[Accommodating intraocular lenses]. / Les implants accommodatifs.

Following cataract extraction, an implant is inserted into the capsular bag of the crystalline lens. Light rays are focused on the retina by the biconvex optical part of the implant. Most implants have monofocal and steady optic so that glasses are mandatory to get a corrected image according to the distance. Multifocal intraocular lenses have two drawbacks: a loss in visual acuity and perception of halos. Recently, we have optimised implants likely to offer a slight antero-posterior move of the optic. The efficiency of it is real, although limited. Those implants do not reduce visual acuity and do not create halos.

[How I explore...significance of ophthalmoscopy in patients with arterial hypertension]. / Comment j'explore... Valeur actuelle de l'ophtalmoscopie dans le bilan de l'hypertension artérielle.

The ocular fundus is the only examination which allows a simple and non invasive visualisation of the terminal vascular system. Feature analysis of fundus examination supposes a similar vascular state in the other organs and permits direct diagnostic, prognostic and therapeutic choices. This article will emphasize the value of an ophthalmoscopy examination in patients with arterial hypertension.

[Anterior lenticonus: diagnostic aid in Alport syndrome]. / Le lenticône antérieur: aide diagnostique au syndrome d'Alport.

Anterior lenticonus is a rare condition in which the lens presents a conical protrusion of its anterior cortex. Sometimes isolated, it may be an ocular manifestation of Alport syndrome, a hereditary nephritis accompanied by deafness and other ocular signs such as flecked retinopathy or posterior polymorphous corneal dystrophy. All these manifestations are a result of a genetic defect in type IV collagen, a major component of basal membranes in the human body. The clinical aspects and therapy of anterior lenticonus and Alport syndrome are described, as well as the exploration that must begin when anterior lenticonus is discovered. This exploration is essential so that this diagnosis can be made as soon as possible.

[Treatment of Graves macular edema with intravitreal injection of corticosteroids]. / Traitement des oedèmes maculaires Graves par injection intravitréenne de corticostéroides.

PURPOSE: To determine if intravitreal injection of triamcinolone is an effective option in treating severe macular oedema unresponsive to other treatments. METHODS: Fifteen eyes with severe macular oedema of long duration (9-30 months) were offered intravitreal injection of 4 mg triamcinolone. The visual acuity and anatomic responses were monitored with pre- and postoperative fluorescein angiography and optical coherence tomography (OCT). RESULTS: The minimal follow-up was 3 months (mean = 6 months). The central macular thickness evaluated by OCT decreased by 50%. This beneficial effect was correlated with a significant improvement in visual acuity. Ten of 15 patients (66%) improved their visual acuity by more than two Snellen lines. We could observe a significant increase in intraocular pressure (mean = 15%) due to corticosteroid medication. No injection-related complication occurred. One patient had to be retreated after 3 months due to recurrence of macular oedema. CONCLUSIONS: Intravitreal triamcinolone is a promising therapeutic option for severe macular oedema. Further study is warranted to evaluate the long-term efficacy and safety, as well as the need for retreatment.

[Corneal ulcers associated with rheumatoid arthritis]. / Les ulcères de cornée associés à la polyarthrite rhumatoïde.

Keratoconjonctivitis sicca, scleritis and keratitis remain the major ocular manifestation, associated with rheumatoid arthritis. Corneal ulcers are a rare complication but can lead to perforation. Unstable epithelial barrier and immune disorders play a key role in the pathophysiology of such corneal melting. Moreover the association with systemic vasculitis reveals the need for an appropriate immunosuppressive treatment. New surgical approaches and early immunotherapy allow to maintain ocular integrity even if the visual prognosis is poor.

Use of human fibrin glue and amniotic membrane transplant in corneal perforation.

PURPOSE: To repair corneal perforation using human fibrin glue (HFG) and amniotic membrane transplant (AMT). METHODS: Three patients in whom central corneal perforations, approximately 2 mm in diameter, occurred after ocular or systemic disease were successfully cured using HFG and AMT. The technique consists first of using a high-viscosity sodium hyaluronate viscoelastic material to restore anterior chamber depth followed by a debridement of the ulcer. The perforation site is filled with the HFG to corneal surface level. The so-formed plug is then secured with an AMT to avoid its extrusion. An extended-wear bandage contact lens and topical antibiotics were used in these patients for 3 weeks. RESULTS: Total reepithelialization was observed after an average of 15 postoperative days. The AMT dissolved within 8 weeks to uncover a whitish scar formed within the perforation sites. No complications were observed in any patients. After a follow-up period of 195-325 days, all corneas remained stable; there was no infection or ulcer recurrence, but some corneal scar thinning was observed in all three cases. CONCLUSION: The described surgical approach using HFG and AMT allowed a successful repair of corneal perforations with a diameter of 2 mm associated with significant loss of stroma. This method may be a good alternative to delay penetrating keratoplasty for treating corneal perforations, especially in acute cases in which graft rejection risk is high. eal

[Current understanding of diabetic retinopathy]. / Principales notions actuelles sur la rétinopathie diabétique.

The incidence of diabetes continues to increase and it is estimated that the world diabetic population will have doubled in 2010. Diabetic retinopathy, one of the most frequent and precocious diabetes' complications, is increasing too and it represents a major cause of blindness in industrialized Countries. The purpose of this article is to describe the relations existing between the risk factors and the physiopathology of diabetic retinopathy, which may be helpful in taking therapeutic and prevention decisions, for the management of diabetic patients.

Lens epithelial cell proliferation in human posterior capsule opacification specimens.

In previous in vitro studies on capsular bags it was shown that, after a sham extracapsular cataract extraction (ECCE) on human donor eyes, lens epithelial cells (LECs) show, in the short term, a dramatically elevated mitotic activity as compared to that in the intact lens. The long term in vivo proliferation of LECs in human lenses after ECCE and intraocular lens (IOL) implantation has not been studied until now. In the present study, the mitotic activity of LECs in human post-mortem eyes with posterior capsule opacification (PCO) was investigated. Human lenses with signs of PCO were dissected from donor eyes and incubated in MEM, supplemented with fetal calf serum, for 1 day (n = 10) or 7 days (n = 9). Six additional specimens were cultured for 7 days after removal of the IOL and lens fibres. After the incubation period, mitotic activity was estimated using the BrdU procedure and the Ki67 proliferating cell marker. The mean number of BrdU-positive nuclei in the intact PCO specimens was at a level of 7.5 (day 1) and 6.5 (day 7). Removal of the IOL and the lens fibres leads to a ten-fold increase in BrdU positive cells (mean = 84.5). No correlation with donor age was found. The Ki67 observations corroborate the BrdU results. The results demonstrate that after an initial rise in proliferative activity, as shown in the capsular bag model, the mitotic activity of LECs returns to a rate comparable to that in intact cultured non-cataractous lenses. As in control lenses, removal of lens fibres significantly elevated the proliferative activity of the remaining LECs. Suppression by newly formed differentiated lens fibres in the in vivo capsular bag may be responsible for this return to control levels of mitotic activity of LECs in the PCO specimens.

[Cataract surgery in primary open angle glaucoma]. / L'opération de la cataracte en cas de glaucome primitif à angle ouvert.

Cataract surgery has a moderate lowering effect on the intraocular pressure. When glaucoma seems controlled by medication, phacoemulsification gives a chance of improving the situation. Those eyes are most likely to get an intraocular pressure rise by retention of visco-elastic substance.

[A proposed variation for glaucoma surgery]. / Proposition de variations logiques dans la chirurgie du glaucome.

When a trabeculectomy does not reduce the intraocular pressure, it is usually due to sealing of the scleral flap to the adjacent sclera, while the trabeculectomy itself remains open. A triangular excision in the scleral flap seems likely to keep the fistula in function. Deep sclerectomy does not lead to major hypotony, "the other complication" of trabeculectomy. However, the non perforating sclerectomy, under a sutured superficial scleral flap, could in the long term become inefficient. I propose a deep sclerectomy with controlled perforation under a notched superficial flap.

[Cataract extraction after angle closure glaucoma]. / L'opération de la cataracte après glaucome par fermeture de l'angle.

The best therapeutic approach to angle closure with cataract is phacoemulsification and foldable implant. The surgery is performed as soon as the acute crisis is over. Both dispersive and cohesive visco-elastic substance are used in the narrow anterior chamber. Poor mydriasis is best managed by means of iris hooks.

[Interest in ophthalmologic examination for familial adenomatous polyposis]. / Intérêt de l'examen ophtalmologique dans la polypose adénomateuse familiale.

We describe the clinical history of four patients belonging to a familial adenomatous polyposis (FAP) family. We stress the importance of a fundus examination for the screening of carriers of the gene responsible for familial adenomatous polyposis.

[Drug-induced cataracts]. / Les cataractes d'origine médicamenteuse.

The fact that corticosteroids, phenothiazines and myotics induce cataract is well known. Moreover some informations about lens opacities have been reported less frequently after the use of cytostatics, deferoxamine, phenytoine, isotretinoine, oral contraceptives, allopurinol, synthetics antimalarial agents, diazepam, tetracyclines and sulfamides. Occasionally some others drugs have been suspected from experimental observations to produce cataract. Amongst all these drugs, corticosteroids are the most often incriminated.

Complicated posterior capsulorhexis: aetiology, management, and outcome.

BACKGROUND: A 1 year retrospective analysis of 650 patients, who underwent a posterior capsulorhexis on their intact capsules, was performed to examine the incidence of complications, their aetiologies, and the outcome. METHODS: Data were analysed on 32 patients with complicated capsulorhexis for type of surgery, preoperative and postoperative factors, and relative risk factors for vitreous issue. RESULTS: There were six patients with vitreous loss. The posterior capsulorhexis was uncontrolled in 14 cases and difficult to perform in 12 cases. Implantation into the capsular bag was possible in all cases. Systemic vascular hazard and old age (over 80 years) were found to be statistically significant risk factors for vitreous loss (p = 0.002 and p = 0.03 respectively). The mean follow up was 13.5 months (range 4-25 months). One patient developed a retinal detachment and two had a transient clinical cystoid macular oedema. Visual acuity of > or = 20/40 was obtained in 93% of the patients. CONCLUSION: Loss of control of the posterior capsulorhexis has a low incidence but can lead to serious problems during surgery. A good knowledge of the technique is necessary to complete the procedure with a posterior capsulorhexis of the optimum size without vitreous loss.

Microcephaly, muscular build, rhizomelia, and cataracts: description of a possible recessive syndrome and some comments on the use of electronic databases in syndromology.

We report on a 7-year-old boy born of consanguineous parents with severe microcephaly (-5 SD) but borderline intelligence, juvenile cataract, muscular build, rhizomelic shortness of limbs predominantly of femora, advanced bone age, and micropenis. This combination of signs appears unique and may represent an undescribed, possibly autosomal recessive MCA syndrome. The use of LDDB and POSSUM in the workup of such "new syndromes" is reviewed. Three search strategies are discussed: single rare sign browsing, best combinatory fit using an array of key words, and combined rare signs scan. Pitfalls in the use of such databases and the some problems raised by inconsistent/ incomplete encoding in those two popular, highly useful syndromology retrieval systems are discussed.

Separation of fibres from the capsule enhances mitotic activity of human lens epithelium.

Proliferation and migration of lens epithelial cells is at the origin of after-cataract, currently the main side effect of cataract surgery. Extracapsular cataract surgery necessitates opening of the anterior lens capsule and removal of the lens fibres before an intraocular lens can be placed in the cleaned capsular bag. The present study was aimed at testing the potential of the lens capsule and the fibres to affect the mitotic activity of the lens epithelial cells in human donor eyes. Pairs of human lenses used in this study were subjected to two different experimental conditions. In the first, only a small anterior capsulorhexis was made. In the other, fibres were separated from the epithelium by gentle hydrodissection, the nucleus was rotated and, either left in the capsular bag or removed by hydroexpression. The specimens were cultured for 48 hr in MEM with 2% serum. Mitotic activity was assessed by immunohistochemistry using the bromodeoxyuridine (BrdU) incorporation technique. Fellow lenses of the same donors were cultured intact as controls. Anterior capsulorhexis showed a small but significant (P < 0.02) increase in the number of BrdU positive nuclei in the equatorial region but not in the wound area. Lenses where fibres were separated from the epithelium showed a large increase in BrdU incorporation in the germinative region, as compared to the intact control lenses (P < 0.01). BrdU incorporation was highest when fibres were removed. Lens capsule integrity and the presence of contacts between fibres and epithelial cells may have a role in the control of the mitotic activity of the lens epithelium. The data recorded here could be useful for understanding lens cell biology and prevention of after-cataract.

Mitomycin against posterior capsular opacification: an experimental study in rabbits.

AIMS/BACKGROUND: Posterior capsular opacification is the most common postoperative complication of extracapsular cataract surgery. The purpose of this study was to attempt to inhibit this secondary cataract formation by using mitomycin (an antimitotic drug). METHODS: A solution containing mitomycin was used to perform hydrodissection (with a 5 minute pause) during extracapsular lens extraction in rabbits. This way of administration was chosen to reduce as much as possible drug diffusion into the anterior chamber. Heparin was added to the irrigating solution to avoid fibrin formation. Its ability to prevent posterior cataract opacification was also evaluated at the end of the study. The animals were sacrificed 4 or 6 months after surgery. Grading concerning two aspects of secondary cataract (proliferation and fibrosis) was obtained on gross examination. Histological analysis was subsequently performed. RESULTS: This study demonstrated that mitomycin has a significant inhibitory effect on secondary cataract formation (proliferation as well as fibrosis) in rabbits whereas heparin does not seem to have the same effectiveness. CONCLUSION: This work is a preliminary study concerning the use of mitomycin for prevention of posterior capsular opacification. It has proved its effectiveness in rabbits but more in depth studies are still necessary before its application in humans.