[Long term postural myopic shift assessment after posterior iris-claw aphakic intraocular lens implantation]. / Résultats à long terme de la bascule posturale myopique après implantation d'un implant clippé postérieurement à l'iris.

PURPOSE: Posterior chamber iris-claw intraocular lens (IOL) is often used in aphakic eyes with inadequate capsular support. Postoperatively, patients may describe better capabilities for near reading in a face-down position. The goal was to evaluate the indications, visual outcomes and complications of this IOL and to compare postoperative spherical equivalent between the prone and the face-down position. MATERIALS AND METHODS: Retrospective single-center case series of 31 eyes of 28 patients who underwent surgery between 2007 and 2016. Visual outcomes, early and late complications were analyzed. The refractive measurements were also assessed using a portable refractometer in prone and face-down position for each patient. The spherical equivalents were then compared. RESULTS: The mean follow up was 29 months (3-73). The final mean corrected visual acuity (0.17±0.5 SD LogMar) was significantly better than preoperatively (0.5±0.50 SD LogMar) (P<0.05). Postoperative refractive error was within±2 diopters of emmetropia in 95 % of patients. The mean spherical equivalents in prone and face down position were different (P<0.05),-0.44 diopters (-4;+2.75) and-1.38 diopters (-5.25; 1) respectively. A mean myopic shift of-0.95 diopters (-5.25; 1.00) was observed in face down position. Cystoïd macular edema (6 %) and IOL disenclavation (9.6 %) were the main complications. DISCUSSION: A posterior iris-claw intraocular lens appears to be an effective and relatively safe IOL to treat aphakia with poor capsular support. When the patient's head is bent forward, a mean myopic shift of 1 diopter is observed. This may support the idea that this IOL could be considered as an accommodative implant. Anterior movement of the iris-IOL complex due to gravity may be responsible for this myopic shift.

[A new classification for meibomian gland diseases with in vivo confocal microscopy]. / Une nouvelle classification des dysfonctionnements meibomiens en microscopie confocale in vivo.

INTRODUCTION: Meibomian gland dysfunction (MGD) is a frequent disorder often associated with dry eye disease. Slit-lamp examination with digital expression of the tarsal Meibomian glands allows examination of the contents of the distal Meibomian gland and the meatus. However, the Meibomian epithelium, interglandular space and proximal secretions cannot be clinically assessed. In vivo confocal microscopy (IVCM) is a rapid and non-invasive imaging technique that provides high-resolution images of the ocular surface and eyelids. The primary objective of the present study was to establish a classification of MGD with IVCM. Secondary objectives were to evaluate this scoring system by analyzing the correlation with OSDI, infrared (IR) meibography and Demodex infestation. MATERIAL AND METHODS: Forty-six dry eye patients (Ocular Surface Disease Index [OSDI] >13) associated with MGD were enrolled. Ten healthy subjects without dry eye disease or blepharitis were also included as controls. An OSDI questionnaire, clinical examination, IVCM and infrared meibography of the lower lid were performed in all subjects by the same examiner. RESULTS: A new MGD score was established based on IVCM findings: the first stage was Meibomian obstruction with a clear epithelium, the second stage was an inflammatory state with Meibomian gland obstruction, epithelial and interglandular inflammation, and the last stage was glandular fibrosis. This score was significantly correlated with the meiboscore obtained with infrared meibography (correlation coefficient 0.47, CI95% [0.22-0.66]). CONCLUSION: IVCM of the Meibomian gland complex complements the clinical examination by determining the stage of dysfunction and may help clinicians evaluate and treat MGD.

Mucosa-associated lymphoid tissue lymphoma of the salivary glands occurring in patients affected by Sjögren's syndrome: report of 6 cases.

OBJECTIVE: Mucosa-associated lymphoid tissue (MALT) lymphoma of the salivary glands occurring in 6 patients affected by primary Sjögren's syndrome is reported. METHODS: Clinical findings, histologic type, stage, treatment and outcome of the 6 patients have been revised. RESULTS: In all 6 cases the lymphoma was of the MALT type. Four patients had stage IE disease, 1 patient had stage IIE disease and 1 patient had stage IV disease. The patients received different treatments resulting in all cases in prolonged remission. After 7 years of complete remission 1 patient developed a diffuse large B-cell lymphoma. CONCLUSION: MALT lymphoma of the salivary glands is an indolent disease. Though the best therapy of this lymphoproliferative disorder remains to be established, prolonged remission has been obtained in our cases with different therapeutic approaches. We review the literature regarding the relationship between Sjögren's syndrome and MALT lymphomas and study the mechanisms which may be involved in the transformation from a lymphoepithelial lesion into a neoplastic disorder.

[Celiac disease and abortion: focusing on a possible relationship]. / Celiachia e abortività: messa a fuoco di un possibile rapporto.

Celiac disease represents one of the most frequent chronic inflammatory diseases. In Italy the prevalence among school-age population has been calculated in 1:180 subjects. Along with typical forms of the disease characterized by overt symptoms and signs of malabsorption, many cases are undiagnosed because they are subclinical, atypical or even symptomless. In adults, the disease may present with infertility; in particular celiac disease may be responsible of multiple abortions. These manifestations, whose pathogenesis is unknown, are not related to the severity of the disease; the gluten-free diet strongly ameliorates the fertility. In this paper we have focused the connection between abortion and celiac disease. A better knowledge of this relationship may lead to correctly diagnose and consequently to treat the cause of some cases of abortion, previously labelled as cases of unidentified origin.

[MALT lymphomas of the salivary glands. Review of the literature apropos of a case in a patient with hepatitis C virus infection]. / Linfomi MALT delle ghiandole salivari. Revisione della letteratura a proposito di un caso insorto in paziente con infezione da HCV.

We describe a 68-year old woman affected by chronic hepatitis C virus infection; hypertransaminasemia was first observed at the age of 46 years, when the patient was diagnosed uterus carcinoma. Since 1994 she had complained of xerostomia, xerophtalmia, pain at the left parotid and laterocervical adenomegaly. Neck ultrasound examination revealed enlarged intraglandular, submandibular and laterocervical lymph nodes. Fine-needle aspiration of both left parotid and laterocervical lymph nodes was not diagnostic. The histologic examination of the surgical biopsy of the left parotid and the right submandibular salivary gland allowed to diagnose mucosa-associated lymphoid tissue lymphoma (MALT lymphoma). The patient was given alpha-interferon obtaining a clinical remission of the lymphoma and transitory normalization of transaminase level. The authors review the literature about some aspects of MALT lymphomas: a) the etiopathogenesis of MALT lymphomas and the mechanisms suspected to be involved in the evolution from a "benign" lymphoepithelial infiltrate to a neoplastic disorder; b) the relationship between chronic inflammatory diseases as Sjögren's syndrome and chronic C virus infection and MALT lymphomas, particularly MALT lymphomas of the salivary glands; c) the significance of the evidence of a B-cell clonality in the context of a lymphoepithelial lesion; d) diagnostic and therapeutic aspects of MALT lymphomas of the salivary glands.

Sjögren's syndrome with anticentromere antibodies.

Clinical and laboratory findings in 10 women with Sjogren's syndrome and positive anticentromere antibodies were compared to those in 50 patients with Sjögren's syndrome and typical serologic features. The anticentromere antibody-positive patients were more likely to have Raynaud's phenomenon and less likely to have leukopenia polyclonal hypergammaglobulinemia, rheumatoid factor, and anti-SSA/Ro antibody. Four anticentromere antibody-positive patients developed limited cutaneous scleroderma during follow-up, but none had lymphoma; some of the other patients in this group exhibited stable symptoms typical for Sjögren's syndrome. Among our overall population of Sjogren's syndrome patients who met diagnostic criteria for primary Sjogren's syndrome at the first evaluation, 16.6% tested positive for anticentromere antibodies.

Finger skin temperature in patients affected by Raynaud's phenomenon with or without anticentromere antibody positivity.

We evaluated finger skin temperature in 36 patients affected by Raynaud's phenomenon with or without anticentromere antibody positivity. The temperature measured under basal conditions and after dipping the finger in water at 10 degrees C for 5 min was similar in both groups; the temperature at the end of an 18-min recovery period was significantly lower in anticentromere antibody positive patients. This observation suggests a persistent digital vasospasm after the cold test in patients suffering from Raynaud's phenomenon with anticentromere antibody positivity. This autoantibody seems to identify a subgroup of patients affected by Raynaud's phenomenon with a severe involvement of the microcirculation.

Three clinical reports of Kikuchi's lymphadenitis combined with systemic lupus erythematosus.

The authors describe three cases of systemic lupus erythematosus (SLE) associated with Kikuchi's histiocitic necrotizing lymphadenitis (HNL). Two patients presented a cytomegalovirus infection concomitantly with Kikuchi's lymphadenitis; in one of them the onsets of SLE and HNL were simultaneous. In the third case an inguinal HNL was concomitant with vaginitis of unknown aetiology.

Histoplasmose disseminada associada a tuberculose em pacientes imunodeprimidos. / Disseminated histoplasmosis associated with tuberculosis in immunosuppressed patients

Relata-se o caso de um paciente com mieloma multiplo que desenvolveou tuberculose pulmonar e histoplasmose disseminada. O Histoplasma capsulatum foi cultivado do material obtido por aspiracao transcutanea pulmonar. No estudo pos-mortem, confirmou-se a presenca do fungo em ambos os pulmoes, nos linfonodos mediastinais e, em maior numero, na supra-renal direita