. PATIENTS AND METHODS: Thirty-two consecutive highly myopic eyes (31 patients) with retinal detachment due to a macular hole were retrospectivly studied. All eyes underwent pars plana vitrectomy with gas tamponade (C3F8). An epiretinal membrane was removed in 9 cases. The 32 cases were divided into 3 groups: anatomical success after the initial surgery (group 1, 15 cases); anatomical success after two surgical procedures without silicone oil (group 2, 5 cases), and silicone oil tamponade (group 3, 12 cases). RESULTS: Retinal reattachment occurred in 15 cases (46.8%) after the initial surgery. The difference of axial length between the 3 groups was not significant. The rate of anatomical success without silicone oil was 88.8% (8/9 cases) when an ERM was peeled and the number of peelings was significantly higher (p=0,04) in group 1 than in group 3. CONCLUSION: The axial length was not a pronostic factor of silicone oil tamponade in this study. The success rate was higher when an ERM was peeled. However, considering the technical difficulty in removing the ERM completely, gas tamponade seems to be the better initial treatment.

[Proton therapy of occult neovessels in age-related macular degeneration]. / Protonthérapie des néovaisseaux occultes dans la dégénérescence maculaire liée à l'âge.

INTRODUCTION: The interest of radiation therapy in the management of age-related macular degeneration inaccessible to photocoagulation is still controversial. Our purpose was to demonstrate the feasibility and the possible efficacy of a single dose delivered to the macular region using a 65-MeV proton beam. MATERIAL AND METHODS: A phase II trial was set up using the cyclotron in Nice, France. Fifty-eight patients were included after signing an informed consent. All patients presented with occult subfoveal choroidal neovascularization. A single dose of 9.1 Gy (i.e., 10 Gy cobalt equivalent) was delivered to the macular region. RESULTS: The results were analyzed 3, 6, 12 and, 18 months after proton therapy. At 3 months, the visual acuity was stable or enhanced for 86% of patients, at 6 months for 82.3%, at 12 months for 80%, and at 18 months for 61%. For 22 patients at follow-up at 18 months, the reasons for a decrease in visual acuity were a macular hemorrhage for 4 patients and a progression of the neovascular membrane for 3 patients. No secondary effects related to the treatment have been observed. Regarding the lesions visible on the angiographies (i.e., hemorrhage, exudates, subretinal detachment), we observed a stabilization or a decrease in two-thirds of the cases. CONCLUSION: Preliminary results of single-dose proton therapy are at least comparable to those obtained by other teams. A second study is in progress comparing 3 dose levels, looking for a dose-effect relationship. Furthermore, a randomized study comparing a single proton dose to a placebo will be necessary to assess the long-term value of proton treatment.

Asymmetric aldol reactions on a soluble polymeric support

[reaction: see text] The combinatorial synthesis of small, nonpeptidic compounds is of increasing interest in current medicinal chemistry. To meet this demand, efficient entries, preferentially on polymeric supports, to pharmacologically interesting classes of compounds such as polyketides are necessary. Therefore, we have developed a synthetic protocol allowing for the asymmetric synthesis of diketides on the soluble support MeOPEG-5000. The strategy employed mainly allows for repeated aldolizations, thus providing access to functionalized polyketides of varying degree of oligomerization.

Current practice of temporary vena cava filter insertion: a multicenter registry.

PURPOSE: To evaluate the current practice of temporary vena cava filter placement and its complications. MATERIALS AND METHODS: A multicenter registry was conducted from May 1995 until May 1997 using a standardized questionnaire. One hundred eighty-eight patients were evaluated. Patient characteristics, filter indications, filter characteristics, and complications were registered. RESULTS: Deep vein thrombosis was proven in 95.2% of the patients. Main filter indication was thrombolysis therapy (53.1%). Average filter time was 5.4 days. An Antheor filter was inserted in 56.4%, a Guenther filter in 26.6%, and a Prolyser filter in 17.%. Transfemoral filter implantation was slightly preferred (54.8%). Four patients died of pulmonary embolism (PE) during filter protection. Major filter problems were filter thrombosis (16%) and filter dislocation (4.8%). When thrombus was found in or at the filter before explantation, additional thrombolysis was performed in 16.7%, additional filter implantation in 10%, and thrombus aspiration in 6.7%; 4.8% of filters were replaced with permanent filters. DISCUSSION: Temporary vena cava filters are placed to prevent PE in a defined patient population. Despite their presence, PEs still occur in a small percentage. Problems of filter thrombosis and dislocation have to be solved. CONCLUSION: The results of this multicenter registry support the need for innovative filter design, as well as a randomized, prospective study.

Results of proton therapy of uveal melanomas treated in Nice.

PURPOSE: To present the first results of uveal melanomas treated with the Medicyc Cyclotron 65 MeV proton beam facility in Nice, analyzing the factors that affect the cause-specific survival (CSS), metastatic rate, and reporting the visual outcome. METHODS AND MATERIALS: This study concerns 538 patients referred by French institutions between June 1991 and December 1996. The eye and tumor parameters were measured using ultrasonography and angiography. Since 1994, CT scans were performed in most patients to help determine the axial length and the shape of the ocular globe. Tantalum clips were inserted around the tumor by the referring ophthalmologist. There were 349 posterior pole tumors (64.9%), 130 equatorial tumors (24.1%), and 59 ciliary body tumors (11%). Two hundred four patients (37.9%) had T1 or T2 tumors, and 334 patients (62.1%) had T3 or T4 tumors. The median tumor diameter was 14.6 mm, and the median tumor height was 5.1 mm. All patients received 52 Gy (57.20 Gy Co-equivalent dose) on 4 consecutive days. The data were analyzed by December 1997. RESULTS: The CSS was 77.4% at 78 months, the overall survival was 73.8% and the local control was 89.0%. The CSS was not influenced by the patient age or the site of the tumor. It was 81.5% for T1 and T2 tumors, versus 75% for T3 and T4 tumors (P = 0.035). It was found that the tumor diameter, rather than the height, was the most important parameter affecting outcome. The metastatic rate was 8%. It depended on the T stage, tumor diameter and thickness, but not the tumor site. Thirty-eight enucleations were performed, most of them due to tumor progression and/or glaucoma. One-third of the patients in whom visual acuity was adequately scored before and after treatment had a stable, if not improved vision, and half the patients retained useful vision after treatment. CONCLUSION: The outcome of patients suffering from uveal melanoma and treated with high-energy protons compares favorably with other techniques of treatment. The tumor dimensions affected CSS and metastatic rate. Even though two-thirds of patients had posterior pole tumors, half of them retained useful vision.

[Course of epithelial scars after surgical removal of small-size subfoveal neovessels]. / Evolution des cicatrices épithéliales après ablation chirurgicale des néovaisseaux rétrofovéolaires de petite taille.

PURPOSE: We analyzed outcomes of 18 subfoveal neovascular membrane scars after surgery removal in age related macular degeneration. Surface and aspect of pigment epithelial defects were evaluated on angiographic data. RESULTS: We differentiated glial scars and atrophic scars, the most numerous. Scar surfaces were larger compared to the initial preoperative lesions. Central epithelial pigments in scars disappeared in the three months following surgery. After on year, scar surfaces moderately enlarged. DISCUSSION: Ideal approach for retinotomy as well as clinical aspects have to be well evaluated in subfoveal neovascular surgical removal. The angiographic mask effect of the avascular ring surrounding the neovessel is sometime detectable; the approximative scar surface is by this fact more predictable. CONCLUSION: Iatrogenic damages of surgery and postoperative inflammatory lesions must be considered before when a surgical removal of neovascular membranes is suggested.

Ocular filariasis: not strictly tropical.

A 65-year-old man consulted for a discomfort in the right eye that had suddenly appeared the evening before. The examination revealed a white worm localized under the temporal bulbar conjunctiva. After extraction, the parasitological characteristics identified the worm as Dirofilaria repens (Nochtiella subgenus). This is a parasite of canids and felids, usually nonpathogenic to humans, but which can be transmitted through mosquito bites, especially around the Mediterranean basin. The simple extraction of the worm, encysted under the skin or under the conjunctiva, cures the patient.

[A new instrument for computerized tomography-guided brain biopsy]. / Ein neues Gerät zur computertomographisch gezielten Hirnbiopsie.

The authors present a new stereotaxic brain biopsy method. After establishment of the CT-and angiographic diagnosis follows the marking of the best suited needle track by means of the CT-scanner Somatom DRG. The trephination is then performed at the operation-theatre during local anesthetization. Repeatedly laying on the CT-table, a low contrasted stereotaxic device is fixed on the patients head. Direction and depth of the puncture are measured and predetermined with an accuracy of +/- 5 mm with a few CT-scans. After guided insertion of a thin-wall nonpaque Teflon-sleeve it is possible to obtain artefactless tomograms or localization control and multiple biopsy probes for histologic evaluation without repeated punctures. Therapeutical interventions may be performed in the same way.