Laurent Levecq

Conjunctival nevi clinical features and therapeutic outcomes.

OBJECTIVE To determine the epidemiology and the clinical and therapeutic outcomes of conjunctival nevi and to identify the clinical variables statistically associated with operative excision. DESIGN Prospective, observational, noncomparative case series. PARTICIPANTS Two hundred fifty-five patients with the clinical diagnosis of conjunctival nevus. METHODS Consecutive cases of conjunctival nevi managed at a single institution were studied to identify the clinical risk factors for operative excision. MAIN OUTCOME MEASURES Reasons for operative excision. RESULTS Of the 255 patients who were periodically observed for a mean of 5.3 years (range, 1-11), nevi were clinically diagnosed in 140 females and 115 males and modified operative excision was performed in 75 patients (29%). The decision of operative excision was made by the surgeon in 13 cases (17%) and by the patient in 62 cases (83%). In those 13 patients, the operative decision was prompted by our concern for possible malignant transformation based on suspicious biomicroscopic features in 10 patients (13%) and photographically documented tumor growth in 3 patients (4%). For the other 62 patients who elected to undergo surgery, their reasons for excision included patients concern for cancer in 34 cases (45%), cosmetic arguments in 9 cases (12%), and patients request owing to lesion-induced ocular surface irritation in 19 cases (25%). Comparison between groups showed that the clinical factors at initial visit that were statistically predictive of surgical excision were the older age of the patient (P = 0.001), the largest basal tumor diameter (P<0.001), tumor location (P = 0.023), and presence of clear cysts (P = 0.013), of intrinsic vasculature (P<0.001), of prominent feeder vessels (P<0.001), and of corneal involvement (P = 0.008). None of the excised lesions showed histopathologically malignant features. CONCLUSIONS In our series, documented tumor growth of conjunctival nevus remained relatively a uncommon event with a incidence of 4%. Conjunctival nevi in older patients, associated with dilated feeder vessels, prominent intrinsic vasculature, and corneal involvement were more likely to be treated with operative excision. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.

Epidémiologie des lésions oculaires et orbitaires adressées à un centre d'oncologie oculaire.

PURPOSE: To study the epidemiology of ocular and orbital lesions referred to an ocular oncology center. MATERIAL AND METHODS: Prospective study of ocular lesions referred between November 1997 and November 2002. RESULTS: A total of 1,257 lesions were recorded in 640 females and 617 males. The mean age at the initial visit was 52 years (range, 0 to 94 years). Patients more than 60 years old accounted for 46% of our series. The lesions were classified into four groups: intraocular lesions (69%), superficial layer lesions (18%), adnexal tissues lesions (7%) and orbital lesions (6%). The posterior uvea was the most frequent localization. The clinical diagnosis of 374 lesions (30%) was confirmed by histological examination. The most frequent tumors were retinoblastoma in children and teenagers, conjunctival nevus young adults, choroidal melanoma in slightly older patients and posterior choroidal nevus in elderly people. CONCLUSION: This study reviewed the epidemiological characteristics of ocular and orbital lesions referred to an ocular oncology center for their diagnosis, treatment and follow-up.

Canaliculite lacrymale à Actinomyces: à propos d'un cas.

The authors report a case of unilateral chronic epiphora resistant to prolonged topical antibiotic treatment in a 62-year-old woman. Culture yielded some colonies of Actinomyces species. A dacryocystorhinostomy was found to be ineffective. Canaliculotomy with removal of cast resolved the chronic canaliculitis. Histological examination confirmed the diagnosis of solid cast of Actinomyces.The authors report a case of unilateral chronic epiphora resistant to prolonged topical antibiotic treatment in a 62-year-old woman. Culture yielded some colonies of Actinomyces species. A dacryocystorhinostomy was found to be ineffective. Canaliculotomy with removal of cast resolved the chronic canaliculitis. Histological examination confirmed the diagnosis of solid cast of Actinomyces.

Six-year outcomes in neovascular age-related macular degeneration with ranibizumab.

AIM To evaluate the outcomes of ≥6y ranibizumab therapy in neovascular age-related macular degeneration (AMD). METHODS HELIX was a retrospective, observational effectiveness study using medical records of patients treated in three clinics in Belgium. Patients had neovascular AMD and were initially treated with intravitreal ranibizumab (0.5 mg) between November 1, 2007 and October 31, 2008, had ≥6y of data available, and were treated on an ongoing, as-needed basis. Outcomes included best-corrected visual acuity (BCVA) and central retinal thickness (CRT). RESULTS The sample consisted of 88 eyes from 69 patients. Mean age was 76.4±6.5y, most patients were female (62.3%). Most eyes (62.5%) were treatment-naive, 33 previously treated eyes had received predominantly other anti-vascular endothelial growth factor agents and verteporfin. Mean baseline BCVA was 57.4±12.7 ETDRS letters and CRT was 291.5±86.1 μm. On average, patients received 20.6±11.9 ranibizumab injections over the ≥6y. Intervals between injections were on average 12.7±16.1wk. Mean change in BCVA from baseline to last observation for the sample was less than one letter (-0.9±17.3 letters), with an average loss of -3.2±15.6 letters in previously treated eyes versus a gain of 0.6±18.4 letters in treatment-naïve eyes. When considering a loss of <15 letters over 6y as stabilization of disease, 75.9% of all eyes showed a positive (improvement or stabilization) outcome. Mean change in CRT from baseline to last observation for the sample was -26.9±148.4 μm with the greatest reduction observed in treatment-naive eyes. CONCLUSION This retrospective study of 69 neovascular AMD patients treated for ≥6y with ranibizumab demonstrates long-term visual stabilization. In light of the natural evolution of the disease, these data confirm that ranibizumab is effective long-term under real-world conditions of heterogeneity of patients, clinicians, and centers.

Corps étranger intra-cristallinien.

Figure 2 : Scanner orbitaire à la recherche d’autres fragments métalliques (coupe sagittale) montrant la localisation intra-cristallinienne stricte d’un seul corps étranger. Figure 3 : Scanner orbitaire (coupe axiale). Figure 4 : Scanner orbitaire (coupe coronale). Figure 1 : Plaie de cornée auto-étanche (flèches) avec conservation de la chambre antérieure, opacités cristalliniennes à l’endroit de la perforation de la capsule antérieure et corps étranger métallique intra-cristallinien chez un patient âgé de 33 ans (acuité visuelle de 1/10). 1 2 3 4

Visual Acuity, Visual Field, and Factors Influencing Automobile Driving Status in One-Thousand Subjects Aged 18 to 59 Years

Objective: To evaluate the number of people driving in accordance with European legal driving requirements, measured as far binocular visual acuity and the binocular visual field, to identify variables associated with driving habits that do not meet legal standards. Methods: Subjects aged 18 to 59 years were recruited at a tertiary referral center. Far visual acuity was measured with the modified ETDRS charts, and defined as equal as or better than 0.3 logMAR units. The visual field was evaluated using the binocular Estermans test, and defined as normal/ complying if the horizontal visual field was at least 120°; the extension was at least 50° to the left and to the right, and 20° up and down; and if no defects were present within a radius of the central 20°. Details of demographic and socioeconomic characteristics were obtained from all of the participants by using questionnaires. Results: One thousand subjects were enrolled in the study, of which 883 were current drivers. Among the 883 current drivers, 849 (96.1%) had both a far binocular visual acuity equal or better than 0.3 logMAR units and a normal field of view, while 34 (3.9%) did not meet these requirements. A logistic regression was performed to identify the variables statistically associated with the practice of driving among licensed drivers who did not meet the minimal visual requirements. This revealed that a non-recent ophthalmology examination (p = 0.002), and not having an acquaintance to drive them (p = 0.014) were influencing factors. Conclusions: In our study, 81% of the subjects aged 18 to 59 years were driving, of whom 3.9% did not meet the European legal driving requirements that are set at equal or better than 0.3 logMAR units and a normal field of view. The variables associated with driving status were the time of the most recent examination, and not having an acquaintance to drive them.

773 Caractéristiques cliniques et options thérapeutiques des nævi conjonctivaux

But Etudier les caracteristiques epidemiologiques et cliniques et le devenir therapeutique des naevi conjonctivaux referes a notre unite d’oncologie oculaire. Materiels et Methodes Etude retrospective non-randomisee conduite sur une periode de 10 ans de 1997 a 2007. Les caracteristiques epidemiologiques et cliniques incluaient l’âge, le sexe et la race du patient, la localisation, la pigmentation et le diametre de la tumeur ainsi que la presence de kystes intra lesionnels et d’une vascularisation intrinseque et nourriciere. La raison ayant motive l’excision chirurgicale a ete enregistree. Discussion 255 lesions chez 142 femmes et 113 hommes ont ete incluses dans cette etude. L’âge moyen a la visite initiale etait de 31 ans (1 a 90). L’approche therapeutique a ete l’observation chez 180 patients (71 %) et l’excision chirurgicale chez 75 patients (29 %). Parmi ces 75 patients, les raisons ayant motive l’excision chirurgicale comprenaient l’anxiete du patient dans 34 cas (45 %), l’irritation oculaire dans 18 cas (24 %), l’aspect inesthetique dans 9 cas (12 %), l’apparence suspecte de la lesion dans 10 cas (11 %), et une croissance tumorale documentee dans 8 cas (4 %). Aucune des lesions excisees ne presentait des signes de malignite a l’examen histo-pathologique. Une regression multi variee a montre que les signes cliniques statistiquement associes a l’excision chirurgicale etaient l’âge avance du patient, la presence d’une vascularisation intrinseque, la presence d’une vascularisation nourriciere et l’envahissement corneen par la tumeur. Conclusion Dans notre serie, les facteurs predictifs d’une excision chirurgicale pour un naevus conjonctival etaient l’âge avance du patient, la presence d’une vascularisation intrinseque, la presence d’une vascularisation nourriciere et l’envahissement corneen. Parmi ces 255 naevi conjonctivaux, aucun cas de transformation maligne n’a ete mis en evidence.

Choroidal metastasis from carcinoma of the bladder.

PURPOSE To report choroidal metastasis from the newly described nested variant of urothelial carcinoma of the bladder as the initial presentation of metastatic disease. METHODS A 58-year-old man with a history of urothelial bladder carcinoma developed progressive decreased visual acuity in the right eye. Fundus examination showed an amelanotic choroidal tumor simulating a choroidal melanoma. Results of ancillary diagnostic tests, needle aspiration biopsy, and systemic workup failed to confirm the diagnosis of choroidal metastasis. The patient was treated with enucleation the affected right eye. RESULTS Histopathologic analysis of the enucleated eye disclosed a choroidal metastatic carcinoma with urothelial features similar to those of the bladder carcinoma excised previously. Despite adjuvant systemic chemotherapy, the patient died 7 months after enucleation. CONCLUSION Choroidal metastasis may be the initial manifestation of metastatic bladder carcinoma and is associated with a poor survival prognosis.

594 Ophtalmoplégie internucléaire révélatrice d’un syndrome de Miller-Fisher

But Rapporter l’observation d’un syndrome de Miller-Fisher a point de depart ophtalmologique. Materiels et Methodes Cas clinique. Un homme de 26 ans consulte en urgence pour diplopie. A l’examen, il presente un ptosis bilateral, ainsi qu’une mydriase et une ophtalmoplegie internucleaire bilaterales. L’examen neurologique met en evidence une abolition des reflexes osteo-tendineux et une instabilite a la marche. La ponction lombaire et la resonnance magnetique sont negatives. Les serologies infectieuses sont egalement negatives, mais la biologie revele un taux eleve d’anticorps IgG AntiGQ1B, ce qui permet de poser le diagnostic de syndrome de Miller-Fisher. Un traitement par plasmapherese est instaure, permettant la resolution des symptomes oculaires et neurologiques. Discussion Le syndrome de Miller-Fisher est une variante du syndrome de Guillain-Barre et se caracterise par une triade symptomatique comprenant ataxie, abolition des reflexes osteo-tendineux et opthalmoplegie des muscles extra-oculaires. Le mecanisme physiopathologique est de type dysimmunitaire. Conclusion Par cette observation rare, nous rappelons que le syndrome de Miller-Fisher peut egalement toucher le systeme nerveux central.

525 Intérêt de l’examen ophtalmologique dans le diagnostic de néoplasie endocrinienne multiple de type 2B

But Rapporter l’histoire, les signes ophtalmologiques et les anomalies endocriniennes d’un patient atteint de neoplasie endocrinienne multiple de type 2B (NEM 2B), un syndrome de pronostic severe. Materiels et Methodes Un patient de 22 ans est refere pour un examen ophtalmologique par le service d’Endocrinologie. Il presente un status marfanoide, des lesions nodulaires sur la langue et un leger diabete. Resultats L’examen en lampe a fente met en evidence une eversion des paupieres superieures associee a un epaississement du bord palpebral superieur, la presence de plusieurs lesions nodulaires de la conjonctive palpebrale et l’existence de nerfs corneens epaissis. Une neoplasie endocrinienne multiple de type 2B est suspectee et l’exploration systemique revele un carcinome medullaire de la thyroide associe a des pheochromocytomes bilateraux. L’etude genetique moleculaire detecte la presence de la mutation typique du proto-oncogene RET confirmant le diagnostic de neoplasie endocrinienne multiple de type 2B. Le patient beneficie d’une surrenalectomie bilaterale et d’une excision des lesions conjonctivales, suivies un mois plus tard d’une thyroidectomie totale. Discussion L’examen ophtalmologique, en particulier la detection de nerfs corneens epaissis, peut jouer un role important dans la detection d’une neoplasie endocrinienne multiple de type 2B et doit pousser le clinicien a rechercher les associations endocriniennes potentiellement letales. Conclusion La decouverte de nerfs corneens epaissis doit faire evoquer une neoplasie endocrinienne multiple de type 2B.