M. Hanssens

Neovascularization after Argon Laser Photocoagulation of Macular Lesions

In three patients treated for macular degeneration with argon laser photocoagulation choroidal neovascularization occurred four to six weeks later at the photocoagulation site. Two of the patients were treated for angioid streaks of the macular region, the third patient was treated for disciform macular degeneration. Argon laser photocoagulation also induced neovascularization experimentally in pigmented rabbits.

Ocular non-Hodgkin’s lymphoma: a clinical study of nine cases

BACKGROUND Primary oculocerebral large cell malignant non-Hodgkin’s lymphoma, formerly called ocular reticulum cell sarcoma, runs a uniformly fatal course. Once the central nervous system (CNS) is involved, survival without treatment is very limited. Although treatment does not substantially improve the long term survival, it provides short term improvement in these patients. METHODS The charts of all patients with ocular involvement of non-Hodgkin’s lymphoma followed during the period 1984–93 were reviewed. The diagnosis of non-Hodgkin’s lymphoma was made by different diagnostic approaches: CNS biopsy, anterior chamber tap, vitrectomy, haematology, and necropsy. RESULTS Eight patients had oculocerebral large cell and one had small cell non-Hodgkin’s lymphoma. Five patients with pure ocular localisation had initially received steroid treatment for intermediate uveitis. First diagnosis was made on CNS biopsy in three, anterior chamber tap in one, vitreous aspirate in three, haematology in one, and necropsy in one case. CONCLUSION Ocular non-Hodgkin’s lymphoma is a difficult diagnosis. Vitrectomy allows cytological diagnosis in most but not all cases. When no treatment is given, patients survive for only a few weeks once the CNS is involved. Although the disease is eventually fatal, treatment by means of radiotherapy, steroid administration, and vitrectomy can allow these patients to lead a normal professional and social life during the years between recurrences.

Subacute sclerosing panencephalitis: fundus changes and histopathologic correlations

This paper describes the fundus changes in 2 patients with subacute sclerosing panencephalitis (SSPE). In both cases the ocular involvement preceded the neurological symptoms by several months. In one patient a localized serous detachment in the macular region was associated with retinal infiltrates and in the second patient an atypical unilateral macular chorioretinitis was first diagnosed. The diagnosis of SSPE was suspected when neurological signs appeared and it was confirmed by the typical EEG changes and especially by the high titers of measles antibodies in serum and CSF. The affected left eye of the second patient could be studied histopathologically and presented mainly pigment epithelial changes at the level of the scar, edema of the external plexiform layer, retinal folds and a detachment and rupture of the internal limiting membrane.

Corneal Ultrastructural Changes in Fabry's Disease

A case of Fabrys disease is reported. The findings of the corneal alterations with the light microscope as well as with the electron microscope are described. The diffuse corneal haziness seems to be due to small intracellular osmiophilic inclusions of the epithelium. There seems also to be a relation between the giant inclusions in the corneal epithelium, not yet described, and the clinical presence of punctiform grey opacities. The pathogenesis of the whorl-like opacities remains unsolved.

Vascular Tumors and Malformations of the Ocular Fundus

This report for the Belgian Ophthalmological Society concerns a number of fundus diseases, which most ophthalmologists only rarely encounter. Still it is of importance that they should be able to recognize them, not only because most of these eye diseases are treatable when they are diagnosed early enough, but also because they are sometimes associated with major visceral and neurological problems. The ophthalmologist may be the first practitioner to suspect a von Hippel-Lindaus disease or a neurofibromatosis. He should realize at that moment that his role is not only to treat the eyes but also to advise his patient, refer him to other specialists and consider the genetical implications of his diagnosis. Clinicopathologic correlations are of great importance and we felt that it was necessary to emphasize the histopathological aspect of these diseases. A report has to overview the literature on a specific topic. The literature on vascular tumors of the fundus is extremely vast and even if we tried to be as complete as possible, we must confess that we did not cite every author who published on such cases. A third aspect, which was considered as important, was to provide sufficient clinical and histopathologic examples of the various disease, which are reviewed. We are indebted to a large number of friends who kindly authorized the publication of their material. In particular we wish thank Prof. A. Brini (Strasbourg), Dr. D. de Wolff-Rouendaal (Leiden), Prof. P.

Scleral Pockets and Lyophilized Sclera in Retinal Detachments

For our buckling operations in retinal detachment, we prefer lyophilized sclera because it is well tolerated without tissue reaction, and very easy to handle. Its inertness is demonstrated by histopathological examination of sclera fragments taken during reoperations.

Statistical Study of Pseudopapillitis vascularis

: In pseudopapillitis vascularis the male sex is preponderant. There are two peaks of frequency in the male as well as in the female group, although 72% of the cases appear between 51 and 70 years of age. The onset may be sudden or progessive. The most important aetiological factors are diabetes, arterial hypertension and arteriosclerosis. The disease is bilateral in 46% of the cases. The vision is less than 3/10 in 77% of the cases. An improvement of the visual acuity is observed in 52% of the unilateral cases, but only in 15% of the bilateral cases. The treatment is ineffective. The biopsy of the temporal artery shows an obvious arteriosclerosis in more than two-thirds of the cases.

Neurosyphilis presenting with optic neuropathy. Report of a case and review

A patient with neurosyphilis, presenting with severe ocular impairment due to optic neuropathy, is described. In such a case, a low index of clinical suspicion and improper use of syphilitic serologic tests may delay diagnosis. However, specific tests of serum and cerebrospinal fluid are mandatory for the diagnosis. Treatment evaluation necessitates the follow-up of serology and cerebrospinal fluid cell count. Recent changes of therapy recommendations in subjects with neurosyphilis and in those syphilitic patients co-infected with HIV are mentioned.

Neurofibromatosis or von Recklinghausen’s disease

At least four different forms of neurofibromatosis can be considered [76]: 1. von Recklinghausen’s neurofibromatosis 2. bilateral acoustic neurofibromatosis, where the cutaneous lesions, typical of the first form, are often lacking 3. segmental neurofibromatosis, where the typical lesions are confined to one segment of the body and 4. cutaneous neurofibromatosis, which is probably to be considered as a ‘forme fruste’ of generalized neurofibromatosis.

Retinal angiomatosis — von Hippel-Lindau’s Disease

The first reports on retinal angiomatosis are attributed to Magnus (1874), Jackson (1878), and Panas and Remy (1879) [58, 43, 65]. Fuchs (1882) published the description and drawings of the classical red peripheral tumor with the typically dilated artery and veins, but considered the lesion to be an arterio-venous aneurysm [23]. Collins (1894) gave the first pathological description of thin-walled vessels and cystic spaces, but called it a capillary naevus [15], while Czermak (1905) described it as a capillary angioma [16]. von Hippel (1911) identified the tumor as a hemangioblastoma and gave it the name of angiomatosis retinae [86]. In later years the entity was described by some authors as angiogliosis or angiogliomatosis [10, 27, 39]. In his classical paper Lindau (1926–1927) described the lesion as a primary hemangioma, noted the association of angiomatosis retinae with cerebellar cysts and proved the histological similarity of both cerebellar and retinal tumors [54, 55]. Van Der Hoeve (1932) finally classified the lesion among the congenital phakomatoses [85]. The disease has since been the subject of many publications under the denomination of angiomatosis retinae or von Hippel-Lindau’s disease.