A novel method for controlling the quantity of mitomycin-C applied during filtering surgery for glaucoma.

The use of a sponge impregnated with mitomycin-C is an increasingly common practice in glaucoma surgery. The appropriate antibiotic concentration and exposure time have been considered in the literature, but not the exact amount to be used or the size of the sponge. The purpose of this study was to estimate the quantity of mitomycin-C contained in sponges prepared by different surgeons as compared to that in applicators of the type used in Schirmer's test graduation (5 x 5 mm). Four surgeons each cut and prepared 10 sponges for intraoperative use according to their usual method. The same procedure was performed with 10 Schirmer's test graduations. Each sponge and each graduation was immersed in a solution of mitomycin-C 0.2 mg/ml, and the quantity of antibiotic (microg) in each was calculated as the difference between wet and dry weight. The mean quantity (+/- SEM) of mitomycin-C contained in cut sponges was 9.6 +/- 4.4 microg (range 1.9-17.3), and the differences between surgeons were statistically significant (p<0.0001). The mean quantity of antibiotic in Schirmer's test graduation was 1.7 +/- 0.3 microg (range 1.1-2.5), and the differences between surgeons were not statistically significant (p=0.79). The quantities of mitomycin-C contained in sponges prepared for glaucoma surgery differed for a given surgeon and between surgeons. Thus, variations in the doses applied to the sclera could account for certain complications due to mitomycin-C. The use of a Schirmer's test graduation improves predictability for the quantity of mitomycin-C applied to the sclera.

[Scale for evaluating desirable ametropia or eumetropia]. / Echelle d'évaluation de l'amétropie désirée ou eumétropie.

GOAL: The purpose of this study is to assess the degree of desirable ametropia in cataract surgery. MATERIAL AND METHODS: A scale for evaluation was created. It allows to measure the desired distance for a neat uncorrected vision (desired ametropia) after cataract surgery that presbyopic patients (monocular vision) would like to obtain. This scale helps to calculate the power of the intraocular lens to be implanted. The scale was shown to a series of 50 consecutive presbyopic patients. Refraction was the same in both eyes. The interest of patients in the evaluation of their desirable ametropia was measured on a scale from 0 to 5. RESULTS: Interest was good for 50% of patients (grade > or = 3). Mean distance desired by patients for a neat uncorrected vision was 1 meter. Preoperative myopia and hyperopia have no significantive influence upon the distance desired for a neat uncorrected vision. CONCLUSION: The choice of the power of the lens implanted during cataract surgery should take into account the patients' desires. An evaluation of the postoperative desirable ametropia should be systematic.

[Does the dosage of mitomycin-C applied during filtering surgery of glaucoma vary with the individual surgeon?]. / La quantité de mitomycine-C appliquée pendant la chirurgie filtrante du glaucome varie-t-elle selon le chirurgien?

PURPOSE: The purpose of this study was to estimate the quantity of mitomycin-C contained in sponges prepared by different surgeons as compared to that in applicators of the type used in Schirmer's test graduation (5 x 5 mm). MATERIALS AND METHODS: Four surgeons each cut and prepared 10 sponges for intraoperative use according to their usual method. The same procedure was performed with 10 Schirmer's test graduations. Each sponge and each graduation was immersed in a solution of mitomycin-C 0.2 mg/ml, and the quantity of antibiotic (microgram) in each was calculated as the difference between wet and dry weight. RESULTS: The mean quantity (+/-SEM) of mitomycin-C contained in cut sponges was 9.6 +/- 4.4 micrograms (range 1.9-17.3), and differences between surgeons were statistically significant (p < 0.0001). The mean quantity of antibiotic in Schirmer's test graduation was 1.7 +/- 0.3 micrograms (range 1.1-2.5), and the differences between surgeons were not statistically significant (p = 0.79). CONCLUSION: The quantities of mitomycin-C contained in sponges prepared for glaucoma surgery differed for a given surgeon and between surgeons. Thus, variations in the doses applied to the sclera could account for certain complications due to mitomycin-C. The use of a Schirmer's test graduation improves predictability for the quantity of mitomycin-C applied to the sclera.

[Epidemiological and clinical aspects of Stilling-Turk-Duane syndrome]. / Aspects épidémiologiques et cliniques du syndrome de Stilling-Turk-Duane.

BASIS: In a retrospective study on 155 patients with Stilling-Turk-Duane's syndrome, we compare our results with those described in the literature. Particular focus was based on the different clinical entities observed. PATIENTS AND METHODS: Patients were selected from 8000 charts of cases of strabismus seen in the Ophthalmological Clinic of the CHU in Nantes between 1980 and 1995. An oculomotor assessment carried out for all of these patients allowed us to determine the clinical type according to Malbran's classification. Patients were classified on the basis of family history of oculomotor disorder and associated pathology. RESULTS: The incidence of this syndrome in the population of strabismic patients was 1.9%. The number of women affected was 83 (53.5%). The syndrome was unilateral in 121 cases (78.1%). The left eye (71.9%) was affected more frequently than the right. Clinical entities not described by Malbran's classification were found in 24% of cases. These were described and classified. The oculomotor disorder most frequently encountered was esotropia. The number of patients with a amblyopia was 51 cases (32.9%). The number of patients with a torticollis was 101 cases (65.1%). The number of cases with associated medical pathology was 38 (24.5%). This pathology was ocular in 17 cases (10,9%) and extra-ocular in 22 cases (14.2%). The number of patients with a family history of oculomotor disorder was 39 (22.2%) among which 9 (5.8%) had at least one family member with Stilling-Turk-Duane's syndrome. CONCLUSION: Data provided by this study allowed us to analyse the clinical and epidemiological features of the Stilling-Turk-Duane's syndrome. What is more, they allowed us to describe and classify clinical forms not described by Malbran's classification.

[Monobloc PMMA lenses. Anteroposterior displacement of the implant as a function of the insertion diameter]. / Implants PMMA monobloc. Déplacement antéro-postérieur du corps en fonction du diamètre d'insertion.

Data concerning the biomechanical properties of IOL are rare. A systematic study of these properties was performed in the "laboratoire de Mécanique des Structures" at the "Ecole Centrale de Nantes". The results of the anteroposterior displacement of the optical part of eleven posterior chamber lenses (all PMMA) which were subjected to a diameter reduction, are reported. The deplacement of the implants was very slight and the position of the posterior side was relatively anterior whatever the diameter of insertion. The clinical implications, especially concerning the posterior capsule, are discussed.