Traumatic fracture of flexible anterior chamber intraocular lenses.

Two patients had fracture of a flexible, open-loop, anterior chamber intraocular lens (IOL) caused by ocular trauma. Case 1 was a 78-year-old woman with a three-point-fixation IOL. The two portions of the fractured lens were removed from the anterior chamber. Visual acuity at 10 months postoperatively was hand motion as a result of corneal decompensation. Case 2 was a 36-year-old man with a four-point-fixation IOL that broke and dislocated into the vitreous. A pars plana vitrectomy was performed; the two lens portions were removed and exchanged with a sutured posterior chamber lens. Best corrected visual acuity 4 months postoperatively was 20/20. In both cases, the lens fracture took place at the loop-optic junction and with minimal visible damage to the eye structures.

Clinical measures of central differential sensitivity in glaucoma.

To verify whether central threshold testing with a common automated perimeter could detect glaucomatous damage, we selected 40 eyes with primary open-angle glaucoma and 43 eyes of age-matched normal subjects. The glaucomatous eyes were free from visual field defects within the central 5 degrees. They underwent the Macula Threshold Test of the Humphrey perimeter, using white and blue targets. Differential sensitivities to both white and blue were significantly depressed in the glaucoma group (p less than 0.001). Blue thresholds of glaucomatous subjects and normal subjects were distributed in two quite separate domains, with a mean difference of 4.51 dB. Sensitivities to blue stimuli were related to age in the normal group (r = 0.62; p less than 0.001), while in the glaucoma group they were related to horizontal cup/disc ratios (r = 0.63; p less than 0.001). These results suggest that threshold testing with an automated perimeter and its built-in colour filters can be of help in detecting early central functional disturbances from glaucoma.

Conservative management of congenital nasolacrimal duct obstruction.

Fifty-nine children 1 to 24 months of age with congenital nasolacrimal duct obstruction (CNDO) were treated with local hydrostatic massage and antibiotic eye drops. Children 1 to 12 months of age showed a cure rate of 93.3%; only two of them underwent nasolacrimal probing. Children 13 to 24 months of age had a cure rate of 79.3%, and six underwent probing. The initial probings were successful in both age groups. Fifty-one children (86.4%) were thus spared nasolacrimal probing.

[Complications of disposable extended-wear contact lenses. Apropos of 6 cases]. / Complications des lentilles cornéennes jetables en port prolongé. A propos de six cas.

We report six cases of corneal complications observed in disposable extended-wear contact lens users: two corneal ulcers, one superficial infiltrate, two punctate keratitis with subepithelial infiltrates and one superficial punctate keratitis. In four cases a bacterial etiology was confirmed. Disposable contact lenses are not complication-free. In our series, complications were favoured or provoked by incorrect use in most cases. Other possible risk factors include poor hygiene during lens manipulation, damage to the corneal epithelium during lens exchange or lens wear, use of contaminated lubricant eyedrops, relative corneal hypoxia during overnight wear or in the case of improper fitting. Correct and adequate patient information is therefore essential to ensure that these lenses constitute a safe choice.

[Threshold testing of the macular area in glaucoma]. / Etude du seuil de sensibilité maculaire dans le glaucome.

The purpose of this study has been to verify whether threshold testing of the central area with a common automated perimeter could detect glaucomatous damage. We selected 31 eyes of 31 patients with primary open angle glaucoma free from defects within the central 5 degrees of the field and 32 eyes of 32 age-matched normal subjects. They underwent the Macula Threshold Test of the Humphrey Field Analyzer using white and blue targets. Statistical analysis of the results obtained showed that threshold sensitivities to both white and blue targets were significantly depressed in glaucomatous eyes (t = 2.44, p = 0.018 and t = 12.59, p less than 0.001 respectively), but only blue thresholds distributed really differently in glaucomatous and normals. Sensitivities to blue stimuli related to age only in normals (r = 0.58; p = 0.0005), while in glaucomatous they were related to cup/disc ratios (r = 0.70, p less than 0.0001 for horizontal C/D; r = 0.52, p = 0.0027 for vertical C/D). These results suggest that it is possible to detect early central functional disturbances from glaucoma using an automated perimeter and its built-in color filters.

[Vascular and rhegmatogenous peripheral retinal changes in essential systemic arterial hypertension]. / Altérations rétiniennes périphériques vasculaires et rhegmatogènes au cours de l'hypertension artérielle systémique essentielle.

The authors examined the peripheral retina of 106 patients affected by essential hypertension grading from 1st to 3rd, as classified by WHO. Research of peripheral retinal vascular alterations and of theoretically possible resulting degenerative changes (lattice degeneration, while without pressure and snail tract degeneration) was carried out. The study included a control group of 39 healthy subjects. A statistical analysis of the resulting data was performed. This showed that the frequency of retinal peripheral vasculopathy is higher in the hypertensive group and is significantly related to the severity of hypertensive retinal angiopathy. In the same way, the incidence of peripheral retinal degenerative changes proved to be significantly higher among the hypertensive group than in the control group. However, a correlation between the frequency of retinal degenerative processes and the presence of vascular changes could not be assessed. The results obtained are discussed, suggesting that peripheral retinal angiopathy could act as a risk factor leading to degenerative alterations on a formerly predisposed retinal tissue.

Chondroid syringoma of the eyelid.

An 81-year-old man underwent excisional biopsy of a big cylindric painless mass of the right lower eyelid, which had been present for over 23 years. Histopathologic and immuno-histochemical examination showed a chondroid syringoma, an uncommon benign neoplasm of possible eccrine sweat gland origin, which occurs generally in the head and neck skin. In the eyelids, it has been previously described as a small nodule in the upper lid. Surgical excision of these tumours is recommendable because malignant transformation is possible, although rare.

Early ultrasonographic diagnosis of hereditary retinoblastoma.

A hereditary retinoblastoma (RTB) was identified by ocular echography in a newborn, whose predisposition to RTB had been assessed based on the family history and DNA testing of the chorionic villi at the eighth week of pregnancy. Ultrasonography was performed during pregnancies without an abnormality being demonstrated. On the third day of life a B-scan examination showed a small membranous lesion in the nasal parapapillary area, whilst on A-scan, the lesion appeared as a hyperreflective peak. Thanks to its early identification, the tumor was successfully treated by photocoagulation.

Prenatal detection and early diagnosis of hereditary retinoblastoma in a family.

A couple asked for prenatal testing, the husband being a retinoblastoma survivor. Family history suggested that the tumor predisposing mutation came from his paternal side. DNA analysis indicated that the foetus had not inherited that mutation. Detection of a regressed retinoblastoma in the husband's mother changed the interpretation of the haplotypes obtained, and it was concluded that the foetus had inherited the mutation. Ultrasonography on the 3rd day of extra-uterine life showed a retinal mass in the newborn's left eye. Two years later, the couple asked for a new prenatal diagnosis. DNA analysis showed that the foetus had inherited the mutant retinoblastoma haplotype from the father. Fundus examination on the 2nd day of extra-uterine life showed a retinal lesion in the newborn's left eye at the posterior pole. This case indicates the necessity of a thorough check on history and an ophthalmological examination of family members.

Clinical detection of early glaucomatous foveal involvement.

The aim of our study was to verify whether threshold testing of the central area with a common automated perimeter could detect early glaucomatous damage. We selected 9 eyes of 9 patients with suspected primary open angle glaucoma and normal visual fields and 18 eyes of 18 age-matched normal subjects. They underwent the Macula Threshold Test of the Humphrey Field Analyzer using white and blue targets. We found no significant difference in retinal sensitivity to white targets between the two groups. Sensitivity to blue targets was significantly lower among glaucoma suspects (18.43 +/- 1.14 dB) than in the control group (22.37 +/- 0.94 dB) p less than 0.001). Blue thresholds related significantly to age only in normals (p = 0.028) while in glaucoma suspects they were strongly related to vertical cup/disc ratios (p less than 0.001). These results suggest that it is possible to detect early central visual disturbances from glaucoma using an automated perimeter and its built-in color filters.

Eye injuries from traditional sports in Aosta Valley.

We reviewed the records of the patients hospitalised for eye injuries in Aosta Valley between January 1976 and June 1993. Eye injuries from traditional regional sports accounted for 27 cases (41.5% of all ocular sport injuries), of which 21 (77.8%) occurred during the game 'tsan', the most popular one. Injuries led to legal blindness in 3 (11.1%) cases and to a permanent visual loss in 2 (7.4%). Although our data do not allow to assess either a significantly higher incidence or severity of eye injuries from Aosta Valley regional games as compared with other sports, the possibility of severe trauma with visual loss suggests to extend the use of protection devices.

Noncontact tonometry in children.

A hand-held noncontact tonometer (Pulsair, Keeler Ltd., UK) was tested in 42 children, from 5 months to 12 years of age. At least 1 intraocular pressure (IOP) reading was obtained in all of the 84 eyes studied, whereas with a Goldman applanation tonometer measurements could be obtained in only 26 eyes (14 subjects). Time required for examination with the Pulsair was quite variable and related to age (p less than 0.0001). Compliance in children was reported as "good" in the majority of cases; it was also age-related (p less than 0.005). Although its reliability could not be definitely evaluated, the results of this study indicate that this instrument may be a valuable choice for screening and follow-up purposes in childhood.

Laser treatment of macular subretinal neovascularizations in angioid streaks.

A serous hemorrhagic maculopathy with a subretinal neovascular membrane appears in about 70% of cases of angioid streaks. In this study a series of 60 eyes (31 patients) was reviewed. In 13 eyes macular subretinal neovascularizations were photocoagulated with blue-green argon laser, green argon laser, dye laser (rhodamine 6G) at 590 nm and red krypton laser. The authors present and discuss the results obtained and suggest that photocoagulation of subretinal new vessels not involving the fovea can be worth performing.

Dye laser photocoagulation of macular subretinal neovascularization in pathological myopia. A randomized study of three different wavelengths.

The authors present a randomized study of 27 eyes affected by pathological myopia with macular subretinal neovascularization which were treated with a tunable dye laser. The effectiveness of three different wavelengths (577, 590 and 620 nm) in the direct treatment of subretinal neovascularizations was evaluated in 3 groups of 9 patients each. Statistical analysis of both visual and anatomical results did not show significant differences among the three wavelengths used.

Electroretinographic findings in panretinal photocoagulation for diabetic retinopathy. A randomized study with blue-green argon and red krypton lasers.

A total of 16 patients (16 eyes) with type II diabetes mellitus and proliferative retinopathy were studied electroretinographically before panretinal photocoagulation, during intervals between the treatment sittings, within 36 h of the final treatment and 4 months after its conclusion. Treatments were carried out with blue-green argon (eight eyes) and red krypton (eight eyes) lasers; the type of laser was randomly chosen. The analysis of the results obtained showed a significant and marked reduction in peak amplitudes of both a- and b-waves in photopic and dark-adapted conditions as early as between the multiple treatments. Electroretinograph (ERG) tracks did not change significantly at subsequent checks. Amplitude reductions were higher for scotopic b-waves and in eyes that had the less altered baseline tracks. Implicit times did not change significantly. The type of laser used did not significantly influence ERG evolution.