Blood flow rate in the microvasculature of the optic nerve head in primary open angle glaucoma. A new approach.

In order to evaluate the optic nerve head perfusion in patients with primary open-angle glaucoma (POAG), we measured the velocity of the red blood cells (RBCs) in the capillaries of the optic nerve head with a laser-Doppler velocimeter and evaluated the blood viscosity by determining the capacity of the RBCs to disaggregate with an erythroaggregameter. Our results showed that in POAG patients optic nerve blood velocity was reduced and that the aggregability of the RBCs was increased. The two parameters were not significantly correlated, possibly because of local papillary autoregulation and anatomical variability in the papilla vessels. These two factors could explain why the same rheological anomaly in two subjects could lead to different responses in blood velocity. The RBC hyperaggregability cannot be explained by quantitative modifications of the plasma proteins. Modifications in the membrane of the RBCs could indeed be responsible for hyperaggregability, since our data suggest that deformability of the RBCs is impaired in glaucoma.

New technique for knife and radial keratotomy.

BACKGROUND: Radial keratotomy is the most popular method of surgical correction of myopia, but requires further improvements. This study presents a new knife design for radial keratotomy. METHODS: Radial keratotomy was performed on 120 eyes of 60 patients with myopia. We utilized two diamond knife designs. The new knife allows a surgeon to perform corneal incisions of varying programmed depth with one movement of the hand, deeper at the limbus. As a control, we used the standard Fyodorov knife. One eye was operated on with one type of knife, the other eye with the other type. The number of incisions was the same with both techniques. RESULTS: After a 2-year follow up of the group of eyes operated on with the new knife, the mean keratometric power changed from 43.20 diopters (D) to 39.30 D, and the mean amount of myopia from -4.37 to -0.32 D. In the group of eyes operated on with the standard knife, the mean keratometric power changed from 43.20 to 39.50 D, and the mean amount of myopia from -4.36 to -0.40 D. CONCLUSIONS: The final refractive effect of the new knife was equal to that of standard knives. However, the new knife was more convenient: duration of surgery was shorter, and there was no need to change the length of the blade to deepen the incisions during surgery.

Optic nerve head blood flow using a laser Doppler velocimeter and haemorheology in primary open angle glaucoma and normal pressure glaucoma.

Optic disc blood flow velocity was measured in healthy patients, those with primary open angle glaucoma (POAG), and patients with normal pressure glaucoma (NPG). The velocity of the red blood cells (RBCs) in the capillaries of the optic nerve head (ONH) has been measured with a laser Doppler velocimeter (LDV), and blood viscosity has been evaluated notably by determining the aggregability of the RBCs with an erythroaggregameter. Our results in POAG patients and NPG patients showed that their optic nerve blood flow velocity was reduced and that the aggregability of the RBCs was increased. The hyperaggregability of the erythrocytes is responsible for the increase of the local viscosity in the papillary capillary network. These haemodynamic modifications observed in patients with glaucoma support the hypothesis of a vasogenic mechanism that could impair the optic nerve in glaucoma patients.

[Hepatocellular carcinoma: a case revealed by metastatic orbital tumor]. / Carcinome hépatocellulaire: un cas de métastase orbitaire révélatrice.

INTRODUCTION: We report a case of metastatic orbital tumor revealing hepatocellular carcinoma. EXEGESIS: Metastatic orbital tumors of hepatocarcinoma are rare. Only six cases have been reported. We compare these cases to our observation. Treatment of the orbital metastasis is important to decrease pain, ophthalmological symptoms and to improve the quality of survival. Radiotherapy and/or surgery can be used. Prognosis for life depends on liver involvement: the modalities of treatment of the hepatocarcinoma have to be discussed for each patient. CONCLUSION: Seven cases of orbital metastasis revealing a hepatocarcinoma have been documented. Effectiveness of radiotherapy makes the local prognosis good, but prognosis depends on liver involvement, since prognosis of hepatocellular carcinoma is poor.

[Diagnostic procedures in optic neuropathies]. / Démarche diagnostique devant une neuropathie optique.

Functional disturbance and ophthalmoscopic feature are the most important parameters to diagnose optic neuropathy. Swelling of the optic disc is produced by 2 aetiologies: inflammation and ischaemia. The most frequent cause of retrobulbar neuritis remains multiple sclerosis.

[Hemo-rheology of glaucomatous neuropathy]. / Hémorhéologie de la neuropathie glaucomateuse.

The vascular participation to the optic nerve pathogenesis has been contradicted. The red blood cell velocity in the optic nerve capillary with a laser Doppler velocimeter, an atraumatic and reliable method, and the aggregability was determined with an erythroaggregameter to know whether an erythrocyte hyperaggregability could slow down the optic nerve blood flow as it has been previously demonstrated in an experimental study. The experiment on the open angle glaucoma patients showed that their optic nerve blood flow was reduced, and their erythrocyte aggregability significantly increased. The two parameters were not significantly correlated, certainly because of a local papillary autoregulation and of the papilla vessels variability, those two factors could modulate the blood flow response to blood qualitative changes. The erythrocyte hyperaggregability could be explained by erythrocyte membrane modifications that could agree with the glaucoma heredity.

[Larrey and Egyptian ophthalmia]. / Larrey et l'ophtalmie d'Egypte.

During the napoleonic expedition to Egypt (1798-1801), a new ophthalmic disease, the "egyptian ophthalmia", was discovered by the french physicians. We analysed a contemporary study published by the surgeon Jean-Dominique Larrey. The accuracy of the clinical description enables us to suggest hypotheses upon the origin if the egyptian ophthalmia: Weeks' conjunctivitis, gonorrheal conjunctivitis, trachoma. Treatments are also reviewed. Larrey is to be seen as a symbol of the transition from the old medical vision to modern clinical medicine.

[Nevus of Ota. Apropos of a bilateral case]. / Le naevus de Ota. A propos d'un cas bilatéral.

A case of bilateral congenital oculodermal melanocytosis is reported. Ota's naevus is characterized by benign melanosis of the skin of the face in the area supplied by the first (and second) branch of the trigeminal nerve. This is associated with ipsilateral pigmentation of the episclera++, uveal tract, conjonctiva and fundus. The condition is usually unilateral, occurring mainly in the dark races (black races and orientals). Eighty percent of patients are women. It is very rarely potentially malignant, this occurring most frequently in white races and when only ocular (and not oculodermal) melanocytosis is present.

[Intolerance causes of indentation material in retinal detachment surgery (author's transl)]. / Intolérance du matériel d'indentation pour décollement de rétine (ses causes).

129 Lincoff sponge's rejection, representing 4,3% of our retinal detachment surgeries during 4 years have been studied. Men were twice more than women, the larger the amount of material was placed the more frequent rejections appeared. Most rejections (56,2%) occured during the first 4 months. Percentage of infection was roughly not influenced by the time after retinal detachment surgery.

[Familial complicated optic disc drusen in a child]. / Drüses familiales compliquées chez un enfant.

We report a case of a 15-year-old child with optic disc drusen with known familial inheritance and disc swelling. Inheritance and visual field defects are discussed.

[Leber's idiopathic stellate neuroretinitis. Apropos of 9 cases]. / La neurorétinite stellaire idiopathique de Leber. A propos de neuf cas.

Leber's optic neuroretinitis is a particular form of optic neuropathy characterized by swelling of the optic disc and a stellate pattern of exsudative deposits in the macula. It occurs most often in healthy young subjects who have acute monolateral visual loss, often preceded by presumed viral illness. The etiology is unknown and viral infection has been suggested in the pathogenesis of this condition. The prognosis for visual recovery is reported to be excellent, but late visual sequelae have been described: loss of vision or visual field loss. This entity should be recognized and distinguished from more serious diseases causing septic neuroretinitis or papillitis.

[2 trials of measuring the flow of the intraorbital ophthalmic artery using pulsed Doppler]. / Deux essais de mesure du débit de l'artère ophtalmique intra-orbitaire par Doppler pulsé.

We studied the flow pattern of the ophthalmic artery by pulsed doppler. The technique of visualization of the artery using bidimensional echography and the method of flow calculation by pulsed doppler are described in this preliminary report. This direct, non-invasive and readily feasible technique may play a prominent role in the clinical diagnosis of ophthalmic artery diseases.

[Trans-scleral diode laser cyclophotocoagulation for the treatment of refractory pediatric glaucoma]. / La cyclophotocoagulation transsclérale au laser diode dans le traitement des glaucomes réfractaires du sujet jeune.

PURPOSE: To evaluate the success rate of contact diode transscleral cyclophotocoagulation (TSCPC) in pediatric refractory glaucoma. PATIENTS: and method: Twenty-eight eyes of 28 patients (age range 5 months to 26 years) with medical and surgical refractory pediatric glaucoma due to primary congenital glaucoma (group 1, 20 eyes) or aphakic congenital glaucoma (group 2: 8 eyes), were included in this retrospective study. All eyes underwent one or more TSCPC with the diode laser (Oculight SLX, Iris Medical) with a minimal follow-up of 2 months. Success was defined as intraocular pressure (IOP) between 6 and 20 mmHg after one or more procedures, with no increase in medical hypotensive therapy, and no progression to another hypotensive procedure. RESULTS: Mean baseline IOP was 29.4 +/- 7.8 mmHg (range 25 to 60 mmHg) and mean follow-up was 10.3 +/- 6.9 months (range 2 to 26 months). Success rates evaluated at 6 and 12 months (Kaplan Meier survival curves) were 54.4% and 27.7% respectively, with one-third of the eyes retreated once or more. These success rates were similar in both groups with a mean baseline IOP decrease of 38.9 +/- 15.9%. Postoperative uncontrolled hypertony occurred in the first 3 months in 6 (21.4%) eyes, leading to surgical IOP management. Other complications were decrease in visual acuity (14.3%), inflammation (25.5%) and phthisis (3.5%). CONCLUSION: TSCPC with the diode laser is a disappointing procedure for the management of refractory pediatric glaucoma, with poor mid-term IOP control and high incidence of complications including severe uncontrolled IOP increase. For these reasons, this cyclodestructive procedure should be considered as a last resort therapy for patients with refractory pediatric glaucoma.

[A glaucoma follow-up of 1500 persons over 20 years]. / Le suivi glaucomateux de 1,500 personnes durant 20 ans.

The parameters of glaucoma risk have been compiled and computer processed on 1,571 patients during 20 years at the C.P.E.M.P.N. (Medical Evaluation Center for the Aeronautic Staff) of Paris. The goal of this study is to follow in real time the évolution of these parameters and to determine their physiological variations across time in terms of age and professional categories. An average intra-ocular pressure of 15.1 mmHg as well as hypertonia and glaucoma percentages respectively of 3.88% and 0.6% have been recorded in this study. These results were below the results of other previous surveys due to the greater age range of our study the youngest being 15 years old. There was no significant difference among pilots and non pilots. The optic disc examination was not decisive for diagnostic screening.

[Absorbable polydioxanone monofilament in the surgery of the anterior segment of the eye]. / Le monofilament résorbable de polydioxanone dans la chirurgie du segment antérieur de l'oeil.

PDS (Polydioxanone suture), a new synthetic absorbable suture, was used in experimental and clinical trials. The experiment was performed on 14 rabbits anesthetized with intravenous sodium pentobarbital. Five months were needed for complete absorption of a piece of PDS left in a tunnelled corneal stroma. As late as the end of the second month no histological absorption was detected. This was twice as long as that persistence of polyglactin sutures studied under the same experimental conditions. In another series of 12 animals, the PDS suture was placed in the central cornea and tied with a buried knot. The PDS suture broke four to six weeks postoperatively in the superficial part of the cornea. The histologic tissue reaction in both these studies was minimal, resembling that obtained with black 10/0 monofilament nylon. In the clinical study, PDS sutures were used (size 0.2 metric and 0.3 metric) in 38 cases of cataract extraction. The material was easy to handle, especially when dyed violet. No side-effects attributable to the suture material were observed. PDS retained its tensible strength longer than other absorbable sutures, but can be used only for closing limbal incisions with conjunctival flaps in order to prevent tear hydrolysis of the suture.

[Essay about lacrymal proteins during sicca syndromes (author's transl)]. / Etude des protéines lacrymales au cours des syndromes secs.

Most of sicca syndromes are expressed in a modification of specifically lacrimal proteins. These modifications are involving:--perturbations in tears-electrophoresis, residing in a more or less important decrease of one or several lacrimal proteins,--a frequent sinking in rate of total lacrimal proteins,--a slump of antimicrobial property in tears. The electrophoretic modifications could serve for base to biological classification of sicca syndromes.

[Acute ischemic optical neuropathy which became bilateral in 3 days in Horton disease]. / Neuropathie optique ischémique aiguë bilatéralisée en 3 jours dans le cadre d'une maladie de Horton.

We report a case of a 71-year-old man with sequential visual loss within 3 days due to giant cell arteritis confirmed by a temporal artery biopsy. The anterior ischemic optic neuropathy was associated with cilioretinal artery occlusion on the right eye. He improved after intravenous corticosteroid therapy. Clinical characteristics and treatment are discussed.

[Unexplained bilateral optic disk edema. So-called idiopathic intracranial hypertension of drug origin should be suspected]. / Oedème papillaire bilatéral inexpliqué. Penser à l'hypertension intracrânienne dite idiopathique d'origine médicamenteuse.

In 2 clinical cases of bilateral optic disk oedema, the optic disk oedema was part of a so-called benign, or rather idiopathic, intracranial hypertension. Aetiological investigations were unable to detect any intracranial or systemic anomaly, except the fact that both patients had been on a long-term treatment. The first, a 35-year-old man, was taking Roaccutane (isotretinoin) for acne, for at least 5 years, Supradyne (containing vitamin A) minimum 1 pill per day. The second patient, aged 16 years, had also been treated for acne with Roaccutane and Mynocine (minocyclin) for several months. Minocyclin and vitamin A, contained in these substances, are likely to have induced the idiopathic intracranial hypertension, and consequently the optic disk oedema. Indeed, discontinuing the treatment and rachicentesis led to a significant resolution of symptoms. A good history of the clinical cases thus remains a key-element in the process of diagnosis-making and should be strictly conducted in cases with bilateral optic disk oedema, particularly when seen in young patients.

[Prevention of postoperative inverse astigmatism during radial keratotomy]. / Prophylaxie de l'astigmatisme postopératoire inverse pendant la kératotomie radiaire.

Seventy eight patients (156 eyes) were treated by radial keratotomy. Patients with spherical axial myopia were selected (including 39% of physiological astigmatism cases). After radial conventional technique the against-the-rule astigmatism > 1.0 D is 31.6% and between 1.0 and 2.0 D is 3.4% versus 0.6% (< 1.0 D) and 0.1% (1.0-2.0 D) with the modified technique. To decrease the frequency of the against-the-rule postoperative astigmatism after RK procedure we performed 1 or 2 vertical additional flag-incisions on the horizontal meridian to counteract the effect of the corneal oedema on the superior incisions.

[Management of corneal microperforations during radial keratotomy]. / Conduite à tenir devant des microperforations cornéennes au cours de la kératotomie radiaire.

Corneal microperforations induce a corneal astigmatism since refractive effect is increased on the perforated meridian. To counteract this induced refractive error, we performed "flag" or tangenital incisions on the perpendicular meridian.