[One-year results on the safety and efficacy of the InnFocus MicroShunt™ depending on placement and concentration of mitomycin C]. / Résultats à un an de l'efficacité et de l'innocuité du MicroShunt InnFocus selon l'emplacement et la concentration de MMC.

PURPOSE: To compare intraocular pressure (IOP) at one year with the InnFocus MicroShunt(®) with or without cataract surgery with according to placement and concentration of mitomycin C (MMC) DESIGN: A retrospective two-center, two-surgeon study (France and Dominican Republic). PATIENTS AND METHODS: Adults with POAG requiring filtering surgery. One MicroShunt(®) was placed in one eye of each patient. The effect of concentration and site of application of MMC was assessed by IOP and medication reduction at one year. RESULTS: Eighty-seven eyes were studied with one-year follow-up. Twenty-three eyes treated with 0.4 mg/mL MMC close to the limbus demonstrated a 55% reduction in IOP from 23.8 ± 5.3 at baseline to 10.7 ± 2.8 mmHg at one year. Topical glaucoma medication/patient was reduced 85% from 2.4 ± 0.9 to 0.3 ± 0.8. Thirty-one eyes treated with 0.2mg/mL MMC close to the limbus demonstrated a 52% reduction in IOP from 27.9 ± 6.7 at baseline to 13.3 ± 3.3 mmHg at one year. Topical glaucoma medication/patient was reduced 88% from 2.5 ± 1.4 to 0.5 ± 1.0. Thirty-three eyes treated with 0.4 mg/mL MMC deep in the pocket demonstrated a 38% reduction in IOP from 25.4 ± 7.9 at baseline to 15.7 ± 4.6 mmHg at one year. Topical glaucoma medication/patient was reduced 72% from 2.9 ± 1.0 to 0.8 ± 1.3. There were no sight-threatening long-term adverse events. CONCLUSION: The InnFocus MicroShunt(®) is a filtering surgery whose efficacy is related to the location of application and concentration of MMC used.

[Ex-PRESS miniature glaucoma implant inserted under a scleral flap in open-angle glaucoma surgery: a retrospective study]. / Implant miniature Ex-PRESS placé sous un volet scléral dans la chirurgie du glaucome à angle ouvert: étude rétrospective.

PURPOSE: (1) To present the Ex-PRESS device implanted under a scleral flap in open-angle glaucoma patients and to report its safety and efficacy; (2) to compare the results obtained without a scleral flap in a glaucoma group. PATIENTS AND METHODS: The case series studied included the eyes of Caucasian patients (82 patients, 99 eyes) with open-angle glaucoma, operated on between January 2003 and June 2004. The Ex-PRESS devices were inserted under the scleral flap in the anterior chamber; if necessary a combined surgery was performed (28 eyes). Each patient underwent ophthalmic examinations (IOP, visual field, gonioscopy, cup/disc ratio) before and after the operation. The surgical procedure lasted between 10 and 20 min with topical anesthesia. An antimetabolite was used under the scleral flap for all patients. The mean follow-up was 7.5+/-4.6 months; 40% had 12 months follow-up (40 eyes). RESULTS: The IOP decreased from 22.9+/-5.3 mmHg preoperatively to 14+/-2 mmHg at 6 months and 14.3+/-2.3 mmHg at 1 year. The success rate was 86.9% (IOP below 21 mmHg with or without drugs). Complete success was achieved in 62.6% (IOP below 21 mmHg without anti-glaucoma drops or medications). In 13 eyes, IOP was not controlled with eye drops, and nine eyes had to be reoperated. Six cases presented athalamia but recovered without surgical treatment. We did not observe any infection, corneal erosion, or Ex-PRESS extrusion. There were no statistical differences between results obtained with and without scleral flap regarding IOP or early complications (athalamia). CONCLUSION: Both the safety and the efficacy of the device under a scleral flap were showed in glaucoma surgery in this retrospective study. Using the scleral flap reduces the risk of erosion but confirmation with a longer follow-up is needed.

[Adult cataract surgery in Aquitaine: motivations, technical procedures and results. Inventory in 1999]. / La chirurgie de la cataracte de l'adulte en Aquitaine. Etat des lieux en 1999.

PURPOSE: Cataract surgery in the Aquitaine department in France has been investigated in terms of motivations, technical procedures, and results. METHODS: Observations were made from a retrospective sample of 500 operations performed during the last 3 months of 1999. Information was collected concerning patient motivation, the technical aspects of the operation, inpatient or outpatient management, the major follow-up events and the functional results. RESULTS: The study showed substantially altered visual function in most of the patients before the operation, very few preliminary technical investigations, a phacoemulsification procedure in 97% of the cases, and 95% good or very good results. Outpatient surgery was performed in 33% cases, comparable to the 23% average in France over the same period of time. Two cases of endophthalmia were diagnosed and successfully treated. Secondary cataract appeared in 16 patients during the 6-month follow-up period. CONCLUSION: These results show that practices in Aquitaine comply with current standards. They suggest that all the components necessary to further development of cataract surgery are in place, as long as the surgical supply is able to respond to the increasing demand.

Ciprofloxacin ophthalmic solution in the treatment of conjunctivitis and blepharitis: a comparison with fusidic acid.

The efficacy and safety of ciprofloxacin ophthalmic solution (0.3%) and fusidic acid gel (1%) were compared in the treatment of bacterial conjunctivitis and blepharitis in a randomized, open, parallel group study. Thirty-nine patients, 21 treated with ciprofloxacin solution and 18 treated with fusidic acid gel, were culture-positive on admission and were evaluable for efficacy. At the end of a 7-day treatment, the infecting organism was eradicated in 81% of those treated with ciprofloxacin and 72% of those treated with fusidic acid gel. There was clinical cure or improvement in 95% and 89% respectively. The clinical cure rate appeared to be higher with ciprofloxacin than fusidic acid (62% compared with 28%) but this was related to the higher proportion of patients with acute conjunctivitis in the ciprofloxacin group. Two patients using ciprofloxacin had mild discomfort and stinging on instillation and one given fusidic acid had moderate edema and discomfort; the latter patient stopped treatment. Topical ciprofloxacin is effective and well tolerated and is a useful treatment of bacterial conjunctivitis and blepharitis.

[Indications of penetrating keratoplasty from a histopathological study of 1129 corneal buttons (from 1982 to 1991)]. / Indications de la kératoplastie transfixiante à partir d'une étude histopathologique de 1 129 boutons cornéens (de 1982 à 1991).

PURPOSE: To analyze the indications or the penetrating keratoplasties which were conducted in the Bordeaux University Hospital over the 1982-1991 period and to compare these findings with those of previously published studies. METHODS: The histopathological study of 1129 corneal buttons was analyzed according to conventional methods in the Histopathology Department Pellegrin Hospital. RESULTS: The main indications for penetrating keratoplasty were (in decreasing order of frequency): pseudophakic or aphakic corneal oedema (28.7%), keratoconus (12.1%), regrafts (11.1%), and corneal scars (10.7%). Less frequent indications for penetrating keratoplasty included Fuchs' endothelial dystrophy (7.8%); corneal trauma (7.3%) and herpes (7.2%). Ophthalmological conditions requiring penetrating keratoplasty fall into six groups of unequal size: 1) corneal oedema (28.7%); 2) keratitis (26%); 3) dystrophies (23.2%); 4) graft failures (11.1%); 5) trauma and chemical burns (8%) and 6) miscellaneous (2.9%). CONCLUSION: The authors emphasize the importance of studying histologically the corneal buttons after penetrating keratoplasty. Corneal oedema after cataract surgery is shown, based on the data presented, to be the main indication for penetrating keratoplasty.

[Paraneoplastic retinopathy associated with cutaneous melanoma. An update apropos of a case]. / Rétinopathie paranéoplasique associée au mélanome cutané. Mise au point à propos d'un cas.

BACKGROUND: Ocular paraneoplastic syndromes are rare, and consist of optic neuropathy or retinopathy. Classically, these syndromes are related to carcinoma. Melanoma-associated retinopathy is extremely rare, and unrecognized. METHODS: A patient with metastatic cutaneous melanoma discovered and operated 18 months before. Visual complains consisted of xanthopsia and shimmering light vision, then hemeralopia, which dramatically worsened. Classical clinical examination, visual field and electroretinogram were performed. RESULTS: Visual acuity was 20/25, and fundus examination was normal. The visual field showed a tubular aspect, with V4 isopter remained, like an advanced retinitis pigmentosa. The photopic electroretinogram was negative, and the scotopic one was flat. CONCLUSION: This recent hemeralopia with normal fundus and "negative" electroretinogram, ruled out congenital stationary night blindness diagnosis, and suggested the diagnosis of melanoma-associated retinopathy. This is a rare paraneoplastic syndrome since to date only 7 cases have been reported. Immunochemistry studies, that show antibodies directed against bipolar cells, are consistent with selective reduction of the electroretinogram b wave.

[Accuracy and reproducibility of the Eyesys corneal topographic analysis system]. / Fiabilité et reproductibilité du système d'analyse topographique cornéenne Eyesys.

Corneal topographic analysis has become quite useful for corneal surgery. Quantitative data on the quality and accuracy of the available instruments are not well known. We studied the accuracy and the reproducibility of the Eyesys machine using 4 calibrated balls: 8.99 mm, 7.93 mm, 7.10 mm, 6.13 mm. The machine is accurate (precision less than 0.1D for all the balls) and reproducible (4 measurements) with a SD less than 0.05 diopter for all the balls except for the 55.04's ball (0.06 to 0.1). We also studied reproducibility with six normal corneas using the same method. SD was 0.26 diopter for keratometry and 0.50 diopter for the astigmatism value.

[Is A29, B12 vasculitis caused by the Q fever agent? (Coxiella burnetii)]. / La vascularite A29, B12, est-elle déclenchée par l'agent de la fièvre Q? (Coxiella burnetii).

The authors describe the first two cases, to their knowledge, of retinal vasculitis, associated with Q fever. The first case was a chronic infection induced by Coxiella burnetii associated with HLA group A29 and B12; in the second case, the phenotype was B12. The authors tried to determine whether this agent could be the "Birdshot chorioretinopathy" promoting factor. Several epidemiologic findings tend to prove that Q fever is not the only cause. On the other hand, its similarity with rickettsia, the fact that it is found in patients with vasculitis, suggest that it could be one of the initial causal factors.

[Astigmatism in corneal graft. Prevention and treatment]. / Astigmatisme dans les greffes de la cornée. Prévention et traitement.

The tremendous development of the photokeratoscope and corneal topography analysis explains the development of corneal astigmatism study in corneal graft. Our study consists in a review of the bibliography. The prevention of the astigmatism needs the following: before the trephination, the astigmatism has to be treated (correction of against the rule astigmatism which is usual in the aphake people); during the trephination, to minimize the deformation of the eye ball, to choose a good diameter for the keratoconus case, to use a pneumatic trephine in order to have a perpendicular cut (the use of the laser Excimer seams promising); The suture of the corneal graft can be done with a double running suture 10/0 and 11/0. The 10/0 is removed at the third month, the visual recovery is faster but the average astigmatism is not as good as with the interrupted 10/0 sutures and running suture 11/0. This technique is good for an old patient or a one eyed people specially interested in a faster recovery of visual acuity. The second possibility is to use 16 interrupted sutures with and 11/0 running suture. With this technique, the sutures are removed selectively depending on the keratometry and the photokeratoscopy. The visual recovery is longer but the astigmatism at the end is very low. When all the sutures have been removed, the residual astigmatism can be treated when there is not any misalignement between the cornea and the graft. The keratometry, photokeratoscopy allows to find the meridian which is abnormal and to find out if the astigmatism is symmetrical or asymmetrical. The astigmatism is symmetrical if the deformation is the same at either side of the meridian. When the abnormal meridian is the steepest, the only thing to do is a relaxing incision (one or two if is asymmetric, two if the astigmatism is symmetric). The size of the relaxing incision is determined by the photokeratoscopy and the deepness by the effect obtained during surgery looking at a qualitative keratometer. On the table, the effect must be about 50% of over correction. When, the abnormal meridian is the flattest, the only thing to do is a wedge resection (if the astigmatism is asymmetric) or two wedge resections (if the astigmatism is symmetric). The size of the cuneiform resection is choosen with photokeratoscopy. The study of the literature about the Ruiz incision adapted to corneal graft cannot nowadays conclude to the accuracy and safety of this technique.(ABSTRACT TRUNCATED AT 400 WORDS)

[Accuracy and reproducibility of Nidek's photokeratoanalyser]. / Fiabilité et reproductibilité de photokératoanalyseur de Nidek.

We studied the accuracy and reproducibility of the keratoscope PKS 1,000 and keratoanalyser PKA 1,000 (Nidek laboratory). When calibrated steel balls are studied without any precaution, the system is unreliable. The photokeratoscope and the keratoanalyser provide good results only if they are used with care. To use the system, we propose the following schedule. Firstly, take a photograph of a steel ball, then set this picture under the video camera and vary the illumination until the accuracy remains unchanged during repeated calibration. With homogenous and constant illumination, the accuracy is about 0.5 diopter.

[Quality of corneal incisions of ceramic and diamond blades. Comparison in optic microscopy]. / Qualité de coupe cornéenne des lames céramique et diamant. Comparaison en microscopie optique.

Six radial keratotomies were performed using a ceramic blade on corneas obtained from cadavers. These incisions were compared by light microscopy with 6 sections performed on the same corneas using a diamond blade. Microscopic examination showed no significant difference in the quality of the incision between the two blades studied.

[Biocompatibility of hydroxypropylmethylcellulose as a vitreous substitute in rabbits]. / Etude de la biocompatibilité de l'hydroxypropylméthylcellulose comme substitut du vitré chez le lapin.

We have studied the biocompatibility of the hydroxypropylmethylcellulose in ten rabbits' eyes after lensectomy and posterior vitrectomy. In seven eyes the inflammatory reaction was severe. The reason why the hydroxypropylmethylcellulose is biocompatible in the anterior segment and not in the vitreous body seems to be explained by its quantity and its concentration in the eye at the end of the surgical procedure.