[Paraneoplastic ophthalmopathies]. / Ophtalmies paranéoplasiques.

Ocular paraneoplastic syndromes are rare conditions that can affect any part of the eye at any age. Thus, every ophthalmologist should be familiar with their management, as some of them may reveal severe, life-threatening conditions. These consist overwhelmingly of neuro-ophthalmological manifestations, affecting the optic nerve (paraneoplastic optic neuritis), retina (paraneoplastic retinopathy) or neurological pathways generating eye movements (saccadic intrusion, oculomotor palsy, nystagmus...); occasionally, they involve the anterior segment, orbit or uveal tract. As some of these manifestations appear to be quite common and non-specific, any systemic or especially neurologic comorbidities should increase suspicion. Treatment relies first on oncologic management, and then often more targeted therapy for the associated immune involvement.

Longitudinal follow-up of vision in a neuromyelitis optica cohort.

BACKGROUND: Neuromyelitis optica (NMO) is an inflammatory disease associated with optic neuritis and myelitis. Recently, several studies showed that optical coherence tomography (OCT) could be an interesting method for the evaluation of disease severity; however, to date there are no studies with a longitudinal follow-up of visual function in NMO. The aim of this study was to assess the ability of OCT to evaluate the progression of visual dysfunction in NMO. PATIENTS AND METHODS: A group of 30 NMO patients (thus, 60 eyes), comprised of 20 women and 10 men with a mean age of 43.7 +/- 12.3 years, were prospectively evaluated clinically and by a whole neuro-ophthalmological work-up, including: visual acuity (VA), fundoscopy, visual evoked potential (VEP), visual field (VF) and optical coherence tomography (OCT). All patients were tested at baseline (after a mean disease duration of 6.1 years) and after a mean time of follow-up of 18 months (range: 12-36 months). RESULTS: Mean VA was similar at the two evaluation times (0.77 +/- 0.36 versus 0.77 +/- 0.35). The mean VF defect decreased slightly, but the difference was not significant (-5.9 +/- 1.3 dB versus -5.3 +/- 1.3 dB). In contrast, the mean retinal thickness seen on OCT decreased from 87.4 +/- 23.3 µm to 79.7 +/- 22.4 µm (p = 0.006). These modifications were only observed in eyes with a past or a recent history of optic neuritis (-15.1 µm; p < 0.001) and not in eyes without any history of optic neuritis (-2.4 µm; not significant). Also, they occurred independently of the occurrence of relapses (n = 13) and especially optic neuritis episodes; however, the number of optic neuritis episodes was low (n = 5). CONCLUSION: OCT seems to be a more sensitive test than VA or VF for monitoring ophthalmological function in NMO and it seems to be helpful for the detection of infra-clinical episodes in patients with a past history of optic neuritis. Our results suggest that this easily performed technique should be used in the follow-up of NMO, but complementary studies are warranted to confirm its interest at an individual level.

Intermediate uveitis, an ophthalmological manifestation of systemic disease.

PURPOSE: Intermediate uveitis is frequently indicative associated with systemic disease. In addition to the initial evaluation of the patient with intermediate uveitis, we sought to determine the role of longitudinal follow-up in improving the diagnosis of systemic disease associated with intermediate uveitis. METHOD: Retrospective analysis of a cohort of 51 patients with intermediate uveitis followed for 5 to 13 years. RESULTS: Upon initial evaluation, an underlying disease associated with the intermediate uveitis was found in nine out of the 51 patients. Among the remaining patients, after at least 5 years of follow-up, eight new associated diagnoses were revealed (primarily inflammatory diseases and cancers). CONCLUSION: These results suggest that the initial work-up of the patient with intermediate uveitis is not sufficiently sensitive and that careful follow-up of these patients considerably improves the diagnosis of associated disease.

[A case of bilateral horizontal gaze ophthalmoplegia: The 1+1 syndrome]. / Un cas d'ophtalmoplégie horizontale bilatérale : le syndrome 1+1.

INTRODUCTION: Oculomotor deficiencies in multiple sclerosis (MS) are frequently characterized by internuclear ophthalmpoplegia or isolated abduction or adduction palsies. Complete unilateral conjugate gaze paralysis and the "one and a half" syndrome are rare. Complete bilateral horizontal gaze paralysis has been exceptionally reported. OBSERVATION: Here, we describe an unusual oculomotor paralysis as a suspected first event of MS. A 24-year-old woman with an uneventful medical history presented for sudden onset of binocular diplopia. On examination, abduction and adduction saccades were impossible, whereas vertical eye saccades and convergence were normal. Oculocephalic reflex failed to improve horizontal eye movement. No nystagmus and no other sign of brainstem dysfunction were observed. Visual acuity was 4/10 in the right eye and 6/10 in the left eye. A sign of Marcus Gunn was noted in the right eye. Blood samples and cerebrospinal fluid were normal, no oligoclonal bands were detected. Visual evoked potentials were significantly impaired in both eyes and argued for bilateral optic neuritis. Brain MRI scans showed white matter T2-hypersignal abnormalities, which fulfill Barkhof criteria for MS. A small symmetric lesion was noted in the posterior part of the medial pontine tegmentum. As a first episode of MS was suspected, treatment with methylprednisolone 1000 mg/d for 3 days was started, and was followed by complete recovery of eye movements and visual acuity after 3 weeks. DISCUSSION: To our knowledge, only two cases of complete horizontal bilateral ophthalmoplegia have been reported in the literature. Both were associated with peripheral facial nerve palsy as a first event in MS. In our case report, we describe for the first time a complete bilateral horizontal ophthalmoplegia with no other brainstem dysfunction. By analogy with the "one and a half" syndrome, such complete horizontal gaze paralysis could be named a "one and one" syndrome and seems to be specifically related to a first event of MS.

[Moebius syndrome. Apropos of 2 cases]. / Syndrome de Moebius. A propos de deux cas.

Moebius syndrome is unusual and associates facial diplegia with a failure of lateral movements, and seems to be of nuclear or supranuclear origin, appearing during foetal life. Association with somatic malformations are frequent such as those of Poland syndrome. Surgery's envisaged when palsy of lateral movements is associated with deviation of the eyes.

[Clinical applications and critical evaluation of helium-neon laser interferometry]. / Applications cliniques et évaluation critique de l'interférométrie au laser à hélium-néon.

Exploration of macular function in patients opaque media has been performed routinely with Helium-Neon Laser interferometry for more than 5 years. Our results in patients with cataract, macular diseases, retinal detachment and functional amblyopia are reported. Accurate correlations, overestimations and underestimations are differentiated with special emphasis on overestimations.

[Intra-ocular implantation and traumatic cataract]. / Implantation intra-oculaire et cataracte traumatique.

Discussion of the indications of the correction of post-injury aphakia intraocular lens. The immediate infectious danger by perforation, the unavoidable inflammatory reactions, the potential retinal risk and the so often alteration of the posterior chamber by synechias, are leading to advice, in the majority of cases, the secondary anterior chamber lens implantations.

[Interocular accommodative disparities: asymmetry and/or paresis?]. / Les disparités accommodatives interoculaires: asymétrie et/ou parésie?

Description of interocular accommodative disparities about 3 cases of young patients, whose occupations require an excellent stereopsis in near vision. Is is a paresis, an asynergy or a constitutional asymmetry? In order to delimit this pathology, the accommodative power of each eye has been measured on a reference population including 100 subjects aged 20 to 35 years. The suitable correction of this anomaly, allows an exact compensation and the recovery of a normal functional comfort.