[Concepts of age-related macular degeneration in 2000].
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Aging↗
Biomedical subjects
P Gastaud
Publications and source records attributed to P Gastaud.
[Subretinal hematoma in age-related macular degeneration: treatment with intravitreal injection of tPA and gas].
PURPOSE: Subretinal hemorrhage involving the macula is a devastating complication of age-related macular degeneration. It may be successfully removed by vitrectomy but this surgery cannot be practiced in all patients. We propose an alternative way to this surgery by injecting tissue plasminogen activator then gas in the vitreous. PATIENTS AND METHODS: We treated seven patients suffering from submacular hemorrhage for less than seven days. We injected in the vitreous 50 micrograms of tissue plasminogen activator followed seven days later by an another intravitreous injection of 0.3 milliliter of C3F8. The patient then had to stay in a "face down" position for seven days. RESULTS: In five cases the subretinal hemorrhage was displaced enough to identify the choroidal neovascularization accountable for the bleeding in four cases. In one case, the displacement of the subretinal hematoma was incomplete but enough to identify and treat the neovascular membrane. In one case the injections were unsuccessfull. One recurrence occurred after four days after an initial successful displacement. The best corrected acuity was increased in four cases. No complication was attributed to the intravitreous injections. DISCUSSION: Treatment of subretinal hemorrhage complicated age related macular degeneration by injected tPA and gas into the vitreous is a safe and efficacious method particularly for patients with anticoagulation therapy or in poor health.
Aged↗
[Diathermic scleral retraction].
Diathermic scleral retraction appears to be an efficient technique, with little aggressivity, allowing both scleral indentation and radial and circumferential shortening of the ocular wall. We compared experimental results of a diathermic technique with those obtained by other authors using infrared laser scleral photocoagulation. The large number of variables, especially IOP, complicates standardization, but the results of the two methods on cadaver eyes were found to be quite similar. Diathermic scleral retraction creates a buckle effect and a 10 to 30% scleral shortening. This retractile effect decreases with rising IOP. This method would appear to have therapeutic interest for the management of retinal detachments with anterior proliferation and for the treatment of residual detachments after prolonged tamponade with silicon oil. These techniques of scleral shortening necessitate other experimental studies to evaluate their effects in the long-term, but the absence of induced chorioepithelial lesions would indicate therapeutic applications.
Diathermy↗
Results of proton therapy of uveal melanomas treated in Nice.
PURPOSE: To present the first results of uveal melanomas treated with the Medicyc Cyclotron 65 MeV proton beam facility in Nice, analyzing the factors that affect the cause-specific survival (CSS), metastatic rate, and reporting the visual outcome. METHODS AND MATERIALS: This study concerns 538 patients referred by French institutions between June 1991 and December 1996. The eye and tumor parameters were measured using ultrasonography and angiography. Since 1994, CT scans were performed in most patients to help determine the axial length and the shape of the ocular globe. Tantalum clips were inserted around the tumor by the referring ophthalmologist. There were 349 posterior pole tumors (64.9%), 130 equatorial tumors (24.1%), and 59 ciliary body tumors (11%). Two hundred four patients (37.9%) had T1 or T2 tumors, and 334 patients (62.1%) had T3 or T4 tumors. The median tumor diameter was 14.6 mm, and the median tumor height was 5.1 mm. All patients received 52 Gy (57.20 Gy Co-equivalent dose) on 4 consecutive days. The data were analyzed by December 1997. RESULTS: The CSS was 77.4% at 78 months, the overall survival was 73.8% and the local control was 89.0%. The CSS was not influenced by the patient age or the site of the tumor. It was 81.5% for T1 and T2 tumors, versus 75% for T3 and T4 tumors (P = 0.035). It was found that the tumor diameter, rather than the height, was the most important parameter affecting outcome. The metastatic rate was 8%. It depended on the T stage, tumor diameter and thickness, but not the tumor site. Thirty-eight enucleations were performed, most of them due to tumor progression and/or glaucoma. One-third of the patients in whom visual acuity was adequately scored before and after treatment had a stable, if not improved vision, and half the patients retained useful vision after treatment. CONCLUSION: The outcome of patients suffering from uveal melanoma and treated with high-energy protons compares favorably with other techniques of treatment. The tumor dimensions affected CSS and metastatic rate. Even though two-thirds of patients had posterior pole tumors, half of them retained useful vision.
Age Factors↗
Effects of EGb761 and superoxide dismutase in an experimental model of retinopathy generated by intravitreal production of superoxide anion radical.
BACKGROUND: A study was carried out to investigate the effect of two antioxidants--Ginkgo biloba extract (EGb761) and superoxide dismutase (SOD)--in an experimental model of vitreoretinopathy obtained by direct production of oxygen free radicals in the vitreous cavity. METHODS: Twenty-eight pigmented rabbits were used. Vitreoretinopathy was induced by intravitreal injection of 50 microliters of a mixture composed of 40 nmol of xanthine and 0.001 IU of xanthine oxidase. Rabbits were randomly distributed into four groups: Group 1 (n = 8) did not receive any treatment and served as a positive control. Groups 2 (n = 8) and 3 (n = 8) received for 1 month EGb761 given orally at a dose of 100 mg/kg/day, respectively 1 day after and 1 week before induction of retinopathy. Group 4 (n = 4) was treated by three intramuscular injections of 15,000 IU/kg of SOD, 24 h before induction and 24 and 48 h thereafter. Clinical evaluations and electroretinograms (ERG) were repeatedly performed until the animals were killed at day 28. Histological examinations and immunohistological procedures were performed to ascertain the origin and characteristics of the cellular proliferation and to compare vitreoretinal structures in the four groups. RESULTS: Intravitreal injection of xanthine-xanthine oxidase produced a strong inflammatory response with vitreous infiltrates and epiretinal membrane formation, inconstantly associated with retinal detachment. ERG showed a decrease of the a-, b- and c-waves beginning within a few hours after injection. Histologic evaluation found an intravitreal and epiretinal infiltration by leukocytes and epithelial-derived cells, dense vitreoretinal membranes and retinal detachments with occasional neovascularization. In the treated groups (groups 2-4), all clinical, electric and histologic data were significantly improved compared to the control group. However, no difference could be found among the three treated groups. CONCLUSION: This study demonstrates the strong pathologic effects of free radical production on the retina and the close relationships between free radicals, inflammatory pathways and vitreoretinal proliferative disorders. It also confirms the pharmacological interest of prevention by antioxidants and free radical scavengers.
Administration, Oral↗
Ocular filariasis: not strictly tropical.
A 65-year-old man consulted for a discomfort in the right eye that had suddenly appeared the evening before. The examination revealed a white worm localized under the temporal bulbar conjunctiva. After extraction, the parasitological characteristics identified the worm as Dirofilaria repens (Nochtiella subgenus). This is a parasite of canids and felids, usually nonpathogenic to humans, but which can be transmitted through mosquito bites, especially around the Mediterranean basin. The simple extraction of the worm, encysted under the skin or under the conjunctiva, cures the patient.
Aged↗
[Representation of normal and pathologic macular color vision].
INTRODUCTION: The computerized chromatic test allows a graphic visualization of the colors perceived by normal and pathologic retina. MATERIAL AND METHOD: This test was returned by an album (six series of plates with ten levels of saturation), a lamp and a program for graphic representation. RESULTS: The graphic image was returned by the computer. For a normal eye, the aspect of the chart was a set of ten concentric saturation levels: the most saturated circle were located on the outside. For an acquired or congenital dyschromatopsia, the limits of the neutral zone are located in the center and are constituted by the most saturated level of blind charts of the album. DISCUSSION AND CONCLUSION: The informatized chromatic test is a very easy one to appreciate color vision defects.
Color Perception Tests↗
[Course of epithelial scars after surgical removal of small-size subfoveal neovessels].
PURPOSE: We analyzed outcomes of 18 subfoveal neovascular membrane scars after surgery removal in age related macular degeneration. Surface and aspect of pigment epithelial defects were evaluated on angiographic data. RESULTS: We differentiated glial scars and atrophic scars, the most numerous. Scar surfaces were larger compared to the initial preoperative lesions. Central epithelial pigments in scars disappeared in the three months following surgery. After on year, scar surfaces moderately enlarged. DISCUSSION: Ideal approach for retinotomy as well as clinical aspects have to be well evaluated in subfoveal neovascular surgical removal. The angiographic mask effect of the avascular ring surrounding the neovessel is sometime detectable; the approximative scar surface is by this fact more predictable. CONCLUSION: Iatrogenic damages of surgery and postoperative inflammatory lesions must be considered before when a surgical removal of neovascular membranes is suggested.
Adult↗
[Indications and results of surgical removal of "congenital" epimacular membranes].
INTRODUCTION: Congenital epimacular membranes differ from acquired membranes of young adults by their slow evolution and absence of vitreously their cortex detachment. CLINICAL CASES: We report five observations. In all these cases of unilateral maculopathy, no etiologic factors were found. Surgical removal was required in only two of these cases. RESULTS: These membranes were whitish and presented extensions along retinal vessals to which they were very adhesive. The absence of posterior vitreous detachment was confirmed during vitrectomy and histopathologic examination found a predominance of extracellular matrix. DISCUSSION: In these idiopathic membranes, clinical and histopathological findings evoke a dysembryopathy. Surgery decision must attach great importance to the relative amblyopia of these eyes, the low evolutivity and the risks of iatrogenic tears during dissection.
Adult↗
Histopathological effects of topical ophthalmic preservatives on rat corneoconjunctival surface.
PURPOSE: Long term use of topical drugs has clearly been shown to induce toxic immunopathological changes in the ocular surface. However, little is known concerning the respective roles of active compounds and preservatives. Benzalkonium chloride (BAC) is the most used preservative and its cytotoxicity is well known, but other preservatives have not yet been clearly evaluated. We thus performed a comparative study to investigate toxic side effects induced in the rat ocular surface by applications of various preservatives, with special attention to inflammatory infiltrates. METHODS: A total of 35 brown Norway rats were divided into seven groups of five each. They received, for one month, in both eyes, either 0.01% cetrimonium chloride, 0.01% benzalkonium chloride, 0.01% benzododecinium bromide, 0.004% thiomersal, 0.05% methyl parahydroxybenzoate or phosphate-buffered saline (PBS), the last group remaining untreated. Then, animals were sacrificed and eyes were processed for histological and immunological procedures with monoclonal antibodies to rat immunocompetent cells. RESULTS: When compared to controls, all preservative-treated eyes consistently showed corneal and conjunctival damage, including epithelial alterations, various degrees of keratinization and inflammatory infiltrates at the limbus and within the conjunctival stroma and epithelium. No difference was found between the five tested drugs. CONCLUSIONS: This study confirms that most preservatives used in ophthalmic eyedrops may similarly induce strong histopathological and inflammatory changes in the ocular surface after short term use. Although obtained in animal model, these results confirm strong toxic side effects in patients with preexisting ocular surface disorders and/or receiving topical drugs for long periods.
Animals↗
[Probable choroid metastasis of an esophageal adenocarcinoma that regressed with chemotherapy].
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Adenocarcinoma↗
[Myopia and retinal detachment].
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Humans↗
[Macular epiretinal membrane and cataract].
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Aged↗
[Surgical treatment of serous detachments of the macular neuroepithelium in diabetics].
PURPOSE: Maculopathy in diabetes mellitus represents one of the most serious complications of the diabetic retinopathy. Retinal photocoagulations are often impossible and even dangerous. We propose a new method of surgical treatment for this macular serous detachment. MATERIAL AND METHOD: Thirteen eyes from 11 patients were treated using the same surgical procedure: vitrectomy, aspiration of subretinal liquid through a temporal retinotomy, fragmentation and extraction of the sub and intra retinal exsudates through one or several retinotomies, macular massaging with fluorodecaline, endophotocoagulations (focal on vascular anomalies and macular grid) and fluid-gas exchange (C3F8). RESULTS: Macular serous detachment and subretinal exsudates disappeared in all the cases, the fluorescein leakage decreased. A functional improvement was obtained in 11 eyes, a stabilization in 2. DISCUSSION: The clinical results of this new surgical treatment appear to depend on the preoperative macular ischemia and on the age of the detachment. This surgical procedure is very beneficial but could perhaps be technically improved.
Aged↗
Use of i.v. insulin in well-controlled non-insulin-dependent diabetics undergoing major surgery.
We conducted a randomized, prospective study to assess the effect of i.v. insulin on blood glucose control, development of ketone bodies and hormonal changes in 60 well-controlled, non-insulin-dependent diabetics (NIDDM) undergoing major surgery. In group A, patients were given only 0.9% saline; in group B, patients were given insulin as a continuous i.v. infusion (1.25 u. h-1); in group C, patients were given insulin 10 u. i.v. boluses every 2 h. Patients in all three groups were given insulin 5 u. when their intraoperative blood glucose concentration increased to greater than 11.1 mmol litre-1. Blood glucose concentrations were measured every 15 min, from just before induction of anaesthesia to 2 h after surgery. Plasma lactate, pyruvate, ketone body, C-peptide and counter-regulatory hormone concentrations were also measured. Blood glucose concentrations in the three groups did not differ significantly. There was a mild-to-moderate increase in plasma ketone body concentrations in group A, but without any deleterious consequences. Plasma C-peptide concentrations decreased significantly in groups B and C, especially in patients given bolus injections of insulin. Plasma growth hormone concentrations also increased significantly in group B and C patients. This study indicated that the "no insulin--no glucose" regimen was a simple, effective way to control blood glucose in well-controlled NIDDM patients, provided blood glucose was measured frequently and insulin used appropriately.
Adult↗
Treatment of cytomegalovirus retinitis in AIDS patients using intravitreal injections of highly concentrated ganciclovir.
PURPOSE: Intravitreal injections of ganciclovir provide a useful adjunct or alternative treatment for cytomegalovirus retinitis in AIDS patients when toxicity or progression is seen with systemic administration of antiviral drugs. To avoid transient increase in intraocular pressure that may impair optic nerve vascularization in long-term treated patients, we modified conventional procedures by injecting a smaller volume of a more concentrated ganciclovir solution. PATIENTS AND METHODS: We used intravitreal injections of 350 micrograms of ganciclovir in a final volume of 50 microliters, in 156 eyes from 111 AIDS patients, 14-53 years old, presenting with necrotizing retinitis despite systemic antiviral agents or who had become intolerant to systemic treatment. RESULTS: Patients underwent a total of 2,890 injections. The mean number of injections was 25.9 +/- 3.2 by patient, with a maximal duration of 32 months (with a total of 220 injections in 1 patient). Forty-five of the 111 patients received bilateral intravitreal injections, 8 had more than 80 injections each. The only major complications were 4 cases of endophthalmitis causing a total loss of vision in 2 eyes, 1 retinal detachment and 3 cases of slow progression of retinitis resulting in optic nerve atrophy despite treatment. We observed a very low rate of amaurosis and ocular pain. Relapse occurred after 2-3 weeks whenever treatment was stopped, so that intravitreal ganciclovir was not discontinued until the patient's death or reintroduction of systemic treatment. CONCLUSIONS: This procedure confirmed the good efficacy of intravitreal ganciclovir in halting progression of retinitis. Injection of a smaller volume of ganciclovir reduced repeated amaurosis and ocular pain. It was considered by patients as improving their comfort and quality of life, thus increasing their compliance to treatment and reducing side effects as compared to usual protocols.
AIDS-Related Opportunistic Infections↗
[Tumors of the choroid. Clinical, paraclinical approach and therapeutic concepts].
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Choroid Neoplasms↗
[Color vision test for detection and evaluation of dyschromatopsia].
METHODS: The color vision test for diagnosis and evaluation of the dyschromatopsias consists of a set of 92 colored test charts of the pseudochromatic type, a lamp and a test report giving a graphic image of the sensitivity to color deficiency. RESULTS: The test makes it possible to identify each neutral zone of all types of dyschromatopsia, places the neutral zone within the color spectrum and establishes its extent according to 6 axes (Protan, Deutan, Tritan, Tetartan, Scotopic and Monochromatic) and 10 levels. The visual sensitivity to color is measured on a 10 point scale, just as visual acuity is. Between a normal sensitivity to color, which is marked 1, and an anopia (i.e complete lack of visual sensitivity to color along one axis), marked 0, there are 9 intermediary levels marked 0.9; 0.8: 0.7; 0.6: 0.5; 0.4; 0.3; 0.2 and 0.1. CONCLUSION: Testing is important for all kinds of eye diseases or common diseases which affect eyesight making possible not only early diagnosis of a disease but also treatment follow-up.
Color Perception Tests↗