No abstract

To evaluate the efficacy and safety of proton beam therapy for complicated circumscribed choroidal hemangiomas. Methods: The study was a retrospective nonrandomized investigation. Seventeen consecutive patients, referred to the Institut Gustave-Roussy, Villejuif, France, for circumscribed choroidal hemangioma associated with serous retinal detachment were studied. Each eye received a total dose of 20 cobalt gray equivalents (CGEs) delivered in 15-second fractions of 5 CGEs over 4 days. Functional tests included the initial and final bestcorrected visual acuity, slitlamp examination, intraocular pressure, fundus examination, fluorescein angiography, and indocyanine green angiography. Tumor thickness was determined on B-scan ultrasonography. Results: The macula was involved in 7 eyes and the lesion was juxtapapillary in 2 eyes. The mean (SD) tumor thickness was 3.06 (9.0) mm. The mean initial tumor diameter was 6.82 mm (range, 3.2-12.1 mm). The right eye was involved in 7 cases and the left eye in 10 cases. The mean (SD) follow-up period was 52 (58) months (range, 36-90 months). Retinal reattachment was obtained in all cases after a mean period of 2 months (range, 1-12 months; median, 1 month). Tumor regression was obtained in all cases. One recurrence occurred 1 year after the initial treatment in an undertreated area. After re-treatment, however, resolution of the retinal detachment occurred, and flattening of the choroidal lesion was obtained. Final visual acuity improved to 2 Snellen lines or more in 16 eyes (94%), was stable in 1 eye, and attained 20/40 or more in 12 eyes (70.6%). No radiation therapy complications occurred during follow-up. Conclusions: Proton beam therapy for choroidal hemangiomas seems to be an effective and safe alternative option. A total dose of 20 CGEs delivered in 4 daily 15second fractions of 5 CGEs seems adequate for local control of both the tumor and serous retinal detachment.

Herpetic retinitis in humans is characterized by a high frequency of bilateral localization. In order to determine the possible mechanisms leading to bilateral retinitis, we studied the pathways by which herpes simplex virus type 1 (HSV-1) is propagated from one retina to the other after intravitreal injection in mice. HSV-1 strain SC16 (90 p.f.u.) was injected into the vitreous body of the left eye of BALB/c mice. Animals were sacrificed 1, 2, 3, 4 and 5 days post-inoculation (p.i.). Histological sections were studied by immunochemical staining. Primary retinitis in the inoculated eye (beginning 1 day p.i.) was followed by contralateral retinitis (in the uninoculated eye) starting at 3 days p.i. Infected neurons of central visual pathway nuclei (lateral geniculate nuclei, suprachiasmatic nuclei and pretectal areas) were detected at 4 days p.i. Iris and ciliary body infection was minimal early on, but became extensive thereafter and was accompanied by the infection of connected sympathetic and parasympathetic pathways. The pattern of virus propagation over time suggests that the onset of contralateral retinitis was mediated by local (nonsynaptic) transfer in the optic chiasm from infected to uninfected axons of the optic nerves. Later, retinopetal transneuronal propagation of the virus from visual pathways may have contributed to increase the severity of contralateral retinitis.

ABSTRACT.Purpose: To evaluate the efficacy of surgical management of pterygium with corneo-conjunctival autograft transplantation. Setting: Ophthalmology Department, Biceˆtre Hospital, University Paris XI and the Assistance Publique Hoˆpitaux de Paris, France. Methods: The records of 104 patients (114 eyes), comprising 40 women and 64 men, who underwent corneo-conjunctival autograft transplantation for primary (104 eyes) and recurrent (10 eyes) pterygia between 1992 and 1998, were reviewed in a retrospective survey. Follow-up ranged from 12 to 78 months (mean 22.5 months). Results: All grafts were planted promptly and donor sites re-epithelialized with no excessive scar tissue formation. No recurrence was noted. Improvement of visual acuity was achieved in 24 patients and stabilization was achieved in 76 patients. The main complication was progression of corneal astigmatism exceeding 4 dioptres in two patients. Conclusion: These results indicate that corneo-conjunctival autograft transplantation is an effective treatment for pterygia.