[Recommendations of the ALFEDIAM (French Association for the Study of Diabetes and Metabolic Diseases) for the screening and surveillance of diabetic retinopathy].
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Biomedical subjects
Publications and source records attributed to G Chaine.
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Oculodermal melanocytosis (nevus of Ota) is an abnormally large accumulation of pigment in ocular tissues as well as the skin in the distribution of the trigeminal nerve. Elevated intraocular pressure is a serious complication of this disease, as well as transformation to malignant melanoma. We report a case of nevus of Ota, documented clinically and histopathologically, associated with severe chronic glaucoma.
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Ocular manifestations of relapsing polychondritis occur in 60% of patients, most often in association with other systemic manifestations of the disease. Episcleritis is the most common manifestation, but scleral perforation, retinal vasculitis, optic neuritis and necrotizing scleritis can lead to blindness and require the use of immunosuppressive agents. We report the case of a 72-year-old woman with diffuse bilateral scleritis as the single manifestation of relapsing polychondritis. High dose steroids were used with success.
Ophthalmologic manifestations of sarcoidosis are multiform, and all parts of the structure of the eyeball can be affected. Involvement of the conjunctiva and of the lacrimal glands is the most frequent and is benign. Uveitis is observed in 20% of patients. It is generally torpid, evolving in chronic fashion. The possibility of uveitis requires routine investigation in all patients with sarcoidosis. Neuro-ophthalmologic involvement is rare but severe. When isolated, it presents difficult problems of diagnosis.
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Hypermetropia, like myopia, is a defect of axial refraction, most often due to reduction of the anteroposterior diameter of the eyeball. Hypermetropia is normal in the young child and usually diminishes with age. Moderate hypermetropia is generally well tolerated in young subjects. When severe or associated with functional changes, hypermetropia should be corrected by prescription lenses. Contrary to myopia, definitive treatment by surgery is not yet current practice in hypermetropia.
We reviewed 165 cases of non-referred pseudophakic retinal detachment. Fifty-three eyes (32%) had sustained significant complications due to cataract surgery prior to retinal detachment; 45 eyes (27%) presented with grade B, C or D proliferative vitreoretinopathy. The overall reattachment rate was 84%. This was significantly higher in the posterior chamber lens group than in the iris-fixated lens or anterior chamber lens groups (93 vs. 69 and 81%). Our data show that uneventful extracapsular cataract extraction plus posterior chamber lens implantation offers the best chance of successful detachment surgery.
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Penetration of cefixime in aqueous humor was investigated in 21 patients about to undergo elective cataract extraction. All subjects received a 400 mg oral dose. Aqueous humor was collected within 4, 6, 10 or 15 hours after the administration. Cefixime was measured by liquid chromatography. The concentration of cefixime in aqueous humor was below 0.05 mg/l in 17 patients. The highest level reached was 0.16 mg/l. In spite of lower minimal inhibitory concentrations than first generation oral cefalosporins, cefixime per os cannot be proposed for the treatment of postoperative ocular infections.
We examined 92 eyes (63 patients) who underwent extracapsular cataract extraction with implantation of a posterior chamber intraocular lens. Visual acuity improved by two lines or more in 65% of cases. Follow-up examination (6 months and 2 years) showed posterior capsule opacification in 30% of cases. Progression of diabetic retinopathy was mild but cystoid macular edema was present in 70% of cases with non proliferative retinopathy. Proliferative retinopathy was treated postoperative by pan retinal photocoagulation. One neovascular glaucoma occurred, secondary to a ruptured capsule.
Four patients (3 young adults and 1 child) with disseminated tuberculosis had choroidal tubercles; none of them was immunodepressed. The clinical and angiographic aspects of these nodules and their evolution are described. Their clinical interest is discussed: fundus examination is always indicated in cases of disseminated tuberculosis and, more generally, in cases of systemic granulomatosis.
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Three patients with retinopathy associated with acute pancreatitis were observed. Each of them had a long history of alcohol abuse. The first patient was asymptomatic. Second one developed moderate visual loss in one eye (visual acuity 20/40), with a fascicular defect on Goldmann visual field registration. Third patient complained with bilateral and severe visual loss, with a large central scotoma. Cotton-wool patches and hemorrhages were present in the mild types of retinopathy. These cases had a good prognosis. An ischemic edema of posterior pole was associated in severe type of retinopathy. In this case, fluorescein angiography showed occluded macular retinal arterioles. Visual prognosis was poor. Pathogenesis of the lesions is still discussed. The main hypothesis are fat emboli or activated complement-induced granulocyte embolus formation. Efficacity of corticosteroids is not known.
The purpose of this study is to appreciate post-operative ametropia in pseudophakic patients (EEC and posterior chamber IOL). Two groups were implanted either with a standard 21 D IOL (group 1) or after calculation of implant power according to the SRK formula (group 2). Results show residual refractive errors over 2 D in 7% of case in group 2 and 22.3% of case in group 1.
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