[Radiation-induced pulmonary fibrosis: New potential targets]. / Fibrose pulmonaire radio-induite : nouvelles cibles pour demain.

Radiation-induced pulmonary fibrosis (RIPF) is one of the major and late complications of radiotherapy (RT) with an average incidence rate between 16 and 28% after RT. RIPF significantly affects the function of the affected tissues/organs as well as the quality of life and survival of patients. The process of radiation fibrogenesis is initiated by a very complex signaling network that involves several cellular and molecular factors and the development of effective treatments relies on a better understanding of the involved mechanisms. Despite a major advance in the field, to date there is no clinical treatment that has really shown efficacy in the prevention or treatment of RIPF. In the present review, we will discuss potential new therapeutic avenues that could effectively treat RIPF.

[Acute Retinal Pigment Epitheliitis: spectral-domain optical coherence tomography findings]. / Épithélite rétinienne aiguë : apport de la tomographie par cohérence optique en Spectral Domain.

PURPOSE: Through a case presentation of Acute Retinal Pigment Epitheliitis (ARPE) we highlight the role of spectral-domain optical coherence tomography (SD-OCT) in the management of this rare entity. MATERIALS AND METHODS: A 29-year-old woman presented for reduced visual acuity in the right eye occurring one week after a viral episode. Fundus examination showed zones of macular hyperpigmentation surrounded by yellowish hypopigmented haloes. Fluorescein angiography noted early hyperfluorescence of the hypopigmented lesions. ICG angiography revealed central hyperfluorescence surrounded by a hypofluorescent halo. SD-OCT showed a linear disruption between the photoreceptor inner/outer segments (IS/OS) and an accumulation of material in the photoreceptor outer segments and retinal pigment epithelium (RPE). Spontaneous normalization of visual acuity was noted after 10 weeks. SD-OCT revealed restored and continuous inner segment and outer segment layers and some persistent deposits in the photoreceptor layer. RESULTS: SD-OCT findings suggest that the initial lesion in ARPE is located at the junction between the photoreceptor outer segments and the apical side of the RPE cells. It would correspond to an accumulation of photoreceptor outer segment debris secondary to RPE dysfunction, which can occur as a post-viral reaction. CONCLUSION: SD-OCT provides very specific information about the topography of retinal lesions during ARPE, allowing a better understanding of its pathogenesis.

[Induced astigmatism after corneal suture removal after cataract surgery]. / Évolution de l'astigmatisme après ablation d'une suture cornéenne pour chirurgie de la cataracte.

PURPOSE: To evaluate the time until astigmatic stabilization after corneal suture removal after cataract surgery. METHODS: A prospective study was performed on 13 patients who had undergone cataract surgery by phacoemulsification with 2.4mm incision, for whom it was felt necessary to remove a corneal suture. A specular corneal topography was performed by OPD Scan before removal, immediately after, then 10, 20, 30 minutes and 15 days later. For each acquisition, the keratometric readings at the steepest (Kmax) and the flattest (Kmin) meridians (central at 1.15 mm from corneal center, intermediate at 2.30 mm and peripheral at 3.30 mm) and the amount of corneal astigmatism were measured. RESULTS: Corneal topography of 13 patients was acquired. Mean age was 70 ± 12 years. Mean time after cataract surgery was 23 ± 14 days. The greatest change in Kmax occurred within the first minutes following suture removal for the central and intermediate cornea (mean variation of -4.38% and -4.59% of initial Kmax respectively, i.e. -2.04 D ± 3.14 D et -2.15 D ± 3.11 D) whereas it was observed between 0 and 10 minutes for the peripheral area (mean 1.57% of Kmax after suture removal i.e. 0.96 D ± 1.85 D). Mean change in corneal astigmatism between 30 minutes and day 15 was 0.08 D ± 0.31 D (3.6% of baseline). When suture removal was performed between 7 and 10 days postoperatively, mean change was 0.16 D ± 0.24 D, whereas it was 0.03 D ± 0.34 D when performed after four weeks. CONCLUSION: Keratometric readings vary only slightly beyond the first 30 minutes after suture removal. These results suggest that the refraction could be accurately measured the same day as suture removal, with no additional follow-up absolutely necessary in order to prescribe the final spectacles.

Uveal metastasis revealing lung cancer.

BACKGROUND: Uveal metastases (UM) are the most common intraocular malignancies and can be the first manifestation of a disseminated disease. The purpose of this study is to determine the frequency with which uveal metastasis results in a diagnosis of lung cancer, to describe the clinical characteristics of patients with lung cancer metastatic to the uvea, as well as diagnostic difficulties that may be encountered. PATIENTS AND METHODS: We carried out a single-center retrospective study of the medical records of all patients who presented with a UM between 1999 and 2010 at the institut Curie in Paris. From these patients, we retrospectively studied UM secondary to lung cancer. A work-up including thoracic-abdominal-pelvic CT was performed for each patient in whom the primary source of choroidal metastasis was unknown. RESULTS: Of 109 patients presenting with UM, 43 were diagnosed with primary lung cancer (39.4%). Of those 43 patients, the UM was observed prior to the lung cancer in 31 patients (72.1%). Demographic data included 61% male and 39% female, mean age 59.1 years (range: 31-78), and mean life expectancy after diagnosis of UM was 7.5 months (range: 0.7-29). Other metastatic sites were associated with UM in 90.7% of the patients. In all, 90.7% of the patients presented with blurred vision, and 25.6% with pain or inflammation. UM were located within the choroid for 39 patients (90.7%), the iris for three patients (7.3%) and the vitreous for one patient. Seventy percent of patients had a solitary lesion, 76.7% had unilateral involvement, and 23.3% of cases were bilateral. Mean thickness on B-scan ultrasonography was 3.61 mm (range: 1-8.5 mm). In all, 81.4% of UM were unpigmented, while 18.6% showed pigment mottling. In all, 20.9% of patients were referred with the diagnosis of choroidal melanoma from their regular ophthalmologist, and three of the 43 patients (6.9%) were initially misdiagnosed and treated for melanoma at Curie. Chest X-ray was unremarkable in 18.9% of patients. CONCLUSION: UM is often the first manifestation of disseminated disease and requires a search for the primary tumor, in particular lung cancer. Standard chest X-ray cannot rule out the diagnosis. Metastases may be solitary with heterogenous pigmentation, and the differential diagnosis from uveal melanoma may be difficult, requiring the expertise of a referral center.