[Surgical treatment of an idiopathic macular hole: preliminary results]. / Traitement chirurgical du trou maculaire idiopathique: résultats préliminaires.

Our preliminary results include 8 patients (8 eyes) presenting with an idiopathic stage III full-thickness macular hole (Gass classification), 6-month-old or less by history. Five eyes were examined after complete disappearance of the gas C3F8 injected in the vitreous cavity at completion of surgery. Anatomical success, defined as a macular hole with a 360 degree flat edge, or as a macular hole which is no more visible, was obtained in 4 cases out of 5, as well as functional success, defined as a visual acuity improvement of 2 lines or more on the Snellen chart. Keeping in mind the well-known natural history of idiopathic full-thickness macular holes, our preliminary results are encouraging and allow us to persevere in this surgery, whom indications and optimal methods are still to be defined.

[Effect of local medications on intraocular pressure control following trabeculectomy]. / Influence des médications locales sur le contrôle de la pression intra-oculaire après trabéculectomie.

Longterm administration of topical antiglaucoma therapies had been indicated to be a serious risk for failure of trabeculectomy through inducing a subclinical inflammation of conjunctival tissues and stimulating secondary fibroblastic proliferation. Our study had 3 main aims: (1) to check if this pejorative effect is present in our population of glaucomatous patients, (2) in order to improve the rate of surgical success in theoretically high risk patients (duration of topical treatment longer than 36 months), to determine the usefulness of the following actions: suppression of beta blocking agents 8 days before surgery, suppression of miotics and eventual topical administration of fluorometholone one month before surgery. (3) to correlate the observed clinical results to the cellular profile of preoperative conjunctival biopsies. We presented in a first step the results of a retrospective analysis including 88 trabeculectomies performed between January '93 and April '95 in 62 GCAO patients older than 40 years and without any previous ocular surgery. The mean age of patients was 66,8 years (41 to 87 years). Patients were classified into "complete success", "qualified success" and "failures" according to the "target" IOP was or was not reached in the last examination. Mean follow up was 5,8 months (1 to 26 months). The second prospective part of our study included 20 trabeculectomies performed in 16 patients we chose according to the nature, the duration of the preoperative topical therapy and the preoperative eventual preparation of the conjunctiva. This study also included a semiquantitative count of the different conjunctival cellular colonies in peroperative biopsies. Mean follow up of this study was 2,3 months (1 to 5 months). 31 "complete success", 52 "qualified success" and 5 "failure" were observed in the retrospective study. The reduction of IOP following trabeculectomy was statistically significant at all examinations (mean IOP in the last examination: 14,9 +/- 4,3 mmHg) but the level of success was not significantly different according to the nature, (mono against polytherapy), the duration of preoperative medical topical treatment, as well as the preoperative actions in order to improve the operative success in high risk patients. Preliminary results of our second prospective study did not yet show any failure and did not exhibit any clear correlation between the counts of the different cellular colonies and the level of operative success on one hand and the different topical therapies in the other hand. The results and limitations of this study were compared to those of the literature.

[Internal approach to dacryocystorhinostomy. General considerations and preliminary results]. / La dacryocystorhinostomie ab interno. Considérations générales et résultats préliminaires.

Although external dacryocystorhinostomy is still preferred by most ophthalmologists, the authors describe the endonasal approach. They comment their preliminary results with 25 endonasal dacryocystorhinostomies.

Subnormal growth during puberty in children treated for acute lymphoblastic leukemia.

Growth was studied longitudinally in 19 children who were long-term survivors after acute lymphoblastic leukemia (ALL). Of the children, 13 were girls; 6 were boys. They had all undergone a 3-year cytostatic treatment period which included vincristine, adriamycin, asparaginase, methotrexate, purinethol, and prednisone. Prophylactic cerebral irradiation (20-24 Gy) had been given to all children; 4 of them had also been given irradiation to the spine (10 Gy). The pattern of growth was nearly identical in girls and boys. Growth in relation to the therapy was almost normal, whereas growth during puberty was subnormal and final height was 1.3 SD less than expected at onset of disease. The growth pattern was the same for children with cerebrospinal irradiation as for those with cerebral irradiation. In view of the present results and previous studies on growth hormone (GH) secretion after cerebral irradiation, we suggest that treatment with luteinizing hormone releasing hormone (LHRH) or GH could be considered at puberty for children who have been treated for ALL, including cerebral irradiation, and who have a poor prognosis for final height.