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1.
J Fr Ophtalmol ; 27(7): 795-800, 2004 Sep.
Article in French | MEDLINE | ID: mdl-15499278

ABSTRACT

INTRODUCTION: Acute retinal necrosis syndrome (ARN syndrome) is a rare viral disease with a poor prognosis in most cases. It is characterized by substantial ocular inflammation with progressive retinal necrosis, occlusive vasculitis and sometimes extraocular features. CASE REPORT: We report the case of a 62-year-old woman who was referred for a suspicion of a stroke. Ophthalmological examination revealed a profound bilateral visual loss due to extensive retinal necrosis. The patient was immediately treated with antiherpetic drugs. ARN syndrome with meningoencephalitis caused by herpes simplex virus type 2 was confirmed by PCR studies performed on aqueous humor and cerebrospinal fluid. Herpes simplex virus 2 (IgG+ , IgM-) was probably reactivated after intrathecal injection of steroids because of pain associated with narrowing of the lumbar vertebral canal. The patient was treated with intravenous Acyclovir for 3 weeks. After 4 months, both retinas were detached. DISCUSSION AND CONCLUSION: ARN syndrome caused by herpes simplex virus 2 most often occurs after reactivation of the latent virus in patients with a neurological medical history or congenital infection. Antiviral treatment must begin early to decrease risks of bilateralization and complications.


Subject(s)
Diagnostic Errors , Encephalitis, Herpes Simplex/complications , Herpesvirus 2, Human/isolation & purification , Retinal Necrosis Syndrome, Acute/etiology , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Aqueous Humor/virology , Cerebrospinal Fluid/virology , DNA, Viral/analysis , Dexamethasone/administration & dosage , Dexamethasone/therapeutic use , Drug Therapy, Combination , Encephalitis, Herpes Simplex/drug therapy , Encephalitis, Herpes Simplex/virology , Female , Ganciclovir/therapeutic use , Hemiplegia/etiology , Humans , Magnetic Resonance Imaging , Middle Aged , Polymerase Chain Reaction , Retinal Detachment/etiology , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/drug therapy , Retinal Necrosis Syndrome, Acute/virology , Stroke/diagnosis , Urinary Incontinence/etiology , Virus Activation
2.
J Fr Ophtalmol ; 26(1): 31-7, 2003 Jan.
Article in French | MEDLINE | ID: mdl-12610407

ABSTRACT

INTRODUCTION: Iris melanoma, even when a malignant tumor, has a slow progressive course. Surgical treatment is easy because of localization of the tumor but can be accompanied by a range of complications, from photophobia to cosmetic problems. MATERIALS AND METHODS: We reviewed the records of 11 patients with iris melanoma treated by surgical excision with posterior limbus incision. Conventional iridectomy was performed in nine cases and iridocyclectomy in two cases. RESULTS: There were seven females and four males ranging in age from 27 to 76 years. Histologically, 10 tumors were composed of B spindle cells and one was mixed. For all patients, followed up for 1-5 years, final visual acuity was more than 6/10. One patient complained of photophobia and cataract developed in one 76-year-old woman at the end of follow-up. CONCLUSION: Because of the good prognosis of iris melanoma, conservative treatment can be given in most of cases (without local complications). Surgical resection confirms diagnosis after histopathological examination, with good final functional result thanks to scleral tunnel incision, which induces less astigmatism than corneal incisions. In the future, these findings will have to be confirmed by a corneal topography study before and after surgery.


Subject(s)
Iris Neoplasms/surgery , Melanoma/surgery , Adult , Aged , Female , Follow-Up Studies , Humans , Iris/pathology , Iris Neoplasms/diagnosis , Iris Neoplasms/pathology , Male , Melanoma/diagnosis , Melanoma/pathology , Middle Aged , Prognosis , Retrospective Studies , Time Factors , Visual Acuity
3.
J Fr Ophtalmol ; 25(10): 1007-13, 2002 Dec.
Article in French | MEDLINE | ID: mdl-12527823

ABSTRACT

PURPOSE: To assess risk factors, clinical characteristics, diagnosis and outcome in patients with Acanthamoeba keratitis. METHODS: We reviewed 23 patients (25 eyes) treated for Acanthamoeba keratitis in the XV-XX Hospital between November 1994 and October 2000. Acanthamoeba were found either in corneal scrapings and/or contact lenses and/or storage solutions. RESULTS: A predisposing factor was found in 22/23 patients: most of them (20/22) were contact lens (CL) wearers, two patients had a recent history of corneal trauma, and 15/23 patients had been treated for presumed herpetic keratitis before examination in our hospital. The average delay between first symptoms and diagnosis was 2 months. All patients were treated with two or three topical antiparasitic eye drops for 2 to 6 months. Five patients received systemic treatment (ketoconazole or itraconazole). Nine eyes received surgical treatment: penetrating keratoplasty in eight cases, conjunctival flap in one case, enucleation in one case. Visual outcome was poor in ten eyes (less than 20/60) because of delayed diagnosis. CONCLUSION: Acanthamoeba keratitis is a serious vision-threatening disease. Early diagnosis and treatment are essential for improving visual outcome. Methods such as confocal microscopy and Acanthamoeba-PCR, allowing earlier diagnosis and treatment, will improve the management of Acanthamoeba keratitis.


Subject(s)
Acanthamoeba Keratitis , Acanthamoeba Keratitis/diagnosis , Acanthamoeba Keratitis/drug therapy , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Prognosis , Retrospective Studies
4.
J Fr Ophtalmol ; 25(10): 1032-5, 2002 Dec.
Article in French | MEDLINE | ID: mdl-12527827

ABSTRACT

Diffuse uveal melanocytic proliferation is a rare paraneoplastic syndrome resulting in rapid bilateral visual loss in patients with systemic carcinoma, caused by proliferation of benign melanocytes within the choroid and the ciliary body. More often visual impairment is due to retinal detachment and cataract. The authors report two cases of presumed diffuse uveal melanocytic proliferation. The first patient was a 74-year-old man with a history of colic carcinoma and hemangioendothelioma of the liver who presented with bilateral multiple nevi of the choroid and extrascleral melanic nodule. The second patient was a 59-year-old woman who presented bilateral multiple nevi of the choroid and a history of carcinoma of the thyroid treated by thyroidectomy 2 years before. There was no evidence of systemic melanoma in either patient. Our two patients showed slow progression with no visual impairment and a longer survival than those described in the literature.


Subject(s)
Melanocytes/pathology , Paraneoplastic Syndromes/pathology , Uvea/pathology , Aged , Cell Division , Female , Humans , Male , Middle Aged
5.
J Fr Ophtalmol ; 24(9): 971-4, 2001 Nov.
Article in French | MEDLINE | ID: mdl-11912843

ABSTRACT

We report the case of a 54-year-old HIV-seropositive man who was referred to us with unilateral uveitis. The patient had been taking triple antiretroviral therapy (three reverse transcriptase inhibitors) for one week when he presented with blurring of vision in the left eye. Two weeks later, active cytomegalovirus retinitis was suspected after fundus examination and ganciclovir was immediately administered. Even if the CD4 cell count was normal (423/microliter), the diagnosis was confirmed by the presence of CMV in the anterior chamber. This case shows that an elevated CD4 count is not incompatible with CMV retinitis, especially at the beginning of the antiretroviral therapy.


Subject(s)
Cytomegalovirus Retinitis/complications , Cytomegalovirus Retinitis/immunology , HIV Infections/complications , HIV Infections/immunology , CD4 Lymphocyte Count , Humans , Male , Middle Aged
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