Bulletin de la Societe belge d'ophtalmologie最新文献

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.

We describe a case of toxic maculopathy caused by unique inhalation of poppers. This maculopathy has spontaneously resolved.

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.

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.

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.