[Unilateral diffuse subacute neuroretinitis]

The authors report two cases of diffuse unilateral subacute neuroretinitis. The evolution of the illness, here at late stage in both cases, and the different paraclinical investigations will be presented.

[Pattern dystrophies and intrafamilial phenotypic variation]

BACKGROUND

Transmitted in an autosomal dominant fashion, the pattern dystrophies involve the retinal pigment epithelium and the external macular retina and are usually divided into four different entities. However, a progression from one form to another is possible, various forms may coexist in the same patient and a combination of different entities may be present in the same family.

CASE REPORTS

Two families (4 cases) are described, in which a butterfly dystrophy coexist with a vitelliform dystrophy or with a central atrophy. Whereas the vitelliform dystrophy is usually characterised by a unique centromacular lesion, a case of multiple lesions is described. The possible association with a neovascular membrane is also presented.

CONCLUSION

The coexistence of various forms of pattern dystrophies in a same family suggests a variable expression of a same genetic disorder. The presence of a centromacular atrophy in one patient demonstrates also that the spectrum of the disease is not limited to the four classic entities.

[Stilling-Duane retraction syndrome; surgical options]

BACKGROUND

The Stilling-Duane's retraction syndrome is a congenital abnormality of ocular movements. In order to maintain simple binocular vision, most patients adopt an abnormal head posture; this can be corrected by surgery.

MATERIALS AND METHODS

We carried out a retrospective study of the clinical files of 56 patients who presented with Duane's syndrome and had been examined at the Strabological Department of the Lausanne Eye Clinic between 1974 and 1993.

RESULTS

Our group study is comparable to that found in the literature as regards the distribution according to sex (45% of males, 55% of females), laterality (75% of the cases with disease predominance in the left eye, 18% in the right eye, and 7% with bilateral, symmetrical disease), and associated anisometropia (18%) or amblyopia (12.5%). Approximately 1 of 5 patients sought medical advice only after 20 years of age. A compensating head turn (towards the ill side in patients with esotropia and towards the healthy side in patients with exotropia) was found in 71% of the cases. Our surgery (10 patients with a mean follow-up of 8 months) resulted in a decreased head turn in 7 cases.

CONCLUSIONS

The purpose of this surgery is to improve the head turn without worsening retraction. This can be achieved with simple muscle recessions.

[Ocular involvement by Epstein-Barr virus: a difficult diagnosis]

BACKGROUND

A correlation has been made, often on the base of very scarce evidence, between several ocular clinical pictures and chronic infection due to the Epstein-Barr virus (EBV).

MATERIALS AND METHODS

Serology of the herpes group viruses is part of the investigations performed in uveitis cases without obvious etiology that are examined at our uveitis clinic. We retrospectively studied the clinical files of patients with an elevated EBV serology for the purpose of studying the type of ocular pathology presented.

RESULTS

According to our criteria, 40 patients had an elevated EBV serology. Twenty-nine presented with a polyclonal elevation of antibodies against several viruses of the herpes group. Six showed an increase of anti-EBV antibodies only (2 uveitis cases without specific diagnosis, 2 HLA-B27 positive anterior uveitis cases, 1 pars planitis and 1 anterior uveitis with endothelitis).

CONCLUSIONS

If we exclude the ocular pathology occurring during acute primary infection (infections mononucleosis), it is difficult to find some correlation between a clinical picture and EBV infection. Before better diagnostic tools are available, the spectrum of ocular EBV disease will remain conjectural.