Screening for diabetic retinopathy in a rural French population with a mobile non-mydriatic camera.

AIM: The aim of this study was to evaluate the yield of diabetic retinopathy (DR) screening in a rural population using a mobile non-mydriatic camera. METHODS: The 72 least medicalized areas of Burgundy were the target areas. An orthoptist took fundus photographs using a Topcon TRC-NW6S non-mydriatic camera (four fields: posterior pole; nasal; temporal; and upper). Interpretations were done in the Department of Ophthalmology according to the classification of the French Language Association for the Study of Diabetes and Metabolic Diseases (Alfediam). RESULTS: Between 2004 and 2006, 1974 diabetics were screened-676 the first year, and 1298 in the second. The rate of non-interpretable photographs was 13%. Of the 1974 screened patients, there were 103 cases of DR (5.2%), comprising 70 mild non-proliferative DR (68%), 21 moderate non-proliferative DR (20.4%) and 12 severe non-proliferative DR (11.6%). The mean age of the patients with a DR was 66.7+/-10.9 years, with a mean duration of diabetes of 16.5+/-9.8 years. Only 35 (34%) patients were aware of their HbA(1c), which had a mean value of 7.8% and 19 had visited an ophthalmologist in the year before screening (18.4%). After the initial screening, 90,5% of the patients consulted an ophthalmologist as recommended. CONCLUSION: Screening improved the quality of the ocular follow-up in diabetics in this rural area. However, improvements in management are needed to lower the cost of such a programme.

[Screening diabetic retinopathy in Burgundy with an itinerant nonmydriatic camera]. / Dépistage de la rétinopathie diabétique en Bourgogne par un rétinographe non mydriatique itinérant.

INTRODUCTION: The aim of this study was to assess the suitability of screening diabetic retinopathy (DR) with an itinerant nonmydriatic camera. METHODS: This program required collaboration between ophthalmologists and general practitioners. Three professional organizations gave their support: L'union Professionnelle des Médecins Libéraux de Bourgogne (UPMLB), le Fonds d'Aide à la Qualité des Soins de Ville (FAQSV), et la Fédération des Associations des Diabétiques de Bourgogne (FADB). The screening programm took place from November 2004 to June 2005 throughout the Burgundy region. General practitioners, health professionals (pharmacists, nurses), local media, and health insurance offices informed patients of the DR screening. An orthoptist took photographs with a nonmydriatic digital camera. Each patient had four fundus photographs without pupillary dilatation. Photographs were analyzed in the Department of Ophthalmology of Dijon's General Hospital. RESULTS: In this study, 676 diabetic patients were screened. Among these patients, 58 had DR, exclusively nonproliferative retinopathies. Nine percent of the photographs were ungradable. The mean age of patients with DR was 65 years. The mean onset of diabetes was 18 years before the study. Insulin therapy was followed by 27 patients (46.6%). Hemoglobin A1c was known in 26 patients (44.8%), with a mean value of 8.14%. Nearly 60% of patients with DR did not have their recommended annual consultation. After screening, 84% of patients consulted an ophthalmologist. CONCLUSION: Screening DR with an itinerant nonmydriatic camera can improve ophthalmologic follow-up of diabetics in rural areas. This screening program has continued in 2006 with an adapted vehicle.

Report of a primary lymphoma of the conjunctiva. A lymphoma of MALT origin?

A case of primary conjunctival lymphoma is reported herein. A 47-year-old woman presented with an indolent salmon-coloured tumour of the lower epibulbar conjunctiva. Histologically, we found a lymphoid infiltrate in the epithelium and subepithelium consisting of two components. One component was characterized by centrocytic-like cells and the other by lymphocytic, plasmacytoid and plasma cells. An immunohistological study demonstrated a light chain restricted immunoglobulin expression of the tumour cells as well as some residual polytypic follicles exhibiting reticular dendritic cells. Tumour cell proliferation was associated with a T cell reactive population. A comprehensive investigation (in particular an orbital scan) did not demonstrate any other localization of this lymphoma. Such a lesion raised the question of a possible MALT origin, by analog with MALT-lymphomas of the gastrointestinal tract described by Isaacson and colleagues.

[MALT conjunctival lymphoma: how to treat?]. / Le caltome conjonctival: que faire?

A case of conjunctival lymphoma belonging to the MALT tissue is reported hereby. It is very uncommon in the literature, but special tools are needed to recognize this conjunctival involvement: Frozen sections of tissue to perform immunocytochemical studies. Investigations of the other lymphoid tissue, to assess the localized feature of the conjunctival disease.

[Intraocular penetration of topical norfloxacin in humans. Preliminary study]. / Pénétration intra-camérulaire de la norfloxacine locale chez l'homme. Etude préliminaire.

The aim of this bicentric study was to assess the intraocular penetration of topical Norfloxacin. Herein, are only reported the results from one center. Topically applied Norfloxacin 0.3% was given to patients who underwent cataract surgery. The first group received 5 drops between 7.55 A.M. to 8 A.M. and after each hour until cataract surgery. The second one received one drop each quarter from 7 A.M. until the surgery. Aqueous and sera samples were dosed using HPLC. In the first group, the aqueous average was 0.066 mg/l and 0.112 mg/l in the second group. Using a T test and Mann Whitney test, we could not find a significant difference between the two groups.

[Ocular toxoplasmosis and AIDS. A case report]. / Toxoplasmose oculaire et SIDA. A propos d'un cas.

Ocular toxoplasmosis is uncommon in the natural course of AIDS. We report here in a case of a 27 year old man with cerebral toxoplasmosis involvement with neurological signs and coma. After an initial improvement with a sulfadiazine and pyriméthamine treatment, we noticed a foveal chorioretinitis with hyalitis in the right eye which deeply decreased the visual acuity (less than 20/400) strongly suggesting a toxoplasmic etiology. Then specific aspects such as serology, acquired or congenital toxoplasmosis, treatment are reviewed.

[Optic neuropathy and Parry-Romberg syndrome. Apropos of a case]. / Neuropathie optique et syndrome de Parry-Romberg. A propos d'un cas.

The present paper reports on the case of a 44 year-old woman with progressive facial hemiatrophy associated with bilateral papillitis who developed an acquired complete third nerve palsy on the unaffected side six months later. This Romberg's disease occurred in the context of an immunologic disturbance which was barely improved by steroids and Disulone. Ophthalmic involvement, particularly neurologic involvement, pathogenic hypothesis are reviewed. The responsibility of sympathetic disorder in Parry-Romberg disease is based on frequent association of progressive facial hemiatrophy and Fuch's and Horner's syndromes.

[Hyperglycemia in the initial phase of cerebral vascular complication. Index of bad prognosis]. / Hyperglycémie à la phase initiale d'un accident vasculaire cérébral. Indice de mauvais pronostic.

The short-term prognostic value of hyperglycemia in acute stroke has been evaluated from the results of the first year of activity of the Stroke Registration unit in Dijon. In 188 patients admitted to hospital for acute hemiplegia blood glucose levels were measured on admission and daily for 7 days thereafter, and a CT scan was performed within a fortnight. Mortality was significantly higher in hyperglycemic patients (more than 2 g of glucose per litre) than in normoglycemic patients. In hyperglycemic patients the increase in blood glucose level was correlated with the initial disturbances of consciousness, the severity of hemiplegia and the presence at CT of an haemorrhage or an infarct with oedematous reaction. Thus, hyperglycemia in acute stroke is related to the severity of the cerebral damage. As a factor of bad prognosis, it is as sensitive as disturbances of consciousness or severe brain lesions at CT.