Biomedical subjects
Publications and source records attributed to O Touzeau.
We describe the case of a 66-year-old woman who had previously undergone facial peeling and developed severe bilateral corneal burn due to direct contact Exopeel((R)) with her eyes. Despite medical treatment and an amniotic membrane graft, deep stromal opacity persisted in one eye.
PURPOSE: To evaluate the accuracy and reproducibility of iridocorneal angle measurement obtained with a slit-lamp method (Orbscan). METHODS: The iridocorneal angle was measured in 100 normal eyes of 50 patients using the Orbscan II device. Angles were measured in eight meridians using both the "plane" and "polynomial" modes. For each eye, two exams were taken successively and the reproducibility was calculated by analyzing the difference between both measurements. Angle value was correlated with subjective spherical equivalent and other biometric measurements obtained by Orbscan (i.e., anterior chamber depth, axial length, corneal diameter). RESULTS: Reproducibility of the angle measurement was significantly better with the plane mode than with the polynomial mode (5.4%+/-4.7 versus 7.2%+/-6.2; p<0.001). Reproducibility significantly varied with localization (p<0.001). Significant differences were found between reconstruction modes (49.3 degrees +/-4.6 degrees for plane mode versus 42.8 degrees +/-6.7 degrees for the polynomial mode; p<0.001) and according to localization (p=0.02). Correlation with the other biometric measurements was higher for the plane mode than for the polynomial mode. Angle measurement with the plane mode showed significant correlation with subjective spherical equivalent (r(s)=-0.59; p<0.001), the anterior chamber depth measurement (r(s)=-0.74; p<0.001), the axial length measurement (r(s)=-0.34; p<0.002), and the corneal diameter measurement (r(s)=-0.34; p<0.002). CONCLUSION: The iridocorneal angle measure obtained with the plane mode showed high reproducibility and it significantly correlated with clinical parameters. It appears to be useful for clinical application.
PURPOSE: To evaluate amniotic membrane transplantation (AMT) in severe corneal epithelial diseases. METHODS: Amniotic membrane transplantation was performed in 14 eyes of 14 patients from four groups: A, five severe ocular burns; B, four cases of cicatricial keratoconjunctivitis; C, three persistent epithelial defects after penetrating keratoplasty; D, two cases of pseudophakic bullous keratopathy. Five patients underwent AMT alone; two patients underwent AMT combined with limbal transplantation; the other three patients had limbal transplantation performed before AMT. Eight patients required combined penetrating keratoplasty. Patients with corneal stable reepithelialization, no corneal neovascularization, and no recurrence of the initial pathology were considered successful. RESULTS: The mean follow-up was 7+/-3 months. All but three patients underwent corneal reepithelialization within 6 weeks of AMT, with a mean healing time of 31+/-23 days. The success rate was 75% at 6 months (Kaplan-Meier method). Three of four procedures in group B failed. In eight patients, visual acuity improved, in one it worsened, and in the last five patients it remained unchanged. Visual acuity increased by an average of 7+/-9 lines. CONCLUSION: AMT is a useful technique for ocular surface reconstruction, especially in association with limbal transplantation. It could also improve the prognosis of penetrating keratoplasty in patients with severe corneal conditions.
PURPOSE: To report the spectrum of fungal keratitis at the Centre Hospitalier National d'Ophtalmologie XV-XX, Paris. METHODS: We reviewed 19 cases of fungal keratitis from January 1993 to January 2001. We evaluated the different risk factors, fungal identification, topical and systemic antifungal therapy, surgical treatment and outcome. RESULTS: Nineteen patients were included, 7 women and 12 men, with visual acuity ranging from 9/10 to no perception of light. The mean age was 56.2 years. Patients were hospitalized for an average stay of 16.3 days and all received a diagnostic and therapeutic scraping and 16 received a local antifungal treatment. The most common risk factors were topical steroid treatment (42.1%), corneal graft (31.6%), trauma or foreign body (31.6%). The mean delay between the first signs and fungal keratitis diagnosis was 14 days. Yeast as Candida parapsilosis and albicans were the most frequently isolated fungi (58%), followed by Aspergillus sp. (21%) and Fusarium sp. (21%). The most commonly used topical treatment was amphotericin B, and itraconazole was used as systemic treatment. Five patients had evisceration, 6 had penetrating keratoplasty and 5 retained leukoma. CONCLUSION: Candida was the most frequently isolated fungi and topical steroid treatment the main risk factor. The prognosis is relatively poor (26% of lost vision) because of a delay in diagnosis and other previous ocular pathology or surgery.
PURPOSE: To identify predictive factors for reversibility of corneal graft rejection. METHODS: The study design was a prospective cohort study. Among 440 consecutive penetrating keratoplasties performed at our institution, 79 grafts from 79 patients who developed signs of transplant rejection were included. Donor, recipient, surgical, and rejection variables were studied, at both univariate and multivariate levels. RESULTS: The rate of reversibility was 51% (40/79). The average postoperative time of rejection was 10.5 +/- 9.3 months, and the average time of visual acuity recovery in patients with reversible rejection was 2.4 +/- 2.3 months. In logistic regression, only two variables significantly influenced the rate of reversibility. The preoperative diagnosis (p = 0.04) influenced the rate of rejection reversibility; patients with bullous keratopathy or regraft were more likely to experience irreversible rejection than patients with keratoconus or Fuchs' dystrophy. The average graft thickness at the time of rejection diagnosis was 774 +/- 129 microm in patients with irreversible rejection and 681 +/- 118 microm in patients with reversible rejection (p = 0.001). CONCLUSION: Rejection was reversible in half of the cases. Rejection was more likely to be irreversible in patients with marked increase in graft thickness and in patients transplanted for bullous keratopathy or graft failure. Donor variables did not influence rejection reversibility.
AIMS: To detect the presence of guttae by means of light microscopy during organ culture and to evaluate the influence of the presence of guttae in the donor tissue on transplantation outcome. METHODS: Donor corneas were investigated for the presence of guttae by means of light microscopy at the end of organ culture. Recipient corneal buttons from patients with severe Fuchs' dystrophy and donor corneas with advanced guttae were first studied by light microscopy and subsequently by transmission electron microscopy. Lastly, 168 consecutive donor corneas were evaluated for the presence of guttae and issued for transplantation. RESULTS: Corneal specimens with Fuchs' dystrophy displayed numerous round highly reflecting guttae at the level of the corneal endothelium. Donor corneas with advanced guttae showed less numerous guttae. Among 168 organ cultured donor corneas issued for transplantation, low density guttae were found in 43 (25.6%) corneas. The endothelial cell density and figure coefficient were significantly lower and organ culture time was significantly higher in the cornea guttata group than in the control group. The presence of grouped guttae significantly decreased the adjusted graft survival. The incidence of postoperative stage 3 cornea guttata was significantly higher when grouped guttae were found (5/6) than when no guttae or scattered guttae were found (8/101). CONCLUSION: Cornea guttata can be detected during organ culture by means of light microscopy. It is associated with a decrease in endothelial cell figure coefficient and cell density. The presence of grouped guttae is associated with poorer graft survival and more frequent stage 3 cornea guttata in the graft after transplantation.
PURPOSE: To study the correlation between subjective refraction and corneal topography. To compare the topographic analysis of surgically induced astigmatism (cataract and penetrating keratoplasty) with that of idiopathic astigmatism. METHODS: Subjective astigmatism, subjective spherical equivalent, best spectacle-corrected visual acuity (LogMAR units), and videokeratoscopy using the EyeSys 2000((R)) device (axial, tangential, and refractive power) were recorded in 100 eyes with idiopathic astigmatism, 100 eyes after cataract surgery, and 100 eyes after penetrating keratoplasty. Topographies were classified according to pattern (Bogan classification) and asphericity (shape factor: prolate or oblate). RESULTS: The asphericity shape distribution was significantly different between the 3 groups (p<0.001). The shape of idiopathic astigmatism was almost always prolate (90%) whereas the oblate shape was more frequent in the penetrating keratoplasty group (75%). There was no significant difference in topographic pattern distribution between the 3 groups (p=0.11). The asymmetric bow tie pattern was the most common topographic pattern. Topography pattern classification was significantly correlated with the subjective astigmatic cylinder. (r(s)=0.60, p<0.001). Unlike the round and oval patterns, the bow tie pattern was associated with the high subjective cylinder. Correlation between the subjective cylinder, the refractive power cylinder, and the axial power cylinder was strong (r(s)=0.92 p<0.001), but it was weak for the tangential power cylinder (r(s)=0.72 p<0.001). The correlation between the subjective spherical equivalent and central cornea power was poor (r(s)<0.37, p<0.001). Subjective astigmatic cylinder showed the strongest correlation with best spectacle-corrected visual acuity (r(s)=0.70, p<0.001), whereas the predicted corneal acuity, corneal uniformity index, asphericity, and refractive power symmetry index were poorly correlated with it (r(s)<0.54, p<0.001). CONCLUSION: Despite the difference in the asphericity shape, the topographic pattern was similar in the 3 groups. The pattern type was significantly correlated with the subjective astigmatic cylinder. Topographic indices failed to predict visual acuity, while the subjective cylinder showed a strong correlation with visual acuity.
We report four cases of Urrets-Zavalia Syndrome (fixed dilated pupil with iris atrophy) observed after penetrating keratoplasty. The precise etiology of the syndrome is uncertain and different mechanisms are reviewed. Care should be taken to avoid the use of mydriatic eye drops after penetrating keratoplasty.
PURPOSE: To study the refractive and topographic modifications induced by penetrating keratoplasty suture removal. METHODS: We prospectively studied 80 corneas from 80 patients who had undergone penetrating keratoplasty. All of the eyes were examined before and after all sutures were removed, respectively at 10.9 5.1 months and 21.5 9.6 months after keratoplasty. Subjective refraction, best spectacle-corrected visual acuity (LogMAR units), keratometry, and corneal topography using the EyeSys 2000((R)) device (axial tangential and refractive power) were recorded. Topographies were classified according to the pattern (Bogan classification) and the asphericity shape (prolate and oblate). RESULTS: Best spectacle-corrected visual acuity (Log MAR units) increased significantly after suture removal (1.1 1.9 lines, plt; 0.001). Suture removal decreased the subjective cylinder (5.01 D 2.06 with suture, 4.11 2.08 without suture; p=0.009). The change in subjective cylinder correlated with the change in topographic pattern(s)=0.67 p<0.001). Conversely to the "bow tie" patterns, the other topographic patterns were more frequent after suture removal. The change in visual acuity was essentially explained by the change in subjective cylinder(s)=0.40 p=0.002). The average central corneal power decreased significantly after suture removal by 0.83 to 1.81 D (p<0.001), whereas the subjective spherical equivalent increased (hyperopization) (-4.07D 3.73 with suture, -3.48 3.40 without suture; p=0.02). The change in central corneal power significantly correlated with the change in subjective spherical equivalent (r(s)()>0.30 plt; 0.001). The corneal power of the mid-periphery did not significantly change after suture removal. Suture removal significantly modified the asphericity shape distribution. (majority of prolate shape with suture, majority of oblate shape without suture, p<0.001). CONCLUSION: Keratoplasty sutures induce a central bulge in the corneal graft. Suture removal induces a decrease in the subjective cylinder and it increases the subjective spherical equivalent (hyperopization) through a decrease in the central corneal power. Suture removal modifies the corneal topographic pattern and shape. Visual acuity improvement after suture removal is mainly explained by the decrease in subjective astigmatism.
PURPOSE: To evaluate the accuracy and reproducibility of the biometric measurements obtained with the Orbscan((R)) device in normal eyes. METHODS: Anterior chamber depth, axial length, and corneal diameter were studied in 50 normal eyes of 25 patients using the Orbscan((R)) device and A-Scan ultrasonography. For each eye, two exams were done successively and reproducibility was calculated by analyzing the difference between both measurements. RESULTS: The reproducibility of anterior chamber depth and corneal diameter measurements obtained by Orbscan((R)) was high (respectively 0.721.25% and 0.831.40%). The anterior chamber depth measurements by Orbscan((R)) and A-Scan ultrasonography were strongly correlated (rs=0.92;p<0.001). The axial length measurement obtained with the Orbscan((R)) device was less reproducible (3.554.11%). For the axial length, the Orbscan((R)) measurements and A-Scan ultrasonography measurement was poorly correlated. (rs=0.64; p<0.001). CONCLUSION: The anterior chamber depth measurement obtained with the Orbscan((R)) device showed high reproducibility and it was strongly correlated with the measurement obtained by A-Scan ultrasonography. Axial length measurement obtained with the Orbscan((R)) device was less reproducible and poorly correlated with the A-Scan ultrasonography measurement. It was not relevant for clinical application.
Idiopathic polypoidal choroidal vasculopathy (IPCV) has recently been recognized as a distinct cause of recurrent subretinal hemorrhages and exudates as well as multiple hemorrhagic retinal pigment epithelium detachments in the macula. IPCV is usually considered to have a good visual prognosis. We report the case of a 44-year-old woman with particularly severe bilateral macular and peripheral IPCV. The patient was followed for 13 years and had final visual acuity of counting fingers in the right eye and 20/400 in the left eye. Patients with IPCV with macular choroidal neovascularization tend to have a poor visual prognosis. This case of IPCV should alert the physician to be particularly attentive to the follow-up of these patients.
PURPOSE: To compare the accuracy and reproducibility of the orbscan pachymetry and ultrasonic pachymetry in the normal eye and in the penetrating keratoplasty eye. METHODS: Pachymetric measurements were assessed in 50 eyes of 25 normal patients and 50 eyes of 48 patients who had undergone penetrating keratoplasty using both Orbscan II and ultrasonic pachymetry (Tomey SP-2000). For each eye, 2 successive measures were recorded with both instruments. For both devices, the default setting was used. Orbscan pachymetry maps were divided into 5 groups using a modification of Liu's classification. RESULTS: Orbscan pachymetry strongly correlated with ultrasonic pachymetry (rs = 0.91; p < 0.001). Ultrasonic pachymetry values and Orbscan pachymetry values showed no significant differences in the normal group (respectively, 557 microns +/- 36 and 555 microns +/- 34; p > 0.05). Ultrasonic pachymetry values and orbscan pachymetry values were significantly different in the penetrating keratoplasty group (respectively, 571 microns +/- 52 and 550 microns +/- 54; p < 0.001). The best value for the acoustic factor for Orbscan pachymetry in the penetrating keratoplasty group was 0.89. Ultrasonic pachymetry reproducibility and Orbscan pachymetry reproducibility were not significantly different (0.86% +/- 0.61 v. 0.67% +/- 0.63; p = 0.13 in the normal group; 1.22% +/- 0.81 v. 1.23% +/- 1.13; p = 0.92, in the penetrating keratoplasty group). Both pachymetry methods showed less reproducibility in the penetrating keratoplasty group than in the normal group (p < 0.02). Thinnest point localization was significantly different in both groups (p < 0.001). In 66% of the normal group, the thinnest point of the cornea was located in inferotemporal quadrant. This point was located at an average of 0.63 +/- 0.25 mm from the visual axis in the normal group and 1.60 +/- 0.81 mm in the penetrating keratoplasty group (p < 0.001). Whereas "Centered round" (40%) and "centered oval" (34%) were the most common patterns in the normal group, "decentered oval" (40%) and "irregular" (30%) were more frequent in the penetrating keratoplasty group (p < 0.001). CONCLUSION: Orbscan pachymetry strongly correlated with ultrasonic pachymetry. Reproducibility of both methods is excellent and not significantly different. Thinnest point localization and pachymetric map classification are significantly different in normal eyes and in penetrating keratoplasty eyes.
We report a case of acute angle-closure glaucoma in a patient treated with bronchodilator nebulization. An 82-year-old man with chronic obstructive bronchopathy was treated for acute respiratory decompensation with salbutamol and ipratropium bromide aerosols. Twenty-four hours after beginning the treatment, the patient developed acute angle-closure glaucoma which resolved rapidly with appropriate treatment. The case emphasizes the importance of precautionary measures (waterproof glasses and inhalation masks). In addition patients with a high risk of angle-closure glaucoma should be detected prior to prescribing bronchodilating aerosols.
We report a case of herpetic perforated peripheral corneal ulcer in a patient with cutaneous porphyria and hepatitis C. The patient underwent peripheral lamellar keratoplasty. Antiherpetic antibodies were found at a significantly higher level in the aqueous humor than in the serum. Outcome was favorable with antiviral treatment. We discuss the causal role of the hepatitis C virus, porphyria and herpes simplex.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
BACKGROUND: The aim of this study was identification of predictive factors for postoperative visual acuity in patients with a clear organ-cultured graft and to analyze the change in visual acuity between 12 and 24 months after transplantation. METHODS: The study design was a prospective cohort study. A total of 342 consecutive penetrating keratoplasties using donor organ-cultured grafts, performed in 324 patients, were included. Visual acuity, graft thickness, and graft endothelial cell density were recorded in patients with clear transplants. RESULTS: At 24 months postoperatively, 25 (18.7%) of 134 patients had 20/200 or worse visual acuity and 66 (49.3%) had 20/40 or better visual acuity. Graft thickness took 1 month to decrease to normal values. A temporary graft thinning occurred at 6 months postoperatively, followed by recovery of normal graft thickness by 18 months. The average postoperative endothelial cell density was 1,533+/-598 cells/mm2 during the second year. The 24-month LogMAR (logarithm of minimal angle of resolution) visual acuity correlated with preoperative LogMAR visual acuity (beta=0.26, P=0.005), postoperative lens status (beta=-0.34, P=0.008), preoperative intraocular pressure (beta=0.50, P=0.020), and postoperative astigmatism (beta=0.17, P=0.040). Visual acuity (P=0.022) significantly improved between 12 and 24 months. Preoperative diagnosis (P < 0.0001) and postoperative lens status (P < 0.0001) significantly influenced the change in LogMAR visual acuity between 12 and 24 months. CONCLUSIONS: Donor variables do not influence the visual acuity results of penetrating keratoplasty using organ-cultured donor tissue, whereas they have a strong influence on graft survival and graft endothelial cell density. Visual acuity improves during the first 2 years after transplantation. After keratoplasty, organ-cultured corneal grafts undergo dramatic modifications of their thickness and probably of their transparency.
PURPOSE: To report the results of arcuate keratotomy performed with the Hanna arcitome in patients with postkeratoplasty astigmatism. SETTING: Department of Ophthalmology, Saint-Antoine Hospital, Paris VI University, Paris, France. METHODS: This retrospective study comprised 22 eyes (22 patients) with postkeratoplasty astigmatism. Paired symmetrical arcuate keratotomy was performed with the Hanna arcitome. Outcome measures included refraction, videokeratography, and keratometry. RESULTS: At 6.6 months +/- 8.9 (SD) after surgery, the mean increase in best spectacle-corrected visual acuity (BSCVA) was 2.1 +/- 2.4 lines. Thirteen eyes gained 2 lines or more of BSCVA, and 15 gained 3 lines or more of uncorrected visual acuity. Two patients had a decrease in BSCVA: 1 had lens opacification unrelated to arcuate keratotomy and 1, increased corneal irregularity. Mean refractive astigmatism was 6.94 +/- 2.11 diopters (D) preoperatively and 3.85 +/- 1.95 D postoperatively (P < .01). Mean change in keratometric astigmatism was -51 +/- 36%. Astigmatism decreased in 21 eyes as measured by manifest refraction, keratometry, and videokeratography; it increased in 1 cornea with a microperforation. CONCLUSIONS: The results of arcuate keratotomy performed with the Hanna arcitome were comparable to those with freehand relaxing incisions. The instrument made safer and more uniform arcuate incisions than a freehand technique.