Predictibility of the efficacy of peripheral iridotomy in primary angle closure: Utility of UBM.

PURPOSE: To assess the utility of UBM in the management of primary angle closure (PAC) and assessing the predictability of peripheral iridotomy (PI) in re-opening the closed angle. DESIGN: Retrospective clinical study. SUBJECTS: Patients with suspicion of PAC. METHODS: This study obtained the consent of all patients and adhered to the Declaration of Helsinki. It was conducted in two ocular imaging centers and based on patients with suspected PAC. Each patient underwent UBM and Visante OCT at each visit, before and after PI when PAC was confirmed. MAIN OUTCOME MEASURE: Irido-corneal angle. RESULTS: Out of 202 eyes (101 patients) with a mean age of 62 years and 69.3% female predominance, we found 186 eyes with PAC. In most cases (77.4%), the iridocorneal angle was open after a single PI at the second visit, and only 14% eyes remained closed at the third visit, regardless of any additional treatment performed (complementary PI, iridoplasty, surgical lens extraction). Mechanisms involved in persistent angle closure after PI were: imperforate PI (45.2% of eyes), iris plateau syndrome (8.6% of eyes), significant lens vaulting (30.9% of eyes) and mixed mechanisms (2.3% of eyes). CONCLUSION: PI remains effective as a first-line treatment in most cases of PAC, even when associated with mechanisms other than pupillary block. Nevertheless, the PI must be completely patent, and UBM can help in understanding underlying mechanisms, hence guiding the treatment in these eyes.

Predominantly Superior Retinal Tears Detected by B-Scan Ultrasonography.

INTRODUCTION: When fundus examination is not possible, ultrasonography (US) is an accurate tool for the diagnosis of retinal tears (RT). The aim of this study was to describe the predominant location of RT, the factors influencing their location, and the vitreous status of eyes with RT using US. METHODS: A prospective study was conducted in all patients diagnosed with RT by B-scan US (Aviso, Quantel Médical, Clermont-Ferrand, France). The primary endpoint was to assess RT preferential location using US. Secondary endpoints were the rate of posterior vitreous detachment (PVD), number of eyes with multiple RT, and axial length (AL). RESULTS: A total of 101 eyes of 100 patients with RT were included. RT main location was in the superior quadrants (either nasal superior, strictly superior, or temporal superior) in 71% of cases. All patients were diagnosed with PVD by US, and 79% had a vitreous hemorrhage. Twelve eyes (13%) were diagnosed with multiple RT. The mean AL was 24.62 ± 2 mm, and it was significantly longer in eyes without superior RT (25.52 mm versus 24.37 mm; p=0.004). CONCLUSION: In this study, we showed a superior location of RT diagnosed by US in more than two-thirds of cases associated with a significantly shorter AL than in other locations. This finding could increase US sensitivity for RT detection and help to improve the US learning curve of ophthalmologists in training and surgical decision-making when the retina is inaccessible due to opacity media.

[Plateau iris-like configuration resulting from numerous iridociliary cysts]. / Syndrome d'iris plateau-like secondaire à une polykystose iridociliaire.

INTRODUCTION: The clinical diagnosis of plateau iris most often remains a suspected diagnosis in absence of complementary imaging tests. We report the case of a plateau-like iris configuration resulting from numerous iridociliary cysts and the diagnostic value of ultrasound biomicroscopy (UBM). OBSERVATION: A 35-year-old Caucasian woman with a family history of PAOG presented asymptomatic high intraocular pressure (IOP) (26mmHg RE, 17mmHg LE). She had a normal deep anterior chamber, a narrow iridocorneal angle with sectoral abnormal insertion of the iris and a normal fundus. Laser peripheral iridotomy was performed. One year later, the patient presented again with elevated IOP in the right eye (25mmHg); hypotensive monotherapy was prescribed. Later she reported eye pain in the evening. Gonioscopy found an iridocorneal contact covering more than 200 degrees in the right eye, with less extensive coverage in the left eye. The hypothesis of plateau iris-like syndrome was suggested because of the failure of the iridotomy and UBM was performed. This confirmed the diagnosis of plateau iris configuration secondary to numerous ciliary body cysts. DISCUSSION: UBM provides great diagnostic assistance, superior to anterior segment OCT in the diagnosis of plateau iris syndrome, particularly in imaging the ciliary body. CONCLUSION: The numerous iridociliary cysts can imitate iris plateau syndrome, which explains aggravation over time, depending on their formation. UBM is a highly valuable tool for the diagnosis and the follow-up of this pathology.

[B-scan ultrasonography and optical coherence tomography (O.C.T.) in epiretinal macular membranes: pre- and post-operative evaluation]. / Echographie en mode B et tomographie en cohérence optique des membranes épirétiniennes maculaires en pré et postopératoire.

PURPOSE: This study was designed to evaluate B-scan ultrasonography and optical coherence tomography in the pre- and post-operative morphologic evaluation of idiopathic epiretinal macular membranes. METHODS: Fifteen eyes were examined using B-scan ultrasonography and optical coherence tomography before and after surgical excision of the epiretinal macular membranes. RESULTS: Ultrasonography prior to surgery allowed an excellent evaluation of both the peripheral and the posterior vitreous and showed the membrane. The thickening of the retina and the retinal folds were equally visualised by either method. An improved observation of the macular oedema was obtained by the optical coherence tomography as well as the type of membrane adhesion. After surgery, both methods were able to detect membrane remnants. A better visualisation of retinal thickness and cystoid macular oedema was obtained by optical coherence tomography rather than ultrasonography. Serous sub-foveal retinal detachment was only revealed by optical coherence tomography. DISCUSSION: Ultrasonography is indispensable in case of media opacity or of optical inaccessibility of the posterior pole. Moreover, it allows an excellent global analysis of the anterior and posterior vitreous, which is very useful for the surgeon. The membrane is always showed by ultrasonography, but not always by optical coherence tomography in case of diffuse adherence. Both methods can detect the membrane and a cystoid macular edema. However, retinal analysis with the optical coherence tomography is more precise. It can even detect cysts of the macular oedema or serous sub-foveal retinal detachment. CONCLUSION: B-scan ultrasonography and optical coherence tomography give complementary information in pre- and post-operative examination of epiretinal macular membranes.

[Retinal detachment following YAG laser section of vitreous strands. Apropos of 3 cases]. / Décollement de rétine après tentative de section de brides vitréennes au laser YAG. A propos de 3 cas.

PURPOSE: Retinal detachment after Nd: YAG laser vitreolysis is rarely reported. The pathogenic role of Nd: YAG laser is analyzed from 3 cases of severe retinal detachment. METHODS: Three men aged (40 to 59 years old) had one or more risk factors for retinal detachment: myopia, complicated cataract surgery, personal or family history of retinal detachment. Nd: YAG laser treatment onto vitreous strand was performed because of: retinal traction, repeated vitreous hemorrhage, anterior vitreous strand in a aphakic patient with cystoid macular edema. Within six weeks following Nd: YAG laser vitreolysis, severe retinal detachment with several tears occurred, complicated with proliferative vitreoretinopathy in two patients, and with choroidal hemorrhage in one. In two cases, several surgical procedures with silicon oil were required and visual acuity remained under 20/1000. In the last case retinal reattachment was obtained with scleral buckling and cryopexy, the patient recovered a visual acuity of 20/100 with a macular pucker. DISCUSSION: Retinal detachment occurred shortly after laser YAG vitreolysis. We assumed Nd: YAG laser was possibly responsible and investigated the possible mechanisms: direct retinal tear, vitreous strand traction, side effect of intraocular shock wave. CONCLUSION: Nd: YAG laser vitreolysis seems to be able to cause retinal detachment. Its use is therefore not recommended, particularly in patients at risk, especially since the efficacy of this treatment has not been proved.

[Posterior scleral reinforcement surgery]. / Chirurgie du renforcement scléral postérieur.

UNLABELLED: Scleral reinforcement is proposed to stabilize the visual acuity in patients with macular myopic staphyloma. Although many patients have been treated, this procedure is still debated. PURPOSE: Evaluation of the feasibility of scleral reinforcement and the operative risk of this procedure. PATIENTS AND METHODS: Patients were eligible for this prospective study patients with a clinical history of visual loss, staphyloma concerning the macular area associated with atrophic lesion and or lacquer cracks. Sixteen eyes in 13 successive patients have been operated on with a single band of PTFE. RESULTS: At the last examination, visual acuity was unchanged for 14 cases. In one case, an improvement of the vision was related to the disappearing of a macular detachment by shortening of the axial length. In one case, vision decline was associated with inadequate band position. Diplopia occurred in 2 cases. A choroidal detachment, and a vitreous haemorrhage disappeared without sequelae. CONCLUSION: An accurate technique is necessary to avoid operative risk. Further long term studies are needed to assess the benefit of scleral reinforcement.

[Myositis, polysynovitis and pulmonary fibrosis: anti-Jo-1 syndrome]. / Myosite, polysynovite et fibrose pulmonaire: le syndrome anti-Jo-1.

Polymyositis/dermatomyositis are rare autoimmune diseases. Classification is usually performed according to the criteria of Bohan and Peter. The occurrence of myositis-specific autoantibodies has recently been described in inflammatory myopathies. Approximately half of the patients can now be classified by these specific autoantibodies. Several of these autoantibodies (anti-aminoacyl-tRNA synthetases, anti-SRP, anti-Mi2) are strongly associated with the clinical presentation. We may expect that in the future different subsets of these diseases will be increasingly identified by serum antibodies. We report on a patient with myopathy, pulmonary fibrosis and polysynovitis, a typical clinical presentation of the anti-Jo1 syndrome (anti-synthetase syndrome).

[Idiopathic and secondary chorioretinal folds]. / Plis chorio-rétiniens idiopathiques et secondaires.

Chorioretinal folds may be observed in many choroidal or retinal diseases. In age-related macular degeneration, they are usually associated with retraction of a neovascular membrane and a typically radial pattern of the folds can be seen. In this disease, pigment epithelium folds were recently described. Their clinical and angiographical characteristics are different from chorioretinal folds and the two diseases should not be confused. A 74-old patient presented, in the left eye, with sub foveal new vessels situated at the center of a pigment epithelial detachment (PED). Radial chorioretinal folds surrounded the PED, as frequently observed during follow-up in subretinal neovascular membranes. Nevertheless, right eye fundus examination revealed roughly horizontal, regular and parallel chorioretinal folds. Ultrasonography demonstrated characteristics of idiopathic chorioretinal folds: flattening and thickening of the posterior sclera and choroid. No sign of posterior scleritis was found. These ultrasonographic elements were observed in the left eye away from the central neovascular membrane. The chorioretinal folds therefore seemed to be idiopathic, in a hyperopic patient. The shape of the folds was modified in one eye by a subfoveal neovascular membrane. Chorioretinal folds may occur in different retinal diseases. The associations with many different aetiologies with modification of the shape of the folds, as described in this clinical case, should be emphasized.

[Hypereosinophilic syndrome with ocular involvement]. / Syndrome hyperéosinophilique avec atteinte oculaire.

The authors report a case of idiopathic hypereosinophilia with Löffler endocarditis in a 19 year old male. Retinal arteriolar occlusions were observed in the pre-equatorial region and documented by angiography. Histologic examination of the globes showed obliteration of the arterioles by a fibrinous coagulum without signs of vasculitis. Clinical data appears to suggest an embolic origin of the occlusions rather than thrombosis in situ.