[Clinical evaluation of the ocular safety of Amukine 0.06% solution for local application versus povidone iodine (Bétadine) 5% solution for ocular irrigation) in preoperative antisepsis]. / Evaluation clinique de la tolérance oculaire d'Amukine 0,06% solution pour application locale versus povidone iodée (Bétadine 5% solution pour irrigation oculaire) en antisepsie pré-opératoire.

INTRODUCTION: The aim of this monocentric, randomized, comparative, open study was to evaluate the safety of Amukine 0.06% solution (an isotonic hypochloride sodium solution) versus a 5% povidone iodine solution (Bétadine 5% solution for ocular irrigation) in antisepsis before cataract surgery. MATERIAL AND METHODS: One hundred and thirteen patients, aged between 49 and 90 years, were included and split, after randomization, into two groups: one testing Amukine 0.06%, the other testing a 5% povidone iodine solution. For each group, after local anesthesia, the antiseptic procedure consisted of an antisepsis of periocular teguments followed by an eye antisepsis through the instillation of two drops of the tested product in the conjunctival fornices. The safety evaluation was performed by grading superficial punctate keratitis 24 hours after surgery (slit lamp examination after fluorescein instillation). Conjunctival hyperemia scores by examination of the bulbar conjunctiva before the first instillation, immediately before surgery, and 24 hours after surgery were also compared. RESULTS: One hundred and seven reports were analyzed. Concerning the presence of corneal superficial punctate keratitis 24 hours after surgery, mean scores were not different (0.27 for the Amukine 0.06% group and 0.38 for the povidone iodine group; p=0.27 Mann Whitney test). The observations did not show a different progression of conjunctival hyperemia depending on the treatment group (p=0.65 (immediately after application) and p=0.52 (after 24 hours); Mann Whitney test). CONCLUSION: In this study, the ocular safety of Amukine 0.06% solution was not different from a 5% povidone iodine solution. Therefore, Amukine 0.06% is a new interesting approach to surgical antisepsis in ophthalmology and an alternative in case of iodine allergy.

[First line endonasal dacryocystorhinostomy Technique and results. Comparison between diode laser and electrocautery instrument. Study based on 422 procedures]. / Dacryocystorhinostomie endonasale de première intention. Technique et résultats. Comparaison entre le laster diode et le bistouri électrique. Etude sur 422 interventions.

PURPOSE OF THE STUDY: To assess the results of the first procedures of endoscopic endonasal dacryocystorhinostomy (ENL DCR). To study the efficiency of diode laser in this operation versus electrocautery instruments (ECI). DESIGN: Prospective study; comparative study. METHODS: Intraoperative comparison between ECI and diode laser is based on 422 ENL DCR achieved between June 1997 until June 2000. Three hundreds and sixty three procedures were diode laser assisted and 59 procedures were done with the use of an ECI. The diode laser was only used to vaporize nasal mucosa laying on the osteotomy site, to realize partial turbinectomy and to vaporize polyps and synechiae. Intraoperative comparison was based on the followings: frequency and extent of bleeding, quality of visibility, perception of pain during the use of the instrument and duration of the operation. Postoperative comparison is based on 318 procedures. Comparison was based on: frequency of granuloma formation in the nasal mucosa at the site of the osteotomy, frequency of acquired nasal synechiae, frequency of important crusting reaction of the nasal mucosa; success rates after a minimum follow up of 6 months. RESULTS: Intraoperative haemorrhages were fewer and smaller in the diode laser assisted procedures than in ECI assisted procedures; visibility was better with the diode laser; the use of the diode laser was painless versus 24% of patients complaining of pain during the use of electro-cautery. The duration of the procedure was shorter with the diode laser (29'30 vs 37'). In the postoperative follow-up frequency of granuloma formation was equal with the two instruments, synechiae were fewer with the diode laser (11% vs 22%) just like crusting reaction of the nasal mucosa (7% vs 36%). Success rates were similar (diode laser: 91.94% vs EC: 86.66%). CONCLUSION: Because of the effeciency of the vaporization and coagulation, the diode laser, in comparison with the ECI, allows to shorten mean operative time, to improve the visibility and to decrase bleeding. Contrary to EC it's use is painless. Fewer important crusting reactions and fewer synechiae after diode laser assisted procedures tend to prove than postoperative inflammation and surgical trauma are smaller than with ECI. There is no statiscally signifant difference between the success rates of ENL laser diode assisted procedures and ENL ECI assisted procedures.

Type 1 diabetes with no diabetic complications, 62 years later.

We report a type 1 diabetes in an 88-year-old female patient discovered in 1938 at the age of 26. She was promptly put on insulin, which lasted 62 years so far. This patient was highly remarkable because she portrayed a historical case of insulin-treated diabetes diagnosed in 1938. The absence of microangiopathy and specially retinopathy was quite singular, all the more reason that her diabetes was ill-controlled. Environmental or genetic factors may, one day, explain this unusual favourable outcome.

[Holmium: YAG and neodymium: YAG laser assisted trans-canalicular dacryocystorhinostomy. Results of 317 first procedures]. / Dacryocystorhinostomie trans-canaliculaire de première intention au laser néodymium: YAG et holmium: YAG.

PURPOSE: To assess the results of the first procedures of trans-canalicular dacryocystorhinostomy according to two different lasers: Neodymium: YAG (Nd: YAG) laser or Holmium: YAG (Ho: YAG) laser. To study the efficiency of two anti-metabolite drugs: mitomycin-C (MMC) and 5 fluoro-uracile (5 FU). To analyse the rate of efficiency of the Ho: YAG laser in the canalicular obstructions. METHODS: Three hundred and seventeen patients were operated: 226 with the Nd: YAG laser, 77 with the Ho: YAG laser and 14 with both lasers; 68 were treated with an application of MMC and 40 patients with an application of 5-FU. Sixty-three patients suffered from a canalicular obstruction. RESULTS: The results are based on 289 procedures 6 months after the operation. The global rate of success was 63.32% after one intervention and 70.24% after one or two revisions. There is no statistically significant difference between Nd: YAG or Ho: YAG lasers. The use of antimetabolites did not improve the success rate. In 65% of the cases the canalicular patency is reached. CONCLUSION: Laser-assisted transcanalicular dacryocystorhinostomy is a very useful method because it does not cause cutaneous scarring and for it has a low rate of morbidity given that it causes very little surgical traumatism. Consequently, it can be used under topical anaesthesia and for patients at risk or suffering from coagulation problems. It can be undertaken in the cases of extremely narrow nasal fossae when an endonasal dacryocystorhinostomy is impossible. This procedure is less successful than external or endonasal dacryocystorhinostomy. The success rate is not modified by the use of antimetabolites or by the type of laser.

[Revision of failed dacryocystorhinostomies using the transcanalicular approach. Results of 118 procedures]. / Reprises des échecs des dacryocystorhinostomies par la technique trans-canaliculaire.

PURPOSE: To assess the efficacy of transcanalicular dacryocystorhinostomy for the revision of other procedures. The results are analyzed following the use of two different types of laser: the Neodymium: YAG (Nd: YAG) laser and the Holmium: YAG (Ho: YAG) laser. To study the efficacy of using two antimetabolite drugs in this context: mytomycin-C (MMC) and 5-fluoro-uracile (5-FU). METHODS: One hundred and fourteen patients were operated on. Of these, 88 had already undergone one procedure, 25 two procedures, and 5 three procedures. The Nd: YAG laser was used in 78 procedures, the Ho: YAG in 30 procedures, and both lasers in 10 procedures. Twenty patients were treated with an application of MMC and 25 patients with an application of 5-FU. RESULTS: The results are based on 106 procedures. The total success rate was 49.06% after one revision and 58.49% after two or three revisions. There is no statistically significant difference between the Nd: YAG and Ho: YAG lasers. The use of antimetabolites did not improve the success rate. CONCLUSION: Transcanalicular dacryocystorhinostomy is a very useful method because it does not cause cutaneous scarring and it has a low rate of morbidity given that it causes very little surgical traumatism. The revision of other dacryocystorhinostomy methods using the transcanalicular approach is theoretically a positive indication because it does not dissect scarring tissues and because the osteotomy has already been performed. However, the success rate is lower than for the external and endonasal approaches. The success rate is not modified by the use of antimetabolites or by the type of laser.

Improved Ronchi tester.

We used a LED in a Ronchi tester to obtain two main improvements: (i) We can choose one of two wavelength bands to illuminate and record the ronchigram, and (ii) we can change the irradiance of the illumination source according to the optical system under test and the detector array. This can be done by use of an adequate electronic circuit.

Evaluation of anterior chamber inflammation after corneal refractive surgery.

PURPOSE: To prospectively evaluate inflammatory response by measuring aqueous flare in the anterior chamber after photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), and intracorneal ring segments (ICRS) implantation. METHODS: Aqueous flare was measured pre- and postoperatively at days 1, 7, and 21 with a laser flare meter (Kowa FM 500). Thirty-one patients (58 eyes) were randomized, only for low myopia, in three groups treated with PRK (myopia <-4.50 D), LASIK (myopia range between -4.00 and -12.00 D), and ICRS (myopia <-4.50 D). RESULTS: Mean preoperative flare intensities were similar in the three groups (p< or =0.05; mean, 4.6 photons/ms). In the PRK group, flare increased significantly (mean day 2, 9.5 photons/ms), as it did in the LASIK group (mean day 1, 23.8 photons/ms). In the ICRS group, there was no significant difference between pre- and postoperative levels of flare at any time (mean day 1, 4.9 photons/ms). In all three groups, flare intensity returned to baseline at day 7, except in the LASIK group, which remained at a significantly higher level (mean day 7, 7.7 photons/ms) than the preoperative one. CONCLUSIONS: According to this method, the blood-aqueous barrier seems to be altered in laser procedures, particularly in LASIK, probably in correlation with the depth of photoablation. ICRS implantation did not increase the postoperative flare significantly.

Screening for atrial fibrillation in the community: a multicenter validation trial.

BACKGROUND: Atrial fibrillation (AF) is an important public health problem. This arrhythmia is common and associated with a high risk of stroke. Further, appropriate interventions in AF can reduce the risk of stroke by approximately 68%. Population studies show that a large group of patients have intermittent or chronic AF that remains unrecognized. If a simple screening test for this arrhythmia could be developed and validated, application of the technique across populations might identify AF patients for early treatment, potentially reducing the incidence of stroke. In this study, we sought to determine whether individuals taken from the general community could be taught to find and classify the pulse of another as very irregular, implying AF, or regular, implying normal sinus rhythm (NSR). The aim was to establish that pulse examination for potential AF could be performed by individuals with sufficient sensitivity and specificity to be effectively used as a screening procedure for this medically important arrhythmia. METHODS: We enrolled 178 subjects selected from the general community from four centers. Subjects received standardized education on the medical importance of AF and its signature, a very irregular pulse. A technique for palpating and characterizing the rhythm of the radial pulse was also taught. Without further coaching, subjects were then asked to find their pulse and then to find and classify the pulse of two models randomly presented who may or may not have had AF. RESULTS: Of the 178 subjects tested, 92% were able to find their own pulse; 17 (9.6%) were unable to find the pulse of one or both patient models and were, therefore, excluded from the study. Of the remaining 161 subjects, 76% (122 of 161) correctly identified the pulse in an AF model, and 86% (139 of 161) correctly identified the pulse in an NSR model. Results did not statistically differ as a function of age, educational status, or location. DISCUSSION: This multicenter trial established that given minimal standardized instructions, subjects from the general community can reliably and consistently find both their pulse as well as the pulse of another and to differentiate a regular pulse from a very irregular pulse. If similar educational programs were widely applied across large populations, periodic screening for AF might lead to earlier diagnosis and appropriate treatment for patients who have this major risk factor for stroke. These screening programs should be focused on the population over the age of 55 where the risk of stroke in AF increases with each decade.

[Macular imaging with optical coherence tomography]. / Imagerie maculaire en OCT.

PURPOSE: Optical Coherence Tomography (OCT) is a novel noninvasive and noncontact imaging technique providing cross-sectional representations of the eye structures. OCT is analogous to Ultrasound B-scan, except that it analyzes the reflection of a 850 nm light wave. The aim of this study was to assess the potential of ocular coherence tomography for diagnosing and monitoring macular diseases. METHODS: Cross-sectional images were performed with the Zeiss-Humphrey OCT. Over one year period, we examined approximately 300 patients with idiopathic full thickness macular hole, lamellar hole, cystoid macular edema, choroidal new vessels, epiretinal membrane, diabetic maculopathy, and central serous chorioretinopathy. RESULTS: OCT can provide new information concerning the posterior pole diseases mentioned above. OCT can also be useful in thickness measurements. CONCLUSION: OCT allows tomographic analysis of macular diseases. The information obtained is different from that obtained by histologic study which is sometimes hard to interprete. OCT is mostly useful in studying internal layers of the retina. Further applications may be developed.

[Multifocal placoid epitheliopathy and anti-hepatitis B vaccination]. / Epithéliopathie en plaque et vaccination anti-hépatite B.

The appearance of ocular pathological outcomes following an hepatitis B vaccination is uncommon. Among them, acute multiple posterior placoid pigment epitheliopathy has been noticed after injections of Engerix B recombinant vaccine. We describe the case of an 11-year-old child who presented this affection following a Genhevac B recombinant vaccine injection.

[Anterior cellular proliferation and silicone implant. Apropos of a case]. / Prolifération cellulaire antérieure et implant en silicone. A propos d'un cas.

We reported a case of pigmentary glaucoma in an elderly black patient, treated surgically with phacoemulsification associated with automatised trabeculectomy. The patient was implanted with a silicone foldable lens introduced in the capsular bag. Three months post-operatively, visual acuity, well restored after surgery, decreased progressively and, biomicroscopic exam revealed a pigmented cellular membrane. Pathogeny of this membrane is discussed.

[Unexplained bilateral optic disk edema. So-called idiopathic intracranial hypertension of drug origin should be suspected]. / Oedème papillaire bilatéral inexpliqué. Penser à l'hypertension intracrânienne dite idiopathique d'origine médicamenteuse.

In 2 clinical cases of bilateral optic disk oedema, the optic disk oedema was part of a so-called benign, or rather idiopathic, intracranial hypertension. Aetiological investigations were unable to detect any intracranial or systemic anomaly, except the fact that both patients had been on a long-term treatment. The first, a 35-year-old man, was taking Roaccutane (isotretinoin) for acne, for at least 5 years, Supradyne (containing vitamin A) minimum 1 pill per day. The second patient, aged 16 years, had also been treated for acne with Roaccutane and Mynocine (minocyclin) for several months. Minocyclin and vitamin A, contained in these substances, are likely to have induced the idiopathic intracranial hypertension, and consequently the optic disk oedema. Indeed, discontinuing the treatment and rachicentesis led to a significant resolution of symptoms. A good history of the clinical cases thus remains a key-element in the process of diagnosis-making and should be strictly conducted in cases with bilateral optic disk oedema, particularly when seen in young patients.

[Transcanalicular endodacryocystorhinostomy using Neodymium:YAG laser]. / Endodacryocystorhinostomie transcanaliculaire au laser Neodymium: YAG.

UNLABELLED: We describe a new technique of dacryocystorhinostomy (DCR) and we present our first clinical cases. The principle of this technique is to create a fistula between the lacrimal sac and the nose with a quartz fibre advanced through a canaliculus and connected to a Neodymium:YAG. TECHNIQUE: An 800 microns outer diameter metallic pipe was inserted through a lacrimal canaliculus up to bone contact. An optical fibre light probe was inserted through the pipe in order to locate the lacrimal sac in the nasal fossa by translumination using a nasal video-endoscope. The optical fibre light probe was then replaced with a laser fibre and a lacrimo-nasal fistula (approximately 5 mm diameter) was created in a few minutes by juxtaposition of twenty or more 10 watt energy pulses. Finally, a silicone stent was positioned for 6 months. MATERIAL AND METHOD: We have operated 41 DCR using this transcanalicular method with the Nd:YAG laser. Our mean follow-up was 6 months (max 16 months). Indications were stenosis of the naso-lacrimal duct, failed classical DCR, abscesses of the lacrimal sac uncurable by antibiotherapy and canaliculary stenosis. RESULTS: Success rate was 75%, both for primary procedures and for operations after failed classical DCR. CONCLUSION: The advantages of this method are its simplicity, its atraumatic feature, minimal bleeding, the absence of scar and its ability to treat obstructions located at all levels of the excretory lacrimal system. Minimal operating traumatism makes it a very convenient method for out patient clinic.

[Multifocal chorioretinitis in spontaneous or induced immunodeficiencies]. / Les chorio-rétinites multifocales au cours des immunodéficiences spontanées ou provoquées.

Multifocal simultaneous retinochoroditis are more and more frequent. They seem improved by immunodeficiencies. In 12 cases observed during only the 1987 year: 5 were spontaneous and 7 in relation with a corticosteroid treatment associated or not with other immunosuppressors. The vitreous products analysis lead in 10 cases to find 7 toxoplasmosis in 2 AIDS and 3 CMV with 2 positive Elisa test. The immunodeficiencies prevention spontaneous but also in relation with uncontrolled treatments appear as a very important necessity and urgency.

[Value of vitrectomy in intermediate uveitis and Behçet's disease with hyalitis. A study of 400 cases]. / Intérêt de la vitrectomie dans les uvéites intermédiaires et la maladie de Behçet avec hyalite. Etude sur 400 cas.

Can vitrectomy help to understand the vitreous role in intermediate uveitis and Behçet's disease with vitritis without retinal detachment? 400 vitrectomies were decided because of vitreous changes but, over all, if macular changes were seen clinically or on the angiogram in 58 Behçet's disease and 342 intermediate uveitis including 59 children cases. Visual acuity, clinical, angiographical and visual field controls, recurrences, reduction of the medical treatment and growth were followed during 1 to 9 years. The vitrectomy products were compared to those of other inflammatory origin vitreous, the both representing 149 cases. Vitrectomy at the early stage of only posterior interface changes prevent the macular edema but this one is irreversible. The preexisting angiographical lesions have not regressed but they are generally quiet. The RD incidence is lower even if it is possible after vitrectomy, in 1.2% of the cases (1% in late vitrectomies). Recurrences and further medical treatment are reduced. This psychological point of view is important. Thus, vitrectomy at alone posterior interface change stage avoid ocular complications. Its pathogenic role in intermediate uveitis is not demonstrated; it seems more a secondary than a primary process.

[A multicenter randomized study of fusidic acid ophthalmic gel and rifamycine eyedrops in acute conjunctivitis]. / Etude randomisée multicentrique acide fusidique gel ophtalmique et rifamycine collyre dans les conjonctivites aiguës.

A total of 163 patients with acute, presumably bacterial, conjunctivitis were included in a randomized trial, comparing: 1% fusidic acid viscous eye drops, a new ophthalmic formulation of fusidic acid instilled twice daily with rifamycin eye drops, four times daily. Both drugs were given 7 days long. Bacterial origin of the conjunctivitis, mainly staphylococcal, was proved in 75% of the cases. Overall, at the end of the treatment, a satisfactory response, on bacteriological and clinical grounds, was recorded for 87.3 and 89.5% of the patients in the Fucidin gel and rifamycin groups respectively. 9 and 12% of the patients in each group respectively, had a clinical recurrence 15 days after the treatment. No significant difference between the groups clinically and bacteriologically was noted. Side effects, mainly burning and smarting were noted by the investigators in 8 and 11 patients treated by fusilic acid and rifamycin respectively. Two patients were taken out of the study in the rifamycin group because of allergy. The difference between the groups is not significant. The use of fusidic acid viscous eye drops as compared to rifamycin eye drops was judged significantly easier by the patients (P less than 0.02), especially because of the reduced number of applications, the lack of color, and the lase of application.

[Tolerability in ophthalmologic surgery of CY 216 in preventing venous thrombosis of the leg]. / Etude de la tolérance en chirurgie ophtalmologique du CY 216 employépour la prévention des thromboses veineuses des membres inférieurs.

The specificity of the action of low-molecular-weigh heparin promotes its prevention use in ophthalmological surgery, where any hemorrhage, even if not of vital consequence, can reduce and even cancel out the results of the surgery. Consequently, we subjected 63 patients (21 male, 42 female) aged 54 to 93 to preventive treatment with Fraxiparine (CY 216) as per the conventional indications of risk factors: essentially venous insufficiency [23], varicose veins [29], a history of phlebitis [20] or pulmonary embolism [12]. A first group of 31 patients (protocol P 1) was given the first injection 2 hours prior to surgery (D 0). A second group of 32 patients (P 2) was given the injection at 10 p.m. on the eve of surgery (D-1). P 1 and P 2 were given CY 216 (0.3 ml, one injection at 6 a.m.) each day from D 1 to D 7 (and 7 patients from P 1 until D 10). The type of surgery concerned was: cataract [46], retinal detachment [11], glaucoma [3]; fifteen patients had already undergone surgery and 6 were given CY 216 twice. P 2 was compared with a control group T of 20 patients (7 male, 13 females, mean age 71.8) in the same department given calcium heparin sc (3 x 0.2 ml daily, D 1 to D 7). In P 1 and P 2, as well as in the T group, no clinical thromboembolic complications were observed. Tolerance, however, differed. In P 1: 2 cases of hyphema and one of choroidal hematoma. In P 2: no significant hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)