[Optical biometry of eyes corrected by phakic intraocular lenses]. / Biométrie optique des yeux avec implants phaques.

PURPOSE: The aim of this study was to determine whether eye length measurements obtained with the IOL Master (Zeiss Humphrey) before and after phakic IOL implantation would show any changes. METHODS: In a prospective study, we used the IOL Master to measure optical biometry in 25 myopic eyes of 15 patients before and after phakic IOL implantation (PRL, ICL, Artisan). The differences between both axial length measurements were calculated and compared using a nonparametric Wilcoxon test. RESULTS: The difference between the preoperative and postoperative measurements ranged from -0.16 mm to 0.06 mm and averaged -0.016 mm, which was not statistically significant (p=0.20). Both measurements correlated in a highly positive manner (r=0.999; p<0.0001). The reproducibility of the preoperative and postoperative axial length measurements was very high (coefficient of variation=0.09% and 0.07%, respectively). The precision was 26 microm for preoperative measurements and 19 microm for postoperative measurements. CONCLUSION: Our results showed that postoperative measurements of axial length are highly comparable to preoperative measurements and that optical biometry can achieve highly precise and reliable axial length measurements in eyes with phakic IOLs. This application becomes clinically relevant in evaluating eyes with phakic IOLs that might require cataract surgery. Hence, accurate axial length measurements in eyes with phakic IOLs will be extremely important when cataract occurs in these eyes and when the preoperative measurements are no longer available.

[Ultrasound biomicroscopy of posterior chamber phakic intraocular lenses: a comparative study between ICL and PRL models]. / Biomicroscopie ultrasonore des implants phaques de chambre postérieure: étude comparative des modèles ICL et PRL.

PURPOSE: To evaluate the anatomic relationships of the implantable contact lens (ICL) and the phakic refractive lens (PRL) posterior chamber phakic intraocular lenses (PCP IOL) using ultrasound biomicroscopy (UBM). MATERIAL AND METHODS: Seventeen phakic myopic eyes corrected with ICL, and 14 phakic myopic eyes that had had PRL implantation, were examined retrospectively using UBM. The main parameters measured and compared were anterior chamber depth, central and peripheral distance between PCP IOL and the crystalline lens, and exact lens haptic position. RESULTS: The mean distance between the PCP IOL and the central endothelium was 2398+/-203 microm and 2640+/-230 microm in the ICL and PRL groups, respectively. The central vault between the implant and the crystalline lens was greater in eyes with ICL (ICL, 402+/-194 microm; PRL, 256+/-187 microm, p<0.05). However, the incidence of lens contact on the peripheral level was higher in the ICL group (41%) than in the PRL group (29%), and the difference between the two implants in the peripheral crystalline lens-PCP IOL distance was significant (p<0.05). Both IOL haptics appeared to be correctly positioned in the sulcus in 13 (76%) eyes of the ICL group, and on the zonule in eight eyes (57%) of the PRL group. CONCLUSIONS: PCP IOL implantation is a safe procedure for the correction of high myopia with regard to refractive results. UBM provides a unique tool to noninvasively evaluate the relations of these implants within the posterior chamber, and helps to analyze the mechanisms of crystalline lens and iris complications.

[Contact lens wearers as candidates for LASIK surgery: two pitfalls to avoid]. / Porteurs de lentilles de contact candidats à un LASIK: deux pièges à éviter.

UNLABELLED: We present two cases of persons wearing hard contact lenses resulting in corneal modifications which could have falsified the indications for LASIK. CLINICAL CASES: In the first case the use of hard contact lenses led to thickening of the cornea which might have led to an erroneous indication for LASIK and an excessive thinning of the cornea. In the second case, the shape of the cornea was modified and the rigid lens masked a subclinical keratoconus. CONCLUSION: Since corneal ectasia is the major complication of LASIK surgery due to excessive thinning of the cornea or LASIK surgery on an undiagnosed keratoconus, these two cases illustrate the importance of a pre-LASIK eye examination for patients wearing hard lenses several weeks after these contact lenses have been discontinued.

[Fifty-two cases of postoperative endophthalmitis treated with one protocol: anatomical and functional results]. / 52 cas d'endophtalmie post-opératoire traités par un protocole thérapeutique unique: résultats anatomiques et fonctionnels.

PURPOSE: To evaluate our management of postoperative endophthalmitis and compare our protocol to the Endophthalmitis Vitrectomy Study's (EVS) recommended protocol. PATIENTS AND METHODS: This study comprises 52 patients with postoperative endophthalmitis treated with the same protocol in 1996 and 1997. Patients were given an intravitreal injection of antibiotics (vancomycin-amikacin) and steroids (dexamethasone), systemic antibiotics (pefloxacin-piperracillin), and systemic steroids in bolus. Vitrectomy was not systematic. So as not to delay the treatment, cultures were obtained only from an anterior chamber paracentesis. RESULTS: Visual acuity was measurable in 86.5% of the patients, with 20/100 in 63.4% and 20/40 in 44.2%. Our results are similar to those of the EVS even when initial visual acuity was Light Perception. CONCLUSION: Our protocol is simple and easy to perform in all ophthalmology centers. It is based on intravitreal injection, which must be performed as quickly as possible.

[Myopic anterior chamber intraocular lens implantation: evaluation at 8 years]. / Implants myopiques en P.M.M.A. de chambre antérieure: bilan à 8 ans.

PURPOSE: The aim of this study was to analyse the tolerance of Myopic Anterior Chamber IOL's 8 years after surgery. MATERIAL AND METHODS: We have studied 21 eyes implanted with an anterior chamber phakic IOL between May 1989 and June 1990. The 21 eyes had a very high myopia (mean pre-operative myopia--13.5 Dipters). Surgical technique was easy, without peroperative complications. RESULTS: Post-operative refractive results were excellent with a mean refraction of -0.25 D. Post-operative complications were a pupillary ovalisation in 42% of the eyes and glare in 50% of the eyes. Specular microscopy was normal pre-operatively for all the eyes but at 8 years, 4 (19%) of the eyes have had a strong loss of their endothelial cells and have to be explanted. Decreasing of endothelial cells is the most severe complication occurring after Phakic anterior chamber myopic IOL implantation. CONCLUSION: These 21 Myopic Anterior chamber IOL's have given a very good refractive result for all the eyes. 4 (19%) of the eyes operated on with these IOL's had a decreasing of their endothelial cells and the IOL had to be removed. Rigourous follow-up of the implanted eyes is required.

[Medium-term tolerance of anterior chamber implants in surgical treatment of severe myopia]. / Tolérance à moyen terme des implants myopiques de chambre antérieure dans le traitement chirurgical de la myopie forte.

PURPOSE: To determine the tolerance of the corneal endothelium and of the haemato-ocular barrier of phakic highly myopic eyes implanted with an anterior chamber I.O.L.ses. METHODS: Twenty-one phakic highly myopic were operated on with a Z.B.A.C.I.O.L. (manufactured by Domilens) by the same surgeon from May 1989 to June 1990. Complete examination including specular microscopy have been performed before surgery and each 6 months and a Laser Flare Cell Meter at 3 years was performed on 14 eyes. RESULTS: Two eyes of the same patient had to be explanted after surgery for important endothelial cell loss. The 19 others had no complication: no cataract, no loss of endothelial cells, no retinal detachment. 14 eyes examined with a Laser Cell Flare Meter had results within normal limits. So, 19 out of 21 eyes implanted for high myopia with Z.B.A.C.I.O.L. have excellent results 4 years after surgery. CONCLUSION: Regarding these results, it seems possible to use this technique again with the new designed Anterior Chamber I.O.L.. Rigorous follow-up of all the implanted eyes is however required.

Results of photorefractive keratectomy on 63 myopic eyes with six months minimum follow-up.

We present our experience with 63 myopic eyes that had photorefractive keratectomy with an excimer laser. Minimum follow-up was six months. Mean preoperative myopia was -3.98 diopters (D) (range: -9.00 D to 1.25 D) and mean preoperative uncorrected visual acuity, 20/220. The epithelium was removed and fixation accomplished with a suction ring. Photoablation was then performed on a 5.0 mm diameter optical zone. Mean postoperative myopia was -0.60 D (range: -6.35 D to +2.25 D) after six months. Mean uncorrected visual acuity was 20/30. All corneas had a subepithelial haze that decreased progressively. There were no major complications. Except in a few cases, predictability was satisfactory. Photorefractive keratectomy proved effective throughout the trial. We need to study more patients with a longer follow-up to determine the indications and applications of this technique.

[Statistical study of the results of radial keratotomy]. / Etude statistique des résultats de la kératotomie radiaire.

The statistical study of 384 R.K. performed by the same surgeon shows that in 82% of R.K., preoperative myopia was between -1.5 to -6 diopters and in 77.5% of R.K., postoperative refraction was between -1 to +1. The 90% confidence interval was between -2 to +1 for all preoperative myopias and was the best when preoperative myopia was between -0.5 to -3 diopters (-1 to +1 D). The study of the stability and security shows that this surgical technique is stable and gives a good security.

Intraoperative and early postoperative complications in 466 radial keratotomies.

We have retrospectively studied the intraoperative and early postoperative complications of 466 radial keratotomies. These complications included: microperforations and macroperforations, incisions into the optical zone, and early bacterial corneal ulcers and endophthalmitis.

[Current limitations of radial keratotomy]. / Les limites actuelles de la kératotomie radiaire.

The so-called R.K. classic technique gives good results for myopias under 5 diopters. We have performed different modifications of the technique for the 8 incisions--optical zone 3 mm R.K. 8 incisions--O.Z. 3 mm. Downhill incision direction or "American technique" incisions (from the O.Z. towards the limbus). 8 incisions--O.Z. 3 mm + a deepening of 20 microns from a 6 mm O.Z. Repeat operations (Stan Franks Backcutting technique or addition of incisions). 8 incisions--O.Z. 3 mm. Uphill incision direction or "Russian technique" (from the limbus towards the optical zone). This study was carried out with 134 R.K. and shows that we get best results for myopias between 5 to 7 diopters, with the last technique (Uphill incision direction).

[Epikeratophakia: results in young patients with unilateral, post-traumatic aphakia using a congelated then dehydrated corneal lenticule (the Mac Donald, Kaufman technic)]. / Epikératophakies: résultats obtenus chez des aphakes jeunes unilatéraux, post-traumatiques avec un lenticule de cornée congelèe puis déshydratée (technique de M. Mac Donald, H. Kaufmann).

We performed 11 epikeratophakias with a congelated lenticule (H. Kaufmann and M. Mac Donald technique) for aphakic post-traumatic eyes. The results have been good for the cicatrisation, and the visual result.

[Oculomotor paralysis of endocrine origin. The value of x-ray scanning]. / Paralysies oculomotrices d'origine endocrinienne. Intérêt du "Scan RX".

The X-ray scanning symptoms of dysthyroidal ophtalmopathy are so typical that they are enough to make the diagnosis in most of cases. Their determination through the FEMEN system increases the sensitivity of the method. The investigation of 60 cases of oculomotor palsies with a FEMEN score greater than 10 confirms that they are certainly or probably subsequent to an endocrinopathy in 93% ot the cases.