H. Offret

Efficacy of Proton Therapy in Circumscribed Choroidal Hemangiomas Associated with Serous Retinal Detachment

OBJECTIVE The purpose of the study is to evaluate the efficacy and safety of proton therapy in complicated circumscribed choroidal hemangiomas. DESIGN The study design was a retrospective review. PARTICIPANTS Studied were 13 patients (13 eyes) who had circumscribed choroidal hemangioma associated with serous retinal detachment. Of these, four eyes previously underwent laser unsuccessfully. INTERVENTION Proton therapy including a total dose of 30 Cobalt-Gray-Equivalent was administered to each eye. MAIN OUTCOME MEASURES Patients were controlled for initial and final best-corrected visual acuity, slit-lamp examination, intraocular pressure, fundus examination, fluorescein angiography, and tumor thickness on B-scan ultrasonography. RESULTS The mean follow-up period was 26 months (range, 9-48 months). Retinal reattachment was obtained in all cases after a mean period of 52 days. The tumor height decreased in all cases. Visual acuity improved to two lines or more in eight eyes (62%) and reached 20/200 or more in nine eyes (69%). No radiation complication was detected during follow-up. CONCLUSIONS Proton radiation seems to be effective and safe in the management of choroidal hemangioma associated with serous retinal detachment. It may be useful when photocoagulation can not be performed.

Neuronal pathways for the propagation of herpes simplex virus type 1 from one retina to the other in a murine model.

Herpetic retinitis in humans is characterized by a high frequency of bilateral localization. In order to determine the possible mechanisms leading to bilateral retinitis, we studied the pathways by which herpes simplex virus type 1 (HSV-1) is propagated from one retina to the other after intravitreal injection in mice. HSV-1 strain SC16 (90 p.f.u.) was injected into the vitreous body of the left eye of BALB/c mice. Animals were sacrificed 1, 2, 3, 4 and 5 days post-inoculation (p.i.). Histological sections were studied by immunochemical staining. Primary retinitis in the inoculated eye (beginning 1 day p.i.) was followed by contralateral retinitis (in the uninoculated eye) starting at 3 days p.i. Infected neurons of central visual pathway nuclei (lateral geniculate nuclei, suprachiasmatic nuclei and pretectal areas) were detected at 4 days p.i. Iris and ciliary body infection was minimal early on, but became extensive thereafter and was accompanied by the infection of connected sympathetic and parasympathetic pathways. The pattern of virus propagation over time suggests that the onset of contralateral retinitis was mediated by local (non-synaptic) transfer in the optic chiasm from infected to uninfected axons of the optic nerves. Later, retinopetal transneuronal propagation of the virus from visual pathways may have contributed to increase the severity of contralateral retinitis.

Evaluation of keratic precipitates and corneal endothelium in Fuchs’ heterochromic cyclitis by in vivo confocal microscopy.

Purpose: To analyse keratic precipitates in Fuchs’ heterochromic cyclitis (FHC) by in-vivo confocal microscopy (IVCM). Patients and methods: A retrospective chart review of 13 consecutive patients with FHC was conducted. Data collection included medical and ophthalmological history, age, age at diagnosis, gender, detailed slit-lamp examination and IVCM images. The IVCM characteristics of keratic precipitates and of the endothelium were analysed. Results: Large hyperreflective deposits corresponding to keratic precipitates were observed on the endothelium of all FHC eyes and showed a great consistency among the different patients. These infiltrating keratic precipitates had a dendritic shape, with a small central core with numerous thin pseudopodia sometimes making connection between different keratic precipitates. The mean density of these keratic precipitates was 16.01/mm2 (SD 6.54). The mean size of the largest dimension of these keratic precipitates was 127.31 μm (SD 41.49; range 66.16–201.4 μm). Hyporeflective round defects were observed at the level of the endothelium at contact or in the close vicinity of keratic precipitates or smaller hyperreflective deposits. All contralateral (non-affected eyes) had no keratic precipitates nor endothelial abnormalities. Conclusions: By providing high resolution images of corneal endothelium and keratic precipitates, IVCM could help the diagnosis and understanding of complex forms of intraocular inflammation such as FHC.

Phacoemulsification combined with silicone oil removal through the posterior capsulorhexis tear.

Purpose To evaluate phacoemulsification combined with silicone oil removal through the posterior capsulorhexis tear. Method The records of 20 patients with cataract after silicone oil repair of retinal detachment with giant retinal tear or complicated by proliferative vitreoretinopathy were reviewed. All eyes underwent phacoemulsification, posterior capsulorhexis, aspiration of silicone oil with an irrigation–aspiration hand piece, and intraocular lens implantation into the capsular bag. Lens calculation was based on the fellow eye. The mean follow-up period after cataract surgery was 15.4 months. Results There were three recurrences of retinal detachment (15%). Transient corneal edema was noted in two eyes. Unpredictable refraction was the main problem, but the myopic refractive error was <4.5 diopters in all cases. Conclusion Cataract extraction combined with silicone oil removal is an effective technique.

Cytomegalovirus retinitis in advanced HIV-infected patients treated with protease inhibitors: incidence and outcome over 2 years.

We prospectively studied the incidence of cytomegalovirus (CMV) retinitis in 93 patients treated with highly active antiretroviral therapy (HAART) containing a protease inhibitor (PI), during a median follow-up period of 24 months. The median initial CD4+ count was 22 cells/microl (range, 1-311 cells/microl), and the median plasma HIV viral load was 5.1 log10 copies/ml (range, 2.4-6.4 log10 copies/ml). The fundus was examined monthly in patients with a history of CMV retinitis or an initial CD4+ count <50 cells/microl and every 3 months in the other patients. Of patients with previously controlled CMV retinitis, 1 of 7 relapsed. In addition, 6 of 59 patients with a CD4+ count <50 cells/microl and no history of CMV retinitis before starting PI therapy developed CMV retinitis. Of them, 3 had at least one relapse during follow-up. CD4+ counts were <40 cells/microl at the time of primary or recurrent CMV retinitis, except in two cases (147 cells/microl and 203 cells/microl). In conclusion, the incidence of CMV retinitis was 0.091 per patient-year among study subjects with advanced HIV infection who were receiving HAART (95% confidence interval [CI], 0.037-0.145). The time to progression of CMV retinitis (mean, 215 days; 95% CI, 113-317 days) was longer than reported before widespread use of PIs.

Maquillage permanent et imagerie par résonance magnétique

INTRODUCTION We report a case illustrating the possible relation between permanent cosmetics (tattoos) and magnetic resonance imaging (MRI). OBSERVATION A 24-year-old woman underwent a permanent cosmetic tattoo (eyeliner) on the four eyelids 5 months before an MRI was performed for headache. After 1 min, the patient reported a burning sensation associated with an eyelid erythema. The MRI examination was interrupted. The burning sensation resolved by the end of the examination and erythema 2 h later. CONCLUSION Cosmetic tattoo technicians, patients, and MR technologists should be informed of the minor risk associated with the site of the permanent cosmetic tattoo (eyelid, eyebrow).

Non-preserved 1% lidocaine solution has less antibacterial properties than currently available anaesthetic eye-drops

Purpose. Some anaesthetics inhibit bacterial growth, and thus may lead to low rates of positive cultures from bacterial eratitis. Antibacterial properties of lidocaine were compared with those of oxybuprocaine or tetracaine, either in current commercial eye lotions or in extemporaneous solutions. Methods. Forty-eight bacterial strains were used to determine the minimum inhibitory and bactericidal concentrations of four commercial eye lotions containing oxybuprocaine or tetracaine, of a non-ophthalmic 1% lidocaine commercial solution and of extemporaneously prepared solutions of oxybuprocaine, tetracaine, lidocaine and benzalkonium. Results. Most strains had their growth inhibited by 0.2% oxybuprocaine or 0.4% tetracaine, which corresponds to a 1/2 dilution of the commercial eye-drops. Bacterial growth was still observed with a 1% lidocaine solution. Conclusions. Currently available anaesthetic eye-drops that are used before corneal specimen collection may lead to false-negative bacterial cultures. Conversely, a non-preserved 1% lidocaine solution might be more appropriate in corneal specimen collection.

The possible role of herpes viruses in multifocal choroiditis and panuveitis

Summary7 cases of multifocal choroiditis and panuveitis are reported here (6 females, 1 male). All clinical data were carefully considered. In all cases an aqueous sampling was made for the detection of anti-herpes virus antibodies in aqueous and serum. 3 specificities were tested: herpes simplex (HSV), herpes zoster (HVZ) and cytomegalovirus (CMV).An intraocular synthesis of specific antibodies was found against VZV in 2 cases and against HSV in 1 case. There was another presumptive case for HSV.

Carcinome transitionnel de la conjonctive

Nous presentons un cas de carcinome transitionnel de la conjonctive. Une femme âgee de 86 ans presentait une tumeur conjonctivale droite volumineuse evoluant depuis six mois apres une premiere exerese. L’histologie evoquait un diagnostic de carcinome transitionnel. Ce carcinome se rencontre habituellement au niveau des voies aeriennes superieures et du sac lacrymal ; des recidives sont possibles. Le carcinome transitionnel peut exceptionnellement se developper au niveau de la conjonctive.

Maculopathie ischémique drépanocytaire résolutive après échange érythrocytaire: À propos d’un cas

The authors report a case of a young patient with a recent decrease in unilateral vision. He had homozygote sickle cell disease with multiple general complications. Fundus examination was normal apart from a mild alteration of the macular reflect in the left eye, but fluorescein angiography showed multiple arteriolar macular occlusions, explaining the decrease in vision in the left eye. After erythropheresis, vision acuity improved and fluorescein angiography showed reperfusion. This case suggests that transfusional exchange may improve acute macular ischemia secondary to sickle cell disease.Les auteurs rapportent le cas d’un patient âge de 13 ans, atteint d’une drepanocytose homozygote associee a de multiples complications viscerales. Il presentait une baisse d’acuite recente unilaterale a 6/10e due a une ischemie maculaire. Un echange erythrocytaire fut realise dans les heures suivantes. Cinq jours apres le traitement, l’acuite visuelle remontait a 10/10e et l’angiographie montrait la reperfusion des territoires d’ischemie maculaire. Ce cas clinique suggere l’interet therapeutique de l’echange erythrocytaire dans le cas d’une ischemie maculaire aigue secondaire a la drepanocytose.