[Pathomimia in ophthalmology: We must acknowledge it!]. / La pathomimie en ophtalmologie : il faut y croire !

Pathomimia is an unconscious falsification of physical manifestations. The eyelids and ocular surface are almost always affected because of the easy accessibility to these structures for the purpose of attracting attention from one's entourage as well as the medical community. We report four cases of lid and conjunctival pathomimia. The diagnosis was made after a long follow-up and numerous ancillary tests.

[Langerhans cell histiocytosis located in the orbit]. / L'histiocytose Langerhansienne a localisation orbitaire.

Langerhan's cell Histiocytosis of the orbit. Langerhan's cell Histiocytosis is a rare condition that affects children and less frequently young adults. It is characterized by a proliferation of histiocytes derived from Langerhan's cells. Orbital involvement is described in 20% of cases where orbital eosinophilic granuloma located in the frontal bone is the most frequent. The malignant nature of this disease is not established. Its evolution is unpredictable and spontaneous regression after simple biopsy were described. The authors report four cases of Langerhan's cell Histiocytosis and will discuss on the clinical and radiological aspects as well as on the evolution of orbital histiocytoses X.

[Langerhans-cell histiocytosis of the orbit. A case study]. / Histiocytose langerhansienne à localisation orbitaire. A propos d'un cas.

PURPOSE: Langerhans' cell histiocytosis is a rare disease representing less than 1% of orbital tumors. METHODS: We report a case of Langerhans cell histiocytosis with orbital involvement in a 9-year-old boy. He presented with an inflammatory swelling if the left lateral orbital wall. The computed tomographic scan revealed an orbital cellular mass with lytic bone lesion within the orbital roof and intracranial enlargement. RESULTS: The cytological study after a biopsy showed infiltrates of histiocytes derived from Langerhans cells. Diagnosis was confirmed by immunohistochemistry, which identified positive staining with anti-S100 and anti-CD1a antibodies. The rapidly expanding orbital tumor, posing a threat of ocular compression as well as intracranial spreading, was treated by chemotherapy (Vinblastine) combined with a steroid. CONCLUSION: A 2-year follow-up showed no evidence of recurrence or systemic involvement. According to this observation, the authors describe the clinicopathological and histological features of orbital involvement in Langerhans cell histiocytosis.

[Diagnostic difficulties in pigmented tumor of the optic nerve head. A case report]. / Difficultés diagnostiques face à une tumeur papillaire pigmentée. A propos d'un cas.

Melanocytoma of the optic disc is a benign pigmented tumor located on the optic nerve head. Most cases are visually asymptomatic but in rare cases it can cause visual loss, which does not necessarily involve malignant transformation. We present a case of melanocytoma in a 49-year-old woman who presented with decreased vision in her left eye. The pigmented mass was in close continuity with the juxtapapillary adjacent choroid. Fluorescein angiography demonstrated hypofluorescence with adjacent disc edema. Ultrasonography disclosed a high internal reflectivity mass in the optic nerve head without retrobulbar extension. Magnetic resonance imaging (T1 weighted images) disclosed a hyperintense signal on the optic nerve head. The tumor was stationary for 20 months. This report emphasizes problems differentiating a melanocytoma from malignant melanoma of the optic nerve. Unusual features of melanocytoma (superior nasal location in the optic disc with an adjacent choroidal component, a decrease in visual acuity and disc edema surrounding the tumor) are discussed. Visual loss can be induced by optic neuropathy or retinal vascular obstruction. Melanocytomas grow very slowly over several years or remains stable, in contrast to malignant melanoma. In suspicious cases, close follow-up with serial fundus photographs is essential, although malignant transformation is exceptional.

[Isolated hypertrophy of the superior oblique muscle in Basedow disease]. / Hypertrophie isoleé du muscle oblique supérieur d'origine basedowienne.

INTRODUCTION: Proptosis is the most common feature of Graves' ophthalmopathy. We report an exceptional case of proptosis in relation with an isolated enlargement of the superior oblique muscle in Graves' ophthalmopathy. OBSERVATION: After ocular contusion a 37 years old man presented a progressive right exophthalmos. On examination there was an unilateral proptosis with dilated conjunctival vessels, without any clinical signs of inflammation and no decreased vision. Ocular movements were full. On general examination signs of hyperthyroidism were present. CT-scan showed a superior oblique muscle enlargement with enlarged superior ophthalmic vein. Cerebral angiography excluded the diagnosis of a carotid-cavernous fistula. Dosage of thyroid hormone revealed hyperthyroidism. DISCUSSION: This case has a double interest: --Diagnostic: a CT-scan picture mimicking a carotido-cavernous fistula in this particular clinical context (history of ocular trauma, enlarged conjunctival vessels). --Isolated enlargement of superior oblique muscle in Graves' disease, which is exceptional in the literature.

125I plaque brachytherapy for anterior uveal melanomas.

PURPOSE: To describe the results of 125I plaque brachytherapy of uveal melanomas anterior to the equator in terms of local control and the associated complications while trying to identify their risk factors (patients' demographic data, ocular, and tumour characteristics). METHODS: Retrospective analysis of a series of patients treated by 125I between 1990 and 2000 in a single institution. The main outcome measures are evaluation of local tumour control and complications associated with 125I plaque brachytherapy of these melanomas. RESULTS: During the study period, 136 patients were treated for an anterior tumour. The median follow-up was 62 months. The overall 5-year survival rate was 88.3%, the 5-year metastasis rate was 4% and the local recurrence rate was 1.5%. The mean final visual acuity was 20/40. The ocular complications most frequently observed at 5 years were cataract (50.3%), maculopathy (18.3%), intraocular inflammation (19.3%), and glaucoma (10.6%). Optic neuropathy, retinal detachment, keratitis, and intravitreous haemorrhage were also described. Risk factors for worse survival were age greater than 65 years and initial tumour thickness greater than 4 mm. Risk factors for the development of cataract were age more than 65 years old, male gender, and tumour diameter of more than 10 mm. Risk factors for intraocular inflammation were tumour thickness of more than 4 mm and invasion of the ciliary body. CONCLUSIONS: The use of 125I plaque brachytherapy to treat melanomas situated anterior to the equator allows good local and systemic control with a low rate of macular and optic disc complications. The most frequent complication was cataract formation.

[Solitary retinal astrocytic hamartoma simulating retinoblastoma]. / Hamartome astrocytaire isolé simulant un rétinoblastome.

Retinal astrocytic hamartoma and retinoblastoma may be very similar clinically and their differentiation in atypical cases can be difficult, even with the use of ultrasonography and computed tomography. In such cases, a close follow-up is recommended before enucleation. This paper reviews the case of a 18 month old girl who presented with a solitary retinal astrocytoma of the right eye, without any other physical or ocular disorder. The initial presentation simulated a retinoblastoma; nevertheless atypical patterns as yellow calcifications and the lack of tortuous and dilated feeding blood vessels were present. Ophthalmoscopic and ultrasound regular evaluation did not reveal any change after one year follow-up. Additional investigations performed in order to exclude tuberous sclerosis (neurological and dermatological examination, CT-scans) showed no other organ involvement, which ruled out a phakomatosis. The clinical appearance and course of astrocytic hamartomas, its differential diagnosis from other retinal tumors, especially retinoblastoma, and its association with tuberous sclerosis are discussed.

[Melanoma of the iris and pregnancy]. / Mélanome de l'iris et grossesse.

Iris melanoma is a malignant melanocytic tumor, making up 1.2%-6.6% of uveal malignant melanomas. The growth of choroidal melanoma during pregnancy is described and a hormonal influence is suggested. We present a case of iris melanoma occurring during pregnancy. A 32-year-old woman, in the 28(th) week of her fifth pregnancy, was referred to the ophthalmologist with a 2-month history of blurred vision and pain in her left eye. The visual symptoms became progressively worse with decreasing vision. Her visual acuity was 20/70 in her left eye, with a temporal, pigmented, prominent iris mass extending into the trabecular meshwork and the corneal endothelium. Elsewhere other pigmented localizations were found in the iris and in the trabecular meshwork. There was secondary glaucoma with intraocular pressure of 36mmHg and C/D=0.9. The right eye was normal. A general physical examination found no pigmented lesions. Chest radiography and hepatic ultrasonography revealed no metastasis. The diagnosis of iris malignant melanoma was made from the diffuse involvement extending into the trabecular meshwork and the advanced secondary glaucoma; an enucleation was performed and histopathological examination confirmed the diagnosis of iris melanoma with involvement of the trabecular meshwork. The patient had no further problems (follow-up of 11 months). From this case report, we discuss the differential diagnosis of iris melanoma and the hormonal influence on its growth.

[Cutaneous leishmaniasis of the lid]. / Localisation palpébrale des leishmanioses cutanées.

We report 3 cases of patients presenting with lid cutaneous leishmaniasis in which clinical presentation was a true diagnostic problem. The patients were 3 women aged 46, 36, and 60 years. The first patient presented with an ulceration of the superior eyelid that had been treated as chalazion. The second patient had a chronic lesion of the eyelid, present for 1 year, fitting the criteria for tuberculosis, syphilis, or sarcoidosis. The last patient had an erosive lesion of the internal canthus, which was suspicious of basal cell carcinoma. The presence of other cutaneous lesions and the chronic progression led to a biopsy for anatomopathology and parasitology analysis. These analyses confirmed the diagnosis of cutaneous leishmaniasis. The patients were then treated with antimony derivatives. Progression of the disease was marked by the appearance of a pigmented nonretractile scar. The different clinical characteristics, epidemiology, and treatment of this affection are reviewed.

[Ophthalmic manifestations of acute leukemia]. / Manifestations ophtalmologiques des leucémies aiguës.

Orbital and ocular lesions are the third most frequent extramedullar locations of acute leukemia after the meninges and testicles. These lesions are treated as a central nervous system lesion; therefore diagnosis is essential to therapeutic adjustment. We present a retrospective study on charts of children treated for acute leukemia between 1996 and 1998. Ophthalmic examination was carried out when there were ocular symptoms. One hundred ninety-six children were treated for acute leukemia. Twelve children (6.1%) had an ocular and orbital lesion: 7 boys and 5 girls, with an average age of 6 years. Six had acute lymphoblastic leukemia, 6 had acute myeloid leukemia. Visual acuity was 1/10 in 9 children. Four children had an initial orbital lesion with a rapidly progressing exophthalmos. The hemogram and myelogram showed a granulocytic sarcoma. Two children who had been previously treated for acute leukemia presented a bilateral anterior uveitis with hypopyon; anterior chamber paracentesis showed blast cells and confirmed the ocular relapse. A corneal lesion was found in 2 children and in 2 cases, the optic nerve had edema; a decrease in visual acuity was the sign of the optic nerve lesion. Two patients had retinal infiltration with hemorrhages in the posterior pole. Prophylaxis consists of intrathecal injection of methotrexate and reinforcement of chemotherapy. Central nervous system irradiation is seldom used in children. Orbital and ocular lesions carry a poor prognosis according to the majority of authors. Two years after diagnosis of the ocular lesions, only 1 of the children studied remains alive.

[Ocular relapse of acute lymphoblastic leukemia]. / Rechute oculaire de leucemie aigue lymphoblastique.

A bilateral leukemic hypopyon can be inaugural in the child's leukemia or reveal a relapse. A five years old child with acute lymphoblastic leukemia presented after 30 months of treatment a bilateral hypopyon. Anterior chamber paracentesis with cytological survey revealed leukemic cells and confirmed the ocular relapse. The treatment included the association of topical corticosteroids, chemotherapy and radiotherapy. This child died unfortunately 16 months later following a medullar relapse. We remind the different clinical aspects of leukemic invasion of the anterior segment and the therapeutic methods for this relapse.

[Medulloepithelioma of the ciliary body. A case report]. / Le médullo-épithéliome du corps ciliaire. A propos d'un cas.

Medulloepithelioma of the ciliary body is an uncommon intraocular tumor occurring during the first year of life. Malignant degeneration may occur. We report the case of a 4-year-old child who presented medulloepithelioma of the left eye disclosed by oesotropia at 2 years of age. Clinically, there was oesotropia, positive light perception and cataract with vascular membrane spreading to the nasal side of the irido-corneal angle. CT scan and ultrasound B revealed a ciliary body tumor involving the sclera and orbital fat. After exenteration, the pathology study reported malignant medulloepithelioma of the ciliary body with scleral extension. No local recurrence or metastasis has been observed at 8 months follow-up. We discuss the clinical, radiological and therapeutic features of this uncommon tumor.

Comments on "On the invertibility of morphological representation of binary images" [and reply].

The authors comments that Charif-Chefchaouni and Schonfeld (see ibid., vol.3, no.6, p.847, 1994) investigated the invertibility of a morphological representation of binary images and determined the necessary and sufficient conditions for its inverse. The authors show that one of the derived necessary conditions is not valid. A counterexample is given to illustrate our observations. Charif-Chefchaouni and Schonfeld reply that the new sufficient condition is proposed for the invertibility of the morphological image representation. A modification of its inverse is subsequently used to derive a new necessary condition for the invertibility of the morphological image representation. A composition of these conditions is finally used to provide a new necessary and sufficient condition under some restrictions for the invertibility of the morphological image representation. These necessary and sufficient conditions form a revision of one of the necessary conditions for the invertibility of the morphological image representation stated in the original paper.

Morphological representation of order-statistics filters.

We propose a comprehensive theory for the morphological bounds on order-statistics filters (and their repeated iterations). Conditions are derived for morphological openings and closings to serve as bounds (lower and upper, respectively) on order-statistics filters (and their repeated iterations). Under various assumptions, morphological open-closings and close-openings are also shown to serve as (tighter) bounds (lower and upper, respectively) on iterations of order-statistics filters. Simulations of the application of the results presented to image restoration are finally provided.

On the invertibility of the morphological representation of binary images.

We investigate the invertibility of the morphological representation of binary images. A criteria for the invertibility of the morphological representation of binary images is proposed. Necessary and sufficient conditions for the exact reconstruction of a binary image from its morphological representation are provided.