Search

Purpose: Treatment of persistent ocular discomfort in patients with Cogan's epithelial basement membrane dystrophy (EBMD) is a challenge for ophthalmologists. This study aimed to determine...

Resume Objectif Evaluer le delai entre l’ablation de la suture corneenne de l’incision principale et la stabilisation de l’astigmatisme induit chez des patients operes de la cataracte. Patients et methodes Il s’agit d’une etude prospective realisee chez 13 patients operes de la cataracte par phacoemulsification avec incision de 2,4 mm, pour lesquelles une suture corneenne avait ete jugee necessaire en fin d’intervention. Lors de la visite de controle, une topographie corneenne speculaire a ete realisee avec un OPD Scan avant l’ablation du fil, immediatement apres, 10, 20, 30 minutes et 15 jours apres. L’astigmatisme corneen ainsi que la keratometrie aux meridiens le plus cambre (Kmax) et le plus plat (Kmin) en cornee centrale (1,15 mm du centre), intermediaire (2,30 mm) et peripherique 3,30 mm) ont ete mesures. Resultats L’âge moyen des patients etait de 70 ans ± 12 ans. Le delai moyen d’ablation du fil apres la chirurgie etait de 23 ± 14 jours. La plus grande variation du Kmax survenait immediatement apres l’ablation de la suture pour la cornee centrale et intermediaire (respectivement –4,38 % et –4,59 % du Kmax initial en moyenne soit –2,04 D ± 3,14 D et –2,15 D ± 3,11 D) et entre 0 et 10 minutes apres cette ablation pour la peripherie (1,57 % du Kmax apres ablation du fil soit 0,96 D ± 1,85 D, en moyenne). Entre la trentieme minute et le quinzieme jour, la variation de l’astigmatisme corneen etait en moyenne de 0,08 ± 0,31 D soit 3,6 % de l’astigmatisme initial. Lorsque les ablations de suture etaient realisees entre 7 et 10 jours apres la chirurgie, la variation moyenne de l’astigmatisme corneen etait de 0,16 ± 0,24 D contre 0,03 ± 0,34 D pour les ablations realisees apres 28 jours. Conclusion Les donnees keratometriques ne varient que tres peu au-dela de la trentieme minute apres ablation de la suture. Ces resultats suggerent qu’une mesure de la refraction definitive peut etre realisee le meme jour que l’ablation de la suture dans la chirurgie de la cataracte, sans necessite absolue d’une nouvelle mesure a distance pour la prescription des verres definitifs.

Purpose To describe the clinical features of secondary glaucoma associated with transthyretin (TTR)-related Familial Amyloid Polyneuropathy (FAP). Methods In this retrospective monocentric study, 5 patients with FAP associated secondary glaucoma were seen at the ophtalmologic consultation of the french national center for FAP between 2011 and 2012. The mutation of the amyloidogenic TTR variants was analysed for all patients. All patients had a complete ophthalmic examination including BCVA, IOP, slit lamp and optic disc photographs, gonioscopy, pachymetry, automated perimetry, and OCT-RNFL. Glaucomatous optic neuropathy was diagnosed based on the presence of visual field abnormalities, neuroretinal rim thining, excavation or RNFL defects. Medical and surgical treatments were analysed for all patients. Results All cases had bilateral involvement except 2 monophtalmic patients. All patients were of portuguese origin and carriers of the Val30Met mutation. There were 4 women and 1 man with a mean age of 58.8±7.7 years. Mean BCVA was 0,83±0.9 LogMAR. Three eyes had a BCVA below 20/400. Mean IOP was 26.6±6.6 mmHg. Mean deviation was -17.6±11.2dB. Fringed pupil and anterior chamber amyloid deposition were noted in all affected eyes. Three patients had concomitent vitreous involvement. Patients were treated with 1.2±1.5 ocular hypotensive drugs. Four eyes had been treated with at least 1 filtrating surgery. Conclusion FAP-associated secondary glaucoma is a very severe disease, associated with amyloid deposits in the anterior chamber and characteristic pupil deformation. Systematic and comprehensive eye examination should be performed in all patients affected with FAP in order to improve early detection of glaucoma.

Purpose To assess the quality of tear secretion in eyes of patients with a history of unilateral and recurrent herpetic keratitis Methods 33 patients with a history of recurrent herpetic keratitis (either archipelago keratitis, KA, or kerato-uveitis, KU, or neurotrophic keratitis, KN) were compared with 33 normal subjects. A complete ophthalmologic examination was performed, with successively the assessment of tear osmolarimetry, tears break-up time (TBUT), Schirmer I test, and corneal sensitivity. Patients with other potential causes of abnormal tears were excluded, and all tests were performed at least 3 months after the last relapse of keratitis. Controls were selected among asymptomatic patients scheduled for cataract surgery or refraction disorders, and were matched for age and gender with patients. Results The patients group (19 men, 14 women, aged 52 ± 7 years) included 16 patients with KA, 13 with KU, and 6 with KN. In the control group (similar sex ratio and mean age), all tests were symmetrical between the two eyes. In the 3 groups of patients, tear osmolarimetry was significantly greater in affected eyes than in controls, as well as TBUT was significantly reduced. In contrast, Schirmer I test was reduced only in eyes of patients with a history of KU or KN. Finally, only KN eyes were statistically less sensitive than healthy eyes. Conclusion Recurrent herpes keratitis induced changes in lacrimal secretion, even when the disease is apparently quiescent, and the abnormalities are more important as the corneal disease is progressing In the context of our study, tear hyperosmolarity appeared to be a particularly sensitive test to detect impairment of tear secretion.

To evaluate the time until astigmatic stabilization after corneal suture removal after cataract surgery.A prospective study was performed on 13 patients who had undergone cataract surgery by phacoemulsification with 2.4mm incision, for whom it was felt necessary to remove a corneal suture. A specular corneal topography was performed by OPD Scan before removal, immediately after, then 10, 20, 30 minutes and 15 days later. For each acquisition, the keratometric readings at the steepest (Kmax) and the flattest (Kmin) meridians (central at 1.15 mm from corneal center, intermediate at 2.30 mm and peripheral at 3.30 mm) and the amount of corneal astigmatism were measured.Corneal topography of 13 patients was acquired. Mean age was 70 ± 12 years. Mean time after cataract surgery was 23 ± 14 days. The greatest change in Kmax occurred within the first minutes following suture removal for the central and intermediate cornea (mean variation of -4.38% and -4.59% of initial Kmax respectively, i.e. -2.04 D ± 3.14 D et -2.15 D ± 3.11 D) whereas it was observed between 0 and 10 minutes for the peripheral area (mean 1.57% of Kmax after suture removal i.e. 0.96 D ± 1.85 D). Mean change in corneal astigmatism between 30 minutes and day 15 was 0.08 D ± 0.31 D (3.6% of baseline). When suture removal was performed between 7 and 10 days postoperatively, mean change was 0.16 D ± 0.24 D, whereas it was 0.03 D ± 0.34 D when performed after four weeks.Keratometric readings vary only slightly beyond the first 30 minutes after suture removal. These results suggest that the refraction could be accurately measured the same day as suture removal, with no additional follow-up absolutely necessary in order to prescribe the final spectacles.

Cholesterol crystal embolism (CCE) is a rare and severe multisystemic disorder. It results from a massive release of cholesterol crystals from widespread atherosclerotic disease. The main difference with atherosclerosis is the severity and the quantity of the embolic events that occur during the course of the disease, eventually leading to multivisceral failure and death. The symptoms are multiple and make it a diagnostic challenge. Fundoscopic examination can be of great help, showing retinal emboli in up to 25% of the cases, and has been rarely described in the ophthalmologic literature. We report the case of a 77-year-old man with acute renal failure after coronarography. Retinal emboli seen in the fundus confirmed the diagnosis of cholesterol crystal embolism and thus prevented any further invasive investigations. In this case, anticoagulants must be stopped and any further endovascular procedure proscribed. Although impossible for this patient, peritoneal dialysis should be preferred to hemodialysis because it does not need any anticoagulation. Systemic corticosteroid can be used in the acute phase. Fundoscopic examination should be performed each time cholesterol crystal embolism is suspected. When typical emboli are seen in the retina, it permits avoiding invasive investigations and saving precious time for the management of this potentially lethal disease.

Purpose Patients with history of recurrent herpetic keratitis very often complain about their vision despite normal visual acuity (VA). The purpose of this study was to assess the optical aberrations and the quality of vision of the affected eye in patients with unilateral recurrent herpetic keratitis with preserved VA, and to compare these results with those of the non-affected eye. Methods Patients (n=15) with unilateral recurrent herpetic keratitis and an normal VA (Best corrected VA≤0 logMAR) were included in this study. Corneal optical aberrations of both eyes were assessed using dynamic skiascopy with OPD Scan II® (Nidek™). Wavefront analysis was performed during a quiescent period of the herpetic disease. The fellow eye was used as control. A blinded examiner retrospectively analyzed all the datas. Results The root mean square was significantly increased for high order aberrations (p=0.004) in the affected eye and particularly for trefoil and tetrafoil (p=0.004 and 0.02, respectively). In addition, The modulation transfer function (area under the curve) and the Strehl’s ratio were significantly lower in the affected eyes compared to the non affected eyes (p=0.02 and 0.02). Conclusion Our data show that herpetic keratitis induces wavefront abnormalities which could explain visual discomfort reported by patients with normal VA. A prospective study including more patients should provide further informations on the rate and the clinical significance of these optical aberrations.

Purpose A narrow iridocorneal angle (ICA) is a risk factor for glaucoma progression. However, many patients treated for primary open angle glaucoma (POAG) have never been assessed with dynamic gonioscopy. In this study, we performed dynamic gonioscopy in patients referred for progressing POAG and suspicion of glaucoma (GS) to evaluate the rate of misdiagnosed narrow ICA. Methods We retrospectively analysed the clinical data of consecutive glaucoma or GS patients referred for evaluation from November 2009 to October 2010. All patients had been previously diagnosed with open ICA. Patients were examined by a single ophthalmologist. The evaluation included detailed medical history, comprehensive ophthalmologic examination, diurnal hourly monitoring of the intraocular pressure, static automated perimetry, retinal nerve fiber layer thickness analysis, central pachymetry and dynamic gonioscopy (Possner® lens). Results 135 patients were included. The mean age was 53.6 years (+/- 6.2 years). Prior to our evaluation, glaucoma and GS patients had been followed 5.2 years (+/- 3.4 years) with an average of 4.2 visits and 2.2 visual fields. 58 patients (43%) had never undergone gonioscopy. A narrow angle was diagnosed in 18 patients (13.3%), including 5 patients with plateau-iris configuration confirmed by ultrasonic biomicroscopy (27.7% of narrow angles). Conclusion A narrow ICA is not a rare finding among patients diagnosed with POAG or GS patients. Dynamic gonioscopy should be performed systematically for all glaucoma and glaucoma suspect patients, especially in cases of glaucoma progression despite an efficient and well conducted treatment. Lens size evolution with time requires repeated evaluations.

Purpose To assess the osmolarity of tears in eyes affected by recurrent herpetic stromal keratitis. Methods All the patients referred for a recurrent unilateral stromal keratitis infection by either Herpes simplex virus (VZV) or varicella-zoster virus (VZV). All the patients have been finally tested for dry eye conditions when all clinical signs of ongoing keratitis had resolved. The osmolority was assessed using the TearLab® and then the corneal sensitivity was tested with the Cochet-Bonnet esthesiometer (Luneau™). Values were compared using non-parametric tests, and statistical significance was defined as p

Purpose To define a combination between Schirmer I and phenol red thread test (PRT) that improves the screening of patients with ocular sicca syndrome. Methods The PRT test was performed before (PRT1) and after (PRT2) the Schirmer I test, in both eyes of 143 patients complaining of ocular dryness secondary to Sjogren’s syndrome (SGS) or Sicca Asthenia Polyalgia Syndrome (SAPS) (72 and 71 patients respectively), and in 40 patients with no sign of dry eye. Groups were matched by age and gender. After determining the best cut-off values using the ROC procedure, several combinations of PRT and Schirmer I were assessed to improve the predictive values of the procedure. Results The best cut-off value for PRT2, estimated at 15mm, provided a satisfying match between sensitivity and specificity indexes (68% and 90% respectively), similar to those obtained with the Schirmer I test. If PRT1 alone was ineffective to screen SGS from control patients, the comparison between PRT 1 and PRT2 (”delta-PRT”) was found as a good marker to detect patients with persistent tear reflex. The combination of positive Schirmer I, PRT 2 and/or delta-PRT tests was found as highly predictive of severe ocular sicca syndrome. Conclusion The combination of Schirmer I and PRT test improves the screening procedure to detect patients with severe ocular dryness. Since PRT test is non-invasive and time-effective, it could be more widely used in daily clinical practice, besides Shirmer I test, to optimize the work-up of patients presenting with dry-eye subjective signs.

Neurotrophic keratopathy is a potential consequence of herpes simplex virus (HSV) or varicella zoster virus (VZV) infection. The treatment is based on artificial tears and the withdrawal of preserved eye drops or other types of epitheliotoxic topical medicines. Autologous serum or amniotic membrane transplantation may also be used in severe cases, but their cost and safety are still under debate. We report a case of a patient with a history of herpes zoster ophthalmicus, who developed a persistent epithelial ulcer after cataract surgery, with no improvement despite 3 weeks of artificial tears (eight drops per day). A new ophthalmologic solution based on a regenerating agent (RGTA, Cacicol20(®)) was then used, with a dosage of two eye drops per week for 6 weeks. Improvement was observed 1 week later, and complete healing was obtained in less than 3 weeks, with no side effects. This heparin mimetic, which may stimulate extracellular matrix healing, may be a possible alternative therapy to autologous serum or amniotic membrane transplantation in severe neurotrophic ulcer. However, randomized studies are necessary to validate this observation.

Purpose To assess optical aberrations using wavefront analysis in the affected eye of patients with unilateral herpetic keratitis with no apparent visual disturbance (visual acuity : 20/20), and to compare these results with those of the non-affected eye Methods Corneal optical aberrations from 5 patients with unilateral herpetic keratitis and normal visual acuity (20/20 OU) have been assessed using dynamic skiascopy with OPD Scan II® (Nidek™). Both eyes in all patients were apparently normal using slit-lamp examination, and wavefront analysis was performed in a quiescent period of the herpetic disease. The fellow eye was used as control. Data were retrospectively analyzed by a blinded examiner. Results Zernike’s polynoms and MTF curve analysis showed bilateral abnormalities in 4 patients, with no specific difference between the two eyes. In contrast, one patient had wavefront disturbances in the affected eye, whereas the non-affected eye was normal. Conclusion Moderate herpetic keratitis may induce wavefront abnormalities in some patients despite a normal visual acuity and an apparently normal cornea. This could explain visual discomfort that is sometimes described in such patients. . Further studies are needed to unerstand waevfront aberrations induced by herpetic keratitis with normal examination.

Purpose Define the interest of QuantiFERON®-TB Gold test (Cellestis) in patients with positive Tuberculin Skin Test (TST) to improve etiologic and therapeutic work-up in uveitis. Methods All patients followed in the Ophthalmology Department of Bicetre Hospital between April 2007 and March 2009 for uveitis had an extensive work-up including Tuberculin Skin Test (TST). Among them, 14 patients had a very positive TST making suspect an active tuberculosis infection. Then all of these patients had systematically a quantiFERON®-TB Gold test. Finally, charts from clinical exam and therapeutic management were retrospectively analysed. Results The mean age at the time of presentation was 58 years (+/- 9) and sex ratio (F/M) was 43%. Uveitis was bilateral in 43% of cases, and the location of inflammation was anterior in 43% of the cases, intermediate (21.4%), posterior (21.4%) or total (7%). The average of PPD test was 21.75mm (+/- 4mm, 15-65mm) and minimal delay between PPD and quantiFERON®-TB Gold test was 3 days (mean: 42 days +/- 17). QuantiFERON®-TB Gold test was positive in 9 patients (64.3%) enjoining introduction of a full anti-tuberculosis therapeutic treatment in 8 patients (57.1%), that preceded oral steroids regimen in 42.8% of cases. Visual acuity increased dramatically (6 lines) in 4 patients and was unmodified for the others. Conclusion QuantiFERON®-TB Gold test seems usefull in systematic diagnostic strategy in uveitis; it stays negative in 35.7% of the case suggesting that positive results are significant. However, further studies are necessary to define its place in diagnostic procedure in uveitis.

Neurotrophic keratopathy is a potential consequence of herpes simplex virus (HSV) or varicella zoster virus (VZV) infection. The treatment is based on artificial tears and the withdrawal of preserved eye drops or other types of epitheliotoxic topical medicines. Autologous serum or amniotic membrane transplantation may also be used in severe cases, but their cost and safety are still under debate. We report a case of a patient with a history of herpes zoster ophthalmicus, who developed a persistent epithelial ulcer after cataract surgery, with no improvement despite 3 weeks of artificial tears (eight drops per day). A new ophthalmologic solution based on a regenerating agent (RGTA, Cacicol20(®)) was then used, with a dosage of two eye drops per week for 6 weeks. Improvement was observed 1 week later, and complete healing was obtained in less than 3 weeks, with no side effects. This heparin mimetic, which may stimulate extracellular matrix healing, may be a possible alternative therapy to autologous serum or amniotic membrane transplantation in severe neurotrophic ulcer. However, randomized studies are necessary to validate this observation.

Introduction L’incidence des keratites herpetiques en France est de 31,5/100 000 personnes-annees. Il s’agit donc d’une infection frequente, parfois grave puisqu’il existe des risques de recidives et de cicatrices corneennes. Meme si l’acuite visuelle redevient normale apres une poussee, un mauvais confort visuel demeure chez de nombreux patients. Objectifs et Methodes L’objectif etait de mettre en evidence des aberrations optiques d’origine corneenne chez des patients atteints de keratite herpetique recidivante, actuellement en remission et ayant recupere une acuite visuelle de 10/10 e . Le front d’ondes a ete etudie par refractometrie a balayage (skiascopie dynamique) grâce au systeme OPD Scan II ® (Nidek TM ), chez 5 patients suivis pour une keratite herpetique unilaterale, a distance de la derniere poussee. Aucune opacite marquee n’etait presente a l’examen a la LAF et l’AV etait de 10/10 e . L’œil controlateral, normal, servait de temoin. Resultats L’analyse des polynomes de Zernike et de la courbe MTF a montre des aberrations de haut grade et de bas grade avec une alteration de la courbe MTF chez tous les patients. Ces anomalies etaient bilaterales chez 4 patients, sans difference significative entre les 2 yeux. En revanche, elles etaient unilaterales du cote atteint chez 1 patient, avec une alteration franche de la courbe MTF de l’œil atteint par rapport a l’œil controlateral. Discussion Les resultats intermediaires ne permettent pas de correler la gene visuelle aux aberrations corneennes chez les patients atteints de keratite herpetique. L’analyse d’un nombre plus important de patients atteints de keratite herpetique et de temoins est necessaire afin d’obtenir plus de donnees. Conclusion Les poussees de keratites herpetiques peuvent se resoudre cliniquement avec la recuperation d’une acuite visuelle apparemment normale. Cependant, des troubles visuels qualitatifs peuvent persister. L’analyse aberrometrique et l’etude de la sensibilite aux contrastes pourraient permettre d’explorer l’aspect qualitatif de la vision chez ces patients.

But Definir l’interet du test QuantiFERON ® -TB Gold (Cellestis) chez les patients presentant une intradermoreaction (IDR) a la tuberculine (10UI) positive pour affirmer le bilan etiologique et pre-therapeutique des uveites. Materiels et Methodes Tous les patients suivis dans le departement d’ophtalmologie du CHU Bicetre entre avril 2007 et juillet 2008 ont ete teste par IDR a la tuberculine (10 UI) dans le cadre du bilan etiologique et/ou pre-therapeutique. Parmi eux, 12 ont presente une reaction phlyctenulaire faisant suspecter une infection tuberculeuse active. Tous ces patients ont alors systematiquement beneficie d’un test QuantiFERON ® -TB Gold. Les donnees des examens cliniques et de l’attitude therapeutique ont ete analysees de facon retrospective. Resultats L’âge moyen des patients etait de 56 ans (+/−2,2) et le sexe ratio (F/M) de 42 %. Les uveites des patients concernes etaient bilaterales dans 42 % des cas, et de localisation anterieure dans 35 % des cas, intermediaire (23,5 %), posterieure (23,5 %) ou totale (9 %). Un patient presentait une sclerite sans inflammation intraoculaire. La mesure moyenne de l’induration de l’IDR etait de 21,75 mm (+/−4 mm, extremes 15-65 mm). Le delai minimal entre la realisation de l’IDR et le test au quantiferon etait de 3 jours (moyenne : 42 jours +/−17, extremes : 3jours-5mois). Le resultat du test QuantiFERON ® -TB Gold etait positif chez 7 patients (58,3 %), ce qui a conduit, apres prise en charge en medecine interne, a la mise en route d’un traitement antituberculeux chez 6 patients (50 %) associe dans 33 % des cas a une corticotherapie par voie generale. Une amelioration nette de l’acuite visuelle (6 lignes) a ete notee chez 2 patients traites par antituberculeux et corticotherapie generale. Discussion Le test par quantiFERON semble utile dans la detection des patients suspects de tuberculose. Meme si le test peut etre fausse par la realisation de l’IDR, il reste negatif dans 42 % des cas, suggerant que les resultats fortement positifs sont cliniquement significatifs. Conclusion Le test quantiFERON ® -TB Gold apparait interessant dans la strategie du bilan systematique des uveites. Cependant la place de ce test couteux devra etre mieux definie.

Objectif Rapporter l’association d’une uveite intermediaire chronique et d’une myelo-radiculite a HSV1. Materiels et Methodes Une patiente de 29 ans, atteinte d’une uveite intermediaire chronique bilaterale avec vascularite veineuse d’etiologie indeterminee evoluant depuis 7 ans, a consulte pour des troubles neurologiques associes a une eruption vesiculeuse. Le diagnostic neurologique etait celui de myeloradiculite d’origine herpetique. La serologie HSV1 etait positive (IgM et IgG) et la PCR HSV1 etait positive dans le LCR. L’IRM medullaire mettait en evidence un hypersignal evoquant une atteinte inflammatoire. L’evolution a ete favorable apres traitement par aciclovir IV. Lors d’une nouvelle poussee inflammatoire, a distance de l’episode neurologique aigu, une ponction de la chambre anterieure etait egalement positive en PCR pour HSV1. La reintroduction d’un traitement par aciclovir IV avec un relais par valaciclovir a permis la guerison de l’atteinte ophtalmologique et la prevention de recidives ophtalmologiques ou neurologiques. Discussion Le diagnostic d’uveite a HSV1 a ete porte grâce a la PCR realisee dans l’humeur aqueuse. Plusieurs cas de meningo-encephalites associees a des uveites anterieures ou des retinites d’origine herpetique ont ete recenses. L’association d’une uveite intermediaire et d’une atteinte du systeme nerveux central est en revanche beaucoup plus rare. Ce tableau justifie un traitement antiviral adapte en urgence puis au long cours en prevention. Conclusion Le diagnostic retenu est celui de myeloradiculite concomitante a une uveite bilaterale atypique a HSV1. Ce cas clinique vient souligner le tropisme particulier de l’HSV1 pour le systeme nerveux central et la possibilite d’une atteinte ophtalmologique simultanee. Le traitement reposant sur l’aciclovir avec un relais par valaciclovir permet generalement une evolution favorable.

Introduction La retinite necrosante aigue est le tableau classique des uveites a CMV. Cependant l’infection a CMV peut reveler des aspects plus atypiques. Materiels et Methodes Nous rapportons le cas d’un patient de 63 ans suivi pour un myelome multiple des os, presentant une panuveite chronique granulomateuse a CMV. Observation Mr T.M, originaire des Antilles et âge de 63 ans, est suivi depuis 4 mois pour un myelome multiple a IgG lambda. En attente d’une autogreffe de cellules souches sanguines, 2 semaines avant son hospitalisation, il signale une baisse d’acuite visuelle progressive de l’œil gauche. Son acuite visuelle est de 4/10 faible ; l’examen ophtalmologique retrouve une panuveite de l’œil gauche associee a des precipites retrodescemetiques granulomateux. Le fond d’œil est difficilement accessible a cause d’une hyalite dense. Un premier bilan est effectue a la recherche notamment d’une sarcoidose, l’ensemble de ce bilan est negatif. Devant l’absence d’amelioration malgre un traitement local par corticoides, une biopsie du vitre est realisee. La PCR CMV revient positive. L’evolution est favorable sous gancyclovir. La visualisation du fond d’œil revele alors une vascularite diffuse ainsi qu’un foyer retinien blanchâtre et quelques rares hemorragies. L’acuite visuelle est alors chiffree a 6/10. Discussion L’aspect granulomateux n’est classiquement pas retrouve dans les infections a CMV. Dans la litterature, cet aspect est decrit dans certaines hepatitis a CMV. Conclusion Les connaissances actuelles couplees aux nouvelles techniques biologiques permettent de retrouver de nouvelles etiologies pour des granulomatoses oculaires et/ou systemiques autrefois qualifiees d’idiopathiques.

Introduction Exophtalmie douloureuse revelant une maladie de Rendu-Osler : a propos d’un cas. Materiels et Methodes Une patiente de 66 ans presentait une exophtalmie droite douloureuse, d’apparition progressive, avec dilatation des vaisseaux episcleraux en « tete de meduse ». Devant cette suspicion de fistule carotido-caverneuse, le scanner, l’IRM et surtout l’angiographie cerebrale successivement realises ont permis de mettre en evidence une malformation arterio-veineuse orbitaire, associee a des malformations arterio-veineuses cerebrales multiples et telangiectasies des fosses nasales. L’examen clinique montrait des telangiectasies de la muqueuse linguale et labiale. Le diagnostic de maladie de Rendu-Osler a donc ete porte. La patiente a ete traitee par corticotherapie IV puis per os, ameliorant l’exophtalmie. Une occlusion de veine centrale de retine est survenue au decours. Discussion La maladie de Rendu-Osler, angiodysplasie hereditaire de transmission autosomique dominante a expression variable, est revelee classiquement par des telangiectasies cutaneo-muqueuses et par les manifestations hemorragiques et compressives des MAV qui la caracterisent : muqueuse nasale avec epistaxis frequente, localisation pulmonaire, hepato-digestive et du systeme nerveux central. La presentation ophtalmologique de la maladie, a type d’occlusion de l’artere ou de la veine centrale de la retine, ou encore de malformations vasculaires asymptomatiques des vaisseaux episcleraux et conjonctivaux, est rare. Le cas de cette patiente semble remarquable par son mode de revelation, la localisation orbitaire d’une MAV au cours d’une maladie de Rendu-Osler, traduite cliniquement par une exophtalmie, etant exceptionnelle. Conclusion Les atteintes oculo-orbitaires au cours de la maladie de Rendu-Osler, bien qu’inhabituelles, doivent etre connues car potentiellement cecitantes et de diagnostic difficile.

But Definir l’interet du test au fil rouge en le comparant au test historique de Schirmer de type 1, determiner sa valeur seuil et une strategie diagnostique dans le cadre de la secheresse oculaire. Materiels et Methodes Le test au fil rouge a ete realise avant (PRT1) et apres (PRT2) realisation du test de Schirmer de type 1 chez 183 patients consecutifs dont 72 atteints de syndrome de Sjogren primitif ou secondaire, 71 atteints de syndrome sec, d’asthenie et de polyalgie et 40 patients temoins. Seule la plus faible des deux valeurs obtenues (droite ou gauche) pour chaque test etait retenue. Discussion L’analyse de la courbe ROC pour PRT1 montre des couples sensibilite/ specificite mediocres quelle que soit la valeur seuil theorique. La valeur seuil la plus appropriee pour PRT2 semble etre 15 mm assurant une sensibilite de 68 % et une specificite de 90 % et de 10 mm pour le test de Schirmer de type 1 assurant une sensibilite et une specificite de 77,80 % et de 82,50 % respectivement. Le PRT2 seul n’apparait cependant pas superieur au test de Schirmer dans le diagnostic de secheresse oculaire. Cependant, la combinaison des tests de Schirmer de type 1 et du test au fil rouge permet d’augmenter le rendement des tests ophtalmologiques, ainsi la combinaison Schirmer ≤ 10 mm, PRT2 ≤ 15 mm et « deltaPRT » (PRT2-PRT1) negatif permet d’obtenir un test dont la sensibilite est de 83 % et la specificite de 100 %. Conclusion Il n’existe pas d’arme absolue en matiere d’œil sec et le test au fil rouge ne permet pas de supplanter le test historique de Schirmer de type 1. Cependant son utilisation en combinaison avec le test de Schirmer permet d’obtenir un test dont la sensibilite et la specificite sont elevees dans le diagnostic de secheresse oculaire et pourrait etre proposee dans les criteres internationaux du syndrome de Sjogren.