[Corneal tattooing. A series of 14 case studies]. / De l'usage du tatouage cornéen. A propos de 14 cas.

AIMS: Evaluate the efficacy of a little-used surgical method: corneal tattooing, using a dermograph to hide unsightly corneal scars on nonfunctional eyes. PATIENTS AND METHODS: Retrospective study of 14 eyes of 13 patients treated by tattooing the corneal surface, by directly introducing the pigments into the corneal stroma using a dermograph. The effectiveness of tattooing was evaluated by pigmentation homogeneity and patient satisfaction. Tolerance was evaluated by the scarring at the 7th day and ocular inflammation. The average follow-up was 18 months. RESULTS: Fourteen eyes presented an unaesthetic, neovascularized major corneal edema (79% traumatism). In 12 eyes, the treatment was homogeneous with a very satisfactory aesthetic result for the patient. One eye presented minor complications of pigmentary migration. One eye presented a corneal perforation 40 days after the procedure on a very pathological cornea. CONCLUSION: Corneal tattooing using a dermograph is a little-used technique since changes in corneal transplantation indications but is also a simple and inexpensive alternative for corneal scar treatment on nonfunctional eyes.

[Abrupt visual loss in children. Three case studies of ocular bartonellosis]. / Baisse d'acuité visuelle brutale chez l'enfant. A propos de 3 cas de bartonellose oculaire.

PURPOSE: To evaluate the severity and progression of neuroretinitis in children caused by Bartonella. PATIENTS AND METHODS: Retrospective study of three consecutive cases. Patients underwent ophthalmological, medical, and radiological evaluations. Bartonella serology was positive. Intravenous treatment was started immediately with antibiotics and steroids. Patients were re-evaluated after visual acuity recovery. RESULTS: Progression was quickly positive with fosfomycin and fluoroquinolones in all cases. CONCLUSION: Bartonella induces neuroretinitis even without systemic signs of cat-scratch disease, with sometimes sudden bilateral blindness. Long-term progression is good but urgent medical treatment is necessary.

[Sudden sight impairment revealing a cat-scratch disease: report of three cases]. / Baisse brutale de l'acuité visuelle révélatrice d'une maladie des griffes du chat: à propos de trois cas.

UNLABELLED: Cat-scratch disease is a frequent but innocuous cause of chronic lymphadenopathy in children. Numerous atypical forms have been described. We report three cases of acute sight impairment revealing a cat-scratch disease. BACKGROUND: A 13 year-old boy and two girls aged 10 and 13 suffered from a sudden bilateral sight impairment with papillary edema, with fever in two cases. Neurological examinations, X-rays and lumbar puncture results were found normal. However, all patients were tested positive to Bartonella Henselae. Antibiotic and anti-inflammatory treatments were efficient in two cases. CONCLUSION: Cat-scratch disease can be characterized by an isolated and acute sight impairment with a stellate neuroretinitis. The potency of antibiotic treatments is debatable.

Dermatological practice in Guadeloupe (French West Indies).

Guadeloupe is a French Caribbean island, with a population of mainly African ancestry, and a high standard of living. We recorded the dermatological diagnoses in 5000 new patients attending dermatologists. The main diagnoses were acne (16.4%), superficial mycoses (12.8%), and eczema (10.5%). Diseases considered to be specific to the tropics were scarce. The main dermatoses attributable to a tropical environment were superficial mycoses, and prurigo. Concerning ethnicity, the majority of Afro-Caribbeans and resident Caucasians visited dermatologists for the same diseases. The main difference attributable to ethnicity was a high rate of visits by Caucasians for melanocytic naevus and malignant/premalignant neoplasms. Dermatoses restricted to Afro-Caribbeans were only secondary ailments. The spectrum of diseases registered in our study was similar to that in Northern countries; this probably reflects the influence of the high standard of life in Guadeloupe.

[Allergy to sunscreens]. / Allergie aux filtres solaires.

Introduced in the 1930s, the sun filters (chemical screens) are very widely used as they are contained in photo-protective creams and in many other cosmetics. Allergy to sun filters seems to be rare in the general population (< 2%), but more frequent in populations which are suspected of photo-dermatosis (2 to 25%). It is composed of contact allergies, but also photo contact allergies in 45 to 85% of cases. Photo-biological exploration is comprised of application of photopatches and thus is necessary together with epidermotests. Crossed allergies, though rare, may be seen between filters, but also with substances that have a close chemical structure. Treatment such as prevention, if photo-protection is necessary, rest in discarding the causal filter and use of non-allergenic mineral screens.

[Membrane stabilizers (chromones and ketotifen)]. / Les stabilisateurs de membrane (cromones et kétotifène).

The drugs called "Membrane stabilisers" are composed of cromones (sodium cromoglycate and nedocromil) and Ketotifen. They inhibit the degranulation of mastocytes by a membrane stabilising effect. Ketotifen is distinguished from the cromones by a conjoint antihistamine effect. Nowadays, the indications are for prophylactic treatment of allergic asthma, rhinitis and allergic conjunctivitis and the manifestations of food allergy. Therapeutic efficacy seems to be good in intermittent or mildly persistent asthma, especially in children or young subjects. Secondary effects are rare and generally benign, with reduced contra-indications.

Clinical aspects of ocular leptospirosis in New Caledonia (South Pacific).

PURPOSE: The incidence of leptospirosis is very high in New Caledonia (average annual incidence rate: 180/100 000 of the population). To investigate the role of pathogenic leptospires as an aetiological agent of ocular diseases, we report the results of a 5-year survey in New Caledonia. METHODS: We reviewed 13 patients (corresponding to 17 investigated pathologic eyes) retrospectively. The selection of patients was based on epidemiological data, initial clinical examination, biological confirmation of leptospirosis according to reference procedures and a specific polymerase chain reaction assay. The anatomic criteria of uveitis and the criteria describing the evolution of the disease were those recommended by the International Uveitis Study Group. RESULTS: Consequent rates of optic neuritis (65%), posterior uveitis (35%), secluded pupil (24%), interstitial keratitis (18%) and pars planitis (12%) were found. Our rates of recurrence (46%) and of ophthalmic complications (82%) were substantial; some symptoms indicated brain involvement.The final visual damage was severe in 35% of eyes. CONCLUSIONS: Microagglutination and polymerase chain reaction hybridization are complementary tests for the diagnosis of Leptospira-induced ophthalmic lesions. Before deciding on treatment, one must consider the ability of virulent leptospires to persist in immunologically privileged sites such as aqueous humor, cerebrospinal fluid and eukaryotic cells. Polymerase chain reaction is a useful tool for the diagnosis of Leptospira-induced ocular complications, which are probably misdiagnosed if based only on routine laboratory tests. It enables early diagnosis and early specific treatment that now consists of quinolone and cyclines.

Pseudomembranous conjunctivitis following bone marrow transplantation: immunopathological and ultrastructural study of one case.

Pseudomembranous conjunctivitis (PMC) is a rare ophthalmic lesion usually caused by infectious agents such as streptococcus, Klebsiella, Chlamydia, or adenovirus. It can also be associated with skin lesions of toxic epidermal necrolysis (TEN) and graft-versus-host-disease (GVHD). We report the pathological study of a patient with PMC and GVHD who had a conjunctival biopsy before death. This allowed us to differentiate this form of PMC from PMC of infectious origin, and to find within the epithelium characteristic features of acute GVHD and mononuclear cells expressing natural-killer markers. This suggests that this form of PMC resulted from a very acute, cytotoxic form of GVHD. Because PMC in bone marrow recipients can be related to infections, TEN, or acute GVHD, a systematic pathological study is required to guide the therapy.

Conjunctival biopsy in scleroderma and primary Sjögren's syndrome.

Keratoconjunctivitis sicca complicates both scleroderma and Sjögren's syndrome. Scleroderma of recent onset is difficult to diagnose, but is easily recognized late in its course. To assess the value of the conjunctival biopsy in the diagnosis of scleroderma, we used light, scanning, and transmission electron microscopy to compare in a masked fashion specimens from 21 patients with scleroderma and 14 patients with primary Sjögren's syndrome. Epithelial changes permitted diagnosis of early scleroderma in the two groups of patients. Lymphocytic infiltrate was always present in Sjögren's syndrome, but not in scleroderma. Fibrosis was always found in scleroderma, even in scleroderma of recent onset, but was absent in Sjögren's syndrome. The fibrosis was distributed around capillaries in a band-like pattern and was associated with degranulating mast cells. Conjunctival biopsy is valuable for the early diagnosis of scleroderma and for differentiating between scleroderma and primary Sjögren's syndrome.

[Gold salt deposits in the conjunctiva in rheumatoid arthritis after gold therapy. A systematic study of 15 biopsies]. / Dépôts de sels d'or conjonctivaux dans les polyarthrites rhumatoïdes traitées par chrysothérapie. Etude systématique de quinze biopsies.

Ocular abnormalities have long been recognized as a potential adverse effect of gold therapy in patients with rheumatoid arthritis. Clinical symptoms and ocular tissue lesions possibly related to use of gold therapy were routinely evaluated in eleven patients. There were few clinical manifestations: only one patient had typical accumulation of gold in the anterior crystalloid. In contrast, routine ultrastructural and microprobe studies of conjunctival biopsy specimens disclosed accumulation of gold salts in every case. Gold was visible as aurosomes in the conjunctival macrophages. Aurosomes were seen in patients treated for as little as one month, occurred even with low doses (0.3 g), and were still visible after several years. Duration of accumulation can be roughly estimated on the basis of the morphologic appearance of aurosomes which are lamellar after a few weeks of gold therapy and rod-shaped beyond one month.

[Syphilitic uveitis]. / Uvéites syphilitiques.

The incidence of syphilitic uveitis is reportedly increasing, up to 1% uveitis in general, with often polymorphic and atypical manifestations. Three cases of syphilitic uveitis are reported here, at different stages (secondary, latent, late). The bacteriologic sterilization is often unlikely in ocular syphilis, and recurrence is frequent; therefore a high-dose intravenous penicillin G treatment is then to recommend. HIV serology must be systematically associated with syphilitic tests.

[Central areolar choroid dystrophy]. / A dystrophie choroïdienne aréolaire centrale.

Central areolar dystrophy is a dominantly inherited macular dystrophy characterized by a bilateral, symmetrical, well circumscribed loss of choroidal and retinal tissues. A family presenting such degeneration is studied on three generations in initial and late stages. Clinical, functional and angiographic datas are characteristic: earliest changes and evolution are analysed.

[Electroretinographic problems in the diagnosis of diseases of the cones and macula]. / Les problèmes électrorétinographiques du diagnostic des affections des cônes et de la macula.

From series of clinical cases, the authors expose how ERG is an essential element for the diagnosis of cone dysfunction with or without macular involvement. They show that to obtain an accurate diagnosis, precise proceedings must be chosen, using stimulation technics correctly selected. They study the advantage of focal or wide stimulations, of the level of the intensity of the stimulation and of the different colored filters. They propose a proceeding for adults examination. For young children, they discuss the advantages and limits of a particular proceeding.

[Jaffe's syndrome and anomalies of capillary permeability]. / Syndrome de Jaffé et anomalies de la perméabilité capillaire.

The parallelism between ophthalmoscopy and angiography in the different grade classifications of idiopathic epiretinal membranes is not compulsory: spotty and irregular fluorescein leakage is apparent in many cases, even early. This leakage, who might bring biochemical factors stimulating cellular migration and proliferation could therefore be usually associated with more progression of the membrane.

Development of tight junctions in the human ciliary epithelium.

Using the freeze-fracture technique, the tight junctions of the human ciliary epithelium were studied from 8 to 24.5 weeks of gestation with regard to their ability to act as a barrier to tannic acid. Zonular tight junctions were present as early as the 8th week of gestation, even before the emergence of ciliary folds, and they constituted an effective barrier to tannic acid at all stages studied. In the earliest stages, intramembranous particles were observed on the crest of membrane elevations, at regions of the future tight junctions. Discontinuous and loose networks of tight junctional strands were also encountered, indicating the formation of tight junctions. After the 10th week of gestation, ciliary folds developed and the configuration of the tight junctional networks underwent important changes. The apico-basal thickness of the junction, the number of superimposed strands, and the number of anastomoses decreased, while the number of complex strands increased. At the same period, junctional elements tended to become arranged in parallel lines. Steps which may lead to the formation of the tight junctions and the possible significance of the morphological modifications are discussed.