[The stele of the eye doctor in the Museum of Bar and the logo of the French Language Society for the History of Ophthalmology]. / La stèle de l'oculiste du Musée barrois et le logo de la Société francophone d'histoire de l'ophtalmologie.

The objectives are to: recall the circumstances of discovery of two corner pillars 45 years apart and other objects belonging to a circa second century Gallo-Roman temple; analyze the sculptures, of which the best known is the "stele of the eye doctor", which the French Language Society for the History of Ophthalmology took as inspiration for its logo; discuss the significance of instruments and procedures within a markedly religious context at a time when the mystery cults appeared; provide elements for discussion on the interpretation of the scenes depicted on the two pillars.

Linear dichroism of the retinal nerve fiber layer expressed with Mueller matrices.

An electro-optic device is used that permits the measurement of polarized absorption spectra (linear dichroism). The change of the polarization state of a light beam brought about by passage through the optic elements of a dichrograph are described mathematically by a transformation of the Stokes vector. The polarization or absorption properties of the optical elements are described by the Mueller matrices. The dichroic properties of sheep retina and cornea are studied in vitro.

Coincident resection-recession (tenectomy-recession) of the medial rectus muscle, bilaterally, for the treatment of esotropia: results in 18 cases.

PURPOSE: To study the effect of preceding tenectomy of the medial rectus tendon on the results of medial rectus muscle recession. SUBJECTS AND METHODS: Eighteen consecutive cases of incomitant esotropia were retrospectively reviewed. The average preoperative esotropia was 35 PD with an incomitant deviation between 10 PD and 30 PD. All patients underwent 7 mm bilateral medial rectus muscle recession after 4 mm tenectomy of the anterior medial rectus muscle. RESULTS: Fourteen patients (78%) had "satisfactory" results (within 10 PD static esodeviation and 12 PD dynamic deviation [incomitance]). Four (22%) were undercorrected. One showed a postoperative consecutive exotropia of 4 PD at distance only. CONCLUSIONS: Tenectomy of the anterior muscle tendon preceding large recessions of the medial rectus was effective in reducing the frequency of overcorrection (consecutive exotropia). Undercorrection did not appear to be more common.

[Small retinal, cochlear, and cerebral infarctions in the young patient, "SICRET" syndrome of Susac syndrome]. / Petits infarctus rétiniens, cochléaires et cérébraux du sujet jeune, ou "SICRET" syndrome ou syndrome de Susac.

A 22-year-old-lady presented with multiple occlusions of the branches of the central retinal artery, accompanied by neuro-encephalic disorders and deafness. This triad is known as SICRET Syndrome (Small Infarction of Cochlear, Retinal and Encephalic Tissue). This rare syndrome, as well referred to as Susac syndrome, affects only the women and the three tissues mentioned above: eye, ear, brain. The course was characterised by a series of partially regressive evolutive steps. A remission had been obtained since two years with immuno-supressor and anti-coagulant therapy. The neuro-encephalic and cochlear disorder regressed in contrast to the severe sequel on the right eye.

[Treatment of vitreoretinal proliferation in rhegmatogenous detachment and silicone oil tamponade]. / Traitement de la prolifération vitréorétinienne du décollement rhegmatogène et tamponnement par huile de silicone.

PURPOSE: To describe our technique of vitrectomy and silicone oil tamponade for managing retinal detachment and to report the last results according to the posterior and anterior proliferative vitreoretinopathy. METHODS: A retrospective study was conducted in 108 patients who underwent vitreoretinal surgery and silicone oil tamponade for proliferative vitreo-retinopathy, 64% patients had already been operated without success and 42% underwent vitrectomy with SF6 or C3F8. Diffuse posterior proliferative vitreo-retinopathy (grade C3-D) was present in 64% patients and anterior proliferative vitreoretinopathy was present in 43.5%. Silicone oil was removed in 79% patients after a mean duration of 6.3 months. It was replaced by 16% C3F8. All patients were followed for a minimum of 6 months. RESULTS: Before silicone oil removal, 55% of the retinas were reattached posterior to the scleral buckle with one operation, 78% after 2 operations and 88% after 3 or 4 operations. An average of 2.1 vitrectomy surgeries were performed. Reproliferation was correlated with the anterior proliferative vitreo-retinopathy (p < 0.001), posterior proliferative vitreo-retinopathy (p < 0.01) or previous vitrectomy (p < 0.05). The final visual acuity was 1/20 or better in 61% of the eyes and 2/10 or better in 30.5%. After silicone oil removal, 8% retinas redetached, 21% of the eyes had hypertony, 7.5% had hypotony and 7% of the corneas had dystrophy. CONCLUSION: Silicone oil tamponade was effective for the treatment of retinal detachments with proliferative vitreo-retinopathy. Since the main complications were hypertony and corneal dystrophy, silicone oil should be reserved for severe proliferative vitreo-retinopathy cases.

Retinal detachment after cataract surgery.

BACKGROUND: A study of the characteristics and the results obtained in 99 consecutive eyes operated on for rhegmatogenous retinal detachment associated with aphakia or pseudophakia in order to find the predictive factors of poor anatomical and functional results. METHODS: The authors retrospectively reviewed the files of 99 consecutive cases of aphakic and pseudophakic retinal detachment operated on by the same surgeon between January 1992 through July 1993 with a minimum follow-up of 6 months. Multivariate and chi square analysis were carried out. RESULTS: Of the pseudophakic eyes, 25 had an anterior chamber lens and 48 had a posterior chamber lens. The posterior capsule was disrupted using a Yag laser in 58% of those with an posterior chamber lens but only 14% of them developed detachment within 6 months. The rate of vitreous loss was 27% with 5% in case of intracapsular extraction, 31% in case of extracapsular extraction and 54% in case of phacoemulsification. PVR was present in 30% of the patients and 51% of detachments occurred more than 24 months as a mean after cataract surgery. The overall anatomic reattachment rate was 88% with no significant difference between the aphakic and the pseudophakic patients, either with an anterior chamber of posterior chamber lens. Visual results were significantly worse in the anterior chamber lens group and in the aphakic eyes (P < 0.02). Negative prognostic indicators for reattachment included poor preoperative vision, extension of the retinal detachment to the macula (P < 0.05) and grades B, C or D proliferative vitreoretinopathy (P < 0.01). In addition to the above factors, eyes with vitreous loss, anterior chamber lens, aphakia and a larger extent of the retinal detachment had a poor visual outcome. CONCLUSION: Most aphakic or pseudophakic retinal detachment can now be reattached with either scleral or vitreo retinal surgery. The main difficulties are the localisation of the breaks and the treatment of PVR. Indirect ophthalmoscopy associated with vitrectomy does well in cases of an opacified posterior capsule. In cases of severe PVR long term internal tamponade either with C3F8 or silicone oil improves anatomical results but the functional results remain inferior.

[Ocular vasospasm in cold provocation test and primary vascular acrosyndrome]. / Vasospasme oculaire par provocation au froid et acrosyndrome vasculaire primitif.

An ocular vasospasm induced by cold has been searched among 8 patients carrying primary vasospastic disease without any ocular pathology. Ocular vasospasm which is characterized by visual field defect was searched with Statpac 24-2 test using HUMPHREY autoperimeter. A baseline visual field was performed first, then a second after provocation by dipping the hand in cold water (13 degrees) and a third after oral administration of 10 mg of Nifedipine. Two patients had ocular vasospasm that regressed after Nifedipine administration. These two patients might have a higher risk to develop normal tension glaucoma.

Fluid air exchange in vitreo retinal surgery.

This study evaluates the efficiency of fluid-air exchange on the reattachment of the retina and clarifies the possibility that a posterior retinotomy is a cause for intra- and postoperative complications. A consecutive series of 211 eyes with retinal detachments due to P.V.R. (47%), diabetic traction, perforating trauma, macular hole or giant tears is presented. All eyes underwent pars plana vitrectomy, fluid-air exchange, internal drainage of subretinal fluid, laser endophotocoagulation and scleral buckling of the tears; 56% of the eyes were phakic and 55% underwent a posterior retinotomy, 54% underwent tamponade with C3F8 and 46% with silicone oil. Intraoperatively the retina was completely flattened in 91% cases. The causes of incomplete reattachment were residual membranes (6.6%), poor visualization (1.4%) and suprachoroidal hemorrhage (1%). These complications were isolated as being the cause of the bad final results (p < 0.001). Postoperatively, the retina remained attached in 66% of cases after the first procedure and with further surgery in 81% (mean follow up 16 months). Best corrected visual acuity was improved in 73% of eyes, unchanged in 17%, and worse in 10%. Complications were retraction of the retinotomy site in 3 cases and peripheral choroidal hemorrhage in 4 cases. We concluded that fluid air exchange with internal subretinal fluid drainage was an efficient and safe technique even if a posterior retinotomy was necessary.

Proteins in the subretinal fluid.

This study was designed to improve the understanding of the mechanisms that govern the origin of retinal detachment (RD) by examining the quantitative composition of proteins in the subretinal fluid (SRF). Inflammation proteins and immunoglobulins (Ig) were titrated from SRF and sera in 25 patients with RD The following concentrations were found in SRF: total proteins 16 g/l, albumin 12.6 g/l; pre-albumin 0.37 g/l; transferin 1.8 g/l in 68% of cases; haptoglobin and alpha 2 macroglobin were present in only one SRF: alpha 1 antitrypsin 0.86 g/l in 48%; orosomucoid 0.57 g/l in 32%; IgG 2 g/l in 52%; IgA 0.17 g/l in 88% and IgM 15.9 mg/l in 56%. Correlations were found between the duration of detachment and the concentration of total proteins (p < 0.01). The extent of RD was correlated with the concentration of IgG or IgA in the SRF (p < 0.01). These findings suggest that the correlation between the Ig concentration and the extent of RD is an argument for the participation of choriocapillaris in the genesis of SRF.

[Efficacy and tolerability of apraclonidine (ALO 2145, 1%) in the prevention of early ocular hypertonia, after trabeculoretraction using argon laser and posterior capsulotomy using Nd:YAG laser]. / Efficacité et tolérance de l'apraclonidine (ALO 2145, 1%) dans la prévention de l'hypertonie oculaire précoce, après trabéculorétraction au laser à argon et capsulotomie postérieure au laser Nd:YAG.

ALO 2145 (Apraclonidine Chlorhydrate)*, is a new hypotensive agent; it acts as a selective alpha-2-adrenergic agonist to produce a marked reduction in intraocular pressure with minimal effect on the cardiovascular system. 38 patients undergoing ocular laser surgery were allocated to treatment with either ALO 2145 1% (n = 20), or to placebo (n = 18), in a double-masked fashion. One drop of study medication was instilled into the operative eye one hour before laser surgery, and one drop immediately after the laser surgery. ALO 2145 treated eyes exhibited a significantly lower mean intraocular pressure increase in the immediate postoperative phase, compared with placebo treated eyes. ALO 2145 also significantly reduced the postoperative incidence of intraocular pressure spikes, defined as intraocular pressure increases of more than 10 mmHg over baseline (17% of cases for active treatment vs 60% of cases for placebo). ALO 2145 1% was shown to be effective and well tolerated in the dosage regimen employed in this study.

[Retinal detachment in patients with pseudophakia]. / Le décollement de rétine du pseudophake.

49 eyes with pseudophakic retinal detachments are operated with 44 good anatomic results (90% success). These detachments are characterised by the high frequency of anterior proliferative vitreoretinopathy.

[A histologic study 7 months after radial keratotomy in a 32-year-old man]. / Etude histologique 7 mois après une kératotomie radiaire chez un homme de 32 ans.

A 32 years old patient died seven months after a radial keratotomy. The histologic study of one cornea is realized. The wound of anterior stroma varies from 0.08 to 0.13 mm; it is filled of epithelial cells with eosinophile cytoplasm and a round nucleus. Near this epithelial ingrowth Bowman's membrane is interrupted and the fibres of stroma lose their parallel direction in comparison with the epithelial plane. These histopathologic results are compared with the other publications; and in reference with the mechanism of the healing, an histogenesis of the corneal healing is proposed.

[Chorioretinitis in congenital toxoplasmosis]. / La choriorétinite toxoplasmique congénitale.

The goal of this study was to establish the incidence of chorioretinitis in 100 infants whose mothers presented a seroconversion during the pregnancy. It is a retrospective study over 6.5 years. There were 17 cases of latent congenital toxoplasmosis (56.7%) and 13 cases of clinical congenital toxoplasmosis (43.3%). Three infants presented with chorioretinitis: one at birth in a context of general stroke, the two others at 2 and 17 months after birth, despite treatment. The risk of retinochorioditis was the same in the case of latent or clinical congenital toxoplasmosis. The fall in the antibody titre was not a good criterion of cure; the percentage of lymphocytes in the cerebrospinal fluid could constitute a better criterion. This study confirmed the efficacy of systemic treatment of congenital toxoplasmosis.

[Histoenzymologic study of the anterior part of the medial rectus muscle]. / Etude histo-enzymologique de la partie antérieure du muscle droit interne.

The anterior region of 16 medial rectus muscles has been studied using myosine. ATPase at pH 4.63. The authors find one third dark fibres type I like, ATPase positive and two thirds fibres type II like ATPase negative. Types II A, II B and II C are difficult to individualize.

[Pneumatic retinopexy using SF6 or C3F8. Results and complications apropos of 56 patients]. / La rétinopexie pneumatique par SF6 ou C3F8. Résultats et complications à propos de 56 patients.

56 patients with primary retinal detachment were treated by pneumatic retinopexy. The overall success rate for reattachment with one operation was 66%. Postoperative complications included development of new tears (18%) and P.V.R. (16%). Pneumatic retinopexy is a valuable new technique, however careful patient selection and postoperative management is required.

[Adaptation of Goldmann's cupula to the detection of subjective cyclodiplopia. Preliminary study]. / Adaptation de la coupole de goldmann à la détection de la cyclodiplopie subjective-Etude préliminaire.

Although the single binocular visual field provides an indication of the area free of horizontal or vertical diplopia, it does not assess cyclorotary diplopia. A cylindric glass is adapted on the Goldmann perimeter and gives a linear spot, allowing the determination of the cyclorotary component of diplopia.

[Endothelial involvement of injection of silicone into the vitreous body]. / Retentissement endothélial de l'injection de silicone dans la loge vitréenne.

Intraocular silicone oil tamponade is used as an adjunct to vitrectomy in the treatment of proliferative vitreoretinopathy. The authors analyzed the effect of silicone oil on the corneal endothelium in 28 patients (10 phakic and 18 aphakic). In the phakic group, the endothelial cellular loss is small, no significant. In the aphakic group, the endothelial cellular loss is 20%.

[Uveal effusion syndrome. Apropos of a case]. / Syndrome d'effusion uvéale. A propos d'une observation.

Uveal effusion syndrome is a rare entity. It associates a nonrhegmatogenous retinal detachment, an annular cilio-choroïdal detachment and peripheral vascular anomalies. It is important to differentiate it from the another retinal detachments and the malignant melanoma.

[Oculomotor disorders and enlargement of the extraocular muscles]. / Déficits oculomoteurs et gros muscles.

Aetiologic conditions for enlargement of extra ocular muscles are graves' orbitopathy, acute or subacute myositis as a subgroup of inflammatory orbital pseudotumor, and sometimes lymphoid or metastatic tumor. The distinction of these aetiologies can be made on clinical versus CT Scan or IRM grounds with two different patterns of oculomotor disfunction. Restrictive extensibility, which found expression in the antagonist field, is typical of grave's myopathy, sequelae of subacute myositis or acute myositis of the superior oblique. Deficiency of the enlarged muscle's contractibility is typical of a recent and transient myositis involving a rectus muscle or of a rare tumor of an extraocular muscle.