Biomedical subjects
N Cassoux
Publications and source records attributed to N Cassoux.
Intravenous immunoglobulin (IVIg) for the treatment of birdshot retinochoroidopathy.
Intravenous polyclonal immunoglobulin (IVIg) treatment has been successfully used in a number of autoimmune conditions. Birdshot retinochoroidopathy (BRC) is a bilateral autoimmune posterior uveitis which, in its progressive form, frequently requires immunosuppressive therapy. We report a clinical study aimed at determining the tolerance and efficiency of IVIg treatment in patients with active BRC. The study was conducted in an open manner. Eighteen patients were included. The initial visual acuity (VA) was < or =20/30 in 26 eyes, 20/25 in five eyes, and 20/20 in five eyes. IVIg was given as sole treatment at 1.6 g/kg every four weeks for six months, followed by injections of 1.2-1.6 g/kg at six to eight-week intervals. The mean follow-up was 39 months, ranging between 12 and 53 months. The results showed that the final VA of the 26 eyes with an initial VA of < or =20/30 was increased by two lines or more in 14 eyes (53.8%) and decreased in two (7.7%). Of the five eyes with an initial VA of 20/25, four had improved to 20/20 and one remained stable. Of the five eyes with an initial VA of 20/20, four remained stable and one deteriorated to 20/25. When present, macular edema was improved in half of the eyes on fluorescein angiography. Benign side effects were observed in 12 patients: moderate transient arterial hypertension (7), headache (6), eczematous lesions (6), and hyperthermia (4). The results suggest that IVIg may represent a safe alternative therapy for patients with BRC.
Neovascular glaucoma after bypass surgery in Takayasu's disease.
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CMV retinitis in the era of HAART.
Since 1996, major advances in the treatment of AIDS have markedly changed the incidence and the prognosis of CMV retinitis. Highly active antiretroviral therapy (HAART) is a combination of nucleoside reverse transcriptase inhibitors and protease inhibitors. This new therapeutic strategy is highly efficient in reducing the HIV viral load and increasing CD(4)+ T-lymphocyte count. These biological effects are associated with an improvement of immune functions. Clinically, the completely quiescent CMV retinitis and the unusual prolonged relapse-free interval suggest a certain restoration of immune functions, making possible the discontinuation of maintenance therapy. For most authors, the decision to stop anti-CMV maintenance therapy is based on a CD4+ cell count >100 cells/microl with a low HIV viral load for at least four months. The improvement of CMV retinitis on HAART may also be associated with an intraocular inflammation called immune recovery vitritis. For some patients, this vitritis may be associated cystoid macular edema and an epiretinal membrane responsible for visual loss.
Cystoid macular oedema and cytomegalovirus retinitis in patients with HIV disease treated with highly active antiretroviral therapy.
BACKGROUND: Although cystoid macular oedema (CMO) is a rare cause of visual loss in AIDS related cytomegalovirus (CMV) retinitis, nine cases are reported of CMO occurring in HIV infected patients with a prior diagnosis of CMV who were receiving highly active antiretroviral therapy (HAART). METHODS: Medical and ophthalmological records of nine AIDS patients with inactive CMV retinitis were retrospectively analysed. Ophthalmic examination data, laboratory findings, and the systemic antiviral treatment were studied. Ophthalmic examination included visual acuity, anterior chamber flare measured with the laser flare cell meter (LCFM), vitreous haze quantification according to the Nussenblatt grading system, and fluorescein angiography. RESULTS: Nine HIV infected patients, eight men and one woman, mean age 39 years (range 29-53 years) presented with inactive CMV retinitis and CMO. On fluorescein angiography, CMO was present only in eyes (14 eyes) with signs of previous CMV retinitis. CMV retinitis was inactive in all of them. Visual acuity ranged from 20/200 to 20/30. In 10 eyes with CMV retinitis, anterior chamber flare measured with the LCFM ranged from 18.5 to 82 photons/ms (mean 35.42 ph/ms). A significant vitreous inflammation (1.5+) was observed in eight eyes. All patients had been treated with anti-CMV drugs for a mean period of 18 months (range 12-36 months). All nine patients received HAART with a combination of two nucleotide analogue reverse transcriptase inhibitors and one protease inhibitor for a mean period of 14 months (range 9-18 months). The HIV viral load was below detectable levels (< 200 copies/ml) in eight patients and low (3215 copies/ml) in one. At the time of CMO, the median CD4+ lymphocyte count was 232 cells x 10(6)/l (range 99-639). CONCLUSION: In AIDS patients, the usual absence of intraocular inflammation in eyes affected by CMV retinitis has been tentatively explained by the profound cellular immunodeficiency. In these patients, treated with HAART, CD4+ counts were increased for several months (mean 14 months). In their eyes, CMV retinitis was associated with significant ocular inflammation and CMO. These findings could be related to the restoration of immune competence after HAART as recently shown.
[Ocular manifestations of Behçet's disease].
Ocular complications of Behçet's disease are considered one of the major criteria upon which the diagnosis is based. The ocular disease is characterized by repeated, explosive ocular inflammatory attacks which can healed spontaneously. During in-between attacks there is little or no evidence of inflammation in the eyes. The anterior segment can be involved alone presenting as a severe anterior uveitis with hypopyon. Posterior pole involvement is often sight threatening presenting as recurrent retinal vaso-occlusive disease. The fundus changes most frequently encountered are hyperhemia of the optic nerve, macular edema, retinal edema, vascular sheathing retinal exudate, and retinal hemorrhages. Complications of the inflammation include retinal and optic disc atrophy, neovascular glaucoma, vitreous hemorrhage, retinal detachment. Treatment is with topical steroids, systemic medications, including corticosteroids, colchicine, and immunosuppressive drugs. These complications are sight threatening and require a close follow up and a collaboration between ophthalmologists and Internal Medicine physicians.
Whipple's syndrome (uveitis, B27-negative spondylarthropathy, meningitis, and lymphadenopathy) associated with Arthrobacter sp. infection.
OBJECTIVE: To report an unusual case of Whipple's disease, including uveitis, seronegative spondylarthropathy, meningitis, and lymphadenopathy, associated with an Arthrobacter sp. infection. DESIGN: Interventional case report. PATIENT AND INTERVENTION: A 60-year-old white man presenting with severe chronic uveitis and systemic inflammatory manifestations was treated efficiently for Whipple's disease after histopathologic analysis of vitreous and inguinal adenopathy biopsy specimens. The authors performed a retrospective, laboratory-based evaluation of stored tissue specimens. MEASUREMENTS: Molecular analysis based on 16S ribosomal RNA gene amplification was applied to pretreatment biopsy specimens of inguinal lymph node to identify a causative bacterial agent. RESULTS: Tropheryma whippelii genome was not detected in these specimens. However, an amplification product was obtained after the first polymerase chain reaction run and subsequently was sequenced. It corresponded to an Arthrobacter sp., a gram-positive agent presenting diagnostic patterns and therapeutic management similar to those of Whipple's disease caused by T. whippelii. CONCLUSION: The absence of T. whippelii identification by molecular amplification during a clinically and histologically oriented Whipple's syndrome should not rule out the diagnosis. Arthrobacter infection may represent a new bacterial etiology of systemic inflammatory disorders involving the eye and associated with periodic acid-Schiff-positive inclusions.
[Endogenous infectious endophthalmitis].
INTRODUCTION: Endogenous endophthtalmitis is an intraocular infection of hematogenous origin. EXEGESIS: It is generally a panuveitis that may be mixed-up with a non-infectious inflammatory disease, promoting delayed treatment and compromising the visual prognosis, as the visual loss rate reaches up to 37.5%. Antibiotherapy should be started immediately after bacteriological examinations and without waiting for vitrectomy. Identification of the causative microorganism is absolutely necessary. It may require aqueous or vitreous culture if cultures from other body fluids are negative and infection progresses. The most common infections are endocarditis and digestive and renal diseases. Virectomy is indicated for first line treatment of ocular abcess and improvement of antibiotic absorption. However, it may lead to retinal detachment. Vitrectomy is also indicated in case of unsuccessful therapy. To decrease the inflammatory reaction and risks of vitreous organization, local or systemic corticotherapy is prescribed after control of the infection. CONCLUSION: Although rare, endogenous endophthalmitis should be diagnosed as it may be mixed-up with inflammatory uveitis, leading to inappropriate corticotherapy. Furthermore, antibiotherapy with good intraocular penetration should be started immediately, but it should be kept in mind that the functional prognosis is poor.
Retinal pigment epithelial detachment: an unusual presentation in ocular sarcoidosis.
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[Episcleritis and brucellosis. Apropos of a case].
A 35-year-old man presented a case of recurrent episcleritis revealing brucellosis. No concurrent diagnosis other than brucellosis could account for the episcleritis. Moreover his status was dramatically improved by specific antibiotherapy. A review of the literature showed that uveitis and optic neuropathies are the most common ocular manifestations of brucellosis. To the best of our knowledge, this is the first case of episcleritis associated with brucellosis.
Efficacy of proton therapy in circumscribed choroidal hemangiomas associated with serious retinal detachment.
OBJECTIVE: The purpose of the study is to evaluate the efficacy and safety of proton therapy in complicated circumscribed choroidal hemangiomas. DESIGN: The study design was a retrospective review. PARTICIPANTS: Studied were 13 patients (13 eyes) who had circumscribed choroidal hemangioma associated with serous retinal detachment. Of these, four eyes previously underwent laser unsuccessfully. INTERVENTION: Proton therapy including a total dose of 30 Cobalt-Gray-Equivalent was administered to each eye. MAIN OUTCOME MEASURES: Patients were controlled for initial and final best-corrected visual acuity, slit-lamp examination, intraocular pressure, fundus examination, fluorescein angiography, and tumor thickness on B-scan ultrasonography. RESULTS: The mean follow-up period was 26 months (range, 9-48 months). Retinal reattachment was obtained in all cases after a mean period of 52 days. The tumor height decreased in all cases. Visual acuity improved to two lines or more in eight eyes (62%) and reached 20/200 or more in nine eyes (69%). No radiation complication was detected during follow-up. CONCLUSIONS: Proton radiation seems to be effective and safe in the management of choroidal hemangioma associated with serous retinal detachment. It may be useful when photocoagulation can not be performed.
[Technique of implantation of A ganciclovir-containing intravitreal device].
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[Tyndall automatized photometry (PAT) in ophthalmology].
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[Retinal detachment secondary to CMV retinitis].
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[Retinal manifestations of AIDS].
Cytomegalovirus (CMV) retinitis is the most common retinal opportunistic infection in AIDS patients and is the main cause of blindness. It is generally associated with a CD4+ lymphocyte count below 50/microL. CMV retinitis is often asymptomatic (54% of the cases), frequent ophtalmoscopic screening is very important. Two virostatic drugs (Cymevan and Foscavir) have been approved for the treatment of CMV retinitis. Both are effective in preventing the progression of the lesion within 3 weeks of induction therapy. Long-term use of virostatic maintenance therapy delays the onset of relapses. The differential diagnosis of CMV retinitis are: human immunodeficiency virus retinopathy, varicella-zoster virus retinitis, ocular toxoplasmosis, syphilis, candida endophthalmitis in intravenous drug users, and unfrequently, tuberculosis, choroidal pneumocystosis, intraocular lymphoma.
Retinal arterial occlusion associated with resistance to activated protein C.
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