[Age-related macular degeneration]

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in industrialized countries in individuals over 65 years of age. It is characterized by a progressive degenerative disorder of the macula, resulting in a loss of the central vision. There are two forms of AMD, the atrophic and the exudative form. A number of risk factors have been implicated in the onset of this condition. With the ageing of the population, the prevalence of AMD is steadily raising and is leading to a growing social and economical burden. Much research has been conducted to improve the diagnosis and management of people at risk of AMD and to develop new treatments. In this review we will discuss the risk factors associated with AMD, the clinical forms and their diagnosis, as well as the current and future therapeutic options.

Fundus autofluorescence in a case of occult macular dystrophy

PURPOSE

To document for the first time intrinsic retinal pigment epithelium (RPE) fluorescence in occult macular dystrophy (OMD). This entity is characterized by a central cone dysfunction leading to a decline of visual acuity without visible fundus and fluorescein angiography abnormalities. A great variability in clinical findings and in the pattern of inheritance have been reported suggesting probably several etiologies of which some are well known but seen too early to detect significant changes.

METHODS

Fundus autofluorescence imaging is a recent method to detect early retinal pigment epithelial alterations. It may visualise disease specific abnormalities in the retinal pigment epithelium often not yet visible on ophthalmoscopy such as Stargardt disease, rod-cone dystrophy. This method was applied in a member of a family with OMD.

RESULTS

The normal fundus autofluorescence observed in our patient allowed the distinction between well-known maculopathies not yet visible on ophthalmoscopy but showing abnormal autofluorescence, and genuine occult macular dystrophy.

CONCLUSION

Fundus autofluorescence imaging in our case of dominant autosomal OMD suggests a healthy and functional RPE. This examination of RPE should therefore be added to the work-up of suspected OMD.

[Crystalline retinopathy]

Crystalline retinopathy is characterized by intraretinal crystalline deposits that, according to their etiology, can be localized in the macular area or, indeed, be found in the entire retina. These deposits can be associated or not to visual loss and electrophysiological perturbations. Among the toxic drugs leading to this retinopathy are tamoxifen, canthaxanthine, methoxyflurane, talc and nitrofurantoin. A detailed description of tamoxifen and canthaxanthine toxicity is reported in this chapter.

[Central serous corticoid and chorioretinopathy]

Central serous chorioretinopathy (CSC) is a relatively frequent ocular disorder. Its pathophysiology remains however unclear. This disease typically affects young men with type A behaviour within a context of stressful events. Recently, endogenous or exogenous hypercortisolism has been associated with development, prolongation and exacerbation of CSC. Exogenous hypercortisolism has been induced by any route: intravenous, cutaneous, or nasal spray. Some clinical features such as bilaterality of lesions, an atypical form of the presentation can evoke this association. Although a few years ago glucocorticoids were still used as treatment of CSC, experimental and clinical observations suggest that they are contra-indicated in the context of CSC.

Diffuse unilateral subacute neuroretinitis in Africa

PURPOSE

Diffuse unilateral subacute neuroretinitis (DUSN) is well known in endemic areas of the southeastern United States, South America, and the northern Midwestern United States. Two different categories of nematodes, according to their length, are related to endemic areas. We report the first case of DUSN caused by a small nematode in Africa.

METHODS

We describe the case of a 12-year-old Senegalese girl who presented a long-standing diffuse unilateral subacute neuroretinitis and in whom the worm could be localized.

RESULTS

The length of the unidentified worm measured using the software of the fundus camera was approximately 600 microm. This measurement corresponds to the smaller nematode usually found in patients from the southeastern United States and South America.

CONCLUSION

Diffuse unilateral subacute neuroretinitis can also be observed in patients living in Africa.

[Rosary-like abnormality of retinal veins:report of a case]

Inherited retinal venous beading is a rare autosomal dominant disorder with variable expressivity. It is characterized by irregular, segmented beading of the retinal veins. Some patients have arteriolar tortuosity. The conjunctiva can be affected by saccular vascular changes. Episodes of acute retinal vascular decompensation are also described. Low to normal leucocyte and neutrophil counts may be an extraocular associated condition. We describe the isolated case of a woman presenting retinal venous beading and conjunctival vascular aneurysms. She has no systemic anomaly and her family members examined are unaffected.

Macular CMV retinitis: a case report

PURPOSE

Cytomegalovirus (CMV) retinitis is the most common ocular opportunistic infection associated with AIDS. It usually affects the peripheral retina, sparing the macula. We describe an atypical CMV retinitis exclusively confined to the macula.

METHODS

A 43-year-old man with the diagnosis of AIDS developed a white retinal lesion confined to the macula of the right eye. Two weeks later, a more typical granular appearance was observed leading to presumption of CMV retinitis.

RESULTS

The patient was treated with ganciclovir without success. With foscarnet, a good response was obtained, leading to total healing of the lesion.

CONCLUSIONS

CMV retinitis has to be taken into consideration in all lesions confined to the macula in immunodepressed patients. An early diagnosis is crucial to avoid blindness.

[Diabetic retinopathy: clinical features and new therapeutic findings]

Diabetic retinopathy remains today a leading cause of blindness. Dramatic progress during the past three decades led to the classification of diabetic retinopathy, to provide guidelines of screening and follow-up, to determine risk factors of progression of retinopathy and to propose treatment strategies. This paper reviews clinical and therapeutical knowledge about this topic.

[The ophthalmology department]

The main clinical activities developed during the first 25 year of the department are described. Topics of fundamental and also clinical research are briefly reviewed.

[Vitrectomy for diabetic macular edema associated with hyaloid posterior traction]

The vitreomacular relationship has been demonstrated to play a role in the physiopathology of the diabetic macular edema. We review the functional and anatomic results of vitrectomy performed on four eyes of three patients with diabetic cystoid macular edema unresolved by photocoagulation. The preoperative visual acuity was "finger counting" at one meter to 1/20. After surgery, for three eyes, the visual acuity raised between 2/10 and 4/10. There was no change for one eye, which presented a subretinal fibrosis. The macular edema resolved in three eyes and improved in one eye. The mean postoperative follow-up is 13 months. The vitrectomy may be effective in cases of diabetic macular traction and edema without posterior vitreous detachment.

Polypoidal choroidal vasculopathy in Caucasians

PURPOSE

To study the prevalence of polypoidal choroidal vasculopathy (PCV) in Caucasian patients with occult choroidal neovascularization (CNV); to study the clinical spectrum of PCV in Caucasians and the outcome after laser photocoagulation of such lesions.

METHODS

(1) A consecutive series of 374 eyes of Caucasian patients at least 58 years old, presenting occult CNV, presumed to have age-related macular degeneration (AMD) on fluorescein angiography (FA) were further characterized by indocyanine green angiography (ICGA) to determine the frequency of PCV. (2) The funduscopic, FA and ICGA findings in a cohort of 36 Caucasian patients with PCV were analyzed. (3) The outcome after laser photocoagulation was studied in 14 PCV eyes with a minimum follow-up of 6 months.

RESULTS

(1) Fourteen of 374 eyes (4%) presenting occult CNV in patients at least 58 years old were diagnosed as PCV by means of ICG-A. (2) A polypoidal lesion was found in the macula in 22 of 45 PCV eyes, in the peripapillary area in 16 of 45, under the temporal vascular arcade in 6 of 45 and in the midperiphery in 6 of 45. Large or soft drusen were observed in 15 of 45 eyes with PCV. (3) Regression of fundus signs without persisting polyps 6 months after laser photocoagulation was obtained in 5 of 5 treated peripapillary lesions but in only 5 of 9 treated macular or arcade lesions.

CONCLUSION

Polypoidal choroidal vasculopathy is not rare in Caucasian patients presenting with occult choroidal neovascularization. The fundus abnormalities seen in such eyes overlap with the typical manifestations of AMD. Whereas the prognosis after photocoagulation of peripapillary polypoidal lesions appears to be relatively good, it is more guarded for macular or arcade lesions.

[Surgery for macular hole without positioning]

Although the macular hole surgery with gas tamponade obtains good results, the face-down positioning for minimum 5 days remains constraining and is often a cause of refusal or abstention concerning the operation. We describe 7 patients who underwent the macular hole surgery by pars plana vitrectomy with internal limiting membrane peeling and fluid-silicone exchange without position restrictions. The silicone oil has been removed 2 to 3 months later. All the holes have been closed except in one case where the internal limiting membrane had not been peeled with certainty. A second surgery with peeling of this membrane has permitted the hole closure. We don't report any complications induced by the silicone oil. Silicone oil tamponade for macular hole surgery with internal limiting membrane peeling shows a good efficiency without particular positioning and without additional complications.

[Placoid pigment epitheliopathy and cerebral vasculitis: a clinical case]

We report the case of a 21 year old man who has severe headache and blurred vision since 2 weeks. Ophthalmologic examination discloses typical lesions of acute posterior multifocal placoid pigment epitheliopathy and an homonymous right inferior quadrantanopsia. An inflammatory syndrome and a cerebrospinal fluid lymphocytosis are found. Cerebral imagery is normal. Headache improves only with corticotherapy. We conclude that the neurological attack associated with this acute posterior multifocal placoid pigment epitheliopathy is most likely due to a cerebral vasculitis.

[Primary herpetic infection after transfixing keratoplasty]

PURPOSE

To describe a case of herpes simplex virus primary infection after a corneal transplantation and to analyse different possible ways by which the infection could have been transmitted.

METHODS

A corneal transplanted patient for a Fuchs dystrophy complains 10 days postoperatively of a flu-like syndrome with keratouveitis. Donor and recipient viral serologies and a polymerase chain reaction analysis of aqueous humor were performed.

RESULTS

An herpetic seroconversion is observed with presence of type I herpes simplex virus (HSV I) nucleic acids in the recipient's aqueous humor. The donor herpetic serology is negative.

CONCLUSION

In this patient, the most probable routes of transmission of the virus are a viral reactivation from the trigeminal ganglion of the recipient, the presence of the virus in the corneal transplant or an external contamination.

Histochemical localization of hyaluronic acid in vitreous during embryonic development

PURPOSE

To determine the chronology of the appearance and localization of hyaluronic acid (HA) in mouse vitreous during the embryonic and early postnatal stages of development and in human vitreous during early embryonic development.

METHODS

A histochemical method using the specific affinity for HA of a bovine cartilage proteoglycan was used on mouse eyes at embryonic (11 to 18 days) and early postnatal (8 and 18 days) stages. The same technique was applied to human embryonic eyes of 6, 8, 9, and 10 weeks.

RESULTS

In the mouse, HA is detected early (12-day embryo stage) in the equatorial vitreous and in the internal portion of the corresponding retinal epithelium, behind the anterior rim of the optic cup. Later in development, HA staining extends temporarily to the posterior vitreous and to the internal layers of the posterior retinal epithelium. In human embryos, HA staining is clearly visible in the posterior vitreous and in the equatorial vitreous, where it is more intense at all the developmental stages. From the 8-week stage onward, the internal layers of the developing retina are also heavily stained.

CONCLUSIONS

HA appears very early in developing vitreous of mice and humans, and staining is observed first and predominantly in the equatorial portion of the vitreous. In contrast to human embryos, HA staining in the posterior mouse fetal vitreous is only faint and transient. In both species, staining of the internal layers of the retinal epithelium is detected in the presumptive ciliary body region and in the more posterior retina. The observed temporal and regional simultaneous localization of HA staining in the vitreous and the internal layers of the retinal epithelium is suggestive of a possible role for these cells in the production of the molecule.

[Sympathetic ophthalmia versus Harada disease]

An algerian woman presents with a panuveitis of the right eye. Main features of this uveitis are exudative retinal detachments. That happened several months after a corneal ulcer of unknown aetiology on the left eye. Immunologic, neurologic and infections workup associated with previous ocular injury points to the diagnosis of sympathetic ophthalmia. However, the diagnosis of Harada disease can also be considered in this case because of similarities regarding the clinical and the histologic aspects which are exposed. If corticosteroids are the drug of choice, enucleation is still indicated for sympathetic ophthalmia.

Overlap of sarcoidosis and rosacea

Numerous descriptions have been applied to rosacea-like eruptions of the face, some of them remaining of questionable nosologic significance. A case of rosacea-like syndrome with lacrimal, ocular and salivary involvement is described. The differential diagnosis and therapeutic response of this unusual association are discussed.