[Disputed optical correction]. / Les corrections optiques contestées.

Problems arising from eyeglasses prescriptions can be due either to a fautive prescription (over correction of hyperopia, of astigmatism, ...), either to a fautive writing of the prescription (inversion of axis or sign of a cylinder, inversion of the value RE/LE, ...) or to a poor work by the optician (decentered glasses ...)

[Transcanalicular dacryocystorhinostomy by pulse Holmium-YAG laser]. / Dacryocystorhinostomie transcanaliculaire par laser pulsé Holmium-YAG.

We report the results of 26 Holmium-Yag transcanalicular DCR made in 23 outpatients, under topical anaesthesia. Success rate was 47% (follow-up: 1 to 7 months). Failures occurred within the first month.

[Results of the intraocular lens SI-30 implantation]. / Résultats de l'implantation de la lentille intraoculaire SI-30.

PURPOSE: clinical evaluation of the flexible silicone intraocular lens SI-30 (Allergan). METHOD: retrospective study over 3 years of 2000 implantations of the SI-30 IOL. The lenses were inserted through a 3.2 mm scleral tunnel and placed in the capsular bag after continuous circular capsulorhexis and phacoemulsification. RESULTS: visual outcome was excellent. Without other causes of impaired vision, 99% of patients regained a visual acuity of 20/30 or better after 1 month. Induced astigmatism was unsignificant: 0.4 D; preop., 0.9 D. at day 7, 0.4 at 1 month, 0.5 D. at 1 year. A disinsertion of the inferior haptic occurred in 2 cases during the insertion manoeuver. More specific postoperative complications consisted of pigmented deposits (less than 1%), pupillary capture (4 cases), and capsule contraction associated with small size capsulorhexis. Aspecific complications were: cystoid macular oedema (3% at 1 month, less than 1% afterwards), chronic uveitis (0.6%), acute uveitis (1 patient). CONCLUSION: implantation of the SI-30 silicone lens is safe and gives the patient the benefits of a small, non enlarged, and sutureless cataract incision. The postoperative follow-up must take in account the properties of the lens.

[Small pupil and phacoemulsification]. / Petite pupille et phakoémulsification.

Miotics pupils are compatible with phacoemulsification. Several techniques have been proposed to enlarge the pupil. We present a multiple sphincterotomies technique which enlarges the pupil to a size compatible with phacoemulsification, and retains postoperatively the circular shape of the pupil as well as its functional role.

[Combined operations: trabeculectomy, crystalline lens extraction and insertion of a posterior chamber implant: a 3-year retrospective study]. / Opérations combinées: trabéculectomie, extraction du cristallin et mise en place d'un implant de chambre postérieure: etude rétrospective sur 3 ans.

Thirty-four eyes of 29 patients with coexisting cataract and glaucoma that underwent glaucoma triple procedure between 1991 et 1994 were retrospectively analyzed. Mean follow-up was 9 months. A phacotrabeculectomy (PHACO-TRAB) was performed in 21 eyes, 13 eyes received extracapsular cataract extraction with trabculectomy (ECCE-TRAB). In 26 eyes, adjunctive 5-FluoroUracil subconjunctival injections were administrated. Our results showed a mean decrease from preoperative intraocular pressure (IOP) baseline of 10.5 mmHg at 3 months. (Mean preoperative IOP = 25.6 mmHg, mean IOP 3 months = 15.1 mmHg). The mean IOP decrease appears equivalent in the PHACOTRAB group compared to the ECCE-TRAB group, with a stable IOP result during the follow-up. Overall mean visual acuity improved from 0.16 preoperatively to 0.6 at 3 months with a slightly better result in the PHACO-TRAB group. Postoperative hyphema and fibrinous anterior uveitis were seen more often in the ECCE-TRAB than in the PHACO-TRAB group. This observation, along with the rapidity of the surgery, the quicker visual rehabilitation and the technique that is less disruptive to the conjunctiva are arguments in favour of phacotrabeculectomy whenever a combined procedure is indicated.

Astigmatism after a large scleral pocket incision in extracapsular cataract extraction.

In this four-month prospective study, we measured astigmatism in 116 patients who had extracapsular cataract extraction through a 13 mm scleral pocket incision. In one group, the wound was closed with five radial 10-0 polypropylene sutures. Early and late postoperative astigmatism in this group was approximately 2 diopters (D), but a significant shift to against-the-rule astigmatism occurred. In a second group, an additional 10-0 polypropylene horizontal suture was placed anteriorly to the radial suture at the 12 o'clock meridian. This reduced the against-the-rule astigmatic decay. Moreover, this group had less postoperative astigmatism. Mean corneal astigmatism was 2.27 D at one week, 1.76 D at one month, 1.37 D at two months, and 1.70 D at four months. In neither group was cutting the sutures necessary.

[Phacoemulsification and flexible implants]. / Phacoémulsification et implant flexible.

We report a study of astigmatism and postoperative complications in 170 eyes following phacoemulsification and implantation of a flexible silicone intraocular lens (SI-18NB) in the capsular bag. No significant difference existed between the preoperative mean astigmatism and the postoperative mean astigmatism after 7 days and after 1 month. Complications were infrequent and compared with those associated with PMMA intraocular lenses.

[Anatomical modification of the levator muscle of the eyelid in congenital ptosis]. / Modification anatomique du muscle releveur de la paupière dans le ptosis congénital.

Congenital ptosis of the upper lid is classified as a developmental anomaly of the levator muscle. We report the histochemical findings in 38 specimens of levator muscle removed in patients with congenital ptosis and operated on by a resection of the levator muscle. Results demonstrated a close relationship between the presence or the absence of muscular fibres in the specimen and the degree of ptosis and the levator function. We suggest that congenital ptosis may result from a failure of differentiation and/or fusion of the anterior portion of the superior orbital mesoderm complex.

Surface-wrinkling maculopathy as a potential complication of trabeculectomy: a case report.

We report a case of "crinkled cellophane maculopathy" which developed during the first few days following an uneventful trabeculectomy in a high myopic patient with primary open-angle glaucoma. We suggest pathogenic mechanisms that may have induced such premacular lesions, emphasizing the patient's high myopia combined with a postoperative inflammatory reaction.

Purtscher-like retinopathy after retrobulbar anesthesia.

A Purtscher-like retinopathy occurred in a 41-year-old woman who underwent the excision of a pterygium after a retrobulbar injection of 3 ml of lidocaine HCl. Visual acuity increased from 20/200 on the first postoperative day to 20/25, 12 weeks later. The exudates and the hemorrhages progressively disappeared. However, a relative, localized, paracentral scotoma and an afferent pupil defect still persist. The pathophysiology of this Purtscher-like retinopathy is discussed.

Transposition of the levator muscle and its reinnervation.

The frontalis transposition of the levator muscle changes the motor innervation of the muscle from the third nerve to the facial nerve. This contributes together with the sling effect of the transfer to achieve a satisfactory result in the treatment of neurogenic ptosis as in the ptosis of the Marcus Gunn's phenomenon.

[Lymphomatoid papulosis of the eyelid]. / Papulose lymphomatoïde de la paupière.

Lymphomatoid papulosis is an infrequent skin disease characterized by lesions which are clinically benign and histologically malignant. We report a case of lymphomatoid papulosis of the lid: the patient was 62 year old and the lesion appeared as a rapidly growing ulcerated tumor of the outer canthus with histological features of malignity. Complete removal of the tumor was performed and the lid was reconstructed during the same time. Similar preexisting and self healing skin lesions helped to make subsequently the accurate diagnosis.