Gender differences in retrieval from long-term memory following acute intoxication with ethanol.

The present study investigated the effects of ethanol on retrieval from long-term memory by using a set of cognitive decision tasks. Male and female subjects were administered either 0.0 or 1.0 milliliter of ethanol per kilogram of body weight, and then asked to make physical, lexical, and semantic decisions about pairs of words. In general, intoxicated subjects responded significantly slower than sober subjects on all decision types. In addition, female subjects demonstrated greater performance deficits than males when intoxicated. The results suggested that the reduction in speed was not due to a simple slowing of motor responses. Rather the ethanol induced memory deficits may result from the slowing of cognitive operations that impair the efficiency of working memory. Several reasons were proposed for the observed difference in reaction to intoxication between male and female subjects, including neuroendocrine processes and cognitive differences.

Therapeutic ultrasound for the treatment of glaucoma.

We present a summary of the results obtained on 1142 treatments of 1072 eyes treated in our hospital during the last 5 years. Ultrasound has been used to treat 843 eyes with refractory glaucoma and also to restore failed trabeculectomy filtering blebs in 229 eyes. The single treatment success rate with success defined as an IOP > or = 20 mm Hg was 59% at one year and 46% at 3 years. In cases of failed blebs, ultrasound treatment performed 3 to 12 weeks after trabeculectomy revived the blebs of 82% of the phakic eyes when 5 FU subconjunctival injections were performed in the following days.

[Simultaneous failure of trabeculectomy and sclerotomy using laser holmium: YAG]. / Echec simultané d'une trabéculectomie et d'une sclérostomie au laser Holmium: YAG.

We present a case of a bilateral chronic open-angle glaucoma in a 74 year old woman, operated on the right eye by conventional trabeculectomy and the left eye by holmium laser ab externo sclerostomy. Both filtering blebs remained elevated and functional for 18 months. After this follow-up period, both blebs simultaneously collapsed and intra-ocular pressure rose again. This case shows that a late conjunctival scarring process, depending on a non surgical factor, may still be encountered after Holmium: YAG laser sclerostomy just as after standard trabeculectomy despite reduced conjunctival tissue trauma.

[Results of argon laser treatment of 100 eyes with open-angle glaucoma (trabeculoplasty, trabeculoretraction)]. / Résultat du traitement au laser à l'argon de 100 yeux atteints de glaucome à angle ouvert (trabéculoplastie - trabéculorétraction).

One hundred phakic eyes of 76 patients with primary open angle glaucoma received argon laser therapy to the trabecular meshwork, a method, based on the works of James Wise, which we prefer to call trabecular retraction for two reasons: 1) the mechanical factor of trabecular tightening caused by the laser microscars and 2) to differentiate it from initial argon laser treatment in primary open angle glaucoma: trabeculopuncture. Argon laser trabecular retraction involves application to the entire pigmentary trabecular ring, just anterior to the scleral spur, of 100 evenly spaced non-penetrating burns, using a 50 microM. beam diameter with a pulse duration of 0,1 sec, and a power level adjusted to produce a minimum visible trabecular reaction. Laser treatment was performed on an out-patient basis using a three mirror Goldmann lens after topical anesthesia. Pre-laser anti-glaucoma medical treatment was continued unchanged during the follow-up period of this study, to assess accurately the effect of the laser treatment on intraocular pressure (IOP) without introducing the variable of changing medications. Treatment was applied to eyes with uncontrolled glaucoma on maximum tolerable medical therapy and, as such, candidates for surgery, eyes of patients unable to tolerate side effects of effective intensive medical therapy, and eyes with controlled open angle glaucoma to permit reduction of medical therapy. Mean pressure drop in the 100 eyes was 8,9 mmHg, the reduction of IOP being achieved between 3 and 6 weeks after the laser procedure. Surgery for glaucoma was avoided in 93% of the eyes. Pressure drop in 75% of treated eyes was between 4 and 11 mmHg, in 16% was 12 mmHg or more, and in 9% was 3 mmHg or less. Follow-up was for at least three months and in some cases extended to 15 months. These results and data from published reports suggest that the pressure drop obtained three months post-laser could be considered definitive, except in a very small percentage of eyes. Average intraocular pressure reduction in patients under 60 years was 8,3 mmHg and 88% of the eyes had a drop in IOP of 4 mmHg or more. In patients over 60 years, average intraocular pressure reduction was 9,3 mmHg and 93% of the eyes had a drop in IOP of 4 mmHg or more. The major complication in eyes with marked glaucomatous damage to their optic nerves is a possible rise in intraocular pressure following treatment. This post-laser increase in IOP was noted in 19 eyes but resolved either spontaneously or easily with medication. No visual field loss was observed in these eyes. Localized peripheral anterior synechiae were noted in 42 eyes, but these did not affect the success of the procedure.4

[Argon laser trabeculoplasty. Results over 10 years]. / Trabéculorétraction au laser à l'argon (TRLA). Résultats à 10 ans.

To appreciate the current place of argon laser trabeculoplasty (ALT) in the therapeutic armamentarium of primary open-angle glaucoma (POAG), the first 211 photocoagulated phakic eyes were analysed. 159 eyes had a 5 year-follow-up, 147 eyes had a 8 year-follow-up and 127 eyes had a minimal 10 year-follow-up. These eyes corresponded to an initial group of 151 patients: 76 women and 75 men with a mean age of 66 years. We decided, arbitrarily, to assess trabeculoplasty results according to three combined criteria of failure (insufficient or transient intraocular pressure drop (< or = 3 mmHg), progression of visual field loss and need of filtrating surgery) and to various expected goals: prevent an increase of drugs with their subsequent side effects, taper a non tolerated medical treatment and, lastly, try to cease all medical treatment in non compliant patients. According to those criteria, during the first five years, the cumulative failure rate in the 159 eyes rose steadily from 19% (31 eyes) in the first year to 52% (82 eyes) in the fifth year. In the 147 eyes with a 8 year-follow-up 25 eyes (17%), and in the 127 eyes with a 10 year-follow-up 14 eyes (11%) were still controlled. At the 10 year-follow-up, the surgical failure rate was 35% (40 eyes in 113), quite similar to the rate at 5 years: 33% (27 in 82). Thirty eyes excluded in the study belonged to patients who died during the follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

[Role of antisepsis in the preventive chemo-antibiotic treatment of postoperative endophthalmitis]. / Rôle de l'antisepsie dans le traitement chimio-antibiotique prophylactique de l'endophtalmie postopératoire.

A protocol associating chemoprophylaxis and two-agent flash antibioprophylaxis was performed for more than two years in order to prevent postoperative endophthalmitis in elective open-globe surgery. The aim of this study is to appreciate whether antibiotic therapy is really useful as a complement to chemoprophylaxis. Three successive conjunctival scrapings were performed in the operating room: two before surgery (one before and one after conjunctival disinfection by povidone iodine), and the third one at the end of the operation. The total number of positive scrapings significantly decreased after disinfection but, some changes appeared on the final scrapings positive and negative. The risks of a positive scraping after the disinfection are greater if the scraping was initially positive. The persistence of a positive scraping after disinfection is noted in about 20% of cases. Therefore, there is a risk for microorganisms to penetrate into the eye, still present on the conjunctiva after povidone iodine. This risk is an argument to carry on the flash antibiotic therapy before surgery, in order to obtain a high intravitreal concentration of antibiotics at the precise time when the bacteria may penetrate into the eye, and to stop their multiplication.

[Preventive chemo-antibiotic treatment of postoperative endophthalmitis in planned open eyeball surgery. Apropos of 2,337 cases]. / Traitement chimio-antibiotique prophylactique de l'endophtalmie post-opératoire en chirurgie réglée à globe ouvert. A propos de 2,337 cas.

A protocol combining chemoprophylaxis and antibioprophylaxis has been used since January 1st, 1990 for all patients (2,337 cases) undergoing planned open eyeball surgery (except emergencies). The chemoprophylaxis is local, by eyedrops (picloxidin) during the days before surgery, and by eyewash of the conjunctival cul-de-sac with iodized polyvidone immediately before surgery. The systemic antibioprophylaxis associates two bactericidal antibiotics with a wide spectrum and good intraocular penetration, active on 89 to 90% of the bacteria incriminated in postoperative endophthalmitis: a ureidopenicillin, piperacillin, and a fluoroquinolone, ciprofloxacin; the adverse effects are minimal. Although the sample size does not allow statistical, analysis the results of this study (the absence of any endophthalmitis) are very encouraging in comparison with those of the literature, those of the same department during the years before the protocol, and those of the other departments in the same hospital which carry out the same surgery under the same conditions.

[Use of perfluoro-octane liquid in the treatment of giant tears with inversion of the retina: preliminary results]. / Utilisation du perfluoro-octane liquide dans le traitement des déchirures géantes avec inversion de la rétine: résultats préliminaires.

Five consecutive cases of giant tears with retinal inversion were easily and successfully treated using vitrectomy and silicone oil injection after repositioning of the retina with perfluoro-octane. The good initial results show the interest of this technique compared with the incarcerations or with the manipulation of the retina and of the perfluoro-octane compared with the other liquid perfluorocarbons.

[Non-refractive complications of keratectomy with Excimer laser in 141 myopic eyes]. / Complications non réfractives de la kératectomie par laser Excimère observées sur 141 yeux myopes.

PURPOSE: The purpose of this study is to evaluate the safety of myopic photorefractive keratectomy and to study the frequency of complications, excepted refractive problems. METHODS: A consecutive series of 170 eyes has been studied in a prospective trial low-up of one year for 107 eyes and six months for 34 eyes. Twenty-nine eyes have been lost. RESULTS: The main complication after six months is the loss of the best spectacle-corrected visual acuity. It was due to a haze in seven eyes (loss of one line in five eyes and four lines in one eye) and to an excentric ablation in three eyes (one line in two eyes and two lines in one eye), results found for treatments of six diopters or more. The haze is a constant complication. A direct relationship between the haze's intensity and the treatment importance was found as was an inverse relationship between the patient's age and the haze's intensity. The excentric ablations have no influence on the final visual acuity when they concern less than one millimeter. The epithelial problems were always of less importance. CONCLUSION: Except in corrections greater than seven diopters, complications are uncommon after Excimer for myopia. Patient's information has to be rigorous.

[Retinal vein occlusion and resistance to activated protein C]. / Occlusion veineuse de la rétine et résistance à la protéine C activée.

BACKGROUND: A new abnormality in the coagulation system, the resistance to activated protein C, has appeared among the numerous hereditary modifications which predispose patients to deep-vein thrombosis. The molecular abnormality responsible for the resistance to activated protein C is due to a mutation of an amino acid in the 506 position (Arg-->Gln) at the level of the factor V, designated under the name of factor V Leiden. METHODS: The authors wished to search for this alteration of the haemostasis in 106 patients with retinal venous occlusion hospitalized in Centre Hospitalier National d'Ophthalmologie des Quinze-Vingts (Paris). RESULTS: In our study of 106 patients presenting a retinal venous occlusion, the resistance to activated protein C was the most frequent coagulation abnormality found (4.71%), when compared with the other deficits of the inhibitors of the clotting system: protein S (2.80%), antithrombin III (0.94%) et protein C (0%). CONCLUSION: The test of resistance to activated protein C should be recommanded in cases of retinal venous occlusion, particularly in the search for a cause of thrombosis in young patients or in recurrent thrombosis.

[Preventive surgical scleral buckling of retinal detachment after severe ocular injuries]. / Cerclage chirurgical prophylactique du décollement de la rétine après traumatisme oculaire grave.

We performed surgical scleral buckling with an encircling band to prevent retinal detachment in twenty eyes with severe ocular injury (three contusions, seventeen penetrating eye injuries including twelve eyes with intraocular foreign bodies). All surgical buckling were performed during the two weeks following the injury. The purpose of this surgical procedure is to prevent the traction from contracting vitreous base which it itself secondary to vitreoretinal proliferation; several factors promote this latter outcome: perforating injury, vitreous hemorrhage, intraocular foreign body and the mix of vitreous substance and lens material. This prophylaxis is justified by the high frequency and often bad prognosis of post-traumatic retinal detachment. A mean follow-up of thirteen months showed no contusion associated delayed retinal detachment, with a final visual acuity superior to 7/10: thus, preventive surgical buckling appears efficient; perforating injuries were followed by retinal detachment in three cases; of these, two were reattached, and the final visual acuity depended on associated destructions. With the limitation of a short follow-up, this surgical procedure seems to be able to prevent most of the delayed retinal detachments.

[Definitive transient monocular blindness caused by ocular compression during general anesthesia]. / Cécité monoculaire transitoire définitive par compression oculaire accidentelle au cours d'une anesthésie générale.

We present a case of irreversible monocular blindness caused by obstruction of the central retinal artery detected in a young patient without any previous history, when waking up from a surgical procedure performed under general anesthesia. Clinical and complementary investigations were not conclusive. Nevertheless, when inquiring on the surgical procedure, it appeared that the patient was lying in a procubitus position, so that his head may have slipped on the head support, resulting in compression on his right eyeball. The fact that the patient was simultaneously submitted to a controlled low blood pressure may have worsened the effects of the compression. Reviewing the medical literature on the subject reveals that, although rare, such accidents do occur; they must be prevented by a constant surveillance when performing surgical procedures.

[Hypertensive anterior uveitis of toxoplasmic origin after vitrectomy]. / Uvéites antérieures hypertensives d'origine toxoplasmique après vitrectomie.

Two cases of vitrectomized congenital chorioretinal toxoplasmosis are presented. During a recurrence, an anterior segment inflammation with hypertony complicated both cases. Hypertony was efficiently controled by a specific antitoxoplasmosis therapy. The role of the vitreous barrier is suggested.

[Technique employing argon laser coagulation to obtain trabecular retraction]. / Technique de la trabéculo-rétraction par photocoagulation au laser à l'argon.

A technique for treating primary open angle glaucoma by argon laser photocoagulation is described. Its elective action on the trabeculum and on trabecular "collapse" in the absence of any trabecular perforation suggested the name of "trabecular retraction" for this procedure. Its efficacy depends on very good visibility of the trabeculum through 360 degrees, on perfect focalization of the point of impact to 50 mu, and on the application of one hundred or so impacts distributed throughout 360 degrees. Any pretrabecular obstacle must be eliminated. Mean pressure drap obtained is 10 mmHg. Complications are minimal and results comparable or superior to those of surgery.

[Pars plana vitrectomy: causal affections, material employed, and approach in 1400 cases (author's transl)]. / A propos de 1400 vitrectomies par la pars-plana. Affections causales, matériel et voie d'abord.

Isolated vitrectomy was employed in half of 1,400 cases operated upon, the other patients receiving an intra-ocular injection of silicone fluid. Emphasis is placed on the simplification undergone by the materials employed, the progress represented by the addition of an autonomous infusion for each instrument complementary to the vitrectomy, and the need for all ophthalmic surgeons, particularly those in training, to become familiar with the use of the vitreotome.

[Discussion of terminology concerning disorders of the optic nerve and disc (author's transl)]. / Discussion sur la terminologie concernant les affections du nerf optique et de la papille.

Progress over the past few years in knowledge concerning disorders of the optic nerve and disc leads to changes in their classification. A new terminology is proposed. It uses a minimum of terms, their very general sense being understandable by any nonophthalmologist physician. It is based upon clinical symptoms and signs, thus being immediately applicable in clinical practice.

[Treatment by horseshoe pattern photocoagulation of diabetic cystoid macular edema]. / Traitement par photocoagulation en fer à cheval de l'oedème maculaire cystoïde diabétique.

Eighty cases Diabetic Cystoid Macular Edema, with or without central spaces underwent photocoagulation from 1978 to 1989 using a horseshoe or ring pattern. Initial visual acuity ranged from 20/25 for far vision and 20/20 for near vision to a central scotoma, with an average of 20/60 for far vision and 20/50 for near vision. As initial treatment, we performed 63 horseshoe pattern and 13 ring pattern photocoagulation around the macula; an additional photocoagulation was carried out in 29 cases, one month to seven years later (average of 18.3 months), either on medial to the previous treatment (18), or closing the initial horseshoe pattern (10) or resulting in focal treatment (13), or associating any of these three. The cystoid macular edema disappeared in 47 cases, decreased in 15 cases, and remained in 14 cases, with a follow up ranging from 6 months to 10.5 years (average of 41.6 months). The post laser visual acuity range from 20/25 for far vision and 20/20 for near vision, to a central scotoma again, with an average of 20/60 for far and near visions. During the follow up various reasons of visual impairment were observed: cataract, intravitreal hemorrhage, epiretinal membrane, macular pucker and macular ischemia. Our results compared with the published ones concerning a grid pattern photocoagulation are encouraging. It is very important to stress that this photocoagulation is only aimed toward the macular edema itself: if necessary it should be associated with a grid pattern or a focal photocoagulation aimed toward extramacular edema.

[Treatment of coloboma pitS of the optic nerve complicated by serous detachment of the neuroepithelium]. / Traitement des fossettes colobomateuses de la papille compliquées de décollement séreux du neuroépithélium.

PURPOSE: The pathogenesis of the sensory retinal detachment of the macula associated with congenital pit of the optic nerve remains controversal. Based on our cases and the cases reported in literature, we propose a management plan for macular retinal detachment associated with optic nerve pit. METHODS: In this retrospective study ten eyes were treated for progressive visual loss. Treatment modalities were different depending on the time period: laser photocoagulation (to the juxtapapillary region) alone, laser combined with intraocular gas injection (C3 F8), laser combined with vitrectomy and intraocular gas tamponnade (S F6, C3 F8), laser combined with vitrectomy and temporary silicone oil tamponade. RESULTS: The follow-up period ranged between one and five years (mean follow-up thirty three months). We had eight successes and two definitive failures (an old macular detachment treated only by one laser session, and a young girl who had not kept the prone position after gas injection). In the group of six eyes treated by laser alone, only two retinal treatments were directly successfully treated; in three other eyes, the detachment recurred and was treated with success in a second step by a gas injection; the sixth eye is the first definitive failure (old detachment). In the five eyes treated by laser combined gas injection with or without pars plana vitrectomy (including three failures of laser alone), the retina remained attached in four eyes during the follow-up period; the sixth eye was the second definitive failure (the young girl). In the both eyes treated by vitrectomy and silicon oil injection, the retina has flattened. CONCLUSION: The results suggest that laser photocoagulation alone is not so efficient and that vitrectomy is not necessary with gas injection. Complete resorption of subretinal fluid occurred in eight eyes: two with laser photocoagulation alone, and six with a long term tamponnade combined with a peripapillary laser photocoagulation. In first treatment, this technique (laser with tamponade) is a valuable approach to manage serous macular detachment associated with optic nerve pit.

[Search for etiology in 110 cases of uveitis. Value of punctures of the aqueous humor and vitreous body]. / Recherche étiologique de cent dix uvéites. Intérêt des ponctions d'humeur aqueuse et du vitré.

PURPOSE: Evaluation of the frequency of each aetiology, comparison with recent and previous publications, focus on less classical pathologies, and interest of some complementary investigations. METHODS: Prospective study of one hundred and ten cases of uveitis, submitted to aetiological investigations, including, when feasible or necessary, an anterior chamber paracentesis and a vitreous paracentesis. RESULTS: An aetiology was identified in 65% of the cases. Toxoplasmosis still remained the most frequent diagnosis (one out of four), followed by viral infection (15%), especially herpes simplex (9%), a notion as yet not mentioned in large statistical surveys, including recent ones. Tuberculosis allergy and rhumatismal diseases (ankylosing spondylitis) represent the two other large groups (5% each). The rest is divided among the other classical causes. These results, particularly toxoplasmosis and viruses, are always based on biological criteria, on the Witmer-Desmonts ratio in aqueous humour, or even the same ratio in vitreous. CONCLUSION: This study confirms the predominant role of anterior chamber paracentesis, the only means of establishing a firm diagnosis for certain categories of uveitis (toxoplasmosis and viruses); it is difficult to conceive how such an investigation can be questioned, to the benefit of a purely biomicroscopic diagnosis, leading to blatant errors, as demonstrated by the results of anterior chamber paracentesis. This study also shows, due to this paracentesis, the increasing role of viruses in the aetiology of uveitis, emphasizing the risks taken when any uveitis is systematically submitted to corticotherapy.

[Liquid perfluorocarbons in the surgical treatment of retinal detachment caused by retinal inversion]. / Les perfluorocarbones liquides dans le traitement chirurgical des décollement de rétine par inversion rétinienne.

Surgical procedures used today to treat retinal detachment with an inverted giant retinal tear have considerably improved. Vitrectomy associated with perfluorocarbon liquid injection has replaced old procedures necessary to unfold the inverted retinal flap. Seventeen patients were operated on with an anatomic success rate of 76% and an average follow up of fifteen months. The successive surgical stages (lensectomy, retinopexy, internal tamponade, circular scleral buckle) are discussed. Proliferative vitreoretinopathy is the maill postoperative complication explaining the high rate of reoperation (56%). In high myopia, a prophylactic circular scleral buckle of the fellow eye has become systematic.