[Rosacea-like demodicidosis and chronic blepharitis]. / Démodécie rosacéiforme et blépharite chronique.

Demodicidosis is a parasitic skin disease caused by the follicle mites Demodex sp. In this article, we present a case of rosacea-like demodicidosis, discuss the clinical features of Demodex infestation in man and review their diagnosis and therapeutic modalities. A 37-year-old woman presented in our department with chronic blepharitis present for one year. On physical examination, the patient presented blepharitis and papulovesicles with fine scaling limited to the face. There was no telangectasia. The patient did not report flushing episodes or any kind of photosensitivity. A diagnosis of rosacea-like demodicidosis and Demodex blepharitis was based on the presence of numerous Demodex folliculorum in the eyelashes and scrapings of skin lesions. The patient was put on topic and oral metronidazole for 2 months and on yellow mercury ointment for 15 days. The course involved disappearance of the facial mites and complete remission without recurrence. Screening for Demodex sp is essential to establish the correct diagnosis and ensure suitable treatment.

Immunohistochemical analysis of vascular endothelial growth factor (VEGF) and p53 expression in pterygium from Tunisian patients.

A pterygium is characterized by abnormal fibrovascular corneoconjunctival tissue. A number of investigations have attempted to elucidate this incompletely understood pathology. Since vascular endothelial growth factor (VEGF) and p53 are known to participate in tumor vascularization, our purpose was to study VEGF and p53 expression in active primary and recurrent pterygium from Tunisian patients. To this end, 15 cases of active primary pterygium and five cases of recurrent pterygium from Tunisia were studied by immunohistochemistry. Antibodies raised against VEGF and p53 were used to analyze the distribution and expression of these markers in pterygium and normal human conjunctiva were used as negative control. VEGF and p53 proteins were found in all cases of primary pterygium in epithelial, fibroblast and vascular endothelial cells. Active primary and recurrent pterygium have different patterns of expression. In primary pterygium, an important variability of p53 and VEGF expression was observed. However, in recurrent pterygium, p53 immunoreactivity was weak to moderate, whereas VEGF immunoreactivity was strong. In normal human conjunctiva, VEGF and p53 expression was weak to negative. The overexpression of VEGF in active primary and recurrent pterygium suggests that angiogenesis may play a role in pterygium pathogenesis and the expression of p53 in active primary pterygium, which might be associated with its mutated form, supports the hypothesis that actinic radiation may be involved in the genesis of pterygium. Thus, VEGF and p53 may be useful biomarkers for understanding the physiopathology of pterygium.

Immunohistochemical analysis of cellular adhesion molecules (ICAM-1, VCAM-1) and VEGF in fibrovascular membranes of patients with proliferative diabetic retinopathy: preliminary study.

PURPOSE: Diabetic fibrovascular membranes are the main pathological changes of proliferative diabetic retinopathy that can cause serious complications leading to blindness. Since the mechanism of fibrovascular membrane development is still unknown, the aim of our study was to identify potential biomarkers for this pathology. To this end, we analyzed the simultaneous expression of ICAM-1, VCAM-1 and VEGF within tissues of diabetic fibrovascular membranes. PATIENTS AND METHODS: Fibrovascular membranes were taken from nine diabetic patients with proliferative diabetic retinopathy. The fibrovascular membrane specimens were analyzed by immunohistochemistry to determine ICAM-1, VCAM-1 and VEGF expression. Controls were collected on nine normal conjunctivas removed during senile cataract surgery. RESULTS: Coexpression of ICAM-1, VCAM-1 and VEGF was found in most of the diabetic fibrovascular membranes studied. Thus, ICAM-1 was positive in eight of nine membranes (82%), VCAM-1 in seven of nine membranes (78%) and VEGF in all the membranes. CONCLUSIONS: The substantial overexpression of adhesion molecules ICAM-1, VCAM-1 and of VEGF suggests that these molecules might contribute to the development of fibrovascular membranes in patients with proliferative diabetic retinopathy, and that they could constitute suitable markers of this pathology.

[Drusen in children: three case studies]. / Les druses papillaires de l'enfant: à propos de 3 cas.

We report three cases of optic disc drusen in children. The children were 5 months, 10 years, and 11 years old. Two of them were male. The optic disc drusen was unilateral in two cases and bilateral in one case. One child had a history of Down syndrome and another one a history of Alagille syndrome. The third child had no particular general history but he had unilateral high myopia with optic disc drusen in the same eye. Fundus examination showed pseudopapilledema in all three cases; the disc appeared elevated and its margins were blurred. Ultrasonography of the eye demonstrated optic disc drusen in the three cases. Optic disc calcification on CT scan was identified in only one case. In children, optic disc drusen are often buried, leading to pseudopapilledema appearance of the optic disc. Ultrasonography is highly sensitive in detecting optic disc drusen, making more expensive investigations unnecessary.

[Expression of Bax and Bcl-2 apoptotic factors in the conjunctiva of diabetic patients: a preliminary study]. / Expression des facteurs apoptotiques Bax et Bcl-2 dans la conjonctive des patients diabétiques: étude préliminaire.

INTRODUCTION: Apoptosis, or programmed cell death, is necessary to multicellular organism survival, in contrast to involuntary necrosis that is devastating for tissue. It is positively or negatively regulated by proteins of the Bcl-2 family. The aim of our study was to analyze the expression of apoptotic factors Bax and Bcl-2 in the bulbar conjunctiva of diabetic patients without retinopathy and to compare it to the expression of these factors in nondiabetic patients. MATERIAL AND METHODS: Twenty-five conjunctival biopsies were obtained from diabetic patients without retinopathy. The ocular fundus and retinal fluorescein angiography results were normal. Normal human conjunctiva was taken from 15 patients undergoing senile cataract surgery. Immunohistochemical analysis was performed using indirect immunoperoxidase with antibodies against Bax and Bcl-2. RESULTS: In the human diabetic conjunctiva, The Bax protein was highly expressed in all specimens (100%). It was distributed in epithelial cells, vascular endothelial cells, fibroblasts, and inflammatory cells. The Bcl-2 protein was always at a low level or absent. In normal conjunctiva, Bax showed a significant level, whereas Bcl-2 showed no trace of positivity. CONCLUSION: Bax is often localized in tissues characterized by an elevated rate of apoptosis; in contrast, Bcl-2 is absent in these places. Our results suggest that diabetic human conjunctiva, with its inflammatory and cicatricial phenomena, is a privileged target for apoptotic cell death.

[Which is the role of parasites and yeasts in the genesis of chronic blepharitis?]. / Quel est le rôle des parasites et des levures dans la genèse des blépharites chroniques?

INTRODUCTION: The chronic blepharitis is a current ophthalmic disease posing a therapeutic problem. The etiologic diagnosis is essential for adapting the treatment. PURPOSE: The aim of this study is to describe the role of Demodex sp, Malassezia sp and Candida sp in the pathogenesis of chronic blepharitis. PATIENTS AND METHODS: It's a prospective study realized during a period of 14 months. It interested 69 patients with chronic blepharitis and 96 controls. The prevalence of Demodex sp, Malassezia sp and Candida sp on the eyelash of chronic blepharitis patients and controls was investigated. RESULTS: Demodex folliculorum was found in 58% of patients with chronic blepharitis and in 15,6% of controls. The difference between the two groups was statistically significant (P<0,00001). The sex and the age intervene neither in the frequency, nor in the abundance of D. folliculorum in the two groups. Malassezia sp was identified in 10,4% of the control group and 31,88% of the group with chronic blepharitis. The difference is significant (P<0,00001). There is no correlation between frequency and abundance of Malassezia, sex and age in the two groups. CONCLUSION: In our study, D. folliculorum and Malassezia sp seem to be accused in the genesis of the chronic blepharitis. Their systematic search is necessary in order to adapt the treatment.

[Expression of intercellular adhesion molecule type 1 in the conjunctiva of diabetic patients: a preliminary study]. / Expression de la molécule d'adhésion intercellulaire de type 1 au niveau de la conjonctive des patients diabétiques: une étude préliminaire.

PURPOSE: Recent research has incriminated adhesion molecules in the pathogenesis of diabetic retinopathy. These molecules have been found to be expressed in many cells participating in inflammatory processes and neovascularization. The purpose of our investigation was to study the expression of intercellular adhesion molecule type 1 (ICAM-1) in the conjunctiva of diabetic patients without retinopathy in comparison with normal human conjunctiva. PATIENTS AND METHODS: Fifteen conjunctival biopsies were obtained from diabetic patients without retinopathy. The ocular fundus examination and retinal fluorescein angiography were normal. The normal human conjunctiva were taken from five patients undergoing senile cataract surgery. Immunohistochemical analysis consisted of indirect immunoperoxidase using the monoclonal antibody ICAM-1. RESULTS: The adhesion molecule ICAM-1 was immunolocalized in epithelial, vascular endothelial, and inflammatory cells. The expression of this molecule was different in diabetic patients for the same duration. In the normal human conjunctiva, the expression of ICAM-1 was very low. CONCLUSION: This preliminary study shows that ICAM-1 is present in the conjunctiva of diabetic patients without retinopathy and thus may add new insights into the pathogenesis of diabetic retinopathy.

[Central serous chorioretinopathy in a kidney transplant patient]. / Choriorétinite séreuse centrale chez un patient greffé du rein: à propos d'un cas.

We report a case of central serous chorioretinopathy in a patient who received a kidney transplant for chronic renal failure. We describe clinical and angiographic particularities and the progression of central serous chorioretinopathy in this case. Many factors can be involved in the occurrence of central serous chorioretinopathy in patients with kidney transplants, especially the hemodynamic problems related to renal failure and to the arterial hypertension that are often associated, the stress due to transplantation surgery, and the long-term corticotherapy prescribed postoperatively.

[Analysis of optic nerve head by confocal scanning laser ophthalmoscope in ocular hypertension]. / Analyse de la topographie de la tête du nerf optique par l'ophtalmoscope laser à balayage confocal dans les hypertonies oculaires.

PURPOSE: To analyze optic nerve head topography using confocal the scanning laser ophthalmoscope (CSLO) in ocular hypertension in comparison to normal eyes. PATIENTS AND METHODS: We examined 25 patients with ocular hypertension and 27 normal controls. All of them had a complete ophthalmic examination. Optic nerve head analysis was performed by using a CSLO-type Heidelberg retina tomograph (HRT). The following stereometric parameters were evaluated: disc area, area and volume of cup, cup/disc ratio, area and volume of neuroretinal rim, mean and maximal cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and retinal nerve fiber layer (RNFL) cross-section area. RESULTS: In ocular hypertension eyes, rim volume, height variation contour and RNFL thickness showed a statistically significant reduction compared to normal eyes. CONCLUSION: HRT appears to be an important tool in detecting early damage of retinal nerve fiber layer in ocular hypertension.

[Patients' opinions about day cataract surgery in a general hospital]. / Opinion des patients sur l'hôpital de jour pour la chirurgie de la cataracte au sein d'un hôpital général.

OBJECTIVE: To evaluate the patient satisfaction as a performance indicator of quality of health care delivery in outpatient cataract surgery. PATIENTS AND METHODS: We performed a prospective study using a questionnaire containing 14 items (preoperative work-up, administrative formalities, local anesthesia..) evaluating all the phases of ambulatory surgery for cataract. RESULTS: We collect 75 responding patients and we observed 2/3 of relative satisfaction about outpatient cataract surgery. Negative opinion was in relation with the prolonged time required for preoperative work-up which is done outside the outpatient surgery structure. CONCLUSION: Advances in techniques of locoregional anesthesia and surgery permit today the frequent use of ambulatory treatment in cataract surgery. This method seems to be well accepted by patients. However the prolonged time used to do the preoperative work-up require in the future a centralisation for this procedure.