Characteristics of patients with complete visual acuity recovery after vitrectomy for macula-off retinal detachment.

PURPOSE: The purpose of this study is to investigate potential factors predicting complete recovery of visual acuity following surgery for macula off retinal detachment (RD). PATIENTS AND METHODS: Retrospective review of patients operated for macula-off RD at Jules-Gonin Eye Hospital between January 2015 and December 2016. The study included patients with visual acuity recovery of 0 LogMAR. A control group of 83 patients with comparable baseline characteristics but partial recovery of visual acuity after vitrectomy for macula-off RD was used for statistical comparison analysis. RESULTS: Seventy-four patients, 46 males (62%) and 28 females (38%), were included. Mean age was 65 years (standard deviation: 12). Median follow-up was 6 months (interquartile range: 3). Fifty patients (68%) were pseudophakic. Median pre-op best-corrected visual acuity (BCVA) was 2 LogMAR (interquartile range: 1.22). Forty-three of the patients (58%) had preoperative BCVA equivalent of count fingers or less. The majority of the patients (91%) had up to 3-day duration of macular detachment (MD) before surgery. In comparison only 18% of the group of patients with partial recovery of visual acuity after vitrectomy for macula-off RD had been operated within 3 days of MD (p < 0.0001). In 63% of the 40 cases in whom an optical coherence tomography (OCT) of the fovea could be interpreted, OCT image showed a retained foveal depression of the detached retina, whereas only 35% of the 46 control eyes with adequate OCT imaging showed a retained foveal depression (p = 0.01). CONCLUSIONS: In our study, patients had significantly better chances of complete visual acuity recovery when operated within 3 days of MD in comparison to more delayed surgery. Additionally, preservation of the foveal depression of the detached retina appeared to be a common characteristic among patients demonstrating complete visual recovery.

[The effects of cycloplegic eyedrops on corneal tomography]. / Effets des gouttes cycloplégiques sur la tomographie cornéenne.

PURPOSE: Whether cycloplegics affect standard keratorefractometric and tomographic measurements is unknown. The purpose of our study was to compare the effects of cycloplegics (cyclopentolate and atropine) on corneal shape and refractive power of the eye. METHODS: This study was performed on 84 eyes of 49 study participants. Patients were randomized into two groups: atropine 1% (32 eyes) and cyclopentolate 1% (52 eyes). Corneal tomography was performed with the Orbscan IIz. To evaluate the corneal shape, simulated keratometry values, anterior and posterior best-fit sphere, white-to-white and tangential and axial corneal power were performed for the anterior and posterior corneal surfaces before and during cycloplegia. Pupil diameter, anterior chamber depth, corneal thickness at the 3, 5 and 7mm optical zones, thinnest area of the cornea and corneal thickness at the visual axis were examined. Data were analyzed using an SPSS statistical package. RESULTS: The anterior and posterior BFS (in the atropine 1% group, anterior BFS was P=0.188; anterior BFS in the cyclopentolate group was P=0.227) and tangential and axial corneal power showed no change during cycloplegia in either group. SimK showed no statistical significance. The ACD was deeper when using atropine than cyclopentolate. Corneal thickness remained unchanged during cycloplegia in both groups. Pupil diameter was larger in light-colored irides in the cyclopentolate group than the atropine group. There was no change in W to W before (P=0.473) and during cycloplegia (P=0.287) in either group. CONCLUSIONS: Our results suggest that usage of atropine or cyclopentolate does not alter corneal shape.

The effects of hemodialysis with different membranes on middle molecules and uremic neuropathy.

Twenty-four hemodialysis patients, 14 with uremic neuropathy and 10 symptom-free, were studied over 12 months. Cuprophan and AN 69 membrane dialyzers were used in their treatment in order to investigate the influence of different membranes on plasma levels of middle molecular weight substances (MMS) and uremic neuropathy. Hemodialysis with the cuprophan membrane caused no significant changes in plasma MMS levels or in the neurological condition of patients. The effect of dialysis with AN 69 membrane depended on initial plasma MMS levels. Initially high plasma MMS levels decreased significantly and significant improvement of neuropathy was achieved. In neuropathic patients with plasma MMS levels similar to those of symptom-free patients, hemodialysis with AN 69 membrane had no effect. These results suggest that hemodialysis with MMS high-permeability membranes may be recommended for neuropathic patients with high plasma MMS levels.

Middle molecular weight substances and uremic polyneuropathy.

A group of 25 uremic patients on regular hemodialysis was examined during 12 months after six-hour dialyses twice a week were changed to five-hour dialyses thrice a week. Twelve of the patients suffered from polyneuropathy, while 13 did not show signs of this uremic complication. The effect was studied of the increase of the amount of dialyses on the severity of polyneuropathy, checked by neurological and electromyographic methods, as well as on the serum levels of uremic middle molecular weight substances (MMS). Sera of the patients were subjected to gel filtration on Sephadex G-15 columns. This analysis resolved MMS into five distinct fractions in the range of middle molecular weight. Sera of the patients with polyneuropathy contained more of MMS in the 2nd and 4th fractions than those without signs of polyneuropathy. During 12 months of treatment with three hemodialyses a week, a significant improvement of polyneuropathy, together with a pronounced decrease of the serum levels of the 2nd and 4th MMS fractions were evidenced. A statistically significant negative linear relationship of polyneuropathy signs and the serum levels of MMS in these two fractions was registered.

[Melkersson's-Rosenthal's syndrome]. / Melkerson-Rozentalov sindrom.

We examined a patient with Melkersson's-Rosenthal's syndrome who was admitted to the Department of Clinical Neurology for acute cerebral hemispheric ischaemic infarction. The patient presented the typical triad of features that include facial oedema, facial palsy, and fissure of the tongue. He had also manifestations unusual for that age (a 33 year-old man): hypertension, permanent haematuria and advanced cerebral stenoocclusive vascular disease. Immunological measurements have shown sligthly increased levels of both serum immunoglobulin and B lymphocytes, and high levels of histamine in blood. The patient was hypersensitive to certain external antigens (exhaust, fumes, Coca-Cola, fungicide--T.M.T.D.). This case demonstates the complexity of this syndrome and illustrates the necessity of long-term follow-up of such patients.