[Positive corneal findings of Propioni bacterium acnes and keratitis]. / Prelevements corneens positifs a Propioni bacterium acnes et keratites.

PURPOSE: Propioni bacterium Acnes may be isolated from corneal specimens. Its presence usually evokes a neighbouring tissue contamination. Nevertheless we have tried to find arguments in favour of a possible pathological responsibility of this microorganism in corneal affections. MATERIAL AND METHODS: A retrospective study was conducted in thirty patients with proved P. acnes corneal infection. The specimens were collected immediately during the first examination in the emergency ward. The research of anaerobic bacteria was made for each corneal specimen. RESULTS: We studied nineteen corneal abscesses and eleven corneal ulcers. Ninety-one percent of the cases presented an associated irritating factor. In decreasing order we found: wearing of soft contact lenses (36%), foreign corneal body still in situ or recently removed (21%), recurrent corneal erosions (9%), palpebral surgery (6%), herpetic keratitis (6%) or rosacea (3%). P. acnes was the only microorganism identified in 97% of the cases. Starting treatment before bacteriological results were known to be effective in each case. CONCLUSIONS: These elements are an argument for the pathological role of P. acnes in corneal infections when combined with favourable local conditions. Its presence does not always mean actual contamination.

[Spontaneous dissection of the internal carotid artery in ophthalmological milieu. Apropos of 10 cases]. / Dissection spontanée de la carotide interne en milieu ophtalmologique. A propos de dix cas.

PURPOSE: Spontaneous dissection of the internal carotid artery is a rare vascular emergency, but represents the first cause of cerebral ischaemia of young patients. Neuro-ophthalmologic symptoms often reveals the pathology. METHODS: Ten cases of spontaneous dissection of the internal artery are reported. The Claude Bernard Horner syndrome is the most frequent symptom typically associated with hemicranial headache. The headache involves the ipsilateral forequarter of the head and the neck. Other ophthalmologic symptoms may also reveal the carotid dissection. RESULTS: At first, the diagnosis is strongly suspected during Doppler ultrasonographic examination. During the acute phase, MRI and MRA replaces advantagiously arteriography, confirming this affection in a non invasive way, and permits investigation of associated vascular pathology like fibromuscular dysplasia (15% of the cases). The patients received anticoagulants in order to prevent thrombo-embolic complications (heparine during the acute phase relayed by AVK). The clinical course is usually favorable with the medical treatment. CONCLUSION: A painful Claude Bernard Horner syndrome strongly evokes a carotid dissection and the arterial check-up must be realised in emergency: at first, the exploratory methods associates Doppler ultrasonographic examination, MRI, and MRA.

[Responsibility of incomplete retinal photocoagulation in the indication of vitrectomy in proliferative diabetic retinopathy]. / Responsabilité des photocoagulations rétiniennes insuffisantes dans l'indication des vitrectomies pour rétinopathie diabétique proliférative.

PURPOSE: We report an epidemiologic study about prophylactic photocoagulation of ischaemic diabetic retinopathy in order to avoid proliferative stage and severe vitreous haemorraghe. METHODS: We studied retrospectively 42 eyes of 32 diabetic patients who underwent a vitrectomy in 1993. For each patient several items were analyzed: nationality, sex, age, type, duration and clinical course of diabetes, and other risk factors. Slit lamp and ocular fundus examination were noted; in particular lens, iris and vitreoretinal framework. RESULTS: Almost all patients had an inadequate laser photocoagulation: in 26 eyes (62%) it was insufficient or non-existent, uncomplete in 12 eyes (29%), and non confluent for 18 eyes (43%). Only four eyes have had complete and confluent panphotocoagulation. CONCLUSION: Photocoagulation appears to be the priority therapy to avoid most severe complications of proliferative diabetic retinopathy. Laser photocoagulation must be started from preproliferative retinopathy, confluent on the useless ischaemic retinal areas, and dense elsewhere.

[Prediction of functional recovery after surgery of macular epiretinal membranes. Value of interferometry using Lotmar's apparatus]. / Prédiction de la récupération fonctionnelle après chirurgie des membranes épi-rétiniennes maculaires. Intérêt de l'interférométrie au visomètre de Lotmar.

BACKGROUND: The predictability of the measurement of the macular function by white light interferometry was evaluated in a group of patients whose epiretinal membranes had been surgically removed. METHOD: Fifteen patients presenting either primitive or secondary epiretinal membranes were included. We used the apparatus described by W. Lotmar. The main evaluation criteria was the best corrected visual acuity (VA) chosen between the third month and the sixth month examinations. RESULTS: Preoperatively the mean visual acuity was 0.227 +/- 0.105. The mean final visual acuity was 0.507 +/- 0.198. The final visual acuity was predicted within an 0.1 interval in ten cases (67%). In two cases the predicted visual acuity was identical to the pre-operative VA and the final results confirmed the test. No improvement occurred. CONCLUSION: The Lotmar visometer is statistically predictive of the visual outcome after epi-retinal membranes surgery.

[Non-refractive complications of keratectomy with Excimer laser in 141 myopic eyes]. / Complications non réfractives de la kératectomie par laser Excimère observées sur 141 yeux myopes.

PURPOSE: The purpose of this study is to evaluate the safety of myopic photorefractive keratectomy and to study the frequency of complications, excepted refractive problems. METHODS: A consecutive series of 170 eyes has been studied in a prospective trial low-up of one year for 107 eyes and six months for 34 eyes. Twenty-nine eyes have been lost. RESULTS: The main complication after six months is the loss of the best spectacle-corrected visual acuity. It was due to a haze in seven eyes (loss of one line in five eyes and four lines in one eye) and to an excentric ablation in three eyes (one line in two eyes and two lines in one eye), results found for treatments of six diopters or more. The haze is a constant complication. A direct relationship between the haze's intensity and the treatment importance was found as was an inverse relationship between the patient's age and the haze's intensity. The excentric ablations have no influence on the final visual acuity when they concern less than one millimeter. The epithelial problems were always of less importance. CONCLUSION: Except in corrections greater than seven diopters, complications are uncommon after Excimer for myopia. Patient's information has to be rigorous.

[Treatment of refractory glaucoma by diode semiconductor laser cyclophotocoagulation]. / Traitement des glaucomes réfractaires par cyclophotocoagulation au laser semiconducteur à diode.

PURPOSE: Ciliary photocoagulation was used to reduce pressure in eyes with refractory glaucoma or to suppress pain in blind painful eyes. The efficiency of transscleral cyclophotocoagulation (TSCPC) with a clinical diode laser system (Iris Medical Instrument, Oculight SLX) was evaluated. METHODS: This diode laser system (wavelengh: 810 nm) provides light energy to the eye through a specially designed quartz glass fiberoptic probe allowing precise location centered 1.2 mm behind the limbus, i.e. in front of the ciliary body. Thirty eight eyes in 38 patients with refractory glaucoma underwent TSCPC with the diode laser. RESULTS: Three months after surgery, intra-ocular pressure was controlled at 20 mmHg or below in 70% of the patients. Patients who most failed with the TSCPC had higher initial IOP (neovascular and congenital glaucoma). Seventy five percent of the painful glaucoma were painless after the laser treatment. Only a few cases (10%) of transient secondary hypertony were observed. The inflammatory response (21%) was mild and transient. No case of scleral perforation, no case of posterior uveitis, cararact or hypotony were observed. CONCLUSION: The transscleral ciliary photocoagulation laser diode system is efficient to reduce intraocular pressure in refractory glaucoma. Complications are mild compared with other methods of cyclophotocoagulation. A long-term study is necessary to evaluate the results on IOP and the incidence of hypotony.

[Treatment of refractory glaucoma with high density focused ultrasonics]. / Traitement des glaucomes réfractaires par ultrasons focalisés de haute intensité.

The efficacy of therapeutic ultrasound was retrospectively assessed in 456 patients who presented with uncontrolled glaucoma refractory to maximal medical therapy and filtration surgery from April 1987 to January 1992. Treatment was performed under local anaesthesia in ambulatory outpatients. Therapeutic ultrasound induced local destruction of the ciliary epithelium and a thickening of the sclera. A 47% decrease in intraocular pressure (IOP) was obtained from the mean preoperative (33.8 mmHg) and the mean postoperative (18.2 mm Hg) values. After a 33-month mean follow-up, 65% of treated eyes had an IOP less than or egal to 20 mmHg. Therapeutic ultrasound was effective in most of the glaucomas, especially in open angle, closed angle, aphakic, pseudophakic and post-silicone oil glaucoma. The main complications were immediate ocular hypertension and corneoscleral alterations. Phtysis bulbi occurred in 5.7% of the eyes. The therapeutic interest of ultrasound were compared with those of the other cyclodestruction techniques.

[The danger of the game called "paint ball"]. / A propos du danger des pistolets à peinture (jeu dénommé "paint ball").

Severe ocular injuries may occur during a new war game in France, called "paint ball". A high pressure carbon dioxide powered gun fires pellets filled with dye. The pellet is coated with a semisoft gelatin and filled with a "nontoxic" dye mixture. We observed six consecutive cases during a ten month-period. In two cases (both due to a shot at point-blank range), mature cataract occurred. Consequently, lensectomy was achieved, preceded by a prophylactic scleral buckle. In one case, a retinal detachment due to a localized retinal necrosis occurred. With endocular surgery and temporary silicone oil tamponade, we achieved retinal reattachment. The three remaining cases did not require surgery. They suffered blunt ocular lesions of the anterior and/or posterior segment. One of these cases showed permanent tattooing to the cornea. After a mean follow-up lasting six months, all patients had, at least, a 40/100 vision. Some recommendations can reduce the incidence and the severity of ocular injuries due to paint balling. Firstly, eyeguards (made of polycarbonate) must be worn before receiving guns and pellets. Secondly, a kind of safety gun stopper can avoid gun firing by accident apart from practices. Thirdly, according to others publications, alcohol or drugs should not be consumed before the game. Lastly, gun fire at point-blank range or toward the head must be forbidden. We hope that wide distribution of such recommendations will help reducing the frequency of this type of ocular traumas.

[Treatment of diabetic macular edema with neuroepithelium detachment combining high-dose corticotherapy and photocoagulation]. / Traitement des oedèmes maculaires diabétiques avec décollement du neuro-épithélium associant corticothérapie forte et photocoagulation.

The clinical course of background diabetic retinopathy in its oedematous form (macular and diffuse posterior pole edema), leads to serous macular retinal detachment. At this stage, even if the laser burns are observed on the retinal pigment epithelium, laser photocoagulation is unsuccessful in such a serous detachment, because retinal neuroepithelium is far from the retinal pigment epithelium. We have previously noticed that high doses of oral steroid drug (one milligram per kilo a day) for fifteen days may allow a partial or complete macular flattening. This flattening is only correctly evaluated by contact glass biomicroscopy, and often associated to a visual improvement. Favourable outcome was observed in 76% of the fifty-eight eyes, which have been laser treated. When laser photocoagulation was successful, the results were stable with an improvement of two or four lines. If flattening did not occur, laser photocoagulation was not performed. Oral steroids treatment for long-term insulin treated diabetic patients required a very close daily diabetic or/and internist survey. At our institution, it was possible because the internist was at the patient's bed once or twice a day: for this reason, this technique seems to be the first study in the literature. Some very unexpected visual improvements incite us to use classic laser treatment as early as possible for macular or diffuse posterior pole oedema, before a serous retinal detachment occurs and renders treatment impossible excepted with the help of high doses steroids.

[Prevention of retinal detachment in Wagner-Stickler disease. Comparative study of different methods. Apropos of 22 cases]. / Prophylaxie du décollement de rétine de la maladie de Wagner-Stickler. Etude comparative des différentes méthodes. A propos de vingt-deux cas.

Prophylactic treatment in patients presenting Wagner-Stickler disease has not been yet well defined. We retrospectively studied twenty-two patients who had a retinal detachment on the first eye. Among the ten patients treated by peripheral confluent laser photocoagulation, five had a retinal detachment after a mean follow-up of fifteen months; with a 42% rate of spontaneous retinal detachment bilateralization, we can conclude that laser therapy has not been efficient. Four patients treated by focal or circular laser photocoagulation, cryotherapy or vitrectomy developed retinal detachment. Eight eyes treated by a preventive encircling scleral buckle did not develop retinal detachment, with a mean follow-up of twenty-one months. This follow-up is still too short, but greater than the mean bilateralization delay. Per and postoperative complications had no consequences.

[Treatment by horseshoe pattern photocoagulation of diabetic cystoid macular edema]. / Traitement par photocoagulation en fer à cheval de l'oedème maculaire cystoïde diabétique.

Eighty cases Diabetic Cystoid Macular Edema, with or without central spaces underwent photocoagulation from 1978 to 1989 using a horseshoe or ring pattern. Initial visual acuity ranged from 20/25 for far vision and 20/20 for near vision to a central scotoma, with an average of 20/60 for far vision and 20/50 for near vision. As initial treatment, we performed 63 horseshoe pattern and 13 ring pattern photocoagulation around the macula; an additional photocoagulation was carried out in 29 cases, one month to seven years later (average of 18.3 months), either on medial to the previous treatment (18), or closing the initial horseshoe pattern (10) or resulting in focal treatment (13), or associating any of these three. The cystoid macular edema disappeared in 47 cases, decreased in 15 cases, and remained in 14 cases, with a follow up ranging from 6 months to 10.5 years (average of 41.6 months). The post laser visual acuity range from 20/25 for far vision and 20/20 for near vision, to a central scotoma again, with an average of 20/60 for far and near visions. During the follow up various reasons of visual impairment were observed: cataract, intravitreal hemorrhage, epiretinal membrane, macular pucker and macular ischemia. Our results compared with the published ones concerning a grid pattern photocoagulation are encouraging. It is very important to stress that this photocoagulation is only aimed toward the macular edema itself: if necessary it should be associated with a grid pattern or a focal photocoagulation aimed toward extramacular edema.

[Argon laser trabeculoplasty. Results over 10 years]. / Trabéculorétraction au laser à l'argon (TRLA). Résultats à 10 ans.

To appreciate the current place of argon laser trabeculoplasty (ALT) in the therapeutic armamentarium of primary open-angle glaucoma (POAG), the first 211 photocoagulated phakic eyes were analysed. 159 eyes had a 5 year-follow-up, 147 eyes had a 8 year-follow-up and 127 eyes had a minimal 10 year-follow-up. These eyes corresponded to an initial group of 151 patients: 76 women and 75 men with a mean age of 66 years. We decided, arbitrarily, to assess trabeculoplasty results according to three combined criteria of failure (insufficient or transient intraocular pressure drop (< or = 3 mmHg), progression of visual field loss and need of filtrating surgery) and to various expected goals: prevent an increase of drugs with their subsequent side effects, taper a non tolerated medical treatment and, lastly, try to cease all medical treatment in non compliant patients. According to those criteria, during the first five years, the cumulative failure rate in the 159 eyes rose steadily from 19% (31 eyes) in the first year to 52% (82 eyes) in the fifth year. In the 147 eyes with a 8 year-follow-up 25 eyes (17%), and in the 127 eyes with a 10 year-follow-up 14 eyes (11%) were still controlled. At the 10 year-follow-up, the surgical failure rate was 35% (40 eyes in 113), quite similar to the rate at 5 years: 33% (27 in 82). Thirty eyes excluded in the study belonged to patients who died during the follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

[Failures of the surgical treatment of rhegmatogenous retinal detachment]. / Echecs du traitement chirurgical des décollements de rétine rhegmatogènes.

The surgical treatment of rhegmatogenous retinal detachment, has considerably improved. But there are still a lot of failures, at least after the first surgical procedure. Out of a group of 320 retinal detachments, a one stage surgical procedure allowed the retina to reattach in 84% of cases. Out of the 51 failures, we defined 2 subgroups: the early recurrences were mainly caused by undiagnosed breaks or insufficient scleral buckling, and the delayed recurrences by a vitreo-retinal proliferation or a new tear. Though a second operation increased the success rate to 97%, it is certainly desirable to lower the failure rate of the first surgical procedure.

Argon laser trabeculoplasty: a 10-year follow-up.

To determine the current place of argon laser trabeculoplasty (ALT) in the therapeutic armamentarium of primary open-angle glaucoma (POAG), 211 photocoagulated phakic eyes were analyzed. 159 eyes had a 5-year follow-up, 147 eyes had an 8-year follow-up and 127 eyes had a minimal 10-year follow-up. These eyes came from an initial group of 151 patients, 76 women and 75 men, with a mean age of 67 years. We decided, to judge trabeculoplasty results according to three combined criteria of failure--insufficient or transient intraocular pressure drop (< or = 3 mm Hg), progression in visual field loss and need for filtrating surgery--and according to various expected goals: prevent an increase of drugs with their subsequent side effects, taper a nontolerated medical treatment, and try to cease all medical treatment in noncompliant patients. According to these criteria, during the first 5 years, the cumulative failure rate in the 159 eyes rose steadily from 19% (31 eyes) in the 1st year to 52% (82 eyes) in the 5th year. In the 147 eyes with an 8-year follow-up, 25 eyes (17%) were successful and in the 127 eyes with a 10-year follow-up 14 eyes (11%) were still controlled. At the 10-year follow-up the surgical failure rate (35%; 40 eyes in 113) was similar to the rate at 5 years (33%; 27 in 82). 30 eyes, which were excluded from the study, despite being still controlled, belonged to patients who had died during the follow-up. Their mean age at the time of ALT was 76 years. The low success rate at 10 years was predictable from the 10% new failure cases per year encountered in the 5-year data.(ABSTRACT TRUNCATED AT 250 WORDS)

[Role of antisepsis in the preventive chemo-antibiotic treatment of postoperative endophthalmitis]. / Rôle de l'antisepsie dans le traitement chimio-antibiotique prophylactique de l'endophtalmie postopératoire.

A protocol associating chemoprophylaxis and two-agent flash antibioprophylaxis was performed for more than two years in order to prevent postoperative endophthalmitis in elective open-globe surgery. The aim of this study is to appreciate whether antibiotic therapy is really useful as a complement to chemoprophylaxis. Three successive conjunctival scrapings were performed in the operating room: two before surgery (one before and one after conjunctival disinfection by povidone iodine), and the third one at the end of the operation. The total number of positive scrapings significantly decreased after disinfection but, some changes appeared on the final scrapings positive and negative. The risks of a positive scraping after the disinfection are greater if the scraping was initially positive. The persistence of a positive scraping after disinfection is noted in about 20% of cases. Therefore, there is a risk for microorganisms to penetrate into the eye, still present on the conjunctiva after povidone iodine. This risk is an argument to carry on the flash antibiotic therapy before surgery, in order to obtain a high intravitreal concentration of antibiotics at the precise time when the bacteria may penetrate into the eye, and to stop their multiplication.

[Simultaneous failure of trabeculectomy and sclerotomy using laser holmium: YAG]. / Echec simultané d'une trabéculectomie et d'une sclérostomie au laser Holmium: YAG.

We present a case of a bilateral chronic open-angle glaucoma in a 74 year old woman, operated on the right eye by conventional trabeculectomy and the left eye by holmium laser ab externo sclerostomy. Both filtering blebs remained elevated and functional for 18 months. After this follow-up period, both blebs simultaneously collapsed and intra-ocular pressure rose again. This case shows that a late conjunctival scarring process, depending on a non surgical factor, may still be encountered after Holmium: YAG laser sclerostomy just as after standard trabeculectomy despite reduced conjunctival tissue trauma.

[Trabeculoretraction by argon laser. 5 and 8-year results]. / Trabéculorétraction au laser à l'argon (TRLA). Résultats à cinq et huit ans.

To appreciate the current place of argon laser trabeculoplasty (ALT) in the therapeutic armamentarium of primary open-angle glaucoma (POAG), the first 211 photocoagulated phakic eyes were analysed. One hundred and fifty-nine eyes had a 5 year-follow-up and 147 eyes had a minimal 8 year-follow-up. These eyes came from an initial group of 151 patients: 76 women and 75 men with a mean age of 66 years. We decided, arbitrarily, to assess trabeculoplasty results according to three combined criteria of failure (insufficient or transient intraocular pressure drop (3 mmHg), progression in visual field loss and need for a filtrating surgery) and to various expected goals: prevent an increase of drugs with their subsequent side effects, taper a non tolerated medical treatment and, lastly, try to cease all medical treatment in non compliant patients. According to these criteria, during the first five years, the cumulative failure rate in the 159 eyes rose steadily from 19% (31 eyes) in the first year to 52% (82 eyes) in the fifth year. The initial mean intraocular pressure (27.22 mmHg) of 7 failures operated on during the first 2 months and that of all 27 operated on failures (24.41 mmHg) was higher than the initial mean intraocular pressure of the 77 successful cases (22.67 mmHg). In the 77 eyes still controlled at 5 years, the intraocular pressure drop was 6.57 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ultrasonic treatment of hypertonia caused by intraocular silicone oil]. / Traitement par ultra-sons des hypertonies provoquées par l'huile de silicone intra-oculaire.

The authors treated 53 patients with uncontrolled glaucoma in silicone oil filled eyes with high intensity focused ultrasound. The silicone oil filled eyes present unusually difficult problems in glaucoma management, since the silicone oil rapidly obstructs filtration openings, and laser techniques have not been effective. The mean pretreatment pressure was 34.2 mmHg. The patients were followed for a mean of 17 months. Seventy-five per cent of ultrasound treated eyes had successful reduction of intraocular pressure to below 20 mmHg with or without concomitant medical treatment at two years after treatment. The complication rate was low in this group of eyes. Five eyes developed hypotonia and three eyes had full thickness scleral perforations but were effectively controlled and developed no other complications during two years of follow-up. This technique appears more effective than cyclo-destructive techniques alone.