[Chronic angle-closure glaucoma in a pseudophakic eye with Soemmering's ring and plateau iris: case report]. / Glaucome chronique par fermeture de l'angle chez le pseudophake avec anneau de Soemmering et antéroposition du corps ciliaire : à propos d'un cas.

We present a case of a pseudophakic woman with chronic angle-closure glaucoma. She had undergone uncomplicated bilateral phacoemulsification in 1994 with 21-diopter implants in the capsular bag. Fourteen years later, the right eye developed progressive angle closure with ocular hypertension, disc cupping and visual field defect. We observed a shallow anterior chamber, myopic shift, and closed angle, not openable on indentation gonioscopy. UBM revealed anteroposition of the ciliary body and a Soemmering's ring, with both appearing to contribute to the angle closure. After two incomplete iridotomies and one complete but blocked by the Soemmering's ring, a final UBM-guided iridotomy afforded a partial reopening of the angle, and satisfactory IOP control. The appearance and development of a Soemmering's ring after phacoemulsification are not always appreciated. It is common but usually asymptomatic. However, in some cases, when it is thick and/or located anteriorly, in the case of an anteroposition of the ciliary body (as in our case), it seems to cause direct pressure on the iris and pupillary block. Angle-closure glaucoma in pseudophakic eyes remains uncommon, the use of UBM is recommended, the role of a Soemmering's ring should be investigated, iridotomies must often be repeated, and long-term monitoring of pseudophakic patients remains necessary.

[Early optic disc changes in open-angle glaucoma]. / Modifications papillaires précoces et glaucome chronique à angle ouvert.

INTRODUCTION: Early diagnosis of chronic open-angle glaucoma is difficult: early changes in the optic disc often precede troubles in the field of vision, which occur gradually with no typical initial aspect. We report here the results of optic disc observations in normal subjects who became glaucomatous. OBSERVATIONS AND METHODS: A study was conducted on 64 eyes of 51 subjects followed on average over 12 years. At the start these eyes were normal or at risk for glaucoma for various reasons. Doubtful, difficult cases (severe myopia, dysversion or with associated pathology) were eliminated. Eventually, all the eyes presented open-angle glaucoma. All patients underwent clinical and paraclinical examinations by the same examiner. The optic discs of 78 dilated eyes were examined with a slit lamp and a 78-dioptre lens and the results systematically tabulated. Of the 78 optic discs, 40% had initial morphological characteristics (including cup/disc ratios) that were difficult to identify precisely. Preference was given to certain criteria that were easy to evaluate and likely to change. RESULTS: The classic aspects of glaucomatous papillary excavation appearance were observed. Forty-four discs showed notable changes (19 typical changes, 25 atypical), which were observed before visual field abnormalities. The size of the disc influences how the disease develops. Also noted were the frequency of changes in the slope of the papillary profile curve (third moment) and the frequency of changes in the quality of the papillary tissue, which takes on a translucent character locally. CONCLUSION: Documented and comparative observation of the optic disc remains a good and simple means for supervising subjects at risk for and in early diagnosis of chronic open-angle glaucoma. The evaluation of changes in the optic disc is greatly aided by the collection and the systematic recording of observations.

Novel evidence of a role for chromosome 1 pericentric heterochromatin in the pathogenesis of B-cell lymphoma and multiple myeloma.

1q rearrangement is a remarkably frequent secondary chromosomal change in both non-Hodgkin's lymphoma (NHL) and multiple myeloma (MM), where it is associated with tumor progression. To gain insight into 1q rearrangement-associated disease mechanisms, we used fluorescence in situ hybridization (FISH) to search for recurring 1q breaks in 35 lymphoma samples (31 NHL patients and 4 lymphoma-derived cell lines) as well as 22 MM patients with cytogenetically determined 1q abnormalities. Strikingly, dual-color FISH analysis with chromosome 1 centromere and 1q12-specific probes identified constitutive heterochromatin band 1q12 as the single most frequent breakpoint site in both NHL and MM (39% and 89% of 1q breaks, respectively). These rearrangements consistently generated aberrant heterochromatin/euchromatin junctions and gain of 1q12 material. A further 30% of NHL 1q breaks specifically involved two other novel, closely spaced sites (clusters I and II) within a 2.5 Mb region of proximal 1q21 (D1S3620 to D1S3623). A possible association between these sites and NHL subtype was evident; the cluster I rearrangement was frequent in follicular and diffuse large cell lymphoma, whereas the cluster II rearrangement was more frequently observed in diffuse small-cell lymphoma (2/2 marginal zone lymphomas, 1/2 atypical chronic lymphocytic leukemias, and 1 lymphoplasmacytic lymphoma in this series). Candidate oncogenes bordering this interval (BCL9 and AF1Q) were not rearranged in any patient except one (AF1Q). This study provides the first evidence of involvement of 1q12 constitutive heterochromatin in the pathogenesis of NHL and MM and indicates proximal 1q21 to be of specific pathological significance in NHL.