[Bilateral acute depigmentation of the iris syndrome]. / Le syndrome de dépigmentation bilatérale aiguë de l'iris.

Bilateral acute depigmentation of the iris syndrome (BADI syndrome) is a new clinical entity. Young females from 20 to 45 years of age are most commonly affected. It is characterized by bilateral nontransilluminating depigmentation of the iris stroma. During the acute phase, this clinical entity also combines with red painful eye, pigmentation of the trabecular meshwork, anterior chamber flare, circulating pigment, and pigmented deposit on the endothelium cornea. At the acute stage, the symptoms are controlled with topical corticosteroid treatment. The prognosis is good. We report a 41-year-old woman presenting with BADI syndrome.

Results of surgery on macular holes that develop after rhegmatogenous retinal detachment.

AIMS: To evaluate the characterics and surgical prognosis of macular holes that develop after rhegmatogenous retinal detachment repair. DESIGN: Retrospective, interventional, consecutive case series. METHODS: The case records of nine patients who developed a new full-thickness macular hole after prior RD repair were reviewed over 6 years. Optical coherence tomography (OCT) confirmed these holes. They were offered surgical repair with a median follow-up of 13.3 months (1-63 months). Main outcomes included preoperative vitreo-macular status, OCT evaluation and postoperative visual acuity. RESULTS: 1007 eyes underwent surgery for prior retinal detachment between August 1999 and September 2005. Nine eyes developed a full-thickness macular hole (prevalence 0.9%): five developed after scleral buckling surgery, one after pneumatic retinopexy and three after primary vitrectomy. The mean time to macular hole diagnosis after RD was 2.9 months (0.5-18). All patients underwent macular hole surgery by the same surgeon. At 1 month, macular hole repair was noticed in eight eyes. In this group, visual acuity at a median of 11.9 months of follow-up was 20/125 (20/400 - 20/63). Three eyes had an improvement of more than three Snellen lines. CONCLUSIONS: Macular holes developing after RD repair is a rare complication (less than 1%). Its physiopathological mechanisms are not well known. Conventional macular hole surgery including pars plana vitrectomy, inconstant internal limiting membrane delamination and long-acting gas tamponade seems to achieve to macular reattachment (89%). The visual outcome seems conditioned by the macular status noticed during the RD.

[Macular hole evaluation with 10-MHz and 20-MHz ultrasonography and optical coherence tomography]. / Comparaison de l'échographie à 10 MHz, à 20 MHz et de la tomographie en cohérence optique dans l'évaluation des trous maculaires.

PURPOSE: To evaluate and compare the data provided by 10-MHz and 20-MHz ultrasonography and optical coherence tomography (OCT) in macular hole exploration. MATERIAL AND METHODS: Sixty patients with macular hole at different stages were included in the study from January 2002 to April 2003. All patients received three successive examinations: an echographic examination with a 10- and 20-MHz probe (Quantel Medical Cinescan) and an examination with optical coherence tomography (OCT) (Humphrey Zeiss). RESULTS: In stages I and II, the 10-MHz examination was not a useful tool; in certain cases the 20-MHz examination highlighted stage II macular holes. OCT was better than ultrasonography in all these cases: it clearly defined the outline of the hole and perifovea posterior vitreous detachment (PVD). In stage III, the 10-MHz examination only allowed the visualization of the high reflectivity of the prefoveal operculum; the 20-MHz examination could also measure the thickness of the macular neuroepithelium. OCT very precisely visualized the hole as well as the opercula and the detachment of the posterior hyaloid located in the macular area but still attached to the papilla. In stage IV, the 10-MHz examination confirmed total PVD. High-frequency ultrasound examination and OCT provided somewhat similar information. OCT provided the advantage of measuring the hole. DISCUSSION: It is possible now to use probes of frequencies higher than 10 MHz for the study of the posterior pole and the vitreomacular junction at the cost of a more reduced exploration area than that usually obtained with a 10-MHz probe and a lower reflectivity of the interfaces encountered. One is indeed very quickly limited by noise if the gain is increased. Usually, the standard gain with 20 MHz is close to 90 dB and beyond 100 dB, the images are uninterpretable because of noise. CONCLUSION: The 10-MHz ultrasonography is very useful for an overall assessment of the vitreous body, its mobility, and in searching for PVD. The 20-MHz examination gives very valuable information on the analysis of the vitreomacular junction, approaching the precision level provided by OCT. It demands a very rigorous examination protocol. OCT, however, remains better for the fine morphological study of this zone, unless opaque media studies are necessary to determine the maximum frequency usable to increase the space resolution of the lesions of the posterior pole. In this case, the combined ultrasonographic study using 10 and 20 MHz provides a valid diagnosis and a therapeutic approach to the posterior pole.

Spontaneous resolution of vitreomacular traction associated with diabetic macular edema.

PURPOSE: Little information is available about the natural history of vitreomacular traction (VMT) associated with diabetic macular edema. A few cases of spontaneous resolution of VMT associated with diabetic macular edema have been described, but have not been documented by optical coherence tomography (OCT). The authors report the spontaneous resolution of VMT associated with diabetic macular edema 1 month after the end of panretinal photocoagulation therapy (PRP). CASE REPORT: A 66-year-old woman presented with complicated proliferative diabetic retinopathy and diabetic macular edema associated with VMT, documented by OCT, in the right eye. Left eye examination showed complete PRP and ischemic maculopathy. PRP was immediately realized in the right eye in regard to the presence of complicated proliferative diabetic retinopathy. RESULTS: One month after the end of PRP, right eye visual acuity improved. OCT examination showed complete release of foveal posterior hyaloid traction, and significant reduction in foveal thickness. The follow-up was 1 year. At the end of follow-up, visual acuity slightly improved again; only a small residual foveal retinal thickening remained. CONCLUSIONS: The authors report spontaneous resolution of VMT associated with diabetic macular edema, probably facilitated by PRP, with concurrent reduction of macular thickness and visual improvement. As spontaneous resolution may occur in some eyes with diabetic macular edema associated with VMT, a period of observation after the end of the PRP may be considered prior to vitrectomy.

[Anterior segment tumor imaging: advantages of ultrasound (10, 20 and 50 MHz) and optical coherence tomography]. / Imagerie des tumeurs du segment antérieur: avantages respectifs de l'échographie (10, 20 et 50 MHz) et de la tomographie en cohérence optique.

PURPOSE: Detail the role of different imaging techniques for diagnosis of tumors of the iris. MATERIAL AND METHODS: Sixty-one tumors of the iris were explored using ultrasound at 10 and 20MHz (Cinescan, BVI Quantel Medical) and 50MHz (UBM, Paradigm) and optical coherence tomography (OCT) (Humphrey Zeiss). RESULTS: Ultrasound should be used at frequencies of 20MHz or greater to precisely characterize, localize and measure a lesion. Ultrasound biomicroscopy (UBM) is inadequate to measure large tumors (extending toward the back of the ciliary body), because of the transducer and the considerably lower image quality caused by the lesion. Ultrasound alone cannot characterize a solid lesion, and moreover cannot differentiate benign and malignant lesions. Clinical notions are also important in diagnosis and patient management. OCT recognizes whether a lesion is liquid or solid in certain cases. CONCLUSIONS: With a tumor that seems solid, a 50MHz examination must be done rapidly, and if the entire lesion is difficult to see, a 20MHz ultrasound should be used. With a protruding iris, high-frequency ultrasound and OCT differentiate a cystic lesion from a solid mass, but only BMU provides a precise measurement and regular surveillance capabilities.

Bilateral eye hemorrhage after laparoscopic cholecystectomy.

A case of bilateral eye hemorrhage after laparoscopic cholecystectomy, probably caused by an increase in venous blood pressure due to carbon dioxide insufflation, is reported.

[Optic biometry in intraocular lense calculation for cataract surgery. Comparison with usual methods]. / La biométrie optique dans le calcul d'implant de la chirurgie de la cataracte. Comparaison aux méthodes usuelles.

PURPOSE: To compare axial length and intraocular lens power calculated from three biometry methods, then to study refractive postoperative results to assess the predictive value of each method. MATERIAL AND METHODS: This prospective study included 40 eyes planned for cataract surgery. Two skilled operators participated in this study: One for the surgery and the other for the biometry and measurement of intraocular lens power. For intraocular lens power, we used the optic biometer from Zeiss and the echograph B Ultrascan from Alcon. IOL power calculation was performed using the usual mathematical formulas based on 3 biometry methods. 1--keratometry measurement, anterior chamber depth (ACD), and axial length using optical biometry; 2--keratometry measurement using the Javal keratometer and biometry using the B mode ultrasonography; 3--keratometry measurement using the Javal keratometer and biometry using A mode ultrasonography. RESULTS: The average age of our patients was 69.5 years old, ranging from 52 to 81 years old. The average axial length was 23.46 mm with, ranging from 20 to 32.73 mm. The average keratometry with optic biometry was 43.97 diopters +/- 1.44 versus 43.84 diopters +/- 1.45 with the Javal keratometer. 40 eyes were examined and there were 4 failures (10%) for axial length measurement by optic biometry because the cataract was very dense. Biometric preoperative results with the 3 methods show that there was a statistically significant difference between the A mode and the B mode optic biometry (P < 0.006). On the other and, there was no statistical difference between optic biometry and the B mode. CONCLUSION: Optic biometry has a number of advantages. This is new method, is non invasive, easy to use, with no contact, and it is reliable. Results with this method are more precise than with ultrasonic biometry. For high myopia, optic biometry is a very valuable method. Its limits are total cataract and intraocular opacities; in these cases ultrasonic biometry is the best method.

[Phacoemulsification following radial keratotomy. Topographic and refractive analysis concerning an 18-month period (apropos of a case)]. / Phacoémulsification après kératotomie radiaire. Analyse topographique et réfractive sur une période de 18 mois (à propos d'un cas).

We followed a 45-year-old man who underwent clear cornea phacoemulsification cataract extraction 3 years after radial keratotomy during an 18 month period. We report early and late refractive analysis and corneal topography during the followup period. The patient experienced an hyperopic shift which was different from the aim of 5 diopters due to an early corneal flattening of 3 diopters and an underestimation of the IOL power of 2 diopters using SRKII calculation formula. Corneal flattening regressed after 3 weeks. We recommend that these patients should be informed of an eventual early hyperopic shift and late refractive error, that Binkhorst II or Hoffer-Q intraocular lens calculation formulas be used and keratometry measurements be obtained from computerized videokeratography.