Endoscopic technique for suturing posterior chamber intraocular lenses.

A challenge of the sutured posterior chamber intraocular lens (IOL) technique is to perform blind actions behind the iris. To avoid imprecise transscleral sutures and complications, we use an endoscopic procedure with 2 goals: to control the entry site of the needle penetration and of the haptic location. The endoscopic technique allows retroiris control during transscleral suturing and iridociliary IOL implantation. It is a safe, precise method that avoids the risks of blind procedures behind the iris.

[Micro-endoscopy of the lacrimal apparatus combined with Erbium YAG laser: an anatomical study. New methods of imaging]. / Micro-endoscopie des voies lacrymales combinée au laser YAG Erbium: étude anatomique. Nouvelles méthodes d'imagerie.

PURPOSE: To study the anatomic structure and the endoscopic aspect of the lacrimal drainage system and to evaluate the efficacy of the Erbium laser with microendoscope in lacrimal obstruction. METHODS: Twenty lacrimal ducts from ten fresh cadaver heads were used to lead a special rigid probe of 1.1. mm diameter (Endognost Schwind). This probe combined a flexible endoscopic probe of 500 mu, an Erbium laser fiber of 375 mu and an irrigation. The probe was introduced through the inferior canaliculus. Progressing in the lacrimal system, all the images were analysed. Then, we used the laser fiber to open the lacrimal sac mucosa and the lacrimal bone. RESULTS: The anatomo-endoscopic analysis was performed using endoscopic data. We appreciated essentially the walls of valves and sinuses that appeared only functional when increasing the irrigation flow. The laser could easily open the mucosa and the lacrimal bone but not the maxilla. DISCUSSION: The small size of the cannula allows to use the system for the diagnosis of lacrimal obstructions. The combined laser allows to treat at same time canalicular obstructions and lower obstructions. CONCLUSION: The endocanalicular study of the lacrimal drainage system can diagnose the type of obstruction and can treat it. A clinical study is requested to confirm these results.

One year clinical results of photoastigmatic refractive keratectomy for compound myopic astigmatism.

PURPOSE: To evaluate the efficacy, predictability, and safety of excimer laser photoastigmatic refractive keratectomy (PARK) to correct compound myopic astigmatism. SETTING: Departments of Ophthalmology, Robert Debré Hospital and Rothschild Foundation, Paris, France. METHODS: This retrospective study included 27 eyes with compound myopic astigmatism treated with a Nidek EC 5000 excimer laser. The refractive results were measured at 1 year, and the cylindrical component was analyzed by the Alpins method. Mean preoperative myopia was -4.50 diopters (D) (range -0.75 to -4.00 D) and mean preoperative cylinder, -1.64 D (range -0.75 to -4.00 D). RESULTS: At 1 year, the spherical equivalent was -0.47 D (range +1.00 to -3.00 D) and residual subjective astigmatism, -0.40 (range -0.25 to -1.50 D). Uncorrected visual acuity of 20/40 or better was obtained in 22 of the 27 eyes; 21 eyes were within +/- 1.0 D of emmetropia. Vector analysis showed a mean coefficient adjustment of 1.50 D +/- 0.53 (SD), a mean axis shift of 2.64 +/- 12.10 degrees, and a mean magnitude of error of 0.45 +/- 0.56 D. Haze was absent in 22 eyes and grade 1+ in 5 eyes. Five eyes gained 1 line of best corrected visual acuity and 3 lost 1 line. No patient lost more than 1 line. CONCLUSION: Excimer laser PARK successfully corrected low and moderate myopia combined with up to 4.0 D of astigmatism with a low mean angle of error. To increase the accuracy of toric ablation, specific algorithms for the cylinder component are needed.

[Multifocal implants of 3 optic zones: optical performance and clinical functional results]. / Implants multifocaux à trois zones optiques: performances optiques et résultats fonctionnels en clinique.

PURPOSE: Evaluation of multifocal IOL (three optical zones). METHODS: Twenty patients were implanted. Main outcome measures were: uncorrected and best corrected distance and near acuity, brigthness acuity test, contrast acuity with differents methods: Pelli-Robson Chart, Gradual System, and spatial visual integration (SVI). RESULTS: Uncorrected visual acuity was restored in 94% of cases. Contrast sensitivity was preserved with the Pelli-Robson chart test but a loss of contrast sensitivity was found with the multifocal IOL with the Gradual system and the SVI in comparison with monofocal IOL. CONCLUSION: Multifocal IOL (three optical zones) allows a good restoration of both near and far visual acuity but a decrease in contrast sensitivity was detected.

Clinical results of excimer laser photorefractive keratectomy: a multicenter study of 265 eyes.

Efficacy, predictability, and safety of excimer laser photorefractive keratectomy were evaluated at centers in Paris and Brest, France. Photoablation was performed with the VISX laser on 265 eyes (151 at the Paris center and 114 at the Brest center). The eyes were clinically and statistically evaluated over a six month follow-up. Initial myopia ranged from -0.7 to -19.4 diopters (D) (mean spherical equivalent [SE] -5.9 D) in the Paris center and from -0.9 to -14.5 D (SE -4.5 D) in the Brest center. At both centers, the mean uncorrected visual acuity was worse than 20/200; over 90% of cases in each center had a best uncorrected visual acuity of 20/100 or worse. Results are reported globally and for subgroups of myopia: Group A, SE better than or equal to -3.0 D; Group B, SE worse than -3.0 D and better than or equal to -7.0 D; Group C, SE worse than -7.0 D. Uncorrected visual acuity was significantly improved in the patients followed for six months; 64% of Paris cases and 62% of Brest cases obtained an uncorrected visual acuity of 20/40 or better. Predictability of the treatment was good; 67% of Paris eyes and 74% of Brest eyes were less than 1.0 D from the intended correction after six months. The data suggest that the initial myopia affected the efficacy and predictability of the treatment; results in the mild to moderate myopia eyes were significantly better than results in the severe myopia eyes. One case of visual acuity regression (less than one line) was observed in the two groups. This was associated with corneal haze of moderate intensity.

[New biomaterials and cataract surgery]. / Nouveaux biomatériaux et chirurgie de la cataracte.

In 1949, Harold Ridley implanted the first intraocular lens, after cataract surgery, he had chosen as the best available material Polymethyl Metacrylate noticing during the war in the injured eyes of the R.A.F. Pilots that the material was perfectly tolerated inside the eye as a foreign body. It took 10 years for intraocular lenses to take off, due to the necessary improvement of both surgery and manufacturing, since then all the intraocular lenses are made of the same material and perfectly tolerated. However the material is hard and not foldable. The improvement of Phakoemulsification have made small incision (3.2 mm) surgery possible, however there is a need for new foldable implants that can be inserted into the eye through a small incision, so rather new bio material are now being used. A variety of silicone foldable lenses have been proposed, their advantages are: easy foldability, solidity and injectability through an injector. Their disadvantages are, as compared to the 40 years standing solid PMMA lenses; less biocompatibility changes in color and apparition of crystal precipitates. Also reports on induced polyarthritis, lupus and paraneoplasic syndromes with other silicone prosthesis, these complications appear after 5 or 6 years. Although new silicone lenses are being brought on the market, there is some hesitation in implanting these lenses on patients less than 80 years of age. Polyhema lenses appeared in 1985, with 38% water content. The material is perfectly biocompatible even more than PMMA, however their initial design was not adequate until 1992. Their advantages are perfect biocompatibility over the years, autoclavability. Their only disadvantage a certain fragility during folding. Our 7 years experience with silicone and hydrogel has shown that 20% of the first silicone lenses had to be exchanged between 3 to 4 years after surgery and 0% of the polyhema. Posterior capsule opacification at 1 year was twice more frequent with silicone than with PMMA or hydrogels and that mild chronic uveitis occurs 3 times frequently with silicone lenses.

Endoscopy under operating microscope. A new device.

Existing technical conditions make it difficult for a single surgeon to simultaneously observe the endoscope and the observation field of the operating microscope. Video endoscopy is not adapted, because it respects neither the constraints of microsurgery (the surgeon has to stop observing the binoculars of the microscope to watch the video screen) nor the micromanipulations necessary for the specialties using micro endoscopy. A new device is described that closely joins endoscope and microscope. This coupling device allows the surgeon to permanently control and alternate the images according to his choice. The surgeon is able to observe in the binoculars the images transmitted by the endoscope and/or the operating microscope. This device respects the requirements of the microscope and, thanks to its optical capabilities, the endoscopic image is improved. The professions requiring double observation will improve their ability in diagnosis and therapy.

[Cytomegalovirus retinitis in children with AIDS acquired through materno-fetal transmission]. / Rétinites à cytomégalovirus chez l'enfant atteint de SIDA de transmission materno-foetale.

PURPOSE: To describe the clinical feature and the outcome of CMV retinitis in children with vertically transmitted HIV infection. RESULTS: Five case-reports of cytomegalovirus retinopathy are described. These children from eight month-old to seven and a half year-old (median age at diagnosis 52 months) had been perinatally contaminated by the human immuno-deficiency virus. The ophthalmic signs included only a red eye for one patient. The clinical signs were similar to the adult's retinopathy. At the opposite the differences were emphasized like the clinical onset with a delayed diagnosis. Mean follow-up since diagnosis is 8 months with 3 patients still alive. CONCLUSION: CMV retinitis in vertically transmitted AIDS can occur early in childhood and must be checked systematically in the patients with low CD 4 count because of the usual asymptomatic onset.

Sex differences in the left and right hemifields of normal subjects with computerised static perimetry.

Results of routine perimetric testing of the left and right hemifields in normal subjects have been assumed to be symmetric although asymmetry due to hemispheric dominance has been established for other psychophysical tests. These asymmetries have sometimes been related to sex. With the advent of computerised static perimetry, subtle differences between the left and the right hemifields might be found that were not obvious before. This study investigated differences in retinal sensitivity between the hemifields and the role of sex and eye dominance. Forty three unequivocally right handed and right eye dominant normal adult volunteers, 24 females and 19 males, underwent Humphrey 24-2 testing, half beginning with the left eye, the other half with the right eye. The Peridata program was used to calculate decibel totals per hemifield. Four subjects were excluded because of poor cooperation or test artefacts. In females, the total of the left hemifield was significantly less than the right (p < 0.01) by a mean 18.2 (SD 24) dB equivalent to a difference of 0.34 dB per tested point. No significant difference in hemifields was found for males, between the sexes for both eyes combined, or between the two eyes for either sex. It was concluded that asymmetries in retinal sensitivity with respect to the vertical axis may be physiological and found in females, but not in males.

Myopic keratomileusis by excimer laser on a lathe.

BACKGROUND: We designed an excimer laser keratomileusis delivery system to increase the regularity of the refractive cut surface and allow greater precision in the level and shape of the ablated zone. METHODS: A parallel faced corneal disc was produced by microkeratectomy from six human eyes and surgical keratectomy in 12 beagle corneas. A 193-nanometer excimer laser that was used to project an oval beam onto the corneal disc was rotated on a flat surface to ensure overlapping of the ovally ablated areas between pulses. RESULTS: Electron microscopy of eye bank lenticules demonstrated a circular smooth regularly concave ablation zone. Histological examination of nine clear corneas confirmed thinning of the stroma without fibroblastic reaction and no epithelial hypertrophy. Mean preoperative corneal power of 43.15 +/- 2.18 decreased postoperatively to 33.61 +/- 2.34. CONCLUSIONS: The new technique of excimer laser keratomileusis has the advantage of a cut surface smoother and the clear zone is devoid of the stepwise concavity and irregularity seen in diaphragm based photoablation delivery systems.

Effect of preoperative YAG laser anterior capsulotomy on the incidence of posterior capsule opacification: ten year follow-up.

One hundred twenty-two patients, who were followed for ten years, had bilateral extracapsular cataract surgery with implantation of J-looped posterior chamber lenses between 1980 and 1981. On the first eye an anterior capsulotomy was performed with a pico-second YAG laser 12 to 20 hours before surgery; on the second eye a capsulotomy was performed manually at the time of surgery. Four of the eyes (3.27%) with laser capsulotomies had opacified posterior capsules after ten years; 61 of the eyes (50.00%) with manual capsulotomies had opacified capsules that had to be opened with a YAG laser.

Preliminary study of argon fluoride (193 nm) excimer laser trabeculectomy. Scanning electron microscopy at five months.

There is an increasing interest in the use of the excimer laser in ophthalmology, particularly in refractive surgery. The argon fluoride (193 nm) excimer laser ablates tissue with a high degree of precision and without any mechanical or thermal damage to surrounding structures. In this study, the argon fluoride excimer laser was experimentally used in the rabbit model to perform a trabeculectomy. Clinical and scanning electron microscopic evaluations showed a successful and patent filtering procedure. At the five-month follow-up the trabeculectomy was smooth and regular and there was no evidence of inflammation or thermal damage on the surrounding structures.

One-movement insertion of the superior loop into the bag.

An efficient, simple technique for one-movement insertion of the superior intraocular lens loop into the capsular bag is described. This bimanual technique avoids undue stress on the capsular bag and zonules, may be used with all extracapsular techniques, and is suitable for almost all flexible loop intraocular lenses designed for in-the-bag implantation.

YAG laser treatment in a series of failed trabeculectomies.

YAG laser treatment was used in 22 consecutive cases of failed or failing trabeculectomy. Seven treatments were considered to be successful with a mean decrease in intraocular pressure of 9.8 mm Hg (6 to 13 mm Hg) over a mean follow-up period of 10.7 months (two to 18 months). In the successful cases the trabeculectomy was the first intraocular surgery that the eye had undergone and the average time from trabeculectomy to YAG laser treatment was relatively short, 6.7 weeks, compared to 1.1 years for the failures. The major complication was an increase in intraocular pressure of 4 mm Hg or more in nine (60%) of the failed cases two hours after laser treatment.

[Quantitative analysis of corneal excisions using argon fluoride excimer laser (193 nanometers)]. / Analyse quantitative des excisions cornéennes au laser à excimère argon fluor (193 nanomètres).

Excimer lasers represent a new and distinctive class of laser-tissue interaction termed photoablation. They can ablate materials with a high degree of precision and minimal damage to surrounding structures. The argon Fluoride excimer laser, which offers the possibility of non-contact corneal cutting, has a potential for clinical application of keratorefractive surgery. Since each pulse of excimer laser etches some amounts of tissue from the cornea, the repetitive pulses focused to a narrow line can create linear excisions. In this study, a quantitative analysis of both depth and width of corneal excisions was made on cadaver eyes at a given fluence (600 mj/cm2) and a constant repetitive rate (20Hz). The amount of ablation per pulse was not constant and the excisional depth did not show a linear correlation with pulse numbers. Both the depth and width of transversal excisions were more homogenous than those of radial excisions along the entire length of ablation.