Intra-orbital Castleman's disease.

Castleman's disease is a rare lymphoproliferative process found in either a focal or multicentric localization. Most cases occur as mediastinal and abdominal mass, although nodal and extranodal locations have been reported. Eleven cases of Castleman's disease involving the central nervous system have been reported, but only one is a proven instance of primary intra-orbital localization. The present report concerns a clinico-pathologic Castleman's disease case, to our knowledge the second orbital case described in the literature.

[Toxocara canis infection. 2 cases of peripheral granuloma in adults]. / Toxocarose canis. Deux cas de granulome périphérique chez l'adulte.

PURPOSE: We report two cases of toxocariasis peripheral granuloma in adults. METHODS: Diagnostic difficulties linked to parasite serologies, particular to these two cases, are presented. Serology is often poorly contributive, but PCA and/or vitreous study with the ELISA reaction to Toxocara canis homologous antigens in the endocular fluids are the most reliable means of reaching a diagnosis, as evidence in our two observations. In the same way, the presence of eosinophils and of IgE in the aqueous humor and or vitreous is of great importance for orienting the diagnosis. RESULTS: The treatment consisted in systemic steroids and granuloma cryotherapy associated with vitrectomy and for one case indentation due to a traction. Later, retinal membrane peel was performed for the same patient. No treatment with antihelminthic drugs was proposed. The functional and anatomic results were good in both cases (8/10-P2 and 6/10-P2). CONCLUSION: Toxocara canis infection is based on clinical aspects. The ELISA technique is useful for biological diagnosis.

[Orbital metastasis of prostatic cancer. Clinical and therapeutic aspects. Apropos of a case (clinical case)]. / Métastase orbitaire d'un cancer prostatique. Aspects cliniques et thérapeutiques. A propos d'un cas (cas clinique).

A metastasis to the left orbit revealed cancer of the prostate in a 60-year-old man. Such localizations are rare compared with the frequency of bone metastasis in cancer of the prostate. Diagnostic methods are discussed together with the urgent required to save the eye.

Ciprofloxacin ophthalmic solution in the treatment of conjunctivitis and blepharitis: a comparison with fusidic acid.

The efficacy and safety of ciprofloxacin ophthalmic solution (0.3%) and fusidic acid gel (1%) were compared in the treatment of bacterial conjunctivitis and blepharitis in a randomized, open, parallel group study. Thirty-nine patients, 21 treated with ciprofloxacin solution and 18 treated with fusidic acid gel, were culture-positive on admission and were evaluable for efficacy. At the end of a 7-day treatment, the infecting organism was eradicated in 81% of those treated with ciprofloxacin and 72% of those treated with fusidic acid gel. There was clinical cure or improvement in 95% and 89% respectively. The clinical cure rate appeared to be higher with ciprofloxacin than fusidic acid (62% compared with 28%) but this was related to the higher proportion of patients with acute conjunctivitis in the ciprofloxacin group. Two patients using ciprofloxacin had mild discomfort and stinging on instillation and one given fusidic acid had moderate edema and discomfort; the latter patient stopped treatment. Topical ciprofloxacin is effective and well tolerated and is a useful treatment of bacterial conjunctivitis and blepharitis.

Comparative evaluation of efficacy and safety of ciprofloxacin and norfloxacin ophthalmic solutions.

The efficacy and safety of ciprofloxacin ophthalmic solution 0.3% and norfloxacin ophthalmic solution 0.3% in the treatment of bacterial conjunctivitis and blepharitis were compared in a double masked randomised study. A total of 131 patients, 65 treated with ciprofloxacin (42 with conjunctivitis and 23 with blepharitis) and 66 treated with norfloxacin (39 with conjunctivitis and 27 with blepharitis) were enrolled in the study at five centres in France. In the efficacy population, pathogens were eradicated or reduced in 96% (24/25) of patients in the ciprofloxacin group and 89% (24/27) in the norfloxacin group. There was no difference between treatments with regard to eradication of particular pathogens. In the efficacy population, clinical cure or improvement was seen in 96% of the patients (24/25 in the ciprofloxacin group and 26/27 in the norfloxacin group). There were no significant differences between ciprofloxacin and norfloxacin with respect to improvements in four symptoms or ten clinical signs. No serious treatment-related adverse events were reported and both ciprofloxacin and norfloxacin were well tolerated.

[True or supposed bacterial endophthalmitis. Study of anatomo-functional outcome apropos of 32 cases]. / Endophtalmies bactériennes ou supposées telles. Etude du devenir anatomo-fonctionnel à propos de 32 cas.

PURPOSE: Vision prognostic study depending on the germs and the therapic performed in bacterial endophthalmitis. METHODS: In a retrospective study over a period of 3 years (1991-1993), 32 cases of post surgery bacterian endophthalmitis were detected: 30 cases after cataract surgery (29 cases after extra capsular surgery and one case after intra capsular), one case after trabeculectomy and one case after keratoplasty. RESULTS: A risk factor was evidenced in 15.6% of the cases. Endocular samples were done in 68.75% of the cases. The positive rate was 36.4% showing a Staphylococcus in 5 cases out of 8 (62,5%). In 37.5% of the cases an intraocular antibiotic injection was associated to the anterior chamber punction. 40% of the cases contaminated with Staphylococcus regained a visual acuity of more than 3/10. For the two cases where a Streptococcus was isolated an evisceration was necessary. Our results show that a higher visual acuity was obtained when a posterior vitrectomy was performed. When the posterior vitrectomy was associated with a corticoid therapy, the visual prognostic was better. Thus, 71% of these cases regained a visual acuity of more than 3/10. CONCLUSION: Our results show that performing a posterior vitrectomy associated to a general corticotherapy within 48 hours from the bacterian endophthalmitis diagnosis would allow best vision improvement.

[Spatial contrast sensitivity in patients with severe myopia]. / La sensibilité au contraste spatial chez le fort myope.

PURPOSE: The purpose of this study was to assess the effects of amount of myopia, axial elongation staphyloma and type of optical correction on contrast sensitivity of high myopic subjects. METHODS: Fifty-one patients (91 eyes) were selected on the following qualifications: myopia > or = 8 dpt and/or axial length > or = 26 mm, and visual acuity > or = 0.1 recorded through spectacle lenses. Contrast sensitivity was measured using a "Moniteur Ophtalmologique" for all subjects when corrected with spectacle lenses, and thereafter on a lot of patients (50 eyes) wearing a contact lens. RESULTS: Contrast sensitivity obtained with spectacle lenses was significantly decreased over the whole spatial frequency range. The higher the spatial frequency was, the lower contrast sensitivity was. The impairment increased with the amount of myopia and axial length, but without positive correlation. Contrast sensitivity was significantly lower for only the three highest spatial frequencies measured (6.4; 12.8 and 25.6 c/deg), when a staphyloma (n = 52) was present by comparison with results obtained for eyes without staphyloma (n = 39). Differences between the two situations (spectacle lens vs. contact lens) were not significant for eyes wearing daily spectacle lenses; conversely, for myopic subjects generally fitted with contact lenses, contrast sensitivity with contact lenses was significantly better than that measured with spectacles for the three highest spatial frequencies tested. CONCLUSION: This suggests that the decrease in contrast sensitivity measured in high myopia is related to defects in the optical and neuro-retinal systems.

[Dacryocystorhinostomy using Nd YAG laser by the intracanicular approach]. / Dacryocystorhinostomie au laser Nd YAG par voie endocanaliculaire.

Endocanalicular dacryocystorhinostomy is a recent surgical procedure for stenosis of the naso-lacrymal duct, thanks to a laser filter fitted into the heart of 800 mu diameter metallic pin constituting a rigid armed laser probe. We create a lacrymo-nasal orifice from inside the lacrymal bag towards the nose, using the laser fiber. The Nd YAG used is the solid state mobilisable Ophtalas sp 32 giving out infrareds at 1064 nm or green at 532 nm. The indications are the stenosis of the naso-lacrymal duct, the failed classical dacryocystorhinostomy, the conjunctivodacryocystorhinostomy and the stenosis of the common canaliculus. This surgical procedure compared to the classical surgical technics appears to the very promising due to its simplicity, innocuousness, time saving. Our results, still inferior to the classical technique for all indications (success rate: 70%) are very good for the idiopathic stenosis of the naso-lacrymal duct (success rate: 87.5%).

Ciprofloxacin ophthalmic solution versus rifamycin ophthalmic solution for the treatment of conjunctivitis and blepharitis.

The efficacy and safety of ciprofloxacin (0.3%) ophthalmic solution and rifamycin (1%) ophthalmic solution for the treatment of bacterial conjunctivitis and blepharitis was compared in this randomized, double-masked, parallel-group study. Forty-one patients, 19 on ciprofloxacin and 22 on rifamycin, were culture-positive on admission and evaluated for efficacy. There was clinical improvement in more than 90% of patients in each group at the end of the seven-day treatment period. However, clinical cure rates on day 7 appeared to be higher with ciprofloxacin (53%) than rifamycin (23%; p = 0.061, Mann-Whitney test). Bacteriological eradication rates were comparable: the infecting organisms were eradicated in 68% of patients on ciprofloxacin and 77% with rifamycin. There were no serious adverse reactions to either treatment. One patient in each group was withdrawn on account of a mild allergy. In conclusion, topical ciprofloxacin was effective and well tolerated and would be a particularly useful agent for the treatment of bacterial conjunctivitis and blepharitis.

[Search for bacterial contamination of the aqueous humor during cataract surgery with and without local antibiotic prophylaxis]. / Recherche d'une contamination bactérienne du liquide intra-oculaire au cours de la chirurgie de la cataracte avec et sans antibioprophylaxie locale.

PURPOSE: Bacterial contamination of anterior chamber at the end of cataract surgery, was compared between two techniques: extracapsular extraction and phacoemulsification. The effectiveness of preoperative antibiotic eyedrops using Norfloxacine 0.3% (Chibroxine) was also evaluated. METHOD: The study focused on 101 patients grouped according to surgical technique and presence of preoperative antibiotic eyedrops. Conjunctival sampling was made the day prior the surgery, as well as in the operating room, after skin and conjunctival desinfection with povidone iodine in all the patients included in the study. Aqueous humour was collected at the end of surgery. RESULTS: Eight samples out of 101 were positive which represents 7.9% of the cases. In 75% of the cases, the anterior chamber aspirate showed a different germ or non-recurrent germ in the second conjunctival sample. None of the included patients developed endophthalmitis. The two most frequent pathogens were Propionibacterium acnes in 62.5% of the cases, and Staphylococcus epidermidis in 50%. Another pathogen was found in a culture environment: Micrococcus roseus. In two samples, two different bacteria grew: Propionibacterium acnes and Staphylococcus epidermidis. Whatever the surgical technique, no statistically significant bacterial contamination was found. There was no significant statistical difference between patients who had local antibiotic eyedrops and those who did not. CONCLUSION: This study confirms the poor reliability of local antibiotic eyedrops to prevent surgical contamination. Furthermore performing an anterior chamber aspirate at the end of the surgery for risk patients would help the physician identify the pathogens involved in endophthalmitis in order to begin antibiotic treatment as soon as possible.

[Clostridium perfringens endophthalmitis. Apropos of a case]. / Endophtalmie à Clostridium perfringens. A propos d'un cas.

The authors report a case of Clostridium perfringens endophthalmitis occurring after a corneo-limb al injury without intraocular foreign body. The diagnosis was made on CT scan prior to bacteriological identification of the bacteria. Rapid and adapted treatment allowed preservation of the eyeball. The clinical signs, often stereotyped, as well as the combined medical--with systemic antibiotics--and surgical--vitrectomy--treatments are described.

[Chlamydia trachomatis conjunctivitis in adults. Study of diagnostic techniques]. / Place des conjonctivites à Chlamydia trachomatis chez l'adulte. Etude des techniques de diagnostic.

The place of Chlamydia trachomatis in acute or chronic conjunctivitis is certainly underestimated due to the difficulties involved in the diagnosis. Three diagnostic techniques for Chlamydia trachomatis conjunctivitis were compared: conjunctival sac swab for ELISA technique, scraping of the tarsal conjunctiva for direct immunofluorescence and for culture. Two groups of patients were studied: 73 patients with acute or chronic conjunctivitis and 44 asymptomatic patients. 19.2% of the patients in the first group had a positive result with the two techniques and 6.8% of the patients in the second group also had positive results with the same criteria. Our results show that indirect immunofluorescence is the technique most frequently positive, followed by ELISA, while culture remains the most specific but the least sensitive technique. The existence of healthy carriers Chlamydia trachomatis is demonstrated.

[Conjunctivitis and lacrimal apparatus infections]. / Conjonctivites et infections des voies lacrymales.

The term conjunctivitis covers all inflammatory processes affecting the conjunctiva. Bacterial and viral infections are the most frequent causes. Infectious conjunctivitis is rarely severe in industrialized countries, but trachomatous kerato-conjunctivitis is still the main cause of blindness all over the world. Most cases of bacterial conjunctivitis are treated with topical antibiotics. Viral conjunctivitis is frequent and, with the exception of herpetic conjunctivitis, has no specific treatment. Canaliculitis and dacryocystitis are rare but require specialized examination, treatment and follow-up.

[Cicatricial ectropion and ichthyosis. Apropos of 4 cases]. / Ectropions cicatriciels et ichtyoses. A propos de 4 cas.

Ichthyosis are dystrophic inheritance skin disorders with inconstant palpebral complications like cicatricial ectropion and lagophthalmos due to large skin retractions. The authors report two cases of cicatricial ectropion in two adults. For one of the two cases, it is the first description to our knowledge of cicatricial ectropion associated with ichthyosis vulgaris sex-linked. The authors, after a short description of physiopathology and of classification of the different types of ichthyosis describe the surgical treatment with skin grafts, with good results in the first post operative period only in two adults. The two newborns had good results with medical treatment only.