Visual outcome and prognostic factors after magnetic extraction of posterior segment foreign bodies in 40 cases.

AIMS: To evaluate the clinical features as well as the visual and anatomical outcome in eyes with magnetic posterior segment foreign bodies, to identify prognostic factors after removal using an electromagnet. METHODS: The records of 40 patients with posterior segment foreign bodies were retrospectively reviewed for 6 years (1989-94). Post-traumatic cataracts and secondary retinal detachments were treated using conventional surgical techniques. Pars plana vitrectomy was used only for late complications. The mean follow up was 30 months (6-71). Clinical factors were studied using univariate analysis. RESULTS: The most common findings before treatment of these 40 eyes were lens wound, hyphaema, vitreous haemorrhage, and retinal impairment. The foreign body was in the vitreous (85%) or minimally embedded in the retina (15%). Initial visual acuity was worse or equal to 20/40 in 70% of the cases. Subsequent to surgical treatment, a cataract was reported in 60% of the patients. Postoperative complications included retinal detachment (15%) and phthysis (5%). The prognosis was worse in cases with intraocular foreign body of largest diameter > or = 3 mm, an initial visual acuity less than 20/200, or the presence of post-traumatic retinal detachment. Presence of initial intravitreous haemorrhage, hyphaema, or intraocular tissue prolapse did not appear to affect the prognosis. CONCLUSION: The long term visual acuity results indicated that wound repair associated with conventional magnet extraction in an emergency is a viable treatment for posterior segment magnetic foreign bodies in this selected group. At the time of diagnosis, size of foreign body (< 3 mm) and initial visual acuity > or = 20/200 were predictors of good visual outcome after primary magnetic extraction.

Posterior chamber intraocular lens dislocation with the bag.

We report a rare case of a 46-year-old man presenting with a luxation of a posterior chamber intraocular lens (IOL) with the capsular bag after ocular contusion. Preoperative axial length was 36.58 mm. After trauma, pars plana extraction of the dislocated IOL inside the capsular bag was performed using a forceps. Capsular fibrosis had probably weakened the zonules, which were ruptured by the trauma. This observation confirms the necessity of a large continuous curvilinear capsulotomy and meticulous cleaning of the anterior and posterior capsules to minimize postsurgical fibrosis and capsule contraction.

[Intraocular cysticercosis: a difficult diagnosis]. / Cysticercose intraoculaire: un diagnostic difficile.

The authors describe a case of intraocular cysticercosis discovered in the ophthalmology department ef Edouard Herriot Hospital. With no biological signs, the diagnosis was made after vitrectomy because the visit was late in the course of the disorder, the patient lived in the mountains, and he had failed to mention a trip to the West Indies 3 months before. The symptomatology began with uveitis worsened in 10 days by greater inflammation in spite of successive corticosteroids, antibiotic, and antiviral therapy. Repeated examination and serological and radiological investigations did not help establish the etiology. Only vitrectomy provided the diagnosis, the vitreous containing cysticercus. This discover was all the more surprising that the patient lived in the French Alps and a trip 3 months before had been forgotten. A review ol the literature allowed us to rapidly start a postoperative parasite examination to check for cerebral, muscular, cardiac, and subcutaneous localizations and to start treatment with praziquantel (50 mg/kg per day) with corticotherapy (1 mg/kg per day). The eye evolved toward a very inflammatory phthisis, which led to evisceration.

[The correction of supra-tarsal depression after enucleation]. / La correction du creux supra tarsal après énucléation.

Supra-tarsal depression after enucleation is a frequent occurrence, and many surgical methods have been applied to correct this anomaly, which results from the relative smallness of the implant, and its downward migration. As subperiosteal orbital floor implants provided unsatisfactory results a mould of the supra- tarsal depression was taken to attempt direct correction of the anomaly, by means of a silicone-gel custom-made prothesis. The prothesis is implanted behind the septum orbitale, above the levator muscle and in front of the recessed orbital fat. Good results have been obtained in the 6 cases treated in this manner, and no complications have been reported.

[Vitrectomy and proliferative diabetic retinopathy. Apropos of 66 eyes]. / Vitrectomie et rétinopathie diabétique proliférante. A propos de 66 yeux.

PURPOSE: We report a retrospective study about vitrectomy in diabetic patients and the analysis of anatomical and functional results after surgery. METHODS: We studied 66 eyes of 52 diabetic patients who underwent pars plana vitrectomy. Vitrectomy was performed for nonclearing intravitreous hemorrhage in 75% of eyes and for tractional macular retinal detachment in 14% of eyes. RESULTS: After vitrectomy for intravitreous hemorrhage, visual acuity increased in 84% of eyes with more than 5/10 in half the cases. After vitrectomy for tractional retinal detachment, visual acuity increased or became stable in only 55% of eyes. The major complication of surgery was recurrence of intravitreous hemorrhage. A new surgery was not necessary in most cases. Neovascular glaucoma, phtysis, retinal detachment and cataract were the other complications of surgery. CONCLUSION: Visual prognosis after vitrectomy performed in complicated diabetic retinopathy depends on the final macular function. Surgery for intravitreous hemorrhage without macular detachment produced in most of cases a good visual acuity. On the other hand, vitrectomy for tractional macular retinal detachment was followed by poor visual prognosis. After recurrent intravitreous hemorrhage, a new surgical procedure is possible with good visual results in most cases, even if several procedures are necessary.

[Capsular bag distension syndrome after capsulorhexis]. / Syndrome de distension du sac capsulaire après capsulorhexis.

We present one case of capsular bag distension associated with lens phacoemulsification, capsulorhexis and posterior chamber intraocular lens (IOL) insertion. Capsular bag distension is a rare postoperative complication of continuous tear anterior capsulotomy and presents the following characteristics: (1) postoperative myopic over-refraction; (2) shallowing of the anterior chamber associated with anterior shift of the IOL and the iris diaphragm; (3) important posterior distension of the posterior capsule and (4) sealing of the capsule to the anterior surface of the IOL. In our case, recovery of vision was incomplete after cataract surgery although the procedure was uneventful and no other ocular pathology was found. A neodymium: YAG laser anterior capsulotomy peripheral to the edge of the IOL remedied the situation allowing the capsular fluid to regress into the anterior chamber and the IOL to return in a normal posterior position.

[Helicobacter pylori in central serous chorioretinopathy and diffuse retinal epitheliopathy. Results of the first prospective pilot study]. / Rôle de l'Helicobacter pylori dans la choriorétinopathie séreuse centrale et l'épithéliopathie rétinienne diffuse. Résultats de la première étude prospective pilote.

PURPOSE: Helicobacter pylori has been implicated in focal occlusive arterial diseases in young people. Central serous chorioretinopathy (CSC) and diffuse retinal epitheliopathy (DRE) being suspected vascular occlusive diseases of choriocapillaris, the purpose of this study was to determine the prevalence of H. pylori infection in patients with long-lasting (>6 months) CSC and/or DRE. METHODS: Sixteen consecutive patients living in southeastern France were included in this prospective pilot study. H. pylori infection was assessed by the (13)C-urea breath test, serology, as well as histology of gastric biopsy specimens in some cases. RESULTS: Evidence for H. pylori infection was detected in nine out of the 16 patients with active long-lasting CSC/DRE (56.3%). H. pylori-infected patients more frequently presented gastric pain (four of nine H. pylori-positive patients: 44%) than H. pylori-negative patients (one out of seven: 14%). Men were more frequently H. pylori-positive (seven men out of ten: 70%) than women (two women out of a total of six: 33%). DISCUSSION: When the prevalence of H. pylori infection (56.3%) was compared to the prevalence in a historical control population from southeastern France (27.5%), it was found to be significantly higher (P<0.05). CONCLUSION: These results may indicate a possible association between H. pylori infection and CSC/DRE manifestations. This new etiopathogenic hypothesis deserves to be confirmed in a national or international multicenter study because it could lead to a new therapeutic approach in CSC/DRE, i.e., Helicobacter pylori eradication.

[Neovascular glaucoma diagnosed following carotid endarterectomy]. / Glaucome néovasculaire diagnostiqué après endartériectomie carotidienne.

We report a case of bilateral asymptomatic rebeosis iridis related to a bilateral obstruction of the carotid arteries. The iridocorneal angles were closed by a neovascular membrane and intraocular pressures were normal within both eyes (normotensive neovascular glaucoma). After left carotid endarterectomy, the increased perfusion of the ciliary body and the increased secretion of aqueous humor resulted in a sudden bilateral ocular hypertension. Management of ocular neovascularization related to carotid artery obstruction may involve the destruction of areas of retinal ishchemia (laser panretinal photocoagulation or cryotherapy) before carotid surgery.

[Persistent hyperplastic primary vitreous syndrome in a girl with Aicardi syndrome]. / Syndrome de persistance et d'hyperplasie du vitré primitif chez une fille présentant un syndrome d'Aicardi.

Aicardi syndrome is characterized by infantile spasms, agenesis of the corpus callosum and chorioretinal lacunae. This disorder affects mostly females with early embryonic lethality in males. We present a case of persistent hyperplastic primary vitreous (PHPV) in association with Aicardi syndrome in a 2-year-old girl.

[Nummular keratopathy in Crohn's disease. Apropos of a case]. / Kératopathie nummulaire au cours d'une maladie de Crohn. A propos d'un cas.

We report an unusual case of nummular keratopathy of the left eye in a 58-year-old woman with active Crohn's disease, presenting colo-anal and joint symptoms. Spontaneously decreased bowel activity and local steroid treatment provided symptom relief and incomplete decrease in volume of subepithelial elevations. We discuss the clinical aspects, the epidemiologic factors, the pathogenic mechanisms and the treatment of keratopathy in Crohn's disease.

[Results of a double-blind medium-term study comparing effects of timolol maleate and epinephrine in 120 patients with chronic open-angle glaucoma]. / Résultat d'une étude à moyen terme en double aveugle comparant le maléate de timilol à l'épinéphrine sur 120 patients porteurs d'un glaucome chronique à angle ouvert.

A double-blind medium term study of the activity of timolol in chronic open-angle glaucoma was conducted in four French ophthalmological centers, using the same protocol. A total of 119 patients were treated: --60 with timolol; --59 with épinéphrine, for comparison. Results showed a significantly superior efficacy for timolol over épinéphrine, after in weeks of treatment. Good tonometric control was obtained in 81.6% of the patients treated with timolol, against 52.5% of those receiving épinéphrine. In 68% of the glaucomatons patients treated with timolol, good tonometric control was obtained with the lowest dose preparation containing 0.1%. No side-effects were noted during the study, either locally or generally (particularly blood pressure changes).

Intraocular foreign bodies. Factors influencing final visual outcome.

PURPOSE: To identify the prognostic factors of poor visual outcome (visual acuity < or =6/240) in eyes with intraocular foreign bodies. METHODS: The records of 95 consecutive patients were retrospectively reviewed for 6 years (1990-1995). All eyes underwent a primary surgical repair and foreign-body removal (electromagnet or vitrectomy). The mean follow-up period was 25 months (6-72 months). Single analysis and multiple logistic stepwise regression analysis were performed to determine predictors of poor vision. RESULTS: Thirty patients (31.6%) showed 6/240 or worse vision at the end of their follow-up period. Three significant predictive factors had independent and combined effects on post-operative visual outcome: a corneo-scleral entry wound (odds ratio (OR)=14.5, p=0.001), largest diameter of IOFB (OR=1.21, p=0.01) and the presence of secondary retinal detachment (OR=9.48, p=0.0002). Post-operative complications included traumatic cataracts (51%), retinal detachments (28%) and phthisis bulbi (8%). CONCLUSION: Using multivariate analysis, corneo-scleral entry wound, largest diameter of foreign body and secondary retinal detachment were found to be predictors of poor visual outcome after intraocular foreign body removal. Our results suggest that patients with high-risk intraocular foreign body trauma should be candidates for pars plana vitrectomy rather than electromagnet procedure.

Transient acute myopia induced by antilymphocyte globulins.

Acute onset of transient myopia may be induced by several drugs, different mechanisms having been described. We report the occurrence of such an event after intravenous administration of equine antilymphocyte globulins in a patient treated for aplastic anemia. Clinical ocular examination revealed no other abnormality, and ultrasonography disclosed no swelling of the ciliary body. The drug-induced myopia resolved completely after instillation of topical cyclopentolate, suggesting that its mechanism was the occurrence of a ciliary spasm. Acute myopia is a rare event and, to the authors' knowledge, this represents the first case described as being induced by antilymphocyte globulins.

Wagner vitreoretinal degeneration with genetic linkage refinement on chromosome 5q13-q14.

BACKGROUND: It has been previously described that Wagner disease is linked to chromosome 5q13-q14. This study was carried out to describe the ophthalmological aspects and report the results of genetic linkage analysis in a large pedigree affected by Wagner disease. METHODS: Fourty members of one same family agreed to be examined. RESULTS: Twenty patients presented vitreoretinal degeneration in both eyes without any extra-ocular abnormalities. In young patients, visual acuity was usually normal after correction of frequent mild myopia. Presenile cataracts progressed by the third decade and required removal for visual rehabilitation. The primary disorder involved an abnormal vitreous. A few avascular vitreous bands were usually the only optical feature in the mostly empty vitreous cavity. A circumferential vitreous condensation formed in contact with the retina on many spots. Less common retinal findings included retinal detachment, abnormal retinal pigmentation, progressive atrophy of the RPE simulating choroideremia and lattice degeneration. Genetic analysis revealed a highly significant linkage (lod score >5.0) between the disease and 10 markers of the chromosome 5q13-q14 region. Two recombination events allowed us to refine the linked interval to 20 cM between the D5S650 and D5S618 markers. CONCLUSION: Ophthalmological aspects of Wagner's disease appear to progress with age. Regular ophthalmological examination is important for detecting retinal abnormalities. The gene involved in Wagner's disease lies in a 20 cM interval on chromosome 5q13-q14.