Exfoliation syndrome and phacoemulsification.

PURPOSE: To evaluate intraoperative and postoperative complications of phacoemulsification and intraocular lens (IOL) implantation in eyes with exfoliation syndrome. SETTING: Eye Clinic, University Hospital of Geneva, Switzerland. METHODS: This prospective study evaluated 20 consecutive patients with exfoliation syndrome and 20 consecutive patients without the syndrome (control group) who had phacoemulsification and posterior chamber IOL implantation. One year later, the incidence of zonular tears, operating time, and fibrinoid reaction were studied in another group of 23 consecutive patients who had the same type of surgery by the same surgeon. RESULTS: Maximal pupil dilation was significantly smaller (P < .0001) in the exfoliation than in the control group. Intraoperatively, the incidence of zonular tears was the same in both groups (10%). In the 23 patients who had surgery 1 year later, no zonular tears occurred. The incidence of postoperative complications was similar in both groups. The exfoliation group had a significant decrease in intraocular pressure over preoperative levels at 1 week and 3 months postoperatively. CONCLUSION: Phacoemulsification with posterior chamber IOL implantation appears to be safe in eyes with exfoliation syndrome.

Risk factors associated with contrast sensitivity loss in diabetic patients.

BACKGROUND: Psychophysical tests in patients with diabetes mellitus reveal deficits of central vision before the development of overt retinopathy. We evaluated the contrast sensitivity thresholds in 30 patients with type II diabetes mellitus and without retinopathy, taking into account the crystalline lens density. Risk factors for contrast sensitivity deficits were investigated. METHODS: Contrast sensitivity was compared in 30 aretinopathic diabetic patients and age-matched controls. Contrast thresholds were determined for stationary gratings at three spatial frequencies (6, 15, and 27 cycles/deg) and for mesopic (5 cd/m2) and low photopic (85 cd/m2) vision. Lens density was measured using a IntraOptics opacity lensmeter. RESULTS: Significant contrast sensitivity losses at all three spatial frequencies were observed in low photopic and mesopic vision in diabetic patients. The optical density of the lens in the diabetic group did not differ from that in the controls. Contrast sensitivity deficits were positively correlated with patient's age, systolic blood pressure and nephropathy at all three spatial frequencies. No relationship between cardiovascular autonomic neuropathy and contrast sensitivity defects was observed. CONCLUSIONS: These data suggest that contrast sensitivity deficits in diabetic patients without retinopathy are not solely explained by a diabetes-induced increases in lens optical density. Abnormalities of the retina or its neural connections occurring before the onset of clinically detectable retinopathy may be involved. Risk factors for these deficits are advanced age, high systolic blood pressure, and nephropathy.

[Effectiveness of treatment of diabetic macular edema by laser photocoagulation]. / Efficacité du traitement de l'oedème maculaire diabétique par photocoagulation au laser.

BACKGROUND: Diabetic macular edema is the most frequent cause of visual loss in patients with diabetic retinopathy. Laser photocoagulation of clinically significant macular edema is effective in reducing the risk of visual loss. METHODS AND RESULTS: Sixty three eyes of 42 diabetic patients with macular edema were included in a clinical study to determine the short-term visual outcome (9 months) of laser photocoagulation. The results suggest that laser photocoagulation is less effective in diabetic patients with high blood pressure and in patients with low visual acuity at treatment time.

[Diagnostic aspects and frequency of retrocorneal precipitates in diagnosis of cytomegalovirus retinitis in the HIV+ patient]. / Aspect et fréquence des précipités rétrocornéens lors du diagnostic de la rétinite à CMV chez le patient VIH+.

Cytomegalovirus retinitis (CMV) is the most common ocular opportunistic infection seen in patients with acquired immune deficiency syndrome. The anterior segment is usually quiet or with minimal aqueous humour flare and cell reaction. Nevertheless, in this prospective study of 30 eyes with CMV retinitis, 22 (73%) had white, small and filamentous keratic precipitates (KPS) which seem to corroborate this inflammation. The positivity of the KPS depends upon the extent of CMV retinitis.

[Occlusion of the ophthalmic artery in Crohn disease]. / Occlusion de l'artère ophtalmique dans la maladie de Crohn.

BACKGROUND: Nearly 10% of patients with Crohn's disease develop ocular complications. Most complications are inflammatory in nature, and involve both the anterior and the posterior segments of the eye. Episcleritis, uveitis and keratopathies are the most frequently described. Occlusions of retinal and optic nerve vessel are less common. We believe this to be an important observation as the ocular involvement was the patients primary complaint, thus allowing the correct diagnosis to be made. PATIENT: We report a case of a 44-year-old woman, who presented with an occlusion of the ophthalmic artery, before the diagnose of Crohn's disease was established.