[Spontaneous peeling of the epimacular membrane after cryotherapy of retinal vasoproliferative tumors: report of a case]. / Decollement spontane d'une membrane epimaculaire apres cryotherapie de tumeurs retiniennes vasoproliferatives: a propos d'un cas.

Epimacular membranes when responsible for a significant loss of visual acuity, generally require treatment by vitrectomy and peeling of the membrane. We report the case of a spontaneous peeling of a macular pucker after cryotherapy of peripheral retinal vasoproliferative tumors. Review of the literature.

[Management of posteriorly dislocated lens material after complicated phacoemulsification. The vitreoretinal surgeon's point of view]. / Conduite à tenir face à une phakoémulsification compliquée d'une luxation postérieure de matériel cristallinien. Le point de vue du chirurgien vitréorétinien.

Posterior dislocation of lens material is a serious complication of phacoemulsification. Its prognosis depends on timely treatment, well-planned by cataract and vitreoretinal surgeons working in collaboration. Pars plana vitrectomy with removal of the dislocated material is nearly always mandatory on a short-term basis in order to prevent and/or treat any further complication, mainly uveitis, hypertony, corneal edema, cystoid macular edema, and retinal detachment. The best time to implant and perform pars plana vitrectomy is still a matter of controversy. The best predictor of final visual acuity is the visual acuity before vitrectomy.

[Does radial optical neurotomy have a place in the treatment of central retinal vein occlusion?]. / La neurotomie optique radiaire a-t-elle une place dans le traitement de l'occlusion de la veine centrale de la rétine?

INTRODUCTION: the goal is to evaluate the anatomical (macular edema) and functional (visual acuity) efficacy of radial optic neurotomy in central retinal vein occlusion. METHODS: the retrospective study is dealing with 15 eyes treated with radial optic neurotomy and at least a 6-month follow-up. The main study parameters are the visual acuity, the characteristics of the vein occlusion with fluorescein angiography, and those of the macular edema with optical coherence tomography. RESULTS: mean preoperative visual acuity was 0.07 (0.003-0.4). At 6 months, mean visual acuity was 0.12 (0.003-0.3) for 14 cases, one eye being blind. Visual acuity was improved in 4 cases (26%), deteriorated in 2 cases and equal in 9 cases. Preoperative fluorescein angiography showed a perfused form in 9 cases and an ischemic one in 6 cases. At 6 months, fluorescein angiography was available in 12 out of the 15 cases. It showed ischemia in 4 cases, macular edema in 4 cases, a scarred macula in 2 cases. The posterior pole was hidden by blood in the last 2 cases. Optical coherence tomography was performed preoperatively and at 6 months in 8 out of the 15 cases. It showed macular edema in every case preoperatively. At 6 months, there was a worsening in 2 cases (25%), an improvement in 4 cases. In 2 cases, edema was replaced by a macular scar. CONCLUSION: at 6 months, this study shows any improvement of the visual acuity in 26% of the cases. This result does not allow us to conclude that optical radial neurotomy has any role to play in the treatment of central retinal vein occlusion.

[Surgical prognosis in idiopathic vitreomacular syndrome and epimacular membrane]. / Pronostic chirurgical respectif du syndrome de traction vitréomaculaire et de la membrane épimaculaire idiopathiques.

INTRODUCTION: The natural history shows less progression for epimacular membrane than for vitreomacular traction syndrome. We tested the hypothesis that the surgical prognosis in idiopathic cases is also better for epimacular membrane. METHODS: This retrospective study investigated a consecutive series of 63 epimacular membrane cases (group I) and 25 vitreomacular traction syndrome cases (group II) that were operated on and followed up for a minimum of 6 months. Eyes that had undergone previous surgery or had posterior or peripheral retinal lesions were excluded. In bilateral macular surgery cases, only the first eye was included. The outcome measures were far and near visual acuities preoperatively and 6 months after surgery, taking into account the crystalline lens condition, the incidence of retinal tears, detachments, and epimacular membrane recurrences. RESULTS: At 6 months, if the lens was stable or operated on, the visual acuity showed at least a two-line improvement in 100% of the cases (12/12) in group I, and 60% (3/5) in group II. The incidence of retinal detachment and tears was 1.5% (1) and 1.5% (1), respectively, in group I, and 8% (2) and 4% (1), respectively, in group II. Recurrence of an epimacular membrane was observed in 6% of the cases (4) in group I and 8% (2) in group II. DISCUSSION AND CONCLUSION: In idiopathic cases, the absence of preoperative vitreomacular adhesion seems to carry a better surgical prognosis for epimacular membrane than vitreomacular traction syndrome.

[Vitreo-retinal pediatric surgery: epidemiologic factors, etiology and prognosis]. / Chirurgie vitréo-rétinienne pédiatrique: facteurs épidémiologiques, étiologiques et pronostiques.

The features of pediatric vitreoretinal surgery are different from those of the adult population. In order to identify those differences, our retrospective study, dealing with a consecutive series of 2230 patients who underwent vitreoretinal surgery, analyzes several parameters for the 43 young patients (under 19 years old) (2%). Two main results can be withdrawn from the study. First, trauma is a major cause of vitreoretinal surgery in children (30% of the cases), proportionally much more frequent than in adults. Second, patient's age is the only factor that significantly influences the surgical prognosis, with a success rate of 35% under the age of 10 years, and 73% above this age (p < 0.05). We conclude that pediatric vitreoretinal surgery has a more guarded prognosis compared to the one performed in the adult population.

[Primary intention to treat intraocular metallic foreign body using radical vitrectomy]. / Traitement de première intention des corps étrangers intraoculaires metalliques par vitrectomie radicale.

In order to compare the prognosis of eyes with a metallic intraocular foreign body withdrawn with a complete versus incomplete vitrectomy, our retrospective study analyzes the functional result and complications in a consecutive series of 13 eyes, depending on whether the vitrectomy included or not the removal of the posterior hyaloïd and the shaving of the vitreous base. Six eyes underwent one of these 2 surgical maneuvers. Three eyes underwent both of these 2 maneuvers and ended up with 10/10 visual acuity and no complications or reoperations. Among the 4 eyes that did not benefit from any of these 2 maneuvers, 3 required a vitrectomy revision because of a retinal detachment or a secondary hemorrhage. We conclude that a radical vitrectomy could improve the prognosis of eyes with an intraocular metallic foreign body.

[Prognosis of surgery in epimacular membranes after retinal break or rhegmatogenous retinal detachment]. / Pronostic de la chirurgie des membranes épimaculaires secondaires à une déchirure rétinienne ou un décollement de rétine rhegmatogène.

INTRODUCTION: The prognosis of the formation of epiretinal membranes after retinal break or rhegmatogenous retinal detachment, treated or not treated, does not seem as favorable as that of the idiopathic membranes, but has not yet been extensively studied. Our goal was to analyze the functional result and the retinal complications of the treatment of these membranes. METHODS: The retrospective study deals with a consecutive series of 28 patients operated on for epimacular membranes, with a minimum follow-up of 3 months. The outcome measures were the postoperative visual acuity at 3-6 months compared with the preoperative visual acuity, taking into account the condition of the crystalline lens as well as the incidence of membrane recurrence and new or recurrent retinal detachment. RESULTS: A 2-line or more visual improvement was achieved in 57% of the cases (16/28), i.e., 36% of eyes with progressive cataract (4/11), 50% of primary pseudophakic eyes (3/6), and 80% of eyes with unchanged lens (8/10). There was no recurrent epimacular membrane formation, with a mean follow-up of 8.7 months. A new or recurrent retinal detachment was observed in 25% of the cases (7/28). DISCUSSION AND CONCLUSION: These results, compared with those achieved in the treatment of idiopathic membranes, as the literature reports, confirm the fair surgical prognosis of epimacular membrane formation after retinal break or rhegmatogenous retinal detachment.

[Preliminary results for treatment of rhegmatogenous retinal detachment and new material for episcleral buckle: silicone Korobelnik sponge]. / Résultats préliminaires du traitement du décollement de rétine rhegmatogène par un nouveau matériel d'indentation épisclérale: l'éponge siliconée et biseautée de Korobelnik.

In order to evaluate the efficacy and short-term tolerance of the Korobelnik sponge in the primary treatment of uncomplicated rhegmatogenous retinal detachments (RRD), a retrospective study dealing with the first 30 consecutive cases of RRD primarily operated on with the use of this Korobelnik sponge is undertaken. Primary anatomical success is obtained in 80% of the cases (24/30), with a mean postoperative follow-up of 3.1 months. Conjunctival inflammation or dehiscence are not observed. Two sponges have to be removed for unrelated reasons. The study shows that the Korobelnik sponge is a reliable and well-tolerated buckling material, at least in the short term.

[Can vitrectomy without use of microscissors improve results of surgery for proliferative diabetic retinopathy?]. / La vitrectomie sans ciseaux améliore-t-elle les résultats de la chirurgie dans la rétinopathie diabétique proliférante?

In order to test the hypothesis that in proliferative diabetic retinopathy surgery the vitrectomy without the use of microscissors could improve the results and decrease the rate of complications as well as the operating time, two groups are compared in a consecutive series of 24 eyes, operated on with or without scissors, and with a minimum follow-up of 6 months. The study shows that the vitrectomy without scissors offers a higher percentage of eyes with a postoperative visual acuity at least two lines better than the preoperative visual acuity. It shows also a trend for a shorter surgery, with fewer complications in case of vitrectomy without scissors.

[Posterior vitrectomy for dislocated nuclear fragments during phakoemulsification: incidence, risk factors and prognosis of postoperative retinal detachment]. / Retrait par vitrectomie postérieure de fragments nucléaires luxés en cours de phakoémulsification.

INTRODUCTION: Dislocated nuclear fragments during phakoemulsification are a well-known complication. The treatment is often surgical, and serious complications, among which a retinal detachment may occur. The purpose of this study was to evaluate its incidence, risk factors, and prognosis. METHODS: This retrospective study included a consecutive series of 24 eyes undergoing posterior vitrectomy for dislocated nuclear fragments during phakoemulsification. The main outcome measures were the postoperative retinal detachment (incidence, risk factors, prognosis). RESULTS: Two retinal detachments occurred after vitrectomy, an incidence of 8%. In both cases, a significant inflammation of the anterior chamber and corneal decompensation were noted before vitrectomy. More than 50% of the nucleus was dislocated. Intraocular implant manipulation did not intervene in either case. Two tears occurred during vitrectomy in one case. The prognosis of the detachment, with proliferation, was poor in both cases. DISCUSSION: and conclusion: The high incidence of retinal detachment compares with that observed after phakoemulsification complicated by vitreous loss. Anterior segment deterioration, which compromises posterior segment visualization, and dislocation of more than 50% of the nucleus, that increases the risk of fragments falling on the retina during vitrectomy, may increase the occurrence of retinal detachment with a poor prognosis because of periretinal proliferation.

[Traumatic vitreous-retinal hemorrhage in infants]. / Hemorragies traumatiques vitreo-retiniennes de l'enfant.

After a short review of the non-traumatic, and rare, causes of vitreoretinal hemorrhages in infants, we analyze the 4 situations where a traumatic hemorrhage can be found: accidental head trauma, which has to be very severe and is then an unfrequent etiology, head trauma in child abuse or the so-called "shaken baby syndrome", which is the most frequent cause, and where we point out the key role of the ophthalmologist in the diagnosis and the prognostic evaluation, the perinatal trauma, which is a frequent, benign, and ephemeral cause, and finally, cardiopulmonary resuscitation, which is a controversial and unlikely cause.

[Surgery for idiopathic macular hole in stage III/IV: is long-acting gas tamponade indispensable?]. / Chirurgie du trou maculaire idiopathique de stade III/IV: un tamponnement gazeux de longue duree est-il indispensable?

In order to test the hypothesis that in stage III/IV idiopathic macular hole surgery, a short-acting gas tamponade with 40% SF6 and postoperative positioning for 7 days is anatomically and functionally as successful as a long-acting gas tamponade with 14% C3F8 and a postoperative positioning for 14 days, 2 consecutive series of eyes operated on with the same technique, excepted for the gas tamponade used, are compared. The anatomical and functional success rates are not statistically different between both groups.

[Surgery for idiopathic macular hole: use of internal limiting membrane peeling]. / Chirurgie du trou maculaire idiopathique: utilité du pelage de la limitante interne.

In order to evaluate the hypothesis that macular internal limiting membrane peeling is useful for closing stages III and IV, but not stages II idiopathic macular holes, anatomic and functional surgical results are compared in a consecutive series of 54 operated eyes including 3 groups: 17 eyes with a stage II macular hole and 18 eyes with a stage III-IV macular hole without additional internal limiting membrane peeling, and 19 eyes with stage III-IV macular hole with additional internal limiting membrane peeling.

["Rupture" of the internal limiting membrane in surgery of the macular hole: preliminary results]. / "Rhexis" de la limitante interne dans la chirurgie du trou maculaire: resultats preliminaires.

Seventeen eyes with a stage III or IV macular hole were consecutively operated on by a technique similar to that of Kelly and Wendel, in adjunction with a systematic peeling of the internal limiting membrane around the macular hole. The results of these 17 surgeries are presented and the operating technique is discussed.

[Weak and moderate myopia and the prognostic value of macular hole surgery]. / La myopie faible a moderee a-t-elle une valeur pronostique dans la chirurgie du trou maculaire?

The comparison of the anatomic and functional results of macular hole surgery, provided there is no associated retinal detachment, shows that preoperative myopia of at least 1 diopter, contrary to the preoperative stage of the hole according to the classification of Gass, is not a prognostic factor. This is suggested by the retrospective study of a consecutive series of 34 eyes operated on by the same surgeon.

[Progressive deterioration of episcleral Miragel explants]. / Deterioration progressive des explants episcleraux de type Miragel.

Miragel (TM) episcleral explants undergo deterioration with the passing years, so that their ablation becomes necessary in a growing number of cases because of progressive discomfort and/or diplopia. The present study deals with 13 eyes undergoing the removal of an episcleral Miragel explant between 10/1/96 and 10/15/98. The Miragel explant ablation, which is tedious because of the material alterations, gives excellent functional and cosmetic results. The risk of retinal detachment recurrence seems low.

Familial adenomatous polyposis associated with multiple adrenal adenomas in a patient with a rare 3' APC mutation.

Familial adenomatous polyposis (FAP) is characterised by hundreds of colorectal adenomas. Endocrine neoplasms have occasionally been reported, as have gastric polyps, which are usually hamartomatous in the fundus of the stomach and adenomatous in the antrum. A 57 year old man with colorectal, gastric, and periampullary adenomatous polyposis, in association with three bilateral adrenocortical adenomas, is presented. Mutation screening showed a 5960delA germline mutation in the adenomatous polyposis coli (APC) gene predicted to lead to a premature stop codon. This mutation was found in three of the four children of the patient. Western blot analysis of a lymphoblastoid cell line derived from the patient failed to detect any truncated APC polypeptide. This rare 3' mutation is responsible for an unusually complex and late onset phenotype of FAP.

[The ophthalmological follow up of the premature infant must go on after the neonatal period]. / Le suivi ophtalmologique du prématuré ne se limite pas à la période néonatale.

Premature infants with very low birth weight (VLBW: < 1251 g) and/or gestational age lower than 32 weeks are at high risk of ocular abnormalities. Retinopathy is a well known complication of the neonatal period, but many abnormalities occur beyond the neonatal period, and must be carefully screened for years, mainly: cicatricial retinopathy, myopia, strabismus, glaucoma, retinal detachment and various functional visual impairments. Guidelines for the postneonatal screening of these abnormalities are given.

[Precocious exudative retinal detachment after surgery of the macular hole]. / Décollement de rétine exsudatif precoce apres chirurgie du trou maculaire.

The retrospective study of our patients operated on for an idiopathic macular hole shows 2 cases of presumed exudative retinal detachment appearing 24 to 36 hours after surgery. This complication, to our knowledge, has never been reported. We describe these 2 cases and discuss on one hand, the arguments for an exudative etiology of the retinal detachment, and on the other hand, the possible causes of this unusual complication.