[Dynamic phototherapy as a treatment for central serous chorioretinopathy]. / Traitement des choriorétinopathies séreuses centrales par photothérapie dynamique.

PURPOSE: To analyze the angiographic and tomographic results and the visual acuity of a group of patients presenting acute or chronic serous central chorioretinopathy (CSCR) treated with dynamic phototherapy. This treatment was guided by ICG angiography data. PATIENTS AND METHOD: We conducted a retrospective/prospective nonrandomized study on 31 eyes of 27 patients, including eight acute forms and 23 chronic forms. One or more spots were treated according to the age-related macular degeneration standard protocol on the zones of choroidal hyperpermeability highlighted by ICG angiography. The criteria for success were based on functional signs, visual acuity, persistence of a point of leakage in angiofluorographic follow-up at 3 months, and the OCT study of serous retinal detachment. RESULTS: An increase in visual acuity (3.58+/-3.22 lines, p<0.0001) was observed for all forms of treated CSCR; 90.32% patients presented a reapplication of serous retinal detachment within a period of 7.28+/-3.93 weeks. No retinal pigmentary epithelium tear or choroidal neovascularization was observed. Recurrence occurred in 12.9% patients within a period of 28+/-16.24 weeks; only chronic CSCR cases were concerned. At 8+/-4.2 months, the visual acuity of the patients who had no recurrence remained unchanged (0.356+/-0.4 LogMAR or 20/50-20/40). CONCLUSION: Although the number of patients included in this study is limited, dynamic phototherapy currently seems to be an effective and sure treatment of CRSC. A randomized study on a large series is necessary to confirm these results.

[Chronic central serous chorioretinopathy and photodynamic therapy: a case report]. / Choriorétinopathie séreuse centrale chronique et photothérapie dynamique, à propos d'un cas.

Chronic central serous chorioretinopathy (CCSC) with recurrent and prolonged exudative retinal detachment may cause multiple degenerative manifestations with poor visual acuity. By acting on choroidal hyperpermeability, photodynamic therapy seems to be a useful treatment for symptomatic CCSC. We present the case of a 60-year-old patient presenting with symptomatic CCSC complicated with serous retinal detachment lasting more than 1 year. Visual acuity on the left eye was 1/20. Photodynamic therapy with indocyanine green angiography guidance was provided. Subretinal fluid was rapidly resolved and visual acuity improved to 7/10. Photodynamic therapy influences choroidal hyperpermeability and thus resolves serous retinal detachment in CCSC. Visual acuity improvement particularly depends on preexisting macular atrophy.

[Unilateral idiopathic leopard-spot lesion of the retinal pigment epithelium: a fibroglial tractional complication]. / Lésion unilatérale idiopathique en taches léopard de l'épithélium pigmentaire: une complication fibrogliale tractionnelle.

The unilateral idiopathic leopard-spot lesion of the retinal pigment epithelium is a rare and acquired entity of the young adult whose clinical description is quite recent. This pathology presents a strong proliferative potential that is both neovascular and fibroglial. The authors report a case with severe fibroglial complications. Careful follow-up of these patients and their descendants seems to be essential in order to better characterize this lesion whose nature and etiopathogeny are still unknown.

[Reconstruction of anophthalmic socket by adipocyte grafting using the Coleman technique, after extrusion of an orbital implant: a case study]. / Comblement d'une cavité orbitaire éviscérée par greffe d'adipocytes selon la technique de Coleman, après expulsion d'implant.

INTRODUCTION: Since the end of the 19th century, autologous fat grafting has often been used in plastic surgery. The first use was described in 1893 by Neurer and consisted in transferring a piece of fat tissue for facial reconstruction. Since then, this technique has evolved somewhat thanks to Coleman, who developed lipostructure. This technique is used in plastic surgery in the filling of orbital cul-de-sacs and unsightly scars. We report a clinical case where this technique was used to fill an anophthalmic socket after extrusion of an orbital implant. OBSERVATION: A 52-year-old man had evisceration of the right eye for ocular phthisis bulbi after injury to the eye. Two weeks later, he presented an expulsion of the hydroxyapatite eyeball with significant secretions. The bacteriological samples showed Staphylococcus aureus and Streptococcus anginous infection. Despite local and general antibiotic treatment and anti-inflammatory drugs, the secretions persisted. The implant material was initially ablated. Twenty days later, adipocyte was grafted in the residual scleral stump using the Coleman technique. Follow-up showed no complications; the adipocyte grafting made it possible to restore orbital volume so that the prosthesis could be adapted. After 6 months, secondary atrophy is moderate and a good esthetic result was obtained. DISCUSSION: The Coleman technique consists in taking adipocytes in abdominal or buttocks fat with nontraumatic liposuction. This is purified after centrifugation, then reinjected into the scars or the orbital cul-de-sacs to be filled. In general, these indications relate to small volumes. In our case, the procedure involved an anophthalmic socket with residual septated scleral tissue. This can explain the good esthetic result obtained. Indeed, the fat atrophy after surgery is more significant when there is no supporting tissue. CONCLUSION: This technique seems simpler and avoids an unsightly scar on the harvest site (contrary to the traditional dermis-fat graft). On the other hand, it is more expensive and requires a minimum of training.

[New treatment for orbital non-Hodgkin's lymphoma: 2 cases treated with rituximab]. / Nouvelle approche thérapeutique du lymphome malin non hodgkinien orbitaire. A propos de deux cas traités par rituximab.

INTRODUCTION: Orbital non-Hodgkin's lymphoma is a rare tumor whose diagnosis is often difficult. Treatment of latent lymphoma have been changing because of progress in immunotherapy. OBSERVATION: We report two patients treated with rituximab (antibody anti-CD20). Two women, 50 and 59 years old, presented low-grade, IE-stage lymphoma. One was conjunctival MALToma, the other was orbitopalpebral, type A, of WFC classification, follicular, with small cells. Immunohistochemistry showed a diffused marking for Ac anti-CD20. Both patients received intravenous rituximab as a first treatment in December 2000, 375 mg/m2, four injections per week. We did not note any major undesirable effects. Both have been in complete remission for 4 years. These patients continue to be followed up. DISCUSSION: Rituximab's efficacy has been proved mainly in follicular LMNH or in recurrent forms. The recurrence may be more frequent in MALT lymphoma. This medical treatment has low hematologic toxicity. CONCLUSION: Rituximab offers an alternative for low-grade lymphoma treatment that is well tolerated by the patient.

[Orbital non-Hodgkin's lymphoma: a retrospective study of 22 patients]. / Les lymphomes malins non hodgkiniens conjonctivo-orbitaires.

INTRODUCTION: Although the number of non-Hodgkin's lymphoma (NHL) cases continues to grow throughout the world, orbital NHL is still a rare tumor that is difficult to diagnose. The objective of our study was to analyze the different orbital NHLs diagnosed in our Ophthalmology Department during the last 20 years. MATERIAL AND METHODS: [corrected] We conducted a retrospective study of conjunctive-orbital lymphomas diagnosed in the Amiens Ophthalmology Department between 1982 and 2002. The pathological reports of 22 cases were investigated, notably the mode of onset, the clinical and radiological description, the diagnostic mode, pathological results, and the type of treatment provided for these tumors. RESULTS: Every NHL was type B. They were for the most part low grade in terms of malignancy, isolated, primitive, orbital and inactive. DISCUSSION: Insidious, slow-growing lesions are often found, and biopsy can be difficult. This may explain delayed diagnosis. The first differential diagnosis is inflammatory pseudotumor. Only a good biopsy can confirm the diagnosis of NHL. CONCLUSION: New immunohistochemistry and genetic diagnostic methods make it increasingly possible to screen for NHL, even if the clinical history can be misleading. Moreover, treatments that are more and more precisely targeted to the immunohistochemical type of NHL seem to be giving very promising results. Several studies are ongoing.

Scleral ectasia as a complication of deep sclerectomy.

Nonpenetrating deep sclerectomy is a filtration surgical technique to treat glaucoma. A 12-year-old girl presented with chronic arthritis complicated with glaucoma secondary to a chronic uveitis. A sclerectomy without a collagen implant was performed for uncontrollable glaucoma with deterioration in visual function. Three weeks later, the patient had a rise in intraocular pressure and a scleral ectasia on the sclerectomy. The eye showed an area of scleral ectasia in the bleb as well as iris adhesion. Partial resection of the bleb after iris detachment led to poor anatomic and IOP results. The indications for deep sclerectomy must be carefully considered, especially in patients at a young age with this type of glaucoma.

[Congenital pit of the optic disk in indocyanine green]. / Fossettes colobomateuses de la papille en vert d'Indocyanine.

PURPOSE: Etiopathogeny of serous retinal detachment (SRD) in optic pits remains a mystery. Several hypotheses have been proposed that lead to different treatments based on the possible mechanisms which explain the occurrence of SRD. The literature data about fluorescein angiography mainly concern the angiographic aspects of the optic pit itself, and seldom the SRD. We have examined these fluorescein angiographic aspects of the SRD. Indocyanine cardiogreen video-angiography gives new information which question the last etiologic hypothesis. METHODS: Nine patients underwent a fluorescein angiography when the SRD was discovered. Indocyanine cardiogreen was performed in four patients. RESULTS: In 8 cases there was hyperfluorescence on the optic pit. In 7 cases in the peripapillar space of the SRD. In one of these cases, there was a leakage on the temporal margin of the optic nerve. In 8 cases in the SRD: we noticed a late minimal hyperfluorescence in the SRD but it already existed in the early angiogram. The SRD became hyperfluorescent in arterio-veinous retinal phase. In late phases we noticed a well-demarcated area of hyperfluorescence. CONCLUSION: These investigations have revealed a permeation problem on the blood-outer retinal barrier of the peripapillar space and above all from the edge of optic pit. This can have a prognosis value for SRD. The hyperfluorescence in SRD remains an enigma and does not allow, as we thought before, to confirm one of the etiopathogenic hypotheses. A better acknowledge of indocyane cardiogreen angiographic semiology will allow us to explain these aspects in the future.

Ophthalmologic aspects of pituitary apoplexy.

Pituitary apoplexy is an acute hemorragic or ischemic infarction in pituitary adenomas. The incidence in our series was 6.5%. Clinical diagnosis can often be difficult as the patient is frequently unaware of an existing adenoma (seven out of 11 patients). Therefore, the classic features of the syndrome must be known. They include sudden headaches, impairment of consciousness, endocrinological disturbances and sudden visual deterioration or oculomotor palsies. In this retrospective study from 1987 to 1994 of 14 patients presenting pituitary apoplexy there were 11 cases with visual abnormalities. Oculomotor palsies were more common (82%) than chiasmatic impairment (54.5%) and often revealed pituitary adenoma. CT-Scan and MRI examinations led to diagnosis, and emergency treatment (surgical removal by rhinoseptal approach or less often medical treatment) generally led to a regression of visual disturbances.

[Uselessness of electroretinogram for detecting retinal poisoning by synthetic antimalarials]. / De l'inutilité de l'électro-rétinogramme dans le dépistage des intoxications rétiniennes par antipaludéens de synthèse.

Authors present two cases of typical macular "bull's eyes" other APS treatment with subnormal electric answer. They evocate the poor sensibility of the different methods used to detect and follow these patients and propose a more sensible, easier and test accepted test: static perimetry within the 12 central degrees, once or twice a year.

[Eales' syndrome and hypereosinophilia]. / Syndrome de Eales et hyperéosinophilie.

Authors report one case of a non typical Eales' disease associated to an hypereosinophily. None etiology was found nosology and physiopathology of Eales' syndrome and Eales' disease are still unclear. Main element of diagnosis is the discovery of a general pathology.

[Spontaneous rupture of Bruch's membrane and transient macular hemorrhage in patients with myopia]. / Ruptures spontanées de la membrane de Bruch et hémorragies maculaires régressives du myope.

18 eyes of 14 pathologic myopia patients with lacker cracks have been studied during a mean follow up of 45 months by initial and final clinical and fluoroangiography evaluation. These lacker cracks happen early in the myopia degeneration evolution in young patients. The evolution is marked by transient coinlike macular hemorrhages without CNM detectable. Prognosis for the retention of central vision after macular hemorrhages resolution is good. It mainly depends of lacker cracks initial location if macular quite wrong, if intramacular, quite right. Development of CNM is an infrequent eventuality but must be systematically research by angio-fluorography after spontaneous macular hemorrhage resolution which usually occurs 4 or 6 weeks later.

[Isolated plasmacytoma of the orbit]. / Plasmocytome isolé de l'orbite.

A case is described of a 62 years-old man who developed solitary plasmocytoma of the lacrimal sack. Treatment was by excision.

[New sub-retinal vessels after chorio-retinal wound caused by intra-ocular foreign body (1 case)]. / Néo-vaisseaux sous-rétiniens après plaie chorio-rétinienne par corps étranger intra-oculaire (1 cas).

We report one case of subretinal neovascularization developed on a chorioretinal scar after metallic intraocular foreign-body trauma. New vessels, occurred three years after the injury at the initial impact site, reached first the foveola and could not be treated by laser photocoagulation.

[Reticular macular dystrophy and Steinert disease]. / Dystrophie réticulée de la macula et maladie de Steinert.

We studied the macular lesions of 14 patients with myotonic dystrophy. 4 of them presented signs of reticula dystrophy of the macular pigmentary epithelium. We searched the association with other ocular modifications.