[Aberrometry and contrast sensitivity after cataract surgery: aspherical IOL evaluation]. / Aberrométrie et sensibilité aux contrastes chez le patient pseudophaque. Evaluation d'un implant asphérique: étude comparative.

PURPOSE: We report a prospective clinical study investigating efficacy in terms of aberrometry and contrast sensitivity of the aspherical IOL (SW60AT) versus the standard IOL Alcon (SN60AT). PATIENTS AND METHODS: Twenty patients in each group underwent phacoemulsification of both eyes. Both eyes of each patient received an aspherical IOL (SW60AT) or a similar standard IOL (SN60AT). The integrity of ocular function was assessed with clinical examination before surgery. Postoperative examination (1 month after the second surgery) included best visual acuity, an aberrometry with a 5-mm pupil (Bausch and Lomb), and a contrast vision (Zalonghi scale) in scotopic place examination. RESULTS: We noted no statistically significant difference between the two groups before surgery. Best spectacle-corrected visual acuity improved in both groups with no difference (8.15/10+/-1.39/10 and 7.95/10+/-1.54/10 for the aspheric group eyes and 7.85/10+/-2.13/10 and 7.60/10+/-2.14/10 for the standard group eyes). Otherwise, a statistically significant difference was found for the Z40 aberration with RMS=0.0095 with SW60AT versus RMS=0.07625 with SN60AT. The pupils had a similar size in both groups. There were no statistically significant differences for contrast sensitivity between two IOLs; nevertheless, contrast vision seemed to be better with the aspherical lens (33.15+/-6.85 points and 32.15+/-6.95 points for the standard group eyes and 36.05+/-3.63 points and 35.70+/-3.93/10 points for the aspheric eyes). CONCLUSION: The quality of vision can be objectively increased with the aspherical IOL because of less spherical aberration.

[Orbitotemporal segmental neurofibromatosis]. / Neurofibromatose de type I segmentaire: à propos d'une localisation orbito-temporale.

INTRODUCTION: Neurofibromatosis is a rare pathology with heterogeneous clinical presentation. OBSERVATION: We report a case of a right orbitotemporal plexiform neurofibroma in a 64-year-old woman with von Recklinghausen's neurofibromatosis. A craniofacial CT scan, with injection, showed a heterogeneous tumor in front of the skull base and the temporoparietal bone with no intracranial extension but an extension into the maxillary sinus and nasal cavity. In summery, she presented orbitotemporal segmental neurofibromatosis type 1 because of the unilateral lesion. She had a first surgery to remove her jugal and preauricular tumor with an exenteration, which provided an eye histology. The histology found no Lisch nodules but a cellular proliferation causing choroidal hyperplasia. We noted neurofibromin on choroidal cells and normal cells in addition to pathologic cells (Schwann cells and melanocytes), meaning that two cell populations were obtained in the same tissue: a somatic mosaicism. DISCUSSION/CONCLUSION: We advance the hypothesis that there was a regulation of cellular growth in a particular microenvironment because of the absence of tumor. To identify and confirm the somatic mosaicism, we would need a FISH analysis (probes containing sequences of the NF1 gene with a probe specific for the chromosome 17 centromere).

[Study of pupillary motility after implantation of an iris claw lens (Artisan) in a phakic population with severe myopia]. / Etude de la motilité pupillaire chez le sujet phaque porteur d'un implant Artisan.

PURPOSE: To assess the effect of the Artisan lens on pupillary motility in a highly phakic myopic population. PATIENTS AND METHODS: Eleven patients (21 eyes) were enrolled in a nonrandomized prospective study between September 2002 and August 2003, with a 6- to 11-month follow-up. A portable Colvard pupillometer was used to measure pupil diameters before and after surgery under two different light conditions: one with scotopic surroundings with absolute darkness in the examination room and the other maximal simulated photopic surroundings, caused by the instillation of a pilocarpine 2% drug until a nonreactive myosis could be observed. Under such light conditions, both the horizontal and vertical pupil motion ranges were measured. Measures were then sorted into five temporal segments in order to have enough samples per temporal segment for a cohesive data analysis. Mean values and confidence intervals were then derived per temporal segment according to Student's law. Constraints on the pupil motion range were identified. RESULTS: After implantation of an Artisan lens, the pupil motion range was limited to both horizontal and vertical axes. For the horizontal axis, the motion range was 4.3+/-0.2mm (p=0.1) before claw implantation and was 2.7+/-0.5mm (p=0.1) 9 months after claw implantation. For the vertical axis, the motion range was 4.46+/-0.28mm before claw implantation and 3.08+/-0.89mm 9 months after claw implantation. CONCLUSIONS: The Artisan lens durably restrains the pupil in its motion range and introduces a noticeable oval deformation under extreme light condition variations. This side effect is, however, not visible under regular conditions but only in maximal photopic surroundings.

[Comparison of PKR and LASIK for the treatment of low myopia: statistic study of refractive and optic results]. / Comparaison de la photo-kératectomie réfractive et du LASIK pour le traitement des myopies faibles.

PATIENTS AND METHODS: We present a study which compares the refractive and optical results obtained after PKR and LASIK for the correction of low myopia without astigmatism. This retrospective study involved 729 patients. All operations performed by the same surgeon, and with the same excimer laser (a Technolas Keracor 117 C). Before operation, all patients had a spherical equivalent between -0.5 and -6.0 D and a cylinder less than -0.5 D. Two groups were formed according to the treatment used. Three postoperative examinations were done (the first between 3 and 7 days, the second between 1 and 3 months, and the third between 10 and 14 months). Refractive results: Our statisticaly study found no difference in the results obtained with the two techniques. COMPLICATIONS: The incidence of complications was similar for the two procedures, but those observed after LASIK are generally more serious. DISCUSSION: In this indication, the efficacy of PKR and LASIK is similar. CONCLUSION: PKR and LASIK are safe and efficacy for the treatment of low myopia. For these patients, the use of PKR of LASIK currently depends on the habit and preference of the surgeon.

[Retreatment after PRK for low and medium myopia. Results and study of contrast sensitivity]. / Retraitement après PKR pour myopies faibles et moyennes. Résultats et étude de la sensibilité au contraste.

PURPOSE: To examine the results of retreatment with eximer laser photorefractive keratectomy (PRK) on refraction, visual acuity, haze, and contrast sensitivity. PATIENTS AND METHODS: Excimer laser photorefractive keratectomy was performed in 18 patients, once for one eye and twice for the other eye due to undercorrection or regression. Outcome was compared between the two eyes. RESULTS: Uncorrected visual acuity was above 20/40 in 94.4% of the retreated eyes. There was no statistical difference between the two eyes for haze and contrast sensitivity. CONCLUSION: Retreatment with laser photorefractive keratectomy is a safe procedure and should be performed when regression or undercorrection occurs after the first laser excimer treatment.

[Secondary intraocular lens implantation: methods and complications]. / Implantation secondaire. Techniques et complications.

PURPOSE: We report a review of the literature on complications of secondary lens implantation without capsular support. METHODS: We assessed results and complications after trans-sulcus sclera l fixation (SSIOL), open-loop anterior chamber intraocular lens (ACIOL) and iris-claw lens (ICIOL). RESULTS: Series published in the literature showed variable results. The rate of increased visual acuity ranged from 71% to 92% for SSIOL, 77% to 92% for ACIOL, 83% to 100% for ICIOL. Complications included: decentration and tilt of th IOL in 0-15.3% for SSIOL, 0-8.6% for ACIOL, 1.8-4.8 % for ICIOL; retinal detachment in 1.1-6% for SSIOL, 0-3.3% for ACIOL; cystoid macular edema in 5.8-23% for ACIOL, 4.8%-5.2% for ICIOL; bullous keratopathy in 0-26.3% for SSIOL, 0-14.2% for ACIOL, 4.8% for ICIOL. Vitreous hemorrhage and suture erosion were specific complications report ed for SSIOL in 1.1-25% and 15-20% of cases respectively. CONCLUSION: Secondary IOL implication is a good alternative for correction of aphakia eyes without a posterior capsule. This analysis shows no one procedures offers more safety than the others. The decisive facto r for choosing among the different types of IOL appears to be surgical experience.

[Tetracaine versus diclofenac in the treatment of pain following refractive photokeratectomy]. / Tétracaïne versus diclofénac dans le traitement de la douleur après photokératectomie réfractive.

PURPOSE: To compare the efficacy and safety of topical diclofenac and tetracaine in reducing ocular pain after photorefractive keratectomy. SETTING: Ophthalmology Department, Minjoz Hospital, Besançon, France. METHODS: Seventy-four patients were randomized to receive either tetracaine 1% or diclofenac 0.1% after undergoing PRK. Tetracaine was instilled at 30 minute intervals for 24 hours. Diclofenac was instilled four times a day for 3 days. All patients were allowed to use oral Diantalvic (paracetamol-noramidopyrine) as a rescue analgesic if the study medications failed to control the ocular pain. Visual analog pain charts were used to record pain levels every hour for 30 hours after surgery. A subjective questionnaire was to be completed by the patient to evaluate discomfort every day for 3 days. Computer analysis of photography performed at D0, D1, D3, was used to evaluate the rate of epithelial closure. RESULTS: Women had significantly more pain. Patients in the diclofenac group had significantly less pain. No statistically significant difference was seen in the rate of epithelial closure. CONCLUSION: Diclofenac is more effective than tetracaine to reduce ocular pain and functional symptoms.

Angle-fixated anterior chamber phakic intraocular lens for myopia of -7 to -19 diopters.

PURPOSE: To assess the safety and efficacy of a second generation, anterior chamber phakic intraocular lens (Baikoff Model ZB5M) in patients with high myopia. METHODS: One hundred and twenty-one patients (134 eyes) with myopia of -7.00 to -18.80 D were implanted with the ZB5M lens and followed for 18 to 52 months; the number of eyes evaluated was: 6 months (104 eyes), 1 year (91 eyes), 18 months (78 eyes), 2 years (68 eyes), and 3 years (35 eyes). RESULTS: Postoperative spherical equivalent refraction averaged -1.00 D and the error in refractive correction (achieved minus intended) averaged -0.40 D during the first 2 years, increasing -to -1.30 D refraction and -0.60 D error in refractive correction at 3 years. At 2 years, approximately 40% of eyes had a spherical equivalent refraction within +/-0.50 D, and 65% within +/-1.00 D. The uncorrected distance visual acuity was 0.048 at baseline and 0.5 at 3 years; near visual acuity was 0.21 at baseline and approximately 0.7 over the 3 years of follow-up. Spectacle-corrected distance visual acuity at baseline was 0.54; it improved to 0.7. Near visual acuity was 0.65 at baseline and it improved to approximately 0.75. Endothelial cell counts in the central and peripheral cornea were reduced by an average 3.3% at 6 months, declining an additional 1% to 2% over the remaining follow-up period. Regression analyses indicated that most of the endothelial cell loss was due to surgery. Additional complications included halos/glare in 37 of 133 eyes (27.8%) and iris retraction with pupillary ovalization in 30 of 133 eyes (22.6%). The intraocular lens was exchanged in four of 133 eyes (3.0%) and removed in three of 133 eyes (2.3%), the latter because of halos (one eye) and a flat anterior chamber with severe inflammation (two eyes). CONCLUSIONS: Implantation of the Baikoff ZB5M lens in the anterior chamber of phakic eyes significantly reduced high myopia and produced a stable refractive outcome over the 3 years, accompanied by marked improvement in uncorrected distance visual acuity and minimal, non-progressive damage to the corneal endothelium. Frequent complications included pupillary ovalization and halos/glare. Improvements in accuracy of IOL power calculations are needed.

[Rhegmatogenous retinal detachment and hypertension: Schwartz-Matsuo syndrome]. / Décollement de rétine rhegmatogène et hypertonie: penser au syndrome de Schwartz-Matsuo.

PURPOSE: To assess the usefulness of electron microscopy of the aqueous cells when confronted with the clinical association of rhegmatogenous retinal detachment after trauma, high intraocular pressure (IOP) and aqueous cells. METHOD: We report a clinical history of a 50-years-old man who had ocular trauma with perforation in 1944, intraocular lens for traumatic cataract in 1988, Yag capsulotomy in 1993 and retinal detachment with oral dialysis, high IOP and aqueous cells in anterior chamber in 1995. During the surgical therapy we performed an anterior chamber puncture to analyse the aqueous cells. An electron microscopic study was performed on 0.2 ml of aqueous humor mixed in the same volume of 2.5% glutaraldehyde and fixed with 1% osmium acid. RESULTS: Electron microscopic ultrastructural study of the aqueous cells showed numerous photoreceptor outer segments, some of them appearing degenerated. CONCLUSION: The combination of rhegmatogenous retinal detachment with tears near the ora serrata, high IOP and aqueous cells in the anterior chamber should lead the physician to do an anterior chamber puncture and analyse the aqueous cells structure. The combination of those three clinical signs associated with the photoreceptor outer segments in the anterior chamber allowed to diagnose the Schwartz-Matsuo syndrome.

[Immunolabelling of collagen types I, III and IV, laminin and fibronectin in the human lens capsule]. / Immunomarquage des collagènes I, III et IV, de la laminine et de la fibronectine dans la capsule cristallinienne humaine.

PURPOSE: To localize collagen types I, III, and IV, laminin and fibronectin in the anterior human lens capsule. MATERIAL AND METHODS: Twenty-one anterior capsules were sampled by capsulorhexis during extracapsular cataract extraction (mean age 71.5). All capsules were labelled by an immunostaining specific for each antibodies. Immunostaining of four capsules was revealed with immunoperoxydase and seventeen using indirect immunofluorescence. RESULTS: Labelling of collagen types I and III was observed throughout the entire thickness of the capsule for each technique, the strongest labelling was found in the base of the epithelial cells with immunofluorescence. Collagen type IV was observed at the base of the epithelial cells whichever technique was used. Laminin could be detected in the inner layer of the capsule, using immunoperoxydase or immunofluorescence. No specific labelling was found for fibronectin using the two techniques. CONCLUSIONS: Different kinds of collagens have been found in capsules, more particularly the type III. The latter does not appear on other ocular basement membrane. Because of this uneven distribution in the capsule's thickness, each collagen might have a specific function.

[Correction of low-grade and mild myopia using Schwind Excimer laser]. / Correction des myopies faibles et moyennes par le laser Excimer Schwind.

PURPOSE: To examine the results of Excimer laser photorefractive keratectomy on myopic eyes. To demonstrate the efficacy, safety, predictability and stability of the Schwind Keratom laser. METHODS: Two hundred and fifty three patients were operated, with myopia from -0.75 to -8 D and cylinder of less than 1.50 D. Ablation zone diameters were from 5.3 mm to 6.5 m. The follow-up was one year. RESULTS: One year after the operation, 92% of myopic eyes have uncorrected visual acuity above 20/40, 90% have best corrected visual acuity at least equal to that evaluated before treatment, 94% were within (1 D without correction. Between 6 months and one year, the spherical equivalent varied in only 4% the patients. CONCLUSIONS: The results with the Schwind Keratom laser are excellent and at least comparable with the other lasers. The best results are obtained with low myopia. At the end of this study, the Schwind Keratom laser was certified in France.

[Grafting of the cornea and implants sutured to the sclera or anterior chamber. Comparative study on graft survival and endothelial cell loss]. / Greffe de cornée et implants suturés à la sclère ou de chambre antérieure. Etude comparative sur la survie du greffon et la perte cellulaire endothéliale.

PURPOSE: We studied the percentage of graft survival and endothelial cell loss after penetrating keratoplasty with scleral sutured posterior chamber lens compared with secondary anterior chamber lens. METHODS: The study concerned 46 patients divided into two groups: group I: 26 cases with scleral sutured posterior chamber lens; group II: 20 cases with anterior chamber lens. The postoperative Kaplan-Meir curve survival was established and cell loss assessed between graft cell density and postoperative cell density according to Sperling's method. RESULTS: After one year, cell loss was less important in group I (69.23%) than in group II (95%). However, after the first postoperative year, this difference decreases and becomes very slight at the fourth postoperative year. The percentage of cell loss during the first year is 44.6% in group I and is 41.8% in group II. After the first year, the percentage of annual cell loss is 3% in group I and ranges between 6 and 8% in group II. CONCLUSIONS: Except for age, there was no significant difference between the two groups preoperatively. This, it seems that the high postoperative intra-ocular pressure, more frequent in group I, was a poor prognosis factor for graft survival. After one year, results were similar in the two groups for graft survival, but in group I, the annual percentage cell loss was lower.

T-cell repertoire of normal, rejected, and pathological corneas: phenotype and function.

The specific immune mechanisms of corneal graft rejection are not completely understood. Recently, the technique of growing T-cell lines from rejected allografts using recombinant IL-2 has enabled the cells involved in allograft rejection to be recognized. In the present study, this method was applied for the extraction and propagation of T lymphocytes from rejected, normal, and diseased corneas. T-cell lines could successfully be grown from rejected and normal corneas, but not from corneas with keratoconus or pseudophakic bullous keratopathy. The phenotypic repertoire of the grown cells was studied by FACS scan analysis. Rejected corneas were invaded by a mixture of activated CD4+ and CD8+ T-cell lines, with one population being predominant. In normal corneas only activated CD8+ cells with cytotoxic function were cultured. No cells were obtained from diseased corneas. The in vitro function of cell lines was assessed by primed lymphocyte testing. The present study shows that the technique of propagating invading T-cell lines from organ grafts can be applied to human corneas, offering a new approach to understanding the immunological mechanisms occurring inside this immune tissue.

[Retinal detachment after posterior capsulotomy with YAG laser]. / Le décollement de la rétine après capsulotomie postérieure au laser YAG.

BASIS: We studied retinal detachment following YAG laser capsulotomy, to determine risk factors, semiology, management, and prognosis. Material and methods During a period of six years, we observed 24 cases: group A: 19 patients aged between 41 and 75 years (19 eyes); group B: 3 patients aged less than 25 years (5 eyes). RESULTS: The mean time interval between posterior capsulotomy and diagnosis of retinal detachment was 14 months for group A, 21 months for group B. The patients in group B presented a clear tendancy to bilateralization. Retinal detachment was total or subtotal in 25% of the cases. The macula was detached in 58%. We could not identify any retinal lesion in 16% and found suspect zones with no clear evidence of dehiscence in 17%. Anatomic success was achieved in 88% of the cases. The proliferative vitreoretinopathy was the main cause of recurrence. Mean visual acuity of the patients who had a re-attached retina was 4.9/10. Seventy-three per cent of the patients recovered a visual acuity > or = 4/10. CONCLUSION: The clinical characteristics of the post-YAG retinal detachment did not differ from those seen in pseudophakic eyes. Some process may reduce the incidence and improve the prognosis of this type of retinal detachment. Retinal detachment. Retinal detachment in young adults. YAG laser.

[T-lymphocyte population in the normal human cornea]. / Population T-lymphocytaire de la cornée humaine normale.

T-lymphocytes of the normal human cornea (10 donors) were studied from corneal fragments cultured in IL-2 medium. Their phenotypic repertoire was performed by FACS analysis using the following monoclonal antibodies: CD3, CD19, CD4, CD29, CD18, CD16, CD56, CD25, TCR alpha/beta, TCR alpha/delta. Functional analysis was done by proliferation assays (PLT). T cell growth was more often obtained from peripheral (n = 7/10) than central corneal parts (n = 3/10). Most of the cultured cells carried the CD8 marker, were activated (HLA-DR+) and had a cytotoxic function (CD 18+). All their T cell-receptors were alpha/beta type. No NK cells could be detected. No specific proliferation was observed when tested on a panel of HLA typed presenting cells. This study demonstrated activated T-lymphocytes in the normal human cornea. These activated, cytotoxic CD8+ lymphocytes could participate in the particular immunological characteristics of the eye.