Biomedical subjects
Publications and source records attributed to F Rousselie.
Congenital or early postnatal ocular malformations are analyzed (first part) in order to specify the ophthalmologist's role (second part). This includes determining the risk of visual loss, evaluating evolutive characteristics and preventing development of amblyopia. Improvement in prognosis is ascribable to significant advances in medical techniques; it ought to be a result of improved screening and better prevention due to early referral.
The influence of arterial hypertension on the prevalence of diabetic retinopathy was evaluated by a cross-sectional study in 882 diabetic patients of whom 337 were insulin-treated and 505 were non insulin-treated. Arterial hypertension was defined by blood pressure values higher than 160-90 mmHg. Retinopathy was considered to be present when at least 2 microaneurysms were observed at the posterior pole. When duration of the diabetes was taken into account the prevalence of retinopathy in hypertensive subjects (69%) was not significantly higher than in normotensive subjects (47%) among the insulin-treated patients. However among non insulin-treated patients retinopathy was significantly more frequent in hypertensive (39%), than in normotensive subjects (25%; p less than 0.05).
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Between 1969 and 1974, ten insulin-dependent diabetic patients underwent surgical hypophysectomy for rapidly progressive proliferative retinopathy endangering sight. Six to 11 years later, the 7 patients who survived had useful visual acuity and were leading a normal life. The long-term results of hypophysectomy on the eye could be observed in this series of patients with exceptionally long follow up: oedema had subsided, haemorrhagic exsudates and newly formed retinal vessels had disappeared, and the retinal had become hypovascular. However, argon laser photocoagulation has now considerably reduced the indications of surgical hypophysectomy.
Evolution of visual function was assessed in 43 insulin-dependent diabetic (IDD) patients treated by maintenance haemodialysis (MH) for a cumulative duration of 1248 patient-months. At start of MH, 23 patients (46 eyes) still had good vision, 20 patients (40 eyes) were blind. All 40 blind eyes had severe proliferative retinopathy (PR) with additional irreversible complications in 32. Of the 46 eyes with preserved vision, PR was present in 24 (52.2%) with only 2 additional severe complications. Restoration of sight was obtained either spontaneously or after ophthalmic surgery in 6 eyes (7%). Stabilisation was achieved in 74% of eyes which retained vision at the start of MH. Two patients with eyesight at start of MH became blind (8.7%). Aggravation of visual function is mainly related to development of PR and not to haemodialysis per se. Careful ophthalmic follow-up, together with close control of diabetes, blood-pressure and uraemia can ensure preservation of vision in most IDD patients treated by MH.
In 80 patients undergoing surgery for retinal detachment, cardiac rhythm was observed to improve some means of prevention from consequences of oculocardiac reflex. The injection of a parasympatholytic agent shown its effectiveness; heavy morphinic analgesia prevented from cardiac disturbances induced by scleral cryoapplication; retrobulbar block had no effect.
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In patients with idiopathic hemochromatosis, retinopathy was investigated by ophthalmoscopy and fluorescein angiography and was present in eight out of 23; this prevalence is similar to that reported in patients with diabetes aged between 30 and 60 years at onset of diabetes and with the same duration of the disease; in these eight patients retinopathy was of mild degree, with no impairment of visual acuity, fewer than 10 microaneurysms in each fundus, and no other retinal abnormatic islets directly. These studies confirm that anticholinergic drugs may be useful adjuvants in treating these patients.
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