Endonasal endoscopic dacryocystorhinostomy for a primary dacryocystocele in an adult

A dacryocystocele refers to a sterile cystic dilatation of the lacrimal sac resulting from a complete obstruction of the lacrimal pathway above and below the lacrimal sac. In most cases, it is a congenital disorder that typically occurs in neonates. It is characterized by a bluish cystic swelling just below the medial canthus accompanied by epiphora. In some cases, there is also an intranasal expansion beneath the inferior turbinate. When this expansion is large and bilateral, it can lead to respiratory distress in neonates since they are obligate nasal breathers. Although congenital dacryocystoceles may resolve with conservative measures, many become infected and require systemic antibiotic treatment, and most require early surgical intervention. Herein, the authors report a rare case of dacryocystocele in an adult that was successfully managed with an endonasal endoscopic dacryocystorhinostomy. The pre-operative images and the intra-operative findings are shown, and the available literature is reviewed.

Photothérapie dynamique des hémangiomes choroïdiens

PURPOSE

To evaluate the safety and efficacy of photodynamic therapy in the management of symptomatic circumscribed choroidal hemangiomas (CCH) with exudative activity.

PATIENTS AND METHODS

This prospective nonrandomized study included eight patients referred to us for management of CCH with exudative activity. PDT was applied by diode laser (689 nm) with a light dose of 100 J/cm2 and using verteporfin (6 mg/m2) IV bolus injection. The treatment spot diameter accurately corresponded to the tumor basal diameter (TBD).

RESULTS

The mean tumor thickness before PDT was 3.3 mm (range, 2.7-7.5 mm) and the mean largest TBD was 6.1 mm (range, 5-12 mm). All patients were managed with a single PDT application. After a mean follow-up of 24.2 months (range, 17-29 months), all CCH (100%) showed regression of tumor thickness and complete resorption of the serous retinal fluid; 87.5% of the patients showed a flat tumor scar. All CCH showed overlying PDT-related retinal pigmented epithelium atrophic changes. No case of retinal vascular occlusion or recurrent leakage was documented. Five patients (62.5%) showed visual improvement, one (12.5%) retained stable vision and two (25%) developed worse vision due to chronic exudation-related RPE changes in one patient and preretinal fibrosis in another.

CONCLUSION

PDT using verteporfin offers a safe and effective therapeutic option to manage CCH. Complete resorption of subretinal fluid is usually associated with visual improvement.

Canaliculite lacrymale à Actinomyces

The authors report a case of unilateral chronic epiphora resistant to prolonged topical antibiotic treatment in a 62-year-old woman. Culture yielded some colonies of Actinomyces species. A dacryocystorhinostomy was found to be ineffective. Canaliculotomy with removal of cast resolved the chronic canaliculitis. Histological examination confirmed the diagnosis of solid cast of Actinomyces.

Épidémiologie des lésions oculaires et orbitaires adressées à un centre d’oncologie oculaire

PURPOSE

To study the epidemiology of ocular and orbital lesions referred to an ocular oncology center.

MATERIAL AND METHODS

Prospective study of ocular lesions referred between November 1997 and November 2002.

RESULTS

A total of 1,257 lesions were recorded in 640 females and 617 males. The mean age at the initial visit was 52 years (range, 0 to 94 years). Patients more than 60 years old accounted for 46% of our series. The lesions were classified into four groups: intraocular lesions (69%), superficial layer lesions (18%), adnexal tissues lesions (7%) and orbital lesions (6%). The posterior uvea was the most frequent localization. The clinical diagnosis of 374 lesions (30%) was confirmed by histological examination. The most frequent tumors were retinoblastoma in children and teenagers, conjunctival nevus young adults, choroidal melanoma in slightly older patients and posterior choroidal nevus in elderly people.

CONCLUSION

This study reviewed the epidemiological characteristics of ocular and orbital lesions referred to an ocular oncology center for their diagnosis, treatment and follow-up.

[Diffuse retinal epitheliopathy: study of 30 eyes]

Retrospective study of 17 patients (30 eyes) with diffuse retinal epitheliopathy followed for at least 5 years. The study is based on clinical data, ophthalmoscopic findings and fluorescein angiograms. The patients (16 men and 1 woman) are all caucasian with a mean age of 43 years. The disease is bilateral in 13 patients. We report an association with systemic corticosteroid treatment after kidney transplantation in 10 cases. Nine patients have arterial hypertension. Two patients are diabetic and 2 present high level of psychological stress. After a mean follow-up of 12 years, a loss of vision of at least 3 lines is noted in 17 eyes. The decrease in vision is related to an enlargement of the pigment epithelium atrophy to the fovea (15 eyes) or with permanent retrofoveolar serous detachment (2 eyes).

The medical management of primary open-angle glaucoma in the elderly patient

Glaucoma is a frequent cause of blindness in the elderly. It is defined as a neuropathy of the optic nerve for which the main risk factor is an elevated intraocular pressure. The management of glaucoma is described with an emphasis on diagnostic procedure and on the topical drug treatment. The potential side effects of these drugs are discussed from the geriatric point of view.

[Ocular manifestations of cancer]

Cancer may affect the eye and orbit as a direct result of metastatic neoplastic infiltration, compression, or circulating antibodies involving paraneoplastic retinal degeneration. A metastatic tumor to the uvea is the most common form of an intraocular metastatic process. The choroid is the most common site for uveal metastasis; metastases to the ciliary body, iris, retina, optic disk, and vitreous are rare. Approximately one-third of patients have no history of primary cancer at the time of ocular diagnosis. Breast and lung carcinomas for women and lung and gastrointestinal carcinomas for men most commonly metastasize to the eye and orbit. The short-term prognosis for vision is usually good after an individualized therapeutic approach (chemotherapy, hormonal therapy, external beam radiotherapy, or plaque radiotherapy), but the systemic prognosis is poor. The visual paraneoplastic syndromes encompass several distinct clinical and pathological entities including carcinoma-associated retinopathy (CAR), melanoma-associated retinopathy (MAR), and bilateral diffuse melanocytic uveal proliferation (BDUMP). The CAR syndrome affects photoreceptors, MAR is thought to affect bipolar cell function, and BDUMP targets the uveal tract. Identification of circulating antibodies against retinal proteins (recovering, 23-kDa retinal protein; 46-kDa and 60-kDa retinal proteins) serves to recognize the paraneoplastic nature of the patient's symptoms, which frequently develop before the cancer is diagnosed. Anecdotal therapeutic responses are described after systemic steroids, immunoglobulin injection, and plasmapheresis. Recognition of their visual symptoms and ocular findings should alert the ophthalmologist to the possibility of cancer and systemic evaluation should be pursued.

[Transpupillary thermotherapy in the treatment of choroid melanoma]

PURPOSE

To report the results of primary transpupillary thermotherapy (TTT) for selected posterior pole choroidal melanomas.

MATERIAL AND METHODS

Prospective non randomized study including 34 patients with choroidal melanoma treated with TTT using near-infrared radiation (810 nm) delivered from the diode laser. All treated tumors had either documented growth or clinical risk factors for future growth and/or metastasis. The treatment was delivered using a specially modified infrared diode laser through a slit lamp adaptor. A contact lens was placed on the cornea to view the fundus and focus the laser beam. Treatment was initiated using a 60-second exposure and a low energy level at 300 mW with a 3.0 mm beam width. The energy was raised stepwise by 50 to 100 mW until the surface of the tumor develop a light grayish discoloration. The TTT sessions were delivered at 3-month intervals.

RESULTS

Among these 34 patients with choroidal melanoma, 29 patients presented with primary choroidal melanoma. Five tumors (15%) were late recurrences after conservative treatment. The mean initial tumor basal diameter was 7.2 mm and tumor thickness was 2.9 mm. Seventeen tumors (50%) touched the optic disc and 10 (29%) were under the fovea. After a mean of three treatment sessions and 20 months of follow-up, the mean tumor thickness gradually decreased to 2.3 mm at month 3 and 2.0 mm at month 6 after the initial TTT. The percent reduction of tumor thickness was 20% at month 3 and 29% at month 6. The mean final thickness was 1.7 mm. Treatment was successful in 33 patients (97%). Tumor regrowth was documented in one patient (3%) and required plaque radiotherapy. After treatment, visual acuity was the same or better than the pretreatment visual acuity in 21 eyes (62%) and worse in 13 eyes (38%). Intraocular complications included retinal traction in 12 eyes (34%) and vascular occlusion in 3 eyes (9%).

CONCLUSION

This series confirms the efficacy of transpupillary thermotherapy in the management of selected posterior pole choroidal melanomas. Longer follow-up is still required to assess late local recurrence and the impact on metastatic disease.

[Etiologies of intermediate, posterior, and panuveitis: a review of 201 cases]

The authors conducted a retrospective analysis of 201 patients with intermediate, posterior or panuveitis to determine the most frequent etiologies and collect some epidemiological data. A specific diagnosis was made in 70% of the cases: 35% were of infectious origin, 23% were associated with a systemic disease and 24% had a specific ocular condition. The most common entities included toxoplasmosis (24%), sarcoidosis (7.5%) and Behçet disease (5.5%). Birdshot retinochoroidopathy was the most frequent specific ocular disease (3.5%). The findings of this study are compared with those previously published in the literature.