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Biomedical subjects

A Gaudric

Publications and source records attributed to A Gaudric.

At least 55 records · Page 3Linked to original sources
PubMed2000

Evaluation of fluorescein-labeled autologous leukocytes for examination of retinal circulation in humans.

PURPOSE: Increased leukocyte-endothelium interaction have been suggested as a phenomenon contributing to capillary occlusion and/or rupture of the blood-retina barrier during human retinal vascular diseases. This study was performed to evaluate if fluorescein-labeled autologous leukocytes (FLALs) can be used for examination of leukocyte transit in the human retina. METHODS: The preparation consisted of human dextran-separated leukocytes mixed with fluorescein. After reinjection in normal subjects and in one diabetic patient, a confocal scanning laser ophthalmoscope was used to visualize them in the retinal circulation. The changes between FLALs and control leukocytes in the expression of leukocytes adhesion molecules CD11b and CD62L were evaluated by flow cytometry. RESULTS: The circulating FLALs were clearly visible in retinal vessels. The mean (+/- SD) capillaries velocity was 1.43 (+/- 1.3) mm/s in the macula and 1.82 (+/- 1.4) mm/s in the peripapillary area. No leukostasis was detected in the normal subjects, while it was detected in te diabetic patient. Flow cytometry revealed an increase in CD11b and a decrease in CD62L expression of leukocytes after labeling, suggesting that compared to normal leukocytes FLALs are more susceptible to interact with vascular endothelium. CONCLUSIONS: The use of FLAL is presently the only technique applicable in humans for study of leukocyte transit in the retina. Their preparation is technically simple and unexpensive. Precise measurement of the velocity of leukocytes in small vessels can be obtained. Despite evidence of a certain degree of leukocyte activation after the labeling procedure, no leukostasis was detected in vivo in normal subjects. Potential applications for this technique may include the detection of leukostasis in the human retina during severe forms of diabetes and retinal phlebitis.

Adult↗
PubMed2000

[Bilateral sino-orbital mucormycosis. A case report].

We report a case of mucormycosis in a 48 year-old diabetic woman. She presented with nasosinusal ulcer accompanied by panophthalmitis in the left eye and central retinal artery occlusion in the right eye. Left eye enucleation was performed and the diagnosis of mucormycosis was made on histopathologic examination displaying fungal micro-organisms in the optic nerve and in the retina. The patient died of stress ulcer hemorrhage. Mucormycoses are rare and severe diseases affecting immunocompromised hosts, especially diabetic patients during ketoacidosis. The treatment includes surgical debridement and amphotericin B but prognosis remains severe.

Amphotericin B↗
PubMed1999

Macular hole formation: new data provided by optical coherence tomography.

OBJECTIVE: To establish the sequence of events leading from vitreofoveal traction to full-thickness macular hole formation. METHODS: Both eyes of 76 patients with a full-thickness macular hole in at least 1 eye were examined by biomicroscopy and optical coherence tomography. RESULTS: Sixty-one fellow eyes had a normal macula. Optical coherence tomograms showed central detachment of the posterior hyaloid over the posterior pole in 19 cases (31%) and a perifoveal hyaloid detachment not detected on biomicroscopy in 26 cases (42%). In the 4 impending macular holes, optical coherence tomography disclosed various degrees of intrafoveal split or cyst, with adherence of the posterior hyaloid to the foveal center and convex perifoveal detachment. In the 14 stage 2 holes, eccentric opening of the roof of the hole was observed, and in the 24 stage 3 holes, the posterior hyaloid was detached from the entire posterior pole. CONCLUSIONS: In fellow eyes of eyes with macular holes posterior hyaloid detachment begins around the macula, but the hyaloid remains adherent to the foveolar center, indicating the action of anteroposterior forces. This results in an intraretinal split evolving into a cystic space, and then to the disruption of the outer retinal layer and the opening of the foveal floor, thus constituting a full-thickness macular hole.

Aged↗
PubMed1999

Sclerochoroidal calcification associated with Gitelman syndrome.

PURPOSE: To investigate sclerochoroidal calcification in a patient with Gitelman syndrome. METHOD: Case report. Bilateral fundus abnormalities observed in a 58-year-old woman were documented with fluorescein angiography and tomodensitometry. RESULTS: Symmetric yellow-white subretinal lesions were observed in the superotemporal midperiphery of the fundus of each eye. Tomodensitometry examination was consistent with calcium deposition. The medical history included Gitelman syndrome. Sclerochoroidal calcification probably resulted from the severe hypomagnesemia. CONCLUSION: Gitelman syndrome may be a cause of sclerochoroidal calcification.

Calcinosis↗
PubMed1999

Effect of autologous platelet concentrate in surgery for idiopathic macular hole: results of a multicenter, double-masked, randomized trial. Platelets in Macular Hole Surgery Group.

OBJECTIVE: To evaluate prospectively the efficacy and safety of autologous platelet concentrate (APC) as an adjuvant in surgery for idiopathic macular hole. DESIGN: Multicenter, double-masked, randomized clinical trial. SETTING: Four university-based ophthalmology clinics. PARTICIPANTS: One hundred ten patients with stage 3 or 4 idiopathic full-thickness macular holes of less than 3 years' duration were randomized (53 eyes to the platelet group and 57 eyes to the control group). INTERVENTIONS: Standardized macular hole surgery versus surgery combined with injection of an APC. In all cases, the procedure consisted of three-port pars plana vitrectomy, posterior hyaloid separation, and nonexpansile fluid-gas exchange. After the fluid-gas exchange, patients were randomized to receive either injection of an APC or no adjunctive treatment. After surgery, patients were positioned face down for 12 days. Platelet counts showed that the concentrates contained a mean of 96.106 platelets (range, 82-102). MAIN OUTCOME MEASURES: Anatomic and functional evaluations were performed at 1, 3, and 6 months after surgery in a double-masked fashion by an independent observer. The main outcome was reapposition of the edge of the macular hole 1 month after surgery. Secondary outcomes were anatomic status at 3 and 6 months, changes in Early Treatment Diabetic Retinopathy Study score, and complications. RESULTS: One month after surgery, the anatomic success rate in the platelet group was 52 of 53 (98%; 95% confidence interval, 0.90-1.00) versus 47 of 57 (82%; 95% confidence interval, 0.70-0.91) in the control group (P = 0.009, Fisher's exact test; relative risk, 0.11; 95% confidence interval, 0.01-0.81). Visual acuity was not significantly different between the two groups at any timepoint. There were no complications specifically attributable to the platelet injection. CONCLUSION: Injection of APC improved significantly the anatomic success rate of surgery for idiopathic macular holes of less than 3 years' duration, but postoperative visual acuity of the platelet group was not statistically different from the control group.

Aged↗
PubMed1999

Visual outcome of surgery for epiretinal membranes with macular pseudoholes.

OBJECTIVE: To evaluate the effect of macular pseudohole on visual results after epiretinal membrane (ERM) surgery. DESIGN: Retrospective case-control study. PARTICIPANTS: The postoperative results for 50 eyes with ERMs combined with pseudohole were compared with the results for a paired series of idiopathic ERMs without pseudohole operated on during the same period. INTERVENTION: All patients underwent standard three-port pars plana vitrectomy, including core vitrectomy, and removal of the membrane. MAIN OUTCOME MEASURES: Anatomic and functional evaluations were performed before and after surgery. Main outcome measures were postoperative visual acuity and the persistence or disappearance of the pseudohole. RESULTS: For the patients with pseudohole, median preoperative visual acuity was 20/63 (range, 20/32-20/860) and median postoperative visual acuity was 20/40 (range, 20/20-20/860). Vision improved by 2 or more lines in 31 (62%) of 50 eyes. Forty eyes (80%) reached visual acuity of 20/50 or more. Pseudohole persisted in 22 eyes (44%) 3 months after surgery and in 15 eyes (30%) at 6 months. There was no difference in visual acuity, whether or not the pseudohole persisted. For the patients without pseudohole, median preoperative visual acuity was 20/63 (range, 20/32-20/860). Median postoperative visual acuity was 20/40 (range, 20/20-20/860). Vision improved by 2 or more lines in 37 eyes (74%). In 36 eyes (72%), it was 20/50 or more. Neither preoperative nor postoperative visual acuity differed significantly in the groups with and without pseudohole. CONCLUSION: After surgery for idiopathic ERMs combined with pseudohole, visual outcome is good, and pseudohole has no adverse prognostic value. Pseudohole disappears inconstantly after surgery, but its persistence does not preclude good postoperative visual recovery.

Adult↗
PubMed1999

Prevalence of macular pattern dystrophy in maternally inherited diabetes and deafness. GEDIAM Group.

OBJECTIVE: To evaluate the prevalence of macular pattern dystrophy (MPD) in maternally inherited diabetes and deafness (MIDD), a new subtype of diabetes mellitus that cosegregates with a mutation of mitochondrial DNA (i.e., the substitution of guanine for adenine at position 3243 of leucine transfer RNA) and to report the clinical characteristics of MPD. DESIGN: Prospective cohort study. PARTICIPANTS: Forty-six patients from 29 families with an adenine-to-guanine mutation of mitochondrial DNA were recruited from a French collaborative multicenter study. Thirty-five patients had MIDD, 8 were asymptomatic children of MIDD patients, and 3 had MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes). The 33 MIDD patients with diabetes were matched for diabetes duration and gender with 33 patients with "common" type-2 diabetes to compare the prevalence of diabetic retinopathy (DR) in both series. METHODS: All patients had a full ophthalmologic examination and fundus photographs. MAIN OUTCOME MEASURES: The presence and severity of MPD and DR were assessed in each patient. RESULTS: Thirty MIDD patients (85.7%) of 35 exhibited bilateral MPD characterized by linear pigmentation surrounding the macula and optic disc. In 24 of these 30 patients, visual acuity was 20/25 or more in both eyes. The prevalence of DR was 6% in MIDD patients with diabetes versus 15% for patients with common type-2 diabetes (a difference that was not significant, P = 0.23). The fundus of each of the eight asymptomatic children was normal. MPD was present in one of the three cases of MELAS. CONCLUSION: The prevalence of MPD in MIDD is high. Its detection may be helpful for the diagnosis of this new subtype of diabetes, for which specific treatments may be proposed.

Adult↗
PubMed1999

[Surgery of retinal detachment without giant tears, macular hole or advanced proliferative vitreoretinopathy].

PURPOSE: To evaluate surgical results in usual detachment cases. MATERIAL AND METHODS: This retrospective study covered 704 non-referred cases treated by the same surgeon. A follow-up duration of at least 6 months was obtained for all the successful cases. RESULTS: In 617 cases (87.6%) permanent reattachment was obtained with the first operation. The two main causes of initial failure were new or non-sealed breaks in 39 cases, 9 of them treated without a buckle, and postoperative PVR in 36 cases. After repeat surgery 48 additional cases were reattached, finally 665 cases (94.5%) were successfully treated. In all, postoperative PVR occurred in 39 cases, 22 of these were reoperated on, successfully for 16; thus PVR caused 23 of the 39 terminal failures. In 13 other failed cases there were no obvious unsealed break or severe postoperative PVR. A final visual acuity of 20/40 or more was attained in 443 cases. CONCLUSION: PVR although infrequent (5.5%), was the main cause of failure. In 13 cases the reason for non reattachment remained uncertain, these failures may have involved an excessive vitreous traction and perhaps in this situation a vitrectomy with a wide angle viewing system might have been helpful.

Follow-Up Studies↗
PubMed1998

Macular serous retinal detachment caused by subretinal leakage in tilted disc syndrome.

OBJECTIVE: To describe a previously unreported complication of tilted disc syndrome: serous retinal detachment, caused by subretinal leakage, that mimics chronic idiopathic central serous chorioretinopathy (ICSC). DESIGN: Retrospective cohort study. PARTICIPANTS: Five patients (five eyes) participated. MAIN OUTCOME MEASURES: Fluorescein angiographic features were measured. RESULTS: All patients presented with visual loss and metamorphopsia. Fundus examination showed features typical of tilted disc syndrome, including obliquely directed long axis of the disc, situs inversus, retinal pigment epithelium conus, hypopigmentation and staphylomatous ectasia inferonasal to the optic disc, as well as a serous retinal detachment. Fluorescein angiography showed a site of leakage or multiple focal areas of staining and atrophy of the retinal pigment epithelium that correlated to the linear pigmentary changes observed at the junction with the inferior staphyloma. The fluorescein angiographic pattern was very similar to that of chronic ICSC. Spontaneous healing occurred in one case, and successful photocoagulation of the site of leakage was applied in two cases; two eyes could not be photocoagulated because of diffuse leakage in the macular region. CONCLUSIONS: To the authors' knowledge, macular serous retinal detachment due to subretinal leakage has not been reported as a complication of tilted disc syndrome. The authors hypothesize that choriocapillary and pigment epithelial disturbances at the junction of the inferior staphyloma permit the subretinal leakage, but the pathogenesis of this complication remains unclear. A study of larger series of such patients is needed to identify the most appropriate management of these cases, which first need to be differentiated from a chronic form of ICSC.

Adult↗
PubMed1998

Functional assessment of macular hole surgery by scanning laser ophthalmoscopy.

OBJECTIVE: This study aimed to evaluate more precisely the benefit of macular hole surgery. DESIGN: The design was a prospective study of 40 eyes in 40 patients examined before and after surgery of full-thickness macular holes with a scanning laser ophthalmoscope (SLO). PARTICIPANTS: Forty patients with full-thickness macular holes participated. Three of the holes were stage 2, 23 were stage 3, and 14 were stage 4. INTERVENTION: The SLO examination consisted of macular imaging and assessment of macular function using tests produced by an acousto-optical modulator. MAIN OUTCOME MEASURES: Preferred retinal locus (PRL) was determined, visual acuity was measured, and scotoma was detected by microscotometry and by the line test (modified Watzke-Allen test). RESULTS: Anatomic success was achieved in 32 of 40 cases as assessed biomicroscopically. On SLO examination before surgery, macular holes were seen as a central bright round disc outlined by a thin dark edge surrounded by a dark ring and a less dark area with ill-defined limits. In all cases, the PRL was located on the upper edge of the hole, a scotoma was always detected inside the hole, and the line was seen as broken in 26 of 32 cases. After surgery, the hole closed completely in 25 of 32 eyes; it disappeared from 14 of these 25 eyes and was replaced by a dark or clear disc in 11. In the other seven successful cases, its size shrank and its edge flattened but remained faintly visible. The hole remained unchanged in eight cases. Eccentric PRL became central in 28 of 32 cases. The scotoma disappeared in 23 of 32 cases. The line was seen as continuous in 24 of 32 cases. Complete anatomic and functional successes were achieved in 19 of the 32 cases of macular hole closure. CONCLUSION: The SLO examination allows accurate assessment of the anatomic and functional results of macular hole surgery. Various degrees of functional success were recorded, depending on the test used.

Fixation, Ocular↗
PubMed1998

Epiretinal membranes surrounding idiopathic macular holes.

PURPOSE: To describe the features of the epiretinal membranes (ERMs) surrounding idiopathic macular holes. METHODS: The charts of 83 consecutive patients (85 eyes) who underwent macular hole surgery with a systematic search for an ERM around the hole were reviewed. Visual acuity testing, fundus biomicroscopy, red free and blue filter fundus photographs, and fluorescein angiograms were performed before and after surgery. Eyes with and without ERM removal were compared. RESULTS: An ERM was removed from 26 of 85 eyes (30.6%). ERMs were found more frequently in stage 4 than in stage 3 macular holes (76.9% versus 24.6%; P < 0.01). Holes had been present for longer in eyes with ERM than in those without (14.7 versus 8.6 months; P = 0.05). Fewer stage 3 holes with an ERM had an operculum than those without (P = 0.01). The outcome and complication rates were similar in eyes with an ERM and those without. Of the 24 ERMs detectable on blue filter fundus photographs, only 11 (45.6%) were visible on red free photographs. CONCLUSION: We support the hypothesis that the presence of ERMs surrounding idiopathic macular holes is secondary to hole formation.

Aged↗
PubMed1997

Scanning laser ophthalmoscope imaging of fluorescein-labelled blood cells.

PURPOSE: To demonstrate the feasibility of a technique for the visualization by scanning laser ophthalmoscope (SLO) of fluorescein-labelled autologous leukocytes and platelets in retinal vessels. METHOD: Individual blood samples from rats and rabbits were centrifuged to isolate platelets and leukocytes, then passively labelled with fluorescein and reinjected into the same animal. An SLO was used to visualize and record cell displacement in the retinal circulation. Labelled platelets were analysed by flow cytometry. RESULTS: By SLO, platelets appeared as a heterogeneous particle flow, and individual leukocytes appearing as brighter spots could easily be traced. Flow cytometry showed that after labelling platelets were well individualized and their size was slightly increased. CONCLUSION: Circulating blood cells can be visualized in retinal vessels by a simple method consisting of passive labelling of autologous platelets and leukocytes by fluorescein. No platelet toxicity was detected. This method could be applied to the study of blood cell movement in human retinal vascular diseases.

Animals↗
PubMed1997

Indocyanine green angiography in choroidal osteoma.

BACKGROUND: Choroidal osteoma is a rare choroidal tumor; knowledge of its indocyanine green characteristics is limited. METHODS: The fundus photographs and the fluorescein and indocyanine green angiograms of three patients were reviewed. Each patient was examined at least twice with a follow-up varying from 10 to 60 months. RESULTS: Late-phase fluorescein angiograms allow assessment of the extension of the osteoma as it is variably hyperfluorescent due to tumor staining combined with a variable degree of overlying retinal pigment epithelial changes. The hypofluorescent area observed in the early phase of the indocyanine green angiogram corresponds with the extent of the osteoma but the borders may be difficult to demarcate. In the late phase of the indocyanine green angiogram, hypofluorescence due to choriocapillaris loss and hyperfluorescence due to leakage from abnormal choroidal vessels are combined. Infrared angiography high-lights abnormal choroidal vessels and vascular spiders present on the tumor surface. It is difficult to differentiate these choroidal vascular anomalies from subretinal neovascularization. CONCLUSIONS: We find no homogeneous pattern either on fluorescein or on infrared angiography. The findings may change with follow-up, indicating changes within the tumor or the surrounding tissue that are still poorly understood.

Adult↗
PubMed1997

Visual field loss after vitrectomy for full-thickness macular holes.

PURPOSE: To report the results of a prospective study of the incidence of peripheral visual field loss after macular hole surgery. METHODS: Prospectively, 30 eyes of 30 consecutive patients with full-thickness macular holes operated on between December 1995 and April 1996 had preoperative and postoperative Goldmann visual field tests. The surgical procedure consisted of three-port pars plana vitrectomy, posterior hyaloid removal, nonexpansile fluid-hexafluoroethane (C2F6) exchange, and, in 19 of 30 patients, autologous platelet injection, followed by face-down positioning. RESULTS: Twenty-nine of these 30 cases were considered to be anatomic successes. Comparison of preoperative and postoperative visual fields disclosed that four patients (13%) had a peripheral scotoma, including one patient with stage 4 macular hole. Three other patients (10%) had a postoperative relative arcuate defect. Mean postoperative intraocular pressure was higher in the latter group. None of the patients complained of peripheral scotoma. CONCLUSIONS: Overall, seven of 30 patients (23%) had a postoperative visual field defect. Two categories of scotomas were observed: peripheral and relative arcuate. The cause of peripheral visual field loss is unclear. Increased intraocular pressure may be the cause of relative arcuate scotomas.

Adult↗
PubMed1997

Late reopening of successfully treated macular holes.

BACKGROUND: Most idiopathic macular holes can be closed by a surgical procedure combining vitrectomy, posterior hyaloid ablation, and fluid-gas exchange followed by postoperative positioning. Reopening of closed macular holes has been reported, but its frequency is not known. Here the incidence of reopening after successful macular hole surgery is reported. METHODS: 77 consecutive cases of idiopathic macular holes operated with autologous platelet injection between July 1993 and October 1995 were reviewed. The procedure consisted of three port vitrectomy, posterior hyaloid removal, nonexpansile fluid-gas exchange, and autologous platelet injection followed by face down positioning. The incidence of reopening was analysed in the cohort of the 72 anatomical successes. RESULTS: Mean follow up was 12.3 months. The macular hole reopened in five eyes of five patients (five out of 72 patients, 6.9%), in four cases after cataract extraction. In four cases too, an epiretinal membrane was noted, either clinically or during reoperation, and fluorescein leakage in the macular area was present in two cases. Three of the five cases of reopening were reoperated and all three were anatomical successes. CONCLUSION: Late macular hole reopening occurred in five out of 72 patient, and in four cases after cataract surgery. The presence of an epiretinal membrane around the hole in four of them suggested that tractional forces were responsible for the reopening. Reoperation, performed in three cases, again closed the macular holes.

Aged↗
PubMed1997

[Extracapsular extraction and posterior chamber implantation in diabetics. Prospective study of 198 eyes].

PURPOSE: Visual results and retinal changes in diabetic patients who underwent cataract surgery. METHODS: In a prospective study we followed up 198 eyes of diabetic patients who underwent cataract surgery for at least six months postoperatively. Pre and postoperative retinal status were assessed by clinical examination and fluorescein angiography. Per and postoperative complications and the evolution of visual acuity were noted. RESULTS: In 83.3% of eyes, visual acuity improved by two or more lines. In 59.6% of patients, visual acuity at six months was more than 6/15. The quality of visual outcome diminished with the severity of retinopathy, but in the most serious cases, lens extraction allowed fundus observation and treatment. Inflammatory complications, posterior capsule opacification and cystoid macular oedema were significantly more frequent in cases of preoperative diabetic retinopathy than in normal fundus. We observed few aggravations of the diabetic retinopathy, but underline the high frequency of cystoid macular edema in diabetic patients. CONCLUSION: Visual results are good in diabetic patients with mild retinopathy and, in severe cases, surgery allows retinal examination and treatment.

Adult↗