Descemet membrane detachment after nonpenetrating filtering surgery.

PURPOSE: To make surgeons performing nonpenetrating filtering surgery aware of an unusual complication namely Descemet membrane detachment. METHODS: We retrospectively reviewed nine eyes of nine patients seen in our hospital with Descemet membrane detachment occurring after nonpenetrating filtering surgery from January 1994 to December 2000. RESULTS: Both planar and nonplanar detachments were reported. Neither scrolls nor tears in the Descemet membrane were observed in any patient. After viscocanalostomy (four patients), the detachment was generally noticed shortly after the procedure and the cornea maintained its clarity. After deep sclerectomy with a collagen implant (five patients), it developed weeks to months postoperatively with adjacent corneal edema. Four patients had descemetopexy. None required more than one procedure. However, at the last visit, two detachments persisted although they had diminished in size: one after viscocanalostomy and conservative treatment and one after descemetopexy after deep sclerectomy with a collagen implant. To date otherwise, no signs of significant corneal damage could be observed clinically nor by specular microscopy and pachymetry. CONCLUSIONS: The diagnosis of Descemet membrane detachment can be easily overlooked or misdiagnosed. The clinical presentation, clinical course, and pathogenesis depend on the type of nonpenetrating filtering surgery performed. Ophthalmologists should be aware of this unusual complication, which is likely to be more common after nonpenetrating filtering surgery than after trabeculectomy. A period of observation before attempting descemetopexy is recommended.

[Formation of a descemetic bleb after deep sclerectomy and visco-canalostomy: apropos of 2 cases]. / Formation d'une bulle descemétique après sclérectomie profonde et visco-canalostomie: à propos de 2 cas.

BACKGROUND: Deep sclerectomy with visco-canalostomy is a new non perforating method for the surgical treatment of glaucoma. PATIENTS AND METHODS: We report 2 patients who developed a descemetic bleb after this surgical procedure. RESULTS: The cornea remained clear for more than ten months, as long as the bleb was not ruptured. In case of rupture, one should inject air into the anterior chamber to fix the descemetic membrane, otherwise the cornea will become quickly cloudy. CONCLUSIONS: Descemetic bleb formation after visco-canalostomy is a new complication which has to be recognized and treated in order to avoid corneal edema.

Diclofenac drops to treat inflammation after cataract surgery.

PURPOSE: To compare the anti-inflammatory effect of topical diclofenac sodium 0.1% in a fixed combination with gentamicin 0.3% to the anti-inflammatory effect of dexamethasone phosphate 0.1% in a prospective randomized double-masked double-dummy study in patients undergoing cataract surgery. SETTING: Trial performed from June 1991 to April 1992 at the Hôpital Jules Gonin, Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland. METHODS: Inclusion of patients scheduled for extracapsular cataract extraction (ECCE) with implantation of an all PMMA intraocular lens (IOL). Double-masked comparison of post-operative inflammation in two randomized treatment groups: (1) fixed diclofenac sodium 0.1%/gentamicin 0.3% and vehicle drops 4X/day until day 12-14 and diclofenac sodium 0.1% 3X/day until day 28. (2) dexamethasone phosphate 0.1% drops 4X/day until postoperative day 12-14 and 3X/day until day 28 and gentamicin 0.3% drops 4X/day until day 12-14. Anterior chamber flare and cells, measured by laser flare-cell photometry, were analyzed as the primary outcomes. RESULTS: Eighty-seven patients were recruited, 45 being assigned to the diclofenac group and 42 to the dexamethasone control group. Diclofenac was significantly better than dexamethasone at controlling flare at day 3 (p< or =0.01) and day 12-14 (p< or =0.002). Mean anterior chamber cells were also significantly lower at day 12-14 (p< or =0.021) and day 28 (p< or =0.012). The commonest adverse event was transient punctate keratitis, which occurred in 15 diclofenac and 3 dexamethasone patients. CONCLUSIONS: While both treatments were effective at controlling post-operative inflammation, the diclofenac-gentamicin combination followed by diclofenac alone was significantly better at suppressing flare and cells but showed a slightly higher incidence of punctate keratitis and eye discomfort.

[Asthenopic symptoms in cervical vertebrae syndrome]. / Troubles asthénopiques au cours du syndrome vertébral cervical (SVC).

The vertebral cervical syndrome is a clinical entity defined as a dysfunction of the cranio-cervical junction of traumatic or non traumatic cause. The authors report on asthenopic disorders occurring in such a syndrome. The fusion amplitude and the accommodation power were reduced in all patients and were a cause of delayed job recurrence. The treatment of fusion was long, painful and, in some cases, not successful. A depressive status associated with a prolonged job interruption were bad prognosis factors. A differential diagnosis has to be made with the so-called insurance neurotic reaction.

[Interleukin 10 and chronic vitritis in a case of ocular lymphoma]. / Interleukine-10 et vitrite chronique dans un cas de lymphome oculaire.

The authors report on a 46 year-old patient who presented with a chronic unilateral vitritis. A diagnosis of cerebral lymphoma was made 4 years earlier and a maxillary sinus recurrence was treated with chemotherapy and radiotherapy. A vitrectomy was performed and the level of Interleukin-10, a lymphoma cells growth factor, was found very high, giving a clue for the lymphomatous cause of the vitritis.

[Dacryocystorhinostomy by nasal endoscopy: an example of multidisciplinary collaboration]. / La dacryocystorhinostomie par voie endonasale: un exemple de collaboration multidisciplinaire.

The authors report on endonasal dacryocystorhinostomy: 19 operations have been done (5 pre-saccal stenosis and 14 post-saccal stenosis). Operations on pre-saccal pathways allow to reduce significantly the tearing, without suppressing it completely. Surgery of the post-saccal pathways gives the best results, with the suppression of the tearing or/and of the superinfection in almost all cases. The pathology of the excretory lacrymal pathways, the surgical technique and the detailed results will be presented.