Non-cycloplegic screening for refractive errors in children with the hand-held autorefractor Retinomax: final results and comparison with non-cycloplegic photoscreening.

AIMS: To establish the results of refractive screening of preschool children with the hand-held autorefractor Retinomax under non-cycloplegic conditions, and to compare these results with those of photoscreening. METHODS: Among 1218 children undergoing non-cycloplegic refractive screening, 302 (25%) were also refracted under cycloplegia using the same refractor and were used as controls. Our criteria for a positive screening test were based on the spherical or cylinder values and were: myopia over 3D, astigmatism > or = 2D, spherical or cylindrical anisometropia > or = 1.5D, and hyperopia > or = 1.5D. Absolute myopia over 3D, absolute astigmatism > or = 2D, absolute anisometropia > or = 1.5D and absolute hyperopia > 3.5D were considered as true positives. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated within the group of controls for each refractive anomaly. On the basis of Bayes' theorem, these figures were then corrected to yield the true screening results that would be expected in a population without verification and selection bias. To determine the usefulness of this screening technique, the likelihood ratios for positive test results (+LR) were also calculated. The results of this screening in terms of sensitivity, specificity and predictive values were then compared with those of photoscreening. RESULTS: The basic results of screening with the hand-held autorefractor were as follows: -EHyperopia: sensitivity 46%, specificity 97%, PPV 55%, NPV 96%, +LR 15; -EAstigmatism: sensitivity 37%, specificity 99%, PPV 69%, NPV 96%, +LR 37; -EAnisometropia: sensitivity 66%, specificity 93%, PPV 19%, NPV 99%, +LR 9; -EMyopia: sensitivity 87%, specificity 99%, PPV 33%, NPV 100%, +LR 87. The comparison with photoscreening revealed a similar performance when screening for hyperopia, but the hand-held autorefractor yielded much better figures when screening for astigmatism. In the case of myopia and anisometropia, the lack of consistent information concerning photoscreening invalidates any comparison. CONCLUSION: The hand-held autorefractor Retinomax appears to have potential as a screening device. Our experience with the non-cycloplegic screening of preschool children for refractive anomalies indicates definite usefulness and reasonable accuracy of the Retinomax for detecting myopia, astigmatism and hyperopia. The weak point of this screening technique is the diagnosis of anisometropia, with only moderate utility and poor accuracy.

[Non-traumatic method of intubation of the lacrimal duct using a silicone tube: synergism between the ophthalmologist and the anesthetist]. / Méthode atraumatique d'intubation de la voie lacrymale par tube de silicone: synergie entre l'ophtalmologue et l'anesthésiste.

The authors evaluate an atraumatic catheterisation of the lacrymal system by using a prolene silastic intubation and a standard nasal aspiration probe. After recovery of both prolene end and nasal probe out of the throat the prolene was threaded into the aspiration probe and both were taken off back out of the nose.

[Cure of post-traumatic bilateral paralysis of the cranial nerve IV]. / Cure de paralysies bilatérales post-traumatiques des nerfs IV.

We relate our own experience about bilateral inferior rectus recession as first surgery for traumatic bilateral superior oblique palsy. An adjustable suture is performed on one side. This procedure is combined or not with an inferior oblique recession. Measurements of ocular deviation and torsion, Lancaster tests and binocular single vision fields are reported pre- and postoperatively. Reduction of diplopia, cyclodeviation and V esotropia with an expansion of the binocular single vision field is achieved in all cases, relieving patients' complaints. This surgery is easy to perform and free of important secondary effects. We think it represents a valuable choice for that kind of pathology.

How accurate is the hand-held refractor Retinomax(R) in measuring cycloplegic refraction: a further evaluation.

AIMS To assess the agreement between the hand-held autorefractor Retinomax(R) and three different on-table autorefractors when measuring cycloplegic refraction in subjects with small and high ametropia. To assess the agreement between the cycloplegic refraction using the Retinomax(R) and by retinoscopy in children with small and high ametropia. METHODS Part A.276 subjects were refracted under cycloplegia using both the Retinomax(R) and an on-table infrared automated refractor (Topcon RM-A 6000, Nidek AR 800 or Nikon NR 5000). They were separated into subjects withsmall ametropia (mean sphere 3.5 D hyperopia, > 3 D myopia). The agreement between both types of refractors regarding the different refractive components was assessed for the whole group and for the two subgroups of small and high ametropia. Part B. 48 infants were refracted under cycloplegia by retinoscopy and by the Retinomax(R). The agreement between both methods of refraction was analyzed in the same manner as in part A. RESULTS Part A. No significant bias was found between the two types of refractors with regard to the spherical equivalent. The 95% limits of agreement were +/- 1 D. Although no clinically significant bias was found with regard to the cylinder power in the 276 subjects, it was found that the 95% limits of agreement were much better (+/- 0.75 D) in small ametropia subjects than in high ametropia subjects (-2.1 to +1.3 D). No significant bias was found with regard to the axis determination. Part B. No significant bias was found between the Retinomax(R) and retinoscopic measurements with regard to the spherical equivalent. The 95% limits of agreement were -1.36 to +1.76 D. However, the mean difference for spheres and cylinders showed a positive bias and a negative bias, respectively, suggesting more positive spheres and larger cylinders when measured by the Retinomax(R) compared to retinoscopy. This was particularly obvious in cases of high ametropia. CONCLUSION Compared to retinoscopy and on-table autorefraction, the hand-held refractor Retinomax(R) is accurate in any ametropia with respect to the spherical equivalent. In small ametropia, there is a good accuracy when measuring the three refractive components (sphere, cylinder and axis). The accuracy decreases in high ametropia, especially with regard to the cylinder power.

[Why and how to correct hypermetropia?]. / Pourquoi et comment corriger l'hypermétropie?

How and why to prescribe an optical correction in hyperopia is described. The reasons for prescribing are closely related to the visual risk of not doing so (amblyopia, lack of stereopsy, strabismus), to the patient's complains and history as well as to his ophthalmological examination. How to correct hyperopia depends on the presence or absence of squint and on the amount of ametropia.

[Peripheral ulcerative keratitis and a form of limited wegener's granulomatosis]. / Kératite périphérique ulcérative et forme limitée de la granulomatose de Wegener.

A man aged 68 years presents superior limbal infiltrates at his left eye two weeks before a marginal ulcer which quickly perforates. He has no systemic complaint. Clinical, biological, radiologic and histological evaluations disclose superior airways and lungs implications, an inflammatory syndrome, high ANCA (antineutrophiles cytoplamic antibodies) titer and vasculitis. There is no sign of renal involvement. A limited form of Wegener's granulomatosis is diagnosed. The outcome is favorable with a partial penetrating keratoplasty and systemic corticosteroid therapy in association with immunosuppressive drugs. This so called limited form of Wegener's granulomatosis is sight threatening when eye is the initial presentation. The early diagnostic and treatment will be performed by the help of ANCA in cases with subclinical systemic manifestations.

Effect of cold pressor test on single-breath DLCO in normal subjects.

We hypothesized that the decrease in single-breath diffusing capacity of CO (DLCO) as observed in patients with Raynaud's phenomenon (P.J. Fahey et al. Am. J. Med. 76:263-269, 1984) may be present in normal subjects. Therefore, we examined 31 healthy subjects in two different laboratories. Two series of experiments were performed. In the first series DLCO was measured in 22 volunteers before (twice) and 5, 10, and 30 min after a cold pressor test (CPT), which consisted of immersing both hands in a 12 degrees C water bath for 2 min. In the second series right heart catheterization was performed in nine healthy seated subjects. Cardiac output, mean pulmonary arterial pressure, heart rate, and pulmonary wedge pressure were measured before, during, and 10, 20, and 30 min after the CPT. In every volunteer the CPT induced a decrease in DLCO that was still present 30 min after the test. In the nine catheterized subjects DLCO increased above control values during the CPT and then decreased below control values for 30 min. The CPT had no effect on cardiac output, heart rate, or pulmonary wedge pressure. In contrast, pulmonary arterial pressure and pulmonary vascular resistance increased during the CPT and then became lower than the control values for at least 30 min. In summary, the CPT induced a biphasic evolution of DLCO in normal subjects, being increased during the CPT and decreased after it. Our data are best explained by the West model of the lung. Our data suggest that the pulmonary Raynaud's phenomenon is not specific to patients with primary Raynaud's phenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)

Astigmatism after a large scleral pocket incision in extracapsular cataract extraction.

In this four-month prospective study, we measured astigmatism in 116 patients who had extracapsular cataract extraction through a 13 mm scleral pocket incision. In one group, the wound was closed with five radial 10-0 polypropylene sutures. Early and late postoperative astigmatism in this group was approximately 2 diopters (D), but a significant shift to against-the-rule astigmatism occurred. In a second group, an additional 10-0 polypropylene horizontal suture was placed anteriorly to the radial suture at the 12 o'clock meridian. This reduced the against-the-rule astigmatic decay. Moreover, this group had less postoperative astigmatism. Mean corneal astigmatism was 2.27 D at one week, 1.76 D at one month, 1.37 D at two months, and 1.70 D at four months. In neither group was cutting the sutures necessary.

[Sturge-Weber syndrome: apropos of an anatomo-clinical case report with prepapillary glial proliferation]. / Syndrome de Sturge-Weber: à propos d'une observation anatomo-clinique avec prolifération gliale prépapillaire.

The authors report the case of a woman with Sturge-Weber syndrome (oculotrigeminate form) presenting with neovascular glaucoma of abrupt onset during pregnancy. Since medical treatment failed, she underwent a retrobulbar alcoholisation. Three months after delivery, enucleation was performed for esthetic reasons. The enucleated eye showed diffuse choroidal angioma, total retinal detachment and a prepapillary glial proliferation. We discuss this uncommon association.

[Role of argon laser trabeculoplasty in the treatment of open-angle glaucoma: a 7-year retrospective experience]. / Apports des trabéculoplasties au laser à argon dans le traitement des glaucomes à angle ouvert: expérience rétrospective sur 7 ans.

We present a retrospective study of 534 Argon laser trabeculoplasty which we realized from January 1983 to July 1990 on 356 primary open-angle glaucoma and secondary open-angle glaucoma patients. Follow-up is ranging from 3 months to 7 years. Photocoagulation was limited to 180 degrees trabecular surface in 300 cases and were completed to 360 degrees in the 234 other eyes. We observed an overall cumulated success rate of 87% at 6 months, which decreased slowly further to reach 32.6% at 6 years. Before laser, the mean intra-ocular pressure was 25 mmHg, this value decreased "a maxima" after 18 months (6.3 mmHg) and slowly increased afterwards but was still significant at 6 years. Some parameters may be of better prognosis: an age equal or older than 65 years, pigmentary dispersion syndrome and pseudo-exfoliative glaucoma. Laser trabeculoplasty associated with hypotensive drugs are an efficient and innocuous technic for controlling open-angle glaucoma; however, after a 30 months mean period, we observe a decrease of their efficiency.