[Handiness and acceptability of the new Abak bottle in chronically treated patients. A cross-sectional, retrospective and multicentre study]. / Maniabilité et acceptabilité du flacon Abak nouvelle génération chez des patients traités au long cours. Étude transversale, rétrospective et multicentrique.

BACKGROUND: Difficulty of use of eyedrops is a factor associated with poor patient compliance that reduces treatment efficacy. The aim of this study was to evaluate the handiness and global acceptability of the new Abak timolol bottle (multidose preservative-free eyedrops) in comparison with that of other administration systems (classical multidose eyedrops or single-doses) in patients treated for glaucoma or ocular hypertension. METHODS: Cross-sectional, retrospective and multicentre study involving 41 ophthalmologists in France. Selected patients were those who had been treated with the new Abak bottle since at least two months, as a replacement for other beta-blocker eyedrops. Handiness and acceptability of the new Abak bottle in comparison with other delivery systems were evaluated using a questionnaire filled by the investigator. RESULTS: Almost all the patients were unanimous regarding the handiness of the new Abak bottle: easy to open for 96.5% of them, easy to handle for 96.0%, and easy to get drops for 91.1%. For all these criteria and in a general manner, patients preferred the new Abak bottle in comparison with the previous eyedrop container. These results were confirmed in the oldest patients. CONCLUSION: The new Abak bottle had a greater acceptability compared to preserved multidose eyedrops or to single-doses. Its handiness and the absence of preservative which may improve local tolerance are in favor of a greater compliance in chronically treated patients.

The low temperature magnetic circular dichroism spectra of iron-sulphur proteins. I. Oxidised rubredoxin.

Variable temperature magnetic circular dichroism spectra have been measured on oxidised Clostridium pasteurianum rubredoxin. Evidence has been obtained for the presence of two one-electron charge-transfer transitions, sulphur to ferric ion, in the region 15 000 to 28 000 cm-1. The first moment of the lower energy band is consistent with it being the orbital transition t1 non-bonding sulphur orbital, to the 2 e ferric d-orbital. The magnitude of the spin-orbit coupling constant in the lower excited state has been determined and shown to be small compared with the axial distortion. The splitting of the low energy band observed in the absorption spectrum can therefore be equated directly with the axial distortion of the lowest excited charge-transfer state. Finally, the potential utility of making saturation experiments at very low temperatures has been examined.

The low temperature magnetic circular dichroism spectra of iron-sulphur proteins. II. Two-iron ferredoxins.

Variable temperature magnetic circular dichroism (MCD) spectra of a number of two-iron ferredoxins have been measured. The spectra of fully oxidised spinach and Spirulina maxima ferredoxin are independent of temperature between room temperature and 18 K, showing that no contribution to the room temperature MCD spectrum arises from the small population of low-lying excited states originating from the exchange coupling. However, the low temperature MCD spectra of the half-reduced proteins spinach and Spirulina maxima ferredoxin and adrenodoxin are all reasonably intense and temperature dependent. An interpretation of the spectrum of the charge-transfer region is suggested by starting with the assignments previously obtained from rubredoxin.

In vivo study of a fluorocarbon polymer-coated intraocular lens in a rabbit model.

PURPOSE: To evaluate the biocompatibility in rabbit eyes of poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) that were surface modified using Teflon AF. SETTING: Hôtel-Dieu Hospital, Paris Cedex, France. METHODS: The IOLs were coated with Teflon AF, an amorphous, transparent, and highly hydrophobic fluorocarbon polymer, by immersing them in Teflon AF 5% and evaporating the solvent (C8F18). The surface quality of the Teflon-coated IOLs was evaluated by scanning electron microscopy (SEM). Teflon-coated (n = 20) and control PMMA (n = 10) IOLs were implanted in rabbit eyes. The presence of iris-IOL synechias and the number of deposits on the IOL surfaces were clinically evaluated in both groups to assess the antiadhesive effect of Teflon AF. The Teflon-coated IOLs were removed, their surfaces were evaluated by SEM, and their elemental composition was checked by EDXA and Raman spectrometry. RESULTS: The PMMA IOLs were completely coated with Teflon AF. The Teflon group had no iris-IOL synechias and the control group, two extensive synechias. There were significantly fewer deposits on the surfaces of Teflon-coated IOLs than on the control IOLs 30 and 60 days postoperatively (P < .0001). Scanning electron microscopy showed lens epithelium proliferation and spindle-shaped cells on the surfaces of the PMMA IOLs and cell deposits on the irregular regions of the Teflon-coated IOLs. White-yellow spots were present on the surfaces of both IOL types. The elemental composition of Teflon-coated IOLs was stable. CONCLUSION: Teflon AF had an antiadhesive effect that increased the biocompatibility of PMMA IOLs in vivo.

[Corneal abscess: therapeutic attitude based on microbiological testing]. / Abcès de cornée: attitude thérapeutique adaptée à l'enquête microbiologique.

PURPOSE: Bacterial corneal ulcers can affect the integrity of the eye and need therefore to be treated following strict rules. The authors present a prospective study on 15 bacterial corneal ulcers for which the initial treatment with topical fortified antibiotics was guided according to the results of Gram stain. MATERIAL AND METHODS: Gram positive cocci ulcers were treated with vancomycine (5 cases), Gram negative rod ulcers with gentamycine and ticarcilline (2 cases), and the association of these 3 antibiotics was used when no bacteria was found (8 cases). RESULTS: The results of the Gram stain and the culture were consistent in all the cases. Mean healing time was statistically significantly shorter when an infectious agent was found on Gram stain (13 days) than when not (23 days). CONCLUSION: These results suggest that the prognosis of bacterial corneal ulcers is enhanced when infectious agents are recovered and that the strategy of initiating an antibiotic therapy adapted to the gram stain results appears reliable and efficient. The successful outcome of this approach needs a perfect collaboration with the microbiologist.

[A new material for intraocular implant]. / Un nouveau matériau pour implant intraoculaire.

PURPOSE: The aim of our study was to evaluate a new fluorocarbon (Teflon AF), used as a coating of poly-methylmethacrylate intraocular lenses. Teflon AF can be dissolved in special solvents (liquid fluorocarbons). It is the first amorphous and transparent form of teflon. MATERIALS AND METHODS: The coating was performed and the surface quality of the teflon-coated lenses was evaluated by scanning electron microscopy. Twenty teflon-coated and 10 uncoated lenses were implanted in rabbit eyes after phacoemulsification. They were compared concerning the presence of iris-lens synechias and the number of deposits on the lens' surfaces. An in vitro static touch model was used to compare endothelial damage produced by the 2 kinds of intraocular lenses. The results from this model were quantitatively analyzed, using the BIOCOM 200 image-processing system. RESULTS: The teflon group had no iris-lens synechias and the control group had 2 extensive synechias. There were significantly fewer deposits on the surfaces of teflon-coated lenses on days 30 and 60 post-operatively (P < 0.0001) than on the control lenses. Teflon-coated lenses produced significantly less endothelial damage than did control lenses (P < 0.0001). CONCLUSIONS: Teflon AF presents an anti-adhesive effect that increases the biocompatibility of polymethylmethacrylate lenses and reduces endothelial damage during their intraocular insertion.

[Uncommon intra-orbital foreign body. Apropos of a case]. / Corps étranger intra-orbitaire inhabituel. A propos d'un cas.

We report an unusual case of an acute iatrogenic unilateral exophthalmos in a woman affected by acinetobacter baumanii septicemia. The possible hypothesis of the exophthalmos is discussed.

[Computerized video-keratoscopic analysis and cataract surgery by phacoemulsification. Predictive calculation of the power of the intraocular implant]. / Analyse vidéokératoscopique informatisée et chirurgie de la cataracte par phacoémulsification. Calcul prédictif de la puissance de l'implant intraoculaire.

PURPOSE: The authors present the results of a prospective study of 125 consecutive cases of phacoemulsification, performed by a single surgeon, to assess the benefit of computerised videokeratoscopy for the improvement of the predictive calculation of the power of intraocular lenses (IOL). METHODS: Preoperative keratometry was determined by means of 3 concurrent techniques, including automated kerato-refractometry (AKR 2000, Nidek) and videokeratoscopy by TMS-1 (Tomey) and CAS-1 (EyeSys). The results of the IOL calculation by these 3 methods was compared postoperatively to the power of the actual IOL yielding emmetropia as calculated by the optical method based on the postop, refraction at the various time-points. RESULTS: Simulated values obtained with videokeratoscopy significantly reduced the refractive error at 1 postop, week (p = 0.001), one month (p = 0.002) and 3 months (p = 0.002) for the CAS1 and at 3 months (p = 0.002) for the TMS1, as compared to values obtained with conventional automated keratometry. The refractive error was significantly reduced with the CAS1 at one month (p = 0.001) and 3 months (p = 0.019) as compared to TMS1. CONCLUSION: The determination of the anterior curvature of the entrance pupil by videokeratoscopy significantly improves the predictive calculation of the IOL power.

[2nd generation bio-integrated keratoprosthesis. Implantation in animals]. / Kératoprothèse biointégrable de seconde génération (BioKpro II). Implantation sur l'animal.

PURPOSE: Our goal was to evaluate a second generation biointegrable keratoprosthetic device (BioKpro II). METHODS: The device consists of a porous transparent PTFE (12 mm diameter) and a soft copolymer structure for the optical system (7 mm diameter). Intraocular pression was evaluated with a Goldmann tonometer on an artificial chamber. A lamellar dissection was carried out 3 mm radially for 360 degrees creating a pocket to accommodate the skirt. The soft optic (42.5 D; 500 microns thick) was positioned through a hole (6 mm in diameter) trephined in the central cornea. A 360 degrees peritomy was performed and conjunctiva was placed in front of the prosthesis, sutured and was opened 15 days post implantation. 14 rabbits were implanted and were allowed to heal for three months. RESULTS: We are able to measure the intraocular pressure by Goldmann tonometer on an artificial chamber. We did not observed epithelialisation on the hydrophilic optical surface (14/14). Aseptic necrosis in direct contact between cornea and the soft optical system was observed when conjunctiva was not effective (4/14). As observed with the first generation devices, conjunctiva or buccal mucosa is needed to avoid local necrosis. In other cases no adverse reactions were observed after implantation. DISCUSSION: The geometry and biomechanical properties of the BioKpro II is closed to that of the human cornea. The junction between the optical and the flange was bound by polymeric interpenetration and prosthesis dislocation was not seen under pressure over 1000 mmHg. CONCLUSION: Second generation biointegrable keratoprostheses (BioKpro II) can be implanted successfully. Further tests will determine if surface modifications designed to promote epithelial cell attachment on the optical system could prevent ulceration at the junction between the fluorocarbon and the core.

[Uncommon corneal hydrops. Apropos of a case]. / Hydrops cornéen inhabituel. A propos d'un cas.

We report a case of corneal hydrops in a young patient with unremarkable ophthalmologic history or intercurrent identified pathology. Different etiologies of corneal hydrops are discussed.

[Rigid endoscope with Gradient-index lenses. Preliminary studies]. / Endoscope rigide à lentilles de GRIN. Premiers essais.

PURPOSE: Endoscopes for use in ophthalmology can be manufactured in dimensions smaller than 0.89 mm. MATERIALS: Gradient-index lenses that give a higher resolution than fiber bundles can be miniaturized down to 0.35 mm. RESULTS: We used this new endoscope in 6 eyes of 6 patients during anterior segment surgery. Preliminary clinical experience has demonstrated the usefulness and practical application of this new instrument. CONCLUSION: The clear views the instrument provides of the ciliary sulcus and ciliary body behind the iris make it useful in secondary posterior chamber intraocular lens implantation, retroprosthetic membrane behind keratoprosthesis, Molteno valve, and in endolaser photocoagulation.

[Reis-Buckler dystrophy: therapeutic photo-ablation with the excimer laser]. / Dystrophie de Reis-Buckler: photoablation thérapeutique au laser excimer.

PURPOSE: Reis-Buckler's corneal dystrophy consist of superficial reticulated opacities with recurring attacks of corneal erosion. Lamellar and penetrating keratoplasties were the traditional surgical means of improving recurrent erosions and vision but the dystrophy recurs following surgery. Phototherapeutic keratectomy (PTK) is now the standard method of managing this anterior corneal disease when intervention is required. MATERIAL AND METHODS: We have treated ten eyes with Reis-Buckler's dystrophy using Excimer laser PTK. RESULTS: All of patients achieved visual improvement (preoperative corrected visual acuity: average 0.3 +/- 0.2 SD, postoperative at one month 0.6 +/- 0.3 SD and 0.7 +/- 0.2 SD at one year. The refractive shift changed from a spherical equivalent of -0.92 D to a postoperative refraction of +1.80 D at one month and +1.65 D at one year.

[Biocompatibility of a porous alumina orbital implant. Preliminary results of an animal experiment]. / Biocompatibilité dans la cavité orbitaire d'une bille en alumine poreuse. Résultats préliminaires de l'expérimentation animale.

PURPOSE: Evaluation of clinical tolerance and scanning electron microscopy study of the bio-colonisation of a porous ceramical alumina implant after evisceration of the rabbit. Preliminary results. METHODS: Sixteen white New Zealand rabbits were eviscerated. A porous hydroxyde alumina ball was implanted in the opened sclera and explanted 15, 30, and 90 days after implantation. Clinical tolerance was assessed and implant tissular ingrowth was analyzed by scanning electron microscopy. RESULTS: One infection was observed and there was no conjunctival breakdown. Fibrovascular ingrowth occurred as soon as 15 days after implantation, and was full at one month. CONCLUSION: Porous alumina implant orbital tissue tolerance and fast fibrovascular ingrowth in the rabbit socket suggest promising result in the human anophthalmic socket.

[Phototherapeutic keratectomy in the treatment of Groenouw's type I corneal dystrophy]. / La photokératectomie thérapeutique dans le traitement de la dystrophie de Groenouw I.

PURPOSE: This study was designed to investigate the therapeutic potential of phototherapeutic keratectomy (PTK) for the treatment of corneal granular dystrophy. PATIENTS AND METHODS: PTK was performed with the Excimed UV 200, (Summit Technology, Inc) on a series of 27 eyes of 22 patients with corneal granular dystrophy. Mean patients' age was 34.6 years. The mean follow-up period was 31 months (ranged from 6 to 52 months). The changes in best corrected visual acuity and spherical equivalent were evaluated at 6, 12, 18 and 24 months. RESULTS: All of patients achieved visual improvement. Mean preoperative best corrected visual acuity (BCVA) was 20/100 and mean postoperative BCVA was 20/30 at one year. The mean hyperopic shift caused by tissue ablation was +/- 2.8 D after one year. CONCLUSION: Corneal grafting was the standard treatment for visually disabling granular dystrophy, but PTK has significant advantages over this procedure and must now be the standard method of managing corneal granular dystrophy when intervention is required.

[Temporomandibular ankylosis in children: apropos of 30 cases]. / Ankylose temporo-mandibulaire de l'enfant: à propos de 30 observations.

Temporomandibular joint ankylosis in children is responsible for facial growth disorder. A series of 30 cases is presented. Patients are aged from 3 months to 15 years (mean = 7.6 years). Infection is the most frequent etiology. Recurrence rate is higher in bilateral cases. Early surgical treatment followed by meconotherapy led us to 93% satisfactory results.

Quantification and localization of hyaluronan in a PTFE polymer implanted in the corneal stroma.

The amount and distribution of hyaluronan in a PTFE polymer used to support an artificial cornea implanted in the rabbit cornea were determined. The findings were used to describe the polymer-corneal stroma interface and the reason for the translucence and wettability of this originally opaque and hydrophobic biomaterial. PTFE disks (6 mm in diameter, 0.2 mm thick, 50 microns in pore size) were implanted after a free-hand intralamellar dissection. The corneas were removed 15 days, 1 month, and 3 months after implantation. The hyaluronan content of pepsin-solubilized corneal stromal extracts and its distribution (7 microns cryostat sections) were investigated using an alkaline phosphatase-linked hyaluronectin assay that specifically detects nanogram amounts of hyaluronan. A PTFE polymer implant caused large, transient increases in hyaluronan density in the implanted stroma. The presence of amphiphilic hyaluronan in the polymer 15 days post implantation probably produced translucence and wettability of this opaque, hydrophobic implant despite the absence of cells. The hyaluronan density in the PTFE polymer increased considerably during the first month and then decreased to stabilize at a moderate level by the third month. These changes in hyaluronan density parallel the invasion of the polymer by inflammatory cells during the first month and the subsequent replacement of these cells by fibroblasts. The PTFE polymer is a good interface that is compatible with the native corneal stroma, and our results indicate that hyaluronan, because of its amphiphilic character, plays a major role in the polymer wettability and translucence and in the production of typical corneal extracellular matrix within the pores of the polymer.

Influence of ePTFE polymer implant permeability on the rate and density of corneal extracellular matrix synthesis.

Microporous polymers have great potential for the production of corneal keratoprosthetic devices. Keratocytes invade the pores of expanded polytetrafluoroethylene implants (ePTFE) and collagen synthesis occurs. This ePTFE becomes translucent after its implantation in the stroma of rabbit cornea. The rate and density of cell growth within this polymer depends on the implant thickness, pore size, and its placement in the cornea. We have investigated the influence of the polymer permeability on the collagen and protein contents ePTFE implants. Rabbit corneal stroma were implanted with ePTFE disks (6 mm in diameter) by intralamellar keratoplasty. The implanted polymers were removed from the stroma after 3 to 6 months. The collagen and protein contents were determined after pepsin solubilization. The collagen content of the high-permeability implant was 3.7-fold greater than that of the low-permeability implant 3 months after implantation and 2.4-fold greater after 6 months. The total protein content of the high-permeability implant was 2.5-fold greater than that of low-permeability implant at 3 months and was the same after 6 months. The collagen-to-protein ratio was 68% in the high-permeability implants, and thus similar to that of normal corneal stroma. Thus, high polymer permeability increased both the rate and density of the corneal extracellular matrix ingrowth.

Confocal microscopy of cystic disorders of the corneal epithelium.

OBJECTIVE: This study aimed to describe the morphology of cystic disorders of the corneal epithelium by confocal microscopy. DESIGN: The study design was a prospective evaluation of confocal microscopic images of patients with cystic corneal disorders. PARTICIPANTS: Thirteen patients (19 eyes) were included. The corneal disorders included four patients with corneal decompensation (Fuchs' dystrophy), five patients with epithelial basement membrane dystrophy (e.g., Cogan's microcystic and map-dot dystrophies), one patient with Meesmann's dystrophy, and three patients with recurrent erosion syndrome of unknown etiology. Confocal images of diseased corneas were compared with those of ten normal control eyes (ten subjects). INTERVENTION: All patients were examined by slit-lamp biomicroscopic analysis and confocal microscopic analysis (Tomey, Erlangen-Temmenlohe, Germany). Image analysis was used to identify the corneal epithelial structures correlated with the corresponding pathology. MAIN OUTCOMES MEASURES: Confocal microscopy was used to assess the size, shape, light scatter, and reflection of the cysts. RESULTS: Slit-lamp examination results showed corneal epithelial cystic lesions in all cases. Confocal microscopy was able to identify cystic lesions in 9 (69.2%) of 13 patients. Of the four patients in whom lesions could not be found by confocal microscopy, three had recurrent erosion syndrome and the other one had epithelial basement membrane dystrophy. The confocal images were compatible with the clinical and histologic pictures of the disease. Normal control eyes did not show any epithelial lesion, either by biomicroscopy or confocal microscopy. CONCLUSIONS: Confocal microscopy provides an in vivo evaluation of cystic epithelial corneal lesions. This study shows that confocal microscopy is suitable for examining cystic lesions of the corneal epithelium. Nevertheless, it is not as sensitive as biomicroscopy in detecting cystic lesions in certain corneal conditions.