Biomedical subjects

J Haut

Publications and source records attributed to J Haut.

At least 37 records · Page 2Linked to original sources

PubMed1994

[The danger of the game called "paint ball"].

Severe ocular injuries may occur during a new war game in France, called "paint ball". A high pressure carbon dioxide powered gun fires pellets filled with dye. The pellet is coated with a semisoft gelatin and filled with a "nontoxic" dye mixture. We observed six consecutive cases during a ten month-period. In two cases (both due to a shot at point-blank range), mature cataract occurred. Consequently, lensectomy was achieved, preceded by a prophylactic scleral buckle. In one case, a retinal detachment due to a localized retinal necrosis occurred. With endocular surgery and temporary silicone oil tamponade, we achieved retinal reattachment. The three remaining cases did not require surgery. They suffered blunt ocular lesions of the anterior and/or posterior segment. One of these cases showed permanent tattooing to the cornea. After a mean follow-up lasting six months, all patients had, at least, a 40/100 vision. Some recommendations can reduce the incidence and the severity of ocular injuries due to paint balling. Firstly, eyeguards (made of polycarbonate) must be worn before receiving guns and pellets. Secondly, a kind of safety gun stopper can avoid gun firing by accident apart from practices. Thirdly, according to others publications, alcohol or drugs should not be consumed before the game. Lastly, gun fire at point-blank range or toward the head must be forbidden. We hope that wide distribution of such recommendations will help reducing the frequency of this type of ocular traumas.

Adolescent↗

PubMed1994

[Treatment by horseshoe pattern photocoagulation of diabetic cystoid macular edema].

Eighty cases Diabetic Cystoid Macular Edema, with or without central spaces underwent photocoagulation from 1978 to 1989 using a horseshoe or ring pattern. Initial visual acuity ranged from 20/25 for far vision and 20/20 for near vision to a central scotoma, with an average of 20/60 for far vision and 20/50 for near vision. As initial treatment, we performed 63 horseshoe pattern and 13 ring pattern photocoagulation around the macula; an additional photocoagulation was carried out in 29 cases, one month to seven years later (average of 18.3 months), either on medial to the previous treatment (18), or closing the initial horseshoe pattern (10) or resulting in focal treatment (13), or associating any of these three. The cystoid macular edema disappeared in 47 cases, decreased in 15 cases, and remained in 14 cases, with a follow up ranging from 6 months to 10.5 years (average of 41.6 months). The post laser visual acuity range from 20/25 for far vision and 20/20 for near vision, to a central scotoma again, with an average of 20/60 for far and near visions. During the follow up various reasons of visual impairment were observed: cataract, intravitreal hemorrhage, epiretinal membrane, macular pucker and macular ischemia. Our results compared with the published ones concerning a grid pattern photocoagulation are encouraging. It is very important to stress that this photocoagulation is only aimed toward the macular edema itself: if necessary it should be associated with a grid pattern or a focal photocoagulation aimed toward extramacular edema.

Adolescent↗

PubMed1994

[Argon laser trabeculoplasty. Results over 10 years].

To appreciate the current place of argon laser trabeculoplasty (ALT) in the therapeutic armamentarium of primary open-angle glaucoma (POAG), the first 211 photocoagulated phakic eyes were analysed. 159 eyes had a 5 year-follow-up, 147 eyes had a 8 year-follow-up and 127 eyes had a minimal 10 year-follow-up. These eyes corresponded to an initial group of 151 patients: 76 women and 75 men with a mean age of 66 years. We decided, arbitrarily, to assess trabeculoplasty results according to three combined criteria of failure (insufficient or transient intraocular pressure drop (< or = 3 mmHg), progression of visual field loss and need of filtrating surgery) and to various expected goals: prevent an increase of drugs with their subsequent side effects, taper a non tolerated medical treatment and, lastly, try to cease all medical treatment in non compliant patients. According to those criteria, during the first five years, the cumulative failure rate in the 159 eyes rose steadily from 19% (31 eyes) in the first year to 52% (82 eyes) in the fifth year. In the 147 eyes with a 8 year-follow-up 25 eyes (17%), and in the 127 eyes with a 10 year-follow-up 14 eyes (11%) were still controlled. At the 10 year-follow-up, the surgical failure rate was 35% (40 eyes in 113), quite similar to the rate at 5 years: 33% (27 in 82). Thirty eyes excluded in the study belonged to patients who died during the follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

[Prevention of retinal detachment in Wagner-Stickler disease. Comparative study of different methods. Apropos of 22 cases].

Prophylactic treatment in patients presenting Wagner-Stickler disease has not been yet well defined. We retrospectively studied twenty-two patients who had a retinal detachment on the first eye. Among the ten patients treated by peripheral confluent laser photocoagulation, five had a retinal detachment after a mean follow-up of fifteen months; with a 42% rate of spontaneous retinal detachment bilateralization, we can conclude that laser therapy has not been efficient. Four patients treated by focal or circular laser photocoagulation, cryotherapy or vitrectomy developed retinal detachment. Eight eyes treated by a preventive encircling scleral buckle did not develop retinal detachment, with a mean follow-up of twenty-one months. This follow-up is still too short, but greater than the mean bilateralization delay. Per and postoperative complications had no consequences.

Adolescent↗

PubMed1993

Argon laser trabeculoplasty: a 10-year follow-up.

To determine the current place of argon laser trabeculoplasty (ALT) in the therapeutic armamentarium of primary open-angle glaucoma (POAG), 211 photocoagulated phakic eyes were analyzed. 159 eyes had a 5-year follow-up, 147 eyes had an 8-year follow-up and 127 eyes had a minimal 10-year follow-up. These eyes came from an initial group of 151 patients, 76 women and 75 men, with a mean age of 67 years. We decided, to judge trabeculoplasty results according to three combined criteria of failure--insufficient or transient intraocular pressure drop (< or = 3 mm Hg), progression in visual field loss and need for filtrating surgery--and according to various expected goals: prevent an increase of drugs with their subsequent side effects, taper a nontolerated medical treatment, and try to cease all medical treatment in noncompliant patients. According to these criteria, during the first 5 years, the cumulative failure rate in the 159 eyes rose steadily from 19% (31 eyes) in the 1st year to 52% (82 eyes) in the 5th year. In the 147 eyes with an 8-year follow-up, 25 eyes (17%) were successful and in the 127 eyes with a 10-year follow-up 14 eyes (11%) were still controlled. At the 10-year follow-up the surgical failure rate (35%; 40 eyes in 113) was similar to the rate at 5 years (33%; 27 in 82). 30 eyes, which were excluded from the study, despite being still controlled, belonged to patients who had died during the follow-up. Their mean age at the time of ALT was 76 years. The low success rate at 10 years was predictable from the 10% new failure cases per year encountered in the 5-year data.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

[Role of antisepsis in the preventive chemo-antibiotic treatment of postoperative endophthalmitis].

A protocol associating chemoprophylaxis and two-agent flash antibioprophylaxis was performed for more than two years in order to prevent postoperative endophthalmitis in elective open-globe surgery. The aim of this study is to appreciate whether antibiotic therapy is really useful as a complement to chemoprophylaxis. Three successive conjunctival scrapings were performed in the operating room: two before surgery (one before and one after conjunctival disinfection by povidone iodine), and the third one at the end of the operation. The total number of positive scrapings significantly decreased after disinfection but, some changes appeared on the final scrapings positive and negative. The risks of a positive scraping after the disinfection are greater if the scraping was initially positive. The persistence of a positive scraping after disinfection is noted in about 20% of cases. Therefore, there is a risk for microorganisms to penetrate into the eye, still present on the conjunctiva after povidone iodine. This risk is an argument to carry on the flash antibiotic therapy before surgery, in order to obtain a high intravitreal concentration of antibiotics at the precise time when the bacteria may penetrate into the eye, and to stop their multiplication.

Anti-Bacterial Agents↗

PubMed1993

[Preventive surgical scleral buckling of retinal detachment after severe ocular injuries].

We performed surgical scleral buckling with an encircling band to prevent retinal detachment in twenty eyes with severe ocular injury (three contusions, seventeen penetrating eye injuries including twelve eyes with intraocular foreign bodies). All surgical buckling were performed during the two weeks following the injury. The purpose of this surgical procedure is to prevent the traction from contracting vitreous base which it itself secondary to vitreoretinal proliferation; several factors promote this latter outcome: perforating injury, vitreous hemorrhage, intraocular foreign body and the mix of vitreous substance and lens material. This prophylaxis is justified by the high frequency and often bad prognosis of post-traumatic retinal detachment. A mean follow-up of thirteen months showed no contusion associated delayed retinal detachment, with a final visual acuity superior to 7/10: thus, preventive surgical buckling appears efficient; perforating injuries were followed by retinal detachment in three cases; of these, two were reattached, and the final visual acuity depended on associated destructions. With the limitation of a short follow-up, this surgical procedure seems to be able to prevent most of the delayed retinal detachments.

Adolescent↗

PubMed1993

[Liquid perfluorocarbons in the surgical treatment of retinal detachment caused by retinal inversion].

Surgical procedures used today to treat retinal detachment with an inverted giant retinal tear have considerably improved. Vitrectomy associated with perfluorocarbon liquid injection has replaced old procedures necessary to unfold the inverted retinal flap. Seventeen patients were operated on with an anatomic success rate of 76% and an average follow up of fifteen months. The successive surgical stages (lensectomy, retinopexy, internal tamponade, circular scleral buckle) are discussed. Proliferative vitreoretinopathy is the maill postoperative complication explaining the high rate of reoperation (56%). In high myopia, a prophylactic circular scleral buckle of the fellow eye has become systematic.

Adolescent↗

PubMed1993

[Definitive transient monocular blindness caused by ocular compression during general anesthesia].

We present a case of irreversible monocular blindness caused by obstruction of the central retinal artery detected in a young patient without any previous history, when waking up from a surgical procedure performed under general anesthesia. Clinical and complementary investigations were not conclusive. Nevertheless, when inquiring on the surgical procedure, it appeared that the patient was lying in a procubitus position, so that his head may have slipped on the head support, resulting in compression on his right eyeball. The fact that the patient was simultaneously submitted to a controlled low blood pressure may have worsened the effects of the compression. Reviewing the medical literature on the subject reveals that, although rare, such accidents do occur; they must be prevented by a constant surveillance when performing surgical procedures.

Adult↗

PubMed1993

[Prevention of non-traumatic retinal detachment by surgical cerclage. Apropos of 20 cases].

Prophylactic retinal detachment with laser photocoagulation is ineffective for some vitreo-retinopathies in which vitreous traction is predominant (non traumatic giant retinal tears, Wagner Stickler's syndrome, Marfan's syndrome...). Twenty eyes were operated by prophylactic episcleral circular buckling. In eighteen cases, the fellow eyes had previously presented a retinal detachment. We performed two types of encircling buckle. We only observed minor operative complications, without any functional consequences, attesting to the innocuity of this type of treatment. But we have to wait for vitreous detachment to know the efficacy of this prophylactic treatment. This detachment occurs at different time in each vitreoretinopathy, but with a specific rate of retinal detachment for each pathology.

Adolescent↗

PubMed1993

[Simultaneous failure of trabeculectomy and sclerotomy using laser holmium: YAG].

We present a case of a bilateral chronic open-angle glaucoma in a 74 year old woman, operated on the right eye by conventional trabeculectomy and the left eye by holmium laser ab externo sclerostomy. Both filtering blebs remained elevated and functional for 18 months. After this follow-up period, both blebs simultaneously collapsed and intra-ocular pressure rose again. This case shows that a late conjunctival scarring process, depending on a non surgical factor, may still be encountered after Holmium: YAG laser sclerostomy just as after standard trabeculectomy despite reduced conjunctival tissue trauma.

Aged↗

PubMed1993

[Failures of the surgical treatment of rhegmatogenous retinal detachment].

The surgical treatment of rhegmatogenous retinal detachment, has considerably improved. But there are still a lot of failures, at least after the first surgical procedure. Out of a group of 320 retinal detachments, a one stage surgical procedure allowed the retina to reattach in 84% of cases. Out of the 51 failures, we defined 2 subgroups: the early recurrences were mainly caused by undiagnosed breaks or insufficient scleral buckling, and the delayed recurrences by a vitreo-retinal proliferation or a new tear. Though a second operation increased the success rate to 97%, it is certainly desirable to lower the failure rate of the first surgical procedure.

Adult↗

PubMed1992

In vitro laser decomposition of silicone fluid used in detachment of the retina.

The in vitro exposure of the silicone fluid Dimethicone 1,000 to radiation from the Nd:YAG laser results in the formation of transient breakdown gases which are composed mainly of methane, ethylene and traces of ethane, as identified by head-space gas chromatography. These hydrocarbons may interfere with the intra-ocular environment in the management of retinal detachment.

Chromatography, Gas↗

PubMed1992

[Is vitrectomy cataractogenic? Study of changes of the crystalline lens after surgery of retinal detachment].

In order to assess the relationships between vitrectomy and postoperative crystalline lens changes we reviewed the records of 298 selected cases of operated retinal detachments in phakic eyes. We compared two groups: 155 eyes were operated with cryotherapy, vitrectomy and gas injection. 143 eyes received cryotherapy and retro-hyaloid fluid-gas exchange. Follow-up of at least 12 months and detailed description of the lens were available in 90 cases and 82 cases of the two groups respectively. Postoperative lens changes were as follows: nuclear sclerosis occurred in 63% of the vitrectomised eyes, mild in 14%, moderate in 16%, severe in 32%. In contrast, nuclear sclerosis occurred in only 4% of the non vitrectomised eyes, all these cases were noted as moderate. Posterior subcapsular opacities occurred in 4.5% of the vitrectomised eyes versus 2.4% of the non vitrectomised eyes. Nuclear sclerotic changes were correlated with vitrectomy and longer follow-up. Posterior subcapsular cataract was correlated with vitrectomy and larger intraocular gas bubble.

Adult↗

PubMed1992

[Ultrasonic treatment of hypertonia caused by intraocular silicone oil].

The authors treated 53 patients with uncontrolled glaucoma in silicone oil filled eyes with high intensity focused ultrasound. The silicone oil filled eyes present unusually difficult problems in glaucoma management, since the silicone oil rapidly obstructs filtration openings, and laser techniques have not been effective. The mean pretreatment pressure was 34.2 mmHg. The patients were followed for a mean of 17 months. Seventy-five per cent of ultrasound treated eyes had successful reduction of intraocular pressure to below 20 mmHg with or without concomitant medical treatment at two years after treatment. The complication rate was low in this group of eyes. Five eyes developed hypotonia and three eyes had full thickness scleral perforations but were effectively controlled and developed no other complications during two years of follow-up. This technique appears more effective than cyclo-destructive techniques alone.

Adolescent↗

PubMed1992

[Trabeculoretraction by argon laser. 5 and 8-year results].

To appreciate the current place of argon laser trabeculoplasty (ALT) in the therapeutic armamentarium of primary open-angle glaucoma (POAG), the first 211 photocoagulated phakic eyes were analysed. One hundred and fifty-nine eyes had a 5 year-follow-up and 147 eyes had a minimal 8 year-follow-up. These eyes came from an initial group of 151 patients: 76 women and 75 men with a mean age of 66 years. We decided, arbitrarily, to assess trabeculoplasty results according to three combined criteria of failure (insufficient or transient intraocular pressure drop (3 mmHg), progression in visual field loss and need for a filtrating surgery) and to various expected goals: prevent an increase of drugs with their subsequent side effects, taper a non tolerated medical treatment and, lastly, try to cease all medical treatment in non compliant patients. According to these criteria, during the first five years, the cumulative failure rate in the 159 eyes rose steadily from 19% (31 eyes) in the first year to 52% (82 eyes) in the fifth year. The initial mean intraocular pressure (27.22 mmHg) of 7 failures operated on during the first 2 months and that of all 27 operated on failures (24.41 mmHg) was higher than the initial mean intraocular pressure of the 77 successful cases (22.67 mmHg). In the 77 eyes still controlled at 5 years, the intraocular pressure drop was 6.57 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Therapeutic ultrasound for the treatment of glaucoma.

We present a summary of the results obtained on 1142 treatments of 1072 eyes treated in our hospital during the last 5 years. Ultrasound has been used to treat 843 eyes with refractory glaucoma and also to restore failed trabeculectomy filtering blebs in 229 eyes. The single treatment success rate with success defined as an IOP > or = 20 mm Hg was 59% at one year and 46% at 3 years. In cases of failed blebs, ultrasound treatment performed 3 to 12 weeks after trabeculectomy revived the blebs of 82% of the phakic eyes when 5 FU subconjunctival injections were performed in the following days.

Glaucoma↗

PubMed1992

[Long-term results of successful surgical treatment of retinal detachment by vitrectomy and silicone oil injection. Effect of removal of the tamponade on further complications].

We present, with a minimal follow up of six months, the results of 118 silicone oil removals following successful treatment of retinal detachment by pars plana vitrectomy and silicone oil injection. A recurrent retinal detachment occurred in 8.5% of cases, 13% of the 61 phakic eyes at the time of silicone oil removal maintained a clear lens, 29.6% of the eyes had a raised intraocular pressure and 6.8% had a keratopathy. The visual acuity improved in 72.8% of eyes after silicone oil removal. The main reasons for a late decrease in visual acuity were recurrence of the detachment, hypertonia, chronic hypotonia and keratopathy. All the eyes with late complications after silicone oil removal had a clinically significant droplet dispersion in the anterior chamber. Only complete and early silicone oil removal seems to decrease the complication rate.

Adolescent↗