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Biomedical subjects

E Sellem

Publications and source records attributed to E Sellem.

32 records · Page 2Linked to original sources

[Quantitation of the visual field].

With kinetic perimetry, the visual field chart had the appearance of a geographical map. Since the isopters were not geometric, their surfaces were barely measurable. However, with recent three dimensional computerised (or semi-computerised) perimetry quantitative evaluation of the print-out may easily be done. The visual acuity is expressed by a fraction or ratio. In a similar way our deficit ratio gives a percentage score of visual field volume defects. Using the Peritest, it is very easy to establish the field's deficit ratio. All the defects are classified and have a score. Scores are then added up to establish the deficit ratio. (The same procedure may be used with other perimeters like the Visual Field Analyser). Why express field loss as a deficit ratio? In the natural history of a Primary Open Angle Glaucoma (i.e. a disease of the visual field), the comparison between consecutive visual fields may be difficult. Instead of looking at a collection of print outs, it is easier to look at the numbers of the deficit ratio to appreciate if there is evolution of the disease. In discussions with the patient, it sounds better if the ophthalmologist speaks of a "percentage" of visual field loss: the patient may understand his own situation more easily. Each point is tested twice at each examination to give an idea of patient response fluctuation. Before finding progression of the disease, it is necessary to know the range of an individual's variation in answers. The principle of all sciences is to measure what is measurable, and to render measurable that which is not.

Computers↗

[Problems and their solutions in today's perimetry].

Progress in the development of perimetry has been slow but certain since the first description of the perimeter by Goldmann in 1946. The creation of static perimetry, and of threshold detection with the multiple stimuli analyser of Friedmann, have been important stages in its development. Automatic perimetry (A.P.) is now available, our choice of apparatus being the Peritest, this instrument combining all the possibilities of A.P. with multiple or single manual perimetry in a very flexible manner. The apparatus allows 153 positions to be examined in the central 25 degrees and 55 in the periphery. The examination is conducted at a suprathreshold level (+ 0,6 log. U) after determination of the patient's eye threshold. Results are grouped in classes on a special chart to facilitate assessment. It is now possible, with the same instrument, to perform a detection A.P. (very useful in suspected glaucoma), a confirmative and limited manual study and, if necessary, a consecutive refined analysis.

Glaucoma↗

[Modern perimetry: automatic or manual?].

The possible applications of computer assisted static perimetry are examined after one and a half year of personal experience. The general advantage of a computer-assisted perimeter may be the elimination of the influence of the perimetrist on the results. We have employed the PERITEST perimeter because this system allows either full automatic perimetry or two types of manual perimetry with presentation of single or multiple stimuli. All perimetric examination is done after the determination of the individual visual retinal threshold. The examination is always performed at a supraliminal level relative to the individual threshold. The following conclusions can be drawn: 1 - Even after complete elimination of the perimetrist's influence fluctuations in results may be observed. Furthermore, the longer examination the more important patient cooperation becomes in automated perimetry as compared to the manual procedure. So we concluded that the best strategy should be related to the studies of the visual field defects. 2 - For perimetry of presupposed normal visual fields, the multiple stimulus procedure is quite adequate. If some problem appears, the flexibility of the PERITEST enables the use of the single manual stimulus mode. The full automatic examination is done only when there are mild field defects and in intelligent patients. 3 - These techniques enable the description of a new presentation of the classical perimetry's signs of early glaucoma: a loss of 0,5 Log. U.L. (which has the same significance as an isolated relative scotoma.

Computers↗

[So-called ocular hypertension and new signs of primary open-angle glaucoma].

Between normal and glaucomatous subjects, a group with ocular hypertension exists which is not homogeneous as 10 p. cent of these will develop glaucoma. The problem is to select early eyes at risk. Three new methods of examination have been proposed: the response to the test of contrast sensitivity, the pupillary reaction test of Marcus Gunn, and photographic exploration of the nerve fiber layer of the retina.

Adult↗

[Developmental ophthalmic ischemia. Regression after emergency extra-intracranial anastomosis].

Recently several publications have insisted on the ability of E.I.C.B. in reversing ocular manifestations due to chronic ophthalmic ischemia, when surgical carotid desobstruction is considered impossible or hazardous. Revascularization with E.I.C.B. can also be useful--on emergency --in case of "in evolution" ophthalmic ischemia, due to low pressure perfusion in the carotid-ophthalmic territory, to save vision. The authors report the case of a patient, presenting an optico-pyramidal syndrome "in evolution", secondary to occlusion of the left carotid artery associated with stenotic lesions in the ophthalmic artery, reversed by E.I.C.B. performed on emergency. Left visual acuity and diastolic retinian arterial pressure --respectively inferior to 1/10 and unmeasurable, before operation--raised up to 6/10 and 18 mmHg within the first twelve post-operative days and reached 8/10 and 38 mmHg after eleven weeks. This case report aims at pointing out the capacity of E.I.C.B. performed on emergency in reversing ophthalmic ischemia--"in evolution"--before constitution of irreversible lesions.

Aged↗

[Efficacy and tolerance of dipivephrin].

The effects and the tolerance of dipivephrin have been studying during 6 months, in 30 glaucomatous or ocular hypertensive patients. The pressure decrease was 29.4%. Three patients were excluded because of undesirable side effects. The tolerance was appreciate good or excellent in the 27 other patients.

Adult↗