Neurobehavioral effects of acute exposure to inorganic mercury vapor.

Mercury has well-established toxic effects on the central nervous system. This article describes comprehensive neuropsychological and emotional functioning of a group of 13 workers exposed to inorganic mercury vapor compared to that of a normal control group. The exposed group was exposed over a 2- to 4-week period and had elevated blood mercury levels. The evaluations were conducted between 10 and 15 months after exposure was terminated. Observed cognitive deficits included impairment in the following domains: motor coordination, speeded processing with and without a motor component, cognitive flexibility, verbal fluency, verbal memory, and visual problem solving and conceptualization. Emotional problems included increased focus on physical functioning, depression, anxiety, and social withdrawal. Cognitive deficits were, for the most part, not significantly associated with the degree of depression present.

[Surgical treatment by vitrectomy and autologous serum of 36 idiopathic macular holes]. / Traitement chirurgical par vitrectomie et sérum autologue de trente-six trous maculaires idiopathiques.

PURPOSE: To analyse the surgical results of a second series of full thickness idiopathic macular hole operated with autologous serum as adjuvant therapy, and to compare them to the results of a first series without autologous serum and the results of literature. METHODS: In a series of thirty-six patients, autologous serum has been used as healing adjuvant therapy. The surgical procedure included a posterior and peripherical vitrectomy combined with posterior hyaloid separation, fluid-air exchange, autologous serum injection, and final flushing with 40% sulfur hexafluoride. The patients then maintained strict face-down position post-operatively for a minimum of ten days. RESULTS: Anatomic success was obtained in twenty-nine cases of thirty-six patients (80%), with an anatomic success rate of 100% for the stage 2 holes. Twenty-nine patients had a pre and postoperative measurable visual acuity. Among these twenty-nine patients, median postoperative visual acuity was 20/70, compared with 20/125 preoperatively. Final visual acuity was improved in twenty-seven patients (75%), was stable five times (14%), and declined four times (11%). Among the twenty-nine anatomic successes, twenty-four (85%) improved their visual acuity. Complications were rare, and observed in the same percentage as described in literature. No complication in relation to autologous serum was noticed. CONCLUSION: Autologous serum is an inexpensive, easy to obtain, healing adjuvant therapy. It seems improving the surgical results like the other adjuvants described in the litterature.

[Hypertensive anterior uveitis of toxoplasmic origin after vitrectomy]. / Uvéites antérieures hypertensives d'origine toxoplasmique après vitrectomie.

Two cases of vitrectomized congenital chorioretinal toxoplasmosis are presented. During a recurrence, an anterior segment inflammation with hypertony complicated both cases. Hypertony was efficiently controled by a specific antitoxoplasmosis therapy. The role of the vitreous barrier is suggested.

[Positive corneal findings of Propioni bacterium acnes and keratitis]. / Prelevements corneens positifs a Propioni bacterium acnes et keratites.

PURPOSE: Propioni bacterium Acnes may be isolated from corneal specimens. Its presence usually evokes a neighbouring tissue contamination. Nevertheless we have tried to find arguments in favour of a possible pathological responsibility of this microorganism in corneal affections. MATERIAL AND METHODS: A retrospective study was conducted in thirty patients with proved P. acnes corneal infection. The specimens were collected immediately during the first examination in the emergency ward. The research of anaerobic bacteria was made for each corneal specimen. RESULTS: We studied nineteen corneal abscesses and eleven corneal ulcers. Ninety-one percent of the cases presented an associated irritating factor. In decreasing order we found: wearing of soft contact lenses (36%), foreign corneal body still in situ or recently removed (21%), recurrent corneal erosions (9%), palpebral surgery (6%), herpetic keratitis (6%) or rosacea (3%). P. acnes was the only microorganism identified in 97% of the cases. Starting treatment before bacteriological results were known to be effective in each case. CONCLUSIONS: These elements are an argument for the pathological role of P. acnes in corneal infections when combined with favourable local conditions. Its presence does not always mean actual contamination.

[Spontaneous dissection of the internal carotid artery in ophthalmological milieu. Apropos of 10 cases]. / Dissection spontanée de la carotide interne en milieu ophtalmologique. A propos de dix cas.

PURPOSE: Spontaneous dissection of the internal carotid artery is a rare vascular emergency, but represents the first cause of cerebral ischaemia of young patients. Neuro-ophthalmologic symptoms often reveals the pathology. METHODS: Ten cases of spontaneous dissection of the internal artery are reported. The Claude Bernard Horner syndrome is the most frequent symptom typically associated with hemicranial headache. The headache involves the ipsilateral forequarter of the head and the neck. Other ophthalmologic symptoms may also reveal the carotid dissection. RESULTS: At first, the diagnosis is strongly suspected during Doppler ultrasonographic examination. During the acute phase, MRI and MRA replaces advantagiously arteriography, confirming this affection in a non invasive way, and permits investigation of associated vascular pathology like fibromuscular dysplasia (15% of the cases). The patients received anticoagulants in order to prevent thrombo-embolic complications (heparine during the acute phase relayed by AVK). The clinical course is usually favorable with the medical treatment. CONCLUSION: A painful Claude Bernard Horner syndrome strongly evokes a carotid dissection and the arterial check-up must be realised in emergency: at first, the exploratory methods associates Doppler ultrasonographic examination, MRI, and MRA.

[Responsibility of incomplete retinal photocoagulation in the indication of vitrectomy in proliferative diabetic retinopathy]. / Responsabilité des photocoagulations rétiniennes insuffisantes dans l'indication des vitrectomies pour rétinopathie diabétique proliférative.

PURPOSE: We report an epidemiologic study about prophylactic photocoagulation of ischaemic diabetic retinopathy in order to avoid proliferative stage and severe vitreous haemorraghe. METHODS: We studied retrospectively 42 eyes of 32 diabetic patients who underwent a vitrectomy in 1993. For each patient several items were analyzed: nationality, sex, age, type, duration and clinical course of diabetes, and other risk factors. Slit lamp and ocular fundus examination were noted; in particular lens, iris and vitreoretinal framework. RESULTS: Almost all patients had an inadequate laser photocoagulation: in 26 eyes (62%) it was insufficient or non-existent, uncomplete in 12 eyes (29%), and non confluent for 18 eyes (43%). Only four eyes have had complete and confluent panphotocoagulation. CONCLUSION: Photocoagulation appears to be the priority therapy to avoid most severe complications of proliferative diabetic retinopathy. Laser photocoagulation must be started from preproliferative retinopathy, confluent on the useless ischaemic retinal areas, and dense elsewhere.

[Prediction of functional recovery after surgery of macular epiretinal membranes. Value of interferometry using Lotmar's apparatus]. / Prédiction de la récupération fonctionnelle après chirurgie des membranes épi-rétiniennes maculaires. Intérêt de l'interférométrie au visomètre de Lotmar.

BACKGROUND: The predictability of the measurement of the macular function by white light interferometry was evaluated in a group of patients whose epiretinal membranes had been surgically removed. METHOD: Fifteen patients presenting either primitive or secondary epiretinal membranes were included. We used the apparatus described by W. Lotmar. The main evaluation criteria was the best corrected visual acuity (VA) chosen between the third month and the sixth month examinations. RESULTS: Preoperatively the mean visual acuity was 0.227 +/- 0.105. The mean final visual acuity was 0.507 +/- 0.198. The final visual acuity was predicted within an 0.1 interval in ten cases (67%). In two cases the predicted visual acuity was identical to the pre-operative VA and the final results confirmed the test. No improvement occurred. CONCLUSION: The Lotmar visometer is statistically predictive of the visual outcome after epi-retinal membranes surgery.

[Search for etiology in 110 cases of uveitis. Value of punctures of the aqueous humor and vitreous body]. / Recherche étiologique de cent dix uvéites. Intérêt des ponctions d'humeur aqueuse et du vitré.

PURPOSE: Evaluation of the frequency of each aetiology, comparison with recent and previous publications, focus on less classical pathologies, and interest of some complementary investigations. METHODS: Prospective study of one hundred and ten cases of uveitis, submitted to aetiological investigations, including, when feasible or necessary, an anterior chamber paracentesis and a vitreous paracentesis. RESULTS: An aetiology was identified in 65% of the cases. Toxoplasmosis still remained the most frequent diagnosis (one out of four), followed by viral infection (15%), especially herpes simplex (9%), a notion as yet not mentioned in large statistical surveys, including recent ones. Tuberculosis allergy and rhumatismal diseases (ankylosing spondylitis) represent the two other large groups (5% each). The rest is divided among the other classical causes. These results, particularly toxoplasmosis and viruses, are always based on biological criteria, on the Witmer-Desmonts ratio in aqueous humour, or even the same ratio in vitreous. CONCLUSION: This study confirms the predominant role of anterior chamber paracentesis, the only means of establishing a firm diagnosis for certain categories of uveitis (toxoplasmosis and viruses); it is difficult to conceive how such an investigation can be questioned, to the benefit of a purely biomicroscopic diagnosis, leading to blatant errors, as demonstrated by the results of anterior chamber paracentesis. This study also shows, due to this paracentesis, the increasing role of viruses in the aetiology of uveitis, emphasizing the risks taken when any uveitis is systematically submitted to corticotherapy.

[Non-refractive complications of keratectomy with Excimer laser in 141 myopic eyes]. / Complications non réfractives de la kératectomie par laser Excimère observées sur 141 yeux myopes.

PURPOSE: The purpose of this study is to evaluate the safety of myopic photorefractive keratectomy and to study the frequency of complications, excepted refractive problems. METHODS: A consecutive series of 170 eyes has been studied in a prospective trial low-up of one year for 107 eyes and six months for 34 eyes. Twenty-nine eyes have been lost. RESULTS: The main complication after six months is the loss of the best spectacle-corrected visual acuity. It was due to a haze in seven eyes (loss of one line in five eyes and four lines in one eye) and to an excentric ablation in three eyes (one line in two eyes and two lines in one eye), results found for treatments of six diopters or more. The haze is a constant complication. A direct relationship between the haze's intensity and the treatment importance was found as was an inverse relationship between the patient's age and the haze's intensity. The excentric ablations have no influence on the final visual acuity when they concern less than one millimeter. The epithelial problems were always of less importance. CONCLUSION: Except in corrections greater than seven diopters, complications are uncommon after Excimer for myopia. Patient's information has to be rigorous.

[Retinal vein occlusion and resistance to activated protein C]. / Occlusion veineuse de la rétine et résistance à la protéine C activée.

BACKGROUND: A new abnormality in the coagulation system, the resistance to activated protein C, has appeared among the numerous hereditary modifications which predispose patients to deep-vein thrombosis. The molecular abnormality responsible for the resistance to activated protein C is due to a mutation of an amino acid in the 506 position (Arg-->Gln) at the level of the factor V, designated under the name of factor V Leiden. METHODS: The authors wished to search for this alteration of the haemostasis in 106 patients with retinal venous occlusion hospitalized in Centre Hospitalier National d'Ophthalmologie des Quinze-Vingts (Paris). RESULTS: In our study of 106 patients presenting a retinal venous occlusion, the resistance to activated protein C was the most frequent coagulation abnormality found (4.71%), when compared with the other deficits of the inhibitors of the clotting system: protein S (2.80%), antithrombin III (0.94%) et protein C (0%). CONCLUSION: The test of resistance to activated protein C should be recommanded in cases of retinal venous occlusion, particularly in the search for a cause of thrombosis in young patients or in recurrent thrombosis.

[Acute retinal necrosis syndrome. Retrospective study apropos of 14 eyes in 11 patients]. / Le syndrome de nécrose rétinienne aiguë. Etude rétrospective à propos de 14 yeux de 11 patients.

PURPOSE: The authors present a retrospective study of fourteen eyes of eleven patients suffering from acute retinal necrosis syndrome (ARN) and compare the results with previously published data. MATERIAL AND METHODS: All patients were referred to us between 1985 and 1993. The results of initial examination, the epidemiological and aetiologic data, as well as the clinical course and treatment are summarized in two tables. RESULTS: First clinical examination found a prominent ocular inflammatory reaction, several sites of peripheral retinal necrosis and one retinal vasculopathy. Bilateralisation occurred in 28% of the patients. An optic neuropathy developed in 57% of the cases, and a retinal detachment in 78%. Initial examination and data on the clinical course are discussed and compared with those described in the literature. CONCLUSION: The results of the current study are representative of the various clinical and biological profiles of acute retinal necrosis and are similar to those described in previous publications. Earlier care in specialized departments of ophthalmology should allow a better anatomical and functional prognosis in the future.

[Treatment of refractory glaucoma by diode semiconductor laser cyclophotocoagulation]. / Traitement des glaucomes réfractaires par cyclophotocoagulation au laser semiconducteur à diode.

PURPOSE: Ciliary photocoagulation was used to reduce pressure in eyes with refractory glaucoma or to suppress pain in blind painful eyes. The efficiency of transscleral cyclophotocoagulation (TSCPC) with a clinical diode laser system (Iris Medical Instrument, Oculight SLX) was evaluated. METHODS: This diode laser system (wavelengh: 810 nm) provides light energy to the eye through a specially designed quartz glass fiberoptic probe allowing precise location centered 1.2 mm behind the limbus, i.e. in front of the ciliary body. Thirty eight eyes in 38 patients with refractory glaucoma underwent TSCPC with the diode laser. RESULTS: Three months after surgery, intra-ocular pressure was controlled at 20 mmHg or below in 70% of the patients. Patients who most failed with the TSCPC had higher initial IOP (neovascular and congenital glaucoma). Seventy five percent of the painful glaucoma were painless after the laser treatment. Only a few cases (10%) of transient secondary hypertony were observed. The inflammatory response (21%) was mild and transient. No case of scleral perforation, no case of posterior uveitis, cararact or hypotony were observed. CONCLUSION: The transscleral ciliary photocoagulation laser diode system is efficient to reduce intraocular pressure in refractory glaucoma. Complications are mild compared with other methods of cyclophotocoagulation. A long-term study is necessary to evaluate the results on IOP and the incidence of hypotony.

[Treatment of refractory glaucoma with Nd:YAG laser cyclophotocoagulation]. / Traitement des glaucomes réfractaires par cyclophotocoagulation au laser Nd:YAG.

We treated 54 eyes of 51 patients with refractory glaucoma by using contact transscleral Neodymium: YAG laser cyclophotocoagulation; 32 burns (7 watts during 0.7 second) were applied to each eye by positionning the anterior edge of the probe at 0.5 to 1 mm from the limbus. The mean preoperative intraocular pressure (IOP) was 33.7 mmHg and the mean postoperative IOP was 25.6 mmHg with a follow-up of five months. There was a decrease of IOP in 72.3% of the cases. The postoperative IOP was controlled (IOP < 21 mmHg) in 41.3% of the treated eyes. Pain decreased in 6.7% of the cases that had no control of IOP and they could stop their medical treatment. During the follow-up period we observed neither early post operative hypertonia nor phtisis bulbi. Three eyes had scleral perforations. Laser treatment can be repeated if necessary in no controlled IOP cases. We had less complications with the laser treatment than with cyclocryoapplication. We described the advantages of the contact probe used.

[Treatment of refractory glaucoma with high density focused ultrasonics]. / Traitement des glaucomes réfractaires par ultrasons focalisés de haute intensité.

The efficacy of therapeutic ultrasound was retrospectively assessed in 456 patients who presented with uncontrolled glaucoma refractory to maximal medical therapy and filtration surgery from April 1987 to January 1992. Treatment was performed under local anaesthesia in ambulatory outpatients. Therapeutic ultrasound induced local destruction of the ciliary epithelium and a thickening of the sclera. A 47% decrease in intraocular pressure (IOP) was obtained from the mean preoperative (33.8 mmHg) and the mean postoperative (18.2 mm Hg) values. After a 33-month mean follow-up, 65% of treated eyes had an IOP less than or egal to 20 mmHg. Therapeutic ultrasound was effective in most of the glaucomas, especially in open angle, closed angle, aphakic, pseudophakic and post-silicone oil glaucoma. The main complications were immediate ocular hypertension and corneoscleral alterations. Phtysis bulbi occurred in 5.7% of the eyes. The therapeutic interest of ultrasound were compared with those of the other cyclodestruction techniques.

[The danger of the game called "paint ball"]. / A propos du danger des pistolets à peinture (jeu dénommé "paint ball").

Severe ocular injuries may occur during a new war game in France, called "paint ball". A high pressure carbon dioxide powered gun fires pellets filled with dye. The pellet is coated with a semisoft gelatin and filled with a "nontoxic" dye mixture. We observed six consecutive cases during a ten month-period. In two cases (both due to a shot at point-blank range), mature cataract occurred. Consequently, lensectomy was achieved, preceded by a prophylactic scleral buckle. In one case, a retinal detachment due to a localized retinal necrosis occurred. With endocular surgery and temporary silicone oil tamponade, we achieved retinal reattachment. The three remaining cases did not require surgery. They suffered blunt ocular lesions of the anterior and/or posterior segment. One of these cases showed permanent tattooing to the cornea. After a mean follow-up lasting six months, all patients had, at least, a 40/100 vision. Some recommendations can reduce the incidence and the severity of ocular injuries due to paint balling. Firstly, eyeguards (made of polycarbonate) must be worn before receiving guns and pellets. Secondly, a kind of safety gun stopper can avoid gun firing by accident apart from practices. Thirdly, according to others publications, alcohol or drugs should not be consumed before the game. Lastly, gun fire at point-blank range or toward the head must be forbidden. We hope that wide distribution of such recommendations will help reducing the frequency of this type of ocular traumas.

[Treatment of coloboma pitS of the optic nerve complicated by serous detachment of the neuroepithelium]. / Traitement des fossettes colobomateuses de la papille compliquées de décollement séreux du neuroépithélium.

PURPOSE: The pathogenesis of the sensory retinal detachment of the macula associated with congenital pit of the optic nerve remains controversal. Based on our cases and the cases reported in literature, we propose a management plan for macular retinal detachment associated with optic nerve pit. METHODS: In this retrospective study ten eyes were treated for progressive visual loss. Treatment modalities were different depending on the time period: laser photocoagulation (to the juxtapapillary region) alone, laser combined with intraocular gas injection (C3 F8), laser combined with vitrectomy and intraocular gas tamponnade (S F6, C3 F8), laser combined with vitrectomy and temporary silicone oil tamponade. RESULTS: The follow-up period ranged between one and five years (mean follow-up thirty three months). We had eight successes and two definitive failures (an old macular detachment treated only by one laser session, and a young girl who had not kept the prone position after gas injection). In the group of six eyes treated by laser alone, only two retinal treatments were directly successfully treated; in three other eyes, the detachment recurred and was treated with success in a second step by a gas injection; the sixth eye is the first definitive failure (old detachment). In the five eyes treated by laser combined gas injection with or without pars plana vitrectomy (including three failures of laser alone), the retina remained attached in four eyes during the follow-up period; the sixth eye was the second definitive failure (the young girl). In the both eyes treated by vitrectomy and silicon oil injection, the retina has flattened. CONCLUSION: The results suggest that laser photocoagulation alone is not so efficient and that vitrectomy is not necessary with gas injection. Complete resorption of subretinal fluid occurred in eight eyes: two with laser photocoagulation alone, and six with a long term tamponnade combined with a peripapillary laser photocoagulation. In first treatment, this technique (laser with tamponade) is a valuable approach to manage serous macular detachment associated with optic nerve pit.

[Treatment of diabetic macular edema with neuroepithelium detachment combining high-dose corticotherapy and photocoagulation]. / Traitement des oedèmes maculaires diabétiques avec décollement du neuro-épithélium associant corticothérapie forte et photocoagulation.

The clinical course of background diabetic retinopathy in its oedematous form (macular and diffuse posterior pole edema), leads to serous macular retinal detachment. At this stage, even if the laser burns are observed on the retinal pigment epithelium, laser photocoagulation is unsuccessful in such a serous detachment, because retinal neuroepithelium is far from the retinal pigment epithelium. We have previously noticed that high doses of oral steroid drug (one milligram per kilo a day) for fifteen days may allow a partial or complete macular flattening. This flattening is only correctly evaluated by contact glass biomicroscopy, and often associated to a visual improvement. Favourable outcome was observed in 76% of the fifty-eight eyes, which have been laser treated. When laser photocoagulation was successful, the results were stable with an improvement of two or four lines. If flattening did not occur, laser photocoagulation was not performed. Oral steroids treatment for long-term insulin treated diabetic patients required a very close daily diabetic or/and internist survey. At our institution, it was possible because the internist was at the patient's bed once or twice a day: for this reason, this technique seems to be the first study in the literature. Some very unexpected visual improvements incite us to use classic laser treatment as early as possible for macular or diffuse posterior pole oedema, before a serous retinal detachment occurs and renders treatment impossible excepted with the help of high doses steroids.