[Iridoschisis, a special form of iris atrophy]. / L'iridoschisis, une forme particulière d'atrophie irienne.

Iridoschisis is a rare degenerative disease characterized by the separation of the anterior iris stroma from the posterior layer. The anterior layer splits into strands, and the free ends float freely in the anterior chamber. We report the case of a 57-year-old man, in whom we incidentally discovered isolated unilateral iris atrophy. The patient had no history of the common causes of atrophy (herpes, pigment dispersion, ocular trauma, etc.). During follow-up, the atrophy gradually worsened, with an increase in the number and bilaterality of the lesions. Ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT) of anterior chamber showed thinning of the anterior iris and cleavage of the iris into two layers, an imaging result which, to our knowledge, has not yet been reported in the literature. Familiarity with iridoschisis is important, due to its frequent association with glaucoma, so that appropriate screening can be carried out at the time of diagnosis and on follow-up.

[Ocular phototoxicity and altitude among mountain guides]. / Phototoxicité oculaire et altitude chez des guides de haute montagne.

PURPOSE: This study aimed to evaluate ocular phototoxicity in mountaineer guides who experience overexposure to ultraviolet related to the altitude at which they work, as well as light reflection on snow. MATERIALS AND METHODS: Ninety-six guides and 90 controls living in plains, over 50 years old, underwent complete examinations. They responded to a questionnaire assessing altitude exposure and protective eyewear. We compared the two groups and performed a logistic regression within the guide group so as to identify risk and protective factors. RESULTS: Guides develop more ocular surface diseases. They exhibit more anterior cortical cataract (P<0.01) and cataract surgery (P=0.01). Only 61.5% of guides had a normal ocular fundus versus 81.1% in control group (P<0.01). They exhibit more drusen (27.2% vs. 15.6%, P<0.01). Among the guide group, exposure at an altitude above 3000 m is risk factor for anterior cortical cataract (OR=1.16, P<0.01). Wearing ski masks (OR=0.50, P=0.04) or photochromic lenses (OR=0.53, P=0.03) reduces this risk. Exposure to snow increases the risk of maculopathy (OR=1.9, P<0.01). Wearing a hat reduces this risk (OR=0.40, P=0.02) and the risk of cataract formation (OR=0.46, P=0.04). CONCLUSIONS: Guides develop more ocular surface diseases, anterior cortical lens opacities and drusen. These results underscore the potential deleterious role of ultraviolet radiation and the importance of light reflection on snow. The best ocular protection includes sunglasses and a hat with a visor or brim.

[Efficacy of prophylactic treatment of intraocular pressure spikes due to intravitreal injections]. / Efficacité d'un traitement prophylactique hypotonisant dans l'hypertonie oculaire induite après injections intravitréennes.

PURPOSE: The purpose of this study was to evaluate intraocular pressure increase after intravitreal injections (IVIs) and the effect of prophylactic pressure-lowering medications. METHODS: A prospective study of 210 anti-vascular endothelial growth factor (VEGF) IVI (0.05 mL of bevacizumab or ranibizumab), that were divided into five groups, group 1: no intraocular pressure (IOP)-lowering medication (n=50); group 2: apraclonidine 1 % one drop 2 hours prior to IVI (n=50); group 3: acetazolamide 250 mg 2 hours prior (n=50); group 4: fixed combination brimonidine+timolol (n=30); group 5: fixed combination dorzolamide+timolol (n=30). IOP was measured before, immediately after (T1), 15 min after (T15) and 45 min after (T45) the IVI using a Perkins tonometer. RESULTS: The mean IOP peak in group 1 was 46.4 ± 4.8 mmHg at T1, 21.7 ± 5.7 mmHg at T15 and 15.4 ± 4.3 mmHg at T45. Apraclonidine 1 % and the fixed combinations produced a significant reduction of IOP at every time point, of around 9 mmHg at T1. The reduction in IOP obtained with acetazolamide was not significant versus group 1 at T1 (-1.6 mmHg, P=0.12), but became significant at T15 and T45 (respectively, P=0.011 and P=0.015). CONCLUSIONS: IOP spikes are high but transient following IVI. Acetazolamide proved to be ineffective in preventing this spike. Topical medications, however, produced a significant reduction in IOP spike as well as in the duration of the increased pressure, with no significant difference between fixed combinations and 1 % apraclonidine at T1. It would seem advisable to prevent this IOP spike in the case of repeated injections, particularly in patients with glaucoma.

[Comparison between Lenstar LS 900 non-contact biometry and OcuScan RXP contact biometry for task delegation]. / Comparaison de la biométrie sans contact cornéen par LENSTAR LS 900 et de la biométrie contact par OCUSCAN RXP dans le cadre de la délégation de tâches.

INTRODUCTION: Non-contact biometers have many advantages including the delegation of tasks to orthoptists. This study analyses the reliability of measurements comparing contact and non-contacts techniques. PATIENTS AND METHODS: Comparative measurements were taken on 86 eyes of 45 patients (mean age: 74 years; 44.4 % males) in preoperative phacoemulsification by three orthoptists with experience in this task. Each patient had non-contact measurements (Lenstar LS 900, Haag-Streit) and contact measurements (corneal biometry and ultrasound pachymetry with OcuScan RXP, Alcon) and a keratometry refractometer (TONOREF II, Nidek). The axial length data, pachymetry, power of the intraocular lens (SRK/T formula), anterior chamber depth, and the average keratometry were analyzed by paired comparisons. RESULTS: The non-contact biometer was ineffective in 5.8 % of cases (Parkinson's disease, two cases; dense posterior subcapsular cataracts, three cases). The non-contact pachymetry was statistically significantly higher (546.4 µm vs. 538.6 µm; p<0.001). The axial length was significantly longer for the non-contact measurement (23.21 mm vs. 23.05 mm; p<0.0001). In 25.9 % of patients, this difference was greater than or equal to 0.3mm and affected the power of the implant chosen. The anterior chamber depth measured on non-contact biometry was statistically greater (3.33 mm vs. 3.03 mm; p<0.0001). However, there was no significant difference regarding the average keratometry (43.82 D vs. 43.78 D; p=0327). CONCLUSION: Besides the infectious benefit for patients, absence of cleaning and decontamination of biometric probes, non-contact measurements using Lenstar are an example of a safe activity that can be delegated to assistants. This technique has been used to optimize the refractive outcome of 25.9 % of our patients undergoing refractive cataract surgery.

[Susac syndrome: variable onset modes and disease courses: two case reports]. / Syndrome de SUSAC. Modes d'entrée et évolutions variables: à propos de deux cas.

INTRODUCTION: Susac syndrome is a rare microangiopathy of unknown etiology, which involves the clinical triad of encephalopathy, visual loss, and hearing loss. Several onset and progression patterns are possible. OBSERVATION: Case 1: a 43-year-old woman developed subacute encephalopathy, which had not been diagnosed and had been evolving for 2 months, as well as left sensorineural hearing loss. The fundus exam found central artery branch occlusion in the left retina. The treatment was based on corticosteroids combined with cyclophosphamide and immunoglobulins. Angiographic monitoring revealed persistent asymptomatic arterial alterations despite positive neurological progression. Case 2: a 27-year-old woman presented visual loss in the right eye after recurrent neurological episodes. The triad was completed by deafness in the right ear. Treatment with corticosteroids led to favorable neurological progression and stabilized the ophthalmologic symptoms. DISCUSSION: This syndrome preferentially affects young women. The nearly constant neurological symptoms can differ. Branch occlusions are frequently bilateral and often come with the appearance of vasculitis. Deafness is bilateral, asymmetrical, and of endocochlear origin. Brain MRI shows lesions of the corpus callosum that are distinctive of the syndrome. The disease mainly evolves in a monocyclic way, self-limited in time, and it rarely becomes chronic. Treatment, which has not been codified to date, is based on corticosteroids and, in severe cases, immunosuppressive drugs. Other therapies have not proved to be effective. CONCLUSION: The diagnosis is based on the triad of neurological, ophthalmic, and ENT damage, but sometimes it can be difficult to formulate because of the chronology of symptom onset. Neurological damage, the first manifestation, will help make therapeutic decisions.

[Intravitreal ranibizumab for choroidal neovascularization secondary to pathological myopia: 12-month results]. / Traitement des néovaisseaux choroïdiens rétrofovéolaires naïfs du myope fort par injection intravitréenne de ranibizumab : résultats à 12 mois.

PURPOSE: To evaluate the efficacy and safety of intravitreal ranibizumab (Lucentis) in the first-line treatment of choroidal neovascularization (CNV) secondary to pathological myopia. METHODS: Consecutive series of patients with primary subfoveal CNV secondary to pathological myopia treated with intravitreal ranibizumab 0.5mg (0.05ml) were included prospectively in this study. Best-corrected visual acuity, fundus examination, fluorescein angiography, optical coherence tomography, and the presence of metamorphopsia were assessed at baseline and then monthly. Indications for retreatment were persistent leakage from CNV shown on FA and/or evidence of CNV activity on OCT. RESULTS: Eight eyes of seven patients were followed from November 2007 to April 2009. The mean age was 61 years. None of these eyes had been treated previously with photodynamic therapy or direct photocoagulation. The mean spherical equivalent refractive error was -10.75 (range: -7.75 to -15.75). Follow-up was 12 months or more for all patients except one (3 months). The mean number of intravitreal injections administered for each patient was 1.5 (range: 1-4). Six eyes received one ranibizumab injection, one eye received two, and one eye received four. Four eyes demonstrated a gain in visual acuity, three eyes stabilization, and one eye vision loss. No injection complications or drug-related side effects were noted during the follow-up period. CONCLUSIONS: In this small series of eyes with limited follow-up, intravitreal ranibizumab was a safe and effective treatment for CNV secondary to pathological myopia, resulting in functional and anatomic improvements.

[Sleep-related breathing disorders and normal or high-tension glaucoma: 35 patients with polysomnographic records]. / Troubles respiratoires nocturnes et glaucome à pression normale ou élevée. A propos de 35 patients hospitalisés pour polysomnographie.

PURPOSE: To look for early stage glaucoma symptoms in patients referred for sleep-related breathing disorders or sleep apnea syndrome. PATIENTS AND METHOD: Thirty-five patients between October 2001 and April 2002 consecutively admitted for polysomnographic evaluation were investigated. Each patient had complete ophthalmologic examination before the nocturnal record. A blue-on-yellow Humphrey computerized perimetry test was given, and a standard perimetry with a color vision test if abnormalities were found. The criteria studied were intraocular pressure, optic nerve cupping and aspect, visual field indices and visual field aspect, which were compared to the respiratory disturbance index. Twenty-seven subjects were included in this analysis, nine women and 18 men. RESULTS: In eight patients, the respiratory disturbance index was higher than 10. All intraocular pressures were normal. Visual field defects were found in two patients with both standard and blue-on-yellow perimetry, and in 12 patients with only blue-on-yellow perimetry. Mean deviation and visual field aspect correlated well with the respiratory disturbance index (p=0.026, p=0.033). Other visual field indices were not correlated with the respiratory disturbance index. CONCLUSION: In this study, we found visual field alterations with blue-on-yellow computerized perimetry that did not exist with standard perimetry. The visual field defects were more frequent when the respiratory disturbance index was poor.

[Usher syndrome: a case report]. / Le syndrome de Usher: à propos d'une observation.

A 60-year-old Jewish woman with consangineous parents had a history of severe sensorineural hearing loss since the age of 2 years. Hearing loss had not progressed since childhood, but her visual impairment due to pigmentary retinopathy, known since childhood, had worsened 15 years ago. The diagnosis was Usher syndrome type I, a rare heterogeneous disorder of autosomal recessive inheritance. Abnormal vestibular function and ataxia with neuroimaging anomalies including cerebellar atrophy have been reported, suggesting the disease process also involves the brain.