[Ocular coloboma associated with cervico-oculo-acoustic syndrome]. / Colobome oculaire associé au syndrome cervico-oculo-acoustique.

INTRODUCTION: Cervico-oculo-acoustic syndrome is an uncommon syndrome consisting of Klippel Feil syndrome, deafness, and Duane syndrome. We relate a new case of cervico-oculo-acoustic syndrome. CASE REPORT: We report the case of 15-month-old girl referred for esotropia of the right eye. Ocular examination revealed type 1 Stilling Duane syndrome in the right eye, in which we also noted microcornea, iris coloboma, and papillary and inferior chorioretinal coloboma sparing the macular area. The left eye was normal. The physical examination revealed Klippel Feil syndrome characterized by an extremely short neck with limited movement, a low posterior head line and fusion of the cervical vertebrae on radiography. The association of hearing loss (due to agenesis of the external ear) with Klippel Feil syndrome and Stilling Duane syndrome confirmed the diagnosis of cervico-oculo-acoustic syndrome. CONCLUSION: This case is unique because of the association of cervico-oculo-acoustic syndrome with ocular coloboma of the right eye. This association has not been reported previously in the literature.

[Expression of intercellular adhesion molecule type 1 in the conjunctiva of diabetic patients: a preliminary study]. / Expression de la molécule d'adhésion intercellulaire de type 1 au niveau de la conjonctive des patients diabétiques: une étude préliminaire.

PURPOSE: Recent research has incriminated adhesion molecules in the pathogenesis of diabetic retinopathy. These molecules have been found to be expressed in many cells participating in inflammatory processes and neovascularization. The purpose of our investigation was to study the expression of intercellular adhesion molecule type 1 (ICAM-1) in the conjunctiva of diabetic patients without retinopathy in comparison with normal human conjunctiva. PATIENTS AND METHODS: Fifteen conjunctival biopsies were obtained from diabetic patients without retinopathy. The ocular fundus examination and retinal fluorescein angiography were normal. The normal human conjunctiva were taken from five patients undergoing senile cataract surgery. Immunohistochemical analysis consisted of indirect immunoperoxidase using the monoclonal antibody ICAM-1. RESULTS: The adhesion molecule ICAM-1 was immunolocalized in epithelial, vascular endothelial, and inflammatory cells. The expression of this molecule was different in diabetic patients for the same duration. In the normal human conjunctiva, the expression of ICAM-1 was very low. CONCLUSION: This preliminary study shows that ICAM-1 is present in the conjunctiva of diabetic patients without retinopathy and thus may add new insights into the pathogenesis of diabetic retinopathy.

[Retinal detachment associated with giant retinal tear: surgical procedures and results of the perfluorocarbon liquid-silicone oil exchange with scleral buckling]. / Traitement des décollements de la rétine par déchirure géante: résultats de l'échange perfluorocarbones liquides-silicone avec indentation circulaire.

INTRODUCTION: Anatomical and functional results of the treatment of retinal detachment associated with giant retinal tear have been markedly improved with the development of the vitrectomy procedure and especially the use of perfluorocarbon liquids. In this study, we report treatment results of retinal detachment associated with giant tear in 17 patients. MATERIALS AND METHODS: Our study included 17 patients (17 eyes), aged between 18 and 61 years, with retinal detachment associated with giant retinal tear. The size of the tear was between 90 degrees and 220 degrees . Proliferative vitreoretinopathy grade C was present in two eyes. Preoperative visual acuity ranged between 40/50 and light perception. All patients underwent scleral buckling, vitrectomy, perfluorocarbon liquid injection to flatten the retina, endophotocoagulation, cryoapplication and temporary silicone oil tamponade. RESULTS: Mean follow-up was 20 months +/- 16. Recurrent retinal detachment occurred in five eyes under silicone oil and in two eyes after its removal. Anatomical success at final follow-up was obtained in 14 eyes (82.3%). Visual acuity improved in all cases with anatomical success in all but one. The most frequent postoperative complications were cataract in 10 cases among 12 phakic eyes and ocular hypertension in four cases. CONCLUSION: Vitrectomy with internal silicone oil tamponade improves the anatomical and functional prognosis of retinal detachment associated with giant retinal tear. Recurrent retinal detachment is usually due to relapsing proliferative vitreoretinopathy. The most frequent postoperative complications remain lens opacification and ocular hypertension.

[Analysis of optic nerve head by confocal scanning laser ophthalmoscope in ocular hypertension]. / Analyse de la topographie de la tête du nerf optique par l'ophtalmoscope laser à balayage confocal dans les hypertonies oculaires.

PURPOSE: To analyze optic nerve head topography using confocal the scanning laser ophthalmoscope (CSLO) in ocular hypertension in comparison to normal eyes. PATIENTS AND METHODS: We examined 25 patients with ocular hypertension and 27 normal controls. All of them had a complete ophthalmic examination. Optic nerve head analysis was performed by using a CSLO-type Heidelberg retina tomograph (HRT). The following stereometric parameters were evaluated: disc area, area and volume of cup, cup/disc ratio, area and volume of neuroretinal rim, mean and maximal cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and retinal nerve fiber layer (RNFL) cross-section area. RESULTS: In ocular hypertension eyes, rim volume, height variation contour and RNFL thickness showed a statistically significant reduction compared to normal eyes. CONCLUSION: HRT appears to be an important tool in detecting early damage of retinal nerve fiber layer in ocular hypertension.

Pterygium with bulbar conjunctival hemorrhages.

BACKGROUND: This study was carried out to describe the clinical features and electron-microscopic characteristics of the capillaries in pterygium with conjunctival hemorrhage. METHODS: We compared the clinical findings in Japanese and Tunisian primary pterygia and in pterygium with and without bulbar conjunctival hemorrhages. The capillary fine structures of pterygium with bulbar conjunctival hemorrhages were studied by electron microscopy and compared with those without bulbar conjunctival hemorrhages. RESULTS: Conjunctival hemorrhages were noted in 16.4% of Tunisian patients but not in any Japanese patients. The former pterygia were significantly larger, more vascular and more frequently hyperemic than the latter. Pterygia with bulbar conjunctival hemorrhages were more hyperemic than without hemorrhages. Electron microscopy revealed interruptions of the endothelial cells and basement membrane of the capillaries in the pterygia with bulbar conjunctival hemorrhages, with blood cells escaping through the endothelial interruptions. CONCLUSION: Conjunctival hemorrhage in pterygia may be caused by fragility of the endothelial cells and basement membrane in the capillaries, which easily induces hemorrhage when the eyes are irritated by rubbing or by conjunctival foreign bodies. Pterygium with conjunctival hemorrhage is more frequently found in Tunisians than in Japanese.

Growth factors in cultured pterygium fibroblasts: immunohistochemical and ELISA analysis.

BACKGROUND: In order to study growth factors in the pathogenesis and recurrence of pterygium, we grew pterygium tissues in culture and compared fibroblasts from primary and from recurrent pterygia with reference to the fibroangiogenic growth factors basic fibroblast growth factor (b-FGF), platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-beta) and tumor necrosis factor alpha (TNF-alpha). METHODS: We used indirect immunohistochemical procedures against human b-FGF, PDGF, TGF-beta and TNF-alpha. As controls, we used cultured normal human conjunctival fibroblasts. A serum-free conditioned medium (CM) from confluent fibroblasts derived from primary and recurrent explants was assessed by enzyme-linked immunosorbent assay to determine the level of the above-mentioned growth factors. RESULTS: Immunoreactivity of b-FGF was stronger in recurrent than in primary pterygium fibroblasts. PDGF immunolabeling was stronger in primary than in recurrent pterygium fibroblasts. TGF-beta and TNF-alpha immunolabeling was weak in both pterygia. All these growth factors were very sparse in normal conjunctival fibroblasts. Basic-FGF and TGF-beta 1 were found in the CM from both primary and recurrent pterygium, while PDGF and TNF-alpha were not detectable. CONCLUSION: The strong immunoreactivity and the release of b-FGF in cultured fibroblasts of recurrent pterygia suggest that fibroblasts may play an important role in the recurrence of pterygium.

TNP-470 (a fungus-derived inhibitor of angiogenesis) reduces proliferation of cultured fibroblasts isolated from primary pterygia: a possible drug therapy for pterygia.

PURPOSE: To study drug therapy for pterygium, especially the effect of a fumagillin analog, TNP-470, a potent anti-angiogenic compound, on the growth of cultured fibroblasts obtained from primary pterygia and normal human conjunctiva. METHODS: Cultured pterygium fibroblasts (PF) were exposed to different concentrations of TNP-470 every other day for 7 days (Treatment A) and to a single dose before 4 days of culture (Treatment B). Human normal conjunctival fibroblasts (HCF) were treated with TNP-470 every other day for 7 days. The cells were observed daily by phase contrast microscopy. Cell proliferation was assessed by counting cells with a hemocytometer. Trypan blue uptake was used to determine cell viability at harvest. RESULTS: TNP-470 induced a significant inhibition of PF and HCF proliferation in a dose-dependent manner (P < .0001). At the lowest dose of TNP-470 (100 pg/ml), the cumulative inhibitory effect of TNP-470 was more potent than the sustained inhibitory effect observed by treatment B in one high dose. Nevertheless, the cytotoxic effect was dose-dependent and more marked after treatment A than after treatment B. After washing out of the drug, partial reversibility was observed at doses lower than 5 mg/ml with a significant increase of viability. HCF were less sensitive to TNP-470 and doses less than 5 mg/ml were not cytotoxic. CONCLUSIONS: TNP-470 appears to have a marked inhibitory effect on PF proliferation, and it may be of considerable value in the prevention of pterygium growth and recurrence.

Immunohistochemical localization of basic fibroblast growth factor, platelet derived growth factor, transforming growth factor-beta and tumor necrosis factor-alpha in the pterygium.

Some fibroangiogenic factors have recently been shown to play potential roles in fibrovascular diseases. The aim of this study was to examine whether there is any relationship between growth factors and pterygium genesis. Twenty-three primary pterygia and 4 normal conjunctiva specimens were analyzed by indirect immunohistochemistry using specific antibodies against basic fibroblast growth factor (b-FGF), platelet derived growth factor (PDGF), transforming growth factor-beta (TGF-beta) and tumor necrosis factor-alpha (TNF-alpha). Positive immunostaining of these growth factors was located in the epithelial cells, endothelial cells of vessels, basement membranes of vessels and epithelium, fibroblasts and infiltrating inflammatory cells in the pterygium. In the normal conjunctiva, positive immunolabeling for TGF-beta and PDGF was much weaker than in the pterygium. We conclude that growth factors may interact directly or indirectly in the pathogenesis of pterygium although proof of this awaits further studies.