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INTRODUCTION: Ocular and orbital trauma is a leading cause of acquired monocular blindness in childhood. These injuries differ from those in adults in some aspects of the management and prognosis, notably the risk of amblyopia. The goal of this study was to analyze the epidemiological, clinical and therapeutic features of ocular trauma in children who consulted in an eye emergency department in Île-de-France. PATIENTS AND METHODS: This was a descriptive, prospective and longitudinal study. Over a period of 6 months, we included children aged 15 years old or less, who consulted during calls for ocular trauma. Each child received an ophthalmologic examination as complete as his or her condition and cooperation permitted. Mechanical injuries of the eyeball and chemical ocular burns were distributed respectively according to the Birmingham Eye Trauma Terminology and Dua's classification. The visual prognosis was defined as the best corrected visual acuity of the affected eye, measured at the conclusion of treatment. RESULTS: Among 586 children who consulted during the study period, 265 suffered from ocular trauma (45.22%). The male:female ratio was 1.6:1. The main places of occurrence of the injuries were home (64.15%) and school (18.11%). Injuries from finger nail scratch were the most frequent (12.45%). One hundred and fifty-seven patients consulted within 6 hours (59.19%). The cornea was the predominant site of the injury (44.40%). Mechanical injuries of the eyeball accounted for 75% of cases. The incidence of ocular chemical burns was 6.41%. Eyelid and orbital injuries were observed in 22.26% and 2.26% of cases respectively. Surgical treatment was required in 6.79% of cases. The incidence of hospitalization was 3.02% with a mean length of stay of 3 days. Four children developed sequelae, including 2 corneal scars and 2 cataracts. No case of blindness was recorded. DISCUSSION: The high frequency of traumatic ocular and orbital pathology in our study may be due to its sudden and accidental onset, leading parents to seek emergency care. Most injuries occurred at home and at school, which reflects the presence in these places of potential hazards, often unrealized or neglected. The low frequency of open-globe injury may be related to the ubiquitous recruitment. Indeed, in studies including only severe trauma, this rate may reach 73.4%. This clinical presentation is associated with a poor prognosis because of the risk of infection and sequelae causing decreased visual acuity and amblyopia. Few children were hospitalized. This could be explained by the predominance of mild to moderate trauma. CONCLUSION: Ocular trauma accounts for nearly half of pediatric conditions encountered in the eye emergency unit. Adequate emergency care improves the visual prognosis.

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The authors report four cases of chronic endophthalmitis following extracapsular cataract extraction with intraocular lens implantation in the posterior chamber. The first attack of intraocular inflammation occurred in the form of recurrent iridocyclitis two to six months after surgery. The first attack usually responded well to local corticosteroids. After many relapses of inflammation, increasingly resistant to medical treatment, a severe attack occurred leading to the decision to treat such endophthalmitis surgically: endocular fluid aspiration, vitrectomy, intraocular injection of antibiotics combined with systemic antibiotics and corticosteroids. It may be very difficult to prove the infectious origin of torpid endophthalmitis. Growing bacteria from endocular fluid aspirates is much more difficult than in acute endophthalmitis. No organisms were found in this series by this method, despite the fact that fluid aspiration was often performed many times in these 4 cases. A bacterium was identified in 3 cases, twice on the implant itself and once after culture of an iridectomy specimen. Intraocular antibiotic injections resulted in the complete recovery of one patient. Following failure of standard treatment, intraocular lens explantation resulted in the disappearance of infectious inflammatory signs in 3 cases. The treatment of chronic endophthalmitis is governed by the same rules as acute endophthalmitis but is not always as successful. Intraocular lens removal is often the only solution and confirms the pathogenic hypothesis that slime production by organisms, their adherence to the intraocular lens and their quiescent state make them less vulnerable to antibiotics and host defences.

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The authors expose a series of seven cases of ocular trauma due to pellet guns. First, they describe the different kinds of lesions, their treatment, and their development. Then, they study the prognostic points, the mechanism of the secondary complications, and the therapeutic conduct to adopt in front of this type of perforating injuries with non-magnetic intraocular foreign body. They insist on the severity of this type of ocular trauma, and on the necessity of a modification of the law concerning pellet guns.

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The authors report one case of traumatic tear in Bruch's membrane which pass close to the fovea in a thirty year old male. Sub retinal neo-vascularization arise from this choroidal rupture four months after trauma. Binocular diplopia was the first symptom of the sub-retinal neo-vascularization. It extends from the tear to involve the macula with reduction in visual acuity to 2/10eme P14. The spontaneous regression of these abnormal vessels allows to improve visual acuity to 6/10eme P2. Compared with reports in the literature, it seems that spontaneous regression of this sub-retinal neo-vascularization can be explained by the fact it grow from healty retina in young patient. There is no conclusive evidence that coagulation therapy is of any benefit in patients developing such lesions.

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The anhydrotic ectodermal dysplasia are malformative syndromes involving the ectodermal components of the organism. They may be associated with very varied ocular manifestations. We described one sporadic case of anhydrotic ectodermal dysplasia in a twenty-four year-old man, involving the following ocular manifestations: severe and bilateral keratopathy corneal hypoesthesia involvement of the lacrymal system horizontal nystagmus and a high rate of antilens antibodies not yet reported a far as we know in the literature.

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The classical form of patent ductus arteriosus (PDA) does not usually pose any difficulty in diagnosing. When the auscultatory signs are atypical, for example in the newborn or in cases with pulmonary hypertension, pulsed Doppler echocardiography may be a useful diagnostic aid. This study reports the results of pulsed Doppler examination in PDA. Twenty-four children with a suspected PDA underwent pulsed Doppler examination during 2D echocardiography. This population was divided into 2 groups; Group I: children who underwent catheterisation, and group II: in which catheterisation was not performed. The mean age in Group I was 7 years compared to 50 days in Group II, which mainly comprised newborn and premature babies. Direct visualisation of PDA by 2D echo was attempted in all cases. The search for a PDA by pulsed Doppler was made by positioning the sample volume at the bifurcation of the main pulmonary artery. PDA is associated with turbulent systolo-diastolic flow away from the transducer. Suprasternal and subcostal views were also used. In Group I (13 cases) PDA was directly visualised by 2D echo in 7 children (53 p. 100). By comparison, pulsed Doppler examination diagnosed all 13 cases of PDA; these results were confirmed at catheterisation or surgery. In Group II (11 cases) direct visualisation of PDA was successful in 6 cases (54 p. 100). Pulsed Doppler was non-specific, showing typical flow disturbances in 8 cases and systolic turbulence in 3 cases at the level of bifurcation.(ABSTRACT TRUNCATED AT 250 WORDS)

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To test the diagnostic accuracy of pulsed Doppler and two-dimensional echocardiography (2D-echo) in ventricular septal defect (VSD), 32 children were studied. All were suspected on clinical grounds to have a VSD. In 17 children, the VSD was proven by cardiac catheterization (group I, mean age 10 years); in 15, only non-invasive investigation was carried out (group II, mean age 1 year). In group I, 2D-echo showed a ventricular septal defect in 14 cases (82%); the Doppler study demonstrated a typical systolic turbulent flow in the right ventricle, in front of the septum, in all cases. In group II, the VSD was visualized by 2D-echo in 11 cases (73%). Pulsed Doppler showed a typical turbulent flow in the right ventricle in all cases. Thus, pulsed Doppler appears more sensitive in detecting ventricular septal defect--especially of small size--than 2D-echo. The diagnostic value of Doppler remains intact when associated cardiac malformations are present and in cases of pulmonary hypertension, as long as the shunt is not reversed.

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The association of atrial septal defect (ASD) and mitral valve prolapse (MVP) is well known but its precise incidence has not yet been established. Most previous publications have only been angiographic studies and the diagnostic criteria of MVP were, therefore, controversial. In this study, 61 consecutive patients, adults and children, underwent M mode echocardiography and cardiac catheterisation with cineangiography. In the adult group echocardiographic MVP was observed in one of 23 patients with secundum ASD. These findings were confirmed on angiography in addition, four other cases were observed in patients without systolic clicks or pansystolic or late systolic murmurs. MVP was observed in four out of 27 children with secundum ASD on M mode echocardiography and all cases were confirmed at angiography. In contrast to the adult group, no additional cases were demonstrated. Three out of 11 patients with ostium primum defects had MVP at echo and/or angiography, a finding which was probably related to the common atrioventricular canal. Follow-up echocardiography 6 weeks after surgical repair of ASD showed persistent but less marked MVP in all cases. Echocardiographic evidence of MVP was therefore demonstrated in 5 out of 50 patients (10%) with secundum ASD. It was more common in children (15%) than in adults (4%). These results differ from those previously published, probably because of differences in method (use of echo and angiography), diagnostic criteria, size of atrial shunt and the incidence of associated mitral regurgitation. The prevalence of MVP in patients with ASD may have been overestimated in previous publications.

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A case of hemangioma of the retina is reported. Its typical ophtalmoscopic and fluorescein angiographic aspects are studied. The benign evolution is stressed in spite of a possible macular risk checked by argon laser therapy.

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