[Pre-papillary neo-vessels in Vogt-Koyanagi-Haradi syndrome. Apropos of a case].
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Adult↗
Biomedical subjects
A Forest
Publications and source records attributed to A Forest.
[Current aspects of the Vogt-Koyanagi-Harada syndrome. Apropos of 9 cases].
We have studied 9 cases of the Vogt Koyanagi Harada (VKH) syndrome as defined by the criteria of the American Uveitis Society; all these cases presented evidence of past or present exudative retinal detachment (RD). In 2 cases the RD was shallow and limited to the posterior pole, in 3 cases encephalo-meningeal symptoms were absent, in 2 cases skin and hair symptoms were absent. In all, 5 cases in this series presented as an incomplete, dissociated form of the disease. However the clinical cause of the disease in these "formes frustes" was not simpler or quieter than in the complete forms; incomplete response or drug dependence were encountered with steroid therapy, and immunosuppressive drugs were used in 3 cases. It is to be noted that in one case an extensive RD involving the posterior pole occurred bilaterally: this RD did not respond to maximal steroid and immunosuppressive therapy and reattachment was obtained only after vitrectomy. In another case bilateral optic disc neovascularization was observed in association with severe papillitis despite heavy steroid therapy. A cure was obtained with immunosuppressive drugs.
Adolescent↗
[Retinal detachment and argon laser prophylactic treatment (author's transl)].
We have studied 6 retinal detachments which hapened after a preventive photocoagulation with argon laser in 6 patients who had already had a severe retinal detachment on the other eye (2 anatomical success on 5 operated cases). This preventive photocoagulation was done on eyes which at the term were free of any retinal dehiscence. In this group of 6 we notice 2 giant tears (greater than 70 degrees) or 33% and 3 large tears (between 20 degrees and 70 degrees) or 33%. These high amounts do not correspond to what has been noticed before: - on the non photocoagulated fellow eyes (neither giant nor large tear) - on the whole lot of operated retinal detachments during the same period of time in our unit (2% of giant and 5,7% of large tears). We think that the responsability of laser in the development of these large lesions in predisposed eyes must be thought about. Studies on a larger scale will be necessary to have a more definite idea on this subject.
Adult↗
[Partial decalcifying algodystrophy].
Partial decalcifying algodystrophy (PDA) appears in two forms: one, a radial form, affects, following a certain metameric topography, one or two radiuses of the hand or of the foot (two cases reported); the other, a zonal form, is more peculiar: only part of a condyle or of the femoral head, are demineralized for two to three months. The authors report 7 cases of this misleading zonal form, 2 of them after histological verification. The image leads to various diagnostic errors: osteitis or infectious osteo-arthritis, acute inflammation close to the bone, and especially malignant processes. However, zonal PDA has its own characteristics: demineralization, that becomes clear only during the second month, and quickly extends over a rather long sub chondral bone surface. Tomography is very useful: it demonstrates better the severe sub chondral osteoporosis and the retention of the bone sole, which becomes detached from the bone. Scintigraphy shows the massive localized or panregional hyperfixation and sometimes other infraradiological sites (hips, knee or ankle). Zonal osteoporosis remains partial and misleading for only 2 or 3 months, after which it becomes a classical panregional form. The rate of development is that of DA. Painful impotence quickly increases, with cure in 6 months.
Adult↗
[Surgical treatment of retinoschisis (author's transl)].
We have made a review of 20 retinoschisis without retinal detachment operated on 12 patients. There is no case of hereditary retinoschisis, the affection may occur at any age, and there is no preferential refractive error. Main surgical indications were macular involvement or impending involvement, and associated retinal tears. A good anatomical result has been obtained in 90% of our cases (18 out of 20) with 2/3 complete reattachments and 1/3 almost complete reattachments (with minimal and well sealed residual schisis). Association of cryocoagulation and indentation is more effective than cryocoagulation alone. On the functional point of view we have had 15% of improved visual acuities and 30% of worsened ones, thus surgical intervention implies macular risks that one must try to prevent by using procedures as atraumatic as possible.
Adolescent↗
[Silicone sponges rejection (author's transl)].
Out of 633 retinal tears or detachments treated by cryocoagulation and Lincoff sponges without scleral dissection, our rate of sponge rejection is 8 per cent (51 out of 633). Out of these 51 rejections we have 4 spontaneous expulsions and 45 surgical removals. In 2 cases we could preserve the buckle by medical treatment. The most pre-eminent causes are in decreasing frequency: --the peroperative sponge infection, mostly by staphylococcus epidermidis, --the existence of an anterior positioned sponge, more than a quadrant long, factor of bad mechanical tolerance, --several operations. The rate of anatomical success is of 86% in this group of 51 patients (80% if we only number successes at six months). We have had 8 recurrences after sponge removals (15%). Recurrences are due to sponge infection; they are mainly due to the reopening of the primitive lesions (6 times out of 8). Only 5 recurrences have been cured (62,5%). This result seems, however, better than the one reached by authors using scleral dissection techniques; according to us this is due to the relatively rare severe vitreous reactions when episcleral sponges' infection occurs.
Age Factors↗
[Prognosis of the retinal detachment in children (author's transl)].
Following features seem to characterize retinal detachments in children. High rate of difficult anatomical problems: invisible retinal breaks, macular or paramacular breaks, giant breaks or desinsertions (37% of our cases). High rate of severe traumatic macular lesions. Important delay in treatment with prolonged macular impairment. These facts explain the prognosis. Difficulties in the treatment of retinal breaks explain anatomical results (75% cure rate vs 78,6% for all the retinal detachments treated). In the same way they explain the high rate of multiple operations. Macular impairment and multiple operations explain visual results: 1/3 of the non amblyopic eyes recover a visual acuity comparable to the initial. So, the macular in children does not seem to have a special functional recuperation ability. Two supplementary facts may be mentioned. Delay in treatment has no adverse effect in anatomic prognosis. Non giant "simple" desinsertions expose to a noticeable risk of massive vitreous retraction.
Adolescent↗
[Drainage of subretinal fluid: technic and results].
The drainage of subretinal fluid (S.R.F.) after choroidal diathermy offers a distinct advantage: important reduction of massive haemorrhages from the drainage site (4% vs 48% in the non diathermy group in our series). According to us it is not a decisive factor for the anatomical prognosis because complications of drainage in themselves seem to be a quite infrequent cause of anatomical failure. On the other hand we think that visual outcome is better in the diathermy group because of a diminution of macular haemorrhages.
Choroid↗
[Ocular tattooing caused by abuse of a methylene blue eye-wash].
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Adult↗
[Indentation of large retinal tears (author's transl)].
According to us large retinal tears are between 20 degrees and 70 degrees in their largest dimension, which excludes true giant tears. Study of the data collected on 42 patients has shown us the following facts:--these retinal tears occur in phakic and often highly myopic eyes;--our global success rate is 73,8%;--tears smaller than 2 to 3 papillary diameters radially are on the whole easy to indent and failures are quite often related to a surgical fault;--tears wider than 3 papillary diameters radially are on the whole difficult to indent and failures are not always related to an obvious surgical fault, fishmouth phenomenon plays an important role;--in every case presence of blood in the vitreous seems to be unfavourable to the prognosis;--use of episcleral pockets solves must of times surgical problems related to fishmouth or tear dimension;--post operative intern limiting membrane retraction is frequent (10% vs 5,7% for all the retinal tears and detachments cured in the same period of time).
Adolescent↗