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P LeHoang

Publications and source records attributed to P LeHoang.

At least 19 recordsLinked to original sources
PubMed2006

[Acute posterior multifocal placoid pigment epitheliopathy, serpiginous and multifocal choroiditis: etiological and therapeutic management].

PURPOSE: To highlight the importance of an extensive medical work-up in serpiginous and multifocal choroiditis, and acute posterior multifocal placoid pigment epitheliopathy before therapeutic management. PATIENTS AND METHODS: Records of patients referred to our department, between January 2000 and January 2002, for the diagnostic and therapeutic management of choroiditis or acute posterior multifocal placoid pigment epitheliopathy were retrospectively reviewed. All patients had a complete ophthalmologic examination, fluorescein and infrared angiographies. An extensive work-up was performed in order to exclude an infectious etiology. RESULTS: Fourteen patients were included (six cases of serpiginous choroiditis, four cases of multifocal choroiditis, and four cases of APMPPE). The mean age was 42.1 years and the sex ratio was 9: 5. Six patients presented with a history of tuberculosis in the family or with a tuberculosis primary infection. Toxoplasmic retinochoroiditis was confirmed in one case by a positive PCR applied to the aqueous humor. In the serpiginous choroiditis group, two patients have been treated with antituberculous drugs, one of whom was initially resistant to immunosuppressive regimens. In the acute posterior multifocal placoid pigment epitheliopathy group, one patient was treated with antituberculous drugs and another received antibiotics. CONCLUSION: An infectious agent may be associated with this group of clinical presentations. All patients presenting with severe forms of ocular inflammation, who resist to corticosteroids or immunosuppressive regimens, must undergo an extensive infectious work-up in order to propose a specific treatment.

Acute Disease↗
PubMed2005

[Severe visual loss due to retinal artery occlusion associated with Susac's syndrome: a case report].

INTRODUCTION: Susac's syndrome consists of the clinical triad of cerebral microangiopathy, branch retinal artery occlusions, and hearing loss. The pathogenesis of the disease remains unknown. The severity of retinal vasculopathy remains variable. CASE REPORT: A 57-year-old Caucasian woman presented in 1999 for the diagnostic and therapeutic management of a severe and complete form of the disease. Fluorescein angiography and cerebral MRI were contributive in this case and confirmed the diagnosis. A severe unilateral visual loss occurred one month after the initiation of systemic corticosteroids. Funduscopy disclosed a temporal retinal artery occlusion with major ischemia. Therefore, cyclophosphamide and anticoagulants were added to corticosteroids and total visual recovery was achieved within 2 weeks without any relapse after a follow-up period of 54 months. CONCLUSION: Therapeutic management of Susac's syndrome is still controversial. Major immunosuppressive regimens are mandatory in the face of severe visual loss associated with central or branch retinal artery occlusions. The final prognosis of the disease seems favorable in the absence of prolonged and symptomatic retinal ischemia.

Blindness↗
PubMed2005

[Diagnostic and therapeutic management of Vogt-Koyanagi-Harada syndrome].

PURPOSE: To determine the most efficient diagnostic tools in Vogt-Koyanagi-Harada syndrome, taking into account the international diagnostic criteria, and to evaluate the therapeutic management of these patients. PATIENTS AND METHODS: This study examined patients with a suspicion of VKH syndrome who presented between January 2001 and March 2003, including ocular and extraocular evaluation of the disease at the time of diagnosis. Each patient was classified according to the 1978 international diagnostic criteria and the revised 2001 criteria. In most cases, intravenous steroid pulses were administered. Immunosuppressors were initiated when inflammation was not controlled with steroids. RESULTS: Twenty-two patients were included. The mean age was 33.5 years (range, 15-49 years). Posterior segment involvement, which was observed in 21 patients, depended on the stage of the disease. Anterior segment inflammation was associated in eleven cases. Neurologic symptoms, including meningitis, cerebrospinal fluid lymphocytic pleocytosis, tinnitus, or hearing loss were observed in 12 patients. Fourteen patients had dermatologic signs. Five patients who developed VKH syndrome did not meet the 1978 criteria, and three patients did not meet the 2001 revised criteria. In 19 cases, intraocular inflammation was controlled with corticosteroids. In three cases, corticosteroids could not be discontinued. These patients were treated with immunosuppressive molecules: azathioprine, cyclophosphamide, interferon alpha. At the end of the follow-up period, inflammation was controlled in all patients. DISCUSSION: Revision of the diagnostic criteria provides a more subtle diagnosis of VKH syndrome. However, it is difficult to consider the variability of clinical symptoms during the duration of disease. Corticosteroids must be used at appropriate dosages, followed by slow tapering over 6 months. This attitude seems to reduce the duration of ocular inflammation and decreases the frequency of recurrence. The use of immunomodulating drugs could be reduced by early and appropriate use of systemic steroids. Interferon alpha seems to be a promising alternative in corticoresistant or corticodependent forms of the disease, but further controlled studies are required.

Adolescent↗
PubMed2005

[MALT-type B-cell lymphoma masquerading as scleritis or posterior uveitis].

PURPOSE: Diagnostic and therapeutic management of masquerade syndromes associated with MALT-type lymphoma. PATIENTS AND METHOD: We report the cases of three patients referred for acute or chronic severe loss of visual acuity. All of them suffered from uveitis or scleritis resistant to corticoid treatment. Each one had posterior uveitis associated with retinochoroidal infiltration, anterior scleritis associated with uveal effusion syndrome, or bilateral pan-uveitis associated with serous retinal detachment. Two patients had medical records of systemic malignancies. They underwent an extensive work-up. Search for an infectious, immune or malignant disease was negative but orbital imaging showed a posterior scleral thickening in all cases. RESULTS: Diagnosis of mucosa-associated lymphoid tissue (MALT) ocular lymphoma was assessed in all cases after scleral biopsy. Immunohistochemical analysis showed CD20(+) and CD5(-) scleral lymphocyte infiltrates. The three patients underwent chemotherapy associated with radiotherapy. Lesions were stabilized in the first case, whereas six lines of visual acuity improvement was noted in the second one, and full recovery was achieved after treatment in the third case. DISCUSSION: Clinical manifestations of this ocular lesion seem to be multiple, masquerading as different types of posterior uveitis or scleritis. In the three cases, we did found other systemic locations of MALT-type lymphoma. Diagnosis was mainly based on pathological analysis. Fast visual recovery in two cases demonstrated the importance of an early diagnosis and a specific treatment. All cases of chronic and corticoid-resistant posterior uveitis require a specialized radiological evaluation followed, if necessary, by multiple orbital biopsies.

Adult↗
PubMed2005

[Optic neuritis associated with infliximab].

Infliximab is a chimeric human-murine monoclonal antibody of the IgG1 type with a high affinity and specificity for tumor necrosis factor alpha (TNFalpha). Infliximab was used in Crohn disease, rheumatoid arthritis, spondyloarthropathy, juvenile idiopathic arthritis, Behcet's disease, Wegener's granulomatosis, HLA-B27-associated uveitis and chronic severe refractory uveitis. Reported adverse effects of this treatment were infections, development of antinuclear antibodies and anti double-stranded DNA, lymphomas, and exacerbation of demyelinating disease. We report a case of infliximab-associated optic neuritis with favorable outcome after systemic steroid treatment.

Antibodies, Monoclonal↗
PubMed2004

[Viral cause and management of necrotizing herpetic retinopathies].

PURPOSE: To study the viral cause and present the management of necrotizing herpetic retinopathies. METHODS: Charts of patients presenting with acute retinal necrosis (ARN) or progressive outer retinal necrosis (PORN) diagnosed between March 1997 and June 2001 were retrospectively reviewed. Intraocular specimens were obtained in 33 cases to determine the viral cause using polymerase chain reaction-based assays and/or detection of intraocular antibody production. RESULTS: The mean age was 43.4 Years. Herpesvirus genome was identified in 29 patients (80.5%). In the ARN group (32 patients, 38 eyes), herpes simplex virus (HSV) DNA was found in 11 patients (34.4%), varicella-zoster virus (VZV) in nine patients (28.1%), and cytomegalovirus (CMV) in four patients (12.5%). One patient (3.1%) presented an Epstein-Barr virus (EBV) infection. ARN was bilateral at initial examination in six patients and secondary bilateralization was observed in four patients. In the PORN group (four patients, eight eyes), the retinitis was bilateral and VZV DNA was detected in all cases. Two patients were treated with intravenous acyclovir, six with foscarnet alone, ten with intravenous foscarnet + acyclovir, 18 with intravenous foscarnet and intravitreous ganciclovir injections. Complications of necrotizing herpetic retinitis were cataract (26%), optic nerve atrophy (23.9%), and retinal detachment (17.4%). Final visual acuity was less or equal to 20/200 in 47.8% of cases. CONCLUSIONS: It is important to determine the specific viral etiology since progression and prognosis may be different in herpetic necrotizing retinitis caused by HSV, VZV, or CMV. Visual prognosis is improved by intensive antiviral therapy, but remains poor if complications occur.

Adult↗
PubMed2004

Helicobacter pylori (H. pylori) molecular signature in conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma.

Conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma is an extranodal marginal zone B-cell lymphoma that is characterized by an exaggerated clonal expansion of B cells, which implicate a pathological proliferative response to antigen(s) including bacteria. Helicobacter pylori (H. pylori) infection is recognized as one of the causative agents of gastric MALT lymphoma; however, it has not been reported in extra gastric MALT lymphoma. We studied 5 patients (4 adults and 1 child) with salmon-colored conjunctival lesions. One patient also had a history of abnormal bone marrow biopsy a year earlier with lymphoid aggregates involving 5% of the overall bone marrow. The conjunctival lesions of the 5 patients were biopsied. Histopathological diagnoses were consistent with conjunctival MALT lymphoma. Lymphoma and normal conjunctival cells were microdissected using laser capture microscopy or manual techniques. DNA was extracted and subjected to PCR amplification using H. pylori gene-specific primers from the urease B and vac/m2 gene. Cells from chronic conjunctivitis (normal lymphocytes), conjunctival human T-cell lymphotropic virus type-1/adult T-cell leukemia/lymphoma (HTLV-1/ATL), and orbital B-cell lymphoma were also microdissected, processed and analyzed. PCR amplification and Southern blot hybridization demonstrated H. pylori DNA in the conjunctival MALT lymphoma cells of 4/5 cases. The negative case was the one with a history of abnormal bone marrow. In contrast, H. pylori gene was not detected in normal conjunctival cells from the cases of MALT lymphoma or the lymphocytes, ATL and orbital B-lymphoma cells from the controls. These data suggest that H. pylori may play a role in conjunctival MALT lymphoma.

Aged↗
PubMed2003

[Chronic severe uveitis: classification, search for etiology and therapeutic approach].

PURPOSE: Severe chronic and refractory uveitis is a major diagnostic and therapeutic challenge for ophthalmologists and internists. Molecular tools, such as PCR but also new imaging techniques, have significantly changed the diagnostic approach during the last 10 years. Presumed and empirical diagnosis should be excluded in the face of atypical clinical presentations. CURRENT KNOWLEDGE AND KEY POINTS: A retrospective study based on 927 consecutive patients presenting with severe uveitis between 1991-1996, has recently defined the epidemiological characteristics and the visual outcome of this group of patients. An associated condition was determined in 67.5% of cases, divided in 4 different subgroups: infectious uveitis; uveitis associated with a systemic disease; eye-limited, presumed immune-mediated disorder and idiopathic eye-limited disorder. The management of patients with sight-threatening forms of uveitis is efficiently performed in collaboration with internists and depends on a complete diagnostic procedure and a well-adapted treatment. FUTURE PROSPECTS AND PROJECTS: Extensive work-up is mandatory when the therapeutic response seems atypical with resistance to corticosteroids and classical immunosuppressive drugs. Infectious uveitis should be excluded in severe and intractable forms of uveitis. Thereafter, new therapeutic strategies based on type I interferon and anti-TNF molecules can be proposed in order to decrease the potential risk of blindness in this young group of patients.

Chronic Disease↗
PubMed2003

Polymerase chain reaction analysis of aqueous humour samples in necrotising retinitis.

AIM: To evaluate the diagnostic value of polymerase chain reaction (PCR) performed on aqueous humour for the detection of viral DNA in patients with necrotising herpetic retinitis. METHODS: The clinical features and laboratory results of 22 patients (29 eyes) presenting with necrotising herpetic retinitis between March 1999 and June 2001 were reviewed retrospectively. Aqueous humour was obtained after anterior chamber paracentesis and PCR was performed in all cases. RESULTS: Viral DNA was detected in the aqueous humour of 19 patients (86.4%). Epstein-Barr virus (EBV) seroconversion was evidenced in one additional patient. In the acute retinal necrosis (ARN) group (n = 19), varicella zoster virus (VZV) DNA was identified in six patients, herpes simplex virus 1 (HSV-1) DNA in two patients, herpes simplex virus 2 (HSV-2) DNA in four patients, and cytomegalovirus (CMV) genome in four patients. In the progressive outer retinal necrosis (PORN) group (n = 3), VZV DNA was detected in all patients. No sample was positive for more than one virus. CONCLUSIONS: PCR analysis of aqueous humour in patients with clinical features of necrotising viral retinitis can provide specific aetiological orientation and the method appears to be safe and highly sensitive.

Acute Disease↗
PubMed2003

[Extensive toxoplasmic retinochoroiditis. Diagnostic and therapeutic management].

INTRODUCTION: To assess the diagnostic and therapeutic management of extensive toxoplasmic retinochoroiditis. PATIENTS AND METHODS: The files of all patients referred between December 1999 and December 2001 for the management of a severe, potentially sight-threatening toxoplasmic retinochoroiditis were retrospectively analyzed. The therapeutic strategy and the progression of intraocular inflammation are reported. RESULTS: Thirteen eyes of seven patients were finally included in the study. The sex ratio (F/M) and the mean age were respectively 4/3 and 44.5 years. Most of the patients were immunocompromised. Both eyes were initially affected in five cases. The diagnosis was confirmed by polymerase chain reaction (PCR) after anterior chamber paracentesis in six cases. Retinal detachment was observed in three cases, initially or during follow-up. All patients were treated with a combination of sulfadiazine and pyrimethamine, but azithromycin was necessary in two cases. Clindamycin was used in two cases of allergy to sulfadiazine. Corticosteroids were associated in five cases. For all patients, infection and inflammation were finally controlled. The visual acuity improved more than two lines in four eyes and remained stable in seven other eyes. DISCUSSION: Clinical diagnosis is still a challenge in severe cases of extensive toxoplasmic retinochoroiditis. PCR is helpful in identifying Toxoplasma gondii DNA. A systemic immunosuppression is frequently associated with a positive PCR. Treatment is based on a standard antiparasitic association and steroids must be discussed for each case according to the intensity of inflammation and the degree of immunosuppression. CONCLUSION: Extensive ocular toxoplasmosis is a serious condition. The final prognosis depends on the location of the necrotic lesions, rapid diagnosis, and efficient treatment.

Adolescent↗
PubMed2002

[Intraocular pressure elevation after subtenon injection of triamcinolone acetonide during uveitis].

INTRODUCTION: New therapeutic concepts in the management of ocular inflammation have led to the development of periocular and intravitreal injections. Such treatment modalities can induce intraocular pressure elevation. PATIENTS AND METHODS: Periocular injections have been given to patients suffering from strictly unilateral or bilateral but asymmetrical and noninfectious posterior uveitis. A history of corticosteroid-induced glaucoma was a contraindication to such treatment. A retrospective review of cases who were given subtenon triamcinolone acetonide injection between May and October 2001 was undertaken to evaluate the efficacy of the treatment and the risk of intraocular pressure elevation. Ocular pressure was measured before and after the injection and the efficacy of the treatment was evaluated by measurements of visual acuity and fluorescein angiography. RESULTS: One or several injections were given to 61 patients. Intraocular pressure rose in 13 patients (21.3%). Medical treatment was unsuccessful in three cases and surgical excision of periocular corticosteroid deposit was required. Therefore, intraocular pressure was controlled with no other medication. Treatment was considered effective in 32 patients (52.45%): improvement of visual acuity (more than two lines) or control of inflammation on fluorescein angiography. DISCUSSION: and conclusions: Periocular subtenon injection of triamcinolone acetonide in posterior noninfectious uveitis is a safe procedure. Intraocular pressure elevation is not frequent and can be controlled through medical treatment or surgical excision of a residual deposit, in which pharmacologically active triamcinolone can be present several months after the injection.

Adolescent↗
PubMed2002

[Vision disorders of central origin].

Cortical blindness (or more generally, cerebral blindness) consists of bilateral visual loss with normal ocular examination and normal pupillary function, related to bilateral occipital lesions. Its most frequent cause in adults is hypoperfusion in the vertebral-basilar arteries, although other curable causes are described. Other syndromes, related to lesions of associative cortical areas or occipital-fugal connections may cause poorly defined visual complaints. Their recognition by the ophthalmologist is mandatory, as they may concern a potentially curable underlying disease.

Blindness, Cortical↗
PubMed2001

Value of high-frequency ultrasound biomicroscopy in uveitis.

PURPOSE: To determine the use of high-frequency ultrasound biomicroscopy (UBM) in the assessment of inflammatory lesions of the iris, ciliary body, pars plana and peripheral vitreous, and in particular to determine the proportion of cases for which UBM contributed significant additional, hitherto inaccessible, information. METHODS: Charts of patients seen in the uveitis clinic at University Eye Hospital from November 1994 to September 1999 for whom a UBM investigation had been performed were analysed. UBM was performed in a standard manner, using a Humphrey UBM 840 system. The clinical relevance of the UBM findings was determined for the whole series and for the following six subgroups of patients arbitrarily established according to the type and location of pathology: hypotony, pseudophakic uveitis, iris and ciliary body pathology excluding hypotony, pars plana pathology, scleritis and Toxocara uveitis. Findings were classified as positive when they confirmed a suspected diagnosis of lesional process or when they gave essential information. Findings were classified as essential when they led to the diagnosis or when they modified therapeutic intervention. RESULTS: During the study period 111 eyes of 77 patients were included. UBM findings contributed essential information that allowed a diagnosis to be reached or that influenced treatment in 43% of cases. It yielded positive findings in 91% of cases, enabling assessment of morphological changes in the iris, ciliary body, and retroiridal and peripheral vitreous induced by intraocular inflammatory or pseudo-inflammatory disorders. Specific UBM signs, present in all patients, were identified in Toxocara uveitis. The groups of patients that benefited most from UBM examination were those with hypotony (83% essential findings) and opaque media (100% essential findings). CONCLUSION: For uveitis patients with an inflammatory process situated in the iris/ciliary body/pars plana/retroiridal vitreous areas, UBM was of great clinical value and improved the management in a significant manner.

Adolescent↗
PubMed2000

Rearrangement of immunoglobulin gene in metastatic Waldenström macroglobulinemia to the vitreous.

PURPOSE: To report metastatic Waldenström macroglobulinemia cells with immunoglobulin heavy chain gene rearrangement in the vitreous and the blood. METHODS: A 58-year-old man with Waldenström macroglobulinemia developed bilateral vitreitis. Diagnostic vitrectomy was performed on the left eye. The vitreous cells and the peripheral blood lymphocytes were analyzed using microdissection and polymerase chain reaction amplification. RESULTS: Vitrectomy specimen of the left eye contained a few degenerated cells. Molecular analysis showed immunoglobulin heavy chain gene rearrangement at the third complementary determining region of the vitreal infiltrating cells and peripheral blood lymphocytes. CONCLUSIONS: Waldenström macroglobulinemia rarely metastasizes to the vitreous. Molecular detection of the immunoglobulin heavy chain gene third complementary determining region rearrangement is helpful in the diagnosis of the malignancy. Microdissection combined with polymerase chain reaction is a useful and innovative tool for molecular pathological investigation.

B-Lymphocytes↗
PubMed2000

[Intraocular hypotony: use of ultrasound biomicroscopy (UBM) for differential diagnosis and its schematic representation].

OBJECTIVES: To determine the use of high-frequency ultrasound biomicroscopy (UBM) in the assessment of hypotony and in particular to determine the proportion of cases for which UBM contributed significant additional hitherto unaccessible information. PATIENTS AND METHODS: Ultrasound biomicroscopy was performed in a standard manner, using a Humphrey UBM 840 system (Humphrey Instruments, Inc., San Leandro, CA). UBM findings were analysed and the clinical relevance of UBM information was determined for the whole collective. RESULTS: Twelve patients with hypotony were examined. UBM findings contributed essential information that allowed to reach a diagnosis or that determined the therapeutic attitude in 10 of the 12 hypotonic patients. In two cases the cause of hypotony was tractional ciliary body detachment, in 5 cases it was post-inflammatory atrophy of the ciliary body, in 3 cases it was post-traumatic irido and cyclodialysis, in one case it was supraciliary and suprachoroidal effusion and in the last case it was due to uveal effusion syndrome. Based on these findings we established a schematic approach for hypotony. CONCLUSIONS: This procedure enabled us to assess the morphological changes found in patients with hypotony. In a majority of cases UBM was useful either to orient therapeutic intervention or to establish a diagnosis. On the base of our findings a schematic approach for hypotony, using UBM, was established.

Algorithms↗