Bulletin de la Societe belge d'ophtalmologie最新文献

Patients with acquired immunodeficiency syndrome (AIDS) can develop severe uveitis. Although infectious and autoimmune causes must always be considered, drug induced uveitis is also an important etiology. Herein, we present two case reports illustrating the classical presentation of rifabutin and cidofovir induced uveitis. The first case was a 33 year old woman with AIDS treated with anti-protease and anti-tuberculosis drugs (including rifabutin). She presented with a red painful right eye. There was a strong anterior segment inflammation with fibrinous exudates and a dense vitritis. Rifabutin was stopped and topical steroids and mydriatics were given. Intraocular inflammation and symptoms rapidly resolved. The second patient was a 36 year old woman who presented with a painful decrease of vision in her left eye. She was followed for bilateral CMV retinitis in the setting of AIDS and had recently received 2 systemic injections of cidofovir. Anterior segment inflammation with posterior synechiae in both eyes and folds of Descemet membrane in the left eye were noted. Intraocular pressure was 0 mmHg in the left eye and 10 mmHg in the right eye. Fundus examination disclosed CMV retinitis scars in the right eye and choroidal folds in the macula of the left eye. Cidofovir was discontinued and topical steroids and mydriatics started. Progressively the inflammation decreased and the intraocular pressure returned to normal levels. In conclusion, rifabutin and cidofovir are classical examples of drug induced uveitis with distinct characteristic clinical presentation. Recognition of those entities in AIDS patients can avoid useless and potentially invasive interventions in those fragile people.

Case report of a floating pigmented vitreous cyst.

Polypoidal Choroidal Vasculopathy (PCV) was first identified in 1985. Initially considered to be rare, PCV is currently frequently diagnosed in patients of African and Asian descent. In Caucasians, PCV counts for 10% of cases of AMD, and for up to 85% of patients with hemorrhagic or exudative retinal pigment epithelial detachment. Although the clinical presentation can be suggestive, extensive investigation with the indispensable indocyanine green angiography, is required for confirmation of PCV. Treatment has to be considered in active disease threatening the macula. Photodynamic therapy with Verteporfin is required for closure of PCV complexes. Anti-VEGF treatment reduces associated macular edema.

A 34-year-old Lebanese man presented with photophobia, tearing, and reduced vision in the left eye, a few hours after being accidentally hit in the eye with a fingernail. The cornea in the left eye showed corneal defect . About three minutes after receiving topical fluorescein in this eye, the patient developed syncope and anaphylactic shock. After immediate reanimation, the patient regained consciousness. When specifically asked, he reported a three-month history of urticaria to the right side of his neck and nose. The possible pathophysiology involves an underlying IgE-mediated mechanism. Ophthalmologists should be aware of complications associated with topical fluorescein.

Aim: To point out the importance of the early diagnosis of giant cell arteritis (GCA) (Horton's disease).

Materials and methods: a case report of a sudden bilateral blindness that had revealed GCA.

Case report: A 68-year old female patient with a history of elevated blood pressure and diabetes mellitus type 2, was examined in emergency for a right painful headache developed one week previously. In ophthalmological examination, her BCVA was 0.9 and P2 in both eyes. Diagnosis of Horton's disease was not initially done in spite of elevated erythrocytes sedimentation rate (ESR) at 30 mm, protein C reactive (CRP) at 19 mg/l. The patient consulted seven weeks later in emergency for a sudden bilateral blindness associated with severe headache, recent asthenia, and limping of the lower jaw. At that time, visual acuity was reduced to light perception in both eyes whereas ophthalmoscopy revealed a bilateral central retinal artery occlusion (CRAO). ESR was 74 mm and CRP 233 mg/I. Temporal artery biopsy confirmed the diagnosis of GCA. The patient was treated with systemic steroids without visual recovery.

Conclusion: This case outlines the importance of the early diagnosis of GCA in order to make possible to start treatment before the occurrence of irreversible complications.

Endogenous panophthalmitis is a rare eye disease with purulent necrosis of all the ocular structures. It is a rare but serious condition that occurs when bacteria cross the blood-ocular barrier and multiply within the eye. Although rare, endogenous panophthamitis is a potentially devastating intraocular infection resulting in a poor visual and anatomic prognosis. We present a 39-year-old woman, without any previous history, who developed a endogenous panophthalmitis in the left eye secondary to a puerperal endomyometritis secondary to infection with Sphingomonas paucimobilis. Despite systemic antibiotic therapy and intraocular injections, there was an evolution to purulent corneal melting.

For some years now, the Braille League has been thinking about ways of improving information of the public with visual impairment about the assistance and services that it can seek. The conclusion that this information was inadequate was highlighted by all those in charge of assisting people with disabilities. As one of the key moments is the announcement of the diagnosis, the association wanted to contact health professionals in order to measure the level of information in their possession and pass on their expectations. Two approaches were used. First, there was a questionnaire that ophthalmologists completed at the Ophtalmologica Belgica 2010 conference. The topics raised were very diverse: their professional context, conditions of announcement, information given to patients, information requested by patients, and their wishes for the future. Moreover, semi-structured interviews enabled various areas of the study to be examined in greater depth: definition of impairment, conditions of announcement of the diagnosis, non-medical aspects, conclusion about lack of information and avenues for improvement. This study confirmed that ophthalmologists lack information on the subject of the psychosocial components of disability and have poor awareness of the existing aids and services. After the presentation of the results, a series of recommendations was made so that the announcement of the diagnosis could be optimal, so as to enable patients to embark on a process of adaptation and acceptance of their visual impairment.