[Ocular and neuro-ophthalmic manifestations of sarcoidosis: retrospective study of 30 cases]. / Sarcoïdose oculaire et neuro-ophtalmologique: étude rétrospective sur 30 cas.

INTRODUCTION: The purpose of this study was to describe the diagnostic strategy and therapeutic approach when sarcoidosis of the visual pathways is suspected, by way of a descriptive study of sarcoidosis patients in the ophthalmology services in Tours, Rennes and Angers. PATIENTS AND METHODS: A multicenter, retrospective chart review was performed for 30 patients diagnosed with sarcoidosis and followed at the university hospitals of Tours, Rennes and Angers between January 1997 and August 2011. The diagnosis of sarcoidosis was based on a combination of clinical and ancillary tests, including pathologic confirmation and/or hyperlymphocytosis with a CD4/CD8 ratio greater than 5 on bronchoalveolar lavage. RESULTS: We identified 30 patients with ocular and/or neuro-ophthalmic sarcoidosis (25 female [83%], five male [17%], median age 48 years (36-87). Histologic confirmation of epithelioid granuloma was obtained in 24 (80%) of the 30 included patients. Sarcoid uveitis was present in 83% of patients; neurosarcoidosis was found in 37% of patients. Additional complaints at presentation included dyspnea (31%), arthralgia (41%), myalgia (24%) and paresthesia (27%). Bilateral ocular involvement was found in 89% of cases. In 83% of patients, there was an active anterior uveitis on slit lamp examination at initial presentation. Funduscopic abnormalities included vitritis in 67%, snowbanking in 13%, snowballs in 27% and disc edema in 30%. Eight patients (27%) had retinal vasculitis and nine patients (30%) were diagnosed with multifocal choroiditis on angiography. An elevated angiotensin-converting enzyme was present in 13 (52%) of 25 patients tested, with an average of 71 (range 36-241). Evidence of sarcoidosis was present on chest CT in 22 (79%) of 28 patients. Neuroimaging abnormalities on brain MRI were found in eight of ten tested patients. The 10 IU tuberculin skin test was negative in all tested patients (12). Median lymphocytosis in the bronchoalveolar lavage fluid (BALF) was 0.3 (0.2-0.7) in the 15 tested patients. BALF CD4/CD8 ratio was positive in all tested patients (12). Oral corticosteroids were initiated at 1mg/kg per day and then tapered in 20 (67%) of 30 patients. Median duration of steroid treatment was 12 months (5-127), resulting in rapid improvement in 84% of cases. However, nearly half of patients experienced a recurrence of the disease. CONCLUSION: Positive diagnosis of sarcoidosis requires a careful history and clinical examination, ancillary testing, and collaboration among several medical specialties. Normal angiotensin-converting enzyme levels do not rule out the diagnosis, since in our series, they were normal in almost half the cases. The tests with highest sensitivity included: a negative tuberculin skin test (100%), an elevated CD4/CD8 ratio in the BALF (100%), radiographic evidence of sarcoidosis on chest CT (79%) and brain MRI (80%). Other factors contributing to the diagnosis were: female gender (83%), age over 40 (67%), arthralgia (41%), asthenia (50%), vitritis (67%) and multifocal choroiditis (30%). In our study, treatment with corticosteroids resulted in significant improvement in over 80% of patients.

[Neuro-ophthalmological assessments in the Ophthalmology Department at University Medical Center, Brest: retrospective study of 269 patients (January 2004-October 2009)]. / Bilans neuro-ophtalmologiques dans le service d'ophtalmologie du CHU de Brest : étude rétrospective sur 269 patients (janvier 2004-octobre 2009).

AIMS: To evaluate the neuro-ophthalmological assessments carried out in the ophthalmology department of the university medical center, Brest, identifying the population seen, the examinations performed, the pathologies treated and patient outcomes, so as to suggest solutions to improve quality of care. METHODOLOGY: Retrospective study over a period of more than five years, between January 1st, 2004 and October 31st, 2009. Data were collected from each patient's chart with the help of a standardized spreadsheet including epidemiological, clinical, paraclinical and treatment data. RESULTS: Analysis of the 269 charts reveals that optic neuropathies are the most frequently encountered etiologies. In addition to the standardized assessment currently used on the service, we suggest adding a specific neuro-ophthalmological clinical intake form so as to standardize and perfect the diagnostic approach. CONCLUSION: Optimization of quality of care in neuro-ophthalmology involves a multidisciplinary approach, requiring close collaboration between ophthalmologists, neurologists and radiologists. A careful, regular analysis of our practice patterns with respect to scientific advances should improve consistency and quality of care for our patients.

[The myopic vitreous. Why is its examination so difficult?]. / Le vitré du myope fort. Pourquoi son examen est-il si difficile ?

The examination of a high myopic vitreous is difficult for several reasons, including optic phenomena and vitreous liquefaction. The diagnosis of a posterior vitreous detachment may be problematic and confused with the observation of a large lacuna posterior margin.

[Finding of Strongyloides stercoralis infection, 25 years after leaving the endemic area, upon corticotherapy for ocular trauma]. / Découverte d'une infestation à Anguillule, 25 ans après retour de zone d'endémie, à l'occasion d'une corticothérapie pour traumatisme oculaire.

In the field of ophthalmology, indications for high-dose corticotherapy are various. This paper reports the case of a Caledonian man who presented with intestinal strongyloidiasis, discovered 25 years after he had left the endemic area. A checkup before corticotherapy for traumatic retina edema provided the diagnosis of the infection. The authors emphasize the importance of searching for Strongyloidiasis stercoralis larva before initiating corticotherapy, as it is the main treatment responsible for parasitic dissemination. The most severe form of strongyloidiasis, the disseminated form, has a high mortality rate: 70%-90%. The definitive diagnostic test is enhanced larva recovery, which should be proposed to every patient returning from endemic area, people with precarious hygiene or with high eosinophilia or intestinal symptoms of chronic infection. Delay in diagnosing strongyloidiasis frequently results in death, despite vigorous treatment.

[Sebaceous tumors of the eyelids in a patient with Muir-Torre syndrome]. / Tumeurs palpébrales à différenciation sébacée dans le cadre d'un syndrome de Muir-Torre.

Muir-Torre syndrome is an autosomal dominant hereditary condition predisposing to cancer. It is characterized by cutaneous tumors (such as sebaceous adenomas, epitheliomas, or carcinoma, and/or keratoacanthomas) and internal malignancies. A 47-year-old male patient with cancer antecedents consulted for two tumors of the eyelid. Histological study of the exeresis biopsies of the eyelid lesions showed a sebaceous adenoma and an epidermoid carcinoma with sebaceous differentiation. With the suspicion of Muir-Torre syndrome, a genetic consultation was requested. The geneticist found a mutation of the MSH2 gene, which was not classified as pathological. Cancer screening was begun for the patient and his descendants. The clinical outcome was death from urothelial carcinoma. Eyelid sebaceous tumors require complete medical check-up in search of carcinoma. Demonstrating Muir-Torre syndrome allows the medical team to propose early cutaneous and visceral carcinoma screening for patients, their collaterals, and their descendants.

[Cystic fibrosis and uveitis in childhood and multiple sclerosis at adulthood]. / Mucoviscidose, uvéite infantile et sclérose en plaques à l'âge adulte.

We report the case of a patient with cystic fibrosis who suffered severe bilateral uveitis, with hypopyon, retinal vasculitis, and polyarthritis when he was 6 years old. No etiology could be found. Multiple sclerosis began when he was 22 years old. This panuveitis was clinically very different from the uveitis usually associated with multiple sclerosis. Polyarthritis and skin vasculitis have been reported in the course of cystic fibrosis, but no uveitis nor retinal vasculitis have been described. This raises the question of the role of multiple sclerosis and cystic fibrosis in the pathogenesis of this case of uveitis.

[An atypical case of malignant hypertensive retinopathy in a young child]. / Présentation d'un cas atypique de rétinopathie hypertensive maligne chez une fillette.

Stage IV hypertensive retinopathies in children have been described, but their incidence appears to be rare. Most etiologies are nephropathies. The authors present a clinical case of malignant high blood pressure in a young girl whose ophthalmological tests detected an unusual nephropathy, the Ask-Upmark kidney, illustrating the importance of determining high blood pressure chronicity and using Kirkendall's classification. Systematic fluorescein angiography and NMR on atypical subjects prevents the diagnosis of Leber neuroretinis, the main differential diagnosis. Early treatment of high blood pressure can avoid complications such as macular exudes.

[Fibrinolysis in the treatment of the amaurosis fugax: a case report]. / Fibrinolyse dans le traitement de l'amaurosis fugax. A propos d'un cas.

The authors report a case of amaurosis fugax treated first by systemic fibrinolysis and then by antiplatelet treatment. A 47-year-old suffering from transient amaurosis due to recurrent occlusion of retinal arterial branches improved after treatment and showed no recurrence. This protocol appears effective in cases of probable embolus in a young patient with no contraindications and when flow is not reestablished (amaurosis fugax), or when the required 6-hour time delay is respected.

Conjunctival epithelial neoplasias in organ transplant patients receiving cyclosporine therapy.

PURPOSE: To report two cases of conjunctival epithelial neoplasias occurring after long-term systemic cyclosporine therapy in organ transplant recipients. METHODS: Case report. Each patient underwent an excision of an extensive limbal conjunctival lesion, followed by a histopathologic analysis. RESULTS: Histopathologic examination results revealed a carcinoma in situ and a squamous cell carcinoma in patients 1 and 2, respectively. Recurrence occurred in patient 1, who needed topical mitomycin C 0.02% treatment. No recurrence was observed in patient 2 after a follow-up of 24 months. CONCLUSION: To our knowledge, these are the first reported cases of its kind after longterm systemic cyclosporine therapy. Further studies will be needed to determine the exact role of cyclosporine in the induction of conjunctival epithelial neoplasias and the need for regular ophthalmologic examination of transplant recipients.

Long-term follow-up of three-piece, looped, silicone intraocular lenses.

PURPOSE: To present long-term follow-up of silicone lens implantation. SETTING: Clinique Ophtalmologique, Centre Saint-Victor, Amiens, Cédex, France. METHODS: In this prospective study, we followed 111 eyes consecutively operated on from March 1988 to July 1989. Foldable silicone intraocular lenses (IOLs) were implanted in 107 eyes and poly(methyl methacrylate) (PMMA) IOLs in 4 eyes. The eyes with PMMA lenses were excluded from the study. RESULTS: After a follow-up of 3 years (average 20 months), 13.7% of eyes with posterior capsule opacification (PCO) required a neodymium:YAG (Nd:YAG) laser capsulotomy. In the group with longer follow-up (average 57 months), 40.6% required Nd:YAG capsulotomy. The majority of capsulotomies were performed in the fourth year after surgery. The PCO rate was the same whether the IOL was placed in the sulcus or in the capsular bag (51.5 versus 48.5%). The Nd:YAG treatment caused pitting of the silicone in most cases, with no effect on visual acuity. We did not observe other serious complications such as retinal detachment, endophthalmitis, or silicone discoloration. There was no visual acuity below 20/35. CONCLUSIONS: In this series, the silicone IOLs were compatible with phacoemulsification and did not have a higher rate of complications than has been reported for PMMA IOLs.

[Efficacy and tolerability of 2 presentations of eyedrops combining carteolol 2% and pilocarpine 2% in primary open-angle glaucoma and simple ocular hypertension]. / Efficacité et tolérance de 2 présentations de collyre associant le cartéolol 2% et la pilocarpine 2% dans le glaucome primitif à angle ouvert et l'hypertension oculaire simple.

PURPOSE: The aim of the study was to compare 2 combinations of eye drops containing 2% carteolol and 2% pilocarpine: LCM 1010: ready to use eye drops CBS 341A: eye drops to be reconstituted (freeze-dried powder + solvent). METHODS: Ninety-seven patients with primary open angle glaucoma or simple ocular hypertension were included in a randomized, double-blind multicentric study comparing 2 parallel groups of treatment. Intra-ocular pressure was greater than 21 mmHg with beta-blocker alone. One instillation of 2% carteolol-2% pilocarpine combination was given twice a day for one month. Before and after this treatment, intra-ocular pressure was measured at 9 am (12 hours after evening instillation) and at 11 am (2 hours after morning instillation). RESULTS: Both treatments reduced intra-ocular pressure by a comparable amount and there was no significant difference between groups at either measure: at 9 am: 2.11 +/- 2.39 mmHg (mean +/- SD) for LCM 1010 1.79 +/- 1.73 mmHg for CBS 341 A p = 0.25 at 11 am: 3.75 +/- 3.83 mmHg for LCM 1010 3.40 +/- 1.69 mmHg for CBS 341 A p = 0.42. Both eye drops were generally well tolerated. CONCLUSION: Efficacy and safety of ready to use eye drops 2% carteolol-2% pilocarpine combination proved to be comparable to that of eye drops to be reconstituted in the treatment of ocular hypertension poorly controlled by beta-blocker eye drops alone.

[Lens complication during panphotocoagulation using a panfundoscope]. / Complication cristallinienne au cours d'une panphotocoagulation avec le panfundoscope.

We report one case of lens opacities, secondary to retinal panphotocoagulation using the panfunduscope. Cataract can be attributable to nuclear sclerosis, optical features of the panfunduscope and blue-green laser.

[Functional outcome of advanced chronic glaucoma after trabeculectomy]. / Devenir fonctionnel des glaucomes chroniques évolués après intervention fistulisante.

We studied the risk of sudden loss of visual fields after trabeculectomy on 17 eyes with primary open angle glaucoma and small residual visual fields. We think that it is possible to try to these patients filtering procedures with precautions before and during surgery.

[Retinal photocoagulation without corneal contact using the 90 diopter lens]. / Photocoagulation rétinienne sans contact cornéen au moyen de la loupe 90 D.

The authors used the hand held 90 diopter lens for practice of non contact retinal photocoagulation in 8 cases when ocular conditions make undesirable the use of a contact lens. The excellent visualisation of the retina, patients comfort, his utilisation immediately after surgery and in gaz filled, are among its more interesting uses. The movements of the eye and the impossibility to go further than the mid periphery of the retina are its principals disadvantages.

[Retinal detachment with vitreoretinal proliferation treated by temporary silicone oil tamponade. Long-term results]. / Décollement de rétine avec prolifération vitréorétinienne traité par tamponnement provisoire d'huile de silicone. Résultats à long terme.

We have analyzed the long-term complications of 14 retinal detachments successfully reattached six months after silicone oil removal. Corneal decompensation and cataract were the most frequent causes of loss of vision between six months and two years.

[Eye perforation caused by retrobulbar injection]. / Perforation du globe oculaire par injection rétrobulbaire.

The authors present a case of scleral perforation following a retrobulbar injection of anesthetic. Predisposing factors are reminded and ways to avoid such complications are expanded.

[Claude Bernard-Horner syndrome. Apropos of a case. Etiopathogenic discussion]. / Syndrome de Claude Bernard-Horner. A propos d'un cas--discussion étiopathogénique.

Authors report a case of Horner's syndrome, associated with symptomatic trigeminal neuralgia and image of vertebral mega-dolicho-artery. Etio-pathogenic hypothesises are discussed.

[Listeria endophthalmitis: an uncommon etiology]. / Endophtalmie à Listéria: une étiologie exceptionnelle.

Listeria monocytogenes is an uncommon cause infections: to our knowledge this is the seventh case of human endophthalmitis isoleted. An early diagnosis and therapy allowed an excellent functional recovery when compared to the reported cases of the literature.