[Fluorometry of the vitreous body. Technics of evaluation and improvement of the spatial resolution].
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Biomedical subjects
Publications and source records attributed to G Coscas.
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Case report of a Fundus flavimaculatus associated with preretinal new vessels in a patient without family history. The problem discussed is the outcome of the retinal vascularization during the progressive atrophy of retinal cells.
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We report the observation of a familiy with 4 cases of macroreticular dystrophy (Mesker) and 1 case of butterfly shaped dystrophy (Deutman) in its ranks. Diagnosis of these conditions is based on ophtalmoscopic and angiographic appearence. Visual loss may be somewhat important in the macroreticular type and it may increase as time passes on. Transmission is autosomal dominant with variable penetrance. The fact that there are anomalies of the retinal pigment epithelium in periphery and around the disk in three of our cases leads us to think that this is a diffuse disease of the retinal pigment epithelium. Macroreticular and butterfly shaped dystrophies are probably similar diseases, they form altogether with the reticular dystrophies (Sjögren) the group of the patterned dystrophies of the retinal pigment epithelium.
The film of an angiography by fluorescence presents specific particular characteristics. Treatment of the film has to be adapted to these particularities, and the chemical products used have to be specially chosen. In this way, the results obtained can be greatly improved. The procedure can be automatized by the use of a simple apparatus, and printing on paper causes no particular difficulty.
Laser photocoagulation has changed the visual prognosis of diabetic patients affected by retinopathy. It aims to lower the risk of blindness of diabetic patients. The goal of photocoagulation is to reduce the tissue damage of microangiopathic origin expressed by nonperfusion areas and permeability abnormalities that are responsible for retinal ischemia and oedema respectively. Loss of visual acuity in the diabetic is due mainly to two causes : first, vitreous hemorrhage with its dramatic loss of vision; secondly, macular cystoid oedema, occuring more commonly and with progressive loss of central vision. The efficiency of pan-retinal photocoagulation in reducing the risk of vitreous hemorrhage and consequent blindness in patients with disc or preretinal newly formed vessels, has been ascertained by American and British randomised studies. The indications, technics and results of photocoagulation in non-proliferative diabetic retinopathy are the subject of many studies. Only photocoagulation for macular oedema due to intra-retinal microvascular abnormality has shown to be of benefit.
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Sub-retinal new vessels arising from the choroid are the most dangerous components in disciform maculopathies. The greatest advance made in their treatment has been due to the use of photocoagulation over the last few years, but their destruction by this method is still a very controversial subject. The aim of the present study was to define which lesions should be treated and which should not. Results demonstrated that the use of photocoagulation to destroy new vascular membrane which is very close to the foveola, is possible, and can restore vision or preserve useful visual acuity. The laser can be used very close to the centre of the foveola, even in a part of the central avascular area. A randomized study is now being conducted and should supply statistical evidence as to whether this treatment should or should not be recommanded.
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