Traumatic optic nerve avulsion: A case report.

INTRODUCTION: Case report of a traumatic optic nerve avulsion. OBSERVATION: We report the case of a traumatic right optic nerve avulsion in an 11-year-old boy as a result of a contusion with a surfboard. On initial examination, the patient exhibited bilateral mydriasis with a right afferent pupillary defect. Visual acuity was no light perception. A moderate microhyphema was noted along with intraocular pressure of 12mmHg and no open globe. Fundus examination revealed retinal ischemia with white retinal edema, attenuated arteries and segmentally occluded vasculature. In place of the optic nerve, there was a hole with associated vitreous hemorrhage. Non-contrast CT and MRI demonstrated vitreous prolapse into the optic nerve sheath, which still appeared securely attached to the globe. Spectral domain OCT and visual evoked potentials confirmed disruption of the ganglion cell layer. DISCUSSION: While obvious in the presence of clear media, an avulsion may remain undetected in the case of associated vitreous hemorrhage. Orbital imaging may clarify the diagnosis. CONCLUSION: Although rare, optic nerve avulsions exhibit the same risk profile as open globe injuries and arterial occlusions.

Efficacy of systemic propranolol for severe infantile haemangioma of the orbit and eyelid: a case study of eight patients.

AIM: To assess the efficacy of systemic propranolol for severe capillary haemangiomas involving eyelid and orbit. METHOD: This was a longitudinal retrospective study that began in November 2007, involving eight children with disfiguring orbit and eyelid capillary haemangioma who received oral propranolol therapy. Three patients with life-threatening haemangiomas spreading to the orbit were first treated with systemic corticosteroids and beta-adrenergenic blocking agents. The remaining five patients with functional visual impairment received propranolol only. All children were given propranolol at a dose of 2 mg/kg body weight per day. The treatment was initiated between 2 and 36 months of age, with a follow-up period ranging from 6 to 30 months. Beta-blocking agents were used for 3-10 months. RESULTS: We observed a successful 100% regression: that is, clinical regression by flattening 24 h after the start of treatment, regression on colour Doppler ultrasound imaging with an increase in resistance index of blood vessels, or regression seen on MRI. No re-growth was observed after the trial ended. CONCLUSION: Despite their self-limiting course, infantile orbital and eyelid haemangiomas can cause visual impairment or disfigurement. Corticosteroids are used as first-line therapeutic agents for problematic infantile haemangiomas. Other options include interferon-α and vincristine, which present problematic side effects. In our series, propranolol was shown to inhibit haemangioma tumour growth with a better benefit/risk ratio. In the absence of any randomised study comparing the effects of systemic corticosteroids and propranolol, we propose that beta-blockers could be used as first-line therapy for severe periocular haemangiomas.

[Congenital cataract removed early: long-term visual acuity outcome and refractive changes]. / Cataractes congénitales opérées précocement: devenir visuel et réfractif à long terme.

INTRODUCTION: Removing pediatric crystalline lens abnormalities has improved recently. Congenital cataract is the main cause. PATIENTS AND METHOD: This retrospective study analyzed 121 eyes in children that were operated early at the Bordeaux Hospital (France) from 2000 to 2005, with no exclusion criterion. The Anova test and the Bartlett Chi2 test were used for the statistical analysis. RESULTS: This cohort mainly recruited congenital cataract with half of the population operated on at less than 1 year of age, including 41 before the age of 6 months. The mean age at surgery was 1.93 years (range, 9 days to 8.86 years). Seventy-nine eyes underwent primary intraocular lens implantation (78.8% for unilateral cataracts and 55.1% for bilateral cataract). The mean postoperative refraction was +1.94 D with a mean myopic shift of -1.22 D over 2.89 years of follow-up. Of the operated eyes, 64.7% improved 0.5 D or better, with a mean gain of 0.38. The final visual acuity (AVF) was 0.51. Before the age of 1 year, the mean AVF was 4.1/10 (range, 1/50 to 12/10). The mean AVF of the implanted eyes (5.4/10+/-4.2/10) was higher than those corrected by contact lenses (2/10+/-1.6/10) (p=0.024). DISCUSSION AND CONCLUSION: Primary intraocular lens implantation provides significantly better AVF than aphakic contact lens-corrected eyes and provides better stabilization over time whatever the age.

[Mycotic keratitis and endophthalmitis caused by unusual fungi: Lasiodiplodia theobromae]. / Kératomycose et endophtalmie d'étiologie exceptionnelle: Lasiodiplodia theobromae.

We report a case of endophthalmitis caused by the fungus Lasiodiplodia theobromae. A 68-year-old man was referred to the hospital for right ocular pain since experiencing right ocular branch trauma 2 weeks before. The best-corrected acuity was limited to hand motion. Slit-lamp examination showed a large corneal abscess and an anterior chamber reaction. The patient underwent systemic and local antibiotic therapy, and corneal scraping for microbiological diagnosis. Sabouraud-chloramphenicol-gentamicin agar disclosed filamentous fungus, which was treated with oral itraconazole and topic amphotericin B. Molecular biology revealed Lasiodiplodia theobromae. Despite antimycotic drugs, severe panophthalmia occurred very quickly and led to evisceration. This case report describes Lasiodiplodia theobromae as the cause of keratomycosis and discusses risk factors and clinical features of fungal keratitis in order to improve prognosis by earlier treatment.

[Melanocytoma of the optic disc. Three case studies]. / Mélanocytome de la papille: à propos de trois observations.

PURPOSE: Melanocytoma is a rare benign tumor that usually occurs as a pigmented lesion in the optic nerve head. It seems to be more frequently encountered in the Black population. We report three cases of melanocytoma observed in Martinique, where 90% of the population is of African origin. OBSERVATIONS: The first and second cases were found on routine ophthalmic examination. These patients had a heavily pigmented lesion that obscured part or all of the optic disc with slight extension into the adjacent nerve fiber layer of the retina. The tumor's margins were finely fibrillated. Fluorescein angiography demonstrated a homogenous hypofluorescent black tumor obscuring the optic disc vessels, with no tumor vessels visible. There were no juxtapapillary choroid vascular abnormalities. The third case was discovered on visual field examination. This melanocytoma was accompanied by papillary edema. CONCLUSION: Only three cases of melanocytoma have been noted from 1994 to 2004 in 150,000 Caribbean patients examined in the University Hospital Center of Fort de France. The rarity of melanoma and the predisposition to melanocytoma are important epidemiologic factors in the etiologic search for pigmented tumor within the Black population. Yearly fundus examination is useful for monitoring growth and detecting malignant transformation.