[Anisometropia and presbyopia: prescription of progressive lenses, a new approach]. / Anisométropie et presbytie: équipements en verres progressifs, nouvelle approche.

OBJECTIVE OF THE STUDY: To show that anisometropia does not absolutely preclude the prescription of progressive lenses. MATERIALS AND METHODS: Forty-one anisometropes and presbyopes were selected for a prolonged trial of visual correction using progressive lenses. The congenital or acquired type of their anisometropia and its particular form were also studied. Each patient was submitted to a protocol comprising of a series of ophthalmologic and orthoptic tests so as to evaluate the patient's subjective far and near refraction, with measurement of phorias and of horizontal and vertical ductions, visual acuity, and the quality of binocular vision while looking in different directions. A preliminary trial of correction in actual situation was done in order to check fusion in near vision. The entire range of tests was repeated two months after the patient was provided with the lenses. The tolerance for progressive lenses during the different activities of daily life was evaluated after the second and the sixth months. RESULTS: Seven patients presenting an associated strabismus were not provided with the lenses because the initial pre-lens trial revealed a total inability to read within the near-vision zone. Among the 34 patients provided with the lenses, 21 constantly wore their progressive lenses and said that they were satisfied, 6 wore their progressive lenses during daily activities but preferred to use their unifocal lenses for prolonged reading, and 7 abandoned their progressive lenses because they could not tolerate them. Association with a strabismus is not synonymous with an initial impossibility or with abandonment because of the 27 patients who constantly wore their progressive lenses 9 were strabismic. The best results were obtained in the age range of 45 to 52 years old, for visual acuity for > 20/40, and in cases of congenital anisometropia with intermittent or permanent unilateral neutralization. On the other hand, patients presenting an acquired anisometropia, particularly postoperative, proved to be poor candidates. CONCLUSION: Weak and strong anisometropia does not absolutely preclude the prescription of progressive lenses except for certain strabismic subjects with an abnormal lateral-oriented posture.

[Prevention of retinal detachment in Wagner-Stickler disease. Comparative study of different methods. Apropos of 22 cases]. / Prophylaxie du décollement de rétine de la maladie de Wagner-Stickler. Etude comparative des différentes méthodes. A propos de vingt-deux cas.

Prophylactic treatment in patients presenting Wagner-Stickler disease has not been yet well defined. We retrospectively studied twenty-two patients who had a retinal detachment on the first eye. Among the ten patients treated by peripheral confluent laser photocoagulation, five had a retinal detachment after a mean follow-up of fifteen months; with a 42% rate of spontaneous retinal detachment bilateralization, we can conclude that laser therapy has not been efficient. Four patients treated by focal or circular laser photocoagulation, cryotherapy or vitrectomy developed retinal detachment. Eight eyes treated by a preventive encircling scleral buckle did not develop retinal detachment, with a mean follow-up of twenty-one months. This follow-up is still too short, but greater than the mean bilateralization delay. Per and postoperative complications had no consequences.

[Macular edema caused by contraction of the posterior hyaloid in diabetic retinopathy. Surgical treatment of a series of 22 cases]. / Oedèmes maculaires induits par la contraction de la hyaloïde postérieure dans la rétinopathie diabétique. Traitement chirurgical sur une série de 22 cas.

We have observed some patients with diabetic macular edema who did not respond to grid laser treatment and who improved with spontaneous posterior vitreous detachment or vitrectomy. These cases have a taut and glistening vitreo-macular interface. Three such cases are presented in detail. Pars plana vitrectomy with separation of the posterior hyaloid was performed in 22 cases. All of them had proliferative diabetic retinopathy, previously treated by panretinal photocoagulation. Fourteen cases had an ineffective macular grid laser treatment. Postoperative visual acuity was improved in 19 eyes and was unchanged in three eyes. The macular edema disappeared in 12 eyes and decreased in 10. Complications included a vitreous hemorrhage in 6 eyes, a paramacular tear in 1 eye, a reghmatogenous retinal detachment in 1 eye and cataract formation in 2 eyes. Vitreous surgery can improve the visual prognosis in cases of diabetic macular edema associated with a pathological vitreo-macular interface.

[Is vitrectomy cataractogenic? Study of changes of the crystalline lens after surgery of retinal detachment]. / La vitrectomie est-elle cataractogène? Etude des modifications du cristallin après chirurgie du décollement de la rétine.

In order to assess the relationships between vitrectomy and postoperative crystalline lens changes we reviewed the records of 298 selected cases of operated retinal detachments in phakic eyes. We compared two groups: 155 eyes were operated with cryotherapy, vitrectomy and gas injection. 143 eyes received cryotherapy and retro-hyaloid fluid-gas exchange. Follow-up of at least 12 months and detailed description of the lens were available in 90 cases and 82 cases of the two groups respectively. Postoperative lens changes were as follows: nuclear sclerosis occurred in 63% of the vitrectomised eyes, mild in 14%, moderate in 16%, severe in 32%. In contrast, nuclear sclerosis occurred in only 4% of the non vitrectomised eyes, all these cases were noted as moderate. Posterior subcapsular opacities occurred in 4.5% of the vitrectomised eyes versus 2.4% of the non vitrectomised eyes. Nuclear sclerotic changes were correlated with vitrectomy and longer follow-up. Posterior subcapsular cataract was correlated with vitrectomy and larger intraocular gas bubble.

[Posterior luxation of lens or implant: surgical treatment using a perfluorocarbon solution. Technique and results of 13 cases]. / Luxation postérieure du cristallin ou d'un implant: traitement chirurgical utilisant un perfluorocarbone liquide. Technique et résultats à propos de 13 cas.

We used perfluorocarbon liquids in the management of 6 cases of posterior dislocation of the lens and 7 cases of (sub-) luxation of a posterior chamber intraocular lens (IOL). The perfluorocarbon liquid was injected into the vitreous cavity after complete vitrectomy, to bring back the lens or IOL to the posterior chamber where it can be easily removed. The main characteristics of perfluorocarbon liquids used in this indication are their high specific gravity and their good surface tension. Because of these two qualities, when injected in a vitrectomized eye, the perfluorocarbon liquid forms a bubble, filling the vitreous cavity from the posterior pole to the ora serrata with the dislocated lens or IOL floating on its surface. We found this technique to be helpful and quite atraumatic in this difficult surgical situation. Complications included regressive corneal edema in 6 cases and retinal dialysis with localized detachment in 3 cases.

[Preventive treatment of retinal detachment of the contralateral eye. Results of 5 years follow-up of 109 eyes]. / Traitement prophylactique du décollement de rétine de l'oeil adelphe. Résultats avec un recul de cinq ans, sur 109 yeux.

In 1987, we presented a study of 141 eyes treated prophylactically following retinal detachment in the fellow eye. A hundred and nine of these patients are reviewed with a minimum follow-up of five years. Only the evolution was studied, whether a peripheral retinal lesion was present or not at the time of prophylactic treatment. The examiner noted if new lesions had occurred, or if lesions present at the time of the first examination had developed: lattice degeneration or snail track developing into a retinal tear, hole or tear causing a retinal detachment, contained or not by laser treatment. Our study contained sixty two myopes. Fifty eyes had visible, dangerous lesions, and fifty nine a normal retina. Forty five circular barrages with four anterior radial rows returning to the ora serrata were performed, and sixty four barrages with tight anterior grids and a localised barrage of visible lesions. The results were judged on one criterion only: retinal detachment requiring emergency surgery. Only one retinal detachment occurred behind the barrage, caused by proliferative vitreoretinopathy due to multiple tears, and surgical results were good. Eight tears appeared in front of the barrage, five of these in healthy retina. Two very posterior tears behind the barrage were blocked with no problem by laser treatment. Four localised detachments occurred in front of the barrage, three of these without anterior grid treatment. The advantage of this is undeniable since out of sixty three cases treated in this way, only three tears were seen to be blocked by the laser shots, and one anterior localised detachment where the anterior grid was insufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

[Suprasellar tumors in patients over 70 years of age. Value of limited frontotemporal craniotomy. Visual results. Apropos of 5 cases]. / Tumeurs supra-sellaires chez les sujets agés de plus de 70 ans. Intérêt d'une crâniectomie fronto-temporale limitée. Résultats visuels. A propos de 5 cas.

The authors report their experience of the surgical approach for suprasellar tumors (Jugum or tuberculum sellae meningiomas, 3 cases, and suprasellar craniopharyngiomas, 2 cases) in over than seventy years old patients (71-78 y). A limited craniectomy was performed at the fronto-temporal junction using three adjacent burr-holes. The duramater was cut with an Y-shaped incision. Cerebrospinal fluid was sucked out through a lateral subfrontal route, allowing an easy cerebral collapse in elderly patients, which can sometimes avoid even retraction. Such an supra-orbital craniectomy allowed a subfrontal approach, opening of the sylvian fissure and control of the inter optic, inter carotido-optic and latero-carotidian spaces as well as a good access to the inter pedoncular cistern. In 4 cases the craniectomy was performed after fronto-temporal skin incision, but a trans eyebrow skin incision was used in 1 case. All patients had uneventful postoperative course. Follow-up was from 3 to 5 years. A visual improvement occurred in all cases. Benefits of this surgical method are discussed and compared with use of a bone flap in patients over than 70 years.

[Intolerance to encircling. 19 cases of section or ablation of encircling]. / Intolérance au cerclage. A propos de 19 cas de section ou ablation de cerclage.

Removal of ten encircling scleral buckles and section with relaxation of nine encircling buckles are displayed. Only episcleral buckles with oval or round silicone sponge exoplants are analyzed. Besides infection (three eyes), removal or section was required because of too tight encircling elements (16 eyes). Anterior buckles created by invagination of encircling elements, without horizontal shortening avoids this risk of constriction.

[A case of tuberculoma of the orbit with sphenoidal origin]. / A propos d'un cas de tuberculome de l'orbite à point de départ sphénoïdal.

We report the case of an orbital and sphenoidal tuberculosis observed in a young Indian man living in France. The orbital disease is presenting as an orbital mass with a radiologic bony lytic aspect, without systemic manifestation. A malignant process was suspected. The diagnosis was obtained by the culture for Mycobacterium tuberculosis of the biopsy specimen. Orbital involvement in tuberculosis is a rare manifestation in developed countries. Most cases reported in the literature were reported from Asia and Africa. Orbital tuberculosis may become established in one of two ways: primarily by heamatogenous spread to cause a periostitis or a tuberculoma of the orbital tissues, or secondarily by direct extension from neighbouring structures. It occurs in patients with or without associated pulmonary tuberculosis. Mycobacterium tuberculosis should be considered in the differential diagnosis of inflammatory orbital diseases. This diagnosis is based on clinical feature, positive tuberculin skin test and positive culture in resected tissues. The complete resolution of the disease with the specific antituberculous drugs emphasizes the point that tuberculosis must be evocated.

[Non-traumatic retinal detachment in children under 15 years of age]. / Décollement non traumatique de la rétine de l'enfant de moins de 15 ans.

In less than fifteen years old children, thirty nine non traumatic retinal detachments are reported. Their poor prognosis is attributed to the late diagnosis, the early age occurrence, the combination with an ocular pathology (congenital aphakia--myopia--hereditary vitreoretinal degeneration) present on the first examination. Prophylaxis of the fellow eye is recommended in order to avoid the alarming occurrence of bilateral detachment.

Study of a new series of large relaxing retinotomies.

Silicone oil injection followed by retinotomy was performed in a second series of 37 patients with retinal detachment and advanced proliferative vitreoretinopathy. The retina posteriorly to the retinotomy was attached in 16 eyes with at least 18 months of follow-up. Ambulatory vision or better vision was restored in 12 eyes. The size and the site of the retinotomy depend on the size and the site of the retraction.

Retinal and choroidal ischemic syndrome, digestive tract and renal small vessel hyalinosis, intracerebral calcifications and phenotypic abnormalities: a new family syndrome.

A new family syndrome is described that affected three of seven siblings and another patient who had been abandoned at birth but came from the same area of France. All four patients were young women with a very peculiar phenotype, poikiloderma and greying of the hair, and idiopathic non-arteriosclerotic cerebral calcifications. Pathological studies demonstrated small-vessel hyalinosis due to basal membrane thickening, mainly in the digestive tract, kidneys and calcified areas of the brain. The clinical and biological expressions of these vascular changes varied. Peripheral retinal ischemic syndrome and chorioretinal scars were found in the ocular fundi of three patients. Malabsorption and protein-losing enteropathy was the main problem in all four, and was the cause of one patient's death. A subarachnoid hemorrhage due to a right sylvian aneurysm also occurred in two of the three sisters and was lethal for one. Nephropathy with renal failure and systemic hypertension is the major problem of the two surviving patients.