[Contemporary refractive surgical procedures]. / Les techniques chirurgicales endoculaires modernes.

Ocular surgery has progressed a great deal these last decades thanks to technological progress. The aim of this article is to describe different contemporary endocular surgical procedures such as cataract surgery, vitreoretinal surgery and corneal grafts. The main indications of the surgeries will be discussed, as well as the type of anaesthesia, the practical issues of every surgical technique and the type and rates of the different complications.

[Acute glaucoma originating from medication]. / Les glaucomes aigus d'origine médicamenteuse.

Secondary angle-closure glaucoma with pupillary block can be related with anticholinergic drugs or sympathicomimetics alpha1. Secondary angle-closure glaucoma with ciliary body oedema is predominantly related with Topiramate.

[Important bilateral corneal astigmatism in a case of ocular ochronosis]. / Astigmatisme cornéen important bilatéral en cas d'ochronose oculaire.

Ochronosis or alkaptonuria is a rare, autosomal recessive metabolic disease where the enzyme homogentisic acid 1,2-dioxygenase is missing. This enzyme is necessary in the oxidation of phenylalanine and tyrosine. As a result of this defect homogentisic acid, which is normally produced during the metabolism of the two amino-acids, cannot be further metabolized and therefore accumulates in the serum. It is massively excreted in the urine and as it is oxidized, the urine turns dark, a feature termed alkaptonuria. Tissue pigmentation called ochronosis is due to the presence and the chemical binding in the connective tissue of oxidized and polymerised products of homogentisic acid. The most important complications of alkaptonuric ochronosis as arthropathy are related to deposition of ochronotic pigment in the affected organs. In ocular ochronosis, the pigment is found in the sclera, conjunctiva, and limbic cornea. Vision is usually not impaired. We report the case of a man aged 73 years, with ochronosis, who developped a marked, late-onset bilateral astigmatism, related to this sclero-limbic ochronotic pigment. The clinical evolution, the result of histological examination and the physiopathology of this astigmatism are discussed.

[Analysis of optical coherence tomography for macular hole closure after surgery]. / Analyse tomographique de la précocité de fermeture du trou maculaire après chirurgie.

PURPOSE: The study of early closure of macular hole after surgery is difficult with intraocular gas. Using silicone oil tamponade, which gives easy access to the fundus from the first postoperative day, the optical coherence tomography (OCT) has been used to make a fine analysis of the macula. METHODS: Our study included 13 eyes with macular hole which have undergone a vitrectomy with silicone oil tamponade. An OCT was performed before the surgery, on the first postoperative day (J1), 1 week (S1) and 1 month (M1) after surgery. RESULTS: The hole closure was confirmed with OCT on the first postoperative day in 11/13 cases. One week after surgery, 12 holes were closed. An old larger hole did not close but its borders were flattened and loosed the cystic aspect. CONCLUSIONS: OCT in macular hole surgery with silicone oil tamponade confirms that in the majority of the cases the hole closes within the first 24 hours. It seems that the hole closure could be speeded by internal limiting membrane peeling.

[Vitrectomy for diabetic macular edema associated with hyaloid posterior traction]. / Vitrectomie dans l'oedème maculaire diabétique associé à une hyaloïde postérieure tractionnelle.

The vitreomacular relationship has been demonstrated to play a role in the physiopathology of the diabetic macular edema. We review the functional and anatomic results of vitrectomy performed on four eyes of three patients with diabetic cystoid macular edema unresolved by photocoagulation. The preoperative visual acuity was "finger counting" at one meter to 1/20. After surgery, for three eyes, the visual acuity raised between 2/10 and 4/10. There was no change for one eye, which presented a subretinal fibrosis. The macular edema resolved in three eyes and improved in one eye. The mean postoperative follow-up is 13 months. The vitrectomy may be effective in cases of diabetic macular traction and edema without posterior vitreous detachment.

[Surgery for macular hole without positioning]. / La chirurgie du trou maculaire sans positionnement.

Although the macular hole surgery with gas tamponade obtains good results, the face-down positioning for minimum 5 days remains constraining and is often a cause of refusal or abstention concerning the operation. We describe 7 patients who underwent the macular hole surgery by pars plana vitrectomy with internal limiting membrane peeling and fluid-silicone exchange without position restrictions. The silicone oil has been removed 2 to 3 months later. All the holes have been closed except in one case where the internal limiting membrane had not been peeled with certainty. A second surgery with peeling of this membrane has permitted the hole closure. We don't report any complications induced by the silicone oil. Silicone oil tamponade for macular hole surgery with internal limiting membrane peeling shows a good efficiency without particular positioning and without additional complications.

[Primary herpetic infection after transfixing keratoplasty]. / Primo-infection herpétique post-kératoplastie transfixiante.

PURPOSE: To describe a case of herpes simplex virus primary infection after a corneal transplantation and to analyse different possible ways by which the infection could have been transmitted. METHODS: A corneal transplanted patient for a Fuchs dystrophy complains 10 days postoperatively of a flu-like syndrome with keratouveitis. Donor and recipient viral serologies and a polymerase chain reaction analysis of aqueous humor were performed. RESULTS: An herpetic seroconversion is observed with presence of type I herpes simplex virus (HSV I) nucleic acids in the recipient's aqueous humor. The donor herpetic serology is negative. CONCLUSION: In this patient, the most probable routes of transmission of the virus are a viral reactivation from the trigeminal ganglion of the recipient, the presence of the virus in the corneal transplant or an external contamination.

[The correction of pseudophakia]. / La correction du pseudophake.

Correction of the pseudophakic patient must consider the possibility of anisometropia with aniseikonia as a consequence. Particular attention has to be brought with young unilateral pseudophakic patient without presbyopia.

Retrobulbar optic neuritis after pamidronate administration in a patient with a history of cutaneous porphyria.

We describe the case of a patient who developed reversible retrobulbar optic neuritis after intravenous pamidronate therapy for established osteoporosis. This possible complication has never been previously reported and, since our patient had a history of porphyria, it suggests that bisphosphonates should be administered cautiously in patients with this disease.

[Sympathetic ophthalmia versus Harada disease]. / Ophtalmie sympathique versus maladie de Harada.

An algerian woman presents with a panuveitis of the right eye. Main features of this uveitis are exudative retinal detachments. That happened several months after a corneal ulcer of unknown aetiology on the left eye. Immunologic, neurologic and infections workup associated with previous ocular injury points to the diagnosis of sympathetic ophthalmia. However, the diagnosis of Harada disease can also be considered in this case because of similarities regarding the clinical and the histologic aspects which are exposed. If corticosteroids are the drug of choice, enucleation is still indicated for sympathetic ophthalmia.

Use of eye muscle antibody measurements to monitor response to plasmapheresis in patients with thyroid-associated ophthalmopathy.

We have measured eye muscle antibodies, in immunoblotting, in the serum from five patients with severe ophthalmopathy associated with Graves' hyperthyroidism who underwent plasmapheresis, correlating their levels with clinical features of the eye disorder and response to treatment. Blood taken before each plasma exchange was tested in SDS-polyacrylamide gel electrophoresis and Western blotting for antibodies reactive with pig eye muscle membrane (PEMM) antigens and in a 51Cr release assay for antibodies which are cytotoxic to human eye muscle cells in antibody-dependent cell-mediated cytotoxicity (ADCC). Antibodies reactive with a 64 kDa PEMM antigen were detected in three patients who had eye disease of less than six months duration, but not in the two with more chronic disease. Antibodies against a 95 kDa PEMM antigen were detected in one patient in whom anti-64 kDa antibodies were also demonstrated. All five patients showed significant improvement in their eye disease following plasmapheresis exchange and titres of the anti-64 kDa protein antibody decreased in the three patients with detectable levels before treatment. TSH receptor stimulating antibodies were detected in all five patients before treatment, falling during plasmapheresis in four and becoming undetectable in three by the end of treatment. There was no close correlation between levels of TSH receptor antibodies and titres of anti-64 kDa protein antibodies although both tended to fall during and following plasmapheresis. ADCC tests were negative in all five patients before plasmapheresis but, surprisingly, transiently positive in three following treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[A new type of negative anterior chamber lens in high myopia]. / Lentille de chambre antérieure négative d'un nouveau type dans la myopie élevée.

We performed 12 implantations of a new type of intraocular lens in high myopia. The optical performance of this new lens, which has been polished along the peripheral rim to reduce its thickness is excellent. After 8 to 23 months, the endothelial cell counts are good.

Beneficial effects of intensive plasma exchange followed by immunosuppressive therapy in severe Graves' ophthalmopathy.

Nine patients with severe Graves' ophthalmopathy were treated by intensive plasma exchange, followed by immunosuppression. Severity of ocular involvement and response to therapy were evaluated by numerical scoring (ophthalmopathy index) and clinically. Serum thyroid stimulating immunoglobulins (TSI) and urinary excretion of glycosaminoglycans (GAG) were measured immediately before and immediately after plasmapheresis. Plasma exchange was rapidly accompanied by marked clinical improvement in 8/9 patients. The most marked effects were on soft tissue involvement, proptosis, intraocular pressure, and visual acuity. The ophthalmopathy index decreased from 9.7 +/- 4.1 to 5.7 +/- 2.2 (p less than 0.001) after plasmapheresis. Serum TSI levels were initially elevated in 6 patients and remained positive in 3 patients after treatment. Urinary GAG excretion was initially 2- to 12-fold normal levels and was decreased by 60%. After plasmapheresis, patients received immunosuppressive drugs for 3-6 months. The follow-up period, after withdrawal of drugs, ranged from 5 to 38 months with a median of 17 months. The ocular condition remained stable in 6 patients. Three patients had a relapse 1 year after plasmapheresis: they were treated a second time by plasma exchange with subsequent improvement. In conclusion, intensive plasma exchange provided prompt and effective improvement in patients with severe progressive Graves' ophthalmopathy. This therapeutic procedure, followed by immunosuppression, gave long lasting results. Relapses were responsive to plasmapheresis therapy. The data suggest that plasma exchange may represent the best primary treatment for severe progressive Graves' ophthalmopathy.

Plasma exchange therapy for severe Graves' ophthalmopathy.

The authors report on the treatment of 11 Graves' disease patients with severe ophthalmopathy by the use of intensive plasma exchange followed by immunosuppression. Results were evaluated by comparing the ophthalmopathy index and the orbital CT scan performed before and after plasmapheresis. Favorable results were obtained in 91% of the patients. The best positive effects of plasmapheresis were observed for soft tissue involvement, proptosis, tonometry, and visual acuity. Furthermore, a significant reduction in the size and density of enlarged extraocular muscles was also found. Six months after withdrawal of immunosuppression, 4 patients presented a moderate recurrence of ophthalmopathy and were treated successfully by a second course of plasmapheresis, followed by short immunosuppression. In conclusion, the use of intensive plasma exchange associated with immunosuppression is an effective approach to the treatment of severe Graves' ophthalmopathy. It yields rapid and dramatic improvements that are maintained in most patients after withdrawal of immunosuppression. Recurrences are still responsive to the beneficial effects of this combined treatment.