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Biomedical subjects

B Ridings

Publications and source records attributed to B Ridings.

At least 19 recordsLinked to original sources

[Bilateral corneal endothelial decompensation after postsepticemia coma].

We report a case of unexplained bilateral corneal endothelial decompensation after a coma. A 71-year-old man with no medical history presented with bilateral endothelial decompensation that required penetrating keratoplasty of the left eye combined with cataract surgery. This coma was caused by septicemia originally due to staphylococcus infection following catheter placement in preparation for a CT scan. Visual acuity of the left eye was 20/400 and 20/100 in the right eye when the patient awoke from the coma. After examination, we noted only stromal thickening and Descemet membrane folds causing corneal edema predominating OS. The rest of the exam was normal. Six months after surgery, visual acuity improved to 20/25. The most probable physiopathological mechanism of this decompensation is an iatrogenic complication from drugs administered during the patient's stay in intensive care (oxacillin), but we cannot rule out direct aggression of a bacterium or its toxin or the decompensation of a preexisting pathology.

Aged↗

[Internal carotid artery dissection on arterial fibromuscular dysplasia causing a central retinal artery occlusion: a case report].

INTRODUCTION: We report a case of a 66-year-old woman presenting a central retinal artery occlusion with no cardiovascular risk factor, with assessment using supra-aortic artery ultrasonography showing total internal carotid artery thrombosis. OBSERVATION: When vascular thrombosis risk factors are absent, more in-depth assessment such as a supra-aortic artery angioscan can provide the diagnosis of arterial dissection on arterial fibromuscular dysplasia. CONCLUSION: Central retinal artery occlusion is a rare but severe pathology. Therefore it is very important not to neglect the etiological assessment, because it can be the revealing element of a severe pathology.

Aged↗

[Quantitative and spatial analysis in image processing: study of drusen distribution from the foveal center in age-related macular degeneration].

Angiofluorograms were obtained from 58 patients presenting posterior pole drusen due to age-related macular degeneration. These frames underwent image processing by morphological mathematics algorithms. The detection sensitivity of this algorithm is 78%. We present a quantitative and spatial analysis of drusen distribution from the foveal center in the form of a graph. This technique may allow for multi-date comparisons, by using a graphic representation of this risk factor for age-related macular degeneration.

Algorithms↗

Metabolic factors and the foveal avascular zone of the retina in diabetes mellitus.

AIM: To study the foveal avascular zone (FAZ) of the central retina in diabetic patients with retinopathy having undergone metabolic evaluation. METHODS: One hundred and ten digital fluorescein angiograms were chosen from our digital image bank after cross matching diabetic patient lists of the ophthalmology and endocrinology departments of our institution. The patients had undergone day visits with systemic, biological and ophthalmologic evaluation, including digital fluorescein angiography. RESULTS: Sex ratio was M 62/F 48. Average age was 52.4 years (+/- 13.8) with 44 type 1 diabetics and 66 type 2. Retinopathy was present in all patients (54 background (BDR), 30 pre-proliferative (PPDR), 26 proliferative (PDR)). Age was positively correlated with FAZ grade (47.3 years +/- 13.2 for normal FAZ, 53.8 years +/- 13.7 for abnormal FAZ, P=0.03). Lipid profile showed a protective tendency of the Apo A1 fraction of cholesterol on macular vascularization (1.7 gr./l in normal FAZ patients vs 1.43 gr./l in abnormal FAZ patients, P=0.004). Body mass index was negatively correlated with macular ischemia (28.11 if FAZ not severely altered, 25.97 if FAZ severely altered, P=0.03). CONCLUSIONS: We found possible relations between BMI and Apo A 1 cholesterol and macular vascularization which may warrant further investigation.

Adult↗

Foveal avascular zone in diabetic retinopathy: quantitative vs qualitative assessment.

PURPOSE: To describe the relations between foveal avascular zone (FAZ) size and outline in patients presenting diabetic retinopathy. METHODS: 110 high-quality fluorescein angiograms from 110 diabetics were chosen from our digital retinal image databank. Patients with significant media opacities, macular scars, macular hard exsudates, high ametropia, and associated macular pathology were excluded. Both FAZ perimeter and surface area were measured with image analysis software. FAZ outline was graded according to ETDRS report Number 11 (from 0=normal to 4=capillary outline completely destroyed). Data were compared to that of 31 healthy controls. FAZ surface in diabetics was compared to that of controls and FAZ surface was compared to FAZ grade, FAZ perimeter and retinopathy stage in diabetics. Quantitative variables were compared using the U-test of Mann-Whitney or Kruskal-Wallis test and correlations between quantitative variables were estimated with the Spearmann coefficient. RESULTS: All patients presented diabetic retinopathy (54 BDR, 30 PPDR, 26 PDR). FAZ size was larger in diabetics than controls (P<0.001). In diabetics, FAZ size increased with FAZ grade (P<or=0.006 except between grades 1 and 2=NS) and with retinopathy stage (P<or=0.024). As retinopathy advanced, there was a higher proportion of altered FAZ outlines (P=0.003). CONCLUSIONS: This study confirms capillary alteration to be the cause of increase in FAZ size in diabetics and presents an alternative evaluation method of the FAZ to FAZ size measurement. No qualitative studies using the ETDRS FAZ grading scale have been performed to our knowledge.

Adult↗

[Branch retinal vein occlusion reveals Takayasu's arteritis].

We report a case of branch retinal vein occlusion in a 28-year-old woman that revealed Takayasu's arteritis. Somatic examination showed humeral blood pressure asymmetry and an abdominal murmur; a biological inflammatory syndrome was noted. Abdominal aortography showed marked stenosis of the superior mesenteric artery. Three of the six diagnostic criteria of Takayasu's arteritis were present in our patient, sufficing to make the diagnosis. This is the first case reported of branch retinal vein occlusion revealing Takayasu's arteritis. It is to be added to the List of atypical initial manifestations of Takayasu's arteritis such as anterior ischemic optic neuropathy. Branch retinal vein occlusion is a rare enough occurrence in a 28-year-old patient to warrant further clinical investigation.

Adult↗

[Ocular metastasis of cutaneous melanoma].

We report a case of vitreal metastases from cutaneous melanoma. We describe the clinical findings and the histological aspects of the lesions, which allows us to discuss the diagnosis of masquerade syndrome and highlight the diagnostic importance of vitreous biopsy.

Eye Neoplasms↗

[Penicillium chrysogenum endophthalmitis: a case report].

We report a case of Penicillium chrysogenum endophthalmitis after penetrating ocular trauma in a 9-year-old child, describing the initial management and the therapeutic adaptation after biopsy culture. After a review of endophthalmitis treatment, we discuss mycotic endophthalmitis treatment and recommend the use of intravitreal antibiotics. In this case, we used amphotericin B to treat the fungal disorder with success.

Child↗

[Teaching phacosection in a tropical setting].

PURPOSE: The aim of this study was to prospectively evaluate the training of a Malagasy ophthalmologist, already proficient in classic manual extracapsular cataract extraction (ECCE), in a small incision manual technique (phacosection). MATERIALS AND METHODS: Within the activity of the Sight First program to fight blindness in Madagascar, the ophthalmologist of Majunga recruited patients presenting total white cataracts. These patients were operated by phacosection using the local hospital's usual instrumentation along with two specific phacosection instruments and extra single-use material (a precalibrated 3.2 mm knife and viscoelastic products). Peribulbar anesthesia with eye pressure was provided. Postoperative follow-up (visual acuity and corneal status) was conducted on days 1, 7 and 30. RESULTS: Forty-four eyes were operated, the first seven by the instructor assisted by the local ophthalmologist, the next 36 by the local ophthalmologist assisted by the instructor. Five postoperative complications were noted: two cases of posterior capsular rupture (one during implantation) and three cases needing reoperation with aspiration of residual cortical masses. Induced astigmatism was low and visual rehabilitation was good, with all corneas clear at day 30. DISCUSSION: The results are quite acceptable given the training period, with only two marked complications (one not related to the operative technique) and good visual rehabilitation in less than 2 weeks. This small incision technique allowed reduction of induced astigmatism and risk-free management of total white cataracts (independent of operator). CONCLUSION: Small incision manual ECCE by phacosection is a safe, possible management option for difficult cataracts in a tropical setting with only a small increase in cost. Moreover, the training of an ophthalmologist mastering classic manual ECCE appears rapid and risk-free for patients.

Adult↗

[Indocyanine green angiography in age-related macular degeneration].

Indocyanine green ocular angiography was developed more than 30 years ago, but has been used commonly for less than 10 years. In exudative age-related macular degeneration, certain cases of occult neovascularization may be converted into well-defined cases, in theory allowing treatment of more patients. Neovascularization is observed as either focal hyperfluorescence (hot spot) or diffuse hyperfluorescence (plaque). Scanning laser ophthalmoscopy imaging allows for better visualization of feeder vessels, allowing even more selective treatment. Even though a multicentric, prospective, randomized study has not yet been conducted, a number of pilot studies are very encouraging concerning indocyanine green angiography-guided laser treatment.

Age Factors↗

[Bilateral exophthalmos diabetes insipidus: Erdheim-Chester disease. Clinical and radiological findings].

The authors report a case of a 61-year-old man presenting bilateral exophthalmos and diabetes insipidus. A retro-orbital biopsy revealed nonspecific fibrocollagenic infiltration. The diagnosis of Erdheim-Chester disease was evoked when a multivisceral affection (retroperitoneal and mediastinal periaortic fibrosis) with specific bone localization became evident. The histopatholgical study of a bone biopsy showed xanthogranulomatous infiltration. The patient died a few months later of an intercurrent infection.

Diabetes Insipidus↗

Simple, reliable and fast spectrofluorometric method for determination of plasma Verteporfin (Visudyne) levels during photodynamic therapy for choroidal neovascularization.

Photodynamic therapy with Verteporfin, a potent photosensitizer dye, is a very effective treatment for age related macular degeneration due to choroidal neovascularization. Photodynamic therapy offers the potential for selective tissue injury in part attributable to preferential localization of Verteporfin, administrated by intravenous infusion, to the choroidal neovascularization complex and irradiation of the complex with non-laser thermal light at 690 nm resulting in at least temporary thrombosis and vessel closure. Verteporfin is a benzoporphyrin derivative monoacid ring A formulated as a unilamellar liposome. In the blood Verteporfin is associated with lipoprotein fractions and is rapidly cleared via a receptor-mediated uptake mechanism due the high expression of LDL receptors in neovascular tissues. Verteporfin was undetectable in plasma 24 hr after infusion of the recommended dose: 6 mg/m2 of body surface area. The main side effect is photosensitivity of skin which is usually short-lived (24-48 hr) with a low incidence (2.3%). As skin photosensitivity depends on circulating rather than tissue drug levels, we investigate the possibility of developing a simple, fast and reliable spectrofluorometric method to measure plasma Verteporfin levels. Fluorescence emission spectrum (550-750 nm) of 1:10 saline diluted plasma with lambda exc=430 nm showed a characteristic emission peak at 692 nm, the height being proportional to the Verteporfin levels. The sensitivity is around 100 ng/ml and the pharmacokinetics of Verteporfin has been studied from 0 to 5 hr after infusion in six patients older than 65 years with age-related macular degeneration.

Aged↗

Comparative morphology of epicorneal conjunctival membranes in rabbits and human pterygium.

A rarely described ocular lesion in the rabbit is presented following the observation of four cases. It is a membrane of conjunctival origin that advances progressively, without adhering, towards the center of the cornea. Clinically the lesion in rabbits looks like pterygium in man, but with several differences: in rabbits, the conjunctival fold is absolutely free and does not penetrate into the superficial corneal layers. It originates from all the limbal circumference in a symetric growth. The cornea itself remains unaltered. The fold consists of fibroblasts and collagen. The microscopic findings suggest the lesion is possibly of a collagenous dysplasia.

Animals↗

Caterpillar setae-induced acute anterior uveitis: a case report.

PURPOSE: To report uveitis secondary to ocular penetration of caterpillar hairs (setae). METHODS: Case report. A documented attack of acute anterior uveitis was caused by initially overlooked penetration of caterpillar setae. RESULTS: A 66-year-old man presenting with unilateral hypertensive keratouveitis was treated with antiherpes simplex medication (along with local anti-inflammatory and cycloplegic agents) after anterior chamber paracentesis and serologic testing. Laboratory testing was negative. Resolution occurred after 5 days, and corneal clearing showed a predescemetic caterpillar seta. CONCLUSION: Patient history taken in an anterior uveitis setting should include gardening habits and searching for possible exposure to insects or arachnids.

Acute Disease↗

[Brown syndrome: current status].

PURPOSE: Brown's syndrome is a form of anatomical strabismus, or retraction syndrome. It is defined by active and passive limitation of upward gaze in adduction in the field of action of the inferior oblique muscle. The etiology of Brown's syndrome remains unknown. The defect lies at the level of the superior oblique's tendonis trajectory via the trochlea. We studied the frequency of clinical signs and results after surgery in patients presenting congenital Brown's syndrome. PATIENTS AND METHODS: Our study involved 18 children. They all underwent complete ophthalmological examination with orthoptic testing, pre and postoperatively. RESULTS: Neither sidedness nor predominance of sex was noted. Compensatory head posture was noted in 7 of 18 cases. Limitation of upward gaze in adduction was a constant finding, with a positive duction test. Eleven cases underwent superior oblique recession. Results of surgery were satisfactory, with resolution of compensatory head posture in over 80% of cases. CONCLUSION: The etiology of congenital Brown's syndrome remains unknown. The different surgical techniques give inconstant results. Operative indication is decided only when in the presence of well defined clinical manifestations: CHP, deviation in primary position with alteration of binocular vision.

Child↗