[Surgical treatment of eyelid tumors]. / Traitement chirurgical des tumeurs palpébrales.

After reviewing the general principles of eyelid reconstruction, the authors present reconstruction techniques with regard to the location and size of the eyelid defect. When the defect is less than one-quarter of lid length, direct suture is possible. When the defect is larger, reconstruction techniques differ for the upper and lower lid.

[Intraocular high pressure in thyroid-associated orbitopathy: physiopathological mechanisms, diagnosis, and management. Three case reports]. / Hypertonie oculaire dans l'orbitopathie dysthyroïdienne: considérations physiopathologiques, diagnostiques et thérapeutiques. A propos de trois cas significatifs.

PURPOSE: To determine the mechanisms and treatment of ocular hypertension in patients with thyroid-associated orbitopathy and to differenciate it from glaucomatous damage. DESIGN: Three case reports. METHODS: Retrospective review of clinical findings, course, and treatment of the three patients. RESULTS: Elevated intraocular pressure in thyroid-associated orbitopathy observed in the three cases may involve different physiopathological abnormalities such as disturbances of venous circulation, compression by infiltrative muscles, and long corticosteroid use. In the first two cases, defects demonstrated in the perimetry are in consistent with glaucomatous damage. In the third case, visual field abnormalities may be compatible with a glaucomatous disease, but all defects resolved after therapy. Treatement was of the greatest difficulty for the three cases, associating antiglaucomatous medication, steroids, orbital radiotherapy, orbital decompression and extraocular muscle surgery. Intraocular pressure was controlled in all cases. CONCLUSIONS: Elevated intraocular pressure in thyroid-associated orbitopathy is distinguished from glaucomatous disease by its physiopathological mechanisms, clinical course, visual field defects, and treatment. The management of this hypertension is closely related to the treatment of dysthyroid orbitopathy.

[Orbital metastasis in malignant melanoma]. / Métastases orbitaires de mélanome malin.

We report the case of a 60-year-old man presenting bilateral progressive proptosis with diplopia, weight loss, tachycardia, nervosity, and stomach pain. These signs seemed at first to favor a diagnosis of Graves'ophthalmopathy. Thyroid tests were negative and the initial orbital CT scan was considered normal. A new radiological investigation 4 months later in our hospital revealed typical hypertrophy of the extraocular muscles compatible with orbital metastasis. The systemic investigations demonstrated a pulmonary tumor, multiple hepatic lesions, and several pigmented nodules of gastric mucosa. The pathology of pulmonary and gastric specimens confirmed the diagnosis of malignant melanoma. The primary lesion remains unknown. The authors discuss the differential diagnoses of orbital metastasis and the radiological characteristics of orbital metastasis in malignant melanoma.

[Enucleation with on-the-table evisceration. Is it a good technique?]. / L'énucléation avec éviscération sur table. Est-elle une bonne technique?

PURPOSE: To evaluate the surgical technique of enucleation followed by an "on-the-table evisceration" and placement of a hydroxyapatite orbital implant wrapped by the patient's own sclera for the treatment of blind phthisis painful eyes. PATIENTS AND METHODS: In this single-center retrospective study, 50 consecutive patients undergoing an operation using the same surgical technique, between April 1993 and November 1999, were studied. Patients underwent enucleation, then the eyeball was eviscerated "on the table". The patient's own cleaned sclera was used to wrap a hydroxyapatite orbital implant, the posterior pole of the sclera was placed at the anterior pole of the implant. Conjunctival breakdown, sphere size, conjunctival discharge, the first signs of sympathetic ophthalmia motility, and cosmetic results were analysed. RESULTS: After an average follow-up of 13.3 months few complications were encountered: 4 cases (8%) of inclusion cyst and 3 cases (6%) of discharge. The implant placed had a diameter of 18 mm, 20 mm, 22 mm in, respectively, 48%, 48%, and 4% of the eyes. The prosthesis motility was good, medium, and poor in, respectively, 33 (78.6%) cases, 8 (19%) cases, and 1 (2.4%) case. The prosthesis tolerance was good, medium, and poor in respectively 86%, 10%, and 4% of the cases. CONCLUSION: The surgical technique of enucleation followed by an "on-the-table" evisceration and autologous sclera wrapping a hydroxyapatite implant is an easy procedure. It allows, on phthisis eyeballs, the placement of a large orbital implant for good cosmesis results, without major complications.

[Orbital exenteration]. / L'exentération orbitaire.

Exenteration of the orbit is a disfiguring and destructive procedure that is usually reserved for treatment of life-threatening orbital malignancy when a less radical operation such as local surgery, chemotherapy, or irradiation are deemed inadequate or have failed. Many methods have been published for managing the socket, but of primary importance is the need to remove all diseased tissue prior to considering any reconstructive efforts. Options include spontaneous granulation, skin grafting, or muscle flaps. This article will describe the development and the indications for this procedure and will outline the surgical techniques and its complications, the various reconstructive efforts, and survival. The success of orbital exenteration depends on recurrence, histological type, tumor size, and tumor-free margins.

Coordinate copper- and oxygen-responsive Cyc6 and Cpx1 expression in Chlamydomonas is mediated by the same element.

Chlamydomonas reinhardtii activates the transcription of the Cyc6 and the Cpx1 genes (encoding cytochrome c(6) and coprogen oxidase) in response to copper deficiency. Mutational analysis of promoter regions of the Cyc6 and Cpx1 genes revealed a four nucleotide sequence, GTAC, which was absolutely essential for copper responsiveness. The Cyc6 promoter contains two copper response elements, each with a functionally important GTAC sequence, whereas the Cpx1 promoter contains only one. This may contribute to the stronger and more tightly regulated expression of the Cyc6 gene. Mutation or deletion of sequences flanking the GTACs implicates additional nucleotides contributing to copper-responsive expression, but none are absolutely essential. Metal ion selectivity of Cpx1 expression is identical to that described previously for Cyc6 and is restricted to the copper deficiency-induced Cpx1 transcript. The Cyc6 and Cpx1 genes are also induced by oxygen deficiency. Reporter gene constructs indicate that the induction occurs at the level of transcription and requires the same GTAC sequence that is critical for copper responsiveness. We suggest that components of the copper-responsive signal transduction pathway are used for some of the changes in gene expression in hypoxic cells.

[Meibomian adenocarcinoma in its blepharo-conjunctival form. Apropos of a case]. / Adénocarcinome meibomien dans sa forme blépharo-conjonctivale. A propos d'une observation.

A case of Meibomian carcinoma of the left eyelid was observed in a 53-year-old-female patient. SHe had been previously treated for chronic unilateral blepharoconjunctivitis; an excisional biopsy disclosed a Meibomian carcinoma. First a total resection of both left eyelids was performed with plastic reconstructive surgery, three months later a recurrence required an orbital exenteration. This case underlines the interest of an early diagnosis which allows a more conservative treatment. The diagnosis must be kept in mind in any case of chronic unilateral blepharoconjunctivitis; histopathology has a key role in the diagnosis of Meibomian carcinoma.

[Cholesteatoma of the orbit: a rare etiology of orbital tumor]. / Le cholestéatome de l'orbite: une étiologie rare de tumeur orbitaire.

The authors report on the diagnosis and treatment of a rare and benign orbital tumor (cholesterol granuloma) in a 40 year-old man. They separate, clinically and histologically, cholesterol granuloma from epidermoid cholesteatoma.

[Supra-tarsus sulcus. Treatment by silicone prosthesis]. / Le creux supra-tarsal. Traitement par prothèse de silicone.

In the anophthalmic socket, the deep superior eyelid sulcus is a quite common syndrome; sometimes with ptosis of the upper eyelid and laxity of the lower eyelid. The treatment by a silicone prosthesis in the deep sulcus fills eyelid volume. The main advantages of this procedure are simplicity and relative harmlessness. The authors relate their technique and the results about 15 cases. The indications are discussed.

[Significance of the "V" syndrome with double "up shoot". Insufficiency of the two superior oblique muscles in craniofacial malformations]. / Signification du syndrome V avec double "up shoot". Insuffisance des deux grands obliques au cours des malformations cranio-faciales.

Craniofacial malformations (telorbitism, craniofaciostenosis, plagiocephalia, Franceschetti's syndrome) are frequently associated with oculomotor anomalies. The most common vertical anomaly is the existence of a "V" syndrome with double "up shoot", with deficiencies in the two superior oblique muscles. Several mechanisms may be involved in the origin of this anomaly, related to the anatomical orbital malformation: orbital torsion with antimongoloid clefts responsible for a syndrome of macular pseudo-ectopia with extorsion of the 4 rectus muscles; plagiocephalia responsible for sagitallization of the inferior obliques; retromaxillia with exorbitism responsible for modification of muscle contact arches. Muscle agenesis is very rarely observed. The pathogenesis of these different mechanisms is discussed based on a study of 64 cases.

[Treatment of cicatricial ectropions of the eyelids (author's transl)]. / Traitement des ectropions cicatriciels des paupières.

Cicatricial ectropions arise following burns, certain dermatoses, trauma with subsequent development of vicions scar tissue, and after evulsion of the eyelids. Operations on the ocular globe or eyelids may also lead to a cicatricial ectropion, while skin retraction during the advanced stages of ectropion due to hypotonia and congenital ectropions have to be considered as a separate group. Surgical treatment consists of correcting the skin deficiency by means of flaps or grafts, and reconstituting the internal angle when necessary. The principal surgical techniques and the types of flaps employed are described, as well as the indications for therapy as a function of the clinical form.