[Corneal ulcers associated with rheumatoid arthritis]. / Les ulcères de cornée associés à la polyarthrite rhumatoïde.

Keratoconjonctivitis sicca, scleritis and keratitis remain the major ocular manifestation, associated with rheumatoid arthritis. Corneal ulcers are a rare complication but can lead to perforation. Unstable epithelial barrier and immune disorders play a key role in the pathophysiology of such corneal melting. Moreover the association with systemic vasculitis reveals the need for an appropriate immunosuppressive treatment. New surgical approaches and early immunotherapy allow to maintain ocular integrity even if the visual prognosis is poor.

[Report of a case of Acanthamoeba keratitis]. / A propos d'un cas de kératite à Acanthamoeba.

CLINICAL REPORT: A clinical report of a contact lenses wearer with Acanthamoeba keratitis pointed out the diagnosis problem. The medical treatment is needed previously to any surgery. Finally the patient underwent enucleation. DISCUSSION: The authors are considering the microbiological aspects and laboratory techniques are described. CONCLUSION: For this very severe but hopefully rare pathology, the sooner the treatment the best. A therapeutic approach is described.

[Use of the cryopreserved human amniotic membrane for reconstruction of the ocular surface]. / Utilisation de la membrane amniotique humaine cryo-préservée pour la reconstruction de la surface oculaire.

The aim of this human research protocol is to determine the efficacy of using preserved human amniotic membrane for reconstruction surgery for ocular surface. Case report and literature will be presented. The characteristics of a new surgical approach using human amniotic membrane will be described.

[Types of corneal transplantation: experience and review]. / Greffes de cornée typées: expérience et revue.

The authors review the 12 cases of matched corneal transplantation, performed at the CHU of Liège between 1991 and 1997. They expose their results together with a summary of the different hypotheses published so far in the field of corneal graft matching.

[A case of Exophiala dermatitidis ulceration]. / Cas d'un ulcère à Exophiala dermatitidis.

The authors present one case of corneal Exophiala dermatitidis ulceration. This case is analyzed in the field of corneal mycosis infection. Classification, rate, clinical history, biomicroscopy aspects will be discussed. Technical samples will be described. Anatomopathologic slides will be discussed. Finally the medical or surgical treatment will be considered.

Efficacy and safety of 0.3% carbomer gel compared to placebo in patients with moderate-to-severe dry eye syndrome.

PURPOSE: Carbomer gel is a water-soluble polymeric resin that has been reported to maintain the tear film in contact with the eye for an extended period. The efficacy and safety of this new artificial tear were assessed. METHODS: A multicenter, single-masked, randomized, placebo-controlled study was carried out on 123 patients with moderate-to-severe dry eyes. The placebo was a mannitol solution with benzalkonium chloride 0.008% as preservative. Patients were observed over an 8-week period, and subjective and objective changes analyzed, compared to a baseline of no therapy, after 1 to 7 days washout period from previous medication. RESULTS: All primary subjective symptoms decreased significantly in the carbomer gel-treated group compared to the placebo group (i.e., dryness, discomfort, and foreign body sensation). The carbomer gel also significantly improved the rose bengal staining score relative to placebo. When data for the primary subjective efficacy variables were stratified for disease severity, there was a statistically significant improvement from baseline by day 10 for severely affected patients and from day 42 for patients with moderate disease. Secondary subjective symptoms that improved significantly in the tear gel group compared to placebo were photophobia, erythema, tear breakup time, blurry-filmy, dry-sandy sensation, and physician impression. However, no significant improvements in the secondary subjective symptoms of tearing, itching, scaling, conjuctival discharge, palpebral conjunctival redness, bulbar conjuctival redness, conjunctival luster, relief of discomfort, ease of use, and overall acceptability were found in either group over the baseline score. In addition, neither carbomer gel nor placebo improved the baseline fluorescein staining score or the Schirmer test score. Two patients suffered local allergic reactions to the carbomer gel or its preservative, which settled on withdrawal of the medication. CONCLUSIONS: Carbomer gel was more efficacious than was placebo in improving a number of subjective and objective symptoms of moderate-to-severe dry eye syndrome. The results of this study indicate that carbomer gel was a safe as was the placebo.

[Emergency corneal grafts]. / Les greffes de cornée à chaud.

Corneal ulceration leading to perforation can mainly occur after infection, trauma, corneal dryness and exposure keratitis. When corneal ulceration does not respond to medical treatment, a penetrating keratoplasty allows the elimination of infected tissue and antigenic material. It can restore the integrity of the anterior segment of the eye. The tissue taken could serve for bacteriologic research. In spite of the great number of complications the percentage of success is about 50%.

[A case of keratitis due to Mycobacterium chelonae]. / A propos d'un cas de kératite à Mycobacterium chelonae.

The authors presents one case of primitive corneal mycobacterium keratitis after corneal graft. This rare form of keratitis is analysed in the field of mycobacterial infections who's nowadays more developed in our industrialised countries. The description of the case point out the multiresistance of this mycobacterium and describe the different treatments.

Long-term corneal involvement following drug-induced toxic epidermal necrolysis (Lyell's disease).

Toxic epidermal necrolysis is a mucocutaneous disease that also causes important ocular sequelae. Conjunctival retraction, scars and sicca syndrome with severe corneal lesions are the principal ocular complications, sometimes resulting in a major handicap for the patient. We report a case where long-term sequelae ended in corneal perforation requiring a keratoplasty more than 20 years after the initial attack.

[Recurrent corneal erosion]. / Erosion cornéenne récidivante.

Anterior stromal puncture has been proposed as a new treatment for recurrent corneal erosion. A soft technique with a curved needle minimize scarring and prevent corneal perforation. An insertion depth of 0.1 mm was sufficient to cause the production of new basement membrane attached to the anterior stroma. GEGGEL and coll. use a new technique with multiple applications of the Nd Yag Laser on the basement membrane. The laser punctures would be more reproducible and work as well as stromal punctures.

[Examination of the corneal epithelium using the specular microscope]. / Examen de l'épithélium cornéen au moyen du microscope spéculaire.

Corneal epithelium examinations were conducted using the Pocklington specular microscope. Fifty cornea were observed and photographed. The most superficial corneal epithelium layer is seen with difficulty as the cells lack sufficient contrast. Epithelial lesions are easier to detect because cellular reflection is more marked. Injured cells are larger, and brighter, and their nucleus is more often visible. Subepithelial deposits can be recognized.

[The preocular tear film: a clinical examination method]. / Le film lacrymal. Méthode d'examen clinique.

The preocular tear film is formed of three superimposed layers: an internal mucus layer, the intermediate layer of water and the external lipid layer. These three layers are functionally necessary for the transparency of the cornea. If one of the constituent parts of the tears is lacking, epithelial repercussions are immediate: epithelial villosities disappear and the cells degenerate and desquamate. Qualitative and quantitative clinical tests can identify certain constituents of tears, establish diagnosis, and determine specific treatment.

[Iridocapsular lenses: limbus versus pars plana approach in secondary cataract surgery (author's transl)]. / Lentilles irido-capsulaires: abord par le limbe et abord par la pars plana dans l'opération de la cataracte secondaire.

We operated on 55 eyes with secondary-cataract following implantation of a Binkhorst's irido-capsular lens. The procedure was through the limbus in 27 cases and via pars plana in 28 cases. For the limbus approach, we made a discission ("membranotomy") in all cases. By pars plana approach, we made a discission in 6 cases and an excision ("membranectomy") by means of phacophage (lensectomy instrument) in 22 cases. We observed that discission frequently yields deceptive or transitory results, requiring one or more reinterventions, while excision of the pupillary membrane by means of phacophage always results in a broad and definitive opening Pars plana approach has the advantage that it facilitates transformation of membranotomy to membranectomy. None of the 55 cases has presented retinal detachment.

[Implantation of Binkhorst's iridocapsular lens (author's transl)]. / Le choix d'une technique d'implantation d'une lentille intra-oculaire.

Advantages of the extracapsular extraction for implantation of Binkhorst's iridocapsular lens. Description of the surgical procedure; its indications and contre indications. Analysis of the results of 131 operations. The follow up of 120 patients exceeded six months. 84% of the patients have a visual acuity higher than 10/20. The major complication is secondary cataract which requires new surgery in 20% of the cases. The major complication is secondary cataract which requires new surgery in 20% of the cases. Other complications are the same as in classical intracapsular extraction when the indications of iridocapsular implants are correct.