[Comparative study of 2 classifications of glaucomatous perimetric deficits]. / Etude comparative de deux classifications des déficits périmétriques glaucomateux.

The purpose of this retrospectively study is to compare the results obtained using the unquestionable criteria, recommended by American Academy of Ophthalmology versus the minimum criteria proposed by HODAPP. The first are founded on the degree of the depth of the deficits in dB, the second take into account the statistically significant loss. One hundred glaucomatous visual fields screened with the Humphrey perimeter, with program 24-2, are retained for their correct indices of reliability, a MD better than -12 dB, and experience of the automated perimetry. This population was divided into two groups of 50:index MD greater than -6 dB. And index MD between -6 and -12 dB. The deficits were analyzed on the graph of individual deviation. Arcuate scotoma and nasal step were the majority of defects: 86 to 90% at the stage of mild deficit; 98% at the stage of moderate deficit. The deficits prevailed in the superior hemifield in 60% of cases. Nasal projection accounted for less than half of the deficits when MD was > -6 dB its frequency fell to less than 10% when MD worsened. Conversely the frequency of arcuate scotoma increased. The isolated deficits decreased with the MD aggravation, but even when the deficit was mild, they accounted for already less than half of the cases. Most of the associated deficits were located in the hemifield opposite to the principal defect. Defects were larger and more frequently multiple with the AAO classification than with the HODAPP. The minimum criteria of the classification of glaucomatous visual field defects proposed by HODAPP appear more specific than the unquestionable criteria of the AAO, and also appear easier to use.

[Toxocara canis infection. 2 cases of peripheral granuloma in adults]. / Toxocarose canis. Deux cas de granulome périphérique chez l'adulte.

PURPOSE: We report two cases of toxocariasis peripheral granuloma in adults. METHODS: Diagnostic difficulties linked to parasite serologies, particular to these two cases, are presented. Serology is often poorly contributive, but PCA and/or vitreous study with the ELISA reaction to Toxocara canis homologous antigens in the endocular fluids are the most reliable means of reaching a diagnosis, as evidence in our two observations. In the same way, the presence of eosinophils and of IgE in the aqueous humor and or vitreous is of great importance for orienting the diagnosis. RESULTS: The treatment consisted in systemic steroids and granuloma cryotherapy associated with vitrectomy and for one case indentation due to a traction. Later, retinal membrane peel was performed for the same patient. No treatment with antihelminthic drugs was proposed. The functional and anatomic results were good in both cases (8/10-P2 and 6/10-P2). CONCLUSION: Toxocara canis infection is based on clinical aspects. The ELISA technique is useful for biological diagnosis.

[True or supposed bacterial endophthalmitis. Study of anatomo-functional outcome apropos of 32 cases]. / Endophtalmies bactériennes ou supposées telles. Etude du devenir anatomo-fonctionnel à propos de 32 cas.

PURPOSE: Vision prognostic study depending on the germs and the therapic performed in bacterial endophthalmitis. METHODS: In a retrospective study over a period of 3 years (1991-1993), 32 cases of post surgery bacterian endophthalmitis were detected: 30 cases after cataract surgery (29 cases after extra capsular surgery and one case after intra capsular), one case after trabeculectomy and one case after keratoplasty. RESULTS: A risk factor was evidenced in 15.6% of the cases. Endocular samples were done in 68.75% of the cases. The positive rate was 36.4% showing a Staphylococcus in 5 cases out of 8 (62,5%). In 37.5% of the cases an intraocular antibiotic injection was associated to the anterior chamber punction. 40% of the cases contaminated with Staphylococcus regained a visual acuity of more than 3/10. For the two cases where a Streptococcus was isolated an evisceration was necessary. Our results show that a higher visual acuity was obtained when a posterior vitrectomy was performed. When the posterior vitrectomy was associated with a corticoid therapy, the visual prognostic was better. Thus, 71% of these cases regained a visual acuity of more than 3/10. CONCLUSION: Our results show that performing a posterior vitrectomy associated to a general corticotherapy within 48 hours from the bacterian endophthalmitis diagnosis would allow best vision improvement.

[Spatial contrast sensitivity in patients with severe myopia]. / La sensibilité au contraste spatial chez le fort myope.

PURPOSE: The purpose of this study was to assess the effects of amount of myopia, axial elongation staphyloma and type of optical correction on contrast sensitivity of high myopic subjects. METHODS: Fifty-one patients (91 eyes) were selected on the following qualifications: myopia > or = 8 dpt and/or axial length > or = 26 mm, and visual acuity > or = 0.1 recorded through spectacle lenses. Contrast sensitivity was measured using a "Moniteur Ophtalmologique" for all subjects when corrected with spectacle lenses, and thereafter on a lot of patients (50 eyes) wearing a contact lens. RESULTS: Contrast sensitivity obtained with spectacle lenses was significantly decreased over the whole spatial frequency range. The higher the spatial frequency was, the lower contrast sensitivity was. The impairment increased with the amount of myopia and axial length, but without positive correlation. Contrast sensitivity was significantly lower for only the three highest spatial frequencies measured (6.4; 12.8 and 25.6 c/deg), when a staphyloma (n = 52) was present by comparison with results obtained for eyes without staphyloma (n = 39). Differences between the two situations (spectacle lens vs. contact lens) were not significant for eyes wearing daily spectacle lenses; conversely, for myopic subjects generally fitted with contact lenses, contrast sensitivity with contact lenses was significantly better than that measured with spectacles for the three highest spatial frequencies tested. CONCLUSION: This suggests that the decrease in contrast sensitivity measured in high myopia is related to defects in the optical and neuro-retinal systems.

[Dacryocystorhinostomy using Nd YAG laser by the intracanicular approach]. / Dacryocystorhinostomie au laser Nd YAG par voie endocanaliculaire.

Endocanalicular dacryocystorhinostomy is a recent surgical procedure for stenosis of the naso-lacrymal duct, thanks to a laser filter fitted into the heart of 800 mu diameter metallic pin constituting a rigid armed laser probe. We create a lacrymo-nasal orifice from inside the lacrymal bag towards the nose, using the laser fiber. The Nd YAG used is the solid state mobilisable Ophtalas sp 32 giving out infrareds at 1064 nm or green at 532 nm. The indications are the stenosis of the naso-lacrymal duct, the failed classical dacryocystorhinostomy, the conjunctivodacryocystorhinostomy and the stenosis of the common canaliculus. This surgical procedure compared to the classical surgical technics appears to the very promising due to its simplicity, innocuousness, time saving. Our results, still inferior to the classical technique for all indications (success rate: 70%) are very good for the idiopathic stenosis of the naso-lacrymal duct (success rate: 87.5%).

[Search for bacterial contamination of the aqueous humor during cataract surgery with and without local antibiotic prophylaxis]. / Recherche d'une contamination bactérienne du liquide intra-oculaire au cours de la chirurgie de la cataracte avec et sans antibioprophylaxie locale.

PURPOSE: Bacterial contamination of anterior chamber at the end of cataract surgery, was compared between two techniques: extracapsular extraction and phacoemulsification. The effectiveness of preoperative antibiotic eyedrops using Norfloxacine 0.3% (Chibroxine) was also evaluated. METHOD: The study focused on 101 patients grouped according to surgical technique and presence of preoperative antibiotic eyedrops. Conjunctival sampling was made the day prior the surgery, as well as in the operating room, after skin and conjunctival desinfection with povidone iodine in all the patients included in the study. Aqueous humour was collected at the end of surgery. RESULTS: Eight samples out of 101 were positive which represents 7.9% of the cases. In 75% of the cases, the anterior chamber aspirate showed a different germ or non-recurrent germ in the second conjunctival sample. None of the included patients developed endophthalmitis. The two most frequent pathogens were Propionibacterium acnes in 62.5% of the cases, and Staphylococcus epidermidis in 50%. Another pathogen was found in a culture environment: Micrococcus roseus. In two samples, two different bacteria grew: Propionibacterium acnes and Staphylococcus epidermidis. Whatever the surgical technique, no statistically significant bacterial contamination was found. There was no significant statistical difference between patients who had local antibiotic eyedrops and those who did not. CONCLUSION: This study confirms the poor reliability of local antibiotic eyedrops to prevent surgical contamination. Furthermore performing an anterior chamber aspirate at the end of the surgery for risk patients would help the physician identify the pathogens involved in endophthalmitis in order to begin antibiotic treatment as soon as possible.

[Measuring visual field loss by automated perimetry in chronic glaucoma stabilized by trabeculectomy]. / Evolution du champ visuel en périmétrie automatisée dans le glaucome chronique équilibré par trabéculectomie.

The progression of field loss was determined by Humphrey Automated threshold perimetry in the short and intermediate term after surgical trabeculectomy for chronic glaucoma: mean indices (MD, PSD et FOV) were studied before and after normalisation of the intraocular pressure. Risk factors such as secondary glaucoma, previous visual field defects and cardiovascular risk factors were significantly correlated to poor or bad progression of field loss: the mean variation of MD = +1.23 dB +/- 2.84 (p < 1.5%), the mean variation of PSD = 0.50 dB +/- 1.37 (p < 6%), but the mean variation of FOV was not significant; so 36% of field defects were improved, 42% were stabilized and 22% were aggravated. When the risk factors were absent, 86% of field losses were stabilised but when cardiovascular factors were present, only 64% were stabilised. These risk factors can also be used to ascertain the prognosis of post-surgical progression of visual field, as already shown in previous reports. Automated threshold perimetry was useful to study the visual field progression with standardized and reliable numerical parameters, allowing statistical computerised management of the patients with glaucoma.

A study of chromium in human cataractous lenses and whole blood of diabetics, senile, and normal population.

Chromium (Cr) is of known biological importance, necessary for the maintenance of normal glucose metabolism. There is a lower level of blood Cr concentrations in cases of diabetes. Diabetes carries a risk of cataract development, so the potential effects of Cr on the eye may need to be studied in more depth. The presence of this trace element in both normal and cataractous human lenses has to our knowledge not been investigated so far. The concentration of total Cr in 61 human lenses and 38 blood samples was determined by electrothermal atomic absorption spectrometry with Zeeman effect (EAASZ). Analysis of the levels of Cr in human lenses shows a significant difference between normal and diabetic populations, and an absence of difference between senile and diabetic populations.

Total chromium in the human lens. Determination with Zeeman electrothermal atomic absorption spectrometry following mineralization in a mini-autoclave.

A simple, quick procedure has been developed for preparation of human lenses for total chromium (Cr) analysis by electrothermal atomic absorption spectrometry (EAAS). This procedure involves wet ashing in a mini-autoclave with HNO3 and H2SO4. Recovery was 101.6%. This procedure is simple to carry out, does not generate corrosive fumes, and minimizes contaminations. Measurements obtained by this method give values similar to those found previously by more cumbersome methods. It can be conveniently used to prepare biological samples for ultratrace analysis. The mean Cr concentration in human lenses varied between 0.345 +/- 0.147 micrograms/g dry wt in the normal population and 0.205 +/- 0.160 micrograms/g dry wt in cataractous lenses.

[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.

[Aniseikonia. A clinical study of 51 unilateral pseudophakic patients and practical applications]. / Aniséiconie. Etude clinique chez 51 patients pseudophaques unilatéraux et applications pratiques.

The subjective aniseiconia was measured with spatial eiconometer on 51 isometropic and unilateral pseudophakic patients in relation with the post-operative anisometropia. The median value of subjective aniseiconia is 2-3% for anisometropia minus or equal to 5 diopters, without statistic correlation, related to a probably "sensorial brain adaptation". So error of intra-ocular lens power calculation less than 7.5 diopters may be accepted.

[Apparent accommodation of the aphakic eye corrected by an artificial lens]. / L'accommodation apparente de l'oeil aphaque corrigé par cristallin artificiel.

We measured apparent accommodation in 51 pseudophakic eyes (44 patients, after implantation of anterior (15 eyes) or posterior (36 eyes) intraocular lens. Glasses for distant vision were born during the test. The mean apparent accommodation was 1.89 +/- 0.91 dpt. 25 among these 51 pseudophakic eyes who were tested without their glasses showed a mean apparent accommodation that was not different in statistical and clinical terms. The mean accommodative power of 25 phakic and presbyopic eyes used as controls was 1.31 +/- 1.01 dpt. For these 51 pseudophakic eyes the correlation between apparent accommodation and the reciprocal of the pupillary diameter is the most significant (r = 0.79): the smaller the pupil, the greater the apparent accommodation. There was a negative correlation between apparent accommodation and anterior chamber depth (r = -0.64). No correlation was found between pseudo-accommodation and corrected visual acuity, corneal astigmatism and refractive error.

[An unusual polymalformation syndrome: "CHARGE association" with unilateral "morning glory syndrome"]. / Un syndrome polymalformatif inhabituel: l'"association CHARGE" à un "morning glory syndrome" unilatéral.

Report of a case of the "CHARGE association" including bilateral papillary coloboma, with an aspect of "morning glory syndrome" on one side. Clinical features of the "CHARGE association" are described; pathogenesis is likely involving cells of neural crests. Discussion, in this field, of the ocular and systemic abnormalities associated with "morning glory syndrome".

[Effects of laser chorioretinal photocoagulation]. / Les effets de la photocoagulation chorio-rétinienne au laser.

Laser-chorioretinal interactions depend on: non controllable parameters: spectral transmission, absorption of tissue, scattering of laser, distribution of ocular chromophores, thermal conductivity of tissue. They are important determinant of laser tissue effects. parameters that can be monitored by the physician: size of the spot, pulse duration, laser energy and laser wavelengths. Theoretical predictions of laser-tissue interaction with the choroid and the retinal agree with histological and clinical data. The choice of physical parameters of laser must be done in order to prevent adverse effects as to obtain researched therapeutic goal.

[Calculation of the implant: is it a useless luxury?]. / Le calcul de l'implant est-il un luxe inutile?

Analysis of the means by which accuracy of intraocular lens power calculation could be improved with theoretical and linear regression formulas. The postoperative refractive errors with the lenses selected by the surgeon were compared with those observed with the emmetropic calculated power lenses and with a standard 20 diopters lens. A consecutive series of 100 eyes with less than 4.50 diopters of pre-operative myopia or hypermyopia, is evaluated. Postoperative refractive errors are out of the range -4; +4 diopters in 6% for standard lens, 4% for actually implanted lens, and 1% for emmetropic power calculated lens.