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PURPOSE: To evaluate the efficiency and safety of intravitreal implant of 0.7mg dexamathasone in visual impairment due to diabetic macular edema (DME). MATERIALS AND METHODS: This was a retrospective, multicenter, study. Seventy-four patients, with a mean age of 65 years, followed for at least 6 months (mean follow-up: 9.8 months) were included in 5 French eye clinics (P 1.5 collective). The mean systolic blood pressure was 138mmHg and the mean HbA1c was 7.2%. We monitored 2 systemic parameters: blood pressure and glycemic balance. Best-corrected visual acuity (BCVA), central retinal thickness (CRT, Spectralis OCT), intraocular pressure (IOP) and cataract progression are studied at baseline and then at 1, 2, 4 and 6 months. RESULTS: The average CRT decrease was: 239µm at month 2 (M2) and 135µm at month 6 (M6). The mean improvement from baseline of BCVA is 8.5 letters at M2 and 7.6 letters at M6. A gain greater than 15 letters is found in 27% of patients at M6. For naive patients the BCVA is 71 letters versus 60 letters (P<0.05). Patients with a baseline CRT <500mmHg have a BCVA of 66 letters versus 57 letters (P<0.05). The mean rate injections was 1.2 at 6 months with an average of 5.4 months for reinjection. Ocular hypertension greater than 25mmHg, managed by topical treatment, is observed in 13.4% of patients. No glaucoma surgery was necessary. CONCLUSION: Dexamethasone has an anatomical and functional effectiveness in the treatment of DME. Outcomes for naive patients and lower CRT suggest that the duration of diabetes mellitus and previous treatments are negative factors of recovery. Side effects are rare and manageable. Ozurdex(®) seems to be a treatment for visual impairment due to DME with a favorable safety profile. Patient follow-up must be adapted to half-life of the product with a control before M1 (intraocular pressure) and before M5 (DME recurrence, BCVA).

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We report a 53-year-old woman with hyperkaliemia secondary to treatment with atenolol. The diagnosis of atenolol induced hyperkaliemia was obtained after excluding other causes of hyperkaliemia and normalization of potassium serum level following the discontinuation of this medication without any other modification (treatment or diet). Furthermore, when atenolol was again introduced, serum potassium level increased and normalized when atenol was definitively discontinued. The mechanism of hyperkaliemia we suspected is probably a reduction of potassium intracellular transfer.

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Human T-cell lymphotropic virus type I (HTLV-I) is associated with adult T-cell leukemia (ATL) and tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM). Other inflammatory disorders may occur in HTLV-I-infected patients, such as sicca syndrome resembling Sjogren's syndrome. The sicca syndrome may be the unique clinical manifestation of HTLV-I infection, but is associated frequently with TSP/HAM, which could suggest that sicca syndrome might be an early event in disease progression to TSP/HAM in some cases. We investigated whether peculiar pX and LTR mutations could be related to sicca syndrome, or might argue the existence of clinical progression to TSP/HAM. pX, especially pX(I), pX(II), and pX(IV) ORFs corresponding to Tax cytotoxic T-lymphocyte epitopes, and LTR regions from Caribbean patients who have sicca sydrome with or without TSP/HAM, ATL patients, and healthy carriers were sequenced. The sequences were aligned and compared with ATK-1 prototype and published sequences. LTR sequences exhibited 1.5-2.4 percent of divergence with ATK-1. pX-sequenced regions showed a lower homology within p12(I) encoding sequences. Only few mutations were found within functionally important regions, but were not associated specifically with the clinical status. Finally, no existence of clinical progression to TSP/HAM were found. It would be of interest to study the clinical evolution of HTLV-I-sicca syndrome in patients and to determine HTLV-I sequences from peripheral blood and salivary glands at different stages. Copyright 1999 Wiley-Liss, Inc.(Au)

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Human T-cell lymphotropic virus type I (HTLV-I) is associated with adult T-cell leukemia (ATL) and tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM). Other inflammatory disorders may occur in HTLV-I-infected patients, such as sicca syndrome resembling Sjögren's syndrome. The sicca syndrome may be the unique clinical manifestation of HTLV-I infection, but is associated frequently with TSP/HAM, which could suggest that sicca syndrome might be an early event in disease progression to TSP/HAM in some cases. We investigated whether peculiar pX and LTR mutations could be related to sicca syndrome, or might argue the existence of clinical progression to TSP/HAM. pX, especially pX(I), pX(II), and pX(IV) ORFs corresponding to Tax cytotoxic T-lymphocyte epitopes, and LTR regions from Caribbean patients who have sicca syndrome with or without TSP/HAM, ATL patients, and healthy carriers were sequenced. The sequences were aligned and compared with ATK-1 prototype and published sequences. LTR sequences exhibited 1.5-2.4% of divergence with ATK-1. pX-sequenced regions showed a lower homology within p12(I) encoding sequences. Only few mutations were found within functionally important regions, but were not associated specifically with the clinical status. Finally, no mutations that could be related to sicca syndrome or argue the existence of clinical progression to TSP/HAM were found. It would be of interest to study the clinical evolution of HTLV-I-sicca syndrome in patients and to determine HTLV-I sequences from peripheral blood and salivary glands at different stages.

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We previously reported a strikingly high prevalence of ocular diseases in HTLV-I infected patients in Guadeloupe (Caribbean basin). We sequenced the surface envelope encoding region of 7 HTLV-I proviruses from guadeloupean patients (5 with sicca syndrome, 2 with TSP/HAM). No relation between sequence and disease was observed. These 7 sequences are the first described from Guadeloupe.

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The induction of specific neutralizing antibodies is an important part of vaccine strategy against human T cell leukemia virus type I (HTLV-I). A recently developed reporter gene induction assay was used to detect and quantify neutralizing antibodies in sera of HTLV-I-infected patients with different clinical states: Most sera (73/89) displayed an inhibitory activity. Neutralizing antibodies were more frequently detected in sera of patients with tropical spastic paraparesis/HTLV-associated myelopathy (TSP/HAM) or sicca syndrome (SS) (100%) than in sera of patients with adult T cell leukemia (ATL; 50%) or of asymptomatic carriers (AS; 83%). The mean titers in the different groups were significantly different (ATL < AS < TSP/HAM and SS). The antibody reactivity detected by the reporter gene inhibition assay was significantly related to the recognition of the neutralizable immunodominant domain (aa 175-199) of the surface envelope glycoprotein, indicating the importance of this region for potential vaccines.

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PURPOSE: To evaluate the role of cryopexy in the stimulation of postoperative proliferative vitreoretinopathy (PVR) in primary rhegmatogenous retinal detachment. MATERIALS AND METHODS: A series of 595 eyes of 554 patients with primary rhegmatogenous retinal detachment, referred before any failed surgery, were prospectively evaluated. Univariate and multivariate statistical analyses of the data were conducted. RESULTS: The incidence of postoperative PVR in relation to the methods used for retinopexy was dependent on the types and anatomy of retinal breaks associated with retinal detachment. The incidence of postoperative PVR was nil in retinal detachments due to atrophic holes in lattice, oral dialyses, and macular holes, regardless of the retinopexy methods. Postoperative PVR occurred solely in retinal detachments due to horseshoe tears (incidence 4.42%), paravascular tears of the postequatorial region (18.18%), and giant tears (24.6%) (P < 0.00001). The incidence of postoperative PVR was 0.5% in eyes with horseshoe tears with mobile posterior edges vs 9.72% in eyes with horseshoe tears with curled posterior edges, regardless of the retinopexy methods (P < 0.00001). In retinal detachments due to horseshoe tears with mobile posterior edges the incidence of postoperative PVR (0.5%) was not influenced by the retinopexy methods. In contrast, in retinal detachments due to horseshoe tears with curled posterior edges the incidence of postoperative PVR was higher in eyes managed with cryopexy (14.77%) than in eyes managed with laser retinopexy (1.78%) (P < 0.02). In retinal detachments due to giant tears the incidence of postoperative PVR was not statistically significantly greater in eyes managed with cryopexy (33.3%) than in eyes managed with laser retinopexy (15.6%). In tears 180 degrees and over in size, however, the incidence of postoperative PVR was significantly higher in eyes managed with cryopexy (9/11 eyes) than in eyes managed with laser retinopexy (5/17 eyes) (P = 0.006). CONCLUSIONS: Cryopexy is not a stimulating factor for postoperative PVR in primary rhegmatogenous retinal detachments due to atrophic holes in lattice, oral dialyses, macular holes, or horseshoe tears with mobile posterior edges. In contrast, cryopexy probably is a stimulating factor for postoperative PVR in retinal detachments due to horseshoe tears with curled posterior edges or to retinal tears 180 degrees and over.

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The reactivity of sera of 96 individuals infected with human T-cell leukemia virus type I (HTLV-I) was tested against various synthetic peptides corresponding to the gp46 immunodominant antigenic domains: residues 86-107, 175-199, and 239-261. The frequency of reactive sera was higher for 175-199 (93%) than for 239-261 (78%) or 86-107 (24%) with some variations in geographical regions and in diseases. The region 239-261 was extensively analyzed and five (linear or conformational) epitopes were found. The reactivity of sera toward functional or immunodominant domains may depend on the sequence of the infecting virus, and the role of three frequent substitutions (asparagine by tyrosine, proline by serine, and serine by proline or leucine at positions 93, 192, and 250 respectively) was established. Finally, the role of the genetic background of the host may condition the humoral immune response as individuals infected by HTLV-Is harboring the same predicted gp46 peptide sequence may recognize one, several, or all regions examined.

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INTRODUCTION: Subcutaneous and vascular calcifications are classical manifestations of pseudoxanthoma elasticum. Visceral calcifications sometimes associated with unbalanced phosphocalcium leels are uncommon. CASE REPORT: We observed pseudoxanthoma elasticum in a French Caribbean patient who had extensive acneiform skin lesions with transepidermal elimination. Multivisceral calcifications were associated hyperphosphoremia alone. DISCUSSION: The pathogenic sequence of phosphocalcium disorders in this disease are discussed on the basis of calcifications and hyperphosphoremia observed in this case and from data in the literature.

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PURPOSE: To determine whether the incidence of severe postoperative PVR in primary rhegmatogenous retinal detachment has decreased over the last twelve years. MATERIALS AND METHODS: We prospectively evaluated 595 eyes of 554 consecutive patients with primary rhegmatogenous retinal detachment, referred before any failed attempt to reattach the retina, managed by the same surgeon between March 1983 and December 1994. The eyes were divided into two consecutive series: 275 eyes operated on from March 1983 through February 1988 (series no. 1), and 320 eyes operated on from February 1988 through December 1994 (series no. 2). We conducted univariate and multivariate statistical analyses to compare the incidence of postoperative PVR in the two consecutive series. RESULTS: The overall incidence of postoperative PVR was 8.72% (24/275 eyes) in series no. 1, versus 2.81% (9/320 eyes) in series no. 2 (p < 0.01). The incidence of postoperative PVR in retinal detachments due to atrophic holes in lattice degeneration, oral dialyses, and macular holes in myopic eyes, was nil in both series. The incidence of postoperative PVR in retinal detachments due to horseshoe tears with mobile posterior edges was 1.16% (1/86 eyes) in series no. 1, and 0% (0/109 eyes) in series no. 2. The incidence of postoperative PVR in retinal detachments associated with horseshoe tears with curled posterior edges was 21.15% (11/52 eyes) in series no. 1 versus 3.2% (3/93 eyes) in series no. 2 (p < 0.001). The incidence of postoperative PVR in giant tears was 35.5% (11/31 eyes) in series no. 1. and 14.7% (5/34 eyes) in series no. 2 (chi square = 3.77; at the limit of significance). The incidence of postoperative PVR in retinal detachments du to paravascular tears of the post-equatorial region in myopic eyes was 25% (1/4 eyes) in series no. 1, and 14% (1/7 eyes) in series no. 2. CONCLUSION: In our own experience, the incidence of postoperative PVR in primary rhegmatogenous retinal detachment has decreased at a statistically significant level since 1988. We believe that the decreased incidence of postoperative PVR in our most recent series is mainly related to the use of laser photocoagulation retinopexy rather than cryopexy in the management of high risk eyes (retinal detachments associated with horseshoe tears with curled posterior edges, and giant tears).

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In this study, evidence for a sicca syndrome was sought in 54 HTLV-1 positive patients of whom 33 (61 percent) were women and 21 (39 percent) were men. Patients who had other known causes of sicca syndrome were excluded from this study. A lacrimal hyosecretion was found in 79 percent of cases. A lacrimal qualitative deficiency was found in 86 percent of patients and a variable intensity coloration with fluorescein and/or Rose Bengal was positive in 83 percent of cases. The histological study of the conjunctivals prints showed an ocular dryness in 65 percent of patients. The labial minor salivary glands biopsy showed a Gougerot-Sjogren syndrome in 78 percent of cases. In our study, a sicca syndrome with varying severity was found in 78 percent of cases (AU)

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UNLABELLED: PURPOSE OF THE STUDY AND MATERIAL: A search for sicca syndrome was performed in 54 HTLV 1 positive patients. Cases of sicca syndrome due to associated pathologies, or iatrogenic, were eliminated from this study. RESULTS: Lacrimal hyposecretion was found in 79% of the cases. Defective lacrimal quality was found in 86% of patients and a variable intensity coloration with the Fluorescine and/or with Rose Bengale was positive in 83% of cases. Histological study of the conjunctival print showed ocular dryness in 65% of the patients. Biopsy of the labial minor salivary glands showed a Gougerot-Sjögren syndrome in 71% of the cases. CONCLUSION: In our study, a sicca syndrome with varied gravity was found in 78% of cases.

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We reviewed the clinical files of 314 patients (341 eyes) affected by rhegmatogenous retinal detachment who were operated on before any failed attempt to reattach the retina. The study was conducted to elucidate the clinical and prognostic value of subretinal proliferation. Clinical evidence of subretinal proliferation visible at preoperative examination was more frequent in eyes with retinal detachments related to retinogenic retinal breaks (oral dialyses, atrophic holes in lattice) (32.35%) as compared to retinal detachments associated with horse-shoe tears (4.60%) (P < 0.001). The mean duration of retinal detachments with subretinal proliferation was 12 months (range: 3 months to 5 years). Postoperative proliferative vitreoretinopathy occurred in 2.27% (1/44 eyes) of retinal detachments with subretinal proliferation compared with 6.73% (20/297 eyes) of retinal detachments without subretinal proliferation. Permanent retinal reattachment was achieved in all eyes with subretinal proliferation. However postoperative visual acuity of 20/40 or better was obtained in only 34% (15/44 eyes) of eyes with subretinal proliferation compared with 58% (160/275 eyes) of retinal detachments without subretinal proliferation (P < 0.01).

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