Bulletin de la Societe belge d'ophtalmologie最新文献

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.

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.

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.

Purpose: Malignant 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).

Methods: A 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.

Results: A 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 obtained

Conclusions: A debulking orbital surgery, in order to relieve optic nerve compression, should be offered to the patients with orbital metastasis.

Purpose: To evaluate the safety of different doses of subconjunctival bevacizumab and their effects on the recurrence rate after primary pterygium excision.

Methods: This 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.

Results: There 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.

Conclusions: In our study, perioperative injections of subconjunctival bevacizumab had no effect on primary pterygium recurrence and were not associated with any specific local complications.

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 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.

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.

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.

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.