[Treatment of macular edema: Comparison of efficacy and tolerability of subconjunctival triamcinolone injections, sub-tenon's triamcinolone injections and intravitreal dexamethasone implant]. / Traitement des œdèmes maculaires : comparaison de l'efficacité et de la tolérance des injections sous-conjonctivales de triamcinolone, des injections sous-ténoniennes de triamcinolone et des injections intra-vitréennes de l'implant de dexaméthasone.

The area of uveitis is related to numerous pathological entities. One of the main causes of decreased visual acuity in these patients is macular edema. One aspect of the treatment includes cortosteroids used peri- and intra-ocularly. MATERIALS AND METHODS: The goal of our work was to estimate the criteria of efficacy (on improvement in visual acuity and macular edema, as well as time to recurrence) and safety (on intraocular pressure and cataract) of these various routes of administration of corticosteroid after a single injection. We compared patients treated with Ozurdex® versus subconjonctival triamcinolone versus sub-tenon's triamcinolone. This is a retrospective study conducted in 2 tertiary centers, the university medical center of Nantes and La Pitié-Salpêtrière hospital from November, 2011 to November, 2013. RESULTS: At presentation, 25 % of the patients displayed VA better than 5/10. During follow-up, this proportion increased to 45 % at M1, 50 % at M3, 49 % at M6 and 48 % at the end of follow-up. There was no significant difference between the groups with respect to VA gain. The reductions in mean CMT compared with D0 were all statistically significant (improvement of one line in log-OCT). We observed an improvement in macular thickness of 88 % at M1, 86 % at M3, 61 % at M6 and 60 % at the end of follow-up, significant at each time, with no significant difference between the three groups. A comparison of time to anatomic vs. functional recurrence was performed, showing no difference. The largest increase in IOP was observed at M1, statistically different from the other time points. DISCUSSION: Intra- and periocular injections should be considered as an adjuvant therapy, since the majority of the conditions in question require systemic treatment. They allow for increased intravitreal concentrations with fewer systemic effects. CONCLUSION: We demonstrated neither any true superiority of any of the 3 treatments nor any difference in tolerability between the 3 groups.

[Ocular syphilis: A retrospective study of 27 cases in Nantes University Hospital (France) from 2000 to 2013]. / Syphilis oculaire: étude rétrospective de 27 cas au CHU de Nantes (France) de 2000 à 2013.

INTRODUCTION: Syphilis may manifest as several distinct ophthalmological forms. The main objective of our study was to describe the diagnostic, therapeutic data and prognosis of ocular syphilis. PATIENTS AND METHODS: We retrospectively analysed the cases of syphilitic uveitis diagnosed in the University Hospital of Nantes between 2000 and 2013. RESULTS: Twenty-seven patients were included in our study. Their mean age was 53.1 years. Bilateral uveitis was the most frequent clinical presentation (67%). The average diagnostic delay after the first symptoms was 2.8 months. Three patients (11%) presented with an anterior uveitis and 24 (89%) with a posterior uveitis, panuveitis or papillitis. The most frequent clinical signs were papillar lesion (44%), multifocal choroiditis (33%) and chorio-retinitis (37%). Ninety-three percent of the patients were treated with benzathine penicillin intravenously, one patient was treated by intramuscular penicillin injections and another by ceftriaxone intramuscularly. Ocular manifestations alone were sufficient to make the diagnosis of syphilis in 25 patients (93%) and of HIV seroconversion in 3 patients (11%). Forty-one percent of the patients benefited from an adjuvant therapy with corticosteroids. The treatment allowed a visual improvement of -0.48 log MAR (P<0.0001) with an average reduction of retinal central thickness of 70.2 µm (P=0.33). CONCLUSION: We did not find a significant difference neither in management nor in results between the HIV seropositive and HIV seronegative groups. Others studies remains controversial about this aspect. The increased frequency of ocular manifestation as well as the increase of syphilis makes systematic screening in uveitis of a great value.

[Diagnosis methods in Sjögren's syndrome (author's transl)]. / Méthodes de diagnostic du syndrome de Sjögren.

The diagnosis value of various methods used to detect or confirm a Sjögren's syndrome are discussed. The Schirmer's test, generally abnormal, is a good test for detection, although not specific. A subnormal concentration of tears lysozyme is seen in about half of the patients, as so as the presence of anti-salivary ducts antibodies, or significant aspects in lip biopsy. The tests that are most frequently disturbed are the salivary immunoglobulin assay and the fonctionnal study of salivary glands with 99m technetium tracer but they are not specific. These abnormalities are neither constant, not specific: for this reason, there are frequently some problems in the diagnosis or the nosologic definition of Sjögren's syndrome. The occurrence in the same subject of many of these abnormalities makes however this diagnosis highly probable even in patients without functionnal troubles.

[Systematic screening for Sjögren's syndrome in patients with various blood diseases]. / Recherche systématique du syndrome de Sjögren dans diverses hémopathies.

A Sjögren's syndrom was looked for systematically in 154 hematological patients, half of them with lymphoproliferative disorders, by means of three current diagnosis methods: the Schirmer's test, the tear lysozyme assay, and the salivary immunoglobulin assay. These tests, poorly specific, are frequently abnormal, but the coexistence of the three abnormalities in the same patient makes the diagnosis highly probable. This corresponded to 4 patients. Taking into account the other diagnostic methods, the diagnosis was considered as possible or probable in 7 patients, and certain in 3 of them. This rate of 2% is discussed but the frequency of latent Sjögren's syndrome in hematologic patients and mainly in lymphoproliferative disease cannot be considered as high.

[Waldenström's macroglobulinemia with preserved antierythrocyte and antilipoprotein antibody activity]. / Macroglobulinémie de Waldenstrôm a activités anticorps anti-hématies conservées et anti-lipoprotéines

One case of Waldenström's macroglobulinemia is reported, in which the monoclonal IgM has an antibody activity against stored red cells, beta-lipoproteins and mammalian glomeruli. The antibody activity is observed with the purified IgM molecule, which cross reacts with the three antigens, and with the Fab piece. The study of the cross reactions shows that the antibody recognizes similar rather than identical antigens. This observation is to be added to the few cases already published of antibody against stored red cells, and of Waldenström's macroglobulinemia with antibody activity. The physiopathology of the occurrence of a M component with such an activity is discussed.