[Specific problems linked to glaucoma in elderly patients]. / Problèmes spécifiques liés au glaucome chez la personne âgée.

Chronic glaucoma is one of the main causes of blindness in France. The incidence of the disease increases with age and forms an ever greater public health problem as the population ages. It is therefore important to be aware of the disabilities related to glaucoma in order to optimise the treatment of elderly patients suffering from the disease.

Manifestations and treatment of ocular syphilis during an epidemic in France.

OBJECTIVES: To review cases of ocular syphilis presenting to a tertiary uveitis clinic during a syphilis epidemic in France between January 2001 and January 2004. STUDY DESIGN: Retrospective chart and patient database review. RESULTS: Ten patients who presented with symptoms and signs of uveitis tested positive for active syphilis. Some of the patients also presented with a rash or headache. Human immunodeficiency virus (HIV) antibody testing was positive in eight of the 10 patients, with CD4 cell counts >200 cells/mm3 in seven of the patients. Ocular inflammation resolved and visual acuity improved in all patients after treatment. CONCLUSIONS: A diagnosis of ocular syphilis should be considered in any patient with visual loss associated with a rash or headache, irrespective of the patient's CD4 cell count. Ocular syphilis in HIV-positive patients should be treated as neurosyphilis, whereas ocular syphilis in non-HIV patients can be treated as secondary syphilis.

Cone dysfunction as a paraneoplastic syndrome associated with retinal antigens approximating 40 kiloDalton.

Reports on cancer-associated retinopathies (CAR) have increased in recent years as the autoimmune reactions responsible have become better understood. The 23-kDalton autoantigen 'recoverin' was the first retinal antigen implicated in CAR, but others have since been described. We report an additional case involving an autoantigen other than recoverin, with five-year follow-up of a 50-year-old woman suffering from the CAR syndrome, with ocular abnormalities restricted to cone dysfunction. The patient had a history of laryngeal carcinoma surgically removed 18 months prior to presenting to the ophthalmologist with photophobia and decreased vision in both eyes. The patient's abnormal retinal hypersensitivity included antibody activity with two retinal antigens approximating 40 kD, located within the outer segments of the photoreceptor layer. To our knowledge, this is the first description of a cancer-associated, cone-specific dystrophy involving an abnormal amount of immunologic activity with two retinal proteins approximating 40 kD, that may prove to be isoforms of the same antigen.

Infliximab in the treatment of posterior uveitis in Behçet's disease. Long term follow up in four patients.

OBJECTIVE: To evaluate the efficacy of infliximab as adjuvant therapy for refractory uveitis in Behçet's disease. METHODS: Retrospective evaluation of 4 patients with Behçet's disease and severe uveitis, refractory to conventional corticosteroid and immunosuppressant regimens, to which infliximab (anti-tumor necrosis factor-alpha (TNFalpha) antibodies) was added. The outcome measures were intraocular inflammation, visual acuity, reduction of daily corticosteroid dose, and adverse effects. RESULTS: The mean follow-up period was 11 months (range: 2-29 months). Patients received a mean of 8 (range: 3-16) infliximab infusions. TNFalpha blockade with infliximab was effective for 2 of our 4 patients: the effect for them was rapid but transient. One patient experienced a thoracic herpes zoster, a severe adverse effect not previously reported. CONCLUSIONS: Response to infliximab was variable in patients with Behçet's disease for whom conventional immunosuppression had failed. Infliximab allowed the daily corticosteroid dose to be reduced for some patients but required repeated infusions.

Optical coherence tomography in the acute and chronic phases of Vogt-Koyanagi-Harada disease.

PURPOSE: To assess the potential of optical coherence tomography (OCT) in the diagnosis and monitoring of serous retinal detachment in Vogt-Koyanagi-Harada (VKH) disease and to describe OCT characteristics of subretinal sequelae of the disease. METHODS: Six patients in the acute phase of VKH disease with serous retinal detachment were followed in our department from July 2001 to December 2003 using slit-lamp biomicroscopy, OCT, and fluorescein angiography. RESULTS: OCT was effective in objectively quantifying the amount of serous retinal detachment present and then in following the resolution of subretinal fluid accumulation. Subretinal pigmented lesions on angiography corresponded with retinal pigment epithelium hypertrophy and fibrosis on OCT. CONCLUSION: A beneficial effect of treatment was observed within days, paralleling the improvement in visual acuity. Retinal pigment epithelium hypertrophy and fibrosis in the chronic phase of the disease were analyzed with OCT for the first time.

Acute postoperative glaucoma after nonocular surgery remains a diagnostic challenge.

IMPLICATIONS: Anesthesia may acutely reveal angle-closure glaucoma. This complication is an ophthalmologic emergency. However, symptoms of acute glaucoma may be overlooked or misinterpreted in a sedated or comatose patient, and this may result in delayed treatment. Immediate diagnosis and appropriate treatment should be done to prevent visual loss.