P. Denis

Detection of Treponema pallidum in Aqueous Humor by Real-time Polymerase Chain Reaction

Purpose: To report the additional clinical value of real-time Polymerase chain reaction (PCR) in the detection of Treponema pallidum in aqueous humor. Methods: A real-time (RT) PCR assay targeting the polymerase 1 gene of Treponema pallidum was performed in aqueous humor samples collected in consecutive patients with ocular syphilis. Results: Five patients presenting with optic neuritis (1), posterior placoid chorioretinitis (1), or panuveitis with retinitis (3) were tested. The PCR results were positive in the 3 cases of panuveitis and negative in the 2 other cases. Conclusion: RT-PCR for Treponema pallidum in aqueous humor is useful to confirm syphilitic panuveitis.

Traumatismes oculaires perforants de l'enfant: Étude rétrospective de 57 cas

PURPOSE: The purpose of this study was to investigate the current causes and outcomes of open eye injuries in children. PATIENTS AND METHODS: We reviewed the hospital records of 57 patients under 14 years of age who were treated for open globe injuries at Edouard Herriot Hospital, Lyon, France, between January 1999 and December 2003. RESULTS: This review includes 57 patients: 41 males and 16 females. The mean age at admission was 6.8 +/- 3.5 years. The injury involved the right eye in 27 cases and the left eye in 30 cases. Sharp or pointed objects accounted for the majority of injuries. The most common location for a perforating ocular injury to occur was at home. Wounds involved the cornea in 41 cases. There was iris hernia in 21 cases, hyphema in 15 cases, vitreous prolapse in 14 cases, lens damage in 12 cases, and shallow anterior chamber in 11 cases. The most frequent complication was traumatic cataract. Secondary lens removal was performed in 15 cases. Visual acuity was 0.5 or better in 27 of the 57 eyes, with a mean follow-up period of 12 months. CONCLUSIONS: Perforating ocular injuries are a frequent cause of unilateral visual loss. The highest proportion of injuries occurred at home and sharp objects were the most frequent causative agents. More adequate adult supervision and educational measures are necessary in order to reduce the prevalence of these accidents.

Age-related macular degeneration screening using a nonmydriatic digital color fundus camera and telemedicine.

Purpose: To investigate the use of a nonmydriatic digital color fundus camera and telemedicine as screening tools for age-related macular degeneration (AMD). Methods: Nonmydriatic color fundus photography was performed on patients consulting health examination centers and transmitted by telemedicine to an ophthalmology department. Rates for different grades of AMD were calculated and also statistically related to the presence or absence of risk factors. Results: Among the 1,022 patients screened, a total of 1,363 color fundus photographs were interpreted, with 80% gradable images, allowing a diagnosis of AMD in 178 photographs. Among all the gradable images, 83.7% had no AMD (grade 0). The rates of AMD at grades 1, 2, 3 and 4 were 8%, 5.6%, 2.3% and 0.4%, respectively. A statistical odds ratio was found between the presence of AMD on fundus photographs and age, familial history of AMD or prior cataract surgery. Conclusions: Nonmydriatic color fundus photography and telemedicine succeeded in screening for AMD.

Bevacizumab versus ranibizumab in the treatment of exudative age-related macular degeneration: A retrospective study of 58 patients

AIM To compare the efficacy and safety of bevacizumab versus ranibizumab in the treatment of patients with neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS Retrospective case-controlled series of 30 patients treated with intravitreal bevacizumab and 28 patients treated with intravitreal ranibizumab for exudative AMD. Main outcomes measured included best-corrected visual acuity (BCVA), central macular thickness (CMT) and foveal thickness, quantity of subretinal fluid, neovessel size and total number of injections over the first year treatment period. A secondary outcome was the report of any adverse events in both groups. RESULTS BCVA stabilized and increased from LogMAR 0.70 to 0.47 in the bevacizumab group and from 0.55 to 0.54 in the ranibizumab group (P>0.05). CMT decreased in the bevacizumab group from 369 to 284 μm and in the ranibizumab group from 340 to 271 μm (P>0.05). The number of injection was significantly lower (4.8) in the bevacizumab group than in the ranibizumab group (5.8) (P<0.05). No serious ocular adverse events were noted in both groups. CONCLUSION This retrospective study failed to show a difference in visual and anatomic outcomes between bevacizumab and ranibizumab. The number of re-treatment was lower in the bevacizumab group (P=0.03).

Œdipisme bilatéral non concomitant : à propos d'un cas

Bilateral oedipism: a case report S. Perignon, P.L. Cornut, F. Boyer, H. Janin Manificat, C. Burillon, P. Denis Introduction: Oedipism (or self-enucleation) is a rare form of self-mutilation and most often described in acutely psychotic patients, less frequently among drug addicts or the mentally deficient. Case report: We report a case of a 46-year-old man, who, 3 years after having enucleated his left eye during a puff delirious acute symptomatic of schizophrenia, mutilated his right eye in the same way. We detail the emergency medical and surgical management indicated in these circumstances. Conclusions: In most cases described, self-mutilation involves one eye and rarely both. This case of bilateral oedipism is therefore exceptional. In these circumstances, it is necessary to prevent any intracerebral complications induced by the traction exerted on the optic nerve, such as subarachnoid hemorrhage, whose signs can be masked by the patient’s psychic state, and to take the neuropsychiatric precautions necessary.

Buphtalmie secondaire à un kyste congénital de l’épithélium pigmentaire de l’iris

Les auteurs presentent un cas clinique rare de buphtalmie secondaire a un kyste congenital de l’iris volumineux et posterieur chez un nouveau-ne de 2 jours. L’examen clinique initial est complete par une analyse ultrasonographique a haute frequence (UBM et echographie de haute resolution a 20 MHz) qui permet de preciser le diagnostic de cette masse, avant l’examen et le traitement sous anesthesie generale. La chirurgie permet un controle de la pression intra-oculaire et libere l’axe visuel. Cependant, il persiste une amblyopie relative a 1 an. Ce cas clinique permet de preciser l’interet de l’UBM pour l’analyse des masses du segment anterieur en offrant un diagnostic precoce du kyste congenital de l’epithelium pigmentaire de l’iris et en permettant une prise en charge rapide et adaptee.

Étude prospective de la sensibilité au contraste et des effets visuels après LASIK

But Nous avons evalue les variations des effets visuels (sensibilite au contraste, halos, eblouissements) apres LASIK (laser in situ keratomileusis). Patients et methode L’etude a ete realisee de facon prospective sur 72 yeux ayant ete traites par LASIK. L’evaluation de la sensibilite au contraste a ete effectuee pour les frequences spatiales 3 c/d, 6 c/d, 12 c/d et 18 c/d, en preoperatoire, a 6 mois et a 12 mois apres l’intervention. La population etait divisee en deux groupes : le groupe 1 regroupait les yeux presentant une myopie comprise entre – 6 et – 7,5 D (n = 30) et le groupe 2 les yeux presentant une myopie comprise entre – 7,5 et – 10 D (n = 25). Il existait 17 perdus de vue. Lors de chacun de ces examens, le diametre pupillaire, la presence de sensation de halo, la presence d’eblouissements ou d’une gene pour la conduite de nuit ont ete notes. Resultats Dans le groupe 1, la sensibilite au contraste etait significativement meilleure pour les frequences spatiales 3, 12, 18 c/d (p Conclusion La correction des myopies par LASIK induit une diminution de la sensibilite au contraste. Cette diminution de sensibilite au contraste reste significative seulement pour les 6 premiers mois. Les patients doivent etre informes en pre-operatoire de cette diminution de qualite visuelle.

Étude prospective de 34 décollements de rétine par déchirure géante

PURPOSE To report the anatomical and functional outcomes of vitrectomy with silicone oil tamponade in the treatment of retinal detachment associated with giant retinal tears due to various factors. METHODS We prospectively followed 34 eyes of 33 patients with giant retinal tear. That underwent vitrectomy, injection of perfluorocarbon liquids and silicone oil tamponade. Scleral buckle was associated with vitrectomy in cases of inferior giant retinal tear; 26,5 % and 11,8 %, respectively, demonstrated pseudophakia and aphakia. Seven eyes (20,5 %) had a history of trauma (blunt injuries in four and a penetrating injury in three) and, 14 eyes (41,2 %) had severe myopia. One patient developed a bilateral giant retinal tear during the follow-up. RESULTS Retinal attachment was obtained in 33 (97 %) of 34 eyes, with a mean follow-up of 14,5+/-6 months. Retinal detachment reoccurred in four eyes (11,6 %) under silicone oil, in one eye (2,9 %) during the silicone removal, and in two eyes (5,8 %) after silicone removal and cataract surgery. Silicone oil was removed from all eyes (4,3+/-1 months). The most frequent postoperative complication was cataract in ten of 18 phakic eyes (55,5 %). Functional success with visual acuity 0,4 or better was obtained in 18 cases (52,96 %). CONCLUSION Pars plana vitrectomy with silicone oil tamponade proved to be highly effective in giant retinal tears in terms of the anatomical and functional results. The analysis of recurrent retinal detachment allowed us to refine the technique and to suggest scleral buckle in one case of inferior retinal tear with laser over 360 degrees .

Survenue d’une neuropathie optique ischémique antérieure aiguë bilatérale en haute altitude : rôle de l’intolérance à l’hypoxie

The pathophysiology of nonarteritic anterior ischemic optic neuropathy (NA-AION) is still imperfectly understood, but arterial hypertension seems to play a decisive role. Intolerance to hypoxia is defined as desaturation of hemoglobin more than 15% at rest and/or elevation of blood pressure at rest or after exercise over 20mmHg in hypoxia. We report the case of a 66-year-old woman who presented bilateral NA-AION during a trek at high altitude (>2500m). The etiological check up was negative. Due to the circumstances of occurrence, we requested a tolerance to hypoxia test, which was positive. In this case, the combined effects of altitude and effort probably led to prolonged desaturation of oxyhemoglobin associated with an excessive blood pressure increase upon exercise leading to ischemia of the optic nerve head. This case showed the value of a systematic search for hypoxia tolerance in patients with nonarteritic anterior ischemic optic neuropathy occurring during a situation of prolonged hypoxia (long-distance flight, high altitude).

Chirurgie des traumatismes oculaires perforants du segment postérieur par plombs : à propos de deux cas

INTRODUCTION Treatment of retinal detachment secondary to perforating ocular trauma (POT) is difficult due to the fragility of the sclera, the number, size, and location of the retinal wounds, the vitreoretinal incarceration into the scleral wound, and the high risk of vitreoretinal proliferation. We report our experience of pars plana vitrectomy to prevent secondary retinal detachment in two cases of POT of the posterior segment caused by lead shot. OBSERVATIONS Two males, about 20 years old, suffered from a perforating ocular injury caused by a single pellet. In both cases, the entrance wound was more than 5mm posterior to the corneoscleral limbus and the exit wound was located in the posterior pole. In both cases, initial visual acuity was limited to perception of hand motions and the Ocular Trauma Score (OTS) was 2. Both patients underwent two surgical procedures, the first procedure consisting only in entrance wound closure. The second procedure was delayed 17 days (case 1) and 10 days (case 2). It consisted in pars plana vitrectomy including careful shaving of the incarcerated vitreous into the wounds and detachment of the posterior hyaloid. Surgery was completed by cryopexy of the retina beneath the entrance wound and by focal scleral buckling between the entrance and the exit wound. Cryopexy was not done on the exit wound. Final visual acuity was 40/200 (case 1) and 30/200 (case 2) after 36 and 8 months, respectively. No retinal detachment was observed. CONCLUSION This report highlights the advantage of early pars plana vitrectomy to prevent retinal detachment in POT related to lead shot.