Should central serous chorioretinopathy be added to the list of ocular side effects of phosphodiesterase 5 inhibitors?

INTRODUCTION: Rare cases of central serous chorioretinopathy (CSC) associated with the intake of sildenafil citrate have been reported, although CSC is not included in the list of phosphodiesterase 5 (PDE5) inhibitor side effects. MATERIALS AND METHODS: We present a review of the literature and 2 cases of CSC in 2 men taking PDE5 inhibitors (vardenafil and tadalafil) for erectile dysfunction. In both cases chorioretinopathy appeared after intake of the inhibitor, resolved once the latter was discontinued, reappeared when the inhibitor was restarted and resolved once again after the inhibitor had been discontinued for the second time. DISCUSSION: PDE5 inhibitors used for male erectile dysfunction have been associated with ocular side effects including lid edema, hyposphagma, photophobia, mydriasis, dyschromatopsia, and nonarteritic anterior ischemic optic neuropathy. CSC was previously described in patients taking sildenafil citrate. Very recently, a case of CSC after tadalafil intake was reported. The relevant literature is reviewed and possible pathophysiologic mechanisms are discussed. CONCLUSION: The 2 presented cases of CSC after intake of vardenafil or tadalafil with positive dechallenge, rechallenge and second dechallenge reactions provide important arguments for considering CSC as a rare PDE5 inhibitor class-specific side effect.

[Multifocal electroretinography in follow-up of patients treated with hydroxychloroquine]. / L'apport de l'électrorétinographie multifocale dans le suivi des patients traités par hydroxychloroquine.

INTRODUCTION: Ophthalmologic follow-up of hydroxychloroquine-treated patients is of major importance because of the risk for potentially irreversible retinal toxicity. The use of the multifocal electroretinogram for the follow-up of such patients has already been reported. We studied the capacity of the multifocal electroretinogram to detect early signs of retinal toxicity. PATIENTS AND METHODS: This study consisted of multifocal electroretinogram analysis of 28 patients treated with hydroxychloroquine for a period of 6-72 months. All patients selected had a normal clinical and paraclinical ophthalmological evaluation. A multifocal electroretinogram according to the international recommendations was obtained. We analyzed the amplitude and the implicit time for kernel 1 responses by quadrant and by ring. RESULTS: For both eyes, in both ring and quadrant analyses, the average implicit times of patients receiving hydroxychloroquine were significantly elevated (p<0.01). On the other hand, the amplitudes were not significantly attenuated. In a total of 28 patients, seven (25%) presented a significant prolongation of the implicit time and significant amplitude attenuation was found in only one patient. DISCUSSION: Implicit time prolongation in hydroxychloroquine-treated patients has already been reported. However, dissociation between amplitude and implicit time changes has, to our knowledge, never been previously described. This observation is important given that numerous studies focus exclusively on amplitude. CONCLUSION: The multifocal electroretinogram of patients receiving hydroxychloroquine can present lengthened kernel 1 implicit time, despite otherwise normal ophthalmological evaluation. Further studies are necessary to evaluate the prognostic value of mfERG responses in the early detection of patients presenting a retinotoxicity risk.

Corneal nerves alterations in various types of systemic polyneuropathy, identified by in vivo confocal microscopy.

BACKGROUND: In vivo confocal microscopy (IVCM) is a newly developed application to assess corneal nerve morphology. The purpose of the study is to evaluate the role of IVCM in the assessment of various types of polyneuropathy, and to define alterations of corneal nerves in such conditions. PATIENTS AND METHODS: Eighteen patients with various types of polyneuropathy were characterized by clinical neurological and ophthalmic examinations, as well as by electroneuromyography (ENMG). Full thickness IVCM of corneal nerves was carried out on all patients and 15 age-matched eyes using Heidelberg Retina Tomograph II (HRT II). The subbasal nerve plexus were statistically analysed regarding long nerve fiber density, nerve branch density, nerve thickness, nerve bead number and nerve tortuosity. RESULTS: In subbasal nerve plexus, the following three parameters were significantly reduced in patients with polyneuropathy compared to controls: long nerve fibre density (p < 0.01), nerve branch density (p < 0.001), and nerve bead number (p = 0.001). In addition, the average grade of nerve tortuosity was 2.87 +/- 0.97 in the polyneuropathic group and 1.17 +/- 0.68 in the control group (p < 0.0001). CONCLUSIONS: IVCM allows a non-invasive, in vivo study of corneal nerves with high resolution. It therefore appears invaluable in clinical investigations. IVCM appears to be valuable in a large variety of polyneuropathic conditions.

Spontaneous orbital haemorrhage into the lateral rectus muscle.

BACKGROUND: Spontaneous orbital haemorrhage can occur at any age. The clinical presentation is often dramatic with acute painful proptosis and nausea. Vision may be severely impaired. HISTORY AND SIGNS: A 77 years old lady woke up with sudden retroocular pain, diplopia and proptosis. Her blood pressure was 235 / 95 mmHg. MRI showed a right retroocular mass, contiguous with the lateral rectus muscle and consistent with a haemorrhage. Vision was preserved in both eyes but the right visual field slightly altered. Motility of the right eye was severely impaired. THERAPY AND OUTCOME: The risks of surgical drainage were considered too high in a case of only slight visual field impairment, and a conservative attitude was decided. Evolution was good with antihypertensive treatment, the haemorrhage resorbed and diplopia improved. MRI showed no morphological orbital anomaly. CONCLUSIONS: Spontaneous orbital haemorrhage is a complication of a vascular orbital anomaly in most cases, more rarely due to a disturbance of coagulation. In our case arterial hypertension in association with antiaggregant intake explains the haemorrhage. Conservative treatment appears adequate with regard to the only slight visual field impairment. Close neuro-ophthalmological follow-up is, however, needed.

Distinct mechanisms of form-from-motion perception in human extrastriate cortex.

The exquisite sensitivity of the human visual system to form-from-motion (FfM) cues is well documented. However, identifying the neural correlates of this sensitivity has proven difficult, particularly determining the respective contributions of different motion areas in extrastriate visual cortex. Here we measured visual FfM perception and more elementary visual motion (VM) perception in a group of 32 patients suffering from acute posterior brain damage, and performed MRI-based lesion analysis. Our results suggest that severe FfM perception deficits without an associated deficit of VM perception are due to damage to ventral occipito-temporal cortex (VOT), whereas associated deficits of FfM and VM perception are due to damage either in proximity to area MT+/V5 or an area including lateral occipital complex (LOC) and VOT. These data suggest the existence of at least three functionally and anatomically distinct regions in human visual cortex that process FfM signals.

Subretinal electrode implantation in the P23H rat for chronic stimulations.

BACKGROUND: In age related macular degeneration and inherited dystrophies, preservation of retinal ganglion cells has been demonstrated. This finding has led to the development of various models of subretinal or epiretinal implant in order to restore vision. This study addresses the development of a polyimide subretinal electrode platform in the dystrophic P23H rat in vivo. METHODS: A technique was developed for implanting a subretinal electrode into the subretinal space and stabilising the distal extremity of the cabling on the rat cranium in order to allow future electrical stimulations of the retina. RESULTS: In vivo imaging of the retina with the scanning laser ophthalmoscope demonstrated reabsorption of the surgically induced retinal detachment and the absence of major tissue reactions. These in vivo observations were confirmed by retinal histology. The extraocular fixation system on the rat cranium was effective in stabilising the distal connector for in vivo stimulation. CONCLUSION: This study demonstrates that a retinal implant can be introduced into the subretinal space of a dystrophic rat with a stable external connection for repeatable electrical measurements and stimulation. This in vivo model should therefore allow us to evaluate the safety and efficacy of electrical stimulations on dystrophic retina.

Pasteurella multocida endophthalmitis: case report and review of the literature.

BACKGROUND: Postoperative bacterial endophthalmitis is caused by the patient's endogenous flora in most cases (80 %). Pasteurella multocida (PM) is a Gram-negative coccobacillus found in the upper respiratory tract of dogs and cats and is very rarely implicated in postoperative endophthalmitis. HISTORY AND SIGNS: We describe a case of PM endophthalmitis that developed after cataract surgery. THERAPY AND OUTCOME: Cultures of both the conjunctiva and the aqueous humor were positive for PM. Topical, intravitreous and intravenous antibiotics were administered. Despite treatment, the outcome was unfavourable and complicated by a corneal perforation. CONCLUSIONS: The prognosis of postoperative PM endophthalmitis remains poor, despite adequate treatment of the infection. A history of recent pet exposure should alert physicians to this possible aetiological factor.

Varicella-zoster virus retinitis: successful evolution with a combination of antiviral therapies.

BACKGROUND: We present the description of a successful outcome in a case of varicella-zoster virus (VZV) acute retinal necrosis (ARN). HISTORY AND SIGNS: A healthy 40-year-old patient was admitted for a VZV retinitis. THERAPY AND OUTCOME: 10 days after the onset of intravenous (i. v.) acyclovir treatment, new small peripheral retinal necrotic lesions appeared in the right eye. A viral resistance was suspected and the acyclovir therapy was optimised with i. v. foscarnet combined with 2 intravitreal injections of ganciclovir. The outcome was favourable with a final vision of 1.0 after a follow-up of 30 months. No systemic or local complications were observed. CONCLUSIONS: VZV ARN is a severe infection with a poor prognosis. This case demonstrates that combination of antiviral therapies given intravenously (acyclovir + foscarnet) and in the vitreous (ganciclovir) may be safe and efficacious in the management of necrotising herpetic retinopathies affecting immunocompetent patients.

Elicited repetitive daily blindness: a new familial disorder related to migraine and epilepsy.

The authors report a family affected by multiple daily episodes of transient visual loss, elicited repetitive daily blindness (ERDB); the onset was early in life, and the disease followed a benign course. ERDB is associated with childhood epilepsy and familial hemiplegic migraine, apparently segregating as a monogenic, autosomal dominant condition with variable expression. Genetic linkage to CACNA1A was excluded.

[The value of multifocal ERG in diagnosis of discrete macular dystrophies]. / Importance de l'ERG Multifocal dans le Diagnostic de Dystrophies Maculaires Discrètes.

BACKGROUND: Multifocal ERG is being extensively applied to numerous retinal disorders. It has gained particular clinical value in retinal disorders developing without morphological alterations. PATIENTS AND METHODS: We investigated a series of 4 patients, aged 10, 18, 29, and 49 years, respectively. When examined, they complained of photophobia and slowly progressive bilateral loss of vision, visual acuity ranging from 0.7 to 0.1. RESULTS: Ophthalmoscopic examination showed no or minimal alterations such as subtle granular changes in the fovea. Photopic-scotopic full-field ERG was normal. Multifocal ERG, in contrast, showed markedly reduced signal amplitudes within the central 10 degrees. CONCLUSIONS: Based on the results of multifocal ERG, we were able in each case to consider with a high degree of probability the diagnosis of progressive foveal cone dystrophy. This is to emphasize the sensitivity of multifocal ERG in disorders affecting primarily the macula, without morphological changes, as cone (-rod) dystrophy, early Stargardt dystrophy, etc. The uttermost advantages of multifocal ERG are its innocuity, its applicability to children and the very early sensitivity to changes in retinal function.

In vitro maturation and fertilization of oocytes from an intact ovary of a surgically treated patient with endometrial carcinoma: case report.

Polycystic ovary syndrome (PCOS) with prolonged anovulation had resulted in endometrial carcinoma in a 43-year-old woman. Since she and her husband did not share common biological children, they requested fertility preservation. Due to the woman's age, high dose progesterone and postponing surgery were both considered inappropriate. We therefore proposed oocyte retrieval from the ovaries removed by staging laparotomy followed by in vitro maturation and ICSI. Surrogacy could then enable a future pregnancy. Fourteen of 17 (82%) retrieved oocytes matured in vitro. Following ICSI, eight embryos (two at the pronuclear stage and six cleaved) were cryopreserved. To the best of our knowledge, this is the first report of oocyte aspiration, maturation and fertilization from an ovary removed by laparotomy.

Ganglion cells from chick retina display multiple functional nAChR subtypes.

We have examined the properties of nicotinic acetylcholine receptors in embryonic chick retinal ganglion cells. Ganglion cells, identified according to morphological and physiological criteria, displayed spontaneous or induced action potentials. In 94/99 cells acetylcholine pulses evoked responses. In current clamp mode, acetylcholine provoked membrane depolarization and triggered action potentials. Under voltage clamp conditions, acetylcholine evoked inward currents that were readily blocked by d-tubocurarine. Antagonists specific for homomeric (alpha-bungarotoxin) and heteromeric (dihydro-beta-erythroidine) receptors revealed that ganglion cells express multiple functional receptor subtypes. These findings demonstrate that ACh modulates the electrical activity of these cells and is likely to mediate synaptic transmission. The presence of multiple receptor subtypes may contribute to processing and transmission of information in the retina.