Biomedical subjects
Publications and source records attributed to M Cordonnier.
How and why to prescribe an optical correction in hyperopia is described. The reasons for prescribing are closely related to the visual risk of not doing so (amblyopia, lack of stereopsy, strabismus), to the patient's complains and history as well as to his ophthalmological examination. How to correct hyperopia depends on the presence or absence of squint and on the amount of ametropia.
A 6.5-year-old child who received a shunt at 3 weeks of age for triventricular hydrocephalus related to his congenital toxoplasmosis developed symptoms of intracranial hypertension and papilloedema. Computed tomographic scan demonstrated slit ventricles. The shunt device was shown to be patent on isotope transit study. Spontaneously the cranial sutures widened and headaches disappeared, but loss of vision occurred and did not reverse despite optic nerve sheath fenestration. We suspect that a rapid drop in intracranial pressure played a role in the pathogenesis of our patient's blindness. This possible complication should be taken into account when calvarial expansion is planned in a patient with an intracranial hypertension syndrome with papilloedema in the presence of slit ventricles and a patent shunt.
An algerian woman presents with a panuveitis of the right eye. Main features of this uveitis are exudative retinal detachments. That happened several months after a corneal ulcer of unknown aetiology on the left eye. Immunologic, neurologic and infections workup associated with previous ocular injury points to the diagnosis of sympathetic ophthalmia. However, the diagnosis of Harada disease can also be considered in this case because of similarities regarding the clinical and the histologic aspects which are exposed. If corticosteroids are the drug of choice, enucleation is still indicated for sympathetic ophthalmia.
A 60 year-old woman complaining of diplopia presents an ocular motility disturbance mimicking internuclear ophthalmoplegia. Idiopathic dermatomyositis is diagnosed by the help of clinical, biological, electrophysiological and histological data. The outcome is favorable under corticotherapy. Ocular muscle involvement is rare in dermatomyositis. An overlap syndrome with another auto-immune disorder like myasthenia should be excluded in this kind of manifestation.
A boy aged 12 prematurely born presents several signs of fetal alcohol syndrome (FAS): mild mental retardation, staturoponderal delay, microcephaly, thin philtrum and vermillion of the upper lip. The ophthalmological aspects are: telecanthus, retinal vascular tortuosity, hypoplastic optic discs, hypermetropia, and an uniform, diffuse posterior haze on both corneas. This haze, which is not described till now as part of the syndrome, is not present in the other members of his family. Radiologic and biologic investigations (namely the profile of the urinary and seric amino acids, the urinary organic acids, and the research for mucopolysaccharides) are normal. Karyotype is normal as well as the research for fragile X which is negative.
We are describing the case of a seventy-four year old woman presenting a voluminous hard and painless tumor of the right lids, which has appeared half a year ago. Past medical history consists in a Sjögren's syndrome secondary to rheumatoid arthritis. The right eye is not visible and the left eye presents an important xerophthalmia and an opaque and vascularized cornea. CT Scan and biopsy allow to diagnose a diffuse monocytoid B cell non hodgkin-lymphoma, starting from the lacrymal gland with an extension to the lids and the anterior orbit. The appearance of a non hodgkin lymphoma in the course of the evolution of a rheumatoid arthritis and/or Sjögren's syndrome has been described well. The monocytoid feature of this lymphoma with the Sjögren's syndrome has recently been reported. However, the orbital localisation of this lymphoma is rare.
Since april 1993, we have an out-patient surgery department in our university hospital. We report our experience of out-patient surgery in 80 strabismic patients> We have divided the 80 patients in a pediatric group and an adult group. We describe the conditions of admission for out-patient surgery, the method of anesthesia, the development of the procedure. Surgical techniques do not differ from those used in hospitalized patients. We report our statistics concerning age, diagnosis, type and length of surgery of our 80 patients. The lack of complications and the satisfaction of our patients convince us to carry on out-patient surgery for strabismus.
It is acknowledged that high-dose corticotherapy, radiotherapy, or surgical decompression of the orbit are often efficient in dysthyroid optic neuropathy. Corticotherapy and radiotherapy are also given to patients with dysfunction of eye-muscle motility and/or proptosis in the absence of visual loss. The latter indication has been retrospectively evaluated in 13 patients. The limited character of our series is partially explainable by strict inclusion criteria (objective evaluation of muscle dysfunction and proptosis). We failed to demonstrate any significant functional improvement after oral corticotherapy and/or radiotherapy. It thus appears that our study sheds doubt on the actual efficacy of these treatments in patients presenting with not very evolutive involvement of eye-muscle motility. A larger study aimed at comparing the benefits and drawbacks of these treatments is consequently to be encouraged.
Physiopathological and clinical characteristics of accommodative strabismus are described. Medical treatment consists in correcting full cycloplegic refractive error. Bifocal lenses are useful in accommodative non refractive esotropia. Surgery aims to correct the residual esotropia with full optical correction.
Having used botulinum toxin for four years, we describe our experience in one hundred squinting patients and compare our results with the literature. We have good results in unilateral sixth nerve palsy and small deviations with binocular potential. Botulinum toxin can also be helpful in third and fourth nerve palsy, in Graves' ophthalmopathy, as an adjunct to transposition surgery and in cases of under- or overcorrections after surgery. In cases of muscle fibrosis and wide angle strabismus, the results are more disappointing. We describe an original method of conditioning the toxin in individual doses which eases the botulinum consultation processing.
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We describe the ophthalmic manifestations of 3 cases of infantile Refsum's disease. The gravity and the aspect of the retinal disorders which we have observed by ophthalmoscopy and electroretinography were quite different from one case to another, including two siblings. We then go on to discuss the pathogeny and the genetic basis of diseases due to a deficiency of the peroxisomal biogenesis.
A three and a half year-old boy with neurofibromatosis-1 was shown to have an unilateral glaucoma without other associated characteristics (homolateral facial hypertrophy, homolateral eyelid plexiform neuroma). This presentation is rare. Moreover, cerebral MRI disclosed a bilateral intraneural optic nerve glioma. The MRI of optic nerve glioma is discussed.
The Crow-Fukase syndrome or POEMS syndrome (Polyneuropathy, Organomegaly, Edema, Monoclonal protein, Skin changes) is an uncommon plasma cell dyscrasia leading to a multisystemic disorder. An optic disc swelling is often related to this syndrome. We report the case of a 51-year-old man with a papilledema. We presume that vasculitis or plasma cell infiltration is the cause of the papilledema.
A 60-year-old woman presents with bilateral ptosis and tearing, predominant on the right and existing since many years. Upper tarsus is much enlarged on the right; lacrymal glands are palpable under the upper lid and seem enlarged as well. CT scan and RMN confirms the hypertrophy of subcutaneous lid tissues, lacrymal glands and ocular muscles. The patient is aware of a progressive change in her physical aspect since years. Medical work-up diagnoses major acromegaly. Discussion about the consequences of acromegaly upon the ocular adnexa.
Case report of a 28-year-old woman presenting with a right abduction paresis. She also has right esotropia which was operated 14 years ago. Forced duction test was positive and there was a widening of the right palpebral fissure on attempted abduction. During reoperation we found thick adhesions between inferior oblique and lateral rectus. Freeing these adhesions restored the abduction and a normal palpebral aperture on abduction.
Case report of a woman with the characteristics of dominant exudative vitreoretinopathy. These anomalies are however unilateral and the family study is not very contributive. A platelet aggregation study carried out on the patient and 3 family members is normal.
The name "neuroretinitis" implies nothing but a fundus picture which can be caused by many infectious agents. The involvement of visual functions is variable and the prognosis relatively good. The treatment depends on which infectious agent is suspected.