Biometric study of the disc cup in open-angle glaucoma.

Stereoscopic and photogrammetric study of the disc cup in open-angle glaucoma reveals several morphological changes. The ovalisation of the cup, upwards, downwards or on the temporal side, appears early. It can be detected at the onset of the disease, even in the absence of visual field defects. It results in a localised thinning of the nervous rim, which is a characteristic sign of beginning glaucoma, but the depth of the cup is not increased even when perimetry already reveals important defects. The aim of this paper is to study, on the one hand, the morphological changes of the disc cup and on the other, the functional defects in open-angle glaucoma, and then to compare the results of the investigations.

[Stereophotography and photogrammetry of the physiological cup of the disc (author's transl)]. / Photographie stéréoscopique et photogrammétrie de l'excavation physiologique de la papille.

Researches related in this study were done on normal optic papillae. Their aim is to measure: a) the surface of the optic disc, the surface of the cup and the surface of the rim surrounding the cup; b) the depth of the cup; c) the diameters of the disc, the diameters of the cup and the width of the rim. Photographs were taken with a stereoscopic fundus camera and analysed by photogrammetry. There is a positive correlation between: a) the surface of the disc and the surface of the cup; b) the surface of the disc and the surface of the rim; c) the surface of the disc and the depth of the cup; d) the diameters of the disc and the diameters of the cup. There is no correlation between the diameter of the disc and the width of the rim. The ratio C/D is high when the disc is large.

[Comparative clinical study of metoprolol and timolol (author's transl)]. / Métoprolol et timolol. Etude comparative.

Timolol is a non-specific beta-blocking agent acting on both beta 1 and beta 2 receptors while metoprolol is a specific beta 1 blocking agent. Both timolol and metoprolol decrease intraocular pressure by reducing aqueous humor secretion without increasing facility of outflow. They have both similar short and long term efficacy which does not diminish even after several months of use. Generally, there are adequate to treat glaucoma without perimetric changes, while treatment of glaucoma with functional defects requires their association with miotics. When blocking beta 1 receptors, timolol causes marked constriction of bronchi and peripheral vessels. Hence, it is contraindicated in bronchial asthma and ischemic optic neuropathy. This is not the case with metoprolol, which does not block beta 2 receptors.

[Keratoplasty. Urgent treatment of the corneal perforation (author's transl)]. / La kératoplastie. Traitement urgent de la perforation de la cornée.

Sixteen keratoplasties (15 perforating, 1 lamellar) were performed on 12 perforated corneas and on 2 eyes threatened by imminent corneal perforation. The causal disease was metaherpetic kératitis (6 cases), chronic and recurrent ulcers (4 cases), acute keratoconus (1 case) and corneal traumas (3 cases). Enucleation has been avoided and the anterior chamber was restored in all the cases, with or without anterior synechiae. One case only developed ocular hypertension which was cured by fistulisation. Architectonic results are satisfying in all the cases. Recuperation of visual functions is possible only in the most favourable cases. It is indicated to perform keratoplasty before the perforation when this one seems unavoidable and to consider this surgical procedrue as an emergency when the cornea is perforated.

[Atenolol: its effects on pressure in open-angle glaucoma]. / L'aténolol. Ses effets tensionnels dans le glaucome à angle ouvert.

1. Instillation of 2 drops of 4% solution of atenolol decreases the ocular pressure in open angle glaucoma. 2. In 12 glaucomatous patients treated as in-patients, 4 daily instillations of 4% solution lower the average tension of the group below 20-22 mm Hg day and night. 3. The tensionnal effects of 4 or 6 daily instillations on out-patients seems to be less effective. 4. The hypotensive effects of atenolol, on some of the patients at least, decreases during the second month of uninterrupted treatment. However, the response to a single dose remains constant even after a long term treatment. 5. Treatment with atenolol is remarkably well tolerated. It does not provoke either local or general side effect. 6. Although the combination of atenolol and myotics or carbonic anhydrase inhibitors produces an additive pressure lowering effect this results in a loss of the advantages of atenolol with regard to absence of undesirable pharmacological effects.

[Indications and contraindications of the combined operation (fistulation and cataract extraction) in open- and closed-angle glaucoma (author's transl)]. / Indikation und Kontraindikation der kombinierten Operation (fistulierende Operation und Kataraktextraktion) beim Weitwinkelglaukom und beim Engwinkelglaukom.

The respective indications are briefly described for: a) trabeculectomy through a scleral flap, b) simple cataract extraction, c) combined operation of lens extraction and fistulation in open-angle glaucoma on the one hand and close-angle glaucoma on the other. The choice of operation is dictated by many considerations. The main considerations are as follows. A Lens extraction alone has no lasting effect on the pressure in open-angle glaucoma, but is a good operation against early closed-angle glaucoma. B. Any fistulising operation predisposes to cataract when performed on old patients whose lenses suffer from senile changes already before the operation. A fistulising operation predisposes more to cataract in close-angle as in open-angle glaucoma. C. Lens extraction removes the risk of post-operative "athalamia" and hence of post-operative malignant glaucoma. D. The combined operation avoids a second surgical intervention and reduces the risks of oedematous dystrophy of the cornea in elderly patients who already have before the operation definite signs of endothelial dystrophy. E. Combining the glaucoma and cataract operations although, having certain peculiar risks, gives in a high percentages of cases efficient and long-lasting fistulation and a satisfactory intracapsular lens extraction.