ABSTRACT
Post-traumatic aniridia is an uncommon complication of blunt ocular trauma. When it is completed, it represents a 360-degree tear from the root of the iris to its insertion into the ciliary body. Since the introduction of the use of corneal micro-incisions in cataract surgery, some cases of complete tear of iris root have been observed in patients who suffered from violent trauma. We report the case of a patient who has a complete aniridia after a fall, 15 years after cataract surgery.
L'aniridie post-traumatique est une complication peu fréquente d'un traumatisme oculaire à globe fermé. Lorsqu'elle est complète, il s'agit d'une déchirure sur 360° de la racine de l'iris à son insertion au corps ciliaire. Depuis l'avènement de l'utilisation de micro-incisions cornéennes en chirurgie de cataracte, la déchirure complète de la racine de l'iris a été observée sur plusieurs patients ayant subi un traumatisme violent. Nous rapportons le cas d'un patient, opéré de cataracte 15 ans auparavant, qui présente une aniridie complète suite à une chute.
Subject(s)
Aniridia , Cataract , Eye Injuries , Phacoemulsification , Aniridia/etiology , Eye Injuries/etiology , Humans , Iris , Phacoemulsification/adverse effectsABSTRACT
Primary open-angle glaucoma is a progressive ocular disease affecting adults and associated with visual field defect. The aim of its treatment is to lower the ocular pressure by means of ocular drops, laser or surgery. To date, traditional surgical techniques still remain quite invasive, but recent research efforts have been made with a view to develop minimally invasive techniques. The Xen Gel Stent is one of them. It allows a safe and efficient lowering of ocular pressure by creating a sub-conjunctival flow, following an ab interno procedure that highly preserves the architecture of the treated eye.
Subject(s)
Glaucoma, Open-Angle/surgery , Stents , Humans , Minimally Invasive Surgical ProceduresABSTRACT
Bilateral Acute Iris Transillumination (BAIT) is a new clinical entity characterized by acute onset of pigment dispersion in the anterior chamber and angle, depigmentation of the iris stroma and permanent iris transillumination, masquerading as uveitis. An association with oral moxifloxacin is reported in some articles. We describe one case of bilateral acute iris transillumination, following the use of systemic moxifloxacin.
La Transillumination Irienne Bilatérale Aiguë (TIBA) est une nouvelle entité clinique, caractérisée par une dispersion pigmentaire aiguë en chambre antérieure et dans l'angle iridocornéen, une dépigmentation du stroma irien et une transillumination irienne définitive, mimant une uvéite antérieure. Une association avec un traitement systémique par moxifloxacine est relatée dans plusieurs articles. Nous rapportons un cas de transillumination irienne bilatérale aiguë ayant suivi la prise systémique de moxifloxacine.
Subject(s)
Fluoroquinolones/adverse effects , Iris Diseases/chemically induced , Acute Disease , Adult , Bronchitis/drug therapy , Female , Fluoroquinolones/therapeutic use , Humans , Iris/drug effects , Iris/pathology , Iris Diseases/diagnosis , Moxifloxacin , Pigment Epithelium of Eye/drug effects , Pigment Epithelium of Eye/pathologyABSTRACT
Topiramate (TPM) is a drug used in migraine prophylaxis. It is involved in the bilateral angle-closure glaucoma due to idiosyncratic response. This side effect is rare but can lead to irreversible vision loss if it is not recognized in time and if it is not managed immediately by an ophthalmologist.
Le topiramate (TPM) est un médicament utilisé dans la prophylaxie antimigraineuse. Il est impliqué dans le glaucome aigu à angle fermé (GAF) secondaire à une réponse idio-syncrasique. Cet effet secondaire est rare mais peut aboutir à la perte irréversible de vision s'il n'est pas immédiatement pris en charge par un ophtalmologue.
ABSTRACT
Bilateral Acute Iris Transillumination (BAIT) is a new clinical entity characterized by acute onset of pigment dispersion in the anterior chamber and angle, depigmentation of the iris stroma and permanent iris transillumination, mas- querading as uveitis. An association with oral moxifloxacin is reported in some articles. We describe one case of bilate- ral acute iris transillumination, following the use of systemic moxifloxacin.
Subject(s)
Anti-Bacterial Agents/adverse effects , Fluoroquinolones/adverse effects , Iris Diseases/chemically induced , Pigment Epithelium of Eye/drug effects , Adult , Female , Humans , MoxifloxacinABSTRACT
PURPOSE: Third cranial nerve palsies are unfrequent in childhood and adolescence and are most often congenital. The association of sellar germ cell tumor and ophthalmoplegia is considered as being very rare at this age. CASE REPORT: A 11-year-old young girl was examined in emergency with a third left cranial nerve partial palsy associated with one- year duration history of hypopituitarism with insipid diabetes and growth retardation. Cerebral IRM revealed a tumor of the pituitary gland. In histopathological examination of pituitary gland biopsies, lesions were compatibles with a sellar germ cell tumor. CONCLUSION: Although they are most often of a congenital nature, third cranial nerve palsies in childhood may be secondary to other causes that should be always taken in mind. When they are secondary to a sellar tumor and according to the clinical presentation and the IRM, the histopahological examination of biopsies is mandatory to have a precise diagnosis.
Subject(s)
Neoplasms, Germ Cell and Embryonal/complications , Neoplasms, Germ Cell and Embryonal/diagnosis , Oculomotor Nerve Diseases/etiology , Ophthalmoplegia/etiology , Pituitary Neoplasms/diagnosis , Sella Turcica , Skull Neoplasms/diagnosis , Child , Female , Humans , Neoplasms, Germ Cell and Embryonal/pathology , Pituitary Neoplasms/complications , Skull Neoplasms/complications , Skull Neoplasms/pathologyABSTRACT
The use of drainage systems in glaucoma treatment progressively increase, mainly in case of failure of medical treatment and/or laser and/or trabeculectomy. They aimed to improve aqueous humor drainage through the trabecular meshwork. New drainage concepts are regularly proposed, either with biomaterial implants, inert or non absorbent, or with approaches to bypass trabecular resistance and facilitate aqueous humor outflow directly in Schlemm canal. The aim of this article is to present and discuss these new approaches.
Subject(s)
Glaucoma Drainage Implants , Glaucoma/surgery , Humans , Prosthesis DesignABSTRACT
We described two cases with papilledema within the first months of amiodarone treatment. The particular aspects of these cases are, on one hand the development of the optic neuropathy before any toxic change of the cornea and on the other hand the daily and weekly doses prescribed in both cases. We reviewed the meta-analysis studies on the subject and the different pathogenic mechanisms described until now.
Subject(s)
Amiodarone/adverse effects , Anti-Arrhythmia Agents/adverse effects , Papilledema/chemically induced , Aged , Humans , MaleABSTRACT
This review summarizes the most important advances that occurred in ophthalmology during the last decade, with a focus on corneal pathology, cataract surgery, glaucoma and retinal diseases.
Subject(s)
Eye Diseases/therapy , Humans , Ophthalmology/methods , Ophthalmology/trendsABSTRACT
Imaging studies in typical glaucomatous cupping are usually needless. This article reviews the various clinical presentations for considering imaging in patients presenting with cupped disc.
Subject(s)
Glaucoma/diagnosis , Optic Disk/abnormalities , Diagnosis, Differential , Glaucoma/complications , Hemianopsia/complications , Hemianopsia/diagnosis , Humans , Optic Nerve Diseases/diagnosis , Visual FieldsABSTRACT
Most severe eye diseases and injuries ultimately require intervention by an ophthalmologist. The urgency of referral depends on various factors, including level of vision loss, duration of symptoms, and presence of comorbid diseases. Of special importance are five acute eye problems in which emergency management by primary care physicians can be critical to visual outcome: high-velocity injuries, chemical injuries, acute angle-closure glaucoma, arteritic ischemic optic neuropathy, and central retinal artery occlusion. This paper will focus on emergencies in glaucoma, especially primary and secondary closed-angle glaucoma and secondary open-angle glaucoma. Delay in presentation, and unresponsiveness to medical treatment of the acute ocular hypertension attack carry a significant risk of chronic glaucoma, whatever the mechanism of disease is. Whenever the acute glaucoma crisis does not cease with an appropriate medical treatment, a laser and/or surgical intervention needs to be urged.
Subject(s)
Glaucoma/diagnosis , Glaucoma/etiology , Acute Disease , Chronic Disease , Diagnosis, Differential , Eye Injuries/complications , Glaucoma/therapy , Glaucoma, Angle-Closure/diagnosis , Glaucoma, Angle-Closure/therapy , Glaucoma, Open-Angle/diagnosis , Glaucoma, Open-Angle/therapy , Humans , Iridectomy/methods , Steroids/adverse effects , Uveitis/complicationsABSTRACT
Agents such as the antimetabolites 5-fluorouracil (5FU) and mitomycin-C (MMC) have revolutionised glaucoma surgery in patients with a high risk of surgical failure. However, vision threatening complications can be associated with the use of these agents. Changes in antimetabolites application during and after the surgery can increase the safety and reduce the complications while maintaining effectiveness.
Subject(s)
Filtering Surgery/methods , Glaucoma/surgery , Postoperative Care/methods , Wound Healing , Adult , Aged , Antimetabolites/pharmacology , Fluorouracil/pharmacology , Guidelines as Topic , Humans , Mitomycin/pharmacology , Wound Healing/drug effects , Wound Healing/physiologyABSTRACT
PURPOSE: To report the effect of an intravitreal injection of 4 mg of crystalline triamcinolone acetonide (Kenacort) as symptomatic treatment of neovascular glaucoma. MATERIAL AND METHODS: This clinical study is based on clinical and experimental investigations that examined the tolerability and the angiostatic effect of triamcinolone acetonide. The study includes prospectively 8 eyes of 8 patients with neovascular glaucoma secondary to ischemic central retinal vein occlusion (n=8). All patients received an intravitreal injection of 4 mg of crystalline triamcinolone acetonide (0.1 cc) as the only procedure or in combination with transscleral cyclodiode as glaucoma treatment. Their mean age was 74.5 +/- 14.4 years. Mean intraocular pressure (IOP) was 38.9 +/- 9.3 mmHg. Mean follow-up was 6 months. RESULTS: 4 of 8 patients were treated by crystalline triamcinolone acetonide as the only procedure (n=3). Twenty seven days after intravitreal kenacort injection, the others four patients have been treated by transscleral cyclodiode (n=4) as glaucoma treatment. After injection, including the first postoperative day, patients report a subjective reduction of ocular pain. Furthermore no intra- or extraocular inflammatory reactions were observed during the follow-up. Intraocular pressure was significantly reduced to 18 +/- 6.2 mm Hg at the end of the follow-up period. When considering only the four patients in which the intraocular cortisone injection was the only procedure performed, mean intraocular pressure decreased from 41.75 +/- 7.05 mm Hg to 20.5 +/- 6.6 mm Hg. Iris neovascularisation was significantly decreased from grade IV to grade I in all patients at the end of the follow-up CONCLUSION: Intravitreal injection of 4 mg triamcinolone acetonide contributes to a better management of the neovascular glaucoma.
Subject(s)
Glaucoma, Neovascular/drug therapy , Glucocorticoids/administration & dosage , Triamcinolone/administration & dosage , Aged , Aged, 80 and over , Female , Humans , Injections , Male , Middle Aged , Vitreous BodyABSTRACT
[reaction: see text] Diastereoselectivity of up to 88% was achieved for the synthesis of an alpha-mercapto gamma-unsaturated phosphonate using the readily available chiral dimenthylphosphonyl ester group and a carbanionic [2,3]-sigmatropic rearrangement. Absolute configuration of the newly formed chiral center of this nonracemic thiol was determined, and the corresponding phosphono thiolane and thiolane S-oxide were also stereoselectively prepared.
Subject(s)
Anti-Infective Agents/chemical synthesis , Organophosphonates/chemical synthesis , Thiophenes/chemical synthesis , Magnetic Resonance Spectroscopy , StereoisomerismABSTRACT
Non perforating trabecular surgery (NPTS) with reticulated hyaluronic acid implant (Skgel) allows aqueous humor to leave anterior chamber through a thin trabeculo-Descemet's membrane into a sclerocorneal space filled with Skgel implant and then via the outflow physiological channels. Good IOP results are obtained with less or without external filtration decreasing the incidence of per- and postoperative complications described after trabeculectomy. This surgery is actually only indicated for primary open angle glaucoma, the trabeculectomy still remaining the gold standard procedure for the other glaucoma cases.
Subject(s)
Glaucoma Drainage Implants , Glaucoma, Open-Angle/surgery , Hyaluronic Acid , Aged , Female , Humans , Intraocular Pressure , Male , Middle Aged , Prospective Studies , Prosthesis Implantation , Trabecular Meshwork/surgery , Trabeculectomy/methods , Trabeculectomy/standards , Treatment Outcome , Visual AcuityABSTRACT
Cataract surgery in glaucoma patients remains a controversial subjects. Indication of surgery depends on a lot of clinical parameters: diagnosis, state, evolution of glaucoma as well as compliance with medical treatment--surgical procedures of cataract and glaucoma--sites of the surgery--use of antifibrosis agents and surgeon's experience. As cataract extraction alone decreases the intraocular pressure in open angle glaucoma and mainly in uncomplicated closed angle glaucoma and trabeculectomy alone reduces the intraocular pressure more than combined surgery with less complications we recommended the following surgical options: Cataract extraction alone in patients with controlled open angle glaucoma and in patients with closed angle glaucoma. A two step procedure: filtering surgery followed by cataract extraction in patients with poorly controlled open angle glaucoma or mixed closed angle glaucoma. Ambulatory surgery and topical anesthesia permit a two stages surgery with less inconveniences. A combined procedure in patients with a chronic closed angle glaucoma where filtering procedure alone is associated with important complications. Actually, the best surgical cataract procedure is phacoemulsification with a small supero-corneal incision and implantation of a foldable intraocular lens. The best filtering procedure remains trabeculectomy, or the new non penetrating trabecular surgery for experimented surgeons, in the superior quadrant. In the future new surgical procedures and new safe and non toxic pharmacologic drugs which modulate wound healing could be found in order to increase the efficacity and indications of combined surgery.
Subject(s)
Cataract Extraction , Cataract/complications , Glaucoma/complications , Glaucoma/surgery , Ophthalmologic Surgical Procedures , HumansABSTRACT
Non perforating trabecular surgery (NPTS) with reticulated hyaluronic acid implant (Skgel) allows aqueous humor to leave anterior chamber through a thin trabeculo-Descemet's membrane into a sclerocorneal space filled with Skgel implant and then via the outflow physiological channels. Good intraocular pressure results are obtained with less or without external filtration decreasing the incidence of per- and postoperative complications found after trabeculectomy. This surgery is actually only indicated for primary open angle glaucoma, the trabeculectomy still remaining the gold standard procedure for the other glaucoma cases.
Subject(s)
Glaucoma Drainage Implants , Glaucoma, Open-Angle/surgery , Hyaluronic Acid , Trabecular Meshwork/surgery , Female , Follow-Up Studies , Humans , Intraocular Pressure , Male , Middle Aged , Trabeculectomy/adverse effects , Trabeculectomy/methods , Treatment OutcomeABSTRACT
We describe the clinical history of four patients belonging to a familial adenomatous polyposis (FAP) family. We stress the importance of a fundus examination for the screening of carriers of the gene responsible for familial adenomatous polyposis.
Subject(s)
Adenomatous Polyposis Coli/complications , Fluorescein Angiography , Retinal Diseases/diagnosis , Adolescent , Adult , Female , Heterozygote , Humans , Hypertrophy , Male , Pedigree , Pigment Epithelium of Eye/pathology , Retinal Diseases/geneticsABSTRACT
PURPOSE: This study was designed to uncover a new sensitive and specific factor for predicting the progression of glaucoma. METHODS: The 24-hour ambulatory blood pressure and diurnal curve of intra-ocular pressure were recorded in seventy patients: 51 primary open angle glaucoma (POAG) and 19 normal tension glaucoma (NTG). The mean systolic, diastolic and average arterial blood pressure were calculated, along with the nocturnal dip of systolic pressure and diastolic blood pressure. Two-year disease progression was assessed for all patients by means of retrospective analysis of visual fields defects on repeated perimetries. RESULTS: Abnormal (absence or increased) nocturnal dip of systolic blood pressure was found to be correlated with disease progression in POAG and NTG patients with a sensitivity of 86% and a specificity of 85%, whereas no significant correlation was found for the other risks factors envisaged. Furthermore, a significant relationship between stable visual field defects and the use of diuretics/laser procedure was evidenced. CONCLUSION: The nocturnal dip of systolic blood pressure should be considered as a predictive factor of disease progression in NTG and POAG. Further prospective studies are needed to ascertain whether dip normalization could help slow down the visual field loss in these patients.
Subject(s)
Blood Pressure Monitoring, Ambulatory , Blood Pressure/physiology , Circadian Rhythm/physiology , Glaucoma, Open-Angle/physiopathology , Intraocular Pressure , Aged , Aged, 80 and over , Chronic Disease , Disease Progression , Female , Follow-Up Studies , Humans , Male , Middle Aged , Predictive Value of Tests , ROC Curve , Retrospective Studies , Visual FieldsABSTRACT
PURPOSE: Unusual description of an uveitis with a cytomegalovirus retinitis in a grafted patient. MATERIAL ET METHOD: A 49 year-old white male had to receive an hepatic transplant. Six month later, a cytomegalovirus chorioretinitis was discovered with an important uveitis. CONCLUSION: Two to five percent of cytomegalovirus retinitis were found in grafted patients. No patient was seen with a significant uveal reaction. In the article will be discussed the evolution, the diagnosis and the treatment of this case report.
