[Contribution of MRI in the dynamic study of the lacrimal outflow system]. / Apport de l'IRM dans l'étude dynamique des voies lacrymales d'excrétion.

PURPOSE: To evaluate a new magnetic resonance imaging protocol for dynamic study of the lacrimal outflow system and to use this protocol to search for problems in patients with an assumed permeable outflow system who develop epiphora. PATIENTS AND METHODS: A prospective study of nine patients, including 2 asymptomatic controls was conducted. The magnetic resonance protocol included, gadolinium instillation into the conjunctival cul-de-sac, 3D gradient-echo T1-weighted acquisition, 2 mm thick images passing through the nasolacrimal duct, dynamic acquisition after gadolinium instillation for timing dye progression through the outflow system. RESULTS: Similar results were obtained for the two control subjects with lacrimal transit time of a median 100 seconds. Three distinct events were individualized gadolinium arrival in the lacrimal sac (t1), at the extremity of the bony portion of the lacrimal duct (té), and the extremity of the mucosal portion of the duct (t3). Patients with an assumed permeable outflow system who had epiphora show results intermediary between passed dye and total blockage of the dye within the lacrimal sac. CONCLUSION: The study of the lacrimal outflow system using this new magnetic resonance imaging protocol contributes to the physiological study of tear evacuation and could be useful for quantitative assessment of lacrimal stenosis, particularly interesting for therapeutic guidance.

[Diffusion if lidocaine after intracameral injection]. / Diffusion de la lidocaïne après injection intracamérulaire.

PURPOSE: To determine the lidocaine diffusion space, we compared lidocaine aquous humor concentration in topical anesthesia with 1% lidocaine intracameral injection and in peribulbar anesthesia with 2% lidocaine prior phacoemulsification. MATERIAL AND METHOD: A gas chromatography technique of analyzing 100 microliters aqueous humor was used to detect the presence of lidocaine prior to phakoemulsification cataract surgery in two groups of patients: group A: after peribulbar anesthesia with 10 ml 2% lidocaine, group B: after 1% tetracaine topical anesthesia and 0.5 ml intracameral injection of 1% preservative-free lidocaine. The intracameral volume was estimated mathematically in group B. Endothelial cells loss was analyzed in two groups with non contact specular microscopy. RESULTS: Lidocaine was detected in aqueous humor with a good reliability. The mean concentration after intracameral injection was 6,300 micrograms/ml and was higher than after peribulbar injection. This concentration was near than theorical intracameral rate, suggesting that there was no diffusion in the posterior segment. There was no significant difference in the 2 groups in endothelial cells loss. CONCLUSION: Intracameral injection of lidocaine is an effective technique to anesthetize intracameral structures without diffusion in posterior segment prior to phakoemulsification.

[Intracameral lidocaine and phacoemulsification under topical anesthesia. Apropos of 80 operations]. / Lidocaïne intracamérulaire et phacoémulsification sous anesthésie topique. A propos de 80 interventions.

PURPOSE: To evaluate the advantage of intracameral unpreserved lidocaine for patient comfort during phacoemulsification under topical anesthesia. METHODS: In this prospective study, we performed 80 phacoemulsifications under topical anesthesia, with tetracaine 1% drops, 10 minutes before and at the start of surgery: 40 patients received 0.3 cc balanced salt solution (BSS) intracameral injection; 40 patients received 0.3 cc unpreserved lidocaine 1% intracameral injection. The same surgical procedure was performed in both groups: 3.2 mm temporal corneal self-sealing incision, capsulorhexis, foldable polyHEMA IOL implantation into the capsular bag. There was no intravenous sedation. RESULTS: Forty-eight percent (19) in the BSS group and 70% (28) in the lidocaine group felt no pain. 10% (4) in the BSS group reported sharp pain during phacoemulsification. During IOL insertion, no pain was reported by 48% (19) in the BSS group, and 75% (30) in the lidocaine group; 10% (4) in the BSS group felt severe pain (significant difference: p < 0.05). Endothelial cell loss was 6% in the BSS group, and 6.4% in the lidocaine group (non significant difference). CONCLUSION: Intracameral lidocaine is safe and effective in decreasing discomfort among patients undergoing phacoemulsification under topical anesthesia.

[Eye injuries caused by lasers in military and industrial environment. Apropos of 13 cases]. / Accidents oculaires par laser en milieu militaire et industriel. A propos de 13 cas.

PURPOSE: The aim of this study was to analyse the nature of wavelengths used by military forces, evaluate their clinical consequences in terms of ocular risk, and determine the therapeutic implications and specific preventative measures which should be implemented both in peace- and war-time-settings. MATERIAL AND METHODS: We analyzed retrospectively 13 cases of laser injury (12 patients) treated in our unit over the past 10 years. We recorded the characteristics of the responsible lasers, effects on visual acuity and visual filed, initial ophthalmoscopic and angiographic aspects, treatment undertaken and patient follow-up. RESULTS: Wavelengths were know in only 10 cases. In 9 cases a NdYag laser operating at 1063 nm was involved. The tenth case was an Argon Coirorint laser accident. In three cases the wavelength could not be ascertained because it was confidential information or had been emitted by the enemy and had not been identified. Ocular injury was bilateral in 1 case and unilateral in 12. Retinal lesions were foveolar in 8 cases with an initial visual acuity varying from 1/10 to 10/10. Visual loss depended on the extent of the burn and did not tend to improve despite vasoprotector and corticosteroid treatments. In 2 cases the injury progressed without formation of an epimacular membrane. Retinal lesions were extra-foveolar in 5 cases and in 1 case vitreous hemorrhage required vitrectomy. CONCLUSION: With the widespread use of Yag lasers and the soon to be employed tuneable lasers, there in major risk of serious ocular injury resulting from foveolar burns or peripheral retina trauma with vitreous hemorrhage. In a war situation, a large number of laser casualties producing peripheral vitreous hemorrhage would create an important logistics problem for vitrectomy. The accent must therefore be focused on prevention. Personnel must be informed of the danger and instructed in wearing filter glasses adapted to the wavelengths being used, if known, or a universal photoactivated protective device, as yet a hypothetical possibility.

[Corneal blindness in tropical areas]. / La cécité d'origine cornéenne en milieu tropical.

Corneal disease is the second most common cause of blindness in tropical countries after cataract. It mainly strikes children who are exposed to numerous infectious agents against which they are unprotected due to the absence of basic health care. In high risk groups, the incidence of childhood corneal-related blindness is more than 20 times higher than in developed countries. There are many causes of corneal-related blindness. Endemic trachoma persists in some areas and inflammatory forms can lead to blindness. Eradication requires instillation of antibiotics in the eye, improvement of sanitary conditions, and campaigns against promiscuity. Xerophthalmia can induce blindness by perforation of the cornea in children with vitamin A deficiency. Measles, herpes simplex keratitis, and corneal ulcer that progresses to bacterial or fungal infections, or to amebic keratitis are also major causes of corneal-related blindness. The incidence of onchocerciasis is decreasing thanks to treatment with ivermectin and programs to control simulium. Neonatal gonococcal ophthalmia and leprosy-associated ocular disease can also lead to blindness. This overview of the various causes illustrates the close correlation between the level of life and living conditions and the occurrence of corneal-related blindness in tropical areas.

[Ocular complications of intracarotid chemotherapies with nitrosourea agents]. / Complications oculaires des chimiothérapies intracarotidiennes par nitroso-urées.

The authors report ocular complications in intracarotid chemotherapy with Nitrosyl-urea on 39 patients with intracerebral malignant tumor (anaplastic astrocytoma). Internal carotid infusion catheter was in infra-ophthalmic position. They also report 13 ocular complications (33% of cases) as arterial retinal occlusions essentially, ipsilateral to catheter site. Their study and literature revue emphasize five ocular toxicity factors; intracarotid catheter position, type of drug, its quantity, its solubility and solvent, the rate of infusion.