[Nevus mimicking a basal cell carcinoma of the eyelid]

A clinicopathologic case of a 41-year-old female patient exhibited a single cutaneous tumor at the inner part of the free margin of the inferior left eyelid. It was a pink, fleshy, and nodular well-circumscribed exophytic mass with thin vessels on its surface. Experienced already for 20 years, this lesion had been observed 6 years before and has not exhibited much change since then. However, its clinical appearance argued for a possible small basal cell carcinoma, which had grown over the inferior left lachrymal duct. After surgical removal, histopathology showed that the tumor was an amelanotic dermal nevus. No disturbance of lachrymal drainage was observed after surgery. This case shows that nodular amelanotic tumors of the eyelid, even when located on the inner segment of the eyelid, may be a nevus.

[Vitrectomy without scleral buckle versus ab-externo approach for pseudophakic retinal detachment: comparative retrospective study]

PURPOSE

Retinal detachment (RD) is a major complication of cataract surgery, which can be treated by either primary vitrectomy without indentation or the scleral buckling procedure. The aim of this study is to compare the results of these two techniques for the treatment of pseudophakic RD.

PATIENTS AND METHODS

The charts of 40 patients (40 eyes) treated with scleral buckling for a primary pseudophakic RD were retrospectively studied and compared to the charts of 32 patients (32 eyes) treated with primary vitrectomy without scleral buckle during the same period by the same surgeons. To obtain comparable samples, patients with giant retinal tears, vitreous hemorrhage, and severe preoperative proliferative vitreoretinopathy (PVR) were not included. Minimal follow-up was 6 months.

RESULTS

The primary success rate was 84% in the vitrectomy group and 82.5% in the ab-externo group. Final anatomical success was observed in 100% of cases in the vitrectomy group and in 95% of cases in the ab-externo group. Final visual acuity was 0.5 or better in 44% of cases in the vitrectomy group and 37.5% in the ab-externo group. The duration of the surgery was significantly lower in the ab-externo group, whereas the hospital stay tended to be lower in the vitrectomy group. In the vitrectomy group, postoperative PVR developed in 3 eyes and new or undetected breaks were responsible for failure of the initial procedure in 2 eyes.

CONCLUSION

Primary vitrectomy appears to be as effective as scleral buckling procedures for the treatment of pseudophakic RD.

[Seborrheic keratosis of the eyelid in a young woman]

A 46-year-old female patient had a tumor of the free margin area of the superior right eyelid, appearing as the fourth recurrence of a primary lesion, occurring 24 years before. The lesion was covered with a thick layer of keratin, giving it a grayish and black color. Excision was performed without involving the free margin. Histopathology disclosed that the tumor was a seborrheic keratosis, which was not completely removed. As the lesion was benign, no further surgery was performed but regular examination was recommended to the patient.

Adventitial sheathotomy for decompression of recent onset branch retinal vein occlusion

Interesting results have been reported on the use of pars plana vitrectomy with adventitial sheathotomy for the decompression of branch retinal vein occlusions (BRVO). Recent onset BRVO responsible for a visual acuity of 20/40 or less have been estimated to be good candidates for this procedure. We report on the results of the prospective evaluation of three eyes (in three patients) with recent onset BRVO which underwent surgical decompression. Three men, aged 40, 50, and 68 years presenting with BRVO for 4, 4, and 3 weeks respectively, underwent surgical decompression. Initial visual acuity was 20/80, 20/80, and 20/200. After 11, 10, and 9 months follow-up, visual acuity was 20/80, 20/200, and 20/200. In two eyes, an increase of the area of retinal non-perfusion was treated with peripheral laser photocoagulation. No cataract, retinal tears or retinal detachment were observed.

CONCLUSION

although feasible, sheathotomy did not lead to a significant visual improvement in our patients. Dissection of the arteriovenous crossing could have induced vascular trauma. Furthermore, vitrectomy with posterior hyaloid detachment alone could be of benefit in the treatment of branched retinal vein occlusions. A prospective randomised trial is needed to assess the effectiveness and the safety of this procedure and to determine the best candidates for surgery.

[Retinal lesion due to an obstetrical traumatism: a case report]

The authors report a case of unilateral, stable, localized, and well-circumscribed choriocapillaris atrophy associated with retinal pigment epithelium dispersion and atrophy. The anterior segment was normal. Facial examination revealed a homolateral malar hypoplasia. The other eye was normal. The electrophysiologic study did not confirm pigmentary degeneration of the retina. The patient's history included a difficult delivery using obstetrical forceps. The authors review the main ocular lesions secondary to birth trauma. In this case, they favored a traumatic chorioretinal lesion secondary to an obstetrical traumatism. In this context, progressive facial hemiatrophy is the main differential diagnosis.

[Treatment of anterior segment fibrinous reactions and hemorrhage with intracameral low dose rt-PA: clinical study and review of the literature]

PURPOSE

to evaluate the efficacy and the safety of low dose intraocular tissue plasminogen activator (rt-PA) in the treatment of traumatic hyphema and postoperative fibrinous membrane.

METHODS

Six microg to 10 microg of rt-PA was injected into the anterior chamber to treat severe fibrinous postoperative membranes and total traumatic hyphemae.

RESULTS

Thirteen eyes of 13 patients were treated. Four cases of traumatic hyphema and 9 cases of fibrinous membranes were included. Complete fibrinolysis within 24 hours was observed in 4 cases (30.8%). A partial success was noted in 7 eyes (53.8%). No beneficial effect was observed in two cases of traumatic hyphema associated with intravitreal hemorrhage after penetrating trauma. No side effect attributable to rt-PA occurred.

CONCLUSION

Low dose intraocular rt-PA appears to be safe and effective in the treatment of postoperative fibrinous membrane and endocular hemorrhage limited to the anterior chamber.

[Evaluation of functional and anatomical changes in the macula after surgery for retro-foveal neovascularization of membranes in age-related macular degeneration]

PURPOSE

The aim of this study was to evaluate the direct effect of surgical treatment of subfoveolar neovascular membranes in age related macular degeneration to macular functions.

PATIENTS AND METHODS

Thirteen eyes of 13 patients were included in this study. Macular function was assayed by visual acuity and central visual field using the Octopus perimeter before surgery and in the first three post operative months. Pre and post operative fluorescein angiography frames were digitalized and the size of each lesions were compared.

RESULTS

After a 3 months follow up, visual acuity remained stable or improved in 66% of the patients. However, visual acuity was better than 0.1 in 15% of the patients. Central visual field comparison disclosed a significant worsening of the retinal sensitivity in the 3 degree field surrounding the central point. On fluorescein frames, submacular scar was 141% of the size of the neovascular membrane. After a mean follow up of 6.9 months (range 3-14), one case of recurrence occurred. A cataract was observed in 85% of the phakic patients followed for more than six months.

CONCLUSION

After a short term follow up, surgery can stabilise visual acuity, even though it remains poor. A worsening of the scotoma in the 3 degrees surrounding the central point is observed. However, patients noticed a subjective visual improvement in 62% of the case.

[Long-term comparative anatomic results of retinal detachment with vitreoretinal proliferation operated with or without using liquid perfluorocarbons]

PURPOSE

To investigate whether peroperative perfluorocarbon liquids (PFCL) improve the long term anatomical success of retinal detachment associated with severe proliferative vitreoretinopathy (PVR).

PATIENTS AND METHODS

The charts of 62 successive patients operated on for retinal detachment associated with severe PVR were retrospectively analyzed. For one group of 39 patients PFCL were used intraoperatively to improve membrane dissection. The anatomical status of the two groups were compared one month after surgery and at least 6 months after silicone oil ablation.

RESULTS

Anatomical success was observed in 84.6% in the group of patients operated with PFCL compared to 52% in the other group (P = 0.005). At the end of the follow up, anatomical success was observed in 64% of patients operated with PFCL compared to 61% in the control group (P = 0.8). However, recurrences were observed later in the group operated on with PFCL.

CONCLUSION

Perfluorocarbons liquids significantly improve the initial reattachment of retinal detachment complicated with severe PVR, but they do not seem to improve their final anatomical status.

[Treatment of ocular cicatricial pemphigoid with sulfasalazine]

PURPOSE

To report on three patients with biopsy-proven ocular cicatricial pemphigoid successfully treated with sulphasalazine.

METHODS

Three case reports.

RESULTS

A 71-year-old man, treated with dapsone for ocular cicatricial pemphigoid stopped his treatment because of an allergy to this drug. Oral sulphasalazine, 2.5 grams daily was successfully used as an alternative treatment (3 month follow-up). Two patients, aged 71 and 84 year old, were treated with dapsone for ocular cicatricial pemphigoid. Both patients stopped their treatment because of drug induced hemolytic anemia. They then received oral sulphasalazine, 4 grams daily. The disease was successfully controlled. In the first patient, sulphasalazine was discontinued after 13 months; and in the second patient no relapse was seen after a 16 month follow-up period. No adverse side effect of sulphasalazine occurred.

CONCLUSION

Sulphasalazine, that has already been proven to be effective for Crohn's disease, also can be used in ocular cicatricial pemphigoid. However, further studies including a larger series of patients along with a longer follow-up are necessary to confirm the efficacy of sulphasalazine in this disease.

[Persistence of a functional hyaloid artery in an adult. Apropos of a case]

We report a case of a persistent hyaloid artery in a 69 year old man. The exam of the right eye and the anterior segment of the left eye disclosed a mild cataract. Fundus examination of the left eye revealed a persistent hyaloid artery emerging from the optic disc, surrounded by primary vitreous on its anterior end, inserting on the nasal pre equatorial retina. Macular ectopia and sectorial chorioretinal atrophy were also present. Fluorescein angiography disclosed a permeable and tight hyaloid artery. There were no macular or optic nerve anomalies precluding visual acuity. After phakoemulsification, the patient regained a visual acuity of 0.9 on the left eye.