[Retinal arterial macroaneurysm complicated by premacular hemorrhage: treatment by YAG laser disruption]

INTRODUCTION

Retinal arterial macroaneurysms are ectatic modifications of the arterial wall. They are a relatively uncommon condition that can threaten visual function by pre- or subretinal hemorrhage if rupture or massive macular exudation occurs.

OBSERVATION

We report a case of a 59-year-old patient with arterial hypertension who presented an arterial macroaneurysm complicated by premacular hemorrhage. We performed Nd: YAG laser photodisruption, which resulted in drainage of preretinal blood, with complete hemorrhage regression and visual recovery.

COMMENTS AND CONCLUSION

Retinal macroaneurysms are acquired malformations, often isolated and located in a temporal artery. Their progression is unpredictable, evolving toward spontaneous occlusion, occurrence of chronic exudative retinopathy, or hemorrhagic complications by fissuration or rupture of the arterial wall. Through this observation, the authors discuss the value of YAG laser photodisruption for preretinal hemorrhage caused by retinal macroaneurysm.

[Bilateral primary pseudotumoral palpebral amyloidosis. A case report]

Ocular amyloidosis is infrequent, and the palpebral location is uncommon. It usually has a primary localized form, but can occur in systemic or familial amyloidosis. The diagnosis is mainly made by histopathology. Its treatment is surgical and the prognosis depends on clinical presentation and recurrences. We report the case of a 54-year-old woman with no medical history of the disease, who had bilateral isolated palpebral amyloidosis presenting as bilateral upper lid swelling with ptosis and corneal dystrophy. Diagnosis was confirmed by palpebral biopsy and the patient underwent excision of the involved lid tissue with reconstruction of the affected lid with cartilage autograft. Clinical progression showed improvement of the ptosis and the patient's comfort. Although rare, palpebral amyloidosis poses management problems, particularly in advanced cases, because of corneal complications and recurrence.

[White-centered retinal hemorrhage revealing acute lymphoblastic leukemia]

Retinal involvement during leukemia is frequent (varying from 28% to 50%), can be the result of different mechanisms, and may reveal the disease. We describe two patients, 10 and 50 years old, who consulted for a sudden drop in visual acuity. Fundus examination showed bilateral retinal hemorrhage with a white center in both eyes associated with other hemorrhages in the posterior pole. Acute leukemia was found in both patients and chemotherapy was institgated. The younger patient died of general complications, the other is in remission phase. Retinal hemorrhage with a white center is a rare manifestation of acute leukemia and is exceptionally the first sign of the disease. Through these cases, we detail the physiopathology and clinical aspects. We stress the importance of ocular findings in leukemia in both diagnosis and therapy.

[Hyphema with secondary hemorrhage: think about sickle cell disease]

The Authors report a case of a 13-Year-old white child who presented a grade I hyphema, anterior chamber inflammation after trauma. He presented a secondary hemorrhage with increased intraocular pressure that was not controlled within 48 h, thus requiring surgical intervention. A hemoglobin electrophoresis and hemostasis test showed a sickle cell trait. After hemorrhage resorption, the ocular fundus showed substantial retinal hemorrhage. The final visual outcome was poor and attributed to optic atrophy. Sickle cell trait is a significant risk factor for secondary hemorrhage, increased intraocular pressure, and permanent visual impairement in children who have traumatic hyphemas following blunt trauma.

[Uveitis in children: about 20 cases]

INTRODUCTION

Uveitis in children is rare: 3%-8% of all cases. It requires the same diagnostic and etiological processes as uveitis in adults, with additional difficulties at examination and a sometimes insidious progression.

MATERIAL AND METHODS

Retrospective study of 20 cases of childhood uveitis from 1995 to 2000. All patients received an ophthalmologic examination and an etiological search, with specific and/or symptomatic treatment and follow-up lasting from 6 months to 5 years.

RESULTS

The 20 children presenting uveitis were 4-16 years old, with etiologies as follows: 8 cases of Behçet's disease, 2 cases of Vogt-Koyanagi-Harada's disease, 1 case of sarcoidosis, 1 case of uveitis associated with coeliac disease, 1 case of toxoplasmosis, 1 case of sympathetic ophthalmia, 1 case of uveitis with streptococcal infection, 3 cases of ocular toxocarosis, and 2 cases with unknown etiology. Treatment based on the etiological findings was started in the cases of toxoplasmosis and uveitis from streptococcal infection. The others were treated with high- and then digressive-doses of corticosteroids.

ANALYSIS

We have noted the high incidence of Behçet's disease in our series. Progression was marked by frequent recurrence for one case of Vogt-Koyanagi-Harada's syndrome and one case of toxoplasmosis. This study also revealed a few cases of complicated cataract.

DISCUSSION

Clinical characteristics, diagnosis, and treatment of uveitis in children are discussed.