Biomedical subjects

G Chaine

Publications and source records attributed to G Chaine.

At least 19 recordsLinked to original sources

PubMed2006

[Cotton-wool spots as first ocular manifestation of giant cell arteritis].

INTRODUCTION: Giant cell arteritis is the most common vasculitis in the elderly. Visual loss is established as the most dreaded and irreversible complication of the disease, which makes giant cell arteritis an ophthalmic emergency. It is important to recognize its various ocular manifestations; isolated cotton wool spots are one of them. CASE REPORT: We describe a patient with constitutional symptoms and mild visual loss who was found to have giant cell arteritis. The ophthalmic examination was significant for only isolated cotton-wool spots. A delay in arm-to-retina circulation time was demonstrated by fluorescein angiography. Prompt treatment with corticosteroids led to preservation of vision and uneventful resolution of the cotton-wool spots. DISCUSSION: Common ophthalmologic presentations include anterior ischemic optic neuropathy or choroidal ischemia when short posterior ciliary arteries are involved, and central retinal artery occlusion. Retinal ischemia has also been recognized as a possible manifestation. Because the disease concerns medium-size and larger arteries, it cannot involve terminal retinal arterioles to produce cotton-wool spots. These are probably caused by platelet microembolization from the partially thrombosed regional arteries. CONCLUSION: Isolated cotton-wool spots can be an early ophthalmoscopic finding in giant cell arteritis and precede severe irreversible visual loss. Their detection is essential because it allows the ophthalmologist to establish a prompt treatment and preserve vision.

Diagnosis, Differential↗

PubMed2004

[Poor visual outcome in acute multifocal placoid pigment posterior epitheliopathy. A clinical case].

We report a case of a fifty-year-old women suffering from acute multifocal posterior placoid pigment epitheliopathy (AMPPPE), very atypical in terms of clinical appearance and course. From this observation, we provide a progress report on the usual course of AMPPPE as well as atypical features of this affection through reports in the literature; finally we detail disorders ressembling both AMPPPE and serpiginous choroidopathy, the main differential diagnosis.

Eye Diseases↗

PubMed2004

[Should patients with age-related macular degeneration have cataract surgery?].

PURPOSE: To study the progression of visual acuity (VA) and retinal abnormalities in patients with age-related macular degeneration (AMD) after cataract surgery. METHODS: Forty eyes of 25 patients with AMD who had had cataract surgery were included in the study. They were divided up into two groups according to AMD stage: the first group with drusen and retinal pigmented epithelium abnormalities and the second in the severe stages of age-related macular degeneration with atrophy and neovascularization. RESULTS: In the first group (15 eyes), we found an improvement in VA in 93.3% of the eyes. New manifestations of neovascularization appeared in only one eye (6.7%) 1 year after surgery. In the second group (25 eyes), we found atrophy in 80% of the eyes and neovascularization in 20% of the eyes before surgery. There was an improvement in VA after cataract surgery in 68% of the eyes, and in three eyes (17%) VA worsened. CONCLUSION: In our study, patients with AMD improved VA and quality of life after cataract surgery. The same results of VA improvement after surgery can be found in the literature. However, no conclusions can be made concerning the progression of fundus lesions on a short term, though it seems that cataract surgery may accelerate the progression of AMD lesions 5 years after surgery.

Age Factors↗

PubMed2002

[Peripheral retinal neovascularization and sarcoidosis: two case reports].

Peripheral retinal neovascularization occurs in approximately 10% of cases of sarcoidosis. Its pathogenesis is unknown, but it probably results from retinal ischemia and/or inflammation. In cases of peripheral retinal neovascularization associated with sarcoidosis, sickle cell disease should be considered, even if sarcoidosis is histologically proved: new vessels seen in sickle cell disease and sarcoidosis may have a very similar pattern. We present two cases with histologically proven sarcoidosis who developed peripheral neovascularization: the first one had no associated disease and new vessels were likely to be related to sarcoidosis; in the second case, hemoglobin electrophoresis revealed hemoglobin SC, and provided diagnosis of sickle cell hemoglobinopathy.

Adult↗

PubMed2002

[Retinal arteritis in a case of sarcoidosis. A case report].

Retinal vasculitis is a common finding and occurs in 10% - 83% of patients with sarcoidosis. In most cases, there are bilateral, peripheral and nonischemic periphlebitis. In contrast, periarterial involvement is rarely observed. We report a case of retinal vasculitis associated with sarcoidosis and its differential diagnosis. Sarcoidosis should not be excluded in case of periarteritis.

Aged↗

PubMed2001

Aqueous flare induced by heparin-surface-modified poly(methyl methacrylate) and acrylic lenses implanted through the same-size incision in patients with diabetes.

PURPOSE: To compare the degree of blood-aqueous barrier (BAB) breakdown in eyes of diabetic patients after phacoemulsification and implantation of heparin-surface-modified poly(methyl methacrylate) (PMMA) or soft hydrophobic acrylic intraocular lenses (IOLs) performed using the same technique with the same incision size to determine the influence of the IOLs on postoperative inflammation independent of other surgical factors. SETTING: Department of Ophthalmology, University of Paris XIII, Bobigny, France. METHODS: In a prospective study, 44 eyes of 31 diabetic patients with or without mild to moderate diabetic retinopathy were randomly assigned to receive an HSM PMMA IOL (22 eyes) or a soft hydrophobic acrylic IOL (22 eyes) after standardized phacoemulsification surgery. Both types of IOLs had a 6.0 mm optic, were inserted unfolded, and were placed in the bag through a calibrated 6.0 mm superior scleral incision. Anterior chamber flare was measured preoperatively and 1, 7, 30, and 240 days postoperatively using the Kowa 500 laser flare meter. RESULTS: The mean flare value was higher on the first postoperative day in both groups. There were no statistically significant between-group differences in flare scores or clinical parameters preoperatively or at any postoperative visit. CONCLUSIONS: No significant difference was observed in inflammation between eyes having HSM PMMA IOL implantation or those having soft hydrophobic acrylic IOL implantation through the same-size incision. This indicates that hydrophobic acrylic and HSM PMMA materials induce the same degree of BAB breakdown after phacoemulsification in eyes of diabetic patients.

Acrylic Resins↗

PubMed2001

[Central serous chorioretinopathy and systemic steroid therapy].

BACKGROUND: The manifestations of the ocular toxicity of systemic corticosteroids include posterior subcapsular cataracts and glaucoma. We describe 14 cases of serous detachment of the macula due to central serous chorioretinopathy in patients given long-term steroid therapy, which may be another potential ocular side effect of corticosteroid. CASES REPORT: The 14 (9 men and 5 women) patients were aged from 39 to 55 year old. Their systemic diseases were allergic thrombopenic purpura, optic neuritis, kidney or heart transplant, Churg and Strauss vasculitis, facial palsy, rheumatoid arthritis, systemic lupus and a kidney tumor. None of the patients had hypertension. RESULTS: Serous detachment occurred between 6 days and 10 years after the start of steroid treatment. The higher the doses, the earlier the onset of ocular disease. All patients were symptomatic, with rapid onset of blurred vision. Serous detachment was bilateral in two cases. The fluorescein angiographic finding was in most cases a single small focal hyperfluorescent leak from the retinal pigment epithelium which appeared early in the angiogram and increased in size and intensity. No diffuse degradation of the retinal pigment epithelium was seen on the fluorescein angiogram. Five patients underwent laser photocoagulation of the leaking area followed by resorption of subretinal fluid. In other patients, the symptoms disappeared as the doses of steroid were reduced. CONCLUSION: The pathogenesis of central serous chorioretinopathy remains unclear and is controversial. Corticosteroids are known to worsen the prognosis of idiopathic central serous chorioretinopathy, and serous detachment has been reported after renal transplantation. In most of these cases, chorioretinopathy was combined with diffuse leakage from the choriocapillaris. We discuss the relationship between steroid therapy and focal leakage as seen in idiopathic central serous chorioretinopathy. In conclusion, we describe 14 cases of central serous retinopathy whose clinical and fluorescein angiography were fairly typical, without obvious diffuse degradation of the retinal pigment epithelium. All these patients had been given long-term steroid therapy for various diseases.

Adrenal Cortex Hormones↗

PubMed2001

[Ophthalmologic manifestations of sarcoidosis].

Ophthalmologic manifestations of sarcoidosis are polymorphous and can involve all the ocular structures. Benign conjunctive and lacrimal gland involvement predominates. Uveitis is found in 20% of the patients and is often torpid, becoming chronic. Systematic screening for uveitis is warranted in sarcoidosis patients. neuro-ophthalmologic involvement is exceptional and severe, raising major diagnostic difficulties when isolated.

Anti-Inflammatory Agents↗

PubMed2001

[Cataract in uveitis patients: extracapsular and intraocular posterior implantation results. A retrospective study of 14 eyes].

PURPOSE: Checking visual results and progression after cataract surgery in uveitis patients. METHODS: Fourteen eyes of 13 patients were retrospectively studied after cataract extraction from December 1993 to April 1997. We describe the surgical procedure followed by the visual outcome of cataract surgery, complications, and treatment. RESULTS: Specific uveitic syndromes were determined in eight patients. Fuchs' heterochromic iridocyclitis was the cause in three cases, ankylosing spondylitis in one case, sarcoidosis in two cases, toxoplasmosis in one case and Birdshot chorioretinopathy in one case. Phacoemulsification was performed in 10 eyes and a manual extracapsular procedure in four eyes. Posterior chamber implantation was performed in 13 cases. Final visual acuity improved in 64% cases, from 1 to 8 lines (average 3.5). Eight eyes had visual acuity worse than 5/10, attributed to posterior segment abnormalities, in particular macular edema, which is the main limiting factor of optimal visual recovery. Capsular opacification was the most frequent complication in the anterior segment. Endophthalmitis was described in one patient. CONCLUSION: Visual results of cataract surgery depend on different uveitic entities and on posterior segment abnormalities. Results are generally successful when uveitis is not severe and the posterior segment can be carefully observed after cataract surgery. Extracapsular cataract extraction and posterior chamber implantation seem to be well tolerated if inflammation is perfectly under control before surgery.

Adult↗

PubMed2000

[Retinal vascularization in sarcoidosis].

OBJECTIVES: To describe the characteristics of retinal vasculitis related to sarcoidosis, and to study the radio-clinical findings of sarcoidosis in case of retinal vasculitis. METHODS: We performed a retrospective study on 33 cases of retinal vasculitis associated with sarcoidosis. Our patients had a complete ophthalmological examination and a systematic fluorescein angiography was performed. Recorded data included clinical, biological and radiological evaluation of sarcoidosis. RESULTS: Retinal vasculitis were and remained asymptomatic in almost a third of the patients (n = 10). In 11 patients (33%) a decreased visual acuity of more than 3 lines was observed. Periphlebitis was observed in all cases, and 75.7% were of non ischemic forms. Thirty patients out of 33 (90.9%) were treated with systemic steroids in whom 17 were treated for ophthalmological reasons. The presence of anterior or posterior uveitis, more than one attack of vasculitis, and significant hyalitis were statistically associated with visual acuity decrease. Ninety percent of patients regained their initial visual acuity, only three patients at the end of the medical follow-up remained with a visual acuity below or equal to 2/10. Thirty one patients (91%) presented with mediastinal and pulmonary signs concordant with sarcoidosis on chest x-rays. Extrapulmonary localisations were common in case of retinal vasculitis (91% of patients). CONCLUSION: Retinal vasculitis associated with sarcoidosis are often asymptomatic. In most cases, there are bilateral, non ischaemic periphlebitis. They seem to have a relatively better prognosis than in other etiologies of vasculitis and they are part of an evolutive multisystemic sarcoidosis. Most of the time treatment with systemic steroids was indicated for ophthalmological or extra ophthalmological reasons.

Administration, Oral↗

PubMed1999

[Early limbal autograft after alkali burn of the ocular surface].

Limbal autograft transplantation is recommended for treatment of limbal stem cell destruction and its complications. It is appropriate to restore corneal reepithelialization and arrest corneal vascularization and scarring. In unilateral alkali injury, limbal transplantation was first recommended for late management of corneal conjunctivalization. Our patient had severe ocular unilateral alkali injury. Early autologous limbal transplant was effective in restoring an excellent corneal surface and a good visual function.

Adult↗

PubMed1999

[Cystoid macular edema and cytomegalovirus retinitis in AIDS patients treated with antiretroviral triple therapy].

AIM OF THE STUDY: This study evaluated cystoid macular edema (CME) occurring during inactive cytomegalovirus (CMV) retinitis, in AIDS patients treated with highly active antiretroviral therapy (HAART) and without anti CMV treatment for 10 patients. PATIENTS AND METHODS: 12 patients were followed over 24 months. Assessment was carried out on visual acuity, biomicroscopy, fundus photographs every month, angiography for each patient, CD4 cell count and plasmatic viral load. RESULTS: 7 patients presented CME in association with chronic uveitis, large CMV retinitis scars and posterior pole involvement. CONCLUSION: CME is a new complication of CMV retinitis occurring in patients treated with HAART.

AIDS-Related Opportunistic Infections↗

PubMed1998

Case-control study of the risk factors for age related macular degeneration. France-DMLA Study Group.

AIM: A case-control study was initiated to determine the risk factors for the development of age related macular degeneration (AMD). METHODS: Study participants, who were all white, aged 50-85 years, and were recruited from private ophthalmology practices. Each practitioner enrolled patients with bilateral AMD, who were then matched with controls for sex and age. Environmental factors and systemic and ocular histories were screened. All patients had bilateral red-free fundus photographs and fluorescein angiography. Photographs were classified into pigment epithelium alterations, drusen, geographic atrophy, and exudative AMD. Statistical analysis included the identification of risk factors for AMD. A multivariate analysis was performed at the end of the study. Analysis included the entire study population and was carried out for each stage of AMD. RESULTS: 1844 controls were compared with 1844 patients with AMD. Mean age was 71 years for controls and 72 for cases. Logistic regression identified six major risk factors for AMD (whole population): arterial hypertension (odds ratio (OR) = 1.28), coronary disease (OR = 1.31), hyperopia (OR = 1.33), light coloured irises (OR = 1.22), and lens opacities or previous cataract surgery (OR = 1.55). The significance of vascular risk factors was increased for late stages of AMD, especially the atrophic forms (coronary disease, OR = 3.19). CONCLUSIONS: This large case-control study confirms some of the risk factors previously identified and may contribute to the determination of methods for prevention of AMD.

Age Distribution↗

PubMed1998

[Papillary edema and the POEMS syndrome].

POEMS syndrome is a multisystem disorder associated with plasma cell dyscrasia. Papilloedema is a feature of this syndrome with an incidence ranging from 33% to 84% in published reports. Its pathogenesis remains unclear. We present an observation that clearly demonstrates the difficulties to diagnose this affection. POEMS syndrome can be accepted as one of the various etiologies of papilloedema. Considering this observation and the recent publications, different pathological hypothesis are reviewed.

Cyclophosphamide↗

PubMed1998

[Choroidal metastases of a bronchial carcinoid tumor. Review of cases in the literature. A case report].

Carcinoid tumors are rare tumors with low malignancy. They are most often located in the digestive system and the bronchial tree. They metastasize to the lymph nodes, liver, bones and very rarely to the eye. Choroidal metastases almost always originate from the bronchial tree. Inversely, most orbital metastases originate in the digestive tract. Sometimes they have an orange color useful for diagnosis. We report the case of a woman who developed a bronchogenic carcinoid tumor at the age of 18, and presented five years later with bilateral and multifocal choroidal metastases. There was no other metastatic site. She has been treated with photocoagulation and cryotherapy. From the 25 previously reported cases, one can summarize that these specific metastasis grow slowly and allow good long-term survival.

Adult↗

PubMed1998

[Candida chorioretinitis in drug addicts. Apropos of 2 cases].

We report two cases of candidal chorioretinitis occurring to two friends who abused of intravenous crack using the same syringe . An endophthalmitis "a minima" due to a therapeutic delay arose in one patient, when a rare spontaneous healing happened to the second patient. In both cases, an epiretinal membrane is noted after the lesions scarred. Ocular candidal infection is a typical complication occurring to intravenous drug addicts. The visual prognosis depends not only on early diagnosis and treatment, but also on a strict follow-up because late complications are frequent in spite of the healing of initial lesions.

Adult↗

PubMed1998

[Course of cytomegalovirus retinitis in HIV positive patients treated with triple antiretroviral therapy].

PURPOSE: The recent developments of protease inhibitors raise big hopes for the fight against AIDS. Combined in a triple therapy with 2 nucleoside analogs, those molecules strongly inhibit human immunodeficiency virus (HIV) replication. Their biological and clinical efficacy for increasing CD4 cell count and survival time has been proved. We have followed evolution of Cytomegalovirus (CMV) retinitis in 12 patients treated by triple antiretroviral combination therapy since April 1996. PATIENTS AND METHODS: Twelve AIDS patients with CMV retinitis background and a treatment by triple therapy were followed in this prospective study. At the onset of combination therapy, retinitis was cicatricial in 10 patients and active in 2 patients. Mean CD4 cell count was 23 +/- 16 CD4/microL [4-50]. Follow-up included ophthalmoscopic examination every 2 weeks and fundus photographs every month. CD4 cell count was noted at each exam. RESULTS: The mean time follow-up after onset of combination therapy was 10.3 +/- 2.4 months [5-14]. Retinitis relapsed in 6 patients (50%) within the 3 first months, and with a CD4 cells count higher than 75/microL for 3 patients. Inflammation response was noted in 3 patients. There was no recurrence after the third month, except in 1 case at the 9th month. CD4 cell count was 122 +/- 41 CD4/microL [30-350] after 6 months. As retinal lesions were completely still for some patients, maintenance therapy was reduced, then even stopped. At the end of follow-up, maintenance therapy was stopped for 8 patients. For these patients, retinitis remained stable without maintenance therapy for a mean time of 4,5 months (10 months in 1 case). Recurrence occurred for only 1 patient after 9 months of triple therapy and 2 months without maintenance therapy. For the 11 remaining patients, retinitis remained stable for a mean total time of 9.5 +/- 2.5 months [4.5-12.5]. CONCLUSION: Those first results show that clinical and therapeutic history of CMV retinitis may be changing. There seems to be a restoration of immune defenses that allowed suppression of maintenance therapy for 8 out of 12 patients. Our results need to be confirmed by a longer follow-up and multicentric studies.

AIDS-Related Opportunistic Infections↗

PubMed1997

[Extracapsular extraction and posterior chamber implantation in diabetics. Prospective study of 198 eyes].

PURPOSE: Visual results and retinal changes in diabetic patients who underwent cataract surgery. METHODS: In a prospective study we followed up 198 eyes of diabetic patients who underwent cataract surgery for at least six months postoperatively. Pre and postoperative retinal status were assessed by clinical examination and fluorescein angiography. Per and postoperative complications and the evolution of visual acuity were noted. RESULTS: In 83.3% of eyes, visual acuity improved by two or more lines. In 59.6% of patients, visual acuity at six months was more than 6/15. The quality of visual outcome diminished with the severity of retinopathy, but in the most serious cases, lens extraction allowed fundus observation and treatment. Inflammatory complications, posterior capsule opacification and cystoid macular oedema were significantly more frequent in cases of preoperative diabetic retinopathy than in normal fundus. We observed few aggravations of the diabetic retinopathy, but underline the high frequency of cystoid macular edema in diabetic patients. CONCLUSION: Visual results are good in diabetic patients with mild retinopathy and, in severe cases, surgery allows retinal examination and treatment.

Adult↗