Bulletin de la Societe belge d'ophtalmologie最新文献

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.

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: 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.

We report a 4-year-old girl presenting with sudden severe bilateral visual loss. Ophthalmological examination revealed optic disc pallor. Further neurological examination was normal. Brain magnetic resonance imaging (MRI) suggested chiasmal optic neuritis, and further etiological investigations were negative. We review the literature on the incidence and underlying etiology of chiasmal optic neuritis in childhood.

Purpose: To analyze the clinical features of the posterior segment in posterior microphthalmos and to describe the aspects of this anomaly in Ocular Coherence Tomography (OCT).

Case report: A diagnosis of posterior picrophthalmos could be confirmed in a 18- year-old young man based on the presence of high hypermetropiea, axial length of the globe measurement of 14 mm and a thickening of the fovea in OCT. Family history was also positive in two other members.

Conclusion: Posterior microphthalmos is a rare entity that may potentially be associated with blindness. OCT may be helpful both in the diagnosis and the follow-up of this anomaly.

Congenital corneal anesthesia (CCA) is an uncommon condition difficult to diagnose. We report the case of a 4-year-old girl who presented with bilateral congenital corneal anesthesia revealed by a corneal ulcer which had been unresponsive to adapted local treatment. Self-inflicted corneal injuries were present. It is important to search for corneal anesthesia in children with chronic ulceration of the cornea and selfinflicted injuries.

Uveitis occuring after Mycobacterium bovis-bacille Calmette-Guerin (BCG) intravesical therapy for bladder carcinoma is rare. Only a few cases have been described. Its physiopathology is still unknown. Two mechanisms can be proposed at the origin of ocular inflammation: a local immune response or a direct choroidal mycobacterial infection as demonstrated by vitreous cultures. We report the case of 63-year-old man who presented with unilateral panuveitis after the fifth BCG intravesical instillation with no other systemic manifestations. There was no evidence for any other etiology for this uveitis. Loss of light perception occurred despite systemic antimycobacterial therapy and systemic prednisone therapy because of delayed diagnosis. This outlines the absolute need for a close ophthalmological monitoring of patients receiving a BCG therapy to allow an earlier diagnosis of this complication and appropriate treatment.

Purpose: To describe the prevalence and the risk factors for the age related macular degeneration (AMD) in a Tunisian hospital population.

Patients and methods: A total of 2204 subjects 50 years of age and older were enrolled in a prospective study conducted between august 2004 and February 2009. Medical history was reviewed. Subjects underwent a complete ophthalmic examination, including best corrected visual acuity and slit lamp biomicroscopy with fundus examination. Fundus photography and fluorescein angiography were performed if clinical features of AMD were observed on fundus examination. Cases were classified in early and late stages of AMD.

Results: The prevalence of late AMD was higher than early AMD. Significant risk factors are age, male gender, smoking, excessive sunlight exposure and poor consumption of fish. Cardiovascular disease, diabetes and dyslipimia were not significantly associated to a high prevalence of AMD.

Conclusion: AMD is a multifactorial disease. In our Tunisian hospital population, the prevalence of AMD was higher than in the Europeen population. It can be explained by genetic differences or risk factors. Age, cigarette smoking and sunlight exposure were associated with increasing prevalence of AMD in Tunisia.

Purpose: To evaluate the surgical outcome after intraocular lens exchange in patients implanted with a multifocal intraocular lens (MIOL) who presented impairing visual complaints

Setting: Department of Ophthalmology, Antwerp University Hospital, Belgium.

Methods: 25 eyes of 17 consecutive patients underwent IOL exchange. Pre- and postoperative evaluation consisted of: determining patient's complaints, type of IOL before and after IOL exchange, degree of glare and aberrometry (mainly preoperative data), pre and postoperative DCVA and NCVA.

Results: Diffractive MIOL were more frequently exchanged than refractive MIOLs and were exchanged when possible by a bag-in-lens IOL. DCVA, NCVA and postoperative subjective complaints improved significantly postoperatively. Eyes with prior Nd:YAG laser capsulotomy needed anterior vitrectomy during MIOL exchange procedure due to the presence of a ruptured anterior vitreous face by the laser treatment.

Conclusion: MIOL exchange can be performed safely and with very good visual outcome in patients with severe postoperative visual complaints related to decentered MIOL. Although, patient's postoperative quality of vision remained poor in 7 eyes out of the 25 in this series.