Initial color Doppler findings in retinal vein occlusion.

PURPOSE: We assessed early hemodynamic characteristics of various types of retinal vein occlusion using color Doppler imaging and spectral analysis. METHODS: We measured the maximum systolic and diastolic blood flow velocities and the resistance index (RI) in the central retinal artery and the maximum and minimum blood flow velocities in the central retinal vein of affected eyes and contralateral unaffected eyes in 102 adults (63 men and 39 women; mean age, 61 +/- 14.6 years) who presented with retinal vein occlusion. Sixty-three control subjects (27 men and 36 women; mean age, 50 +/- 22.1 years) were also investigated. RESULTS: No significant differences in hemodynamic characteristics were found between the control subjects' eyes and the patients' unaffected eyes. In the 18 cases of ischemic central retinal vein occlusion, the mean diastolic arterial flow velocity (p = 0.005) and venous flow velocity (p < 0.04) were lower and the mean RI was higher (p = 0. 0002) in the affected eyes than in the unaffected contralateral eyes. In the 51 cases of nonischemic central retinal vein occlusion, the mean diastolic arterial flow velocity (p < 0.0001) and venous flow velocity (p < 0.0001) also were lower and the mean RI (p < 0.0001) was higher in the affected eyes than in the unaffected contralateral eyes. These variables were different in the ischemic versus nonischemic types of central retinal vein occlusion. In the 33 cases of branch retinal vein occlusion, no significant differences were observed in arterial or venous blood flow velocities in the affected versus unaffected eyes. The mean RI in the affected eyes was significantly higher (p = 0.009) in patients with central versus branch retinal vein occlusion. CONCLUSIONS: These results suggest that previous arterial disorders were not involved in the pathogenesis of central retinal vein occlusion in these patients. The findings also support the value of Doppler imaging and spectral analysis in the diagnosis and evaluation of retinal vein occlusion and confirm the involvement of arterial flow in venous occlusion.

Hemianopsia related to dissection of the internal carotid artery.

Spontaneous dissection of the internal carotid artery is typically associated with cerebral vascular infarction along the anterior and middle cerebral distribution, whereas occipital infarction is usually related to posterior circulation abnormalities. Hemianopsia with occipital infarction related to carotid artery dissection has therefore rarely been reported. A 40-year-old woman in whom acute-onset hemianopsia developed, related to occipital infarction secondary to internal artery dissection, is described. This atypical association is explained by anatomic variations of the posterior part of the circle of Willis. Neuroimages showed occipital infarction related to internal carotid artery dissection associated with hypoplasia of the proximal portion of the cerebral posterior artery (P1). The anatomic correlation of this atypical association and a review of the literature are presented.

[Localization by immunogold of collagen VI, laminin and fibrillin in the trabecular meshwork of patients with glaucoma]. / Localisation par immunogold du collagène VI, de la laminine et de la fibrilline dans les trabéculums de patients glaucomateux.

PURPOSE: To localize the collagen type VI, laminin et fibrillin in glaucomatous and non-glaucomatous trabecular meshworks. MATERIAL: Twenty-four trabeculectomy specimens from patients suffering of primary open angle glaucoma (POAG, 15 cases), pigmentary glaucoma (PG, 2 cases), pseudo-exfoliative glaucoma (PEG, 7 cases) and 2 non glaucomatous aged trabeculums of enucleated eyes. METHODS: Post-embedding immunogold indirect labelings on 4% paraformaldehyde-0.1% glutaraldehyde fixed and LRWhite embedded samples. RESULTS: Labeling of type VI collagen was observed on the 64 nm collagen fibers in all samples, less intensively on POAG or PG disorganised microfibril areas, and especially on PEG pseudo-exfoliative material deposits. Laminin labeling was strongly positive on healthy basal membranes and less intense on POAG and PG abnormal basal membranes. Fibrillin labeling was found on POAG or PG disorganized microfibril areas, especially around pigment granules, around 64 nm striated collagen fibers and with a mild intensity on POAG and PG juxtacanalicular microgranular substance areas. No labeling was found on pseudo-exfoliative substance deposits. CONCLUSION: Collagen type VI abundance in pseudo-exfoliative substance deposits could result from a fibrillogenesis abnormality. POAG and PG basal membrane ultrastructural abnormalities and weak laminin content could share the origin. The abundance of fibrillin in disorganized microfibrils could result from the chronic elevated tensile strength due to ocular hypertony.

Doppler assessment of hemodynamic changes after hemodilution in retinal vein occlusion.

PURPOSE: We assessed the usefulness of color Doppler imaging and spectral analysis in monitoring the effect of isovolemic hemodilution on retinal vein occlusion. METHODS: Color Doppler imaging was used to measure the systolic and diastolic blood flow velocities and the resistance index (RI) in the central retinal artery and the maximum and minimum blood flow velocities in the central retinal vein of affected eyes and contralateral unaffected eyes before and 1 day after isovolemic hemodilution in 70 adults (40 men and 30 women; mean age, 62.4 +/- 13.7 years) who presented with retinal vein occlusion. RESULTS: With hemodilution, the hematocrit value was decreased from 41.8 +/- 3.0 to 33.0 +/- 3.0. In central retinal vein occlusion, the pretreatment arterial and venous flow velocities of affected eyes were significantly lower than those of unaffected eyes. After hemodilution in eyes affected by ischemic occlusion, a significant improvement in the RI in the central retinal artery was observed without changes in venous flow velocity. After hemodilution in eyes affected by non-ischemic occlusion, a significant increase in maximal venous flow velocity only was noted. In branch retinal vein occlusion, no significant difference was observed in the RI between affected and unaffected eyes. After hemodilution, an improvement in RI was noted only for affected eyes. CONCLUSIONS: The present results confirm the potential value of Doppler analysis in monitoring the impact of hemodilution on arterial and venous velocity in patients with central retinal vein occlusion.

Quantitative analysis of immunogold labellings of collagen types I, III, IV and VI in healthy and pathological human corneas.

BACKGROUND: We studied the distribution of collagen types I, III, IV and VI in one healthy human cornea and in seven pathological human corneas, in which the disorders were three cases of pseudophakic bullous keratopathy (two severe, one moderate) and one case each of stage IV keratoconus, chronic ulcer, vascularized cornea and disciform keratitis. METHODS: Transmission electron microscopy examinations were performed on post-embedding immunogold-labelled sections. The staining was evaluated by gold particle count in the different tissues. The presence or absence of a given antigen was determined by statistical analysis, using a d-value test. RESULTS: Our results on healthy corneal tissues corroborate the data available from previous studies, except for collagen type VI, which we found to be absent in Bowman's layer. In pathological corneas with a collagenous layer posterior to Descemet's membrane, collagen types I, III and especially IV were detected in this collagenous layer. Collagen types I, III and VI were detected in the anterior healed stroma of other pathological corneas, except for the keratoconus cornea, in which intense collagen III staining was observed. CONCLUSION: The presence of collagen types I and III in the posterior collagenous layer of our pseudophakic bullous keratopathy corneas suggests that this layer corresponds to scar tissue secreted by stimulated endothelial cells.

[Basedow's neuropathy]. / Neuropathie basedowienne.

A case report of grave's neuropathy. The symptoms appeared in a treated patient when there was a biologic hypothyroidy. A total remission was observed after corticotherapy. Nevertheless, a recurrence of disease happened for reduced doses, so an orbital radiotherapy was requisited. Student of differents treatments for dysthyroid neuropathy.

[Optic disk drusen and intracranial tumor]. / Druses papillaires et tumeur intra-cranienne.

A fifty-one year old woman with a Lindau sickness presented bilateral optic disc swelling and peripapillary haemorrhage. Intracranial hypertension was suspected. Perimetry, echography and fluorescein fundus angiography revealed optic disc drusen.

[The association of primary acquired conjunctival melanosis, malignant melanoma and Parinaud's dermoepithelioma]. / Association d'une mélanose conjonctivale primitive acquise, d'un mélanome malin et d'un dermo-épithéliome de Parinaud.

The association of a primary acquired conjunctival melanosis, a malignant conjunctival melanosis, and a nevus cysticus, has never been reported in the literature, as far as we know. If the coexistence of a malignant melanosis and a primary acquired melanosis may be explained easily, it is still difficult to construe the presence of a nevus cysticus, since it is usually a mild tumor, that does not degenerate.

[Acquired toxoplasmic chorioretinitis]. / Chorio-rétinite toxoplasmique acquise.

An acquired toxoplasmic retinochoroiditis is really unusual. The examination reveals an oedematous and hemorrhagic central retinochoroiditis. Immuno deficiency must be thoroughly investigated. The management is the same than the congenital ocular retino choroiditis.

[Prolonged mydriasis caused by Lamaline]. / Mydriase prolongée à la Lamaline.

Atropine derivatives. The presence of atropine derivatives in numerous combined medicines is often ignored or reflected. A case report of prolonged bilateral non reactive mydriasis with "cycloplegia", linked with the utilisation of a therapeutic dose of Lameline suppositories raises the question of individual susceptibility, with particular ocular sensitivity. This urge one not to ignore the presence of these products and to respect the contraindications, even with minute doses.

[A familial case of Recklinghausen's disease]. / A propos d'un cas familial de maladie de Recklinghausen.

The case report of familial Von Recklinghausen disease, allows to remind the frequency, and the polymorphism of this affection, which is provoked by the neuro-ectodermal layer dysplasia. This case, moreover, poses a difficult problem, about the appearance of asymptomatic large optic nerves in two patients.

[Epidermoid cyst of the iris]. / Kyste épidermoïde de l'iris.

Epidermoid cyst of the iris is a primary cysts of the iris, and more precisely a congenital cyst of the iris stroma. The embryological origin of these tumours is controversial owing to the clinical and histological aspects. Because the possibility of complications, excision is often necessary and permits accurate histologic diagnosis.