Systematic error in computerized pachymetry.

In a polycentric study, the influence of some of the most common variables capable of influencing the reliability of prekeratotomy pachymetry has been evaluated. The fluctuation in a sequence of measurements from the same point on the cornea, with the patient in different positions (orthostatic and clinostatic), during progressive drying of the lacrimal film and before and after corneal marking have been evaluated. Three operators, working randomized, used the same computerized pachymeter (DGH 1000) to make the measurements. The data obtained in this way were statistically analyzed by the Statgraphics personal computer program. Some interesting and useful considerations about the more correct methods to run the test and its real accuracy have emerged.

[Comparison of the anti-miotic effect of 0.03% flurbiprofen with 1% indomethacin in cataract extraction]. / Comparaison de l'effet antimiotique du flurbiprophène 0.03% par rapport à l'indomethacine 1% pendant l'extraction extracapsulaire de la cataracte.

Maintaining successful mydriasis is essential during cataract extraction. The use of nonsteroidal anti-inflammatory drugs in order to inhibit trauma induced miosis has been advocated by many authors. Indomethacin 1% has proved his efficacy since many years. Flurbiprofen has been introduced more recently and has been accepted largely because of a better patient comfort. He proved his efficacy against placebo. We conducted a randomized double blind study in order to verify if there is any difference in efficacy between these two drugs. 40 cases were randomly assigned to a pretreatment, not known by the surgeons, with Indomethacin 1% (Indoptic) or Flurbiprofen 0.03% (Ocuflur). Measurements were taken at the beginning of surgery, after nucleous extraction and after irrigationaspiration of lens cortical material. Sodium hyaluronate and epinephrine were not used during this study. After nucleous extraction, the mean pupillary constriction was 1.53 mm in the Indomethacin group and 1.23 mm in the Flurbiprofen group (p greater than 0.1). After aspiration of cortical material, the mean pupillary constriction was 2.27 mm in the Indomethacin group and 2.00 in the Flurbiprofen group (p greater than 0.1). Cumulative results of patients who constricted the pupil more than 2 and 3 mm showed a better result in the Flurbiprofen group. Flurbiprofen has proved in this study his efficacy compared to an other nonsteroidal anti-inflammatory drug in inhibiting trauma induced miosis.

[Early vitrectomy in the treatment of severe eye injuries]. / La vitrectomie précoce dans le traitement des traumatismes graves de l'oeil.

Several authors regard early vitrectomy as the best guarantee of success in cases of severe ocular injury. The present authors reviewed their own group of 27 patients, which included 13 cases with intraocular foreign bodies, 6 cases of blunt trauma and 8 with perforating injuries. Aside from cases which later developed retinal complications, vitrectomy was performed in 25 patients, though rarely more than a month after injury. The mean duration of postoperative follow-up was 22 months (minimum 6 month, maximum 66 months). The results and the need for silicone oil injection are discussed and compared with the literature. The timing of vitrectomy is of major importance.

[Endophthalmitis and pseudophakia]. / Endophtalmite et pseudophaquie.

The authors describe seven cases of endophthalmitis following cataract surgery and intraocular lens implantation. The patients were treated with antibiotics together with mydriatics or with mydriatics and antiinflammatory medication only. Rapid healing of the endophthalmitis was observed in both series, with good restitution of visual acuity. According to various articles on this complication, approximately 75% of the aqueous humor samples taken are bacteriologically positive. The present authors therefore took samples of aqueous humor intraoperatively in randomly chosen cases, in order to establish whether there were any false-positive results due to external contamination. A brief review of the literature is presented.

[Conjunctival calcification in patients in chronic hemodialysis. Morphologic, clinical and epidemiologic study]. / Les calcifications conjonctivales chez les patients en hémodialyse chronique. Etude morphologique, clinique et épidémiologique.

The authors compared the presence of conjunctival calcifications in a group of 37 patients undergoing chronic hemodialysis with laboratory findings and radiologic examinations. These calcifications appear to develop in patients suffering from hypercalcemia, particularly when the mathematical product of inorganic calcium and phosphorus (Ca x PO4) exceeds the value of 3.8-4.0. Ocular calcifications are usually asymptomatic although conjunctival inflammation due to crystal deposition, better known as "red eyes", has been reported in uremic patients. This has been noted to improve after the Ca x PO4 product is reduced. Such a conjunctival inflammation has not been reported in patients undergoing chronic hemodialysis and we do not report any case of disturbance due to the presence of conjunctival lesions. These lesions usually occur in the paralimbal conjunctiva, in the limbal area exposed by the interpalpebral fissure. This is thought to be due to the relatively high alkalinity, resulting from the diffusion of CO2 from the exposed surface of the eye, which promotes the deposition of calcium salts. However, the frequent presence of pinguecula, or histologic elastosis, in the eyes of uremic patients with calcifications, suggests a pathogenic role of local degenerative changes as well. Among these 37 patients, 6 underwent a biopsy of the conjunctival lesions, allowing a pathological examination. This permitted the authors to confirm the presence of calcium deposits in the basal lamina of the conjunctival epithelium and also in the sub-epithelial tissue. In every case, a significant degeneration of the elastic tissue of the conjunctiva was found, confirming that this lesion can precede calcium deposition in these particular patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intraocular implants in diabetic patients]. / Implants intraoculaires chez les patients diabétiques.

We conducted a retrospective study of 641 cataract operations performed in our service from January 1982 to January 1986 in order to evaluate the results obtained on diabetic patients who had cataract extraction with intraocular lens implantation. In this general population who underwent cataract surgery, diabetics represent 14% of our cases. In this sub-group, we identified 28 patients (33 eyes) who received an intraocular lens. Among these eyes, 25 (76%) achieved a post-operative visual acuity of 5/10 or better. We found that cataract surgery with intraocular lens implantation in diabetics carries the same risks and the same complications rate as it does for a general population. However, for these patients are found a particular risk of activation of the diabetic retinopathy with early development of diabetic maculopathy in 10% of the cases. The examination and treatment of this retinal complication did not seem to be affected by the presence of an intraocular lens. Therefore, the advantages gained by the introduction of an intraocular lens, justify this type of correction of aphakia in selected diabetic patients.

[Corneoscleral melanosarcoma. Keratoplasty]. / Mélano-sarcome cornéoscléral. Kératoplastie.

In cases of corneoscleral melanosarcoma enucleation is generally ineritable. In the case described, the patient was treated with a corneoscleral lamellar graft after excision of the enormous tumor and of a recidive. Uneventful recovery and good anatomical and functional result in the six months since the last operation.

[Fat embolism syndrome without fractures]. / "Fettemboliesyndrom" ohne Frakturen.

Report on an 18-year-old patient who developed a respiratory distress syndrome after trauma without bone fractures and with only minimal soft tissue contusion. Twelve hours after the accident fever and dyspnea appeared, accompanied later by hemoptysis, microhematuria, a fall in hemoglobin and in platelet count, petechiae on the skin and in the conjunctiva, cotton-wool lesions in the retina and micronodular shadows in the lungs. Various pathogenetic mechanisms other than bone marrow fat embolism are discussed in the light of this case.

[Mucous graft in acute spastic ectropion (author's transl)]. / La greffe de Denig dans l'ectropion spasmodique aigu.

Acute spactic ectropion often occurs with concomitant inflammatory and degenerative conditions of the conjunctiva. This is the cause of failures in the classic ectropion's surgery. Authors suggest to replace the altered conjunctiva with transplant of oral mucous membrane.