[Screening method for angle closure and angle closure glaucoma using scanning laser polarimeter GDxVCC and photodynamic gonioscopy in a darkened room. One-year outcomes of systematic peripheral iridotomy]. / Méthode de dépistage du glaucome chronique par fermeture de l'angle basée sur l'utilisation systématique du GDxVCC et de la gonioscopie photodynamique. Résultats à un an d'une iridotomie systématique.

INTRODUCTION: Angle closure glaucoma, a recognized major world health issue disproportionately affecting women and Asians, is not often considered in our European populations, normotensive subjects, myopic patients, or subjects with a deep anterior chamber. Early diagnosis is worthwhile, as laser peripheral iridotomy (LPI) is an effective one-step treatment of the causal mechanism. PATIENTS AND METHODS: We have performed a retrospective study of patients who underwent an LPI, the indication for which was based on "photodynamic" gonioscopy in a darkened room showing iridotrabecular contact in darkness. Such photodynamic gonioscopy was motivated by the presence of even minute defects in the nerve fiber layer as seen on the GDxVCC or the presence of a Van Herick sign (narrow limbal anterior chamber depth). RESULTS: One hundred and three eyes of 103 patients underwent LPI and a minimum 1-year follow-up (mean follow-up almost 2 years). Mean age was 63.7±11.8 years, and women accounted for 63.1% of cases. The vast majority (78.6%) of patients had neither glaucoma nor ocular hypertension. There were 60.1% hyperopes and 39.9% myopes. Over half (57%) had a deep or a very deep anterior chamber. After LPI, there was immediate deepening of the limbal depth of the anterior chamber in 100% of cases. The aqueous humor that flowed forward was almost always viscous-looking. After 1 year, the IOP was 1.3mm Hg±2.4 lower (P<.001) (t test). All patients who had experienced morning headaches (44% of patients) were relieved of this symptom. GDxVCC after 1 year was clearly improved in 18% of cases, slightly improved in 20%, stable in 50%, slightly worse in 11% of cases, and clearly worse in 1%. Cases treated at an earlier stage had a better improvement in GDxVCC. DISCUSSION: Our study shows frequent chronic angle closure in our European population even with deep anterior chambers. Absence of a Van Herick sign does not rule out angle closure at night. A photodynamic gonioscopy with the Goldmann three-lens mirror (to avoid unintentional indentation with the small diameter lenses in these normotensive eyes) should be performed in a darkened room. LPI is an effective one-step treatment of the underlying cause, that is particularly beneficial if performed early.

[Choroidal melanoma. An anatomic-clinical case report]. / Mélanome choroïdien. A propos d'une observation anatomo-clinique.

A 78-year-old-male-patient had his left eye affected by a 10 mm thick choroidal malignant melanoma. The size of the tumor did not allowed to keep the eye, and no conservative treatment was used for therapy. Enucleation was performed and histopathological study of the eye showed a mushroom-shaped and mixed-cell choroidal melanoma, devoid of transcleral extension, but harboring intrascleral infiltration. A period of 2 year-follow-up without metastasis was observed since the removal of the tumoral eye.

Collagen synthesized in fluorocarbon polymer implant in the rabbit cornea.

The integration of microporous polymer into tissues is of great interest for the production of keratoprosthetic devices. Our previous studies showed functional differentiated cells and collagen synthesis in the pore of an expanded polytetrafluoroethylene implant. This study identifies and quantifies collagen types synthesized in the implant. Expanded polytetrafluoroethylene polymers were implanted in the rabbit corneas. The collagen extracted from the polymer and implanted stroma after 1, 3 and 6 months was quantified by measuring hydroxyproline. The relative proportions of collagen types were determined by densitometric analysis after SDS-PAGE. The collagen-to-protein ratio in the polymer increased from 0.22 to 0.70 between the first and third month after implantation becoming similar to control cornea. So that of the protein and collagen densities in the polymer and implanted stroma were similar to the control from the third month. The collagen synthesized in the polymer was mainly type I (87%) plus a small amount of type III (8%) 1 month after implantation. The collagen distribution from the third month after implantation was similar to that of the controls and remained constant thereafter in the polymer implant and in the implanted stroma. Immunogold labelling techniques confirmed these results. Implantation of this PTFE disc induced no obvious modification of the corneal stroma, confirming that this polymer is a good interface that is compatible with the native corneal stroma. The keratocytes in this polymer rapidly adopted a corneal phenotype, distinct from the dermal or scaring phenotype as shown by the collagen types produced in the implant.

[Biodegradable controlled-release 5-FU implant in the surgery for glaucoma. Experimental study]. / Implant biodégradable à libération contrôlée de 5-FU dans la chirurgie du glaucome. Etude expérimentale.

BACKGROUND: 5-Fluorouracil (5-FU) is useful as an adjunct treatment for glaucoma filtering surgery. However, efficacy depends upon maintaining sustained drug levels, currently achieved by repeated daily injections of the drug for several days. To overcome this limitation, we designed a biodegradable implant for the sustained release of 5-FU. MATERIAL AND METHODS: The implant (0.79 mm diameter, 6 mm long, 2.2 mg weight) contains 0.66 mg of 5-FU and is loaded in a needle coupled to a custom-made instrument to permit subconjonctival insertion of the implant through a 2 mm wide snip incision. The in vitro and in vivo pharmacokinetics as well as the biocompatibility studies of the implants were assessed in the rabbit. RESULTS: No infection, inflammatory reaction or extrusion occurred. The implant released the drug at a constant rate of 1.20 micrograms/hr for over 18 days and totally biodegraded in less than 86 days. CONCLUSION: Implantation of the device, after laser sclerostomy or conventional trabeculectomy shows great potential for the treatment of glaucoma. To determine the implant's efficacy, additional studies in the cat are underway.