Bulletin de la Societe belge d'ophtalmologie最新文献

We describe an African patient with sarcoidosis involving the lacrimal glands. Gallium scintigraphy showed the so-called "panda sign".

Purpose: Third cranial nerve palsies are unfrequent in childhood and adolescence and are most often congenital. The association of sellar germ cell tumor and ophthalmoplegia is considered as being very rare at this age.

Case report: A 11-year-old young girl was examined in emergency with a third left cranial nerve partial palsy associated with one- year duration history of hypopituitarism with insipid diabetes and growth retardation. Cerebral IRM revealed a tumor of the pituitary gland. In histopathological examination of pituitary gland biopsies, lesions were compatibles with a sellar germ cell tumor.

Conclusion: Although they are most often of a congenital nature, third cranial nerve palsies in childhood may be secondary to other causes that should be always taken in mind. When they are secondary to a sellar tumor and according to the clinical presentation and the IRM, the histopahological examination of biopsies is mandatory to have a precise diagnosis.

Introduction: Melanocytoma of the optic disc is a stable condition that unfrequently undergoes malignant transformation.

Case report: We reported the case of a 42-year-old woman who presented with a pigmented tumoral lesion of the optic disc in her left eye. We described its characteristics in optical coherence tomography (OCT).

Conclusion: Patients with pigmented tumors of the optic disc should have a periodic monitoring. OCT may be helpful in the difficult differential diagnosis between malignant and benign tumor and the monitoring of this lesion.

Since about 20 years, the large panel of the antiglaucoma eyedrops has drastically changed the management of glaucoma. Indications for filtering surgery had decreased in frequency. A great number of patients are controlled only by medications. However ocular intolerance and side effects have been reported until in 50% of the cases with 10% of severe manifestations of intolerance. Ocular side effects to topical medications may very often alter compliance. Ocular intolerance had been shown to be secondary to immunological mechanisms and direct or indirect toxicity. The immunological or allergic mechanisms are induced by a type I or IV hypersensibility and only represent 3% to 10% of all the side effects induced by topical medications. Toxic effect can be a direct through different mechanisms: pure toxic effect, acid pH, osmolarity of the solution, photosensibilisation. This will induce inflammatory reaction that will produce fibrosis in the long term. This toxic effect can be worsened by eye dryness or rosacea. Toxicity can also be indirect through an alteration of the conjunctival microbial flora and/or the lacrymal secretion. Concomitant obstruction of the lacrymal ducts may also contribute to this effect. These mechanisms could have been elucidated thank to histological studies from conjunctival mark, and more recently with confocal HRT, which gives an analysis of the ocular surface in vivo. Appropriate and early detection of intolerance to antiglaucoma medications is mandatory to adjust management strategies accordingly. These are based on the suppression or the reduction of conservative agents whenever possible, the use of fixed combinations, the reduction of the number of the instillations and the associated treatment of the ocular surface.

Report of a case of orbital inflammation after the use of zoledronic acid for metastasized prostate cancer.

Purpose: To determine the efficacy of preoperative eye disinfection by comparing antibiotic and antiseptic eye drops.

Design: Prospective, randomized double-masked comparative study with three study arms: untreated, antibiotic treated and antiseptic treated.

Methods: Patients that were scheduled for vitrectomy were asked to use an antibiotic or antiseptic eye drop 4 times a day, 5 days before the surgery. Conjunctival smear was cultured at the onset of the surgery. Culture results for each study arm were compared.

Results: Comparable results were found in the patients treated with an antibiotic or antiseptic eye drop.

Conclusions: Since an antiseptic eye drop will cause less bacterial resistance than an antibiotic eye drop, and both treatments have a similar antibacterial effect, this study indicates that prophylactic antiseptic eye drops may be preferred over antibiotic treatment, when prophylaxis is needed.

A 35-year-old woman with zonular weakness in the left eye had phacoemulsification with inthe- bag implantation of an acrylic intraocular lens (IOL) and a capsular tension ring. 6 months postoperatively, the patient developed significant visual loss secondary to capsule shrinkage and contraction of the capsulorhexis opening, associated to a slight IOL decentration. Neodymium: YAG laser radial anterior capsulotomy and anterior capsulectomy were performed leading to visual acuity restoration.

Purpose: To provide a numerical comparison of the efficiency of spherical aberration (SA) compensation methods commonly used in commercial aspheric intraocular lenses (IOLs).

Methods: Numerical simulations were performed using the wavefront data of 139 right eyes implanted with a spherical Morcher 89A ("Bag-in-the-Lens") IOL. Simulations were done for spherical, constant aspherical and SA-free IOLs, as well as for the customized selection method.

Results: Constant aspherical IOLs bought 49.6% of the eyes to a targeted postoperative SA value +/- 0.05 microm, while zero-SA IOLs brought 61.2% of the eyes to this range. However with customized selection 95% of the eyes could be brought to this target, resulting in more control over the postoperative spherical aberration. If no aspherical correction was used, only 8.6% of the eyes could reach the set target.

Conclusion: These numerical results suggest that IOLs with an asphericity as a function of IOL power, supplemented by a customized selection from a number of fixed SA values according to preoperative corneal SA, may provide sufficient control over the postoperative SA. Given the surgeon centration possibility of the Bag-in-the-Lens IOL used in this study, as well as its centration stability, this is an ideal lens to implement the customized selection method.

Treatment of glaucoma aims at preserving the visual function and the Quality of Life (QoL) of the patients. To slow down the progression of the disease, the IOP should be decreased to a level where the risk of further deterioration is reduced to a minimum. Rates of progression vary between patients. Detection of glaucoma progression should be based on the assessment of structure and function. When making a treatment plan, one should take into consideration the rate of progression and the impact of visual field deterioration on the QoL. Therefore, a careful and reliable baseline examination is crucial. Furthermore, yearly documentation of the optic disc and frequent examinations of the visual field, especially during the first two years of follow-up, are mandatory to evaluate how aggressive the treatment should be. Slowing down progression of the disease is closely related to a good communication with the patient, the quality of the information provided, and the tolerance of the medications, all keys to a good adherence. Other risk factors than IOP should be looked for and treated if possible, especially when worsening of glaucoma damage is observed despite apparently good IOP control and compliance. Modern monitoring of the glaucoma patient can be summarized in six keys. Current limitations of this approach will be briefly discussed.