[Phacoemulsification for visual refraction on the clear lens. Apropos of 33 severely myopic eyes]. / Phakoémulsification à visée réfractive sur cristallin clair. A propos de 33 yeux myopes forts.

PURPOSE: To evaluate visual benefit, predictability and complications after clear lens phakoemulsification and posterior chamber implantation in highly myopic eyes. METHODS: Thirty-three highly myopic eyes were reviewed at a mean postoperative follow-up of 27 months. The mean age of the 19 patients was 31.04 +/- 5.51 years. The mean preoperative spherical equivalent was -19.50 +/- 7.0 D (-12 to -40 D). Preoperative best spectacle corrected visual acuity was compared with the last postoperative one. Postoperative spherical equivalent was compared with the desired value. All complications were reviewed. RESULTS: A mean visual benefit of 0.24 +/- 0.18 (decimal notation) was noted (p < 0.05). The mean postoperative spherical equivalent (-2.57 +/- 1.84 D) was not significantly different from the mean previous value (p = 0.75). Retinal detachment arose in the two eyes of the same patient (incidence of 6.1%). BSCVA decreased slightly in only one of the two eyes (0.1). The incidence of Nd-YAG capsulotomy was 30%. CONCLUSION: Clear lens phakoemulsification is an effective and predictable method for the correction of high myopia. Retinal detachment is the major complication of this technique, even if a severe decrease of the visual acuity is not usual.

[Radial keratotomy for the treatment of Excimer laser undercorrections]. / Kératotomie radiaire pour le traitement des sous-corrections après le laser Excimer.

BACKGROUND: Effectiveness of radial keratotomy for undercorrections following photorefractive keratectomy. METHODS: Twenty myopic eyes from minus 4.75 to minus 8.25 were treated by Excimer laser photorefractive keratectomy and regressed to a mean myopic refraction of minus 2.20 +/- 0.81 after a follow-up of 10 to 22 months (mean: 16.25). Radial keratotomy was performed using Hoffmann Fyodorov Thornton nomogram. Blade depth was set according to pachymetry performed before surgery under microscopic examination, paracentrally on the meridian of each incision. RESULTS: Postoperative results were evaluated after 6 to 20 months follow-up. After radial keratotomy mean refractive error was minus 0.30 +/- 0.43 and minus 0.32 +/- 0.25 at 3-6 and 6-12 months respectively. Visual acuity, without correction, was prior to radial keratotomy: 2.18 +/- 0.99; 8.125 +/- 0.6 at 3-6 months and 8.43 +/- 1.57 at 6-12 months after radial keratotomy. CONCLUSION: Radial keratotomy appears to be a safe, simple and predictible technique to treat undercorrections following Excimer laser photokeratectomy.

[Asymmetric radial keratotomy for low-grade myopia]. / Kératotomie radiaire asymétrique pour la myopie faible.

Thirty patients (47 eyes) underwent a radial keratotomy for low myopia (from -0.75 to -2.5 D). Surgical technique was as follows: optical zone between 3.0 and 4.5 mm according to the degree of the myopia; two radial incisions in vertical superior and nasal horizontal meridian. The incisions were full thickness, obtained either with the "Russian" (centripetal) technique or with a centrifugal technique, but using a special designed knife. Mean refractive result was 1.73 D. For low myopia, our technique seems less traumatic and the refractive effect more rapidly steady.

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.

[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.

[Cataract and implantation in the vitrectomized eyes]. / Cataracte et implantation sur oeil vitrectomisé.

Cataract is a frequent complication of vitreous surgery after some months or years. In these cases cataract extraction is somewhat difficult. We performed cataract surgery with implantation in 38 eyes from 37 patients between 1986 and 1991. Twenty patients underwent vitreous or vitreoretinal surgery with or without internal tamponade by gas, 17 underwent silicone oil tamponade and silicone oil removal, prior to cataract surgery. Timing of surgery, number of surgical procedures and complications previous to cataract surgery are detailed in the paper. Cataract extraction was extracapsular in 7 cases, intracapsular in 6 cases; phako was performed in 24 cases and phacophagy in one case. A posterior IOL was inserted in 31 cases, an anterior chamber IOL in 7 cases. Anatomical and visual results were satisfying. Visual acuity improved postoperatively in 29 cases (up to 20/20 in 4 cases), was unchanged in 6 cases, decreased in 3 cases. Among these, loss of vision occurred in 5 cases due to retinal detachment or redetachment. For anatomical reasons, lack of vitreous support and the frequent zonular weakness of these eyes, account for surgical difficulties. Thus, phakoemulsification appears the best way to manage cataract in vitrectomized eyes.

[Phacoemulsification by the anterior approach combined with vitreoretinal surgery]. / Phacoémulsification par voie antérieure combinée à la chirurgie vitréo-rétinienne (22 cas).

Phacoemulsification was combined with vitreoretinal surgery in 22 cases in which lens opacity prevented good visualisation of the fundus. The main indications were proliferative diabetic retinopathy and retinal detachment complicated by proliferative vitreoretinopathy. Phacoemulsification was achieved by a limbal approach. The technique was adapted to the hardness of the lens nucleus. The incision was temporarily or definitely closed. The visualisation system was set up and the endocular surgery performed. In 5 cases an implantation in the bag was realised at the end of surgery. This type of combined procedure offers both the benefits of extra capsular surgery: avoids neovascular glaucoma in diabetic patients, keeps silicone oil in good position, possible implantation in the capsular bag, and those of a small incision: absence of leakage, of myosis, of corneal clouding, rapid rehabilitation.

[Surgical treatment of non-traumatic retinal detachment in children under 15 years of age]. / Traitement chirurgical des décollements de rétine non traumatiques de l'enfant de moins de 15 ans.

Etiological and clinical features of 151 retinal detachments in childhood are studied and discussed. Results of surgical management of 92 of them, after at least a 6 month follow-up, especially after ablation of silicon oil when used temporarily, are described. Clinical aspects of the contralateral eyes and their prophylactic treatment is also studied. Though surgical techniques have done great strides, prognosis of retinal detachment in childhood is still desperately poor. Proliferative vitreo-retinopathy, frequent, early and very progressive, is the leading complication and cause of failure in surgical of these retinal detachment. In this series of 151 retinal detachments, only 38% have achieved long term retinal reattachment because of it. If high grade (C-D) proliferative vitreo-retinopathy is associated 14.5% only achieved long term reattachment though 86% it when proliferative vitreo-retinopathy was moderate or absent. It is for this reason that we wish to emphasize the need to inform practitioners and "at risk" families. Strict and systematic follow-up of the "at risk eye" is essential. The most complete surgery at the outset seems to be the best way of managing high-grade proliferative vitreo-retinopathy associated with retinal detachments.

[Surgical treatment of traumatic retinal detachment in children under 15 years of age]. / Traitement chirurgical du décollement de rétine traumatique de l'enfant de moins de 15 ans.

The clinical features and results of surgical management of 68 out of a series of 101 cases of traumatic retinal detachment in childhood are described and analysed. Follow-up, in particular after the removal of silicon oil used temporarily, was always been longer than six months. Cases were divided into three groups: contusions, ocular injuries without foreign body and with foreign body. Cases of retinal detachment related to traumatic aphakia, severe myopia and associated with proliferative vitreo-retinopathy were also studied. The prognosis of retinal detachment in childhood, the main characteristics of which are late diagnosis and the early and rapid growth of proliferative vitreo-retinopathy appears to be worse in this series than usually published figures. Proliferative vitreo-retinopathy is the leading cause of surgical failure. The long term retinal reattachment rate did not exceed fifty per cent and the functional success rate was only thirty-three per cent. It is for this reason that the authors wish to emphasize the need for the provision of information to families and to ophthalmologists responsible for the management of these "high risk eyes". It is felt that the most complete surgery possible should be performed at the outset when proliferative vitreo-retinopathy exists.

[Effects and complications of Nd YAG laser posterior capsulotomy after ECA + PCI (extracapsular extraction and posterior chamber implantation)]. / Incidence et complications de la capsulotomie postérieure au Nd YAG laser après E.E.C. + I.C.P.

264 consecutive cases of ECCE are reviewed. In this series 28 cases of Nd YAG laser capsulotomy have been performed. Visual results are excellent: visual acuity is improved in 90% of cases. The rate of complications is low: 1 case of retinal detachment, 2 cases of IOP raise, no clinical CME. Laser therapy is performed when visual acuity decreases, prior to other extra clinical examination.

[Cyclodiathermy: is it effective in the treatment of glaucoma?]. / La cyclodiathermie: a-t-elle encore une valeur dans le traitement du glaucome?

The authors describe the non penetrating technique of cyclodiathermy in the treatment of different types of glaucoma and publish the results and the complications of the application of this technique on thirty three eyes among their patients. These eyes included congenital glaucoma (8 eyes), aphakic glaucoma (5 eyes), after silicone surgery (5 eyes), neovascular glaucoma (4 eyes), traumatic glaucoma (4 eyes), secondary glaucoma (3 eyes), Sturge-Weber-Krabbe (2 eyes) and open angle glaucoma (2 eyes). Their study with a mean follow up of 2.5 years shows an overall success rate of 60%. The success is defined as an ocular tension less than or equal to 22 mmHg in the absence of serious complications. All the encountered complications are mentioned. Phtysis occurred in not more than 3% of cases (1 eye). They establish a comparison with the published results and complications of the other cyclodestructive procedures: Sonocare, transcleral laser Yag, transcleral laser Ruby and cyclocryotherapy. This comparison does not prove the superiority of these other procedures with regard to the non penetrating cyclodiathermy. They conclude that this non penetrating cyclodiathermy is a non expensive procedure which still have its good therapeutic value.

[Retinal detachment: temporary internal tamponade with silicone oil after vitrectomy. Anatomic and functional results]. / Décollement de rétine: tamponnement interne provisoire par huile de silicone après vitrectomie. Résultats anatomiques et fonctionnels.

Forty-seven patients with retinal detachment treated by vitrectomy and silicone oil injection benefited from semi-premature ablation of the oil: after a mean of 5 months for supple retinal detachments and 6 1/2 months for those associated with vitreoretinal proliferation. Ablation was performed after obtaining a solid chorioretinal scar by cryopexy or endodiathermy, usually combined with laser panphotocoagulation. The technique used for ablation is described. After follow up for from 9 months to 3 1/2 years (mean 18 months) two-thirds of the patients had flat retinas. Recurrences developed usually during the first month. An explanation for these relapses is proposed.

[Obliteration of the posterior holes and tears of the retina by endodiathermy after vitrectomy]. / Oblitération des trous et déchirures postérieurs de la rétine par endodiathermie après vitrectomie.

The authors report 19 cases of posterior retinal and tears treated by endodiathermy after vitrectomy. Nine cases were iatrogenic with a retinal break occurring during an intravitreal procedure. The remaining 10 cases were non-iatrogenic. A flat or reapplied retina is a prerequisite for achieving an adequate chorioretinal adhesion by endodiathermy. Short-term internal tamponade by intravitreal gas is recommended in cases with tears and no detachment, whereas, longer term tamponade with intravitreal silicone is preferable when the retina is detached. This method can be used when external retinopexy becomes impractical for lesions too far posterior, or when endophotocoagulation cannot be performed.