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To evaluate whether careful exercise training improves pulmonary perfusion and blood flow in patients with pulmonary hypertension (PH), as assessed by magnetic resonance imaging (MR).Twenty patients with pulmonary arterial hypertension or inoperable chronic thromboembolic PH on stable medication were randomly assigned to control (n = 10) or training groups (n = 10). Training group patients received in-hospital exercise training; patients of the sedentary control group received conventional rehabilitation. Medication remained unchanged during the study period. Changes of 6-min walking distance (6MWD), MR pulmonary flow (peak velocity) and MR perfusion (pulmonary blood volume) were assessed from baseline to week 3.After 3 weeks of training, increases in mean 6MWD (P = 0.004) and mean MR flow peak velocity (P = 0.012) were significantly greater in the training group. Training group patients had significantly improved 6MWD (P = 0.008), MR flow (peak velocity -9.7 ± 8.6 cm/s, P = 0.007) and MR perfusion (pulmonary blood volume +2.2 ± 2.7 mL/100 mL, P = 0.017), whereas the control group showed no significant changes.The study indicates that respiratory and physical exercise may improve pulmonary perfusion in patients with PH. Measurement of MR parameters of pulmonary perfusion might be an interesting new method to assess therapy effects in PH. The results of this initial study should be confirmed in a larger study group.

We proposed to assess the feasibility of low mechanical index (MI) contrast enhanced ultrasound (CEUS) in the characterisation of thoracic lesions. Fifty patients were prospectively examined by CEUS and images acquired on a low MI (0.17-0.24) setting following injection of SonoVue. From region-of-interest (ROI) generated signal intensity (SI) time curves, the maximum SI, bolus arrival time (BAT), time to peak intensity (TTP), wash-in slope and mean transit time (MTT) were calculated. Using the Wilcoxon rank test; parameters and threshold values for positive differentiation were determined. In addition, for the parameters that allowed positive differentiation between malignant and benign lesions receiver operator curves (ROC) were obtained. The wash-in slope, TTP and MTT (p = 0.0003,0.0001, 0.02) allowed positive differentiation. The sensitivity and specificity was 93% and 78%, with 6.87 s(-1) threshold value for the wash-in slope, 78% and 89% with 11.84 s threshold for the TTP and 48% and 89% with 78.6 s threshold for the MTT. CEUS is a useful tool for differentiating malignant and benign thoracic lesions.

PURPOSE Magnetic resonance imaging (MRI) allows for quantitative evaluation of pulmonary perfusion and has shown high clinical usefulness for the evaluation and differentiation of different lung pathologies. The reproducibility of quantitative analysis of whole-lung perfusion has not been investigated previously. Our aim was to assess the intraobserver and interobserver repeatability and reproducibility of perfusion MRI to prove the concept that perfusion is suitable for therapy monitoring. MATERIALS AND METHODS The study was approved by the International Review Board. Fourteen healthy volunteers were examined using a time-resolved FLASH 3-dimensional perfusion sequence (1.5-T MRI, TREAT, GRAPPA 2, coronal orientation, voxel size 3.9×3.9×6.3 mm(3)). Perfusion was assessed initially and after 24 hours during an inspiratory and an expiratory breath hold. For each examination, 0.05 mmol/kg BW of Gd-DTPA was injected. Perfusion parameters such as pulmonary blood flow (PBF), pulmonary blood volume, and mean transit time were calculated. The evaluation was performed independently by 2 blinded observers. Intraobserver and interobserver differences were determined. RESULTS The intraobserver differences between the initial and follow-up examinations for pulmonary blood volume, mean transit time, and time to peak were not significantly different for observers 1 and 2. PBF showed a significant difference for both observers only on inspiration (P

The purpose of the study was to evaluate the feasibility of suppressing the pulmonary vasculature in lung perfusion MRI using cross-correlation analysis (CCA). Perfusion magnetic resonance imaging (MRI) (3D FLASH, TR/TE/flip angle: 0.8 ms/2.1 ms/40 degrees ) of the lungs was performed in seven healthy volunteers at 1.5 Tesla after injection of Gd-DTPA. CCA was performed pixel-wise in lung segmentations using the signal time-course of the main pulmonary artery and left atrium as references. Pixels with high correlation coefficients were considered as arterial or venous and excluded from further analysis. Quantitative perfusion parameters [pulmonary blood flow (PBF) and volume (PBV)] were calculated for manual lung segmentations separately, with the entire left and right lung with all intrapulmonary vessels (IPV) included, excluded manually or excluded using CCA. The application of CCA allowed reliable suppression of hilar and large IPVs. Using vascular suppression by CCA, perfusion parameters were significantly reduced (p/= 0.001). The reduction was 8% for PBF and 13% for PBV compared with manual exclusion and 15% for PBF and 25% for PBV when all vessel structures were included. The application of CCA improves the visualisation and quantification of lung perfusion in MRI. Overestimation of perfusion parameters caused by pulmonary vessels is significantly reduced.

Pathological changes of the peripheral pulmonary arteries induce pulmonary arterial hypertension (PAH). Aim of this study was to quantitatively assess the effect of PAH on pulmonary perfusion by 3D-MR-perfusion techniques and to compare findings to healthy controls. Furthermore, quantitative perfusion data were correlated with invasive pressure measurements.Five volunteers and 20 PAH patients (WHO class II or III) were examined using a 1.5T MR scanner. Measurement of pulmonary perfusion was done in an inspiratory breathhold (FLASH3D; 3.5 mm x 1.9 mm x 4mm; TA per 3D dataset 1.5s). Injection of contrast media (0.1 mmol Gd-DTPA/kg BW) and image acquisition were started simultaneously. Evaluation of 3D perfusion was done using singular value decomposition. Lung borders were outlined manually. Each lung volume was divided into three regions (anterior, middle, posterior), and the following parameters were assessed: Time-to-Peak (TTP), blood flow (PBF), blood volume (PBV), and mean transit time (MTT). In 10 patients invasive pulmonary artery pressure measurements were available and correlated to the perfusion measurements.In both, controls and patients, an anterior-to-posterior gradient with higher PBF and PBV posterior was observed. In the posterior lung region, a significant difference (p0.05) was found for TTP (12s versus 16s) and MTT (4s versus 6s) between volunteers and patients. PBF and PBV were lower in patients than in volunteers (i.e. dorsal regions: 124 versus 180 ml/100 ml/min and 10 versus 12 ml/100 ml), but the difference failed to be significant. The ratio of PBF and PBV between the posterior and the middle or ventral regions showed no difference between both groups. A moderate linear correlation between mean pulmonary arterial pressure (mPAP) and PBV (r=0.51) and MTT (r=0.56) was found.The only measurable effect of PAH on pulmonary perfusion is a prolonging of the MTT. There is only a moderate linear correlation of invasive mPAP with PBV and MTT.

Objectives: We sought to assess the agreement between lung perfusion ratios calculated from pulmonary perfusion magnetic resonance imaging (MRI) and those calculated from radionuclide (RN) perfusion scintigraphy. Materials and Methods: A retrospective analysis of MR and RN perfusion scans was conducted in 23 patients (mean age, 60 ± 14 years) with different lung diseases (lung cancer = 15, chronic obstructive pulmonary disease = 4, cystic fibrosis = 2, and mesothelioma = 2). Pulmonary perfusion was assessed by a time-resolved contrast-enhanced 3D gradient-echo pulse sequence using parallel imaging and view sharing (TR = 1.9 milliseconds; TE = 0.8 milliseconds; parallel imaging acceleration factor = 2; partition thickness = 4 mm; matrix = 256 X 96; in-plane spatial resolution = 1.87 X 3.75 mm; scan time for each 3D dataset = 1.5 seconds), using gadolinium-based contrast agents (injection flow rate = 5 mL/s, dose = 0.1 mmol/kg of body weight). The peak concentration (PC) of the contrast agent bolus, the pulmonary blood flow (PBF), and blood volume (PBV) were computed from the signal-time curves of the lung. Left-to-right ratios of pulmonary perfusion were calculated from the MR parameters and RN counts. The agreement between these ratios was assessed for side prevalence (sign test) and quantitatively (Deming-regression). Results: MR and RN ratios agreed on side prevalence in 21 patients (91%) with PC, in 20 (87%) with PBF, and in 17 (74%) with PBV. The MR estimations of left-to-right perfusion ratios correlated significantly with those of RN perfusion scans (P < 0.01). The correlation was higher using PC (r = 0.67) and PBF (r = 0.66) than using PBV (r = 0.50). The MR ratios computed from PBF showed the highest accuracy, followed by those from PC and PBV. Independently from the MR parameter used, in some patients the quantitative difference between the MR and RN ratios was not negligible. Conclusions: Pulmonary perfusion MRI can be used to assess the differential blood flow of the lung. Further studies in a larger group of patients are required to fully confirm the clinical suitability of this imaging method.

Purpose To assess the use of time-resolved parallel 3D MRI for a quantitative analysis of pulmonary perfusion in patients with cardiopulmonary disease. Materials and methods Eight patients with pulmonary embolism or pulmonary hypertension were examined with a time-resolved 3D gradient echo pulse sequence with parallel imaging techniques (FLASH 3D, TE/TR: 0.8/1.9 ms; flip angle: 40 degrees; GRAPPA). A quantitative perfusion analysis based on indicator dilution theory was performed using a dedicated software. Results Patients with pulmonary embolism or chronic thromboembolic pulmonary hypertension revealed characteristic wedge-shaped perfusion defects at perfusion MRI. They were characterized by a decreased pulmonary blood flow (PBF) and pulmonary blood volume (PBV) and increased mean transit time (MTT). Patients with primary pulmonary hypertension or Eisenmenger syndrome showed a more homogeneous perfusion pattern. The mean MTT of all patients was 3.3 - 4.7 s. The mean PBF and PBV showed a broader interindividual variation (PBF: 104 - 322 ml/100 ml/min; PBV: 8 - 21 ml/100 ml). Conclusion Time-resolved parallel 3D MRI allows at least a semi-quantitative assessment of lung perfusion. Future studies will have to assess the clinical value of this quantitative information for the diagnosis and management of cardiopulmonary disease.

Tissue microcirculation can be quantified by a deconvolution analysis of concentration-time curves measured by dynamic contrast-enhanced magnetic resonance imaging. However, deconvolution is an ill-posed problem, which requires regularization of the solutions. In this work, four algebraic deconvolution/regularization methods were evaluated: truncated singular value decomposition and generalized Tikhonov regularization (GTR) in combination with the L-curve criterion, a modified LCC (GTR-MLCC), and a response function model that takes a-priori knowledge into account. To this end, dynamic contrast-enhanced magnetic resonance imaging data sets were simulated by an established physiologically reference model for different signal-to-noise ratios and measured on a 1.5-T system in the lung of 10 healthy volunteers and 20 patients. Analysis of both the simulated and measured dynamic contrast-enhanced magnetic resonance imaging datasets revealed that GTR in combination with the L-curve criterion does not yield reliable and clinically useful results. The three other deconvolution/regularization algorithms resulted in almost identical microcirculatory parameter estimates for signal-to-noise ratios10. At low signal-to-noise ratios levels (10) typically occurring in pathological lung regions, GTR in combination with a modified L-curve criterion approximates the true response function much more accurately than truncated singular value decomposition and GTR in combination with response function model with a difference in accuracy of up to 76%. In conclusion, GTR in combination with a modified L-curve criterion is recommended for the deconvolution of dynamic contrast-enhanced magnetic resonance imaging curves measured in the lung parenchyma of patients with highly heterogeneous signal-to-noise ratios.

Purpose Assessment of lung cancer perfusion is impaired by respiratory motion. Imaging times for contrast agent wash-out studies often exceed breath hold capabilities, and respiration triggering reduces temporal resolution. Temporally resolved volume acquisition of entire tumors is required to assess heterogeneity. Therefore, we developed and evaluated an MR measurement technique that exceeds a single breath hold, and provides a variable temporal resolution during acquisition while suspending breath-dependent motion. Materials and methods 20 patients with suspected lung cancer were subjected to perfusion studies using a spoiled 3D gradient echo sequence after bolus injection of 0.07 mmol/kg body weight of Gd-DTPA. 10 acquisitions in expiratory breath hold were followed by 50 navigator-triggered acquisitions under free breathing. Post-processing allowed for co-registration of the 3D data sets. An ROI-based visualization of the signal-time curves was performed. Results In all cases motion-suspended, time-resolved volume data sets (40 x 33 x 10 cm(3), voxel size: 2.1 x 2.1 x 5.0 mm(3)) were generated with a variable, initially high temporal resolution (2.25 sec) that was synchronized with the breath pattern and covered up to 8 1/2 min. In 7 / 20 cases a remaining offset could be reduced by rigid co-registration. The tumors showed fast wash-in, followed by rapid signal decay (8 / 20) or a plateau. Conclusion The feasibility of a perfusion study with hybrid breath hold and navigator-triggered time-resolved 3D MRI which combines high initial temporal resolution during breath hold with a long wash-out period under free breathing was demonstrated.

Introduction The investigation of pulmonary perfusion by three-dimensional (3D) dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was proposed recently. Subtraction images are generated for clinical evaluation, but temporal information is lost and perfusion defects might therefore be masked in this process. The aim of this study is to demonstrate a simple analysis strategy and classification for 3D-DCE-MRI perfusion datasets in the lung without omitting the temporal information. Materials and methods Pulmonary perfusion measurements were performed in patients with different lung diseases using a 1.5 T MR-scanner with a time-resolved 3D-GRE pulse sequence. 25 3D-volumes were acquired after iv-injection of 0.1 mmol/kg KG Gadolinium-DTPA. Three parameters were determined for each pixel: (1) peak enhancement S n ,max normalized to the arterial input function to detect regions of reduced perfusion; (2) time between arterial peak enhancement in the large pulmonary artery and tissue peak enhancement τ to visualize regions with delayed bolus onset; and (3) ratio R = S n ,max / τ was calculated to visualize impaired perfusion, irrespectively of whether related to reduced or delayed perfusion. Results A manual selection of peak perfusion images is not required. Five different types of perfusion can be found: (1) normal perfusion; (2) delayed non-reduced perfusion; (3) reduced non-delayed perfusion; (4) reduced and delayed perfusion; and (5) no perfusion. Types II and IV could not be seen in subtraction images since the temporal information is necessary for this purpose. Conclusions The analysis strategy in this study allows for a simple and observer-independent visualization and classification of impaired perfusion in dynamic contrast-enhanced pulmonary perfusion MRI by using the temporal information of the datasets.

Purpose To evaluate an optimized method for oxygen-enhanced MRI of the lung, using simultaneous electrocardiograph (ECG) and navigator triggering. To correlate oxygen-enhanced MRI with lung function tests assessing alveolar-capillary gas exchange. Materials and Methods A total of 12 healthy volunteers (aged 20–32 years) and 10 patients (aged 37–87 years) with interstitial lung diseases (ILD) underwent oxygen-enhanced MRI and pulmonary functional tests (PFTs) assessing alveolar-capillary gas exchange. The paradigm room-air–oxygen–room-air was acquired with a nonselective inversion-recovery half-Fourier single-shot turbo spin-echo sequence (inversion time = 1200 msec; acquisition time = 134.5 msec; slice thickness = 20 mm; matrix size = 128 × 128), using simultaneous double triggering (navigator plus ECG trigger). Cross-correlation was performed in regions of interest (ROIs) encompassing both lungs. The number of oxygen-activated pixels over the total number of pixels in the ROIs (OAP%) of volunteers and patients was compared. OAP%s were correlated with PFTs. Results The mean OAP% of patients was significantly lower than that of volunteers (36.7 vs. 81.7, P = 0.001). OAP% correlated with the transfer lung factor for carbon monoxide (Tlco) (r = 0.64; P = 0.002), the transfer coefficient (Kco) (r = 0.75; P = 0.001), the arterial partial pressure (r = 0.77; P < 0.001), and the saturation (r = 0.70; P < 0.001) of oxygen. Conclusion Navigator-triggered oxygen-enhanced MRI of the lung may have a potential role in the quantitative assessment of lung function in ILD. J. Magn. Reson. Imaging 2007. © 2007 Wiley-Liss, Inc.

Oxygen-enhanced magnetic resonance (MR)-ventilation imaging of the lung is based on the inhalation of a high concentration of oxygen (hyperoxia). However, the effect of hyperoxia on the pulmonary circulation is not yet fully understood. In this study the impact of hyperoxia on the pulmonary circulation was evaluated.Ten healthy volunteers were examined in a 1.5 T MRI system with contrast-enhanced perfusion MRI (saturation recovery 2D turboFLASH) of the lung and phase-contrast flow measurements in the pulmonary trunk. Both measurements were performed breathing room air (RA) and, subsequently, 100% oxygen (15 L/min) (O(2)).The perfusion measurements showed a significant difference between RA and O(2) for the pulmonary blood flow (181 vs. 257 mL/min/100 mL, P = 0.04) and blood volume (14 vs. 21 mL/100 mL, P = 0.008). The mean transit time of the contrast bolus was not changed (P = 0.4) in the dorsal part of the lung, whereas it was significantly prolonged (P = 0.006) in the central part. The mean heart rate during flow measurements breathing RA (67 +/- 11 beats/min) and O(2) (61 +/- 12 beats/min) were not significantly different (P = 0.055). The average cardiac output (pulmonary trunk) was not significantly lower while breathing O(2) (RA: 5.9 vs. O(2): 5.5 L/min, P = 0.054).Hyperoxia causes a significant increase and redistribution of the pulmonary perfusion, whereas it leads to a not significant decrease in cardiac output. Thus, for MR-perfusion and MR-flow measurements oxygen inhalation should be avoided, if possible. In the context of oxygen-enhanced MR-ventilation imaging of the lung the contribution of this effect needs to be further evaluated.

Purpose To compare the signal characteristics and bolus dynamics of 1.0 M gadobutrol and 0.5 M Gd-DTPA for time-resolved, three-dimensional, contrast-enhanced (CE) MRA of the upper torso. Materials and Methods Ten healthy volunteers were examined with time-resolved three-dimensional CE-MRA (scan time per three-dimensional data set: 0.86 second; voxel size: 3.6 × 2 × 6.3 mm3). Each volunteer underwent eight individual examinations after intravenous injection of 0.05 and 0.1 mmol/kg body weight (b.w.) of 1.0 M gadobutrol and 0.5 M Gd-DTPA using two injection rates (2.5 and 5 mL/second). The data analysis included quantitative measurements of the peak signal-to-noise ratio (SNR) and bolus dispersion (full width at half maximum (FWHM)) in the pulmonary artery, left atrium, and thoracic and abdominal aortas. Results No significant differences in the peak SNR and bolus dispersion were observed between gadobutrol and Gd-DTPA for all dose levels and injection rates in any of the vascular segments. For both contrast agents a dose of 0.1 mmol/kg b.w. injected with 5 mL/second achieved the highest SNR in all vascular segments. Conclusion For the imaging parameters used in this study, higher-concentrated gadolinium chelates offer no relevant advantages for time-resolved three-dimensional CE-MRA of the upper torso. J. Magn. Reson. Imaging 2005;22:286–290. © 2005 Wiley-Liss, Inc.

The effect of breathholding on pulmonary perfusion remains largely unknown. The aim of this study was to assess the effect of inspiratory and expiratory breathhold on pulmonary perfusion using quantitative pulmonary perfusion magnetic resonance imaging (MRI).Nine healthy volunteers (median age, 28 years; range, 20-45 years) were examined with contrast-enhanced time-resolved 3-dimensional pulmonary perfusion MRI (FLASH 3D, TR/TE: 1.9/0.8 ms; flip angle: 40 degrees; GRAPPA) during end-inspiratory and expiratory breathholds. The perfusion parameters pulmonary blood flow (PBF), pulmonary blood volume (PBV), and mean transit time (MTT) were calculated using the indicator dilution theory. As a reference method, end-inspiratory and expiratory phase-contrast (PC) MRI of the pulmonary arterial blood flow (PABF) was performed.There was a statistically significant increase of the PBF (delta = 182 mL/100 mL/min), PBV (delta = 12 mL/100 mL), and PABF (delta = 0.5 L/min) between inspiratory and expiratory breathhold measurements (P0.0001). Also, the MTT was significantly shorter (delta = -0.5 sec) at expiratory breathhold (P = 0.03). Inspiratory PBF and PBV showed a moderate correlation (r = 0.72 and 0.61, Por = 0.008) with inspiratory PABF.Pulmonary perfusion during breathhold depends on the inspiratory level. Higher perfusion is observed at expiratory breathhold.

Evaluation of lung perfusion by contrast-enhanced 3D MRI using partial parallel imaging techniques.Eight healthy volunteers were examined using a contrast-enhanced dynamic FLASH 3D sequence with partial parallel imaging technique at 1.5 T MRI with a TA of 1.5 sec. The whole lung was covered by 36 coronal slices. A ventral, middle and dorsal slice of each lung was manually segmented and signal-to-time curves were computed. For absolute quantification of blood flow through the right and left pulmonary artery, phase-contrast flow measurements were performed.No significant difference was found between the signal intensity in the right (8.9 +/- 2.6) and left (8.0 +/- 3.5) lung, corresponding to a left-to-right signal intensity ratio of 0.9. A significantly higher signal intensity was found in the dorsal regions of the lungs (p = 0.01) compared to the ventral regions. The time to peak of the signal intensity was significantly shorter in the dorsal (15.3 sec) and middle (15.7 sec) regions of the lungs (p = 0.03 and p = 0.04, respectively) than in the ventral regions (16.3 sec). The ratio between blood flow through the left (2.2 L/min) and right (2.7 L/min) lung was 0.84.Partial parallel image acquisition can assess the perfusion of the lungs at high temporal resolution. The perfusion is slightly higher on the right than on the left. The signal increases faster and has a higher peak in the dorsal lung regions.

The purpose of this retrospectively study is to compare the results obtained using the unquestionable criteria, recommended by American Academy of Ophthalmology versus the minimum criteria proposed by HODAPP. The first are founded on the degree of the depth of the deficits in dB, the second take into account the statistically significant loss. One hundred glaucomatous visual fields screened with the Humphrey perimeter, with program 24-2, are retained for their correct indices of reliability, a MD better than -12 dB, and experience of the automated perimetry. This population was divided into two groups of 50:index MD greater than -6 dB. And index MD between -6 and -12 dB. The deficits were analyzed on the graph of individual deviation. Arcuate scotoma and nasal step were the majority of defects: 86 to 90% at the stage of mild deficit; 98% at the stage of moderate deficit. The deficits prevailed in the superior hemifield in 60% of cases. Nasal projection accounted for less than half of the deficits when MD was-6 dB its frequency fell to less than 10% when MD worsened. Conversely the frequency of arcuate scotoma increased. The isolated deficits decreased with the MD aggravation, but even when the deficit was mild, they accounted for already less than half of the cases. Most of the associated deficits were located in the hemifield opposite to the principal defect. Defects were larger and more frequently multiple with the AAO classification than with the HODAPP. The minimum criteria of the classification of glaucomatous visual field defects proposed by HODAPP appear more specific than the unquestionable criteria of the AAO, and also appear easier to use.

We report two cases of toxocariasis peripheral granuloma in adults.Diagnostic difficulties linked to parasite serologies, particular to these two cases, are presented. Serology is often poorly contributive, but PCA and/or vitreous study with the ELISA reaction to Toxocara canis homologous antigens in the endocular fluids are the most reliable means of reaching a diagnosis, as evidence in our two observations. In the same way, the presence of eosinophils and of IgE in the aqueous humor and or vitreous is of great importance for orienting the diagnosis.The treatment consisted in systemic steroids and granuloma cryotherapy associated with vitrectomy and for one case indentation due to a traction. Later, retinal membrane peel was performed for the same patient. No treatment with antihelminthic drugs was proposed. The functional and anatomic results were good in both cases (8/10-P2 and 6/10-P2).Toxocara canis infection is based on clinical aspects. The ELISA technique is useful for biological diagnosis.

Vision prognostic study depending on the germs and the therapic performed in bacterial endophthalmitis.In a retrospective study over a period of 3 years (1991-1993), 32 cases of post surgery bacterian endophthalmitis were detected: 30 cases after cataract surgery (29 cases after extra capsular surgery and one case after intra capsular), one case after trabeculectomy and one case after keratoplasty.A risk factor was evidenced in 15.6% of the cases. Endocular samples were done in 68.75% of the cases. The positive rate was 36.4% showing a Staphylococcus in 5 cases out of 8 (62,5%). In 37.5% of the cases an intraocular antibiotic injection was associated to the anterior chamber punction. 40% of the cases contaminated with Staphylococcus regained a visual acuity of more than 3/10. For the two cases where a Streptococcus was isolated an evisceration was necessary. Our results show that a higher visual acuity was obtained when a posterior vitrectomy was performed. When the posterior vitrectomy was associated with a corticoid therapy, the visual prognostic was better. Thus, 71% of these cases regained a visual acuity of more than 3/10.Our results show that performing a posterior vitrectomy associated to a general corticotherapy within 48 hours from the bacterian endophthalmitis diagnosis would allow best vision improvement.

The progression of field loss was determined by Humphrey Automated threshold perimetry in the short and intermediate term after surgical trabeculectomy for chronic glaucoma: mean indices (MD, PSD et FOV) were studied before and after normalisation of the intraocular pressure. Risk factors such as secondary glaucoma, previous visual field defects and cardiovascular risk factors were significantly correlated to poor or bad progression of field loss: the mean variation of MD = +1.23 dB +/- 2.84 (p1.5%), the mean variation of PSD = 0.50 dB +/- 1.37 (p6%), but the mean variation of FOV was not significant; so 36% of field defects were improved, 42% were stabilized and 22% were aggravated. When the risk factors were absent, 86% of field losses were stabilised but when cardiovascular factors were present, only 64% were stabilised. These risk factors can also be used to ascertain the prognosis of post-surgical progression of visual field, as already shown in previous reports. Automated threshold perimetry was useful to study the visual field progression with standardized and reliable numerical parameters, allowing statistical computerised management of the patients with glaucoma.

A study was carried out in the North of Cameroon concerning the frequency of trachomatous blindness among 3,326 cases of blindness. A 4.63% frequency was found. The results show a 2 women for one man sex ratio and differences between the studied ethnic groups. The role of hygiene is stressed in order to explain these numbers.

The subjective aniseiconia was measured with spatial eiconometer on 51 isometropic and unilateral pseudophakic patients in relation with the post-operative anisometropia. The median value of subjective aniseiconia is 2-3% for anisometropia minus or equal to 5 diopters, without statistic correlation, related to a probably "sensorial brain adaptation". So error of intra-ocular lens power calculation less than 7.5 diopters may be accepted.

A case of orbital zygomycosis, probably mucormycosis, histologically demonstrated was observed in a healthy host. The etiologic agent could not be identified because of the unsuccessful cultures. No clinical antecedent allowed us to suppose that an immunological deficiency statement was present. It seemed that the fungus did not penetrates by the classical nasal and sinusal pathways. The fungus inoculation probably resulted from a subocular traumatism. The ketoconazole treatment, the only one possible in our case, was efficient.

Two patients with unilateral painful ophthalmoplegia are presented, a woman of 26 and a man of 28. In both cases the phlebography of the orbit shows an alteration of the orbital veinous blood flow, specially of the third segment of the superior orbital vein. Another characteristic feature of this syndrom is efficiency of corticotherapy and heparinotherapy, which may suggest an inflammatory and thrombophlebitic origin.

Eighty-seven patients (mean age 73 years) with histologically proven Horton's disease were followed up in 5 different specialized hospital units from 1970 to 1984. Except for one patient treated exclusively with antimalarials, all were under corticosteroids. The mean initial dose of prednisone or equivalent was 0.7 mg/kg/day and the mean maintenance dose, 10 mg/day. Steroids could be discontinued in 21 cases after 36 months on average; the other patients could not be weaned, even though 4 of them had been on steroids for more than 10 years. Side-effects were noted in 43 cases. Twenty-four patients died, mostly of cardiovascular diseases. Survival rates were 89 +/- 6.35% at 1 year, 60.2 +/- 8.7% at 5 years and 48 +/- 11.3% at 10 years. In the long run, mortality in our series proved to be exactly the same as in the general population. Nineteen patients had ocular manifestations of giant cell arteritis always from the onset, except for a fall in visual acuity; 26 relapses were observed in 18 patients, either during reduction of steroid dosage (21 cases) or after withdrawal (5 cases). In 2 cases histology showed typical lesions of giant cell arteritis after 41 and 50 months respectively under corticosteroid therapy.

A description of vitelliform degeneration of the macula in 6 year-old child, and Leber's amaurosis in his first cousin aged 7. The evolution has been followed and studied for 18 months from the point of view of slit-lamp examination, function and electrophysiology. The intrafamilial association of these two types of hereditary tapeto-retinal degeneration allows a discussion on their respective nosological character in the light of the small amount of literature available.