Ocular perforation in utero.

Midtrimester amniocentesis has rarely been reported to cause ocular damage. Findings in the literature include corneal perforation, a vascularized corneal leukoma, a non pigmented epithelial cyst of the anterior chamber, eyelid coloboma, microphthalmos, retinal hole, axial myopia and retinal detachment. We describe the case of a paralimbal scleral perforation with iris prolapse, distortion of the pupil, aphakia due to resorption of the lens and a chorioretinal scar possibly caused by an amniocentesis needle.

Uveitis-glaucoma-hyphema syndrome: a late complication of posterior chamber lenses.

The uveitis-glaucoma-hyphema (UGH) syndrome is a triad that rarely occurs in the late postoperative period after an extracapsular cataract extraction (ECCE) with implantation of a posterior chamber (PC) intraocular lens (IOL). Surgical techniques as well as IOL design can influence the incidence of the UGH syndrome. We describe two patients who developed an UGH syndrome respectively 5 and 6 years after an ECCE with implantation of a flexible closed-loop one-plane PC IOL of the Anis type. Intraoperatively, an envelope technique had been used. Although no tears had occurred, an asymmetrical bag-sulcus fixation of the IOL had been obtained, with manifest upward decentration of the IOL, probably eroding the ciliary sulcus by its closed loops, acting as a semi-rigid system.

Antimetabolites in the surgical treatment of glaucomas.

Fibroblast proliferation with scarring at the surgical site plays an important role in the failure of filtration surgery. Several antimetabolites inhibit fibroblast proliferation in vitro. These observations have lead to the widespread clinical use in humans of 5-fluorouracil and more recently mitomycin-C in glaucoma filtering surgery.

Postoperative astigmatism in cataract surgery.

The postoperative visual results after cataract surgery are sometimes disappointing because of induced astigmatism. A good wound construction is mandatory. A scleral incision, which is astigmatism neutral, is preferred. In case of corneal or limbal incision great care must be given to the placement and the tension of the sutures.

[The multifocal intraocular lens]. / De multifocale intraoculaire lens.

The new multifocal intraocular lens gives 2 simultaneous foci by combination of conventional refraction and diffraction. The diffraction is induced by circular microsteps on the posterior face of the lens. The first clinical results are good: 3 patients out of 4 obtain a far-vision of 5/10 or better and a near-vision of P3 or better without spectacle correction.

Two-year postoperative results of Galand lens implantation.

The Galand lens is a closed J-loop implant for capsular-bag fixation. We present a retrospective study of 214 eyes implanted with this lens. Eyes were examined at three months, six months, one year, and two years after surgery. Results indicate that 82.2% of eyes obtained a visual acuity of 20/40 or better at two years after implantation. If patients with other ocular pathology were excluded, the percentage of those whose visual acuity was 20/40 or better at two years was 93.7%. Although this implant avoids "spring action" within the capsular bag, the rate of dislocation into the posterior chamber was low (0.93% in this series). Early stability, before sealing of the capsular leaflets, was obtained by limiting the anterior capsulectomy to the pupillary area. No late zonular rupture was observed. Secondary posterior capsulotomy has been performed in 9.8% of the eyes.

Pseudophakic glaucoma.

Pseudophakia by itself does not cause ocular hypertension. Pseudophakic glaucoma should be defined as glaucoma that would not be present in an eye if it were not pseudophakic. Ocular hypertension was noted in 15 (9%) of 166 pseudophakic eyes. Only 5 eyes (3%) had ocular hypertension requiring treatment. Three of these eyes (1.8%) had permanent ocular hypertension resulting in chronic pseudophakic glaucoma. This study shows that pseudophakic glaucoma is no more frequent than aphakic glaucoma. Secondary glaucoma in pseudophakic eyes is not always related to the presence of the lens. Pupillary block glaucoma and UGH syndrome are directly related to the lens. Secondary glaucoma by ghost cells and by pigment-dispersion are also in some cases directly related to the lens.

Retinal phototrauma during intra-ocular lens-implantation.

The use of the operating microscope has become almost a necessity in the surgery of the anterior segment of the eye. However the coaxial light of the operating microscope is potentially hazardous for the retina, especially during intra-ocular lens implantation. The risk of producing a photic retinopathy increases if the duration of the surgical procedure is prolonged once the pseudophakos is in the eye and if high levels of illumination are used. We encountered our first case in a patient, whose intervention was filmed and where thus an increased illumination was needed. This complication is however also found in cases where no extra illumination was needed. As the clinical signs are usually very mild, the retinal lesions related to over-exposure to light are easily overlooked.

[Goniotomy in congenital glaucoma]. / La goniotomie dans le glaucome congénital.

Sixty eyes presenting with congenital glaucoma and operated on by goniotomy, have been followed-up for 1 to 30 years (mean 10.4 years). Intraocular pressure was normalized in 91 p. cent of cases, either by goniotomy alone with or without medical treatment, or by goniotomy with an associated fistulizing operation, if necessary. When preoperative intraocular pressure is less than 40 mmHg, 2 cases out of 3 are normalized, but when it is more than 40 mmHg, only 1 case out of 3 is normalized.