[Ophthalmology and urban underprivileged. Experience of 150 patients]. / Ophtalmologie et situation de précarité en milieu urbain. À propos d'une expérience de 150 patients.

INTRODUCTION: An ophthalmology consultation was carried out at the Hôtel-Dieu to facilitate eye care in underprivileged patients referred by the general medicine PASS (socialized health care) of the same hospital. MATERIALS AND METHODS: The files of 150 consecutive patients examined by a single ophthalmologist between January 2012 and June 2013 were reviewed. A standard examination was performed in these patients, sent with a consult sheet, to which a response was sent to PASS. As necessary, prescriptions were also written for the patients. RESULTS: Most patients (89/150) were immigrants from sub-Saharan Africa. Additionally, there were 25 Europeans with only 5 French, and 17 Asians. The mean age was 41 years with 90 men (mean age 43) and 60 women (mean age 36). The most common systemic diseases observed were hypertension, (13), diabetes (6), and hepatitis (6). The mean best-corrected visual acuity (129 patients) was a slightly more than 8/10 (16/20) (measurable in 143 patients). Refractive state (measured in 129 patients) was myopia (46), hyperopia (41), presbyopia (isolated in 12 cases), astigmatism (26), and emmetropia (28). Optical correction was prescribed in 87 patients. The main pathological conditions included pingueculae (19), cataracts (19), trauma (13) of which 4 patients were monocular, and pterygia (9). DISCUSSION AND CONCLUSION: Refractive errors were the main abnormality observed in these underprivileged patients. Apart from cataract as a pathologic condition observed in the general population, more characteristic of this sub-Saharan population were pinguecula, pterygium and trauma. This study highlights the more general question of access to eye care for all underprivileged patients.

[Vascular tumors of the orbit]. / Tumeurs vasculaires de l'orbite.

Vascular tumors of the orbit include capillary hemangioma, cavernous hemangioma, hemolymphangioma, hemangiopericytoma and a few rare tumors. Capillary hemangioma and hemolymphangioma, occurring mainly in children, are covered in the chapter devoted to childhood tumors. In this chapter, cavernous hemangioma and hemangiopericytoma are discussed as well as rare vascular tumors. Although orbital varix is not a tumor, it is also considered because of the diagnostic problems and the close correlation of orbital varix with a true tumor: hemolymphangioma.

[Carcinoma of the lacrimal sac: a clinicopathologic case study]. / Carcinome du sac lacrymal: un cas anatomo-clinique.

A case of undifferentiated carcinoma of the right lacrimal sac is reported in an 85-year-old woman who had already presented three previous carcinomas (uterine cervix, rectum, and breast). After a 1-year history of chronic dacryocystitis, she was admitted in January 2008 because of a painful and inflammatory swelling in the medial right lower eyelid. Imaging techniques showed an infiltrative mass in the lacrimal sac area and surgical biopsy disclosed undifferentiated carcinoma. The patient underwent orbital exenteration and the histopathological study confirmed the diagnosis. During 6 months of follow-up, no local recurrence was detected, but a thoracic CT scan revealed a pulmonary nodule that was probably metastatic. Making an early diagnosis of a lacrimal sac tumor is difficult and it should be considered in the differential diagnosis of chronic dacryocystitis. In these cases, more extensive research with lacrimal sac biopsy should be conducted.

[Macroscopic and histological data in the prognosis of malignant choroidal melanoma]. / Aspects macroscopiques et histopronostiques du mélanome malin choroïdien.

The macroscopic study of choroidal melanoma gives information on tumor extension and tumor size, which help in determining the prognosis and in making the therapeutic choice. Numerous microscopic changes observed in melanomas are also important in the prognosis. However, the number of available histologic specimens has dramatically decreased since the generalized use of conservative radiation treatment. Except in cases of enucleation or choroidectomy, the histologic criteria to establish the prognosis are not available in many cases and cannot be used for wide-range statistical studies.

[Contribution of in vivo confocal microscopy to limbal tumor evaluation]. / Apport de la microscopie confocale in vivo dans l'exploration de tumeurs limbiques.

PURPOSE: To explore tumors of the limbus with a new in vivo confocal microscope and to compare the images to histology results. METHODS: We evaluated three tumors in three patients with the Heidelberg Retina Tomograph II, Rostock Cornea Module. A diagnostic and therapeutic excision with adjunctive cryotherapy was performed for each individual. Confocal microscopy was compared to histopathologic sections. RESULTS: Histology identified two dysplasias and one carcinoma in situ. The main pathological features were visible on our images: cytonuclear atypias, epithelial folds into an inflammatory and vascularized conjunctival stroma, fine vessels perpendicular to the surface, a clear limit with normal epithelium, papillomatous organization, and abnormal keratinization. CONCLUSION: Our preliminary study showed that this type of limbal tumor could be explored using in vivo confocal microscopy. We were not able to determine whether there was a microinvasion. This new method could be a diagnostic aid, especially for atypical lesions and for follow-up because of frequent recurrences. Other studies are necessary to confirm our hypothesis.

[Results of treating uveal melanoma with proton beam radiation: 10-year follow-up]. / Résultats du traitement du mélanome malin de l'uvée par faisceau de protons: 10 ans de recul.

PURPOSE: We analyzed the long-term results of uveal melanoma treatment with proton beam irradiation in a series of patients with a follow-up of at least 10 years. PATIENTS AND METHODS: The patients were treated with proton beam radiation between September 1991 and December 1992. They had an initial examination including visual acuity, funduscopy, A and B scan ultrasonography of the eye, fundus photographs and fluorescein angiography. General examination included chest radiography and B scan ultrasonography of the liver. All tumors received a total dose of 60 cobalt-Gray equivalents (applied in four daily fractions) at the Orsay proton therapy center. RESULTS: A total of 167 patients were treated with a median follow-up of 116 months. Their median age was 59 years. Thirteen tumors were anterior to the equator, 76 overlapped the equator and 78 were posterior to the equator. An initial retinal detachment was present in 41 cases. The optic disk was invaded in 10 cases. The median tumor diameter was 12 mm and the median tumor thickness was 5.8 mm. The mean initial acuity was 20/50. The survival rate was 62.93% at 10 years; 72.9% of deaths resulted from metastasis. Statistically significant risk factors for death identified in the multivariate analysis were tumor diameter greater than 12 mm (p=0.0004) and age over 60 years (p=0.0001). The metastasis rate at 10 years was 31%. The liver was affected in 97.8% of these patients. Risk factors for metastasis were the anterior site of the tumor, its volume greater than 0.4 cc and the presence of retinal detachment at diagnosis. The secondary enucleation rate at 10 years was 13.23%, mainly attributable to secondary neovascular glaucoma. The local recurrence rate was 6%. The visual acuity rate in 42.1% of patients was better than 20/100 at 10 years. Visual loss was mainly due to postradiation maculopathy and neuropathy. CONCLUSION: Our study confirms the long-term results found in the literature on proton beam radiation. This therapy allows good tumor control, an excellent eye retention rate, and good final visual acuity for approximately half of the patients.

[Nodular melanoma on primary acquired conjunctival melanosis]. / Mélanome nodulaire sur mélanose acquise primitive de la conjonctive.

A 74-year-old woman consulted for bloody tears. The etiology was a large conjunctival nodular melanoma hidden in the left superior fornix that had developed quietly on an unknown primary acquired melanosis. In this report the clinical and histological features as well as the treatment are presented. A decisional tree summarizes the treatment for conjunctival melanosis.

Basal cell carcinomas of the eyelids.

Basal cell carcinomas (BCC) are the more frequent malignant tumors seen in France as in other western countries. They represent 20% of eyelid tumors and 90% of eyelid malignancies. Due to their local growth, problems may arise when treating BCC, and curative exeresis must be the preferred choice each time it is possible. BCC of the eyelids have a high risk of recurrence. Recurrences are more aggressive, infiltrative and destructive and have a considerably poorer rate of cure than primary tumors. Eyelid reconstructions can entail use of complex methods which should only be carried out by a trained ophthalmologist who is also able to treat any associated age-related ocular pathologies. BCC is the most common cause leading to eyelid reconstructive surgery; a surgery which has a triple objective: tumor removal, functionality and an esthetic outcome.

[Acanthamoeba stromal keratitis: epidemiology and prognosis factors]. / Kératites stromales amibiennes: épidémiologie et facteurs pronostiques.

PURPOSE: Early treatment of amebic stromal keratitis can change patients' final visual and esthetic prognosis. The aim of this study was to review all proven Acanthamoeba stromal keratitis cases presenting at our ophthalmology emergency department over the past 3 years, in order to delineate the incidence and the factors still leading to this serious complication. PATIENTS: and methods: All cases of Acanthamoeba stromal keratitis confirmed with a parasitology examination and treated between January 2000 and December 2002 were recorded. During this period of time, eight patients were identified with this condition. Their charts, as well as biomicroscopic, therapeutic, and outcome data were analyzed. RESULTS: All patients were referred in a second or third intention. Only one patient did not usually wear contact lenses. Six patients had an associated bacterial abscess. The typical amebic annular infiltrate was only observed in one patient. Three patients received an effective antiamebic treatment in the 15 days following the first symptoms and five patients 1 month or more after. An emergency keratoplasty was carried out in one patient. Finally, visual acuity was lower than 5/10 in all cases. The patients treated in the first 15 days had the best final visual acuity. DISCUSSION: Soft contact lenses are still responsible for the majority of serious amebic corneal complications. Late diagnosis remains the main cause of Acanthamoeba stromal keratitis development, particularly in the absence of contact lens history, because of the delay in treatment. CONCLUSION: The catastrophic consequences of this complication justify a systematic treatment against ameba in each case of suspected diagnosis. An early and effective treatment of the stromal amebic keratitis can increase the final visual prognosis.

[Modified evisceration for biocolonizable orbital implant: the four-square technique]. / Eviscération modifiée pour implant orbitaire biocolonisable: la technique des "quatre carrés".

INTRODUCTION: The introduction of a porous, biocolonizable, orbital implant is difficult after a classic evisceration. We have developed a modification of the method that provides better results. MATERIAL AND METHODS: Four scleral squares pediculized on the right oculomotor muscles were cut. They were sutured two-by-two over the anterior part of the implant. RESULTS: Fifteen patients were operated. There were no complications during a mean follow-up of 12.4 months. DISCUSSION: The soft anterior tissues were protected by the two vascularized scleral layers. The diameter of the implant was 18 mm for three patients, 20 mm for eight patients, and 22 mm for four patients. Operating time was much shorter than with enucleation and covering of the implant with autologous sclera. CONCLUSION: Evisceration with the four-square technique is a safe and quick method, which can be used for most patients, except those with an intraocular neoplasia.

[Molluscum contagiosum of the eyelid]. / Molluscum contagiosum de la paupière inférieure.

A 6-year-old girl had a single molluscum contagiosum of the lower eyelid. Clinically, the tumor had grown slowly since it had been discovered 8 months before the child was seen at our consultation. It appeared as a nodular lesion on the middle part of the eyelid. Its surface was irregular and its color was the same as the epidermis. It was surgically excised, using the shaving biopsy technique. Its histopathological study showed a papillomatous lesion with the typical features of a molluscum contagiosum. The patient was lost to follow-up soon after the surgery.

[Chalazion mimicking an eyelid tumor]. / Forme pseudotumorale d'un chalazion.

A 3-year-old girl had a tumor growing for a month on the superior right eyelid, attached on the free margin of the eyelid and partially necrotic. A surgical excision was performed under general anesthesia. The histopathological study found an inflammatory lesion with epithelioid and giant cells, evidence of a granuloma, suggesting the diagnosis of chalazion. This case shows the various clinical presentations of this common and benign disease of the eyelid.

[Pleomorphic adenoma mimicking dacryoadenitis]. / Adénome pléomorphe simulant une dacryoadénite.

A 56-year-old female patient displayed an increased volume of her left lacrimal gland with pain and inflammation. On CT scan, a hyperdense lacrimal mass was found in the left lacrimal fossa. Observation was the first course, for no steroid therapy could be applied because of evolving digestive ulcers. After 9 months of observation, the gland was surgically removed en bloc through a wide anterolateral approach. Pathological analysis of the gland showed a pleomorphic adenoma. This case illustrates the advantage of a wide surgical approach in treating lacrimal gland tumors, in order to avoid or limit the risk of recurrence.

[Conjunctival pyogenic granuloma in a patient with chalazions]. / Granulome pyogénique de la conjonctive palpébrale chez un patient porteur d'un chalazion. A propos d'une observation anatomo-clinique.

A 28-year-old male patient had a chalazion on his left eyelid. Increased discomfort led to the discovery of a conjunctival mass under the inner part of his upper eyelid. On clinical examination, a small reddish mass on the palpebral conjunctiva of the upper left eyelid was only visible on the underside of the lid; the mass was diffusely reddish. Additionally, a chalazion was present in the middle of the lower left eyelid. As this condition was a source of discomfort to the patient, the mass was surgically resected. The histological study found a typical pyogenic granuloma, a possible complication in the course of a chalazion.

[Corneal edema in pseudophakia. A case report]. / Oedème cornéen du pseudophake. A propos d'une observation anatomo-clinique.

Pseudophakic bullous keratopathy is one of the most common complications of intraocular lenses, which explains the high rate of this condition in series of patients experiencing corneal grafts. It is caused by irreversible damage to the endothelial layer of the implanted eye involving the artificial lens, and occurs either during cataract extraction or after the operation. Intraoperative endothelial protection and the choice of an appropriate lens may contribute to decreasing this secondary disease, which can have severe consequences for many patients whose corneal graft may not restore their visual potential as well as expected. We report a clinicopathological case of a 59-year-old male, previously operated on for cataract in both eyes with an anterior chamber lens. A bilateral corneal edema occurred a few years after the operation, with a bilateral decrease in vision as a consequence. A corneal graft was performed in 2000 on the left eye in order to improve the patient's visual autonomy. The best treatment of this condition remains prevention, avoiding the use of this type of intraocular lens, whose main complication is corneal edema.

[Conjunctival semi-lunar fold nevus of presumed late onset]. / Naevus du repli semi-lunaire de la conjonctive de découverte tardive.

Conjunctival nevi are lesions observed commonly occasionnally and can be found later in a life. Such a lesion was observed on the conjunctival semilunar fold in a 76-year-old female patient. It was oval in shape, pigmented, and was mainly visible when the affected eye was in abduction. As no accurate anterior clinical history was available, surgical resection was performed. Hitopathological study disclosed a subepithelial nevus, which was completely resected. Regular follow-up was recommended, as is usual after surgical resection of a conjunctival pigmented tumor.

[Pseudotumoral eyelid inflammation. Apropos of an anatomo-clinical case]. / Inflammation palpébrale pseudotumorale. A propos d'une observation anatomo-clinique.

A clinicopathological case of a 76-year-old male patient with a chronic inflammatory change of the inferior left eyelid is reported. The inflammation appeared as a reddish area of the inner part of the eyelid, without sharp limits, but with loss of lashes. Numerous local treatments did not to cure this condition. As some true eyelid tumors may mimic an inflammation during growth and, for example, sebaceous carcinoma may clinically present as chronic unilateral blepharitis, a surgical excisional biopsy was performed on this left eyelid. Its histopathological study showed a granulomatous inflammation, which was typical of a simple chalazion. This case clearly illustrates that the chalazion may not always appear as a limited nodular inflammation of the eyelid, but may have a more diffuse clinical presentation.

[A cutaneous horn of the free margin of the eyelid: an anatomical and clinical observation]. / Corne cutanée du bord libre palpébral. A propos d'une observation anatomo-clinique.

A cutaneous horn was observed close to the free margin of the inferior right eyelid in a 26-year-old-male patient. A minimal resection was primarily performed. Histopathologic study disclosed a precancerous keratosis. As the tumor had not been entirely excised, a complementary resection was performed secondarily to obtain the entire resection of the tumor.

[Hypertrophic eyelid conjunctival scar. A tarsal keloid]. / Cicatrice hypertrophique de la conjonctive palpébrale ou chéloïde de la conjonctive tarsale. A propos d'une observation anatomo-clinique.

The clinicopathologic case of a 53-year-old female patient with an abnormal tumor growing on the mucous part of the superior right eyelid is reported. The patient was operated on for ten years ago and a whitish mass slowly developed on the conjunctival face of the eyelid disturbing the use of corneal lenses. It was hard, painless and had the shape of a flat mushroom. The removal was performed under local anesthesia and allowed us to resect a hard and fibrous lesion. Histopathology showed that the lesion was made of a fibrous tissue organized like a hypertrophic scar. Surgical treatment of chalazion is frequent and rarely gives rise to abnormal scarring.

Blue light dose distribution and retinitis pigmentosa visual field defects: an hypothesis.

The hypothesis that retinitis pigmentosa (RP) is worsened by blue light has been raised a century ago. In order to check this hypothesis we calculated the theoretical dose distribution of light on the retinal surface. The relative dose to the different parts of the retina was calculated using a Monte-Carlo method. The changes in the peripheral isopters were calculated both degrading at a constant rate and degrading proportionally to light exposure. There is a considerably greater exposure to the superior compared to the inferior visual field. The maximum dose of UV and blue light is located on the superior field about 4mm above the macula. The dose received by the peripheral retina is markedly lower than the dose received by the central retina. The visual field defects most commonly described in RP are concentric, centered by the macula. These defects cannot, therefore, be explained by the impact of light on the retina. But some regional form of RP with a superior field defect can result from an abnormal genetically encoded sensitivity to ultraviolet and blue light.