Ophtalmologie : organe de la Societe francaise d'ophtalmologie最新文献

We are using Cobalt 60 plaques at Curie Institute since 1968 for the treatment of malignant choroidal melanoma. We reviewed a series of 79 patients treated between 1982 and 1984 with a minimal follow up of 5 years. Tumors thickness varies between 2 and 11 mm with a mean thickness of 5.7 mm. All the tumors received at least 70 grays at the apex. 7 patients died from other cause, 7 patients presented metastasis 65 patients are alive and well, 49 of them have kept their eye and 16 have been enucleated. 18 patients have a visual acuity below 20/200 because of severe maculopathy, 29 patients have a visual acuity between 20/200 and 20/25. The most severe functional visual loss was due to maculopathy. It consisted of obliteration of the capillaries, exsudation and cystoid macular oedema. If we compare these results to other authors we see that maculopathy is a frequent problem with cobalt 60. For these reasons, we intend in the future to use iodine 125 plaques and prothontherapie that should give us better functional results.

Steady-state VEPs responses (pattern reversal stimulation) have been studied by the application of frequency analysis with Fourier methods. Authors examined with this method a group of children aged from 4 to 12 years, without ophthalmological or neurological pathologies. Responses evaluation is based on the number of harmonic frequency components and also on the power spectra of the first two components. Frequency analysis shows a well proportioned responses development that can be considered as a good index of visual function growth.

Analysis of vergence troubles is weight by an heavy handicap. In clinical conditions it is easy to value the static vergence balance with a great lot of tests. On the contrary examination of kinetic vergence pattern is generally neglected. Usually a refixation vergence is a combination of an horizontal convergence-divergence of 5 to 10 degrees with a vertical component of 15 to 20 degrees. It is impossible to do their reliable analysis by kinetic EOG because the unequal transmission of potential towards the orbital rim. The authors give the results obtained by photo-oculographic method perfected by Charlier and Buquet. On all recordings it can be noticed that, in vergence refixation, vertical movements of both eyes are always true congruent saccadic versions, while the horizontal movements are disjunctive, dissociated and unequal. On the vertical axis it seems to be no real kinetic vergence at all, but in some cases only a mere tonic alignment. Such a device is a very good mean to study the vergence troubles in daily practice.

Retinal nerve fiber examination is confronted with the results of automatic exploration of visual field with Octopus. 99 eyes affected by open angle glaucoma were studied during a period of 4 years or less. Analysis is done in accordance with the course under therapy. Good pressure results are obtained. Meanwhile visual field indexes show a slow deterioration under medical treatment, a stabilisation after laser trabeculoplasty and a marked improvement after surgery (trabeculectomy). Retinal nerve fiber are clear prior affected in comparison with visual field in early glaucoma, and a perfect agreement is demonstrated in mature cases.

We present 15 cases of chronic endocular posterior inflammation, so called vitritis, following cataract surgery. All these cases occurred after uneventful extracapsular surgery plus posterior chamber intraocular lens implantation. Aqueous and a vitreous taps did not reveal any germ but they were done long after the onset of inflammation. Vitrectomy for optical purpose may be helpful for these patients. The two main complications have been retinal detachment and cystoid maculopathy. Retinal detachment can be cured but this requires quite often sophisticated surgical procedures. We found no effective treatment for cystoid maculopathy.

The authors study two hundred observations of children with esotropia operated by recession of internal muscles associated or not with one or two loops. The indications are precise, then the secondary exotropia is studied. The technic doesn't seem to give more frequent exotropia than other surgical procedures if the initial protocol is right.

The availability of more and more reliable obstetrical echographies makes now possible to screen fetuses for microphtalmies and anophtalmies. More over, by mean of linkage studies with DNA markers within a family, we can identify the women who will transmit X-linked diseases, and realize a prenatal diagnosis. This technology can be applied to the following ophthalmological diseases: the X-linked retinoschisis, the choroideremia, the ocular albinism, the Noorie disease, and recently the retinoblastoma. From now on, the use of such a technology which makes it possible to detect ophthalmological diseases in the fetuses, is posing ethical problems especially in case of diseases without any survival prognosis involvement.

Several studies support that retinoblastoma originates from a primitive neuroectodermal cell, the main argument being the expression of the neuron-specific enolase (NSE) by the retinoblastic cells. NSE was measured in the aqueous humor taken off: 1) in 19 patients with various eye disorders for which the diagnosis of retinoblastoma was definitely excluded (NSE = 5.0 +/- 7.7 micrograms/l); 2) at the time of the enucleation, in 7 cases of proved retinoblastoma (NSE = 83 to 17,900 micrograms/l); 3) in 2 cases of retinoblastoma held as cured for more than 5 years (NSE = 2.8 and 8.7 micrograms/l). The high level of NSE in the aqueous humor of the subjects with retinoblastoma is very significant, so that it can play a great part in the diagnosis, particularly in the case of atypic tumors. Specific indications of this determination may be considered for the survey of tumors under treatment or of the controlateral eye after a first tumor.

We have done two argon-laser iridotomies 24 and 72 hours before cataract surgery, to study ocular inflammation. We have taken aqueous samples to study IgA, IgG, C3 and AAT by laser immunonephelometry. All the proteins raised in the first 24 hours (P less than or equal to 0.01) except IgA in aqueous humor, taken with control levels, but only AAT (P less than or equal to 0.05), albumine at 72 hours (P less than or equal to 0.01) in aqueous humor. We tried to understand the observed gap by immunomodulation of released mediators.

The association 106Ru/106Rh and 60Co was used to treat choroidal malignant melanomas with a height of 7 mm above the scleral surface (4 cases) and tumors unsuccessfully treated with a first 60Co plaque therapy (3 cases). The association of both radionuclides allowed a dose of 85 Gy at the apex of the tumor and of 700 Gy at least on the base in every case. All the patients were alive without evidence of metastases with a minimum follow up of one year and the tumor regression was constant and sometimes spectacular.