Intraocular foreign bodies in children: A retrospective case series.

INTRODUCTION: Open globe injuries are a major cause of visual impairment in children, related to the severity of the trauma or secondary to induced amblyopia. Intraocular foreign bodies (IOFB) have been reported in approximately one third of cases of open globe injuries. As clinical presentation and management may differ between adults and children, data is lacking about IOFBs in children under 18years of age. The purpose of this study was to assess the clinical characteristics and visual prognosis of ocular trauma associated with intraocular foreign bodies in children. MATERIALS AND METHODS: This single-center retrospective study included patients under 18years of age treated for ocular trauma with IOFB. Demographic characteristics, complete initial and final ophthalmological examination, imaging data and details of medical and surgical management were collected. RESULTS: Fourteen patients were included (78.6% boys), with a mean age of 10.3years (min 7months-max 17years). In 92.9% of cases, patients were found to have a single IOFB, mostly metallic (71.4%). Posterior segment IOFBs were found in 50% of cases, anterior segment IOFBs in 28.6% and orbital IOFBs in 21.4%. The clinical examination permitted detection of the IOFBs in 50% of cases, while they were visible on CT scan in all cases. The mean initial visual acuity was 20/320, and the mean final visual acuity was 20/125. Endophthalmitis occurred in 2 cases (14%). DISCUSSION: Open globe injuries associated with IOFB are severe and sight-threatening. Localization of the IOFB in the posterior segment has a worse prognosis. CT scan is mandatory, especially in children, as the trauma history is often missing. Retinal detachment and endophthalmitis appear to be the main prognostic factors requiring urgent specialized pediatric ophthalmology management.

[Acute retinal necrosis: clinical presentation, treatment, and prognosis in a series of 22 patients]. / Nécrose rétinienne aiguë: présentation clinique, modalités de prise en charge et pronostic à partir d'une série de 22 patients.

PURPOSE: To evaluate the clinical outcome and medical management in a series of patients diagnosed with acute retinal necrosis. MATERIAL AND METHODS: Between 1993 and 2000, 22 patients suffering from acute retinal necrosis were referred to our department. We retrospectively reviewed the clinical course, delay between diagnosis and first clinical manifestation, biological profiles, treatment and complications. RESULTS: All patients had vitreous inflammation; retinitis was seen upon examination in 82% of the cases. Nevertheless, for six patients (27% of the cases), failure to recognize the diagnosis led to delay (mean, 5.5 days) between the first ophthalmological examination and antiviral therapy. Nineteen patients underwent laboratory evaluation, and virological diagnosis was made in 16 of them: varicella zoster virus was found in 11 cases, herpes simplex type 1 in three cases, and herpes simplex type 2 and cytomegalovirus in one case each. Nine patients were treated with a combination of aciclovir and foscarnet and 13 with aciclovir alone. Among the 16 patients who received aciclovir, one did not respond to therapy after 2 days and was cured only after foscarnet was added. Recurrence occurred at the end of treatment in only one patient. Retinal detachment complicated the course for 11 patients and was always associated with proliferative vitreoretinopathy. Among those, seven of the ten patients who accepted surgery were successfully treated. Eleven out of 22 patients had a final visual acuity up to 20/200 and two up to 20/40. CONCLUSION: In our series, acyclovir alone was sufficient to cure the majority of cases. Even with antiviral therapy, the prognosis of acute retinal necrosis remains poor. Retinal detachment is the main complication.

[Acute ischemic optical neuropathy which became bilateral in 3 days in Horton disease]. / Neuropathie optique ischémique aiguë bilatéralisée en 3 jours dans le cadre d'une maladie de Horton.

We report a case of a 71-year-old man with sequential visual loss within 3 days due to giant cell arteritis confirmed by a temporal artery biopsy. The anterior ischemic optic neuropathy was associated with cilioretinal artery occlusion on the right eye. He improved after intravenous corticosteroid therapy. Clinical characteristics and treatment are discussed.

Optical coherence tomography of idiopathic macular epiretinal membranes before and after surgery.

PURPOSE: To examine the preoperative and postoperative anatomical features of the macula using optical coherence tomography in patients who underwent surgery for epiretinal membrane and to correlate these features with functional results. METHODS: In a noncomparative interventional series, 62 eyes of 62 consecutive patients operated on for an idiopathic epiretinal membrane were followed up using a standardized protocol. Preoperative and postoperative examination included best-corrected visual acuity using an Early Treatment Diabetic Retinopathy Study chart, biomicroscopy of the fundus with a contact lens, fundus photography with blue and green filters, fluorescein angiography, and optical coherence tomography. RESULTS: Median preoperative visual acuity was 20/60 (range, 20/32 to 20/320). Median postoperative visual acuity was 20/40 (range, 20/20 to 20/160). Fifty-one eyes (82%) obtained visual acuity of 20/50 or better. Preoperatively, all eyes had increased macular thickness (mean, 419 +/- 105 microm; range, 265.5 to 689 microm), with disappearance of the foveal pit. An epiretinal membrane was visible on optical coherence tomography scans in 26 cases (42%). Intraretinal cystic spaces were present in the thickened macular tissue in 15 cases but corresponded to cystoid macular edema on fluorescein angiography in only three. Postoperatively, mean macular thickness decreased to 300 +/- 65 microm (range, 185 to 511 microm) but returned to normal in only three eyes. The foveal pit reappeared in 20 eyes. Preoperatively, visual acuity correlated with macular thickness (r = 0.56, P <.0001), but not postoperatively (r = 0.12, P =.37). CONCLUSION: Macular thickness decreases after epiretinal membrane surgery, but the macular profile rarely returns to normal. However, this does not preclude satisfactory improvement of visual acuity.

[Multiple eccrine hydrocystomas of the eyelids in the framework of Schöpf syndrome. A case report]. / Hidrocystomes eccrines multiples des paupières dans le cadre du syndrome de Schöpf. A propos d'un cas.

Schöpf-Schultz-Passarge syndrome is a rare ectodermal dysplasia described by Schöpf in 1971. The disease is characterized by hypodontia, hypotrichosis, palmoplantar keratoderma, hypoplastic nails and eyelid hydrocystomas. We report the case of a 71-year-old man, the first French description of this syndrome, who remarkably presented all the signs. The patient also had skin tumors, multiple eccrime hidrocystomas and aspectific macular degeneration. A review of the literature is discussed.

[Hepatocellular carcinoma: a case revealed by metastatic orbital tumor]. / Carcinome hépatocellulaire: un cas de métastase orbitaire révélatrice.

INTRODUCTION: We report a case of metastatic orbital tumor revealing hepatocellular carcinoma. EXEGESIS: Metastatic orbital tumors of hepatocarcinoma are rare. Only six cases have been reported. We compare these cases to our observation. Treatment of the orbital metastasis is important to decrease pain, ophthalmological symptoms and to improve the quality of survival. Radiotherapy and/or surgery can be used. Prognosis for life depends on liver involvement: the modalities of treatment of the hepatocarcinoma have to be discussed for each patient. CONCLUSION: Seven cases of orbital metastasis revealing a hepatocarcinoma have been documented. Effectiveness of radiotherapy makes the local prognosis good, but prognosis depends on liver involvement, since prognosis of hepatocellular carcinoma is poor.

[Surgery of intravitreous nuclear luxations post-phacoemulsification]. / Chirurgie des luxations nucléaires intravitréennes post-phacoémulsification.

PURPOSE: To evaluate anatomical and functional results after surgery of retained nucleus or nuclear lens fragments into the vitreous cavity after phacoemulsification. METHODS: Files of 46 patients that underwent vitrectomy for posterior retained nuclear fragments between July 92 and June 96 were studied retrospectively. Minimum follow-up was 6 months. Patients having only cortical material were excluded. In 34 cases the nucleus or nuclear fragments were removed posteriorly during a pars plana vitrectomy using either fragmentation with fragmatome (13 cases) or cutting with the vitreotome tip (21 cases). Anterior removal after pars plana vitrectomy was performed in 12 cases. 20 patients were operated on the first week, 12 during the second week and 14 after the second week following phacoemulsification. RESULTS: Forty-one per cent of the patients reached 20/40 or better. 28% had less than 20/200. 8 (17%) patients presented a retinal detachment, 6 a cystoid macular edema, 6 a bullous dystrophy, and 9 an elevated intraocular pressure. At the end of follow-up 89% have been implanted (50% had been implanted at the end of the cataract surgery). We found no correlation between visual acuity and timing of surgery, anterior or posterior site removal of nuclear fragments or lens implantation during phacoemulsification. CONCLUSION: Dislocation of the nucleus into the vitreous cavity is a serious event during phacoemulsification because of its inflammatory and retinal complications. Vitreoretinal surgery allows good visual recovery in about half of the patients. Technical handling depends primarily on the nucleus density. An IOL may be placed at the end of phacoemulsification if the nucleus is not too hard and if the anterior segment has been cleaned carefully.

[Retinectomies in the treatment of retinal detachments with vitreoretinal proliferation]. / Rétinectomies dans le traitement des décollements de rétine compliqués de prolifération vitréo-rétinienne.

PURPOSE: To investigate the anatomical and functional results of retinectomy in the treatment of complex retinal detachment. METHODS: We reviewed the files of 48 patients who underwent peripheral retinectomy of 90% or more for retinal detachment with anterior proliferative vitreoretinopathy stage A1 (6 cases), A2 (23 cases, A3 (11 cases) or A4 (8 cases). Retinotomy was performed when complete reattachment of the retina posterior to the buckling was not obtained despite careful dissection of the peripheral vitreoretinal contraction. Retinotomy was completed by excision of the anterior retinal flap. After perfluorocarbon liquid injection, laser retinopexy and perfluorocarbon-silicone exchange were performed. RESULTS: Silicone oil was removed from 46 eyes (96%). The retina remained attached in 37 eyes (77%) with a visual acuity of 1/20 or more in 19 of them. Functional results did not correlate with the size of the retinectomy. The major complications were retraction of the retinectomy edge and recurrence of proliferative vitreoretinopathy, responsible for anatomic failure in 9 of the 11 cases. Hypotony (i.e. intraocular pressure of 5 mmHg or less) only occurred in 6 of the 37 successful cases. CONCLUSION: Retinectomy is a useful surgical tool for eyes with advanced proliferative vitreoretinopathy when careful membrane dissection and encircling buckling seem to be insufficient to obtain retinal setting. Its success rate is good and leads to relatively few complaints.