[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.

[Results of early removal of intra-ocular silicone after vitreoretinal surgery]. / Résultats du retrait précoce du silicone intra-oculaire après chirurgie vitréo-rétinienne.

Report of the anatomic results of early silicone oil removal in 23 eyes successfully treated by vitrectomy and silicone oil injection after membrane peeling. After cicatrization of retinopexy using panretinal photocoagulation, the silicone oil was removed. The retina remained attached in 87% of cases. The utility of laser retinopexy before silicone oil ablation is discussed.

[Prevention of non-traumatic retinal detachment by surgical cerclage. Apropos of 20 cases]. / Prévention du décollement de rétine non traumatique par cerclage chirurgical. A propos de vingt cas.

Prophylactic retinal detachment with laser photocoagulation is ineffective for some vitreo-retinopathies in which vitreous traction is predominant (non traumatic giant retinal tears, Wagner Stickler's syndrome, Marfan's syndrome...). Twenty eyes were operated by prophylactic episcleral circular buckling. In eighteen cases, the fellow eyes had previously presented a retinal detachment. We performed two types of encircling buckle. We only observed minor operative complications, without any functional consequences, attesting to the innocuity of this type of treatment. But we have to wait for vitreous detachment to know the efficacy of this prophylactic treatment. This detachment occurs at different time in each vitreoretinopathy, but with a specific rate of retinal detachment for each pathology.

[Acute retinal necrosis: clinical presentation, treatment, and prognosis in a series of 22 patients]. / Nécrose rétinienne aiguë: présentation clinique, modalités de prise en charge et pronostic à partir d'une série de 22 patients.

PURPOSE: To evaluate the clinical outcome and medical management in a series of patients diagnosed with acute retinal necrosis. MATERIAL AND METHODS: Between 1993 and 2000, 22 patients suffering from acute retinal necrosis were referred to our department. We retrospectively reviewed the clinical course, delay between diagnosis and first clinical manifestation, biological profiles, treatment and complications. RESULTS: All patients had vitreous inflammation; retinitis was seen upon examination in 82% of the cases. Nevertheless, for six patients (27% of the cases), failure to recognize the diagnosis led to delay (mean, 5.5 days) between the first ophthalmological examination and antiviral therapy. Nineteen patients underwent laboratory evaluation, and virological diagnosis was made in 16 of them: varicella zoster virus was found in 11 cases, herpes simplex type 1 in three cases, and herpes simplex type 2 and cytomegalovirus in one case each. Nine patients were treated with a combination of aciclovir and foscarnet and 13 with aciclovir alone. Among the 16 patients who received aciclovir, one did not respond to therapy after 2 days and was cured only after foscarnet was added. Recurrence occurred at the end of treatment in only one patient. Retinal detachment complicated the course for 11 patients and was always associated with proliferative vitreoretinopathy. Among those, seven of the ten patients who accepted surgery were successfully treated. Eleven out of 22 patients had a final visual acuity up to 20/200 and two up to 20/40. CONCLUSION: In our series, acyclovir alone was sufficient to cure the majority of cases. Even with antiviral therapy, the prognosis of acute retinal necrosis remains poor. Retinal detachment is the main complication.

[Treatment by internal tamponade of retinal detachment with a macular hole]. / Traitement par tamponnement interne des décollements de la rétine présentant un trou maculaire.

The authors analyse the operative results of 92 cases of retinal detachment with macular hole, treated by internal tamponade, since 1976. Three technics were used: vitrectomy + silicone oil injection (75 cases), vitrectomy + SF6 gas injection (9 cases), intra-ocular liquid suction + SF6 gas injection (8 cases). Silicone vitrectomy is particularly advisable in the case of large, old retinal detachment with proliferative vitreoretinopathy. This form of treatment is imperative when there is no hope of a satisfactory postoperative positioning, or after an unsuccessful gas treatment due to epiretinal macular membrane. Suction gas is a new and simple technique which is recommended when the macular hole is isolated and without epiretinal membranes. A lattice pattern argon-laser retinopexy is performed, by means of a series of laser impacts at the posterior pole, up to the edge of the macular hole. Treatment of isolated macular holes in a flexible retina by silicone vitrectomy achieved a 78.5% success rate; suction + gas achieved a similar success rate; this last method appears to be the ideal first choice for most of the cases, i-c the two failures which were subsequently turned into successes by silicone vitrectomy.

[Relaxing retinopathies and liquid perfluorocarbons]. / Rétinectomies relaxantes et perfluorocarbones liquides.

PURPOSE: To assess the long term anatomic and functional follow-up of large relaxing retinotomies performed with liquid perfluorocarbon in severe vitreoretinal proliferation surgery. METHODS: A large relaxing retinotomy (more than 90 degrees) was realized in 40 eyes of 39 patients for anterior vitreoretinal proliferation (30 rhegmatogen retinal detachments, 8 intraocular foreign bodies, 2 ocular traumas). Follow-up was always longer than 6 months. Vitreoretinal proliferation secondary to ischemic or inflammatory retinopathy were excluded. The liquid perfluorocarbon was perfluorodecalin and was used for all eyes, as well as final intraocular tamponade by silicon oil ended every intervention. RESULTS: Sixty-seven % of patients had already had a former vitrectomy, and 75% a retinal surgery. Mean size retinectomy was 170 degrees. Nine patients underwent a new vitreoretinal procedure which included in 7 cases a necessary new retinectomy. Silicon oil could be removed in 55%, after a mean period of 6, 5 months. Mean time follow-up was 13 months. At the end of follow-up, 80% of retina were attached. Visual acuity remained low with 25% equal to 1/20 or more; 45% of eyes increased their acuity, 25% remained stable and 30% worsened. Main complications were epimacular proliferation, keratopathy and increased intraocular pressure. CONCLUSION: Relaxing retinotomies provide satisfying anatomic results and allow a preservation of some visual function. The use of liquid perfluorocarbons facilitates their realization. The initial size of retinectomy should be sufficient.

[The danger of the game called "paint ball"]. / A propos du danger des pistolets à peinture (jeu dénommé "paint ball").

Severe ocular injuries may occur during a new war game in France, called "paint ball". A high pressure carbon dioxide powered gun fires pellets filled with dye. The pellet is coated with a semisoft gelatin and filled with a "nontoxic" dye mixture. We observed six consecutive cases during a ten month-period. In two cases (both due to a shot at point-blank range), mature cataract occurred. Consequently, lensectomy was achieved, preceded by a prophylactic scleral buckle. In one case, a retinal detachment due to a localized retinal necrosis occurred. With endocular surgery and temporary silicone oil tamponade, we achieved retinal reattachment. The three remaining cases did not require surgery. They suffered blunt ocular lesions of the anterior and/or posterior segment. One of these cases showed permanent tattooing to the cornea. After a mean follow-up lasting six months, all patients had, at least, a 40/100 vision. Some recommendations can reduce the incidence and the severity of ocular injuries due to paint balling. Firstly, eyeguards (made of polycarbonate) must be worn before receiving guns and pellets. Secondly, a kind of safety gun stopper can avoid gun firing by accident apart from practices. Thirdly, according to others publications, alcohol or drugs should not be consumed before the game. Lastly, gun fire at point-blank range or toward the head must be forbidden. We hope that wide distribution of such recommendations will help reducing the frequency of this type of ocular traumas.

A new method for the evacuation of aqueous humor in uncontrolled glaucoma. The vitreo-tenonian tube.

The vitreo-tenonian tube is a new procedure, used in uncontrolled glaucoma, for the drainage of aqueous humor. It presents three original characteristics: it is made of a stainless metal, it is implanted in the posterior segment after vitrectomy and it drains the aqueous humor in the subtenonian space. We will describe first the surgical technique for the implantation of the tube, and then we will present the results of the first eight cases treated by this method. The advantages and drawbacks of this type of drainage are discussed: they are compared with the other surgical techniques used in cases of glaucoma which is uncontrolled by the classical methods.

[Post-traumatic retinal detachment in children under 15 years of age]. / Décollement post-traumatique de la rétine de l'enfant de moins de quinze ans.

In less than 15 years old children 33 post-traumatic retinal detachments were operated during these last four years (postocular wound retinal detachment with or without intraocular foreign body, post contusion retinal detachment). A very close posterior pole monitoring of these high risk eyes is mandatory to prevent late diagnosed retinal detachments. The post-contusion retinal detachment surgery good results are quite opposite to the bad results of the postocular injury retinal detachment with intraocular foreign body and secondary proliferative vitreoretinopathy. These retinal detachment severity must lead to a strict prophylactic laser therapy of all the traumatic eyes.

Localized retinectomy indications in the treatment and prevention of retinal detachment.

Retinectomy can be helpful in several cases: retinal inversion and giant tears when the edges are rolled up, and when vitreous strands are implanted on to pieces of the tear flaps; the approach to the subretinal area (subretinal glial strands, subretinal fluid drainage, subretinal foreign bodies); nondissectable areas of retinal retraction (retinal incarceration, vitreo-retinal proliferation, etc.). Most of these retinectomies have to be supplemented by vitrectomy followed by a silicone oil injection, with peroperatory cryotherapy or argon laser photocoagulation.

Treatment of epiretinal membranes: report of 40 operated cases.

40 patients with an operable epiretinal membrane were divided into two groups: patients of group 1 were operated without intraocular silicone oil, patients of group 2 were operated with silicone oil. The operation was carried out with simple instruments. The percentage of anatomic success (complete removal in 62% of cases) and functional success (increase of visual acuity in 58% of the cases) opens new perspectives in retinovitreous microsurgery.

[Intolerance to encircling. 19 cases of section or ablation of encircling]. / Intolérance au cerclage. A propos de 19 cas de section ou ablation de cerclage.

Removal of ten encircling scleral buckles and section with relaxation of nine encircling buckles are displayed. Only episcleral buckles with oval or round silicone sponge exoplants are analyzed. Besides infection (three eyes), removal or section was required because of too tight encircling elements (16 eyes). Anterior buckles created by invagination of encircling elements, without horizontal shortening avoids this risk of constriction.

Circular subtotal retinectomy and inferior semicircular retinotomy. Material and results in 38 cases.

Anatomical and functional results in 38 eyes with retinal detachment and major proliferative vitreoretinopathy (C3, D1, D2) treated by more or less wide retinotomy or circular retinectomy; 50% of the retinae have reattached, with an improvement of the visual function in 12 cases out of 21. The best procedure in these cases seems to be a retinotomy of at least 180 degrees on an eye filled with silicone oil to prevent secondary retractions. Circular retinectomy has been given up for retinotomy.

Study of the first hundred phakic eyes treated by peripheral iridotomy using the N.D. Yag laser.

Performing a peripheral iridotomy with a ND Yag laser is a simple and efficient technique, with no side effects, no need for anaesthesia other than local and no surgical opening of the eye, with all the risks it entails. Out of 100 cases, 100% were a success from a technical point of view, and we observed no lesion of the lens which could have caused cataract. This out-patient technique, causing fewer complications than with Argon laser, can be used on any patient, whatever the age and the state of the angle, who has to be treated by peripheral iridotomy. The Neodymium Yag laser (ND: Yag) is a pulsed solid laser (1, 2, 3, 8, 29, 31). It cuts tissues (photodisruption) by means of a shock-wave produced by optical breakdown (plasma formation). Its effect is different from that of the Argon laser which burns tissues (photocoagulation). The present study, of 100 cases, deals with the use of ND: Yag in peripheral iridotomies.

In vitro laser decomposition of silicone fluid used in detachment of the retina.

The in vitro exposure of the silicone fluid Dimethicone 1,000 to radiation from the Nd:YAG laser results in the formation of transient breakdown gases which are composed mainly of methane, ethylene and traces of ethane, as identified by head-space gas chromatography. These hydrocarbons may interfere with the intra-ocular environment in the management of retinal detachment.

Gas tamponade as a single technique in the treatment of retinal detachment: is vitrectomy needed? A comparative study of 120 cases.

Internal gas tamponade is employed with no episcleral buckle and can be combined with or without a vitrectomy for the surgical treatment of some forms of retinal detachment. These techniques are for forms of retinal detachment with no proliferative vitreoretinopathy that are being operated upon for the first time and have one or several breaks located on the superior half of the retina. We compare these two techniques, their anatomical results, and their complications.

Atrophies 'like flows' of the retinal pigment epithelium: a neuroepithelium-draining method of the posterior pole.

17 cases of eyes affected jointly by diseases of the posterior pole (central serous chorioretinopathy, serous detachment of pigmented epithelium, melanoma, osteoma, hemangioma) and flow-like atrophy of the pigmented epithelium, originating from the lesion and always directed downwards, are presented. It is likely that serous detachment of the neuroepithelium constituting the original wound (central serous chorioretinopathy) or the secondary one (serous detachment of the pigmented epithelium) of the posterior pole prolongs itself downwards, leaving a localized atrophy as a mark on the pigmented epithelium. The eventual draining role of serous detachment of the neuroepithelium by this 'flow' is disputed.

[In vitro study of the effects of neodymium-YAG laser on silicone oil]. / Etude "in vitro" des effets du laser Neodyme-Yag sur l'huile de silicone.

Composition of gas generated by the utilisation of Nd-Yag laser in eyes filled with silicone oil were studied by means of an in vitro optical breakdown in silicone oil. The newly formed gas were analysed by headspace gas chromatography on two separate columns. The secondary gas were mainly methane and ethylene which might be potentially harmful to the ocular tissues.

Study of a new series of large relaxing retinotomies.

Silicone oil injection followed by retinotomy was performed in a second series of 37 patients with retinal detachment and advanced proliferative vitreoretinopathy. The retina posteriorly to the retinotomy was attached in 16 eyes with at least 18 months of follow-up. Ambulatory vision or better vision was restored in 12 eyes. The size and the site of the retinotomy depend on the size and the site of the retraction.

Circular subtotal retinectomy and inferior semicircular retinotomy: preliminary report.

Progress in the treatment of vitreoretinal proliferation has led ophthalmic surgeons to combine vitrectomy, peeling of the epiretinal membrane and silicone oil injection with surgery on the retina. The intervention consists either of a circular subtotal retinectomy leaving only the retina of the posterior pole and a retinal crown of two papillary diameters in width at the periphery of the temporal vessels; or, when the upper retina is already reapplied by silicone oil, of a semicircular lower retinotomy that suppresses the tractions against which the silicone oil is powerless. The sectioning is preceded by an endodiathermy that must be very precise, in order to avoid hemorrhages which are the major complication of the intervention. These preliminary studies will be followed by a detailed study when a larger number of cases is available.