Comparative effects of argon green and krypton red laser photocoagulation for patients with diabetic exudative maculopathy.

AIMS/BACKGROUND: Focal treatment of diabetic macular oedema is usually done using a haemoglobin absorbing wave-length, such as argon green laser. This study aimed to compare photocoagulation with argon green (514 nm) and krypton red (647 nm), which is poorly absorbed by haemoglobin, in the focal treatment of patients with diabetic exudative maculopathy. METHODS: A total of 151 eyes of 78 outpatients were assigned randomly to receive either argon green (n = 79) or krypton red (n = 72) laser treatment. Pretreatment and post-treatment ocular examinations included visual acuity, fundus biomicroscopic examination, and fluorescein angiography. A total of 141 eyes of 73 patients were available for evaluation after 1 year follow up. RESULTS: No statistically significant difference was found between the two treatment groups with respect to visual acuity results, resorption of hard exudates, and resolution of focal retinal oedema. CONCLUSION: Krypton red laser was effective in the treatment of diabetic exudative maculopathy. Our data suggest that differential absorption of the various wavelengths by haemoglobin within microaneurysms may not be an important factor for ultimate success of focal treatment.

[Central serous chorioretinopathy in a pregnant woman]. / Choriorétinopathie séreuse centrale chez une femme enceinte.

PURPOSE: A case of central serous chorioretinopathy in a 28-year-old pregnant woman is reported. METHODS: A complete ocular examination was performed including fundus biomicrospic examination and fluorescein angiography. RESULTS: Examination of the left eye revealed central serous chorioretinopathy associated with greyish-white subretinal exudate. In the right eye, sequaele of asymptomatic central serous chorioretinopathy was found. Reattachment of the retina and dissolution of the exudate, with return of visual acuity to normal, occurred soon after delivery. CONCLUSION: This case report is the 19th case of central serous chorioretinopathy during pregnancy reported to date. Central serous chorioretinopathy in pregnant woman is often associated with subretinal exudation which is probably fibrinous in nature. The affection resolves spontaneously at the end of pregnancy or after delivery, but may recur in the context or outside of subsequent pregnancy. The special conditions of pregnancy, including haemodynamic, biological and psychological alterations may lead susceptible women to develop central serous chorioretinopathy.

[Familial exudative vitreoretinopathy and hereditary retinal vascular tortuosity]. / Vitréorétinopathie exsudative familiale et tortuosités vasculaires rétiniennes héréditaires.

PURPOSE: A 9 year-old child demonstrated symptomatic exudative vitreoretinopathy. The other family members were examined to detect funduscopic changes suggestive of the disease. METHODS: A complete ocular examination was performed including fundus biomicroscopic examination and fluorescein angiography. RESULTS: The patient with exudative vitreoretinopathy exhibited retinal neovascularisation and minime vitreous hemorrhage in one eye. He was successfully treated with laser photocoagulation. The mother and her 5 other children had isolated retinal vascular tortuosity. CONCLUSION: The association in the same pedigree of exudative vitreoretinopathy and retinal vascular tortuosity suggest the same nosologic frame to these autosomal dominant diseases. They could represent different expressions of the same genetic disorder.

[Late polymorphous aspect of familial reticulated dystrophy of the pigment epithelium]. / Aspect polymorphe tardif d'une dystrophie réticulée familiale de l'épithélium pigmentaire.

The authors report the observation of a family with different dystrophies of the retinal pigment epithelium: a macroreticular dystrophy (1 case), a butterfly-shaped dystrophy (1 case), a butterfly-shaped or a macroreticular dystrophy associated with vitelliform lesion (3 cases), and hard drusen (2 cases). The association of pattern dystrophies and vitelliform lesions was described in some families or subjects in previous reports. The different fundoscopic aspects could constitute the same autosomal dominant dystrophy with variable expressivity. The presence, in this family, of two cases of probably inherited drusen could reflect the similarity of this disease with the other autosomal dominant dystrophies of the retinal pigment epithelium. Further biological studies should be performed to identify the pathogenesis of these diseases and will allow clearer classification.

[Post-laser choroidal hematoma in a diabetic patient treated with an oral anticoagulant]. / Hématome choroïdien post-laser, chez un diabétique traité par un anticoagulant oral.

We report a case of a 45 year old diabetic man treated with insulin who developed a right choroidal hematoma after krypton laser treatment for proliferative retinopathy. This patient had a history of myocardial infarction and had been treated with oral anticoagulants for 3 years. Choroidal hematoma was associated with vitreous hemorrhage and presumed herpetic uveitis. Since the retina could not be visualized the diagnosis was based on ultrasound findings. Irreversible blindness of the affected eye occurred. In this case report, oral anticoagulant treatment seems to be the major risk factor leading to the development of this unusual hemorrhagic complication of panretinal photocoagulation. To avoid this serious accident, patients submitted to long-term oral anticoagulant treatment should be managed with particular caution before and during photocoagulation.

[Congenital retinal arteriovenous fistula and central retinal vein occlusion]. / Communication artério-veineuse rétinienne congénitale et occlusion de la veine centrale de la rétine.

The authors report a case of congenital arteriovenous communication of the retinal near the macula, associated with a central retinal vein occlusion. This occlusion only affected the inferior half-retina, especially the area surrounding the arteriovenous anastomoses. Laser photocoagulation was applied to areas of peripheral ischemia. After a 12 month follow-up, a marked decrease of visual acuity occurred, attributable to severe ischemia and edema in the posterior pole. An extension of the peripheral capillary non perfusion required additional laser treatment. We also observed the reduction in caliber of the arteriovenous anastomosis. The association of congenital arteriovenous communication and retinal vein occlusion is rare. The clinical and pathogenic features are discussed. Photocoagulation of extensive peripheral capillary occlusion is recommended in order to prevent neovascular complications.

[Hereditary maculopathy in typical retinitis pigmentosa. Apropos of 40 cases]. / L'hérédité de la maculopathie dans la rétinopathie pigmentaire typique. A propos de 40 cas.

The authors have studied the hereditary mode of transmission of 40 maculopathy associated to typical pigmentary retinopathy. The genealogic tree was established for each case along with a complete exam. The three types of modes found were: 12.5% dominant autosomal, 15% recessive autosomal, 72.5% sporadic. The authors discussed the different mode of hereditary transmission in a family of three generations. They point out the difficulties of the genetic investigations and concluded that the maculopathy doesn't have a specific transmission mode in the typical retinitis pigmentosa.

[Preliminary study on the effect of 1% indomethacin eyedrops in surgery of glaucoma]. / Etude préliminaire de l'effet de l'indométacine collyre à 1% dans la chirurgie du glaucome.

Indomethacin collyrium, a powerful inhibitor of prostaglandin synthesis, was used successfully in many applications. The authors evaluated its action in the surgery of glaucoma. Two groups of patients had a trabeculectomy. The first group received instillation of indomethacin; the second was a control group. Four parameters were evaluated and compared in both groups: 1. Inflammatory state of the anterior chamber (AC). 2. Anterior chamber depth. 3. Filtration bleb state. 4. Intra-ocular pressure. Indomethacin promotes the establishment of a good filtration bleb that yields on a lasting ocular hypotonia, thus improving the results.

[Maculopathy in typical retinitis pigmentosa apropos of 33 cases]. / La maculopathie dans la rétinopathie pigmentaire typique. A propos de 33 cas.

The authors studied 33 maculopathies in 54 patients affected by typic retinitis pigmentosa: atrophic macular degeneration 31 cases (49%); cystoïd macular oedema: 1 case (3%) and macular retraction syndrome: 1 case (3%). These results are confronted with those of the literature. Two therapeutical trials based on pathogenical hypothesis were conducted. The patient with cystoïd macular oedema was treated by Hyperbar oxygenotherapy, basing one of selves on the theory ischemia. Six other patients with atrophic foveolopathies were treated by the cyclophosphamide, according to the autoimmune theory. In the first trial, the result was positive. In the second one, the results did not permit any available conclusion.