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ABSTRACT: OBJECTIVE: To evaluate early strabismus treatment in patients suffering from diplopia after orbital decompression for dysthyroid orbitopathy. PATIENTS AND METHODS: We conducted a chart review of 51 patients (87 orbits) who underwent orbital decompression from July 1998 to June 2007. Ocular deviations, incidence of diplopia according to the type of decompression performed and the type and results of strabismus surgery were evaluated. RESULTS: Diplopia was induced by decompression in 34.2% of patients, with no statistically significant difference with respect to the type of decompression performed. Forty-nine percent of patients had postoperative diplopia. Strabismus surgery was performed on average 10.9weeks after decompression. Diplopia persisted in two patients (8%). CONCLUSION: Early strabismus surgery and the intraoperative relaxed muscle positioning technique appear to provide favorable results. It allows for a more rapid rehabilitation. Better adapted choice of decompression technique may improve final outcomes.
Journal francais d'ophtalmologie 10/2012; · 0.51 Impact Factor
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ABSTRACT: According to the literature and to the advice of experts, the French Agency for the Safety of Health Products (AFSSAPS) edited recommendations about the antibioprophylaxis in ocular surgery. One goal was to avoid the extensive use of oral and topical fluoroquinolones in antibioprophylaxis, in order to preserve their antibacterial activity for curative treatments of severe eye infections. The medical team decides for the indication and the type of antibioprophylaxis for each patient. A topical antibiotic is recommended for any eye surgery until the etancheity of incisions. Due to the risk of selection of bacterial resistance topical fluoroquinolones are not recommended in this indication. In open eye surgery, an additional antibioprophylaxis is recommended: in cataract surgery, injection in the anterior chamber at the end of the procedure of 1mg of cefuroxime; in other open eye surgeries, only in case of risk factors for endophthalmitis, administration of 500 mg oral levofloxacin tablet 12 hours and two hours before surgery. For ocular punctures and intravitreal injections, only a topical postoperative antibiotic is recommended until healing.
Journal francais d'ophtalmologie 06/2011; 34(6):428-30. · 0.51 Impact Factor
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ABSTRACT: Crohn disease is an inflammatory bowel disease. Extradigestive manifestations can occur, especially ocular inflammation, but posterior choroidal inflammation is more unusual.
We report the case of a 42-year-old woman, suffering from histologically proven Crohn disease for one year, who developed choroiditis in the left eye of unknown etiology. Fundus and fluorescein angiography displayed an aspect mimicking ampiginous choroiditis, and indocyanine green (ICG) angiography disclosed a large choroidal subtractive aspect.
This case is a rare example of posterior segment manifestation in Crohn disease, possibly due to choroidal infiltration by inflammatory cells or choroidal focal ischemia.
Journal francais d'ophtalmologie 05/2011; 34(9):653.e1-5. · 0.51 Impact Factor
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ABSTRACT: To evaluate the efficacy and efficiency of the new small anterior incision, small-incision dissection procedure (Frueh's procedure) for the correction of involutional and congenital blepharoptosis.
This was a retrospective study to compare different parameters between Frueh's procedure and the traditional aponeurotic anterior approach in a group of 98 involutional blepharoptosis patients and between Frueh's procedure and Whitnall's sling in a group of 21 congenital blepharoptosis patients. The main criterion was recurrence requiring reintervention.
In the adult's group, the rate of reoperation was not significantly different for the two surgical procedures (p=0.82). In the children's group, the rate of reoperation was not significantly different for the two surgical procedures (p=0.3).
In adults, compared with the traditional aponeurotic approach, Frueh's procedure for blepharoptosis correction is equally efficacious in correcting eyelid height, superior in producing desirable eyelid contour, and much quicker to perform. In children, Frueh's procedure is a good technique for mild and moderate blepharoptosis with a good levator function. However, Frueh's procedure in severe blepharoptosis with low levator function seems not to be as efficient as the traditional surgical techniques.
This study confirms Frueh's procedure as a reference for the treatment of adults and children with blepharoptosis.
Journal francais d'ophtalmologie 05/2011; 34(7):439-47. · 0.51 Impact Factor
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ABSTRACT: Endophthalmitis is one of the leading sources of dispute in ophthalmology. The patient has a number of means to make an appeal. Fortunately, appeal to the criminal justice system is rare in medicine, but always possible (e.g., indictment for endangering the life of others or for involuntary injury). Civil action is more frequent, allowing the patient to recover damages in case of negligence on the part of the surgeon. Finally, the law of March 4th 2002 allows the CRCI to award an indemnity to patients if the surgeon is not at fault, but in certain conditions only. The knowledge of the surgeon's obligations and the means of appeal available to the patient is very useful for the ophthalmologist.
Journal francais d'ophtalmologie 01/2011; 34(1):46-50. · 0.51 Impact Factor
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ABSTRACT: We report the direct genotyping analysis of Toxoplasma gondii in ocular samples collected from 20 patients, as well as associated clinical and epidemiological data. This work was aimed at better understanding the impact of genotypes of Toxoplasma gondii strains on toxoplasmic retinochoroiditis. For this purpose, we studied the aqueous humor (AH) or vitreous humor (VH) of 20 patients presenting with ocular toxoplasmosis (OT) in 2 hospitals in France. Genetic characterization was obtained with microsatellite markers in a multiplex PCR assay. In contrast to the results of previous studies, we found no association between atypical Toxoplasma gondii genotypes and the occurrence of OT. Considering the local epidemiological data, our OT patients seemed to be infected more frequently by ordinary type II strains found in the environment. In conclusion, direct genotyping of Toxoplasma gondii strains from aqueous or vitreous humor showed a predominance of the type II genotype in ocular toxoplasmosis; this may be due to a high exposure rate of this genotype in humans.
Journal of clinical microbiology 01/2011; 49(4):1513-7. · 4.16 Impact Factor
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A Sauer,
F Abry,
J-P Berrod,
A Bron,
C Burillon,
C Chiquet,
J Colin,
C Creuzot-Garcher,
B Delbosc,
L Hoffart, [......],
J Beynat,
M Brisard,
A Combey de Lambert,
A Donnio,
G Gendron,
R Pagot,
M Saleh,
D Gaucher,
C Speeg-Schatz,
T Bourcier
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ABSTRACT: microbial keratitis is a significant health concern for the one million wearers of contact lenses and their ophthalmologists, with some potentially modifiable risk factors. The number of risk factors for contact lens-related microbial keratitis has been described, but many of them still remain assumed or unknown.
a multicenter prospective case-control study was conducted in 12 French university hospitals (Besançon, Bordeaux, Dijon, Fort-de-France, Grenoble, Limoges, Lyon, Nancy, Nantes, Paris, Marseille and Strasbourg) beginning in July 2007 on contact lens wearers presenting with microbial keratitis and on healthy contact lens wearers. Patients and healthy wearers were interviewed using a 51-item anonymous standardized questionnaire to determine subject demographics and contact lens wear history.
two hundred and fifty-six patients with microbial keratitis were included. One hundred and thirteen healthy contact lenses wearers were surveyed. Cosmetic contact lens wear highly increased the relative risk (RR) of microbial keratitis (RR, 16.5). Time since the last visit to an ophthalmologist longer than 1 year (RR, 3.4) or prescription by someone other than an ophthalmologist (RR, 7.6) also increased the risk of microbial keratitis. Education on lens care and handling was deficient (hand washing: RR, 2.2; rub and rinse: RR, 2.7).
a standardized questionnaire is a powerful tool to determine risk factors for contact lens-related microbial keratitis, but also to analyze individual mistakes in contact lenses use and care.
Journal francais d'ophtalmologie 12/2010; 33(10):701-9. · 0.51 Impact Factor
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ABSTRACT: Albers-Schönberg's disease is a rare disease (one case in 100,000 inhabitants), asymptomatic in the majority of cases. It belongs to the four clearly individualized forms of human osteopetrosis and has an autosomal dominant transmission. It induces generalized osteosclerosis, and most symptoms result from complications such as fractures following mild injury, compression of cranial nerves, especially the optic nerve, by stenosis of extracranial ostia, but also osteomyelitis of the lower maxilla. The treatment of Albers-Schönberg's disease is disappointing and only symptomatic, although the responsible genetic anomaly was recently identified. We report here the case of a 54-year-old woman, whose diagnosis of the disease has been known since adolescence, who presented with unilateral loss of vision and perimetric deficit due to papilla edema resulting from stenosis of the optic canal and benign intracranial hypertension.
Journal francais d'ophtalmologie 11/2010; 33(9):655.e1-9. · 0.51 Impact Factor
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Journal francais d'ophtalmologie 10/2010; 33(8):599-602. · 0.51 Impact Factor
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ABSTRACT: Commonly used visual test charts can be used to measure 1-m minimal visual acuities (VA) of 20/1000 (Snellen chart) and 1/40 (Early Treatment of Diabetic Retinopathy Study [ETDRS] charts).
In a prospective study, we considered all patients who visited in a Low Vision and Rehabilitation Center between September 2007 and January 2009. Distance best corrected VA (DBCVA) was evaluated with the ETDRS LogMAR 4-m chart and a customized ETDRS 1-m chart, while near best corrected VA (NBCVA) was measured with the LogMAR conversion of the Parinaud 30-cm chart.
One hundred and sixteen eyes (58 patients; 34 males and 24 females with a mean age of 69+/-19.4 [19-94] years) were included in the study. Mean DBCVA was 0.97+/-0.58 LogMAR, mean NBCVA was 0.28+/-0.2 LogMAR. In 52 eyes (44.8%), distance VA was less than 1/20 (DBCVA 1.86+/-0.5 LogMAR, NBCVA 0.08+/-0.05 LogMAR). Among the 58 best seeing eyes, DBCVA was 0.87+/-0.6 LogMAR, while NBCVA was 0.34+/-0.2 LogMAR. In 18 of 58 cases (31%), distance VA was less than 1/20 (DBCVA 1.86+/-0.59 and NBCVA 1.51+/-0.42).
In a center for low vision and visual rehabilitation, a customized chart was necessary in 31% of cases for evaluation of VA. A fine measurement of low VA is useful for baseline assessment and for evaluation of changes during rehabilitation.
Journal francais d'ophtalmologie 06/2010; 33(6):391-6. · 0.51 Impact Factor
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ABSTRACT: Bacterial conjunctivitis is characterized by hyperemia and discharge of one or both eyes. These clinical signs appear quickly and are contagious. This study compares the clinical efficacy (signs and symptoms) and safety of azithromycin 1.5% eye drops with tobramycin 0.3%.
This was a multicenter, randomized, investigator-masked study including 1,043 patients with purulent bacterial conjunctivitis. Patients received either azithromycin twice daily for 3 days or tobramycin, 1 drop every 2 hours for 2 days, then four times daily for 5 days. The primary variable was clinical cure at the test-of-cure (TOC) visit (D9) on the worst eye. The cure was defined as bulbar conjunctival injection and discharge scores of 0. Clinical signs were evaluated at D0, D3, and D9.
In the azithromycin group 87.8% of patients and in the tobramycin group 89.4% were clinically cured at D9. Clinical cure with azithromycin was not inferior to tobramycin at D9: discharge was absent in 96.3% of patients treated with azithromycin and 95.1% with tobramycin. Azithromycin was well tolerated.
Azithromycin 1.5% for 3 days (six drops) was as effective as tobramycin for 7 days (36 drops). Furthermore, patients on azithromycin presented earlier clinical cure on Day 3 than patients on tobramycin. Azyter, with its convenient dosing (bid for 3 days), is a step forward in the management of purulent bacterial conjunctivitis.
Journal francais d'ophtalmologie 03/2010; 33(4):241-8. · 0.51 Impact Factor
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ABSTRACT: The aim of this study was to assess the efficacy of Naabak((R)) eyedrops in reducing inflammation in dry eye syndrome.
This pilot, multicenter, randomized, double-blind, parallel study was carried out in adult patients suffering from moderate dry eye syndrome. Patients were treated for three months with preservative-free NAAGA (Naabak((R))) or with sodium chloride 0.9% without preservative (Larmabak(R)). They received the treatment four to six times a day during the 1(st) month and three to four times a day during the 2(nd) and 3(rd) months. At each visit (D28 and D84), clinical tests were performed as well as a biological evaluation of HLA-DR and MUC5AC expression on conjunctival imprints using flow cytometry.
After three months of treatment, the ocular surface symptoms and overall discomfort were improved in patients treated with Naabak(R) and in those treated with Larmabak(R) with no significant difference between the groups. Cytological impression showed a significant decrease in the expression of inflammatory markers, notably antigen HLA-DR, in the Naabak(R) group.
This study confirms the anti-inflammatory property of preservative-free NAAGA (Naabak(R)) in the context of dry eye syndrome with a similar clinical efficacy compared to sodium chloride solution (Larmabak(R)). Naabak(R) could present an additional advantage compared to artificial tears and could be indicated in the treatment of moderate inflammatory dry eye syndrome.
Journal francais d'ophtalmologie 10/2009; 32(9):613-20. · 0.51 Impact Factor
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ABSTRACT: Purpose Whitnall's ligament is one of the main landmarks in ptosis surgery. However, its relationship with the levator muscle is still unclear. In order to define its anatomical position precisely the authors have performed a study on 18 cadaver orbits. Material and methods Macroscopic anatomy of the upper eyelid was examined using surgical observation and three fresh cadaver dissections. Microscopic anatomy was examined using 13 fresh cadaver dissections after a subperiosteal exenteration with histologic sections of the upper eyelid. Results The distance between the origin of the levator aponeurosis and the superior border of the tarsus varied between 5.4 and 8.2 mm. The aponeurotic fibers blending with the septum are located between 2.4 and 5.3 mm from the superior border of the tarsus. The thickness of Whitnall's ligament averages between 0.1 and 1 mm. Conclusion The unit levator muscle, levator aponeurosis, Whitnall's ligament plays a primary role in the statics and the physiologic movements of the upper eyelid.
07/2009; 14(1):43-51.
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ABSTRACT: Purpose Optic nerve sheath decompression is advocated for the treatment of certain types of optic nerve dysfunction with progressive visual loss such as pseudotumor cerebri and progressive non arteritic anterior ischemic optic neuropathy. Symptoms can recur however in 25 to 33% of cases due to obstruction of the fenestration. Material The authors describe the use of a valve for optic nerve sheath fenestration. The valve is made by introducing one end of a silicone tube between the two layers of arachnoid tissue overlying the optic nerve head and suturing the other end to the sclera. The latter tube end is obstructed except for two slits created laterally and has two small silicone wings used to anchor the sutures. When pressure inside the tube exceeds 10 mmHg, fluid spills through the two slit openings. This valve has been designed to improve the results of optic nerve sheath fenestration operations. Results Three patients underwent surgery using this technique. Visual acuity improved in one patient and visual loss did not progress in the two other patients. Conclusion A theco-conjunctival shunt in the form of a valve to prevent obstruction of optic nerve sheath fenestration is an option that must be studied on a larger scale.
07/2009; 14(1):37-41.
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ABSTRACT: Photodynamic therapy (PDT) can prevent visual loss and the risk of hemorrhage in exudative ARMD. Nevertheless, it can sometimes complicate with massive hemorrhage. We report the case of a massive macular hemorrhage 4 days after a first treatment with dynamic phototherapy (PDT) with Visudyne for rapidly progressive (6 months) exudative AMD with occult neovessels in an 86-year-old female. The rationale for PDT was a rapidly progressive lesion with preserved visual acuity (20/40). Four days after injection, a massive submacular hemorrhage of 6 disc diameter developed, with a dramatic decrease in visual acuity. This hemorrhage recovered within 6 months, producing large, fibroglial, submacular scarring with changes on the retinal pigment epithelium. This case highlights the possible side effects of this treatment.
Journal francais d'ophtalmologie 10/2008; 31(7):714.e1-7. · 0.51 Impact Factor
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P-Y Robert
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ABSTRACT: Given the increase in bacterial resistance, antibiotics use has been carefully studied during the last decade. In France, topical antibiotics have therefore been restricted to medical prescription, and specific guidelines were published by the French Agency for the Safety of Healthcare Products (AFSSAPS) in 2004. This article reviews the literature on emerging bacterial resistance in ophthalmology, and summarizes the AFSSAPS guidelines.
Journal francais d'ophtalmologie 05/2007; 30(4):417-22. · 0.51 Impact Factor
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Journal francais d'ophtalmologie 05/2007; 30(4):436-7. · 0.51 Impact Factor
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ABSTRACT: The ophthalmic artery arises from the internal carotid at the level of the carotid siphon; in 3.5-5% of the population, it arises from the middle meningeal artery, a branch of the internal maxillary artery, terminal of the external carotid artery. We report a rare case of bilateral malformation in a 28-year-old patient. Our study covers the possible dual origin of orbital blood vascularization. This variation in the anatomic distribution is important to know, particularly if embolization is intended as inadvertent occlusion of the ophthalmic artery, because it may lead to permanent loss of vision.
Journal francais d'ophtalmologie 11/2006; 29(8):e20. · 0.51 Impact Factor
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ABSTRACT: Granulocytic sarcoma rarely involves the orbit. It is the local proliferation of immature myeloid cells and occurs most often in patients suffering from myelodysplastic syndromes. We report a case of granulocytic sarcoma that revealed acute myeloid leukemia in a patient suffering from chronic myelomonocytic leukemia. At the time of diagnosis, the lesion involved the nasal fossae, the ethmoidal sinus, and the orbit, with subperiosteal tumoral infiltration toward the skin. The treatment involved surgery and radiotherapy. The patient died 3 months later of complications of the hematological disease. This observation is original for the occurrence of granulocytic sarcoma during chronic and well-known leukemia, the age of onset, and the fatal outcome in just a few weeks. In this observation, the ophthalmologist revealed the acute nature of the myelodysplastic syndrome.
Journal francais d'ophtalmologie 11/2006; 29(8):961-4. · 0.51 Impact Factor
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ABSTRACT: The clinical aspect of tumors of the eyelids is polymorphous; however, the most frequent are benign tumors such as papillomas, basal cell carcinoma, squamous cell carcinoma, meibomian gland carcinoma, and melanomas. An important step in the management of the malignant types is to try to establish clear margins through histopathologic techniques: the Mohs technique, the rapid fixation technique, and the frozen section method are the most frequent technical tools used today. For the most malignant tumors such as malignant melanoma and Merkel cell tumor, lymph sentinel biopsy is a recent, valuable tool, but its benefit needs to be confirmed in large series.
Journal francais d'ophtalmologie 07/2006; 29(6):687-93. · 0.51 Impact Factor
