An atypical case of Foster Kennedy syndrome.

Foster-Kennedy syndrome was described in 1911 as an ophthalmologic manifestation of compression by a solid tumor in the frontal area with intracranial hypertension (ICHT). We describe a peculiar case of Foster-Kennedy syndrome associated with an arteriovenous malformation in which neither optic nerve compression nor ICHT was obvious. We discuss the different pathogenic mechanisms to explain this case, for which a chronic venous hypertension was the most probable etiology.

[Ocular manifestations of primary pulmonary artery hypertension]. / Manifestations oculaires de l'hypertension primitive de l'artère pulmonaire.

INTRODUCTION: To report two patients with primary pulmonary hypertension (PPH) and associated ocular findings. CASE REPORT: Two men, 54 and 50 years old, were referred for primary pulmonary hypertension: one patient had had a double-lung transplantation a month before and noticed pain and decreased vision in the right eye; the other man was waiting for a lung transplant and noticed decreased vision in the left eye. Both patients presented with a dilatation of the conjunctival and episcleral veins, without glaucoma, and with bilateral chronic choroidal ischemia. One patient underwent a fluorescein angiography examination and indocyanine green videoangiography. CONCLUSION: Elevated venous pressure is responsible for the dilatation of the conjunctival and episcleral veins, sometimes associated with glaucoma, and for chronic choroidal ischemia with a decrease in visual acuity. Other clinical pictures are discussed.

Evaluation of keratic precipitates and corneal endothelium in Fuchs' heterochromic cyclitis by in vivo confocal microscopy.

PURPOSE: To analyse keratic precipitates in Fuchs' heterochromic cyclitis (FHC) by in-vivo confocal microscopy (IVCM). PATIENTS AND METHODS: A retrospective chart review of 13 consecutive patients with FHC was conducted. Data collection included medical and ophthalmological history, age, age at diagnosis, gender, detailed slit-lamp examination and IVCM images. The IVCM characteristics of keratic precipitates and of the endothelium were analysed. RESULTS: Large hyperreflective deposits corresponding to keratic precipitates were observed on the endothelium of all FHC eyes and showed a great consistency among the different patients. These infiltrating keratic precipitates had a dendritic shape, with a small central core with numerous thin pseudopodia sometimes making connection between different keratic precipitates. The mean density of these keratic precipitates was 16.01/mm(2) (SD 6.54). The mean size of the largest dimension of these keratic precipitates was 127.31 microm (SD 41.49; range 66.16-201.4 microm). Hyporeflective round defects were observed at the level of the endothelium at contact or in the close vicinity of keratic precipitates or smaller hyperreflective deposits. All contralateral (non-affected eyes) had no keratic precipitates nor endothelial abnormalities. CONCLUSIONS: By providing high resolution images of corneal endothelium and keratic precipitates, IVCM could help the diagnosis and understanding of complex forms of intraocular inflammation such as FHC.

[Permanent cosmetics and magnetic resonance imaging]. / Maquillage permanent et imagerie par résonance magnétique.

INTRODUCTION: We report a case illustrating the possible relation between permanent cosmetics (tattoos) and magnetic resonance imaging (MRI). OBSERVATION: A 24-year-old woman underwent a permanent cosmetic tattoo (eyeliner) on the four eyelids 5 months before an MRI was performed for headache. After 1 min, the patient reported a burning sensation associated with an eyelid erythema. The MRI examination was interrupted. The burning sensation resolved by the end of the examination and erythema 2 h later. CONCLUSION: Cosmetic tattoo technicians, patients, and MR technologists should be informed of the minor risk associated with the site of the permanent cosmetic tattoo (eyelid, eyebrow).

[Eyedrops in children and pregnant or breast-feeding woman: why so many difficulties?]. / Les collyres chez l'enfant et la femme enceinte ou allaitante: quelles difficultés et pourquoi?

The use of eye drops in a child or a pregnant or a breast-feeding woman is often difficult, since clearly established license and scientific data are rare. These two difficulties are related. Indeed, clinical research programs exceptionally include children or pregnant/breastfeeding women, except when the product is directly intended for these populations, unusual in ophthalmology. As a consequence, the scientific publications give very little information on the balance between benefit and risk in these patients. Legal authorities therefore cannot base authorization decisions on robust data or on the contrary clearly mention the danger of many ophthalmic solutions. For that reason, the summaries of the characteristics of the product most often include precautionary recommendations, in practice a rejection, even when the empirical clinical practice suggests their possible use. The analysis of these difficulties underlines the importance of conducting clinical trials including this type of patient or, failing that, the necessity of consensus conferences to facilitate physicians' daily medical practice.

[Eyelid necrosis caused by an hymenopteran insect bite]. / Nécrose palpébrale par piqûre d'hyménoptère.

We report a case report of extensive eyelid necrosis caused by an insect bite. A 39-year-old man had suffered ocular trauma from a hymenopteran insect in Tunisia. The patient presented with eyelid necrosis. Eyelid necrosis mechanisms following insect bites are discussed and other causes of eyelid necrosis are presented. Eyelid necrosis, often caused by vasoconstrictive medications or animal venoms, notably hymenopteran insect bites, can result in substantial eyelid injury.

[Adenomatous hyperplasia of the conjunctiva]. / Hyperplasie adénomateuse de la conjonctive.

We report a case of adenomatous hyperplasia of the conjunctiva. A 42-year-old man was referred for a left conjunctival lesion involving the caruncle; the histopathological patterns revealed benign adenomatous hyperplasia, a disease that may originate in the conjunctiva. Adenomatous hyperplasia of the conjunctiva is a benign condition. The absence of cytonuclear anomalies and mitotic activity distinguishes adenomatous hyperplasia from adenocarcinoma and mucoepidermoid carcinoma.

[Purtscher-like retinopathy: case report and review of the literature]. / Pseudo-rétinopathie de Purtscher: à propos d'un cas et revue de la littérature.

Purtscher's retinopathy is a rare condition, seen in patients with a history of trauma. Purtscher-like retinopathy includes the nontraumatic causes of this retinal disease, which is often misdiagnosed. The diagnosis is based on clinical settings and is supported by intravenous fluorescein angiography. We describe a case of acute, severe retinopathy in a patient experiencing a scleroderma renal crisis. We discuss the pathogeny, prognosis and treatment, which is still widely controversial.

[Bilateral elastosis of the limbus]. / Elastose bilatérale du limbe.

We report of a case of bilateral limbus involvement by white lesions. A 72-year-old man was referred for bilateral lesions involving the inferior part of the corneal limbus. White excrescences associated with a vascular pannus were observed at biomicroscope examination. Histologic patterns showed degenerative fibroelastosis. Degenerative fibroelastosis can be observed at the inferior corneal limbus.

Congenital dyserythropoietic anaemia, type I, in a Caucasian patient with retinal angioid streaks (homozygous Arg1042Trp mutation in codanin-1).

A congenital dyserythropoietic anaemia (CDA) was recognised in a French Caucasian male patient. Blood smears showed a pronounced aniso-poikilocytosis. Bone marrow light microscopy showed signs of dyserythropoesis, but no internuclear chromatin bridges. Electron microscopy disclosed erythroblast nuclei with the Swiss cheese aspect and the presence of cytoplasmic organelles, assessing the diagnosis of CDA I. The presence of internuclear chromatin bridges may thus be missing in CDA I. The patient proved to be homozygous for the Arg1042Trp mutation in codanin-1 (the 'Bedouin mutation'). By the age of 25, the patient's vision started to deteriorate as a result of retinal angioid streaks and macular abnormalities. Evolution was controlled and the patient, being nearly 50 yr old now, still has a partial use of his eyes. This second case of retinal angioid streaks reported in CDA I adds to the non-haematological features likely to be associated with this condition.

[Congenital grouped albinotic spots: a case report]. / Taches blanches albinoïdes congénitales groupées de l'épithélium pigmentaire de la rétine.

INTRODUCTION: Case report of congenital grouped albinotic spots. OBSERVATION: A 24-year-old woman was referred for frontal headache related to +1.50 hypermetropia. Visual acuity was 20/20 in both eyes. During routine examination, fundus examination revealed multiple, irregular white spots involving the juxtapapillary and peripheral retina in both eyes. Color vision, visual fields, and electroretinographic findings were normal. Fluorescein angiograms showed hyperfluorescent spots; indocyanine green (ICG) showed hypofluorescence of these lesions. CONCLUSION: These albinotic spots are uncommon benign developmental lesions of the retinal pigment epithelium; they appear to represent focal thickening of the retinal pigment epithelium (RPE) that is filled with white material, possibly an abnormal precursor of melanin.

[Eyelid metastasis from a bladder urothelial carcinoma]. / Métastase conjonctivo-palpébrale d'un cancer de la vessie.

INTRODUCTION: Case report of an eyelid metastasis from a bladder urothelial carcinoma. OBSERVATION: A 71-year-old man presented with an eyelid metastasis. The patient had had a bladder carcinoma (pT1HG-2) resected 3 years before. Histologic patterns of bone and eyelid metastases were consistent with a high-grade urothelial carcinoma (pT1HG-2). In this case, eyelid metastasis was an incidental finding of end-stage disseminated metastatic spread of the tumor. CONCLUSION: Eyelid metastases of the bladder are infrequent and associated with disseminated metastatic spread of the tumor.

[Transitional carcinoma of the conjunctiva]. / Carcinome transitionnel de la conjonctive.

We report a case of transitional carcinoma originating from the conjunctiva. An 86-year-old woman was referred for a right conjunctival swelling lasting 6 months after a first surgical excision. The histopathological pattern revealed a transitional carcinoma, which usually originates from the airways and the lacrimal sac; recurrences are not uncommon. Transitional carcinoma may originate in the conjunctiva.

[Corneal edema and systemic NSAIDs]. / Oedème de cornée et AINS systémiques.

INTRODUCTION: We report a case of a transient corneal edema related to systemic NSAID treatment. OBSERVATION: A 48-year-old woman treated with a systemic NSAID [piroxicam B-cyclodextrin (Brexin) and naproxen (Apranax)] presented with a corneal edema and a transient decrease in visual acuity for a period of 24 h. No ocular etiology was found to explain this corneal edema. Another treatment with Apranax was follow by another corneal edema. CONCLUSION: Corneal edema could be related to systemic NSAID treatment.

[Recovery of sickle cell disease ischemic maculopathy after erythropheresis: a clinical case study]. / Maculopathie ischémique drépanocytaire résolutive après échange érythrocytaire.

The authors report a case of a young patient with a recent decrease in unilateral vision. He had homozygote sickle cell disease with multiple general complications. Fundus examination was normal apart from a mild alteration of the macular reflect in the left eye, but fluorescein angiography showed multiple arteriolar macular occlusions, explaining the decrease in vision in the left eye. After erythropheresis, vision acuity improved and fluorescein angiography showed reperfusion. This case suggests that transfusional exchange may improve acute macular ischemia secondary to sickle cell disease.

[Syphilitic chorioretinitis in the immunocompromised patient: a case report]. / Choriorétinite syphilitique chez l'immunodéprimé

Syphilitic chorioretinitis is a rare manifestation of secondary syphilis. The Authors report a case of a patient tested positive for human immune deficiency virus. A 26-Year-old man presented with a history of suddenly blurred vision in the right eye. Because of a central scotoma, visual acuity was reduced to counting fingers. Slit-lamp examination found one-plus anterior chamber cells and one-plus vitreous cells. Results of ophthalmoscopic examination showed a large yellow lesion in the macular area with a papillar edema and peripheral vasculitis. Serum and cerebrospinal fluid were positive for syphilitic serology. Visual acuity improved to 20/20 after three courses of intravenous ceftriaxone (2g/day for 15 days). The fundus lesion resolved almost completely, resulting in slight pigmentary changes in the macular area. This case report highlights the need for syphilitic serology in cases of uveitis in immunocompromised patients.

[Circumstances of choroid and ciliary body melanoma detection]. / Circonstances de découvertes des mélanomes de la choroïde et du corps ciliaire.

PURPOSE: To report and analyze the circumstances of uveal melanoma detection. METHODS: The records of 143 consecutive patients diagnosed in the Ophthalmology Department of Gustave Roussy Institute between September 1994 and September 2001 were analyzed. The study included 66 females and 77 males, aged from 21 to 91 years (mean, 62.75 years). RESULTS: The first symptom was decreased visual acuity in 37% of cases. In 34.9%, there was no functional sign and a systematic fundus exam provided the diagnosis. Of the 143 patients, 18.8% presented alteration of the visual field or scotoma, 9.9% complained of phosphenes, 9% complained of metamorphopsia, and 6.5% complained of floaters. In 5.5% of cases, there was documented tumor growth. In 2%, the presence of extrascleral exteriorization was the first sign. At the time of diagnosis, anterior tumors tended to be significantly larger than posterior tumors (p<0.007). Smaller lesions were significantly associated with a systematic detection of the tumor (p<0.005). Liver metastasis occurred more frequently with ciliary body melanomas (p<0.001), which were more frequently the largest lesions. CONCLUSION: These results emphasize the importance of early detection of uveal melanoma. We recommended frequent fundus examination after pupil dilatation.

[Characteristics of uveitis presenting de novo in the elderly]. / Caractéristiques des uvéites de novo chez les patients de plus de 60 ans.

INTRODUCTION: This study aimed to describe the clinical characteristics of uveitis presenting de novo in the elderly. The study design was a description of a retrospectively identified case series. PATIENTS: The records of 193 patients with uveitis referred to Bicêtre Hospital's department of ophthalmology between January 1995 and January 2000 were reviewed. Among these patients, the records of 57 patients with uveitis de novo beginning after age 60 were analyzed. RESULTS: Idiopathic uveitis accounted for the majority of cases. Whereas herpes viruses were the most frequent specific diagnosis, presumed sarcoidosis and birdshot choroidopathy were also identified as diagnostic entities of uveitis presenting for the first time in the elderly. Only three cases of masquerade syndrome were identified, two cases of intraocular lymphoma, and one metastasis of a visceral melanoma. CONCLUSION: Masquerade syndromes are not the leading cause of uveitis in the elderly. Idiopathic uveitis and herpes viruses are the most common etiology found.

[Iris melanomas. A retrospective study of 11 patients treated by surgical excision]. / Les mélanomes de l'iris. Etude rétrospective de 11 cas traités par excision chirurgicale.

INTRODUCTION: Iris melanoma, even when a malignant tumor, has a slow progressive course. Surgical treatment is easy because of localization of the tumor but can be accompanied by a range of complications, from photophobia to cosmetic problems. MATERIALS AND METHODS: We reviewed the records of 11 patients with iris melanoma treated by surgical excision with posterior limbus incision. Conventional iridectomy was performed in nine cases and iridocyclectomy in two cases. RESULTS: There were seven females and four males ranging in age from 27 to 76 years. Histologically, 10 tumors were composed of B spindle cells and one was mixed. For all patients, followed up for 1-5 years, final visual acuity was more than 6/10. One patient complained of photophobia and cataract developed in one 76-year-old woman at the end of follow-up. CONCLUSION: Because of the good prognosis of iris melanoma, conservative treatment can be given in most of cases (without local complications). Surgical resection confirms diagnosis after histopathological examination, with good final functional result thanks to scleral tunnel incision, which induces less astigmatism than corneal incisions. In the future, these findings will have to be confirmed by a corneal topography study before and after surgery.