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Biomedical subjects

P Gastaud

Publications and source records attributed to P Gastaud.

At least 19 recordsLinked to original sources

[Floating membranes].

INTRODUCTION: Floating membranes are epiretinal membranes that spontaneously detach from the retina and float in the vitreous cavity. PATIENTS AND METHOD: We studied a series of nine patients with a spontaneous separation of a premacular membrane. The majority of these detached membranes were secondary to vitreomacular traction syndrome. In four patients, the presence of peripheral retinal tears treated in the past by laser photocoagulation were found. None of the patients had complete vitreoretinal detachment before progressing to floating membranes. RESULTS: The separation of the membrane from the macular area occurred at the time of posterior vitreous detachment. The appearance of a bulky intravitreous floating body attached to the posterior vitreous cortex sometimes proved to be very awkward for vision, resulting in a vitrectomy in four patients for ablation of this large floating body. In five patients who were not operated, the presence of the membrane in the vitreous cavity was not responsible for significant functional disorders. DISCUSSION: The epimacular membranes concerned in this series were not very symptomatic before their detachment. They seemed to be integrated within the context of vitreomacular traction syndrome. The most invalidating cases that required surgery were those where the separation of the vitreous cortex remained incomplete, leaving an opaque membrane floating with a little mobility in front of the macular area (three out of four cases). CONCLUSION: The spontaneous detachment of a premacular membrane is an event that is quite seldom observed and generally follows the spontaneously favorable progression of vitreomacular traction syndrome.

Aged↗

[Arteriovenous malformation of the brain revealed through a visual blur and Adie's pupil].

INTRODUCTION: Arteriovenous malformations of the brain (BAVMs) are a relatively rare group involving intracranial vascular lesions (telangiectasia, cavernous malformation, venous anomaly). We report the case of a patient who presented an atypical visual symptomatology revealing a BAVM. OBSERVATION: A 48-year-old woman consulted for a recent bilateral visual blur. In darkness, discrete anisocoria appeared on the left eye. At the biomicroscopy light examination, we found areflexic semi-mydriasis (direct and consensual) on the left eye; the light reflex (direct and consensual) on the right eye was normal. During the accommodative reflex test the left pupil contracted. We propose the diagnosis of Adie's pupil, which was confirmed by the pilocarpine test (0.125%). We decided to examine the visual field because the symptomatology of the visual blur remained unexplained. The visual field showed a left homonymous inferior lateral scotoma. MRI showed a right occipital arteriovenous malformation. DISCUSSION: A quick examination could confuse painless anisocoria with a compression of the IIIrd intrinsic left nerve. This recent scotoma revealed BAVM progression. The natural history of BAVMs shows that the essential risk of these injuries is the onset of an intracranial hemorrhage. To reach a radical therapeutic decision, a cerebral arteriography clarifying the afferent and efferent vascularity of the nidus was carried out. CONCLUSION: This case is original in that it associates the concomitant discovery of a BAVM and Adie's pupil. Symptomatic BAVMs are extremely serious. Planning their treatment requires multidisciplinary cooperation in order to reduce the risk of mortality.

Female↗

[Vitreous changes in Stickler syndrome].

We report the ultrastructural feature of a vitreous membrane with multiple fenestrations in a case of a 40-year-old woman with a Stickler syndrome. The left eye showed a type 2 vitreous phenotype. Vitreous abnormalities of the right eye may correspond to phenotypic conversion to a type 1 appearance of a type 2 vitreous phenotype. Fenestrated membrane may correspond to posterior hyaloid membrane in complete posterior vitreous detachment in this phenotypic conversion. Fenestrated membrane consisted of avascular fibrocellular tissue with cells arranged in a cohesive pattern around the fenestration. Ultrastructural findings of cells were characteristic of proliferative Müller cells. Ultrastructural examination of collagen fibrils showed them to be similar to normal vitreous. This finding suggests that collagen molecules are not functionally altered and are probably quantitatively insufficient during vitreous development.

Abnormalities, Multiple↗

[Optic disk neovascularization in fungal endophthalmitis].

A case of optic disk neovascularization is reported in a 30-year-old female heroin addict with suspected fungal endophthalmitis treated with an intravitreal injection of amphotericin B and fluconazole (200mg/day). Membrane healing was characterized by densification and contraction leading to tractional retinal detachment; excision by vitrectomy was required. Electron microscopy analysis of the membrane removed the tenth month revealed a poorly vascularized fibrous tissue infiltrated by chronic inflammatory cells. Visual improvement was poor owing to a postoperative macular disorder and a full-thickness retinal scar.

Adult↗

[The role of surgery in the treatment of age-related macular degeneration].

The place of surgery in DMLA amounts to the surgical treatment of choroidal neovascular membranes and submacular hemorrhage. After a brief historical review, the different techniques currently used are described, but indications have become rarer since the development of dynamic phototherapy. However, despite a high complication rate, these surgical methods should not disappear from our therapeutic arsenal because they have proved their ability to restore good visual acuity.

Choroid Hemorrhage↗

[Surgical indications for diabetic maculopathy].

INTRODUCTION: The place of surgery in the treatment of diabetic macular edema is still not clearly defined even though the functional benefits of photocoagulation are less than satisfactory. Key words: Diabetic maculopathy, vitrectomy, internal limitant layer, serous detachment, hard exsudates. EQUIPMENT AND METHODS: We conducted a retrospective study on 40 consecutive cases of diabetic patients, each suffering from serious diabetic maculopathy and for whom photocoagulation would be either impossible to carry out or ineffective. Eighty percent of this study sample exhibited solid vitreomacular adhesions at vitrectomy. The internal limitant layer was dissected systematically. In all cases, plugging by perfluorocarbon liquids during the operation helped posterior focal endophotocoagulation. A gas tamponade was used in all cases. In 18 cases, surgical extraction of large intra- and/or subretinal clumps of hard exudates was necessary to replace the posterior pole. RESULTS: The anatomical results were satisfactory in 97.5% of cases. The functional results were good but their interpretation is more difficult: the visual gain varied as a function of the clinical preoperative condition and how recent the condition was. The best results were obtained in edema with tractional predominance. The smallest visual gains were observed in cases of massive macular hard exudates. The most serious complication was a retinal detachment secondary to a parapapillary nasal retinal break occurring at a distance from the operation during a postoperative photocoagulation complement. DISCUSSION AND CONCLUSION: Vitrectomy released both tangential and axial tractional forces found in diabetic macular edema pathogenesis. The extraction of large clumps of exudates allowed us to replace serous retinal detachments and the photocoagulation of capillary anomalies. In addition, removing premacular vitreous body and gaseous plugging seemed to osmotically resorb the posterior pole edema. These surgical results have made us considerably reduce the use of photocoagulation for diffuse diabetic macular edema in the past four years.

Adult↗

[Necrotizing fasciitis of the eyelids and orbit: a life-threatening ophthalmological emergency].

INTRODUCTION: Necrotizing fasciitis is an extremely serious exceptional infectious process affecting subcutaneous soft tissues with skin gangrene and vascular thromboses. Starting from a case repat of necrotizing fasciitis of the eyelids and orbit, which occurred in a child of 4, we analyse the early diagnostic elements and the urgency of treatment of a pathology which can rapidly be life-threatening. OBSERVATION: A child, aged 4 presented a necrotizing fasciitis of the eyelid and orbit with serious toxic shock, after minor skin abrasion. RESULT: Resuscitation and parenteral antibiotic therapy were not sufficient to stop the necrotizing process, which required surgical debridement of gangrenous tissues. DISCUSSION: Necrotizing fasciitis is a rare affection with fatal local and general prognosis. Location on the orbit and eyelids is extremely rare, with only a score of cases recorded in the literature, principally in adults. Our observation shows the possibility of occurrence in a young child and found the typical features of the pathology: minor initial trauma, beta hemolytic streptococcus, extremely fast progression requiring resuscitation, extensive antibiotic therapy and surgical excision of the gangrenous tissues. Eyesight remained intact, but cases of blindness have been described in the literature. Secondary reconstructive surgery on the eyelids may be necessary. CONCLUSION: Urgent diagnosis of this exceptional pathology that may affect the young child and prompt antibiotic therapy and surgical debridement are the only guarantees of survival of infected patients.

Anti-Bacterial Agents↗

[Primary signet ring cell carcinoma of the eccrine sweat gland in the eyelid. Immunohistochemical and ultrastructural study of a case].

We report a case of a 45-year-old woman who exhibited a primitive eccrine sweat gland carcinoma of the eyelid. Histological study showed cellular proliferation with an Indian file pattern and some signet ring cells with sialomucin secretion. Immunohistochemical study demonstrated these cells to be positive with the anticytokeratin, anti-EMA, anti-HMFG, antiestrogen receptor and antiprogesterone receptor antibodies. Ultrastructural study showed intracytoplasmic vacuoles with numerous microvilli at the apical side. Differential diagnosis with a metastasis from a mammary adenocarcinoma is difficult and a complete staging is necessary to confirm the primitive origin of the tumor. The behavior of this tumor is marked by locoregional recurrence.

Carcinoma, Signet Ring Cell↗

Asymmetric synthesis of functionalized 1,2,3,4-tetrahydroquinolines.

[reaction: see text] Highly enantioselective rhodium-catalyzed asymmetric hydrogenation (>98% ee) and Sharpless epoxidation (>90% ee) of o-nitrocinnamyl substrates lead to intermediates that can be transformed into tetrahydroquinoline derivatives. Starting materials are produced in high-yielding Heck reactions of an o-nitroaryl iodide and alpha-acetamidoacrylate or methyl acrylate.

Antioxidants↗

[Retinal detachment due to macular holes in highly myopic eyes. Prognostic factors].

PURPOSE: To evaluate the prognostic value of axial length and epiretinal membrane (ERM) separation during vitrectomy for retinal detachment due to macular hole in high myopia. PATIENTS AND METHODS: Thirty-two consecutive highly myopic eyes (31 patients) with retinal detachment due to a macular hole were retrospectivly studied. All eyes underwent pars plana vitrectomy with gas tamponade (C3F8). An epiretinal membrane was removed in 9 cases. The 32 cases were divided into 3 groups: anatomical success after the initial surgery (group 1, 15 cases); anatomical success after two surgical procedures without silicone oil (group 2, 5 cases), and silicone oil tamponade (group 3, 12 cases). RESULTS: Retinal reattachment occurred in 15 cases (46.8%) after the initial surgery. The difference of axial length between the 3 groups was not significant. The rate of anatomical success without silicone oil was 88.8% (8/9 cases) when an ERM was peeled and the number of peelings was significantly higher (p=0,04) in group 1 than in group 3. CONCLUSION: The axial length was not a pronostic factor of silicone oil tamponade in this study. The success rate was higher when an ERM was peeled. However, considering the technical difficulty in removing the ERM completely, gas tamponade seems to be the better initial treatment.

Adult↗

[Ultrastructural features of peripheral choroidal neovascular membranes in age-related macular degeneration].

PURPOSE: Some neovascular membranes comprise two parts: a fibro - vascular central body and an avascular marginal component. Certain authors have suggested that this avascular part could be involved in post laser treatment recurrence of subfoveal membranes. The purpose of this study was to determine the ultrastructural features of the marginal avascular component. METHODS: Four well-defined subfoveal neovascular membranes associated with age-related macular degeneration were surgically excised. The peripheral portion of each membrane was evaluated by transmission electron microscopy for cellular and extracellular constituents. RESULTS: Each subretinal neovascular membrane was composed of two regions demonstrated by fluorescein angiography: a central area of hyperfluorescent leakage and an annular rim of hypofluorescence. The edge of the central body corresponded to a richly neovascularized tissue and was surfaced by a hyperplasic retinal pigmented epithelium. The rim was composed of a layer of retinal pigmented epithelium and a layer of photoreceptor outer segments associated with macrophages. The stroma was composed of fibrin and was avascular and acellular. DISCUSSION: Neovascular removal of membrane was surgically removed as well as native retinal pigmented epithelium beyond the surface of fibrovascular central body which could explain why post operative scar surfaces were larger than to the initial preoperative membrane defined by fluorescein angiography. CONCLUSIONS: The peripheral rim of neovascular membrane is an exsudative complication of the outer epithelium made up fibrin, native retinal pigmented epithelium, and photoreceptor outer segments. The front of the active neovascularization is localized in the periphery of the central fibrovascular body.

Choroidal Neovascularization↗

[Idiopathic vitreomacular traction syndrome. Vitrectomy results].

PURPOSE: Evaluate the visual results, the complications and the prognosis factors of surgery for idiopathic vitreomacular traction syndrome. METHODS: We retrospectly reviewed 29 consecutive eyes that had undergone pars plana vitrectomy and posterior epiretinal membrane peeling for idiopathic vitreomacular traction syndrome. RESULTS: The mean follow-up after surgery was 17.7 months. Among the 29 cases, 21 were phakic. Visual acuity improved by 2 lignes or more in 72.4% of the cases and the mean improvement was 2.7. Eyes with preoperative visual acuity of 0.25 or more had better postoperative vision than the others (0.42vs0.65;p=0.006). During the follow-up, 10 patients underwent phacoemulsification and posterior chamber implantation (47.6%). The mean visual acuity of these 10 cases was poorer than the mean visual acuity of the 8 pseudophakic patients that underwent vitrectomy (0.45vs0.61;p=0.046). Five recurrences of epiretinal membrane were observed (17.2%). CONCLUSIONS: Surgical treatment of vitreomacular traction syndrome improves visual acuity in most of cases. Further studies with optical coherence tomography are necessary to understand the pathogenic mechanisms of vitreomacular interface syndromes.

Aged↗

[Proton therapy of occult neovessels in age-related macular degeneration].

INTRODUCTION: The interest of radiation therapy in the management of age-related macular degeneration inaccessible to photocoagulation is still controversial. Our purpose was to demonstrate the feasibility and the possible efficacy of a single dose delivered to the macular region using a 65-MeV proton beam. MATERIAL AND METHODS: A phase II trial was set up using the cyclotron in Nice, France. Fifty-eight patients were included after signing an informed consent. All patients presented with occult subfoveal choroidal neovascularization. A single dose of 9.1 Gy (i.e., 10 Gy cobalt equivalent) was delivered to the macular region. RESULTS: The results were analyzed 3, 6, 12 and, 18 months after proton therapy. At 3 months, the visual acuity was stable or enhanced for 86% of patients, at 6 months for 82.3%, at 12 months for 80%, and at 18 months for 61%. For 22 patients at follow-up at 18 months, the reasons for a decrease in visual acuity were a macular hemorrhage for 4 patients and a progression of the neovascular membrane for 3 patients. No secondary effects related to the treatment have been observed. Regarding the lesions visible on the angiographies (i.e., hemorrhage, exudates, subretinal detachment), we observed a stabilization or a decrease in two-thirds of the cases. CONCLUSION: Preliminary results of single-dose proton therapy are at least comparable to those obtained by other teams. A second study is in progress comparing 3 dose levels, looking for a dose-effect relationship. Furthermore, a randomized study comparing a single proton dose to a placebo will be necessary to assess the long-term value of proton treatment.

Aged↗

[Coats disease].

In spite of an unclear definition of Coats disease, this angiomatosis can be defined by the presence of retinal telangiectasis of nondetectable etiology, complicated by severe exudative phenomena. The diagnosis of this serious affection remains difficult because of its numerous clinical forms, which vary according to the age at which the disease appears and the progressive nature of the exudative phenomena. The consequences on the young child are all the more dangerous because it is too often discovered late. It seems necessary to attempt to stop the progression of Coats disease by destroying the telangiectasis responsible for intra- and subretinal exudation. No coagulation technique has been shown to be more effective than others and the predominance of heterogeneous series in the literature makes it difficult to evaluate the therapeutic results. In cases of severe retinal detachment, these coagulations can only be done after the often difficult drainage of the subretinal fluids.

Adolescent↗

[Pigmentosum retinis and tubulo-interstitial nephronophtisis in Sensenbrenner syndrome: a case report].

PURPOSE: Sensenbrenner syndrome or cranio-ectodermal dysplasia is an extremely rare autosomal recessive condition (12 cases reported in literature). Our observation shows the possibility of both ocular and renal involvement associated with cranio-ectodermal abnormalities. PATIENTS: and method:We report the case of a girl who presented a typical cranio-ectodermal syndrome with dolicocephaly, short thorax, short limbs, short fingers and teeth abnormalities. At five years, she was found to have pigmentosum retinitis with amblyopy and moderate hyperopia. A chronic renal failure with uncontrollable hypertension underwent a cadaveric-donor transplantation at the age of six years. RESULTS: Two years later, the pigmentosum retinitis was stable. The kidney histology revealed a tubulo-interstitial nephronophtisis. The molecular analysis of the NPH 1 locus, which was associated with nephronophtisis, was negative. DISCUSSION: Our observation and two recent publications have in common ocular and renal abnormalities associated with cranio-ectodermal dysplasia. The underlying genetic defect would involve not only morphogenesis but also development and maturation of organs as eye and kidney. Sensenbrenner syndrome would thus be similar to certain disorders affecting the eye, kidney, skeleton and ectodermal structures such as the EEM, Senior-Loken, Mainzer-Saldino, and Jeune syndromes. CONCLUSION: The retinal dystrophy falls within the spectrum of clinical and genetic forms of pigmentosum retinitis. Our observation would confirm possible links between Sensenbrenner syndrome and oculorenal syndromes.

Abnormalities, Multiple↗

[Place of "exploratory vitrectomy" in the treatment of retinal detachment without proliferative vitreoretinopathy].

INTRODUCTION: One of the principal causes that may contribute to failure in the treatment of retinal detachment without PVR is the inability to detect the retinal break before and during surgery. We propose in these cases the use of exploratory primary vitrectomy allowing the location and the treatment of the retinal break. MATERIAL AND METHODS: We have studied retrospectively 19 cases of retinal detachment without any preoperatively identified break. In 14 cases, it was a pseudophakic detachment (the IOL was in the posterior chamber with an optic between 5 and 6 mm), in 5 cases it was a phakic detachment. Peripheral fundus was examined with the vitrectomy probes with and without perfluorocarbon liquid injection. Cryotherapy or endophotocoagulations have been used to create a chorio-retinal adhesion and a gaz tamponade was used without scleral buckling procedure. RESULT: In 2 cases, no retinal break was found. In the other cases, the retinal tear has been identified during basal vitrectomy in 8 cases, during injection of perfluorocarbon in 2 cases and during the vitrectomy done forward the PFLC in 7 cases. The retinal break was identified as a small retinal tear along the posterior margin of the vitreous base in 15 cases (several in 2 cases) and as atrophic hole in 2 cases. DISCUSSION: Exploratory vitrectomy is an interesting technique to identify a retinal break when a scleral indentation cannot offer a good visualization of the anterior retina or retinal tears. In young phakic patients, a primary vitrectomy may be dangerous but seems to be justified in pseudophakic eyes. The research of the tear is sometimes facilitated by a peroperative tamponade of the retro equatorial retina.

Aged↗

[Ultrastructural findings of epimacular membrane and detached posterior hyaloid in vitreomacular traction syndrome].

PURPOSE: Vitreomacular traction syndrome is characterized by an incomplete posterior vitreous detachment and by the cortical vitreous remaining attached to the macula. In certain case epimacular membrane is clinically well defined. We studied the electron microscopic features of epiretinal tissue and posterior hyaloid removed from the posterior pole. MATERIAL AND METHODS: [corrected] Six epimacular membranes were removed during a pars plana vitrectomy, placed in 2.5% glutaraldehyde solution, embedded in Epoxy resin, and examined in a transmission electron microscope. The detached posterior hyaloid was removed and analyzed separately in two cases. RESULTS: The analysis disclosed five morphologically cell types. Fibrous astrocytes were predominant in five cases. Other cell types were less frequent and were identified as fibroblasts, macrophages and myofibroblasts. In one case epithelial-like cell type was predominant. The stroma was mainly composed of a thin layer of 15-nm diameter collagen evoking a vitreous origin. Internal limiting membrane was present in one case only. Detached posterior hyaloid was constituted by the same cellular constituents on thin layer of vitreous collagen. DISCUSSION: The cellular proliferation is principally constituted by fibrous astrocyte and occurs on the inner surface of cortical vitreous. Some glial cells seem to present an epithelial differentiation. CONCLUSION: The attached and detached posterior hyaloid in vitreomacular traction syndrome is the place of glial cells migration and proliferation.

Humans↗