[Validation of the French version of the health-related quality of life questionnaire for adult strabismus (AS-20)]. / Validation de la version française d'un questionnaire de qualité de vie de l'adulte strabique (AS-20).

INTRODUCTION: A growing number of articles have shown the negative impact of strabismus on self image, relationships with others and professional life. The AS-20 is a standardized questionnaire in English measuring the psychosocial impact of strabismus in adults. The goal of this study is to validate the AS-20 in the French language. PARTICIPANTS: Three hundred and ninety one patients took part in the study: 131 had strabismus (group 1), 128 other ocular diseases (group 2) and 132 "normal" patients (group 3). RESULTS: The AS-20 scale showed good psychometrical properties in 2 or 4 dimensions: internal consistency was very good (Cronbach's alpha coefficient>0.9 in all dimensions and overall) and the reproducibility was satisfactory (intra class coefficient>0.7). The comparison of the scores in the 2 dimension scale showed significant differences between the groups (P<0.001): lower score in strabismus (63.9±18.3) than in other ocular diseases (73.5±17.8) and normal group (89.4±12.0) (divergent validity). The 4 dimension psychometric analysis was performed by removing 2 items and grouping the 18 others in 4 groups. It confirmed the divergent and convergent validity, internal consistency and reproducibility of the scale. The results of the confirmatory factor analysis were better with the 4 dimension scale than the 2 dimension scale (adjustment coefficients>0.9). CONCLUSION: We now have access to a health related questionnaire in French to quantify the impact of strabismus on quality of life and measure the results of treatment.

A novel method for controlling the quantity of mitomycin-C applied during filtering surgery for glaucoma.

The use of a sponge impregnated with mitomycin-C is an increasingly common practice in glaucoma surgery. The appropriate antibiotic concentration and exposure time have been considered in the literature, but not the exact amount to be used or the size of the sponge. The purpose of this study was to estimate the quantity of mitomycin-C contained in sponges prepared by different surgeons as compared to that in applicators of the type used in Schirmer's test graduation (5 x 5 mm). Four surgeons each cut and prepared 10 sponges for intraoperative use according to their usual method. The same procedure was performed with 10 Schirmer's test graduations. Each sponge and each graduation was immersed in a solution of mitomycin-C 0.2 mg/ml, and the quantity of antibiotic (microg) in each was calculated as the difference between wet and dry weight. The mean quantity (+/- SEM) of mitomycin-C contained in cut sponges was 9.6 +/- 4.4 microg (range 1.9-17.3), and the differences between surgeons were statistically significant (p<0.0001). The mean quantity of antibiotic in Schirmer's test graduation was 1.7 +/- 0.3 microg (range 1.1-2.5), and the differences between surgeons were not statistically significant (p=0.79). The quantities of mitomycin-C contained in sponges prepared for glaucoma surgery differed for a given surgeon and between surgeons. Thus, variations in the doses applied to the sclera could account for certain complications due to mitomycin-C. The use of a Schirmer's test graduation improves predictability for the quantity of mitomycin-C applied to the sclera.

[Optico-geometric axes of the eye: application to the alpha angle and its representatives. Review of the literature]. / Les axes optico-géométriques du globe: applications à l'angle alpha et ses représentants. Synthèse de la littérature.

The different positions of the corneal reflex and the center of the pupil demonstrates the decentration of the ocular structures. The optic axis and the visual axis are different. They form a angle (defined as angle alpha) important for appreciation of strabismic deviation. This phenomenon is well-known since the nineteen century. This review discusses the different definitions of the optico-visual axes and angles (angle alpha, gamma, kappa, lambda). A possible clinical application is discussed.

[Scale for evaluating desirable ametropia or eumetropia]. / Echelle d'évaluation de l'amétropie désirée ou eumétropie.

GOAL: The purpose of this study is to assess the degree of desirable ametropia in cataract surgery. MATERIAL AND METHODS: A scale for evaluation was created. It allows to measure the desired distance for a neat uncorrected vision (desired ametropia) after cataract surgery that presbyopic patients (monocular vision) would like to obtain. This scale helps to calculate the power of the intraocular lens to be implanted. The scale was shown to a series of 50 consecutive presbyopic patients. Refraction was the same in both eyes. The interest of patients in the evaluation of their desirable ametropia was measured on a scale from 0 to 5. RESULTS: Interest was good for 50% of patients (grade > or = 3). Mean distance desired by patients for a neat uncorrected vision was 1 meter. Preoperative myopia and hyperopia have no significantive influence upon the distance desired for a neat uncorrected vision. CONCLUSION: The choice of the power of the lens implanted during cataract surgery should take into account the patients' desires. An evaluation of the postoperative desirable ametropia should be systematic.

[Specular microscopy of the corneal endothelium during different methods of lens implant surgery (author's transl)]. / Effects de différentes méthodes d'implantation intra-oculaire sur la population endothéliale cornéenne. Etude en microsco]ie spéculaire.

The authors relate their experience with five types of I.O.L. A retrospective study had been done with a specular microscope in order to determine which way provokes the lowest endothelial cell loss. The less traumatic technique is E.C.C.E. with posterior chamber lens: cell loss is 10%. There is no difference between this method and conventional E.C.C.E. without implantation.

[Cell density of the corneal endothelium after penetrating keratoplasty. A retrospective study by specular microscopy]. / La densité cellulaire de l'endothélium cornéen après kératoplastie perforante. Etude rétrospective en microscopie spéculaire.

Endothelial cell density of 70 penetrating grafts and 11 lamellar keratoplasties was studied by specular microscopy. In perforating transplants, mean cell density was 1150 cells/mm2. No correlation could be established between cell counts and diagnosis or associated surgical procedures. Minimal cell density for a clear transplant appears to be of the order of 450 cells/mm2. In lamellar keratoplasties cell loss is reduced, and this may be one way to increase the proportion of clear grafts when endothelium is healthy.

[The new surgery of functional esotropias (author's transl)]. / La nouvelle chirurgie des ésotropies fonctionnelles (opération du fil et techniques classiques).

In two previous papers published in this journal, mechanic phenomena induced by the surgical procedures and the surgical management of fundamental troubles in esotropias were analyzed fully into details. In this third part, the authors explain the various pratical conclusions which result from their study. They underline that more than 60-70% convergent squints in children have a apastic component, and to overcome it classical procedures alone (resections and recessions) are fully unfitted. Equally, the Fadenoperation cannot by itself make away with motor disorders. Generally, the various technics must be associated to get cure. But to draw up an adequate surgical plan it is necessary to take into account the anaesthetic sign and the muscular traction test. The Authors have settled a pratical surgical scale allowing to know immediatly according to clinical and electro-oculographic findings, and the results to those tests, the particular operating actions which are convenient to do in each case and also their amount.

[Medial rectus stretching test in recurrent esotropia]. / Le test d'élongation musculaire du droit interne dans les ésotropies récidivantes.

In oculomotor surgery, evaluation of muscle elongation is necessary before deciding on the operative plan. This is particularly important in recurrent esotropia where the motor problem is highly complex because of visco-elastic alterations caused by previous surgery. The study of a series of 132 cases of recurrent esotropia shows that weakening of the medial rectus almost always causes reduced muscle elongation, the extent of which is directly proportional to the amount of recession.

[Electro-oculographie study of vergence movements. II. Asymmetric vergence (author's transl)]. / Etude électro-oculographique des mouvements de vergence. II - La vergence asymétrique.

In relation to symmetrical vergence, a study of asymmetrical vergence reveals, in normal cases, particular kinetic phenomena of the most marked degree. In binocular fixation, Johannes Müller's phenomenon is noticed on the axial eye. It exhibits reflex competition between fast and slow vergence, and is always impaired in amblyopias. Monocular fixation with the centered open eye induces a pure and slow consensual vergence on the excentric occluded eye. The movement is mainly be accommodative in nature, and anomalies are shown to very frequent. Monocular fixation with the excentric open eye induces a relative vergence characterized by a fast version phase, limited and corrected by a slow vergence phase. Relative vergence is largely impaired in amblyopias, convergence deficiencies, functional squints and oculo-motor palsies. Generally, the different methods for investigating kinetic vergence patterns reveal a more or less physiological asymmetry in sensori motor potentialities of each eye. This asymmetry strongly increases in nearly all oculo-motor disorders.

[Statistical study of the basic angle and intensity of spasm in functional esotropia (surgical consequences)]. / Etude statistique de l'angle de base et de l'intensité du spasme dans les ésotropies fonctionnelles (conséquences chirurgicales).

In esotropia surgery all statistical results give the correlation between the amount of the operative correction and the angle of deviation; but this last entity is without value, because a consistent deviation nearly ever exists in spite of protracted medical management; indeed it is usual to notice large spatial variations. In a prospective series of 122 cases the authors have carefully studied the basic angle, the amount of angular variations which give evidence of the strength of spasm, the deep narcosis angle and the muscle elongation test. The various statistical correlations are analyzed. It appears that the basic angle and the strength of spasm are two essential connected but distinct characteristics of innervational imbalance, and it is necessary to carefully evaluate each one. There exists a highly significant correlation between the degree of innervational troubles and the frequency of visco-elastic impairments. The authors make several statements about medical management, early surgery and one-step surgery. They give new guidelines for their operative plan with the Faden operation.

[Non-immunologic factors of failure of penetrating keratoplasties. Prospective study of 119 corneal grafts at the Nantes Hospital Center in 1995]. / Facteurs non immunologiques d'échec des kératoplasties perforantes. Etude prospective de 119 greffes de cornée au CHU de Nantes sur l'année 1995.

PURPOSE: A single-center prospective study was carried out in Nantes to evaluate corneal graft outcome, while immunosuppressive treatment was used topically or systemically, during the first year. METHODS: A cohort of 119 patients underwent penetrating keratoplasty between 1-1-95 and 31-XII-95. Systematic standardized exams were performed at 15 days, 1 month, 4 months, 6 months and 1 year. Grafts were obtained from organo-cultured corneas at +31 degrees C. Intraveinous methyl prednisolone was given at the time of the surgery in most cases (82%). Corticosteroid eye drops are used in all cases and systemic Cyclosporin A was given for high-risk rejection keratoplasties (29.5%). RESULTS: The clear graft rate at 1 year is 97% for keratoconus, 87.8% for bullous dystrophies and 80.7% for regrafts. The leading causes of graft failure are: graft rejection (25%), endothelial consequences of a non controlled elevated intra ocular pressure (25%) and ocular surface disorders (16%). Prevalence and management of elevated IOP (from 8% to 20%) and ocular surface disorders (from 18% to 43%) are reported over one year. CONCLUSION: This study points out the great frequency of elevated-IOP-related disorders and ocular surface diseases in corneal graft outcome. They must be tracked down and uncompromisingly treated before and after transplantation.

[Monobloc PMMA lenses. Anteroposterior displacement of the implant as a function of the insertion diameter]. / Implants PMMA monobloc. Déplacement antéro-postérieur du corps en fonction du diamètre d'insertion.

Data concerning the biomechanical properties of IOL are rare. A systematic study of these properties was performed in the "laboratoire de Mécanique des Structures" at the "Ecole Centrale de Nantes". The results of the anteroposterior displacement of the optical part of eleven posterior chamber lenses (all PMMA) which were subjected to a diameter reduction, are reported. The deplacement of the implants was very slight and the position of the posterior side was relatively anterior whatever the diameter of insertion. The clinical implications, especially concerning the posterior capsule, are discussed.

[Current epidemiology of strabismic amblyopia in France]. / Epidémiologie actuelle de l'amblyopie strabique en France.

It is well known that good early management of squint prevents the appearance of functional amblyopia and, when it exists, allows a cure in more than 90% of cases. The authors report a series of 1 552 esotropias. Statistical analysis reveals that the present epidemiologic state of functional amblyopia is dismal. 47% of cases have an amblyopia in spite of 64.6% of children being previously treated. The mean age is 7 years 6 months. The therapeutic results after a 6 months range still shows 38% of poorly applied treatment, but 57% of well-managed patients recover normal visual acuity. The long range results (average 33 months) show that in 47% of cases the treatment was badly applied. On the contrary, 70% of patients having good management were successful. Two main reasons explain such a situation : firstly the lack of information and casualness of parents; and on the other hand faltering and unsuitable medical technics. The only real answer to such a problem is early medical management of every squint. According to the author's experience it seems that such a state is not a special feature of amblyopia epidemiology in the western part of France, but it is observed in the same way in many countries having high level medical care.

[New surgical technics in functional esotropias (the thread operation and classical technics)]. / La nouvelle chirurgie des esotropies fonctionnelles (opération du fil et techniques classiques).

The surgical management of functional esotropias is now very different from some years ago with Fadenoperation settled by Cüppers. Indeed this procedure is the only one which can act in a fitted manner on muscular spasms responsible of more than 60% of convergent squints. The simultaneous using of classical technics remains necessary, but in very different way from the custom formely. In the first part of this work, the authors begin to analyze the mechenism of medical rectus recession, and they show that operation doesn't act by a modification in arc of contact as it was always said, but only by a muscular slacking. On the contrary the change in arc of contact is the main factor which intervenes in Fadenoperation, but the muscle exclusion has also an important part. Whereas the effects of Fadenoperation on adduction incomitance are perfectly clear, those on the deviation in primary position still remain very abstruse. A statistical report on 143 cases of operated blocking esotropias shows that often Fadenoperation alone does not bring a complete cure of motor troubles. The authors explain the reasons of these failures and point out the other accurate muscular actions which must be associated to obtain a good result.

[The new surgery of functional esotropias (Faden operation and classical technics) (author's transl)]. / Nouvelle chirurgie des ésotropies fonctionnelles (opération du Fil et techniques classiques). 2e partie: less dérèglements fondamentaux et leur cure chirurgicale.

This paper is the second part of a work devoted to the surgery of functional esotropias. The Authors bring a systematic study of fundamental motor impairments, and their particular management. Sucessively they consider the length, the alterations of contractible properties and the visco elastic changes of ocular muscles. Then they point out the partical means to reveal those troubles by clinical examination, electro-oculography, study of eye position during anesthesia and muscular traction test. They underline the advantages, limits and drawbacks of Fadenoperation. Theorically and practically, a too posterior scleral fastening is dangerous. To avoid some complications of Cupper's original technic, they use a personal procedure: the muscle slapping, which seems to give good results. Finally, they analyze central disorders. The electrooculographic recordings prove that motor troubles are certainly related with primitive visual impairments. They note that the frequent surgical cure means the muscle operations have a binding effect of proprioceptive nature on the central motor disorders.

[Electro-oculographic study of vergence movements (author's transl)]. / Etude électro-oculographique des mouvements de vergence. Première partie: la vergence symétrique.

The study of vergence movements imperatively needs a recording method. Nowadays, in spite of its various drawbacks, electro-oculography is the most accurate method for clinical wants. The authors have studied the refixation vergence along a symmetrical inducing axis. With regard to both eyes in binocular and monocular fixations the analysis of a great lot of recordings in normal patients allows to reveal some phenomena unknown till now. In binocular fixation it is usual to notice a physiologic dyssynergy of vergence movements. The monocular fixations bear out evidence that Hering's Law doesn't apply to vergence movements. On the contrary they are submitted to a complete opto-motor dissociation, because the motor responses fully change according to the modalities of inducing visual inputs. In others respects, the analysis of all recordings proves that a vergence movement is made up with two synkinetic phases: a slow phase which was known for a long time thanks to physiological laboratory works; but also a fast phase having a saccadic feature. The fast vergence is related with a monocular visual attraction reflex and it is not bound only to the macular function.

[Surgical treatment of optical nystagmus (author's transl)]. / Le traitement chirurgical des nystagmus optiques.

Effective management improves the sensory-motor state of most optical nystagmus cases. Treatment is always medical and sometimes surgical. Previous complete sensory and motor examinations are necessary. A surgical cure is warranted by the extent of nystagmus, a torticollis, or when a squint is associated. The authors review the various clinical aspects, and their operative plan, which is simple in Kestenbaum's, more delicate in dissociated forms, convergence blockages and nystagmic squints. It is often very difficult in complex nystagmic impairments.

[Surgery for idiopathic and secondary epiretinal membranes: functional results and complications]. / Chirurgie de membranes épirétiniennes idiopathiques et secondaires. Résultats fonctionnels et complications.

PURPOSE: To evaluate visual outcome after epiretinal membrane surgery. MATERIAL: and method: Retrospective study of 50 consecutive epiretinal membranes (ERM) (23 idiopathic and 27 secondary) with 12 to 42-month follow-up (mean 24 months). Functional evaluations were performed before and after surgery according to the idiopathic or secondary nature of the epiretinal membranes. RESULTS: For idiopathic ERM, vision improved by more than two lines in 43% of the eyes (33% after ERM surgery alone and 55% after ERM followed by cataract surgery) with final visual acuity of 4/10 for 66% of the patients (58% and 82% respectively); there was visual degradation for the two ERM on highly myopic eyes. For the secondary ERM, vision improved by more than 2 lines for 41% of the eyes and final visual acuity of 4/10 for 33% of the patients; visual degradation for almost all ERM secondary to uveitis was associated with preoperative cystoid macular edema. CONCLUSION: After surgery for idiopathic or secondary ERM, visual acuity is good with the exception of the idiopathic ERM on highly myopic eyes and of the uveitic ERM with preoperative cystoid macular edema. Progression of cataract often perturbs visual outcome analysis.

[A case of Tolosa Hunt syndrome]. / Un cas de syndrome de Tolosa Hunt.

The authors review the clinical signs, results of investigations and clinical course under treatment of the Tolosa-Hunt syndrome; they illustrate their case presentation with a complete sequence of the imaging and the clinical and radiological findings of a case which fits the classical description found in the literature. They insist on the term of syndrome rather than disease because of the obvious diversity of anomalies encountered in this condition.

[Spatial binocular adaptation in microtropia and orthotropia. Definition and method of measurement]. / L'adaptation binoculaire spatiale des microtropies et des orthotropies. (Définition et méthode de mesure).

For a long time the problem of the functional recovery in convergent strabismus has been a hardly debated topic. For some authors, it is very rare; for others, on the other hand, the result is frequently achieved. Such disparities seem to be chiefly related to the tests used. The authors have selected 10 binocular tests and they carried out this scale in a prospective study in 100 cases of esotropias having normal moving performances following a medico-surgical management and in 20 normal cases. statistical correlations reveal that there is a very large disparity of "good answers" according to the tests; but there is no redundancy at all between them. Consequently for a relevant check up every single one is necessary. The total of "good scores" and differential values of ten tests allow to know the true state of binocular spatial adaptation. The statistical analysis shows that in secondary microtropias and orthotropias there is almost always an actual binocular spatial adaptation. Its level may be high, medium or low. The high margin is clearly different from the binocular scores in normal cases. Two events are very uncommon: a full recovery of binocular vision and the opposite condition of its complete suppression. The results of such a method give a clear explanation of conflicting opinions about the binocular evolution of convergent squints following medical and surgical management.