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Biomedical subjects

Y Guex-Crosier

Publications and source records attributed to Y Guex-Crosier.

At least 19 recordsLinked to original sources
PubMed2006

Biodegradable scleral implants as new triamcinolone acetonide delivery systems.

The goal of this study was to develop ocular scleral implants able to release triamcinolone acetonide (TA) overall several months. Scleral discs were manufactured by a compression-molding method using a new synthetic polymer, poly(methylidene malonate) (PMM2.1.2), as matrix. Implants with good mechanical properties adapted for in vivo implantation have been obtained when using high M(w) PMM2.1.2 (100,000 - 150,000 Da) associated with ethoxylated derivatives of stearic acid (Simulsol) or oligomers of methylidene malonate as plasticizer. After implantation in rabbit eyes, scleral implants showed a good ocular biocompatibility. Indeed, the clinical follow-up and ocular inflammation parameters, such as inflammatory cell number and protein content in aqueous humor, demonstrated that implants were well tolerated and did not provoke abnormal inflammation. Implants were able to release significant concentrations of TA in the vitreous and the sclera throughout 5 weeks.

Absorbable Implants↗
PubMed2006

Bilateral giant retinal tear and retinal detachment in a young emmetropic man after Jarish-Herxheimer reaction in ocular syphilis.

BACKGROUND: Giant retinal tears were previously described in patients affected by panuveitis. We report the case of a patient presenting giant retinal tears in both eyes affected by ocular syphilis. PATIENT AND METHOD: A 45-year-old patient presented a 5 days history of sudden bilateral drop of vision, two weeks after penicillin therapy for secondary syphilis. The best visual acuity was 0.5 RE and light perception LE. Biomicroscopy showed an intense vitritis associated with bilateral giant tear and retinal detachment. Both TPHA and VDRL were positive. Lumbar puncture showed lymphoplasmocytosis with intrathecal synthesis of IgM. RESULTS: Topical steroids treatment was applied and intravenous penicillin was given during 14 days. Pars plana vitrectomy with silicon oil tamponade was performed in association with endophotocoagulation in the left eye and cryocoagulation in the right eye. Vitreous PCR was negative. Evolution was successful with an attached retina. CONCLUSIONS: This represents the first reported case of giant retinal tear with retinal detachment in a patient presenting a syphilitic panuveitis.

Humans↗
PubMed2006

Autoimmune retinal dysfunction in sarcoid chorioretinopathy.

BACKGROUND: Visual loss, photophobia and night-blindness in a middle-aged patient with a previous history of cancer are highly suggestive of cancer-associated retinopathy. HISTORY AND SIGNS: A 63-year-old man complained of slowly progressive bilateral visual loss, photophobia and night-blindness. His past medical history was remarkable for surgical and medical treatment of a carcinoma of the base of his tongue nine years earlier. Visual acuity was 0.3 RE and 0.15 LE, with constricted visual field in both eyes. Ocular examination and fluorescein angiography were non-relevant. Electroretinography revealed diffuse cone and rod dysfunction. ICG angiography showed multiple small widespread hyperfluorescent spots. A chest CT scan revealed multiple focal lesions which were biopsied. Histological diagnosis was sarcoidosis. THERAPY AND OUTCOME: Upon systemic steroid therapy, visual function gradually improved, and ICG anomalies disappeared. Vision recovered to 1.0 RE and 0.8 LE with normal visual field in both eyes. CONCLUSION: Sarcoidosis may present as an autoimmune retinal dysfunction with photophobia and night blindness as the presenting symptoms.

Autoimmune Diseases↗
PubMed2006

Blood-brain barrier disruption associated with topiramate-induced angle-closure glaucoma of acute onset.

BACKGROUND: Topiramate (Topamax(R)) is an anti-epileptic drug of the sulfamate group used secondarily for bipolar disease. HISTORY AND SIGNS: One week after initiation of topiramate treatment for a bipolar disorder, a 57-year-old man presented with blurred vision. Clinical examination revealed a bilateral conjunctivitis, areflexic mydriasis, severe anterior chamber shallowing, with a myopic shift and vitritis. THERAPY AND OUTCOME: A spinal tap revealed an increased protein content of 1581 mg/L on cerebrospinal fluid (CSF) analysis, being compatible with a rupture of the blood-brain barrier (BBB). UBM exposed bilateral ciliochoroidal effusions with secondary angle-closure. Topiramate was promptly discontinued, whereas visual acuity, intraocular pressure (IOP), and anterior and posterior segments anatomy normalized within 1 week. One month later, bilateral iris atrophy was present. CONCLUSION: The presence of BBB disruption with increased protein content in CSF with simultaneous blood ocular barrier breakdown may suggest a common inflammatory mechanism.

Acute Disease↗
PubMed2005

[New therapies in ophthalmology: inhibitors of cytokines and chemokines: new treatment perspectives].

Anti-TNF-alpha (infliximab and etanercept) are potent, selective inhibitors of the inflammatory cascade. They have been widely used in the therapy of rheumatoid arthritis, Crohn's disease and psoriasis. Their efficacy in ophthalmology has been recently proven. The wide use of cytokines inhibitors could also be very useful in the therapy of neovessels in macular degeneration age-related, since the role of inflammation in the proliferation of neovessels has been recently discovered.

Chemokines↗
PubMed2005

[Anterior segment necrosis in multidrug-resistant Fusarium keratomycosis: a case study].

Keratomycosis is a rare sight-threatening infection of the cornea, with greater morbidity than bacterial keratitis. Predisposing factors in its pathogenesis are corneal trauma, mostly of plant origin, and overuse of topical corticosteroids, associated or not with antibiotics. We report a case of a 71-year-old man who developed Fusarium (lichenicola or solani) keratitis, 15 days after beginning topical therapy with a corticosteroid and antibiotic. Despite aggressive antifungal therapy with fluconazole, he required a penetrating keratoplasty for impending corneal perforation, and finally, even after systemic use of itraconazole and topical use of amphotericin B, the infection progressed and an evisceration was required. In the evisceration material, a multidrug-resistant Fusarium lichenicola or solani, was found, partially sensitive to voriconazole only.

Aged↗
PubMed2004

Retinal vasculitis and cystoid macular edema after body tattooing: a case report.

BACKGROUND: To report a case of retinal vasculitis occurring after the placement of permanent tattoos. HISTORY AND SIGNS: A 21-year-old male was referred to our department with impairment of visual acuity. Permanent tattoos covered the head, body, arms and legs. The patient was examined with ophthalmoscopy, fluorescein angiography, indocyanine green angiography and optical coherence tomography. Systemic medical and laboratory work-up were performed in order to exclude an infectious agent or an inflammatory disease. He had no history of intravenous drug abuse. THERAPY AND OUTCOME: Our patient presented severe posterior uveitis associated with retinal vasculitis and cystoid macular edema. Laboratory tests ruled out all diseases causing vasculitis. HIV and B, C hepatitis tests were negative. Cystoid macular edema and vasculitis were resolved after immunosuppressive therapy. CONCLUSIONS: This is the first description of a retinal vasculitis associated with cystoid macular edema in a completely healthy individual after the placement of permanent tattoos. A phagocytosis of tattoo pigments leading to their lysis is described in the literature as a mechanism causing vasculitis.

Adult↗
PubMed2004

Phacoemulsification with intraocular lens implantation in patients with uveitis.

BACKGROUND: Cataract remains a challenge for ophthalmologists in uveitic eyes. The aim of this study is to report the clinical course of phacoemulsification with intraocular lens implantation in eyes suffering from uveitis. PATIENTS AND METHODS: Patients presenting a uveitis were prospectively followed from June 2001 to June 2003. Ocular surgery was performed according to a standard protocol, autoimmune follow-up visits were focused on the early detection of complications of uveitis: increased ocular inflammation, synechiae, retraction of the rhexis, opacification of the posterior capsule or onset of cystoid macular edema. RESULTS: Thirty-two eyes of 24 patients suffering from uveitis were operated with cataract surgery between June 2001 and June 2003. The mean age at surgery was 56 years (range 24 - 86 years). Mean preoperative visual acuity in uveitis patients presenting cataract was 0.3 +/- 0.3, and final visual acuity was 0.8 +/- 0.3. Three patients presented minor postoperative complications. One patient had a cystoid macular edema that appeared 5 months after surgery and one patient had a relapse of herpetic dendritic keratopathy despite topical antiviral therapy combined with steroid drops. The latter presented a slight increase of intraocular pressure (24 mm Hg). CONCLUSIONS: In patients with uveitis requiring cataract surgery, intraocular lens implantation is safe. Visual prognosis is better when pre- and postoperative inflammation is minimized. Macular scars or other retinal lesions are poor prognostic indicators.

Adult↗
PubMed2004

Photodynamic therapy with verteporfin for subfoveal choroidal neovascularization secondary to toxoplasmic chorioretinal scar.

BACKGROUND: To assess the effect of photodynamic therapy in the treatment of subfoveal choroidal neovascularization consecutive to a toxoplasmic chorioretinal scar. HISTORY AND SIGNS: Three patients with a previous history of toxoplasmic chorioretinal scar noticed a decrease in visual acuity and metamorphopsia. Fundus examination and fluorescein angiography revealed the presence of subfoveal choroidal neovascularization at the edge of the toxoplasmic chorioretinal scar. THERAPY AND OUTCOME: The first patient, aged 78, was treated by photodynamic therapy followed by three subsequent treatments of feeder vessel by laser photocoagulation. Visual acuity decreased during follow-up in the presence of recurrence of choroidal neovascularization and subretinal fibrosis. The second patient, a 20-year-old lady, was treated with three sessions of photodynamic therapy for a subfoveal choroidal neovascularization related to a toxoplasmic scar. Visual acuity was stabilized on the last follow-up visit at 0.3. The third patient, aged 53, received four treatments with photodynamic therapy at an interval of 3 - 4 months. choroidal neovascularization was stabilized and the last visual acuity was 0.2. CONCLUSIONS: This preliminary report suggests that photodynamic therapy with verteporfine may be an effective therapeutic modality for subfoveal choroidal neovascularization related to a toxoplasmic chorioretinal scar. Further assessment is needed in order to confirm this preliminary findings.

Adult↗
PubMed2002

Rifabutin-induced cystoid macular oedema.

Rifabutin is a semi-synthetic antimycobacterial agent mainly used in the treatment of Mycobacterium avium-complex (MAC) in AIDS patients. Rifabutin-induced anterior uveitis has been reported previously. We report the case of a rifabutin-induced cystoid macular oedema (CMO) in an immunocompetent patient with pulmonary MAC infection. As far as we know, CMO secondary to rifabutin therapy has not been described previously.

Anti-Bacterial Agents↗
PubMed2001

[Non-steroidal anti-inflammatory drugs and ocular inflammation].

BACKGROUND: Ocular inflammation is regulated by complicated mechanism that are responsible for the rupture of the blood-ocular barrier and the attraction of leukocytes towards the eye. This cellular trafficking is regulated by the liberation of inflammatory mediators and cytokines. MATERIALS AND METHODS: The main effects of prostaglandins that are described in the literature were reviewed. RESULTS: Despite the fact that the inhibitory action of aspirin and NSAIDs on prostaglandins secretion is known since 1971, it is quite recently that two isoenzymes of cyclooxygenase were discovered. The Cyclooxygenase-1 (COX-1) is constitutive and is responsible for the production of PGE2. This prostaglandin is related to the housekeeping functions such as gastric protection, platelet aggregation and maintenance of renal function. The expression of the cyclooxygenase 2 (COX-2) is induced by inflammation. The presence of COX-2 could be demonstrated in many ocular tissues (corneal epithelium and endothelium, pigmentary epithelium etc. ...). The use of NSAIDs in clinical practice allows a good control of ocular inflammation, of pain, of the maintenance of a good mydriasis during surgery and are impending the onset of postoperative cystoid macular edema. CONCLUSION: Prostaglandins are potent anti-inflammatory agents but their use is limited in the presence of severe dry eye syndrome or allergy towards NSAIDs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2001

Bacterial keratitis: a prospective clinical and microbiological study.

AIM: To define the clinical and microbiological profile of bacterial keratitis at the Jules Gonin Eye Hospital and to test the in vitro bacterial resistance. METHODS: Patients presenting with bacterial keratitis were prospectively followed; clinical features (age, risk factors, visual acuity) and response to therapy were analysed. Bacteriological profile was determined and the sensitivity/resistance of isolated strains were tested towards 12 ocular antibiotics (NCCLS disc diffusion test). RESULTS: 85 consecutive patients (mean age 44.3 (SD 20.7) years) were prospectively enrolled from 1 March 1997 to 30 November 1998. The following risk factors were identified: contact lens wear, 36%; blepharitis, 21%; trauma, 20%; xerophthalmia, 15%; keratopathies, 8%; and eyelid abnormalities, 6%. The most commonly isolated bacteria were Staphylococcus epidermidis, 40%; Staphylococcus aureus, 22%; Streptococcus pneumoniae, 8%; others Streptococcus species, 5%; Pseudomonas, 9%; Moraxella and Serratia marcescens, 5% each; Bacillus, Corynebacterium, Alcaligenes xyloxidans, Morganella morganii, and Haemophilus influenza, 1% each. 1-15% of strains were resistant to fluoroquinolones, 13-22% to aminoglycosides, 37% to cefazolin, 18% to chloramphenicol, 54% to polymyxin B, 51% to fusidic acid, and 45% to bacitracin. Five of the 85 patients (5.8%) had a poor clinical outcome with a visual loss of one or more lines of visual acuity. CONCLUSION: Fluoroquinolones appear to be the therapy of choice for bacterial keratitis, but, based upon these in vitro studies, some strains may be resistant.

Acute Disease↗
PubMed2000

[Study of panophthalmitis after cataract surgery from 1997 to 1999].

PURPOSE: To define the clinical outcome and microbiological pattern of bacterial endophthalmitis that were referred at the Jules Gonin Eye Hospital from January 1997 to September 1999. METHODS: Patients were recorded in a computerised databank and were managed according to a standard protocol. An anterior chamber tap combined with a vitreous biopsy by the pars plana was performed in all patients. The treatment included an intravitreal injection of 1 mg Vancomycin and 400 micrograms Amikacin diluted in 0.2 ml NaCl 0.9%. Postoperatively hourly therapy Cefazolin 50 mg/ml and Garamycin 9 mg/ml was applied. To determine possible risks factors a standard form was sent to all referring surgeons. The following data were analysed: delay of onset, risk factors, initial and final visual acuity. RESULTS: From January 1997 to September 1999, 31 patients were referred. 18/31 (58%) of the cases were admitted between April and June of each years. The mean age was of 75 +/- 10 years. Initial visual acuity ranged from light perception to 20/40. 17/31 of the patient's cultures were positive. The major pathogen were Staphylococcus epidermidis in 9/31 patients and Staphylococcus aureus in 4/31 patients. No correlation between the endophthalmitis and the surgical technique or perioperative management of the patient, could be determined. Visual outcome was significantly improved in 56.7% of the patients. CONCLUSIONS: The severity of outcome could be correlated to the type of bacteria isolated. The high prevalence of panophthalmitis from March to June suggests that a climatic factors may be involved in its pathogenesis.

Aged↗
PubMed1999

[Epidemiology of uveitis].

Uveitis are a large group of inflammatory diseases involving the iris, the ciliary body and the uvea. Multiple causes can be responsible for ocular inflammation that can result either from infectious or autoimmune disease. The incidence varies from 14 to 28/100,000 habitants. According to the anatomical classification, about 30-60% (average 47%) are related to anterior uveitis. 6-30% average 21%) are posterior uveitis, 7-15% (average 12%) are intermediate uveitis and 7-69% (average 20%) are panuveitis. A specific diagnostic can be established in more than 70% in most series. The most frequently diagnosed entities are HLA-B27 related uveitis, acute anterior uveitis in herpes zoster disease, toxoplasmosis, sarcoidosis and pars planitis.

Adolescent↗
PubMed1999

Posterior sub-Tenon's steroid injections for the treatment of posterior ocular inflammation: indications, efficacy and side effects.

PURPOSE: Posterior sub-Tenon's steroid injections (PSTSI) are a standard drug delivery method used for the treatment of chronic uveitis of the posterior segment. The aim of this study was to analyse the indications, efficacy and complications of PSTSI in the treatment of chronic uveitis. METHODS: During the period 1990-1994, 53 (9.5%) of 558 patients (58 eyes) followed up in the uveitis clinic received a total of 162 PSTSI of triamcinolone acetonide 40 mg in the superior quadrants. Indications for treatment were vision inferior or equal to 0.7 and/or intolerable visual disturbance. Only patients in whom PSTSI were the only treatment parameter changed were analysed. Among the main parameters analysed were visual acuity, aqueous laser flare photometry, intraocular pressure (IOP) and complications. RESULTS: Anatomical location of uveitis was as follows: anterior HLA-B27-related uveitis with CME (1 patient/1 eye), intermediate uveitis (28/32), posterior uveitis (10/10) and panuveitis (14/15). Mean duration of follow-up was 448+/-57 days. Visual acuity improved significantly from 0.40+/-0.03 to 0.79+/-0.07, with 59.4% of eyes having a gain of 2-5 Snellen lines and 18.7% a gain of >5 lines. Mean aqueous flare photometry decreased significantly from 29.6+/-3.5 to 13.6+/-2.2 photons/ms. Mean IOP increased significantly from 13.6+/-0.5 to 18.5+/-0.8 mm Hg with a rise of pressure >8 mm Hg in 23 cases (36%), transient in 16 cases, but chronic in 6 cases, needing filtering surgery. Partial superior ptosis was seen in two cases and cataract progressed in seven cases. CONCLUSION: PSTSI are very effective in restoring visual acuity in chronic uveitis of the posterior segment, without systemic complications, but at the expense of intraocular hypertension, a complication that was found more frequently than expected.

Adolescent↗
PubMed1999

The pathogenesis and clinical presentation of macular edema in inflammatory diseases.

Cystoid macular edema (CME) is a classical complication of ocular inflammation. This syndrome was already described by Irvine in 1953 but the pathogenesis of this condition remains unclear. Cystoid macular edema can result either from a rupture of the inner or from the outer blood ocular barrier. Clinical CME that is responsible for a low visual acuity must be differentiated from angiographic CME that can be present even without any decrease in visual acuity. Fluid progressively accumulates into the outer plexiform layer of the retina and pools into cystic spaces. Fluid accumulation can now be better seen with optical coherence tomography (OCT). In chronic CME fluid accumulation is associated with thinning of the retina and fibrosis. At this stage irreversible lesions are present and CME does not respond to medical therapies. Inflammatory CME must be differentiated from CME resulting from irreversible vascular damage such as in diabetic CME or due to vein occlusions. Experimental research on cystoid macular edema has been hampered by the lack of animal model: most of laboratory animals have no macula, monkeys appear to be highly resistant to macular edema. Five major causes have been suspected to be at the origin of CME: (1) photic retinopathy, (2) trauma of ocular tissue, (3) secondary irritation of the ciliary body, (4) vitreous traction and (5) pharmaceutically induced CME. Clinical experience has shown that pseudophakic CME usually responds well to local therapy of steroids and non-steroidal antiinflammatory drugs (NSAIDs) and/or in association with systemic acetazolamide. Acetazolamide is increasing fluid resorption through the retinal pigment epithelium. Postoperative CME rarely needs additional posterior subtenon's injections to resolve. But in CME occurring secondary to uveitis additional posterior sub-Tenon's steroid injections or systemic steroids may be necessary to decrease the constant release of inflammatory mediators.

Animals↗