Archives d'ophtalmologie et revue generale d'ophtalmologie最新文献

After a short survey of the symptoms of the serous central retinopathy, the authors describe its treatment by argon laser. Almost all their results have been good in so short a time that they think the best way to manage the disease is to photocoagulate the leakage point as soon as it is discovered. In this manner a long course will be prevented, which disables the patient and is not harmless for the retina.

The prevention of retinal detachment by the argon laser photocoagulation of the peripheral degenerations of the retina was unsuccessful in 6 p. 100 of the cases. The proportion of failures is about the same as that of xenon photocoagulation. It is much more important than that of cryocoagulation. In the contrary the results are better in the management of macular holes without detachment.

We have performed 40 keratoplasties in 35 eyes presenting with corneal wounds. These injuries follow accidents of which the most frequent are:--metallic foreign bodies;--windscreen. The following results have been obtained after these grafts;--49 p. 100 success;--51 p. 100 failure. In fact 51 p. 100 of the eyes did not benefit from a satisfactory functional result despite the fact that the graft remained clear in 63 p. 100. Our failures are due to two principle complications: cataract and its subsequent surgical management in 28 out of 35 cases, and detachment of the retina in 3 out of 35 cases. The remaining failures are related to the usual complications of other keratoplasties. These keratoplasties are special since a contussion of the posterior pole is often associated with the corneal wound. The indications for these grafts cannot wait until an accurate assessment of the state of the posterior segment is possible, and this is why these grafts are special and why there should be reservations on the prediction of the final visual result. Keratoplasty however remains the only hope for visual recovery and in children the only means of preventing the development of definite amblyopia. Nevertheless in children the prognosis remains the most pessmistic (4 failures out of 5 cases in children under 10).

The authors give their opinion about the treatment of the Diabetic Retinopathy by the argon laser. They made use successively of xenon, then argon laser photocoagulation and they prefer the latter. They present 15 cases of patients treated by photocoagulation and watched during an average period of 4 years. The results are plainly favourable to the photocoagulation.

After the hypothesis of Porter and Yamada about the photoreceptive role of myeloid bodies of the vertebrate pigment epithelium, we have pointed out the fine ultrastructure of these organelles: they consist of piles of flattened saccules, with a lipidic content, and linked together by an inter-saccular cement. They are not like Golgi bodies: they do not content glycoprotein. They must be discarded from phagosomes, which are membrane-bounded and content acid phosphatase activity. An oxido-reductive activity cannot been demonstrated at their level, similar to that observed on the rod outer segments. Freeze-etching does not show peculair organization on their fracture faces. They represent a special organization of the endoplasmic reticulum which seems to have a function in the metabolism of visual pigments in certain species of animals, the retina of which is avascular.

A report of a study on the cellular and tissue morphology of organotypic cultures of rabbit cornea using a method conforming to physiological conditions. The results demonstrate that in the first few hours there exist structural changes in the tissues as well as on ordinary histology, scanning and electron microscopy. These affect the endothelium primarily, whereas the keratocytes and epithelium seem to be more resistant, the latter having the tendency to invade the surfaces of the explant and to transform itself into fibroblastic cells. Certain reservations should therefore be expressed about the use of these explants, whether they are intended to preserve pathological corneas of different origin, or to be used in transplants.

The authors discuss the problems posed by carotico-cavernous fistulae. New radiological techniques enable a more precise diagnosis, a haemodynamic approach and the therapeutic solutions are able to avoid all surgical intervention.

This investigation is based on 262 cases of retinal detachment treated with episcleral silastic sponge implants and cryopexy. Anatomical restoration of the retina after one operation or more was successful in 89 percent. Drainage of subretinal fluid was carried out in 52 percent of the cases. Supplementary light-coagulation 3 or 4 weeks after the operation was applied in 43 cases (17 percent) in order to seal off retinal holes on the buckle due to inadequate chorioretinal adhesion following cryopexy. Insufficient adhesion was directly related to the retinal elevation in the area of the tear. Chorioretinal haemorrhages in the group without release of subretinal fluid were caused by the following factors: Repeated cryo-application in the same place, application of the probe on the open part of the tear instead of around the tear, sponge-fixation in the immediate area to vortex veins, pressure exerted by the sponge on choroidal and retinal vessels, particularly in persons of advanced age. Local haze of the vitreous corresponding to the location of the cryp-application was directly related to the number of applications and the position of the tear. Vitreous haze was more frequent where the hole was situated towards the ciliary body. Pigment migration was observed in 9 percent of the cases. It should be noted that this complication was also encountered preoperatively in a group amounting to 4 percent of the total number of cases after padding of the eyes and absorption of subretinal fluid. Such cases should be distinguished from those of postoperative occurrence of pigment migration. Detachment of the choroid happened more often in the group in which subretinal fluid was released. In this group expulsive haemorrhage also occurred, which, apart from the choroidal detachment, resulted, immediately upon drainage of subretinal fluid, in high intracular pressure. Macular puckering was noticed in 5 cases (2,7 percent). In 4 out of the 5 cases with this complication, the tear was located towards the posterior pole and sponge fixation was radial.