[Conjunctival squamous cell carcinoma. Four cases reported in the French West Indies]. / Carcinome épidermoïde conjonctival. A propos de quatre cas aux Antilles.

We report four cases referred to the Ophthalmologic Department of the University Hospital Center of Fort de France for the therapeutic management of a conjunctival malignant tumor. All cases reported involved conjunctival squamous cell carcinoma. All tumors were unilateral, one was localized, another was recurrent, one occurred in a patient with acquired immunodeficiency syndrome, and the last one was seen at the late stage of massive locoregional invasion. Three patients had surgery completed by corneolimbic cryotherapy. The last case was exentered. All of them consulted regularly. These four cases were collected over 5 years in approximately 15,000 patients examined per year in the University Hospital Center of Fort de France. Conjunctival squamous cell carcinoma is rare, even in Martinique, a tropical area. Careful attention to risk factors such as the sun exposure is recommended, as is the histologic diagnosis with any conjunctival tumour, since it changes quickly. The treatment must be adapted to the extension of the disease and to the patient's general health. The high rate of recurrence requires long-term follow-up in corneal and conjunctival intraepithelial neoplasia.

[Melanocytoma of the optic disc. Three case studies]. / Mélanocytome de la papille: à propos de trois observations.

PURPOSE: Melanocytoma is a rare benign tumor that usually occurs as a pigmented lesion in the optic nerve head. It seems to be more frequently encountered in the Black population. We report three cases of melanocytoma observed in Martinique, where 90% of the population is of African origin. OBSERVATIONS: The first and second cases were found on routine ophthalmic examination. These patients had a heavily pigmented lesion that obscured part or all of the optic disc with slight extension into the adjacent nerve fiber layer of the retina. The tumor's margins were finely fibrillated. Fluorescein angiography demonstrated a homogenous hypofluorescent black tumor obscuring the optic disc vessels, with no tumor vessels visible. There were no juxtapapillary choroid vascular abnormalities. The third case was discovered on visual field examination. This melanocytoma was accompanied by papillary edema. CONCLUSION: Only three cases of melanocytoma have been noted from 1994 to 2004 in 150,000 Caribbean patients examined in the University Hospital Center of Fort de France. The rarity of melanoma and the predisposition to melanocytoma are important epidemiologic factors in the etiologic search for pigmented tumor within the Black population. Yearly fundus examination is useful for monitoring growth and detecting malignant transformation.

[Glaucoma screening in Martinique. Results in 813 hospital employees]. / Dépistage du glaucome en Martinique: résultats au sein d'une population de 813 salariés hospitaliers.

INTRODUCTION: Several US and Jamaican studies have shown that glaucoma is more severe in black populations than in Caucasian populations, which would lead to the assumption that the people of Martinique have a high glaucoma risk. METHODS: A prospective study was conducted in workers of Fort de France University Hospital with the occupational medicine unit. Intraocular pressure was measured with a pulse air tonometer (Topcon CT 60) and visual field abnormalities were detected with automated perimetry using Humphrey frequency doubling technology (FDT). Patients with known glaucoma or with intraocular pressure over 21 mmHg and/or a visual field abnormality were referred to ophthalmology examination to diagnose ocular hypertension, open-angle glaucoma or normal-pressure glaucoma. RESULTS: The occupational medicine unit examined 813 workers. The sex ratio was 0.36, mean age was 45.35+/-8.4 years (22-64 years), and mean ocular pressure was 12.1+/-2.62 mmHg (6-28 mmHg). Roughly 20% of workers had a family history of glaucoma. We found 22 patients with glaucoma (2.7%) (CI95: 1.6%-4%): 12 patients had open-angle glaucoma (1.5%) and 10 patients were diagnosed with normal-pressure glaucoma (1.3%). Glaucoma prevalence increased with age, reaching 8% in patients over 55 years of age. Of patients with normal-pressure glaucoma, 42.9% had a family history of glaucoma. CONCLUSION: Our results confirm previous data from the literature that found higher glaucoma prevalence in black people and in particular in the mixed-race population of Martinique. In addition to this ethnic feature, the insularity of Martinique could support glaucoma expression. Easy and fast to use, FDT associated with the pulse air tonometer provides early detection of glaucoma.

[Hypophysis metastasis of a hypernephroma tumor revealed by a chiasma syndrome]. / Métastase hypophysaire d'un hypernéphrome révélée par un syndrome chiasmatique.

In a 45-year-old man with a hypernephroma tumor of the right kidney, a metastasis in the pituitary gland of this neoplasm was diagnosed 9 years after removal of this kidney. He complained of bitemporal hemianopsia and slight impairment of vision. A hypernephroma metastasis in the pituitary gland is very rare and few have been reported to date. In general, these metastases occur in cases with multiple metastasis to many organs, which suggests that the appearance of pituitary metastasis represents extensive disease. Many of these patients present diabetes insipidus. Visual defects are frequently associated. The Goldmann perimeter is important to detect visual field anomalies. MRI is the key radiological exam to localize the tumor. Surgery is the preferred treatment and should be undertaken quickly if visual function is affected. The histological exam should be made to confirm the diagnosis.

[Lisch nodules: description of 2 clinical cases and their significance]. / Les nodules de Lisch: description de deux cas cliniques et signification.

We report two cases of Lisch nodules in both eyes in two women. It was the only ocular manifestation of their Von Recklinghausen disease. The other general signs of their disease were cutaneous neurofibromas. Lisch nodules are melanocytic hamartomas consisting of melanocytic cells containing various quantities of pigment. They can be found in 90 to 100% of neurofibromatosis patients over 6 years of age. They are practically pathognomonic of type 1 neurofibromatosis and their finding is an important diagnostic argument. They must be distinguished from other iris nodules: nevus, melanoma, inflammatory nodules, and development anomalies.

Prevalence of open angle glaucoma in a diabetic population in Martinique

OBJECTIVE: To determine the prevalence of open angle glaucoma in a hospital-based sample of diabetic people living in Martinique. DESIGN: Retrospective study during 23 months. PARTICIPANTS: A total of 917 patients were examined and received a complete eye examination for diabetes. MAIN OUTCOME MEASURES: A form was established with all examination data, patient ID, non ophthalmological data (blood pressure, body mass index, type of diabetes...) and ophthalmological data with intra-ocular pressure and optic disc cup. RESULTS: Glaucoma was present in about 9.8 percent of patients and there were 3.28 times more females than male. With regard to the type of diabetes, 1.11 percent were type 1, 18.89 percent were type 2, and 80 percent were insulin treated but not all insulin dependent. The prevalence of diabetic retinopathy is similar in the glaucomatous group and in the non-glaucomatous group. High blood pressure was present in 80 percent of glaucoma patients versus 58.8 percent in the non-glaucoma group. CONCLUSION: This 9.8 percent prevalence of glaucoma is the only data on open angle glaucoma so far available in Martinique. High blood pressure is a main risk factor for glaucoma in Martinique. Diabetes represents also a risk factor for glaucoma in Martinique. The sex ratio showed 3 times more females than males in the diabetic population. (AU)

[Prospective study of eye burns at the Fort de France University Hospital]. / Etude prospective des brûlures oculaires par bases au CHU de Fort de France.

PURPOSE: We report the results of a three-years prospective study focusing on ocular alkali burns conducted in the University hospital of Fort de France (French West Indies). PATIENTS AND METHODS: This case record survey included all alkali burns evaluated by ophthalmologists in the emergency unit of the Fort de France hospital. All recruited patients were either called to identify the alkali (pH determined with a Prolab pH-meter) or underwent an anterior chamber puncture showing evidence of an aqueous humor pH above 8. The recorded data were: age, gender, cause of burn, in case of aggression the relation between the victim and the aggressor, initial clinical findings, Ropper Hall classification. The therapeutic protocol was initiated according to this classification. The course of the ocular burn was noted. Economical and medicolegal consequences were assessed from duration of off work time and from information provided by the public prosecutor respectively. RESULTS: Twenty-four patients who had 39 burned eyes were included. Most ocular burns (18) were caused by aggressions with Alcali (ammonia, pH = 12.8). Most victims were men accused of adultery. In the West Indies, Alcali is thought to have power to drive away evil spirits. Most victims were young men (mean age 42 years). Eight court suits have been filed and in 5 cases the judge dismissed the charge. In 13 eyes, the delay to the first ocular wash was 30 minutes and resulted in serious ocular burn (Ropper Hall class 3 or 4). After application of the therapeutic protocol, 6 of these eyes recovered in an average 55 days; 3 required limbal autograft, 2 were successful. Three of these severe burns were complicated by spontaneous perforation (1 eye), atrophy (1 eye), and leucoma (1 eye). One patient was lost to follow-up. All minor ocular burns (Ropper Hall class 1 and 2) healed within an average 12 days (range 3-38 days). CONCLUSION: Particular circumstances of ocular alkali burns in Martinique (French West Indies) have been indentified in this study which established the seriousness of these burns and their social and sometimes legal consequences. The importance of prevention is emphasized. It would seem that minor ocular alkali burns do not require a treatment duration longer than 15 days. Finally, the clinical data reported in this study show that a delay of several minutes is required for the development of severe ocular alkali burns.

[Benign intracranial hypertension. Retrospective study of 20 cases]. / Hypertension intracrânienne bénigne. Etude rétrospective de 20 cas.

PURPOSE: We conducted a retrospective study in 20 cases of idiopathic intracranial hypertension (IIH) referred to the ophthalmology out-patients department at the Centre Hospitalier Universitaire of Fort de France. The objectives were to characterize symptomatology, severity, disease course and to discuss treatment. METHODS: We performed a complete ophthalmological and neurological examination, calculated the body mass index (BMI) and evaluated visual field. Each patient underwent a CT scan with injection and a lumbar punction with measurement of cerebrospinal fluid pressure. We also specified the treatment chosen and its duration, and the number of recurrences. RESULTS: This study included 20 cases, 19 women and 1 man, with a mean follow-up of 28.6 months. The average BMI was of 32.2 kg/m2. Fifteen patients out of 20 were obese (75%), all of them women, so 79% of the women were obese. Sixteen patients had headache (80%), 15 a loss of visual acuity (75%) and 5 transient visual loss (25%). For all the clinical examination showed bilateral papilloedema. Visual field disturbances were observed in 11 patients (73.3%). Papilloedema disappeared after medical treatment of a mean 2.4 months duration for each access. In 9 cases of 18 (50%) recurrences were observed after gradual treatment with-drawal. CONCLUSION: The long-term treatment, the side effects, the possible severity of the ocular disease, the difficulties of dietary restriction and the high rate of recurrence, would, for us, indicate a need to reconsider surgical treatment. We propose to perform lumboperitoneal shunt or optic nerve sheath decompression if medical treatment fails at the first onset of IIH or in case of severe visual loss, pregnancy or recurrence.

[Juvenile glaucoma. Seven case reports]. / Le glaucome juvénile. A propos de 7 cas.

BACKGROUND: Juvenile glaucoma is an uncommon form of chronic open angle glaucoma that appears between 3 and 35 years of age. METHODS: We report in this study seven cases of juvenile glaucoma that occurred in patients melanoderma. RESULTS: Three of them had unilateral blindness and in two others visual acuity was reduced to light perception in one eye. The intraocular pressure is above to 30 mmHg in 64.3% of the cases and a myopia was frequently associated. CONCLUSION: The insidious development of this pathology and the difficulty of its diagnosis among children often result in severe clinical manifestations with high visual field defects and optic disc cuppings particularly in melanoderma patients. Recent studies have proved autosomal dominant transmission with variable penetrance for one kind of juvenile glaucoma and location of the defective gene on chromosome 1q.

[Dysthyroid optic neuropathy. Apropos of 2 cases]. / Neuropathie optique dysthyroïdienne. A propos de deux observations.

Among 50% of patients with hyperthyroidism develop manifestations of ophthalmopathy and there are between 2% and 5% with severe Graves' ophthalmopathy. The optic neuropathy is a complication of Graves' disease and can be very dangerous for the visual acuity and the treatment must be very fast. We report two cases of severe Graves' ophthalmopathy observed in two black patients from Martinique (French West Indies). Orbital irradiation can be choosed after initial unsuccessful treatment with corticotherapy and before a surgical decompression. These three therapeutics can be combined together according to the results of the treatment and require a real coordination between ophthalmologists, endocrinologists and radiotherapeutists as well as a good cooperation from the patient himself.

[Isolated blow out fracture of the medial wall of the orbit with medial rectus entrapment. Apropos of 3 cases]. / Fracture isolée de la paroi interne de l'orbite par "blow out" avec incarcération du muscle droit interne. A propos de trois cas.

We report three cases of isolated medial orbital wall blow out fracture with medial rectus entrapment. Few cases have been reported in the literature, predominantly in black people as in this paper. Predominance of this rare fracture in black population could be explained by an anatomic hypothesis based on racial origin. The diagnosis is often suggested by the medial rectus entrapment. Depending on the position of the incarceration in front of or behind the equator of the eyeball, the eye presents pseudo-Duane syndrome or exotropia with decreased adduction. The diagnosis is established by orbital computed tomography visualizing the lamina papyracea of the ethmoid bone fracture and the medial rectus incarceration. This exceptional fracture must be detected to avoid complications: enophthalmos and motility disturbances.

[Ocular burns caused by latex from manchineel trees]. / Brûlures oculaires par le latex de mancenillier.

OBJECTIVE OF THE STUDY: The objective of this study is to enter on an inventory and to appreciate the severity of the ocular burn caused by the latex of manchineel tree and to propose a therapeutic attitude. MATERIAL AND METHOD: We report on the results of a prospective study included 11 patients examined in the Department of Ophthalmology (Centre Hospitalier Universitaire de Fort-de-France) between November 1992 and November 1993. All of them presented with ocular burn due to a contact with the latex of the manchineel tree. RESULTS: The study included 11 patients, 8 adults and 3 children, the mean age was 22.9 years (range 4-40). All of them had hyperhemia and conjunctival erosions of various intensity. Ten patients had corneal lesions: superficial punctate keratitis in 5 cases and corneal ulcers in 5 cases. Three cases of corneal ulcerations were associated with an inflammatory reaction of the anterior segment. Both eyes were affected in 4 cases (37%), and only the right one in the other cases (63%). Seven patients had cutaneous lesions (63%), of whom 4 periocular burns of superficial second degree. Full recovery was obtained within 15 days for all the patients. CONCLUSION: Ocular lavage is the first treatment, as for all chemical burns. Local antibiotherapy is used systematically to prevent superinfection. With a proper treatment, a complete recovery with no sequelae is obtained.