[Evaluation of the Ocular Response Analyzer in ocular hypertension, glaucoma, and normal populations. Prospective study on 329 eyes]. / Evaluation des facteurs biomécaniques cornéens mesurés à l'Ocular Response Analyzer dans l'hypertension intraoculaire, le glaucome primitif à angle ouvert et chez le sujet normal. Etude prospective sur 329 yeux.

OBJECTIVES: (1) Evaluate and analyze the Ocular Response Analyzer (ORA) in three groups of patients: glaucoma, intraocular hypertension, and normal; (2) study corneal hysteresis values in the three groups according to age; and (3) compare intraocular pressure values measured with the ORA with intraocular pressure measured with Goldmann (IOPGoldmann) and pulsed air (IOPair) applanations. MATERIAL AND METHODS: This prospective, single-center study included 329 eyes divided into three groups: normal (n=207), intraocular hypertension (n=55), and primary angle glaucoma (n=67). Corneal hysteresis (CH), IOP corneal-compensated (IOPcc), and Goldmann correlated IOP (IOPg) measurements were provided by the ORA device for all patients. Ultrasonic central corneal thickness (CCT US), and intraocular pressure measured with Goldmann and pulsed air tonometry were also assessed in each eye. RESULTS: The mean values were: IOPGoldmann 14.4+/-3.4 mmHg, IOPair 15.5+/-3.6 mmHg, CCT 542.1+/-36.6 microm, CH 10+/-1.7 mmHg, IOPcc 16.6+/-4.1 mmHg, and IOPg 15.7+/-3.9 mmHg. All the IOP measurements (IOPGoldmann, IOPair, IOPg, IOPcc) were strongly correlated into the three age groups. The mean CH in the glaucoma (9.8 mmHg) and intraocular hypertension (9.6 mmHg) groups was lower than in the normal group (10.3 mmHg), but there was no difference between the three groups for the CH values, with an age-related analysis of the three groups. The CH was correlated with CCT US in the three groups. IOP measures were not strongly correlated with CH except for IOPcc. There was a negative correlation (-0.79) between CH and IOPcc. DISCUSSION/CONCLUSION: In our study, the mean ORA, CCT US, and IOP values in the normal group were similar to those found in the literature. These are the first CH values reported for a normal group according to age. We confirm the good correlation between all the IOP measurements. The mean corneal hysteresis value was low in glaucoma and intraocular hypertension, but there was no difference between the three groups for the CH values, when the three groups were analyzed according to age. There was a correlation between corneal hysteresis and central corneal thickness. Moreover, IOPcc seems to be the best evaluation of IOP with no influence from corneal biomechanical factors. The Ocular Response Analyzer and corneal hysteresis should be considered a useful parameter for patients with intraocular hypertension and/or glaucoma.

[Practical assessment. Ocular hypertension]. / Bilan en pratique. L'hypertonie oculaire isolée.

In cases of high intraocular pressure, the patient's hypertension must first be confirmed and its characteristics delineated with a diurnal IOP curve or at least several different measures. Central corneal thickness should be measured, since a thin cornea is a risk factor of progression toward glaucomatous neuropathy. Later, the optic nerve head and retinal nerve fibers should be tested (HRT, GDx, and OCT), to determine whether the ocular hypertension is associated with other findings, and visual field analysis should be carried out (standard automated perimetry, blue-yellow perimetry, FDT), completed by a search for associated risk factors. Therapeutic decisions will be based on this workup, keeping in mind that in the majority of cases, monitoring and information are sufficient but necessary; treatment should, however, be initiated in cases of ocular hypertension with a high risk of progression.

[Diagnostic laser in glaucoma: scanning laser polarimetry (GDx VCC) and confocal scanning laser tomography (HRT)]. / Les lasers diagnostiques dans le glaucome: la polarimétrie à balayage laser (GDx VCC) et la tomographie confocale par balayage laser (HRT).

Automated structural measurements of retinal nerve fibers and optic nerve head are possible with new lasers providing objective and reproductible data for analysis. Scanning laser polarimetry (GDx VCC), based on retardation of polarized light, assesses peripapillary nerve fiber layer thickness. Confocal scanning laser tomography yields precise topographic maps of the optic disc and peripapillary retina. The advantages, applications for glaucoma detection, both in a screening setting as well as for monitoring progression, limitations and pitfalls need to be well known and results should be analyzed with clinical data.

[Corneal burns and matrix metalloproteinases (MMP-2 and -9): the effects of human amniotic membrane transplantation]. / Brûlures cornéennes et métalloprotéases: influence des greffes de membranes amniotiques.

PURPOSE: Human amniotic membranes have recently been used in ophthalmology to restore deleted ocular surface after burns. Matrix metalloproteinases-2 and -9 have been implicated in the development of neovascularization. In this study, MMP-2 and MMP-9 expression was analyzed by in situ zymography on rabbit corneal chemical burns with and without human amniotic membrane graft. METHOD: Corneal neovascularization was induced in 10 Fauve de Bourgogne rabbits by means of a heptanol chemical burn on controlled deep keratotomy using a Chiron ALK-E corneal shaper. Half of rabbits received acute amniotic membrane transplantation 30mn after chemical burn; the remaining five rabbits received medical treatment. In situ zymography is a recent nondestructive technique which preserved the fine morphological details of the cornea and showed the active enzyme location in different corneal layers. The MMP-2 and -9 substrate was gelatin, which was detected by fluorescent microscopy. RESULTS: There was an overexpression of MMP-2 and -9 in corneal burns versus control corneas. Expression of MMP-2 and -9 was low in corneal burn without amniotic membrane graft. Following amniotic membrane transplantation, MMP-2 and -9 were strongly expressed and clinical neovascularization and inflammation decreased. Active enzymes were located in epithelium layers in the uncovered group. In the covered group, the active enzymes were located in the anterior and posterior stromal layers. CONCLUSION: The results support a role for MMP-2 and MMP-9 in corneal burn neovascularization. Amniotic membrane transplantation can play a protective role by up-regulation of their biological expression.

[Episcleral single injection anesthesia in the caruncle for cataract surgery: report of 350 cases]. / L'anesthésie épisclérale en injection unique à la caroncule dans la chirurgie de la cataracte: expérience de 350 cas.

Episcleral single injection anesthesia in the caruncle ovoïds the rare but potentially dangerous complications and incidents of classic local anesthesia. Excellent motor and sensory block is obtained with a single injection in the anatomic marks are well defined. We have practiced this technique since February 1999 for cataract surgery in 350 cases. The different surgical techniques used were manual extracapsular extraction in 52% of cases, phacosection through tunnel incision in 38%, and phacoemulsification in 10%. Our preliminary results show good acceptance of the episcleral anesthesia for both patients and surgeons. Because it is effective and safe, this anaesthtic technique may be an alternative to classic anesthetic techniques in all cases where topical anesthesia is not indicated.

[Value of a new non-contact biometer for intraocular crystalline lens power calculation]. / Intérêt d'un nouveau biomètre non-contact pour le calcul de la puissance des lentilles intra-oculaires cristalliniennes.

PURPOSE: One of cataract surgery's current imperatives involves refraction: the power of the lens implant must be calculated as accurately as possible. Here we present a new method of biometric ocular measurement using the partial optical consistency interferometer. MATERIAL AND METHODS: This investigation studied the axial length measurement of 100 eyes. Five measurements were taken with a classic echobiometric contact technique using the ultrasonic mode; 5 others were taken with the infrared noncontact technique (IOL Master, Zeiss Humphrey). The latter technique is based on interferometric biometry with optical consistency and measurements were taken with an infrared luminous ray. With extreme rapidity and no contact, the device provides a complete biometry, including axial length, keratometry, and anterior chamber depth. It includes a built-in computer. RESULTS: Comparing the ultrasonic and infrared measurements emphasizes the precision and particularly the high reproducibility of the infrared method. The standard deviations of the samples were significantly lower for the 100 measurements. Its limitations depends on the type of cataract since success was not obtained for certain posterior subcapsular opacities. DISCUSSION: This new method of performing a biometry with a partial consistency interferometer contributes a number of advantages: speed, its noninvasive nature with no contact, the high reproducibility of the exam, as well as precise measurements as shown by the difference in the standard deviations of the two methods. CONCLUSION: Biometry using the optical consistency interferometer seems to be a reliable, reproducible, and precise technique that brings great precision for the calculation of the power of the intraocular implant in cataract surgery.

[New medical treatments of glaucoma. New strategies?]. / Nouveaux traitements médicaux dans le glaucome. Nouvelles stratégies?

Several new classes of ocular hypotonia medications have recently become available. These include the topical treatments carbonic anhydrase inhibitors, the alpha-2 agonists, the prostaglandin analogues, and a fixed combination of beta-blockers and carbonic anhydrase inhibitors. With an equal or superior efficacy than beta-blockers, these new treatments must be reconsidered as first-line therapy in glaucoma. The long-term safety profile of antiglaucomatous drugs plays an important role in the new trends of medical treatment. These data, better known and detailed over time by clinical experience, are changing our habits and advancing therapeutic strategies for a more effective treatment, better suited to the individual, thus allowing the best quality of life possible.

[Contribution of MRI in the dynamic study of the lacrimal outflow system]. / Apport de l'IRM dans l'étude dynamique des voies lacrymales d'excrétion.

PURPOSE: To evaluate a new magnetic resonance imaging protocol for dynamic study of the lacrimal outflow system and to use this protocol to search for problems in patients with an assumed permeable outflow system who develop epiphora. PATIENTS AND METHODS: A prospective study of nine patients, including 2 asymptomatic controls was conducted. The magnetic resonance protocol included, gadolinium instillation into the conjunctival cul-de-sac, 3D gradient-echo T1-weighted acquisition, 2 mm thick images passing through the nasolacrimal duct, dynamic acquisition after gadolinium instillation for timing dye progression through the outflow system. RESULTS: Similar results were obtained for the two control subjects with lacrimal transit time of a median 100 seconds. Three distinct events were individualized gadolinium arrival in the lacrimal sac (t1), at the extremity of the bony portion of the lacrimal duct (té), and the extremity of the mucosal portion of the duct (t3). Patients with an assumed permeable outflow system who had epiphora show results intermediary between passed dye and total blockage of the dye within the lacrimal sac. CONCLUSION: The study of the lacrimal outflow system using this new magnetic resonance imaging protocol contributes to the physiological study of tear evacuation and could be useful for quantitative assessment of lacrimal stenosis, particularly interesting for therapeutic guidance.

[Diffusion if lidocaine after intracameral injection]. / Diffusion de la lidocaïne après injection intracamérulaire.

PURPOSE: To determine the lidocaine diffusion space, we compared lidocaine aquous humor concentration in topical anesthesia with 1% lidocaine intracameral injection and in peribulbar anesthesia with 2% lidocaine prior phacoemulsification. MATERIAL AND METHOD: A gas chromatography technique of analyzing 100 microliters aqueous humor was used to detect the presence of lidocaine prior to phakoemulsification cataract surgery in two groups of patients: group A: after peribulbar anesthesia with 10 ml 2% lidocaine, group B: after 1% tetracaine topical anesthesia and 0.5 ml intracameral injection of 1% preservative-free lidocaine. The intracameral volume was estimated mathematically in group B. Endothelial cells loss was analyzed in two groups with non contact specular microscopy. RESULTS: Lidocaine was detected in aqueous humor with a good reliability. The mean concentration after intracameral injection was 6,300 micrograms/ml and was higher than after peribulbar injection. This concentration was near than theorical intracameral rate, suggesting that there was no diffusion in the posterior segment. There was no significant difference in the 2 groups in endothelial cells loss. CONCLUSION: Intracameral injection of lidocaine is an effective technique to anesthetize intracameral structures without diffusion in posterior segment prior to phakoemulsification.

[Intracameral lidocaine and phacoemulsification under topical anesthesia. Apropos of 80 operations]. / Lidocaïne intracamérulaire et phacoémulsification sous anesthésie topique. A propos de 80 interventions.

PURPOSE: To evaluate the advantage of intracameral unpreserved lidocaine for patient comfort during phacoemulsification under topical anesthesia. METHODS: In this prospective study, we performed 80 phacoemulsifications under topical anesthesia, with tetracaine 1% drops, 10 minutes before and at the start of surgery: 40 patients received 0.3 cc balanced salt solution (BSS) intracameral injection; 40 patients received 0.3 cc unpreserved lidocaine 1% intracameral injection. The same surgical procedure was performed in both groups: 3.2 mm temporal corneal self-sealing incision, capsulorhexis, foldable polyHEMA IOL implantation into the capsular bag. There was no intravenous sedation. RESULTS: Forty-eight percent (19) in the BSS group and 70% (28) in the lidocaine group felt no pain. 10% (4) in the BSS group reported sharp pain during phacoemulsification. During IOL insertion, no pain was reported by 48% (19) in the BSS group, and 75% (30) in the lidocaine group; 10% (4) in the BSS group felt severe pain (significant difference: p < 0.05). Endothelial cell loss was 6% in the BSS group, and 6.4% in the lidocaine group (non significant difference). CONCLUSION: Intracameral lidocaine is safe and effective in decreasing discomfort among patients undergoing phacoemulsification under topical anesthesia.

[Eye injuries caused by lasers in military and industrial environment. Apropos of 13 cases]. / Accidents oculaires par laser en milieu militaire et industriel. A propos de 13 cas.

PURPOSE: The aim of this study was to analyse the nature of wavelengths used by military forces, evaluate their clinical consequences in terms of ocular risk, and determine the therapeutic implications and specific preventative measures which should be implemented both in peace- and war-time-settings. MATERIAL AND METHODS: We analyzed retrospectively 13 cases of laser injury (12 patients) treated in our unit over the past 10 years. We recorded the characteristics of the responsible lasers, effects on visual acuity and visual filed, initial ophthalmoscopic and angiographic aspects, treatment undertaken and patient follow-up. RESULTS: Wavelengths were know in only 10 cases. In 9 cases a NdYag laser operating at 1063 nm was involved. The tenth case was an Argon Coirorint laser accident. In three cases the wavelength could not be ascertained because it was confidential information or had been emitted by the enemy and had not been identified. Ocular injury was bilateral in 1 case and unilateral in 12. Retinal lesions were foveolar in 8 cases with an initial visual acuity varying from 1/10 to 10/10. Visual loss depended on the extent of the burn and did not tend to improve despite vasoprotector and corticosteroid treatments. In 2 cases the injury progressed without formation of an epimacular membrane. Retinal lesions were extra-foveolar in 5 cases and in 1 case vitreous hemorrhage required vitrectomy. CONCLUSION: With the widespread use of Yag lasers and the soon to be employed tuneable lasers, there in major risk of serious ocular injury resulting from foveolar burns or peripheral retina trauma with vitreous hemorrhage. In a war situation, a large number of laser casualties producing peripheral vitreous hemorrhage would create an important logistics problem for vitrectomy. The accent must therefore be focused on prevention. Personnel must be informed of the danger and instructed in wearing filter glasses adapted to the wavelengths being used, if known, or a universal photoactivated protective device, as yet a hypothetical possibility.

[Ocular manifestations of vitamin A deficiency and their prevention]. / Les manifestations oculaires de la carence en Vitamine A et leur prévention.

PIP: Vitamin A deficiency and xerophthalmia are among the most widespread human nutritional problems worldwide. High levels of vitamin A deficiency are seen especially among disenfranchised populations where young children are the most severely affected, leading to blindness and early mortality. Not seen in the industrialized countries since the 1950s, vitamin A deficiency still exists in Africa, Asia, and South America. There are approximately 10 million new cases of xerophthalmia per year, of which 280,000-500,000 are blinded. For 20 years, international organizations, governments, and private concerns have found such deficiency with some, but not complete, success. The authors describe the metabolism of vitamin A, analyze its ocular manifestations, and consider the epidemiology of vitamin A deficiency, its association with excess infant mortality, and the course of disease leading to blindness. The global distribution of vitamin A deficiency and xerophthalmia are described. All factors related to vitamin A level in the human body can be changed for the better. Food supplementation with vitamin A and the occasional administration of vitamin A are discussed as possible options to pursue.^ieng

[Corneal blindness in tropical areas]. / La cécité d'origine cornéenne en milieu tropical.

Corneal disease is the second most common cause of blindness in tropical countries after cataract. It mainly strikes children who are exposed to numerous infectious agents against which they are unprotected due to the absence of basic health care. In high risk groups, the incidence of childhood corneal-related blindness is more than 20 times higher than in developed countries. There are many causes of corneal-related blindness. Endemic trachoma persists in some areas and inflammatory forms can lead to blindness. Eradication requires instillation of antibiotics in the eye, improvement of sanitary conditions, and campaigns against promiscuity. Xerophthalmia can induce blindness by perforation of the cornea in children with vitamin A deficiency. Measles, herpes simplex keratitis, and corneal ulcer that progresses to bacterial or fungal infections, or to amebic keratitis are also major causes of corneal-related blindness. The incidence of onchocerciasis is decreasing thanks to treatment with ivermectin and programs to control simulium. Neonatal gonococcal ophthalmia and leprosy-associated ocular disease can also lead to blindness. This overview of the various causes illustrates the close correlation between the level of life and living conditions and the occurrence of corneal-related blindness in tropical areas.

[Dacryocystography using CT and MRI. Comparative study apropos of 13 clinical cases]. / La dacryocystographie en TDM et IRM. Etude comparative à propos de 13 cas cliniques.

Magnetic Resonance Imaging of a dacryocystography and a watersoluble computed tomographic dacryocystography were compared in 13 prospective cases after facial traumas, infections or without previous history. All had either watering eyes, ephiphora or dacryocystitis. This study demonstrated the superiority of computed tomography which must be used in first intention for complexe problems of the lacrimal drainage system. Only tumoral pathology (very rare) requires Magnetic Resonance Imaging. Combined computed tomography and dacryocystography in the same time provide diagnostic precision and less radiation. Confortable for the patient by helicoidal acquisition, computed tomography is cheaper than a Magnetic Resonance Imaging.

[Efficacy and tolerability of 2 presentations of eyedrops combining carteolol 2% and pilocarpine 2% in primary open-angle glaucoma and simple ocular hypertension]. / Efficacité et tolérance de 2 présentations de collyre associant le cartéolol 2% et la pilocarpine 2% dans le glaucome primitif à angle ouvert et l'hypertension oculaire simple.

PURPOSE: The aim of the study was to compare 2 combinations of eye drops containing 2% carteolol and 2% pilocarpine: LCM 1010: ready to use eye drops CBS 341A: eye drops to be reconstituted (freeze-dried powder + solvent). METHODS: Ninety-seven patients with primary open angle glaucoma or simple ocular hypertension were included in a randomized, double-blind multicentric study comparing 2 parallel groups of treatment. Intra-ocular pressure was greater than 21 mmHg with beta-blocker alone. One instillation of 2% carteolol-2% pilocarpine combination was given twice a day for one month. Before and after this treatment, intra-ocular pressure was measured at 9 am (12 hours after evening instillation) and at 11 am (2 hours after morning instillation). RESULTS: Both treatments reduced intra-ocular pressure by a comparable amount and there was no significant difference between groups at either measure: at 9 am: 2.11 +/- 2.39 mmHg (mean +/- SD) for LCM 1010 1.79 +/- 1.73 mmHg for CBS 341 A p = 0.25 at 11 am: 3.75 +/- 3.83 mmHg for LCM 1010 3.40 +/- 1.69 mmHg for CBS 341 A p = 0.42. Both eye drops were generally well tolerated. CONCLUSION: Efficacy and safety of ready to use eye drops 2% carteolol-2% pilocarpine combination proved to be comparable to that of eye drops to be reconstituted in the treatment of ocular hypertension poorly controlled by beta-blocker eye drops alone.

[Ocular complications of intracarotid chemotherapies with nitrosourea agents]. / Complications oculaires des chimiothérapies intracarotidiennes par nitroso-urées.

The authors report ocular complications in intracarotid chemotherapy with Nitrosyl-urea on 39 patients with intracerebral malignant tumor (anaplastic astrocytoma). Internal carotid infusion catheter was in infra-ophthalmic position. They also report 13 ocular complications (33% of cases) as arterial retinal occlusions essentially, ipsilateral to catheter site. Their study and literature revue emphasize five ocular toxicity factors; intracarotid catheter position, type of drug, its quantity, its solubility and solvent, the rate of infusion.

[Trachoma in North Cameroon]. / Trachome au Nord Cameroun.

A study was carried out in the North of Cameroon concerning the frequency of trachomatous blindness among 3,326 cases of blindness. A 4.63% frequency was found. The results show a 2 women for one man sex ratio and differences between the studied ethnic groups. The role of hygiene is stressed in order to explain these numbers.

Corneal blindnesses in tropical environment.

Corneal blindnesses make up a main public health problem in numerous developing countries where they constitute a sign of low sanitary level. The main diseases which cause corneal blindnesses are: Trachoma. Xerophthalmia. Measles. Corneal ulcerations and keratitis. Onchocercosis. Neonatorum ophthalmia. Leprosy. Injuries. Some therapeutic practices. Epidemiological analysis leads to the definition of risk groups: Small children. Isolated rural communities. Unhealthy urban communities. Out of place populations. Under-fed populations. Only a joint prevention can be able to fight against this social, economic, a human plague constituted by corneal blindnesses. Simple prevention measures which are often not very expensive, showed their efficiency. They are as follows: Individual and collective hygiene measures. Improvement of alimentary conditions. Earliness and quickness in ocular care. Vaccination against measles. Improvement of the care to mother and child. Sanitary education for prevention. These prevention tasks are supported by the health workers who are spread out inside the population. Their formation, the means they are granted with constitute a main priority which has to be taken into account in the choices and the decisions to be made in order to fight against blindness linked with cornea opacification with efficacy.