In patients with angioid streaks, additional investigations are useful to identify underlying systemic disease, unless age and short peripapillary streaks are indicative of senile streaks as an isolated abnormality. In middle-aged or young adults with angioid streaks and no obvious systemic disease, the possibility of a hemoglobulinopathy or pseudoxanthoma elasticum (PXE) as etiologic entities should be investigated. Hemoglobinopathies can be excluded based on blood screening and the absence of typical ocular fundus changes, such as retinal vessel tortuosity. This allows making a presumed clinical diagnosis of PXE in patients with angioid streaks, based on exclusion of a hemoglobinopathy, and on the presence of extensive angioid streaks, peau d'orange, crystalline bodies and comet tail lesions. For confirmation of PXE, the gold standard was dermatologic examination and skin biopsy, but since the last decade molecular diagnosis is available. In rare cases, PXE can be diagnosed using molecular techniques in patients with apparently normal skin and negative skin biopsies, as demonstrated in this case and another case published in 2011.
PURPOSE:To evaluate the causes and success rates of pars plana vitrectomy (PPV) in uveitis patients.METHODS:Retrospective study of the charts of 26 uveitis patients (28 eyes) who underwent PPV between the years 2008 and 2011. We examined surgical indications and success rates, based on visual outcomes, complications and diagnosis in case of vitreous biopsy.RESULTS:(1) Therapeutic PPV (TV) was performed in 36% of the eyes, (2) TV combined with epiretinal membrane (ERM) peeling in 21% and (3) diagnostic PPV (DiV) was performed in 64% of the eyes. Eight eyes (28,6%) underwent a combined cataract and vitreous surgery. Visual acuity (VA) improved in 16 eyes (57%), with a mean improvement of -0,9 log of the minimum angle of resolution (logMAR), although the effect was transient in 7% of the cases. VA remained stable in 11 eyes (39%) and decreased in 1 (4%). Post-operative complications were cystic macular oedema (CMO) in 3 eyes (11%), cataract in 5 eyes (18%) and retinal detachment in 2 eyes (7%). Diagnostic tests were performed in 18 eyes with a success rate of 55%.CONCLUSIONS:In our series of patients with uveitis, a good andstable improvement of VA was found when PPV was performed with ERM peeling while the effect on VA was more transient in the other cases. A good success rate of diagnosis was also found in DiV. However, considering the possible severe complications, diagnostic vitrectomy should be limited to selected cases.
PURPOSE:To evaluate the clinical and therapeutic characteristics of rhegmatogenous retinal detachment (RRD) with unseen retinal breaks.PATIENTS AND METHODS:Retrospective study 50 eyes (50 patients) with RRD with unseen retinal breaks in the pre and intraoperative examination. These patients were treated between 2005 and 2010 by vitrectomy or scleral buckling. Retinal breaks were meticulously sought by indentation of the vitreous base. The subretinal fluid was drained by a peripheral retinotomy when a vitrectomy was needed and puncture ab externo when a scleral buckling was performed.RESULTS:A retinal detachment with unseen retinal breaks accounted for 15% of all RRD operated during this 5-year duration period (2005 - 2010). The average age of our patients was 57 years.Ten were myopic (20%) and 27 (54%) pseudophakic, with inferior RRD in 60% of the cases cases while advanced vitreoretinal proliferation (PVR) greater or equal to stage C in was present in 72%. Primary vitrectomy was performed in 46 cases. Retinal reattachment rate was achieved after a single procedure in 41 eyes (82%). Among them, 40 were operated by vitrectomy and one eye by scleral buckling. The recurrence rate was significantly higher in patients operated by scleral buckling (75%) than by vitrectomy (15%).CONCLUSION:RRD with unseen retinal breaks are often seen inferiorly and have a chronic evolution (60%). They concern pseudophakic patients in the majority of the cases. Their poor prognosis and high recurrence rate also appear to be related to an advanced PVR (72%). The good results of primary vitrectomy should be confirmed by randomized studies, especially in phakic eyes.
INTRODUCTION:Cancer associated retinopathy (CAR) is an uncommon paraneoplastic syndrome associated with epithelial neoplasm. Ocular symptoms of this syndrome are varied.CASE REPORT:A 40-year-old man with an existing smoking history noticed a bilateral visual loss.Fundus examination showed a bilateral vitreous hemorrhage.In the left eye, there were narrowed retinal arterioles and peripapillary neovessels. An X-ray chest revealed a lung lesion which on biopsy proved to be a bronchial squamous cell carcinoma. After conducting several explorations,we have diagnosed CAR.CONCLUSION:Vitreous hemorrhage is one of the symptoms of CAR. Thus, systems review, searching for an extraocular cancer, X-ray chest and ERG are recommended in this case.
PURPOSETo evaluate the safety of different doses of subconjunctival bevacizumab and their effects on the recurrence rate after primary pterygium excision.METHODSThis prospective randomized placebo-controlled clinical study was conducted on 59 eyes (59 patients). The visual acuity, refractive astigmatism, horizontal length of the pterygium, and recurrence risk factors were recorded. There were no statistically significant differences between the groups for age, sex, horizontal length of pterygium, preoperative visual acuity, astigmatism, and recurrence risk factors. The pterygium was excised from the conjunctival side and then peeled off the cornea. The bare sclera was covered with a rotational conjunctival flap from the superonasal area. After surgery, Group 1 (22 patients), Group 2 (17 patients) and Group 3 (20 patients) received 7.5 mg bevacizumab, 2.5 mg bevacizumab, and Balanced Salt Solution (BSS) subconjunctivally, respectively. Postoperatively, horizontal length of corneal epithelial defect, conjunctival congestion, and lacrimation were checked on the first and seventh day. The rate of recurrence (>1.5 mm fibrovascular overgrowth on the cornea) at month 6 was compared between the groups.RESULTSThere were no statistically significant differences between the groups for all measured variables except for moderate conjunctival congestion on the first postoperative day which was more common in the bevacizumab groups (P=0.002). Four eyes in Groups 1 (20%) and 2 (26.7%) and 3 in Group 3 (15.8%) experienced recurrence (p=0.73). All recurrences occurred at month 3 and subsequently thereafter.CONCLUSIONSIn our study, perioperative injections of subconjunctival bevacizumab had no effect on primary pterygium recurrence and were not associated with any specific local complications.
PURPOSE:reporting three rare cases of Marcus Gunn Syndrome and analyzing the clinical features of this entity.METHODS:Case reports of three patients with a Marcus Gunn Syndrome, treated at the Ophthalmology B CHU service Rabat - Morocco.RESULTS:Our patients are two boys aged 1 and 2 years old, and a 31 year old woman with a Marcus Gunn Syndrome. As special features, in the boys' cases this syndrome is bilateral, as for the other case it is associated with congenital fibrosis clinically predominant of the Ipsilateral inferior rectus muscle in an adult. Surgical treatment was not offered for children because of their young age. The adult patient has benefited from a recession of the inferior rectus muscle and a pleating in the superior rectus muscle. The forced duction test objectified a fibrosis of the inferior rectus muscle. Surgical correction of Ptosis and Synkinesis has not been indicated in this patient, given the residual oculomotor disorder and the risk of exposure keratitis.CONCLUSION:Marcus Gunn Syndrome is exceptional in adults. This can be explained by the tendency of the lid retraction to fade with age. Bilateral involvement in Marcus Gunn Syndrome is rare. Its association with congenital fibrosis of extraocular muscles has allowed a better etiopathogenic approach highlighting a supra nuclear origin of this Syndrome.
We report the case of a 66-year-old woman with visual loss due to anterior ischaemic optic neuropathy. The diagnosis of giant cell arteritis was made on the basis of classic clinical characteristics and haematological abnormalities. Despite corticosteroid treatment, involvement of the other eye occured, resulting in a bilateral and permanent loss of vision. The follow-up was marked by two relapses within the 6 months after the first episode. In order to prevent blindness, ophthalmologists should be familiar with this disorder and should actively participate in the treatment, not leaving the internist deciding alone about tapering corticotherapy.
The pilomatricoma or epithelioma of Malherbe is a mummified benign and rare skin tumor. We report a rare case of palpebral pilomatricoma simulating a chalazion in a 26-year-old patient. This skin tumor is exceptional in adults. Its diagnosis is often missed preoperatively because of its great clinical polymorphism and is histopathologically based on the detection of mummified cells. Its surgical treatment will aim at a complete excision of the tumour in order to minimize the risks of recurrence.
Epimacular membranes when responsible for a significant loss of visual acuity, generally require treatment by vitrectomy and peeling of the membrane. We report the case of a spontaneous peeling of a macular pucker after cryotherapy of peripheral retinal vasoproliferative tumors. Review of the literature.
PURPOSEMalignant tumors metastatic to the orbit are rare and only about 5% of orbital tumors are metastasis. We report on orbital surgery in a patient with orbital metastasis from small cell lung carcinoma (SCLC).METHODSA 75-year-old man complained of pain in the left orbital region and proptosis. Head CT scan showed a left retrobulbar mass compressing the optical nerve. Chest and body CT scans showed a round-shaped mass at the apex of the left inferior lobule of the lung and widespread nodal involvement.RESULTSA surgical intervention on the left orbit through a lateral approach was performed, with complete removal of the mass. Histology showed features of a non-anaplastic SCLC. A complete restoration of visual acuity was obtainedCONCLUSIONSA debulking orbital surgery, in order to relieve optic nerve compression, should be offered to the patients with orbital metastasis.
PURPOSE:To report lens subluxation with additional stretching of the ciliary processes as ocular features of Goltz syndrome.METHODS:Case report.RESULTS:A now 4-year old girl was diagnosed at birth with Goltz syndrome. Best-corrected visual acuity was 1/60 in both eyes. Slitlamp examination showed bilateral iris colobomata and inferior subluxation of the lens with abnormally stretched ciliary processes. Funduscopy revealed bilateral chorioretinal and optic disc colobomata.CONCLUSIONS:Ocular anomalies are often associated with Goltz syndrome. Although ectopia lentis is a known ocular feature, this is the first case of lens subluxation with additional, abnormally stretched ciliary processes.
PURPOSE:The waveform score (WS) indicates the reliability of each intraocular pressure (lOP) measurement signal performed with the Ocular Response Analyzer (ORA, Reichert). We aimed to assess i) the range of waveform score in IOP measurements with ORA in healthy subjects and to ii) identify a cut-off WS value under which an ORA measurement should be discarded. METHODS:Prospective study including three ORA IOP measurements performed in the right eye of 80 healthy normal subjects. The different WS were recorded and the highest WS of the three measurements was analysed. ANOVA test was used to assess variance in repeated measurements. RESULTS:Mean age of 80 subjects was 46.7+/-15.6 years. Mean WS of the first IOP measurement was 4.8+/-2.0 and 4.8+/-1.7 and 5.0+/-1.9 respectively for the second and third measurements (p= 0.74). Mean WS of the analysed 240 signals (3 measurements per eye) was 4.9+/-1.9 (range: 1.2-9.5). The mean value of all the highest values per eye was 6.2+/-1.8 (range: 2.9 -9.5 and was significantly higher than the mean WS of the 240 signals together (p <0.001). The 10th percentile of all the best values was 3.7 and the 75th percentile 7.5. CONCLUSION:ORA measurements with WS <3.7 should be discarded in healthy normal subjects. As much as that the corresponding quality of the waveform ORA scan is satisfying, one single measurement with a WS >7.5 could be considered as sufficient. If this score cannot be reached after three consecutive measurements, the signal with the highest WS should be selected.
OBJECTIVE to determine the frequency of ocular manifestations in Congolese children aged 0 to 15 years infected with HIV/AIDS and to identify the predicted clinical and/or biological elements. METHODS This was a prospective, descriptive and cross-sectional study performed from November 2010 to April 2011 in five sanitary structures who take care of children infected with HIV/AIDS. During the period of study, one hundred children infected with VIH/AIDS were examined. Seventy- six (76%) of children were under highly active anti-retrovial therapy (HAART). The age of children ranged from 0,5 month to 15 years. Children underwent a routine ophthalmic examination which included measurement of visual acuity, inspection of the adnexa and cornea, slit-lamp examination and dilated ophthalmoscopy. The CD4 lymphocyte count was determined in 88 of them. RESULTS The frequency of ocular manifestations was 36%. The mean age of children was 8 years (SD: 4.01; range 0,5 month-15 years). The male female sex ratio was 0.8/1. Ocular complaints were present in 22 children (22%). Visual symptoms were most frequent in children with severe decrease of immunity. Of four children identified with a visual handicap, one (1.5%) had blindness and three (4.4%) had visual impairment. All of these four children had a CD4 lymphocyte count less than 15%. Among ocular manifestations, the adnexial manifestations were the most frequent with 18 cases (18%) followed by the posterior segment manifestations with 14 cases (14%) and the neuroophthalmic lesions with 5 cases (5%). CONCLUSION This study documented 36% of ocular manifestations; this frequency is comparable with the other African studies. Comparatively to studies conducted in other continents the frequency in African studies is high. This study also showed that the adnexial manifestations are the most frequent ocular findings and that the children with severe decrease of immunity are most exposed to visual troubles that can lead to blindness.
We describe a case of toxic maculopathy caused by unique inhalation of poppers. This maculopathy has spontaneously resolved.
PURPOSE:To report a case of acute posterior placoid chorioretinitis, a rare manifestation of ocular syphilis.METHODS:The patient was examined at age 59 with symptoms of subacute severe unilateral vision loss of the right eye. He underwent fundus examination, automated perimetry, optical coherence tomography imaging and fluorescein angiography. There was a close follow-up for 3 months.RESULTS:At time of presentation, the visual acuity in the right eye was hand movement. Fundus examination showed a central retinal placoid yellowish lesion going beyond the temporal vascular arcades. Optical coherence tomography showed thickening of the neuroretina and disappearance of the inner and outer segment junction. Fluorescein angiography showed in the early phase areas of hypofluorescence followed by hyperfluorescence and late staining. Serologic examinations were positive for secondary syphilis. After treatment with intravenous ceftriaxone 2g/d for 2 weeks there was a complete functional recovery with regression of the fundus lesion.CONCLUSIONS:Acute syphilitic posterior placoid chorioretinitis has been described as a rare chorioretinal manifestation in patients with syphilis. The pathogenesis of this entity still remains unknown. Since there are no pathognomonic features of ocular syphilis, findings may often mimic those of other diseases. Maintaining an awareness of the different manifestations of this disease allows ophthalmologists to play a key role in the early diagnosis of syphilis.
PURPOSE:To assess the efficacy of subconjunctival bevacizumab injection as adjuvant therapy in the prevention of recurrence following the surgical treatment of pterygium by comparison with intraoperative mitomycin-C application.METHODS:This prospective comparative study included thirty consecutive patients with primary nasal pterygium that were surgically treated with simple excision. In addition to surgical excision, subconjunctival bevacizumab was injected in 15 eyes (group A), and, in the remaining 15 eyes, topical mitomycin-C 0.2 mg/mL was applied for 2 minutes (group B). The postoperative outcome was followed clinically for a minimum of 12 months. The main outcome criteria were recurrence rate and postoperative complications.RESULTS:A significantly higher recurrence rate was found in bevacizumab group (66.7%) compared to MMC group (26.7%) (P= 0.028). In group A, conjunctival wound separation was observed in 3 of 15 eyes; however, no conjunctival separation was observed in Group B and no other serious complications were observed in either group.CONCLUSION:The intraoperative use of subconjunctival bevacizumab does not seem to be effective in reducing the rate of pterygium recurrence following excision when compared with intraoperative mitomycin-C application.
PURPOSE:To evaluate the long-term IOP-lowering effect of an initially successful switch from prostaglandine-analog (PGA) monotherapy to bimatoprosttimolol fixed combination (BTFC) METHODS: Prospective, monocentric, open-labeled clinical trial. 30 patients with insufficient intraocular pressure (lOP) control under PGA monotherapy were screened. Following a one month run-in period of BTFC, patients who presented an effective IOP-lowering response were prospectively studied for an additional 11-month period. IOP, tolerability and safety (adverse reactions, slit lamp biomicroscopy) were further assessed at month 6 and month 12 after initiating BTFC. RESULTS:BTFC therapy significantly decreased IOP when compared to PGA monotherapy (PGA monotherapy: 17.3+/-3.8 mmHg; BTFC 1 month 13.2+/-3.3mmHg; p<0.05). This decrease from PGA-monotherapy IOP was sustained throughout the time-frame (6-month: 13.5+/-3.6mmHg; 12-month: 13.9+/-2.4mmHg; p<0.05 in pairwise comparison). There was no statistical difference in IOP between BTFC study visits (p>0.05). Of the 27 patients who had a satisfactory lOP-lowering response to BTFC after one month, 18 (66.7%) still had sufficient IOP control at the 12 month study visit. Therapy was discontinued at 1 month in 3 patients (2 due to intolerance to medication and 1 failing to achieve IOP control). No intolerability was reported beyond the 1 month of BTFC therapy. CONCLUSION:In the majority of patients, the initial lOP lowering effect of replacing PGA monotherapy by BTFC seems to predict a long term response to the new treatment strategy.
PURPOSE:Optic nerve and optic nerve sheath infiltration by a systemic lymphoma is uncommon, but is exceedingly rare when caused by a T-cell lymphoma. This then generally occurs in association with central nervous system (CNS) involvement. We report on a rare case of optic and facial nerve T-cell lymphoma infiltration, without CNS involvement.METHODS:A 63-year old female with systemic T-cell lymphoma in clinical remission presented with painful loss of vision in the left eye. She was initially treated for presumed recurrent optic neuritis. A thorough clinical work-up was performed, followed by an optic nerve biopsy with histopathology.RESULTS:There was no perception of light in the left eye, with a marked relative afferent pupillary defect. Fundoscopy showed significant optic disc oedema and a large peripapillary subretinal infiltration. Subsequently, she developed a 7th cranial nerve paresis. Cranial MRI showed thickening and contrast enhancement of the left optic nerve and right facial nerve. Optic nerve biopsy showed infiltration of CD3- and CD5- positive lymphocytes. A complete systemic workup revealed no evidence of disease elsewhere. The patient was thus considered to have bifocal cranial recurrence of T-cell lymphoma, for which radiotherapy was started.CONCLUSIONS:Optic nerve infiltration from systemic lymphoma is rare and generally occurs with CNS involvement. A bifocal pattern of recurrence from systemic T-cell lymphoma involving the right facial nerve and left optic nerve was seen in this patient. A review of the literature highlights the highly atypical nature of this presentation.
The authors report a case of a 20 year old female who presented a bilateral decrease in vision. Detailed history revealed that 15 days before the onset of symptoms, the patient presented a dengue fever during her stay in Martinique. On initial examination, the fundus exam revealed a bilateral loss of foveal reflection. The optical coherence tomography demonstrated the macular edema and the dengue serology was postive. The patient received an interferon2a-based therapy. The macular edema disappeared and we noticed a partial but fast improvement of visual acuity 12 days after the treatment initiation.
KERATOUVEITIS AND LENS OPACITY CAUSED BY BUTTERFLY HAIR Butterfly hair is known to cause eye injury. In Africa, incriminated butterflies are Hylesia (spp). We report a case of a sub-epithelial keratitis associated with anterior uveitis following a trauma by a butterfly that was complicated by late lens opacity due to butterfly hair. Ocular lesions caused by butterfly hair are rare, but require an urgent management to prevent late and severe complications due to intraocular migration of the hairs. MOTS-CLES Papillon, keratite, uveite, cataracte
