Clinical features of dysthyroid optic neuropathy: a European Group on Graves' Orbitopathy (EUGOGO) survey.

BACKGROUND: This study was performed to determine clinical features of dysthyroid optic neuropathy (DON) across Europe. METHODS: Forty seven patients with DON presented to seven European centres during one year. Local protocols for thyroid status, ophthalmic examination and further investigation were used. Each eye was classified as having definite, equivocal, or no DON. RESULTS: Graves' hyperthyroidism occurred in the majority; 20% had received radioiodine. Of 94 eyes, 55 had definite and 17 equivocal DON. Median Clinical Activity Score was 4/7 but 25% scored 3 or less, indicating severe inflammation was not essential. Best corrected visual acuity was 6/9 (Snellen) or worse in 75% of DON eyes. Colour vision was reduced in 33 eyes, of which all but one had DON. Half of the DON eyes had normal optic disc appearance. In DON eyes proptosis was > 21 mm (significant) in 66% and visual fields abnormal in 71%. Orbital imaging showed apical muscle crowding in 88% of DON patients. Optic nerve stretch and fat prolapse were infrequently reported. CONCLUSION: Patients with DON may not have severe proptosis and orbital inflammation. Optic disc swelling, impaired colour vision and radiological evidence of apical optic nerve compression are the most useful clinical features in this series.

A questionnaire survey on the management of Graves' orbitopathy in Europe.

OBJECTIVE: To determine management patterns among clinicians who treat patients with Graves' orbitopathy (GO) in Europe. DESIGN AND METHODS: Questionnaire survey including a case scenario of members of professional organisations representing endocrinologists, ophthalmologists and nuclear medicine physicians. RESULTS: A multidisciplinary approach to manage GO was valued by 96.3% of responders, although 31.5% did not participate or refer to a multidisciplinary team and 21.5% of patients with GO treated by responders were not managed in a multidisciplinary setting. Access to surgery for sight-threatening GO was available only within weeks or months according to 59.5% of responders. Reluctance to refer urgently to an ophthalmologist was noted by 32.7% of responders despite the presence of suspected optic neuropathy. The use of steroids was not influenced by the age of the patient, but fewer responders chose to use steroids in a diabetic patient (72.1 vs 90.5%, P<0.001). Development of cushingoid features resulted in a reduction in steroid use (90.5 vs 36.5%, P<0.001) and increase in the use of orbital irradiation (from 23.8% to 40.4%, P<0.05) and surgical decompression (from 20.9 to 52.9%, P<0.001). More ophthalmologists chose surgical decompression for patients with threatened vision due to optic neuropathy, who were intolerant to steroids than other specialists (70.3 vs 41.8%, P<0.01). CONCLUSION: Deficiencies in the management of patients with GO in Europe were identified by this survey. Further training of clinicians, easier access of patients to specialist multidisciplinary centres and the publication of practice guidelines may help improve the management of this condition in Europe.

[Primary ocular lymphoma manifesting as anterior uveitis. Apropos of a case]. / Lymphome oculaire primitif révélé par une uvéite antérieure. A propos d'un cas.

We report the case of a primitive ocular lymphoma occurring in a 48 year old patient. Non-Hodgkin's lymphomas are usually found in ocular localizations, and are often associated with a lymphomatous cerebral affection. The most frequent mode of presentation of these rare intra ocular tumors is usually posterior uveitis with chorioretinal lesions, and must be suspected for every long-standing chronic uveitis, especially posterior ones. The diagnosis can only be based on histological or cytological analysis. Our patient presented a primary ocular lymphoma which was initially revealed by an anterior uveitis and had evolved into a panuveitis that was resistant to treatment. The initial checkup of this uveitis remained negative and did not allow for an etiological diagnosis. The eye came less operational, hypertonic crisis became more frequent and controlled less and less by the treatment, therefore the patient had to be enucleated in order to establish a diagnosis and for therapeutic reasons. The histology revealed the existence of a NK lymphoma.

Case-control study of the risk factors for age related macular degeneration. France-DMLA Study Group.

AIM: A case-control study was initiated to determine the risk factors for the development of age related macular degeneration (AMD). METHODS: Study participants, who were all white, aged 50-85 years, and were recruited from private ophthalmology practices. Each practitioner enrolled patients with bilateral AMD, who were then matched with controls for sex and age. Environmental factors and systemic and ocular histories were screened. All patients had bilateral red-free fundus photographs and fluorescein angiography. Photographs were classified into pigment epithelium alterations, drusen, geographic atrophy, and exudative AMD. Statistical analysis included the identification of risk factors for AMD. A multivariate analysis was performed at the end of the study. Analysis included the entire study population and was carried out for each stage of AMD. RESULTS: 1844 controls were compared with 1844 patients with AMD. Mean age was 71 years for controls and 72 for cases. Logistic regression identified six major risk factors for AMD (whole population): arterial hypertension (odds ratio (OR) = 1.28), coronary disease (OR = 1.31), hyperopia (OR = 1.33), light coloured irises (OR = 1.22), and lens opacities or previous cataract surgery (OR = 1.55). The significance of vascular risk factors was increased for late stages of AMD, especially the atrophic forms (coronary disease, OR = 3.19). CONCLUSIONS: This large case-control study confirms some of the risk factors previously identified and may contribute to the determination of methods for prevention of AMD.

[Late effects of radiation on the eye and ocular adnexa]. / Effets tardifs de l'irradiation sur les yeux et les annexes.

Late ocular effects after irradiation of the eyes and ocular adnexa are reviewed. Ocular and orbital injuries occur more often after irradiation of central nervous system neoplasms or treatment of paranasal sinus malignancies. The complete loss of vision is the major complication which is multifactorial. This paper describes the radiation effects and grading of ocular adnexa, lens, retina, optic nerves and orbit. The tolerance doses and treatment are described.

[Acanthamoeba keratitis. Morphologic and isoenzymatic study of a strain isolated from a medically treated case]. / Kératite amibienne à Acanthamoeba. Etude morphologique et isoenzymatique d'une souche isolée d'un cas traité médicalement.

We report here the third case of Acanthamoeba keratitis discovered in France in a 30 year-old man wearing soft contact lenses. Amoebas of Acanthamoeba genus could be isolated twice from his corneal ulcer with simple ocular swabs. Owing to medical treatment alone, a successful healing of his eye was obtained. The isolated strain was studied morphologically and biochemically: the cysts observed microscopically after silver stain possessed less than six arms surrounded by a non reticulated ectocyst and belonged to group II defined by Pussard and Pons. But the isoenzymatic study of the ocular strain by isofocusing did not allow us to identify it with any one of the 18 reference strains used, although these represent 14 different described species.

[Risk factors of non-proliferating retinopathy in insulin-dependent diabetes]. / Facteurs de risque de la rétinopathie non proliférante dans le diabète insulinodépendant.

Risk factors for non proliferative retinopathy were investigated by comparing two groups of insulin dependent diabetic patients: group NR of 25 patients without retinopathy and group R of 25 patients studied at the time of discovery of non proliferative retinopathy. The two groups were matched for age, sex and diabete duration. They were significantly different for insulin treatment regimens, blood glucose control and blood pressure. Lipid parameters and renal function were similar in the two groups.

[500 visual acuity tests in infants with Teller acuity cards]. / Cinq cents examens d'acuité visuelle du nourisson avec les Cartes d'Acuité de Teller.

Assessment of visual resolution with Teller Acuity Cards is now routine procedure in infant visual check-up. A grating is printed on one end of a card on an homogeneous background of the same mean luminance. A series of spatial frequencies at an interval of one half octave covers the range of infant acuity. Binocular and monocular acuities have been measured on 517 infants between 100 and 399 days of age. The cards can be used from a few weeks of age up to 18 months at least. Then it gets more chancy to keep the child attentive. Binocular and two monocular tests take 6 minutes with a normal child. Binocular grating acuity normally reaches 6.5 cycles/degree at 4 months of age, and 12 c/deg at 12 months. Monocular acuity is one half octave lower. From the level of acuity obtained and observation of the behaviour, amblyopia can be detected and low vision can be estimated easily in infants.

[Measurement of visual acuity in infants in 6 minutes: Teller's Acuity Cards]. / La mesure de l'acuité visuelle du nourrisson en six minutes: les Cartes d'Acuité de Teller.

Most of the development of infant visual function occurs during the first year of life. Early pathological symptoms affecting visual or oculomotor processes, particularly ocular misalignment or amblyopia, should be detected and treated at the earliest age. Orthoptic and ophthalmological tests have been available for a long time but there remained a need for a convenient test for measuring visual acuity. Preferential looking techniques fulfill this demand and have been proven reliable and convenient to estimate visual acuity in preverbal infants. A new commercial presentation of the test, called Teller Acuity Cards, is described. Testing an infant was rapid, 5 to 6 minutes for a normal child, and easy because the child enjoys the convivality of the situation. Space requirement is reduced. Measures were taken from a population of 50 normal children aged 4 to 12 months. All children responded in the three situations, binocular and monocular (there was no blind eye in the group). Grating acuity values were higher than those obtained by projection preferential looking techniques. Binocular acuity was 6.5 cycles/deg (approximately 2.5/10) at 4 months of age, 9.8 cycles/deg (approximately 3.3/10) at 9 months and up to 13 cycles/deg (approximately 5/10) around 12 months. Acuities were found to be half an octave lower in monocular condition as compared to binocular. Orthoptic and ophthalmological check-up of infants is important, especially in case of children at risk of visual disorder. In most instances acuity can be preserved by therapeutic action provided it is initiated during the first year of life, when sensitivity to appropriate stimulation is at its peak.(ABSTRACT TRUNCATED AT 250 WORDS)

[Detection of vision disorders in newborn infants and children]. / Le dépistage des troubles visuels chez le nouveau-né et l'enfant.

Early detection of visual deficits is of most importance in childhood. To be adequately treated; it requires systematic screening before 18 months of age. Basic tests include objective refraction study (skiascopy), preferential sight test with estimation of visual acuity which is possible after 3 months of age, and, if poor vision, is found, electroretinography evoked visual potentials is performed. Many disorders can be recognized early on and treated (mainly strabismus, congenital cataract or glaucoma). The early correction of refractive disorders results in good visual development and subsequent facility in reading and writing.

[Early evaluation of the vision of infants: baby vision, a reality today]. / Evaluation précoce de la vision du nourrisson: Bébé Vision, une réalité aujourd'hui.

Non invasive techniques such as preferential looking, Teller acuity cards and orthoptic examination allow an early detection and treatment of visual defect. As early as 3 months of age, the pediatrician should refer to an ophthalmologist any child at risk on the ground of its personal or family history. Visual evoked potentials and retinography should be used in the case of more severe problems.

[Convergent strabismus in children. Clinical aspects and treatment]. / Les strabismes convergents de l'enfant. Formes cliniques et traitement.

The classification of convergent strabismus of the child, "esotropies", is mainly based upon the age of appearance. It is indeed fundamental to distinguish the early esotropies where the recovery of binocular vision is impossible and the orthoptic reeducation unnecessary, from the late forms where orthoptic reeducation and treatment could achieve the recovery of the binocular vision.

[Examination of convergent strabismus in children]. / L'examen d'un strabisme convergent de l'enfant.

Esotropia or converging squint is a common pathology in early age, generally followed by unilateral functional amblyopia of the deviating eye if an adapted treatment is not prescribed very early. Amblyopia occurs when the subject has lost use of one eye, now constantly deviating. Every strabismic child must have an early complete ophthalmologic examination. The author describes the main steps of this examination and discusses the diagnostic aspects. The main differential diagnosis is benign pseudo-strabismus of the epicanthus.