A prospective comparison of 4% polyacrylamide (Orcolon) and 1% sodium hyaluronate (Healon) in cataract and intraocular lens implant surgery.

We performed a prospective randomized clinical trial of 4% polyacrylamide (Orcolon) and 1% sodium hyaluronate (Healon) in routine extracapsular cataract extraction with posterior chamber lens implantation or in secondary anterior chamber lens implantation. Seventy consecutive patients were enrolled. The viscoelastic agents were compared in four areas intraoperatively: ease of injection, ease of removal, clarity of field and ability to hold back ocular tissues. Healon was significantly superior to Orcolon in all four areas. Further evaluations were performed on the first day and at 2 weeks postoperatively. Measurements of intraocular pressure (IOP) by Goldmann applanation and evaluations of corneal edema, epithelial keratitis and anterior chamber cellular reaction were recorded. Multivariable statistical analysis revealed only one difference between the two groups: significantly more patients in the Orcolon group (eight cases) than in the Healon group (two cases) had an IOP of 21 mm Hg or greater on the first postoperative day.

Fibrous histiocytoma of the corneoscleral limbus and conjunctiva.

An 11-year-old boy and a 28-year-old woman each had a painless, slowly enlarging, elevated, yellow lesion of the inferior corneoscleral limbus and adjacent cornea and conjunctiva of the left eye. Histopathologic examination of both lesions disclosed involvement of the conjunctival substantia propria and the adjacent limbal and peripheral corneal stroma by a nonencapsulated, dense infiltrate composed of elongated fibrocytic cells, plump histiocytic cells occasionally with a vacuolated cytoplasm, some multinucleated giant cells, and scattered lymphocytes. The diagnosis in each case was fibrous histiocytoma. Both patients were otherwise in good health with no dermatologic, systemic, or other ocular abnormalities.

A comparative study of two preservative-free tear substitutes in the management of severe dry eye.

Between mid-May and mid-July 1987 we performed a prospective crossover study of two unit-dose preservative-free artificial tear solutions, 1.4% polyvinyl alcohol (Refresh) and 0.1% sodium hyaluronate (Hylorin) in 14 female patients with severe dry eye syndrome. The patients were examined before treatment and after each of two trials with both products. A significant reduction in the mean score for dry-eye-induced keratitis (p = 0.001) and for mucous strands (p = 0.03) was observed following the second of two trials with sodium hyaluronate. A significant reduction in the mean score for burning and irritation was observed with both solutions (p = 0.009). We believe that the elimination of preservatives from artificial tear preparations may substantially reduce the iatrogenic effects of these frequently applied medications.

[Severe band keratopathy following cataract surgery with intraocular lens implantation]. / Kératopathie en bandelette sévère après chirurgie de la cataracte avec implantation d'une lentille intra-oculaire.

Two similar cases of severe band keratopathy are reported that occurred about 4 weeks after routine intracapsular cataract extraction with implantation of an anterior chamber intraocular lens. The calcareous deposits were removed and analysed. The cornea remained damaged because of severe, irregular thinning. The cause of the condition could not be determined.

Keratoconus with spontaneous perforation of the cornea.

A 24-year-old woman with a 5-year history of bilateral keratoconus who was in her eighth month of pregnancy presented with central corneal edema and mild acute iritis in her right eye. The iritis responded rapidly to therapy with topical corticosteroids, which was stopped after 1 week. The patient returned 1 week later with a markedly edematous central cornea, which had perforated. Management included a therapeutic soft contact lens, patching and, eventually, penetrating keratoplasty. The authors discuss the possible role of the pregnancy and of the topical corticosteroids in the development of the corneal perforation, a rare complication of keratoconus.

Mycobacterium chelonei keratitis following penetrating keratoplasty.

Atypical mycobacteria are responsible for an increasing number of skin and soft-tissue infections. We present a case of Mycobacterium chelonei keratitis that developed 3 months after penetrating keratoplasty. Our case illustrates how early diagnosis of M. chelonei keratitis and aggressive therapy with appropriate antibiotics can lead to a complete cure, with excellent functional results.

[Inverse corneal incision in cataract surgery]. / L'incision cornéenne inverse dans la chirurgie de la cataracte.

In a prospective study of 100 cases of cataract surgery, astigmatism surgically induced by the reversed corneal incision technique was evaluated. There was a tendency towards with-the-rule and oblique astigmatism in the early post-operative period, but the final distribution of cases was similar to the preoperative distribution. The sutures could be left in place in about one third of the cases.

[Recurrent pterygia: frequency and treatment by conjunctival autograft]. / Les ptérygions récidivants: fréquence et correction par autogreffe conjonctivale.

Of 91 pterygia treated by simple excision (by the same surgeon, using the same technique) followed by beta-irradiation 7 recurred. Of 15 recurrent pterygia treated by complete excision by the bare-sclera technique associated with a conjunctival autograft only 1 recurred again. Conjunctival autografting is simple and efficacious, and gives very good esthetic results in cases of recurrent pterygium.

[Ophthalmic herpes: treatment of herpetic neuralgia by repeated stellate block]. / Zona ophtalmique: traitement de la nevralgie zonateuse par infiltrations stellaires repetees.

Eight cases of herpes zoster with severe neuralgic pain were treated by repeated stellate blocks, 5 during the acute stage and the 3 others later on. Of the 5 patients treated during the acute stage 3 were cured, the pain disappearing completely. Four other patients were substantially improved. Only one case was a failure. It is important to begin the injections soon after the beginning of the illness, preferably in the first couple of weeks after the rash appears.

[Comparative value of 2 technics of corneal preservation for rabbit corneal grafts]. / Valeur comparee de 2 techniques de conservation corneenne par greffes de cornee chez le lapin.

The author compares corneal cryo-preservation in liquid nitrogen with corneal preservation using McCarey-Kaufman solution. Corneal grafts were performed on 38 rabbits which were then studied histologically at different intervals after surgery. The clinical results were similar: 45.5% clear grafts 1-2 months after surgery in the first group (cryo-preservation) and 50% clear grafts 1-3 months after surgery in the second group (preservation with the McCarey-Kaufman solution). The histological results indicated that in both groups, enough donor endothelial cells survive to keep the corneal graft clear; however there were many important endothelial changes in the first group and only a few in the second group.

[Zona ophthalmica and dendritic keratitis]. / Zona ophtalmique et kératite dendritique

Two cases of herpes zoster ophthalmicus with dendritic keratitis are reported. Virological studies confirmed the double infection with herpes simplex type 1 virus in the corneal lesions and herpes zoster virus in the cutaneous lesions. We suggest the use of the immunoperoxidase test to identify the viral agent mainly because of its rapid and specific results. We are against the use of local steroids in dendritic keratitis unless the etiological agent is proved to be herpes zoster virus and not herpes simplex virus.

[Epithelial invasion of the anterior chamber. Apropos of eight cases operated on using Maumenee's technic]. / L'invasion epitheliale de la chambre anterieure: a propos de 8 cas operes selon la technique de Maumenee

Eight cases of epithelial downgrowth have been operated on by Maumenee's technique. Two cases were considered entirely successful, using the stringent criteria of Maumenee. Four other cases were partly successful maintaining a visual acuity of 20/300-20/400 without any recurrence, and normal ocular pressure or glaucoma controlled by topical medication. The value of Maumenee's surgical technique in these cases is obvious if one wishes to save these patients' eyes and keep useful vision. The only change suggested is not to treat the involved cornea by any specific procedure.