[Problems posed by the presence and absence of the crystalline lens in cases of intraocular injections of silicone].
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Biomedical subjects
Publications and source records attributed to J Haut.
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Observation with long follow-up of the first 200 cases of intraocular injection of silicone combined with vitrectomy led us to discover three major complications: cataract, keratopathy and hypertonia, the last two found only in aphakic eyes. No toxic action of silicone could be proved to explain these complications. They seem to be related to physical properties of the silicone which we use, and in particular its gravity lower than one. This density is responsible for noxious mechanical phenomena. They can be partially kept back by preserving the lens in the first stages, avoiding segmentary iridectomy in aphakic eyes, nocturnal procubitus position and silicone ablation in failed cases.
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This observation perfectly illustrates the main epidemiological, clinical and biological peculiarities of this parasitic disease. Particularly, as it concerns a tourist who travelled across Africa for a short period of time it is possible to assess the time of exposure to infecting mosquito bites, the maturation period of time as well as the time of clinical incubation. On the other hand the value of the immunological techniques to make the diagnosis of loaiasis as well as the difficulties to treat this affection are stressed upon.
A total of 18 patients with retinal detachment from macular holes were treated by intra-ocular injections of silicone oil after vitrectomy. Successful reapplication was obtained in all cases operated upon by primary intention (12 out of 12). This procedure has the advantage of not requiring coagulation around the hole, as employed by other methods, thus avoiding enlargement of the central scotoma.
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Systematic oral glucose tolerance tests in patients due for operation for senile cataract revealed the presence of latent diabetes, undiagnosed by standard investigations, in 20% of cases. The proportion of diabetics in patients with cataract is abnormally high when compared to a population free from cataract (43% as against 16%), which is in favor of a diabetic condition being the cause of lens opacification. An H.G.P.O. is therefore justified in all patients over 50 years of age with cataracts, especially those that are bilateral and mainly cortical.
A case of intraocular myasis is here reported, as well as the difficulties of diagnosis--mostly too late--of this disease, which is rare in Europe and the northern hemisphere and which leads, almost invariably, to functional or even anatomical loss of the eye.--The determination of IgE in human aqueous humor (ah) and corresponding serum (s) by means of the ultrasensitive and quite simple PRIST method could represent a possibility of timely diagnosis, and this theoretically too in the case of other, much more frequent oculoparasitosis cases.--A retrospective study of the preoperative aqueous humor of the ophthalmomyiasis case presented here revealed an IgE concentration of 113 U/ml in the aqueous humor, with only 3 U/ml (1 U congruent to 2 ng) in the corresponding serum. A simple serum-IgES-determination would not have permitted the diagnosis--at least not in the case examined--just as little as numeration of eosinophilic granulocytes in blood and/or aqueous humor.
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A double-blind medium term study of the activity of timolol in chronic open-angle glaucoma was conducted in four French ophthalmological centers, using the same protocol. A total of 119 patients were treated: --60 with timolol; --59 with épinéphrine, for comparison. Results showed a significantly superior efficacy for timolol over épinéphrine, after in weeks of treatment. Good tonometric control was obtained in 81.6% of the patients treated with timolol, against 52.5% of those receiving épinéphrine. In 68% of the glaucomatons patients treated with timolol, good tonometric control was obtained with the lowest dose preparation containing 0.1%. No side-effects were noted during the study, either locally or generally (particularly blood pressure changes).
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