[Using systemic corticotherapy for adult gonococcal keratoconjunctivitis: three case reports]. / Intérêt de la corticothérapie générale dans la kératoconjonctivite gonococcique de l'adulte: à propos de trois cas.

INTRODUCTION: adult gonococcal keratoconjunctivitis is a rare disease possibly leading to blindness, whose severity is related to the risk of corneal perforation and whose progression is conditioned by the rapidity of diagnosis and therapeutic management. PURPOSE: discuss the value of general corticotherapy in the treatment of scleritis associated with this disease. PATIENTS AND METHODS: retrospective analysis of patients with adult gonococcal keratoconjunctivitis managed in an emergency setting in 2007. OBSERVATION: three patients aged 22-55 years contracted the disease during unprotected sexual activity. Involvement was bilateral in two cases out of three; the intensity of the signs was always asymmetrical. Each patient underwent stromal melting of the superior limbic structures, with severity proportional to the delay in treatment. For each case, systemic and local antibiotics did not control corneal thinning, which seemed correlated with the intensity of the systematically associated signs of scleral inflammation. Treatment of scleritis with general corticotherapy under antibiotic cover stabilized the corneal thickness. DISCUSSION: whether the physiopathology of perilimbic corneal thinning can lead to ocular perforation in this condition is unknown. In our experience, the stabilization of corneal thickness seems correlated with regression of the scleritis observed after introducing general corticotherapy, potentially indicating aseptic inflammatory involvement. CONCLUSION: stromal melting of the limbus observed in adult gonococcal keratoconjunctivitis seems to be related to the associated scleritis. Systemic corticotherapy controls progression and reduces the risk of corneal perforation.

[Perforating ocular injuries in children: a retrospective study of 57 cases]. / Traumatismes oculaires perforants de l'enfant: étude rétrospective de 57 cas.

PURPOSE: The purpose of this study was to investigate the current causes and outcomes of open eye injuries in children. PATIENTS AND METHODS: We reviewed the hospital records of 57 patients under 14 years of age who were treated for open globe injuries at Edouard Herriot Hospital, Lyon, France, between January 1999 and December 2003. RESULTS: This review includes 57 patients: 41 males and 16 females. The mean age at admission was 6.8 +/- 3.5 years. The injury involved the right eye in 27 cases and the left eye in 30 cases. Sharp or pointed objects accounted for the majority of injuries. The most common location for a perforating ocular injury to occur was at home. Wounds involved the cornea in 41 cases. There was iris hernia in 21 cases, hyphema in 15 cases, vitreous prolapse in 14 cases, lens damage in 12 cases, and shallow anterior chamber in 11 cases. The most frequent complication was traumatic cataract. Secondary lens removal was performed in 15 cases. Visual acuity was 0.5 or better in 27 of the 57 eyes, with a mean follow-up period of 12 months. CONCLUSIONS: Perforating ocular injuries are a frequent cause of unilateral visual loss. The highest proportion of injuries occurred at home and sharp objects were the most frequent causative agents. More adequate adult supervision and educational measures are necessary in order to reduce the prevalence of these accidents.

[Conjunctival tumors in children. A histopathologic study of 42 cases]. / Tumeurs de la conjonctive bulbaire de l'enfant. Résultats de l'examen histologique de 42 lésions opérées.

PURPOSE: The aim of this study was to describe the clinicopathological characteristics of 42 conjunctival tumors surgically removed in children. PATIENTS AND METHODS: Records of all conjunctival tumors surgically removed in children during the 11-year period 1990-2001 were collected from the records of the Department of Ophthalmology, Edouard Herriot Hospital, Lyon. In all cases, the tumor was resected with no additional treatment. Sections of all cases were reviewed by the same pathologist. RESULTS: A total of 42 cases (40 patients) were included in the study. The mean age of the subjects at the time of surgical excision was 10 years, with a range of 1-17 years; 45% were male. The most frequent indication for tumor removal was suspected growth. The clinical diagnosis was accurate in 91% of cases. The tumor was localized at the limbus in 57% of cases. Most tumors were pigmented nevi, accounting for 83% of the lesions. The histopathological diagnoses in decreasing order of frequency were: nevi (35), angioma (2), dermolipoma (2), dermoid (1), papilloma (1), and squamous cell carcinoma (1). In one case, the histological study revealed squamous cell carcinoma in a child suffering from xeroderma pigmentosum. CONCLUSIONS: This retrospective study suggests that malignancy of pigmented conjunctival lesions is extremely rare in children. Although squamous cell carcinoma is rare in children, surgical excision and histological study are necessary when a conjunctival lesion is associated with xeroderma pigmentosum or immunodeficiency.

[Prospective study of contrast sensitivity and visual effects after LASIK]. / Etude prospective de la sensibilité au contraste et des effets visuels après LASIK.

PURPOSE: To evaluate changes in visual effects (contrast sensitivity, halos, and glare) following laser in situ keratomilleusis (LASIK). PATIENTS AND METHODS: In this prospective study, 72 eyes had LASIK to correct myopia. Contrast sensitivity was tested preoperatively, as well as 6 and 12 months postoperatively. The spatial frequencies tested were 3, 6, 12, and 18 cycles per degree (c/d). There were two groups: group 1 for myopia between -6 D (n=30) and -7.5 D and group 2 for myopia between -7.5 D and -10 D (n=25). There were 17 cases with loss of sight. For each visit, pupil diameter, halos, and glare were measured. RESULTS: Contrast sensitivity was better in group 1 than in group 2 (p<0.05) (for spatial frequencies of 3, 12, 18, c/d). In group 1, contrast sensitivity decreased 6 months postoperatively for all spatial frequencies (p<0.05); 12 months after surgery the changes were not significant. In group 2, changes were not significant. For halos and glare, pre- and postoperative percentages were not different. There was no correlation with pupil diameter. CONCLUSIONS: After LASIK to correct myopia, there may be a persistent decrease in contrast sensitivity. Changes are only significant at 6 months postoperatively. Patients should be informed preoperatively of this possible decrease in functional vision.

[Femtosecond laser: a micromachining system for corneal surgery]. / Laser femtoseconde: système de micro-usinage pour chirurgie de la cornée.

INTRODUCTION: The authors present the diode-pumped, all-solid state, neodymium:glass femtosecond laser from the Laboratory of Ocular Biotechnology, Hotel-Dieu Hospital. MATERIALS AND METHODS: We worked with a 1,065-nm wavelength infrared laser. This laser is composed of an oscillator and amplification glass matrix mixed with neodymium. Its stretching and compression system is capable of producing pulses lasting a few hundred femtoseconds. The repetition rate is adjustable, ranging from 1 to 10 kHz, and can reach energies up to 60 microJ. The delivery system was set up on an optical table, with human corneal samples fixed to an anterior chamber system, which can be moved over the X-Y-Z axis by a computer-guided translation motor with micrometric precision. We analyzed the biological effects of laser impacts in human corneal tissue, obtained from the French Eye Bank. RESULTS: The femtosecond laser provides automated corneal cutting with a high level of precision, which can be verified on the corneal surface regularity by scanning electron microscopy analysis. Silicon samples can also be cut and can be used for calibration testing of the laser. CONCLUSION: The set-up composed of the femtosecond laser and the described delivery system enable precise corneal cutting and offer the opportunity to study its characteristics.

[Buphthalmia secondary to congenital pigmented epithelial iris cyst]. / Buphtalmie secondaire à un kyste congénital de l'épithélium pigmentaire de l'iris.

We report the case of a 2-day-old child with buphthalmia caused by a congenital pigmented epithelial iris cyst. The use of ultrasound biomicroscopy (UBM) and high-resolution echography (20MHz) specified the diagnosis before general anesthesia for complete examination and treatment. Surgery can control intraocular pressure and the opening of the visual axis; there is, however, relative amblyopia. This case confirms the advantage of UBM in examining tumors of the anterior segment. The early diagnosis, facilitated by use of the UBM, provided quick and well-adapted treatment.

[Ciliary body melanomas. Survival and prognostic aspects after brachytherapy or proton therapy]. / Mélanomes uvéaux impliquant le corps ciliaire. Analyse de la survie après protonthérapie ou bêta-curiethérapie par ruthénium-106. A propos de 106 cas.

INTRODUCTION: Our main goals were to study the survival of patients with uveal melanomas involving the ciliary body 5 and 10 years after treatment and to review prognosis. MATERIAL AND METHODS: This study investigated 106 tumors (27 ciliary body melanomas and 79 choroidal-ciliary melanomas) of patients treated between June 1983 and April 1998. Seventy-two patients were treated with 106-ruthenium applicators and 34 were treated with proton therapy. Some large tumors or recurrences required a second treatment. The mean follow-up period was 91 months. RESULTS: The mean tumor sizes before treatment were 6,6mm for melanoma thickness and 10.3mm for mean largest basal melanoma diameters (LTD). Of the patients studied, 71% were still alive at 5 years, 35% had metastasis and 27.7% developed recurrences. Multivariate analysis showed that the risk factors for melanoma-related death were LTD greater than 13mm, presence of exudative retinal detachment, macroscopic iris root involvement at the time of diagnosis, and choroidal-ciliary location. DISCUSSION AND CONCLUSION: With 71% of patients still alive at 5 years, this review shows that melanomas involving the ciliary body do not seem less severe than more posterior uveal tumors. Because of size differences between ciliary body melanomas and choroidal-ciliary melanomas, we cannot come to the conclusion that choroidal-ciliary melanomas have a poorer prognosis than ciliary body melanomas. Largest tumor diameter over 13mm, presence of exudative retinal detachment, and macroscopic iris root involvement at the time of diagnosis are important risk factors for melanoma-related death, as shown by the multivariate analysis.