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Summary Purpose During the surgical correction of dysthyroid diplopia, the risk of ischemia by transection of the anterior ciliary arteries is well-known. In order to avoid this, we modified the classical surgical technique: (1) through the preservation of the vascular pedicles during muscle recession and (2) if necessary, through a plication (instead of a resection) of the ipsilateral antagonist muscle. The objective to be achieved is thus the resolution of the diplopia without ischemic complications. Subjects and methods We report a prospective series of 10 patients with dysthyroid ophthalmopathy, causing strabismic diplopia, all operated on by the same surgeon (BR) after at least 12 months of euthyroidism. Data collection included: history of previous decompressive surgery, surgical procedure, and oculomotor status before and after surgery. Results Ten patients (8 females), aged 51 to 74 years (mean age, 58.00 ± 7.62 years), were collected between 2008 and 2012. All patients had one or more vascular risk factors (diabetes, smoking, obesity, high blood pressure). With a follow-up from 16 to 67 months (mean ± SD 27.7 months ± 14.87), surgical outcomes were excellent: diplopia was cured in all cases, with recovery of stereoscopic vision. We had no operative or postoperative complications. Conclusions The technique of preservation of the anterior ciliary vascularization, which is particularly justified for these fragile patients, is compatible with moderate muscle recessions. For larger deviations, in which a larger recession might increase the proptosis, it is possible to add a plication of the ipsilateral antagonist. This surgical technique made possible the suppression of the diplopia in all cases.

Lower eyelid retraction is a complication that frequently follows large inferior rectus recession. It may result in cosmetic problems or lagophthalmos with corneal exposure. We report the case of a child who had restrictive strabismus related to orbital fibrosis. He underwent bilateral inferior rectus recession and bilateral brow suspension. Retractor lysis was performed to treat a lower lid retraction that followed strabismus surgery. Lower lid retraction results from the anatomic connections between the inferior rectus muscle and the lower eyelid retractor. Several techniques have been proposed to prevent or treat lower eyelid retraction after inferior rectus recession.

Acute or rapidly progressive visual loss in children needs urgent attention and treatment. It may be unilateral orbilateral. Etiology depends upon the involved areas: eye ball, optic nerve, retro-chiasmatic pathways. Psychogenic origin is quite common in school-age children, however, it has to be considered last. Unilateral visual loss may be overlooked. Acute total transitory visual loss may be due to epilepsy or to migraine. Rapidly progressive visual loss may be due to retinal disease, optic neuritis or cortical blindness. Management of visual loss depends on clinical features, associated symptoms, and aspect of the optic disc. It needs collaboration between ophthalmologist,pediatrician and neuropediatrician. Retinal hemorrhages first call to mind a traumatic origin. Swelling of the optic disc may be due to increased intracranial pressure or due to optic neuritis. When the optic disc is normal it is necessary to rule out organic diseases before establishing the diagnosis of a psychogenic vision disturbance. In emergency, brain neuroimaging is the best way to diagnose intracranial mass and visualize optic pathways.

Introduction Les kystes epitheliaux du stroma irien, congenitaux ou acquis, sont des tumeurs rares du segment anterieur. Nous rapportons 2 cas, l’un chez un nourrisson de 4 mois et l’autre chez une adolescente de 14 ans. Observations Dans le premier cas, un volumineux kyste a base superieure obstruait l’aire pupillaire. L’enfant avait deja developpe une amblyopie et une esotropie intermittente, sans hypertonie oculaire. Une ponction du kyste avec exerese complete de son enveloppe a ete effectuee sans iridectomie. Deux ans plus tard, l’apparition d’une corectopie secondaire a necessite une iridotomie inferieure. Finalement, apres 4 ans, une endophtalmie, developpee sur un fil corneen, a conduit a une enucleation. Dans le second cas, la patiente avait remarque une modification irienne, due a un kyste temporal inferieur. L’exerese du kyste a ete effectuee par une large iridectomie peripherique. Malgre une exerese initiale complete, une recidive, survenue l’annee suivante, a ete reduite par laser Yag. Un an plus tard, l’aspect clinique etait stable. Discussion et conclusion Ces tumeurs benignes posent le probleme de leur extension locale et de leur caractere recidivant. Le traitement chirurgical avec iridectomie est souvent propose, malgre ses eventuelles sequelles esthetiques voire fonctionnelles. Le laser Yag peut alors etre une alternative therapeutique. Cependant, ces deux techniques ne permettent pas d’exclure les recidives. Les kystes epitheliaux du stroma irien sont des tumeurs benignes rares, qui exposent ades complications locales et a des recidives. Plusieurs traitements peuvent etre discutes selon les cas.

Resume Le spasmus nutans est un syndrome survenant chez le nourrisson et comportant une triade symptomatique: oscillations de la tete, nystagmus oculaire acquis et torticolis. Les examens ophtalmologique et neurologique sont normaux. Patients et methode. Seize enfants atteints de ce syndrome ont ete vus a la consultation de neuropediatrie de l'hopital Trousseau, entre 1980 et 1995, adresses par des pediatres ou des ophtalmologistes. Leurs dossiers ont fait l'objet d'une etude retrospective. L'etat actuel a ete precise par un examen clinique apres convocation ou par questionnaire adresse au medecin traitant. Resultats. L'âge moyen de survenue est de 7 mois (1 a 15 mois). Les oscillations de la tete etaient le motif principal de consultation (13 cas sur 16); elles etaient observees dans tous les cas. Le nystagmus etait present dans 14 cas sur 16. Le torticolis ne completait la triade que dans sept cas sur 16. L'imageric (scanner RX ou IRM cerebrale) a ete realisee dans 13 cas: elle a toujours ete normale. Le suivi — avec un recul superieur a 2 ans — a permis de constater que le syndrome a disparu spontanement dans 12 cas, dans un delai de 6 mois a 6 ans (moyenne 2 ans et demi). Pour les quatre autres cas, le suivi est insuffisant. Discussion. Il s'agit d'un syndrome de cause inconnue, dont le diagnostic repose sur la constatation chez un nourrisson de la triade caracteristique et impose necessairement l'elimination des autres causes de nystagmus. Les oscillations de la tete, lorsqu'elles sont predominantes, doivent faire eliminer une hydrocephalie (syndrome de la poupee ballottante). Certains auteurs ont tente de preciser les caracteristiques des symptomes par des enregistrements electro-oculographiques. Dans certains cas, les mouvements de la tete semblent compenser le nystagmus, de meme que le torticolis permet transitoirement son blocage. Conclusion. Le diagnostic de spasmus nutans ne peut etre retenu qu'apres un examen complet (neurologique et ophtalmologique) et une IRM cerebrale. L'evolution favorable doit etre verifiee grâce a un suivi prolonge.

Lower eyelid retraction is a complication that frequently follows large inferior rectus recession. It may result in cosmetic problems or lagophthalmos with corneal exposure. We report the case of a child who had restrictive strabismus related to orbital fibrosis. He underwent bilateral inferior rectus recession and bilateral brow suspension. Retractor lysis was performed to treat a lower lid retraction that followed strabismus surgery. Lower lid retraction results from the anatomic connections between the inferior rectus muscle and the lower eyelid retractor. Several techniques have been proposed to prevent or treat lower eyelid retraction after inferior rectus recession.

Acute or rapidly progressive visual loss in children needs urgent attention and treatment. It may be unilateral orbilateral. Etiology depends upon the involved areas: eye ball, optic nerve, retro-chiasmatic pathways. Psychogenic origin is quite common in school-age children, however, it has to be considered last. Unilateral visual loss may be overlooked. Acute total transitory visual loss may be due to epilepsy or to migraine. Rapidly progressive visual loss may be due to retinal disease, optic neuritis or cortical blindness. Management of visual loss depends on clinical features, associated symptoms, and aspect of the optic disc. It needs collaboration between ophthalmologist,pediatrician and neuropediatrician. Retinal hemorrhages first call to mind a traumatic origin. Swelling of the optic disc may be due to increased intracranial pressure or due to optic neuritis. When the optic disc is normal it is necessary to rule out organic diseases before establishing the diagnosis of a psychogenic vision disturbance. In emergency, brain neuroimaging is the best way to diagnose intracranial mass and visualize optic pathways.

Intrastromal epithelial cysts, congenital or acquired, are rare tumors of the anterior chamber. We report two cases, one in a 4-Month-old girl and one in a 14-Year-old teenage girl.In the infant case, a large cyst with a superior base obstructed the visual axis. The child had already developed amblyopia and intermittent esotropia, with normal ocular pressure. Aspiration of the cyst with complete excision was done without iridectomy. Two Years later, a secondary corectopia required an inferior iridectomy. Finally, 4 Years later, endophthalmitis developed on a corneal stitch, and the eye was enucleated. In the second case, the teenage girl had noticed a modification in her iris due to an inferior temporal iris cyst. The cyst was excised with a peripheral iridectomy. Despite a first complete excision, a recurrence the following Year was treated by Yag laser. One Year later, the clinical aspect was stable.These benign tumors present the problem of local extension and recurrence. Surgical treatment with iridectomy is often proposed despite eventual aesthetic or functional consequences. Yag laser may be a therapeutic alternative. The two operations reported here did not prevent recurrence. In conclusion, intrastromal epithelial cysts of the iris are rare and benign tumors that may induce local complications and lead to recurrence. Many treatments can be discussed for each case.

We reported a retrospective study of 27 children (mean age = 10 years), who presented a loss of vision due to an acute optic neuritis, between 1982 and 1997. The symptoms ar more likely bilateral in children, and frequently associated with systemic viral infection or hepatitis B vaccination. Multiple sclerosis occurs approximately in 20 p. cent of the cases, i.e. less frequently than by adults. Magnetic resonance imaging is now systematic: in 20 children hyperintense nodular abnormalities in a various distribution was demonstrated by 9 children. During the follow-up, 23 eyes of 27 have an excellent recovery of vision, but 4 patients have developed multiple sclerosis. Corticotherapy was uses in 23 cases, in the form of methylprednisolone intravenous flashes in 14 cases.

Analyzing a personal series of children with acute optic neuritis (AON), we studiedA retrospective study of 28 eyes in 20 patients (mean age: 10;7 years), examined between 1982 and 1997, with a follow-up ranging from 6 months to 15 years (mean: 5;5 years). We recorded etiologic factors, clinical features (ocular and extra ocular), biological results, and neuroimaging findings.Initial involvement was uni- or bilateral with poor visual acuity (under 20/200 in 22 eyes of 28). Intracerebral inflammation was present in 9 of 13 cases where MRI was performed. We found a cause in only 7 cases (5 viral diseases and 2 recent vaccinations against hepatitis B). Visual recovery was good (over 20/25 in 20 eyes of 28) whatever the treatment, but AON recurred in 5 children. Four children later developed multiple sclerosis.The cause of AON is rarely found. After eliminating an infection, we retained viral disease, complication of a recent vaccination against hepatitis B, and neurological diseases. MRI was the imaging study of choice. Development of multiple sclerosis occurred in 4 cases of 20, the same frequency as in the literature. The risk of later development of multiple sclerosis was 20%. Progression of AON was often excellent. Nevertheless, corticotherapy was added, in form of intravenous boluses followed by decreasing oral therapy for one month.

Several research studies have explored the abnormal crossing of the retinogeniculate and geniculocortical optic pathways in human albinos. This prospective study has dealt with visual evoked potentials (VEPs) of human subjects to identify the percentage of albinos with asymmetric VEPs.A series of 16 albino patients ranging in age from 6 to 37 years were examined. They had measurable visual acuity, with or without nystagmus. Diffusion of flash stimuli not allowing selective study of the two visual pathways (direct and crossed), two stimulation patterns were used for VEP recordings: monocular full open field then hemi-field stimulation to isolate the activity of each visual pathway.In the normally pigmented subject, fibers derived from the nasal half of the retina of each eye decussate at the chiasma, while temporal retinal fibers are uncrossed and project to the ipsilateral hemisphere. In albinos, the majority of temporal retinal fibers subserving the nasal field (from fixation to an eccentricity of about 20 degrees ) anomalously cross with the nasal retinal fibers. Therefore with monocular stimulation, the evoked visual response should be obtained only in the contralateral hemisphere. The asymmetry, morphology and latency for the first major positive peak and the amplitude of the VEP were examined and compared with the normal population.We managed to demonstrate the characteristic VEP asymmetry only in 3 out of the 16 patients. The results presented herein lead to question the absolute validity of VEP abnormality in diagnosis of albinism for clinical purposes.

Spasmus nutans is a syndrome occurring in early childhood. It consists of a triad of symptoms: head nodding, ocular oscillations and anomalous head position. Ophthalmologic and neurological findings are otherwise normal. This syndrome is benign and has spontaneous resolution.Sixteen patients with spasmus nutans seen from 1980 to 1995 were retrospectively studied. Their present status was evaluated by clinical examination or questionnaire.The age at onset ranged from 1 to 15 months (average 7 months). Thirteen of 16 patients were referred for head nodding, which was a constant manifestation; its direction was horizontal, vertical or rotatory. Nystagmus was present in 14 infants. It was acquired, asymmetrical, bilateral (or unilateral in three cases), rapid, fine, pendular and horizontal. Both head nodding and nystagmus were intermittent. Anomalous head position was present in seven cases, consisting of head tilt or a chin upon/chin down posture. Neuroimaging (13 cases) was always normal. The follow-up in 12 children (up to 2 years) showed a complete resolution of the syndrome in 6 months to 6 years (average 2.5 years).The diagnosis was established by the constancy of the characteristic triad and the elimination of the other causes of nystagmus. Isolated head nodding had to be distinguished from bobble head syndrome. In several reported cases, electronystagmography recordings have suggested that head nodding is a compensatory process against nystagmus and that the head tilt allows transient resolution of the nystagmus.Spasmus nutans is a self-limiting benign clinical entity. Normal complete ophthalmologic and neurological examination, as well as magnetic resonance imaging (MRI) are necessary to confirm the diagnosis.

But En strabologie de l’adulte, l’etat des muscles oculomoteurs peut etre modifie par des operations prealables, par d’autres atteintes oculaires ou par des affections generales concomitantes. Ces parametres, eventuellement majores par l’âge, induisent de facon non exceptionnelle des complications immediates, differees ou tardives. Materiels et Methodes Sur les 10 dernieres annees, nous avons pris en charge trois patients atteints respectivement (1) d’une ischemie du segment anterieur, (2) d’une necrose sclerale partielle et (3) d’un granulome inflammatoire retarde (40 ans apres la chirurgie du strabisme), simulant une episclerite. Nous decrivons l’evolution sous traitement de ces atteintes post-chirurgicales, de gravite certaine. Discussion L’ischemie du segment anterieur apres intervention pour strabisme a ete rapportee a de nombreuses reprises, notamment apres desinsertion de plus de 2 muscles droits. Le terrain vasculaire du patient et une forte myopie peuvent constituer des facteurs favorisants, comme le demontre notre cas. L’evolution est loin d’etre toujours favorable et peut aboutir a la perte fonctionnelle de l’œil. On a egalement decrit la necrose sclerale qui survient parfois face au site de section tendineuse des muscles droits. Elle peut aller jusqu’a la scleromalacie. Notre cas se distingue par sa bilateralite et par la guerison complete survenue sous corticotherapie et antibiotherapie. Enfin un fil non resorbable peut etre la source d’un granulome inflammatoire, meme a tres longue echeance, dont le traitement ne peut etre que chirurgical. Dans tous les cas, on peut discuter les mesures preventives qui pourraient etre choisies, par exemple en evitant de sectionner les tendons et leurs paquets vasculaires ou en utilisant des fils resorbables. Conclusion A cote des complications les plus frequentes de la chirurgie du strabisme (hypo- ou hypercorrection et diplopie), les complications locales meritent d’etre connues. Elles touchent davantage les adultes, surtout lorsqu’il existe des troubles de la vascularisation ou une maladie dysimmunitaire. Elles sont egalement favorisees par la myopie forte. On peut tenter de les eviter par des techniques chirurgicales adaptees.

Persistent hyperplastic primary vitreous (PHPV) is a rare developmental malformation of the eye. This anomaly is usually unilateral and unassociated with other disease. PHPV may have clinical variations: an anterior and/or a posterior one. Diagnosis and treatment are exposed in our paper.We study 38 eyes in 34 patients. All patients had an anterior form of PHPV. Nine of them associated a posterior form. Eighteen eyes underwent surgery, the mean postoperative follow-up is 4.7 years. Treatment is discussed, depending on the initial form of PHPV. We report the evolution of the surgical eyes and the untreated eyes.Slit lamp examination and echographic findings (A-scan and B-scan) support the diagnosis. In some cases computed tomography or RMN can be useful. If the cataract is mild in the anterior form of PHPV, treatment of amblyopia and frequent clinical examination can be sufficient. If the cataract is dense, a lensectomy must to be performed. The surgical technique can be difficult. For the eyes with posterior PHPV, the surgical treatment is to be avoided, because of high risk of retinal detachment.PHPV may have clinical variations, mostly with cataract as major sign. In purely anterior presentation, in absence of marked microphthalmos, lensectomy can be useful.

Some ocular diseases are detected by amniotic fluid analysis. However, some serious eye malformations are only detected at birth. By analogy to other organs, we were concerned by fetal sonography studying in utero ocular structures.We performed 150 fetal sonograph with 2 abdominal probes and one vaginal probe. We defined: (a) Axes where ocular structures are best visualised, (b) sonographic images of these structures, (c) the date at which these structures are detected.Orbit are detected between 11th and 12th week amenorrhae. Lens are detected between 12th and 14th week. Hyaloid artery appears around the 18th and disappears around the 32nd. Lids were recognised at 16th week. These results were confirmed by similar studies. Pathologic cases described in the literature are discussed.Fetal sonography must include a precise study of the eye. However, the eye is a small organ, so its study implicates technically skilled and an experienced practitioner. Fetal sonography gives precise information about normal eye development and allows the detection of structural anomalies (anophthalmos, microphthalmos, cyclopia) or orbital prenatal malformations (hyaloid artery persistance).

To determine the visual outcome of surgical therapy and conservative management, we retrospectively reviewed all our patients with ectopia lentis and Marfan's disease.Thirty-five eyes of 18 patients (age 8 to 47, average 25.3) were studied. Eight eyes were followed conservatively, the remaining 27 eyes underwent a lensectomy either with the Klöti vitreous stripper (18) or using other techniques (9).Over follow-up periods ranging from 0.5 to 13 years (average 6.2 years) low visual acuity was found in non-operated eyes. Retinal detachment occurred in 2 out of 8 eyes. Eyes undergoing other surgical techniques had a mean final visual acuity of 0.2. Retinal detachment occurred with high frequency (6 out of 9 eyes). Lensectomy-vitrectomy was a safe and effective procedure with a mean final visual acuity of 0.6. No retinal detachment or secondary glaucoma were found.Our study suggests that performing lensectomy-vitrectomy with the Klöti vitreous stripper is the best surgical approach in ectopia lentis with Marfan's disease. This technique allows the vitreous to be handled more effectively and has led to improve results.

Introduction Dans les cas ou il n’existe pas d’œil fixateur preferentiel, le recul bilateral des deux droits lateraux (RBL) peut etre equivalent en terme de resultats chirurgicaux a une chirurgie monoculaire de recul-resection (RR). Le but de cette etude est de comparer les resultats chirurgicaux du groupe RBL et du groupe RR, dans des cas ou il existe clairement un œil fixateur preferentiel. Objectifs et Methodes Nous rapportons les cas de 70 patients operes entre janvier 2002 et avril 2008 suivis pendant au moins 6 mois en post-operatoire. Les criteres d’inclusion etaient une exotropie basique ou un pseudo-exces de divergence avec ou sans vision stereoscopique et avec un œil fixateur preferentiel. Ces patients ont subi soit un RBL soit un RR sur l’œil non fixateur. Par la suite nous avons compare les resultats chirurgicaux. Un succes etait defini par une microtropie post-operatoire a 6 mois (+/− 10 dioptries prismatiques). Observation Dans le groupe RBL, le succes a ete obtenu dans 57,1 % des cas (20 patients sur 35). Il n’y a eu aucun cas de sur-correction. Dans le groupe RR, on retrouve un taux de reussite de 77,1 % (soit 27 patients sur 35). 3 patients etaient sur-corriges (soit 8,6 %). Tous les patients sur-corriges presentaient une faible vision stereoscopique. Le succes chirurgical etait statistiquement meilleur dans le groupe RR que dans le groupe RBL ( P Discussion Cette etude met en evidence la superiorite du RR dans ce contexte. Conclusion Dans les cas d’exotropie avec un œil fixateur preferentiel, une chirurgie monoculaire de recul-resection semble meilleure en premiere intention, meme si elle expose a un plus fort risque de sur-correction.

Several studies support that retinoblastoma originates from a primitive neuroectodermal cell, the main argument being the expression of the neuron-specific enolase (NSE) by the retinoblastic cells. NSE was measured in the aqueous humor taken off: 1) in 19 patients with various eye disorders for which the diagnosis of retinoblastoma was definitely excluded (NSE = 5.0 +/- 7.7 micrograms/l); 2) at the time of the enucleation, in 7 cases of proved retinoblastoma (NSE = 83 to 17,900 micrograms/l); 3) in 2 cases of retinoblastoma held as cured for more than 5 years (NSE = 2.8 and 8.7 micrograms/l). The high level of NSE in the aqueous humor of the subjects with retinoblastoma is very significant, so that it can play a great part in the diagnosis, particularly in the case of atypic tumors. Specific indications of this determination may be considered for the survey of tumors under treatment or of the controlateral eye after a first tumor.

The authors describe the non penetrating technique of cyclodiathermy in the treatment of different types of glaucoma and publish the results and the complications of the application of this technique on thirty three eyes among their patients. These eyes included congenital glaucoma (8 eyes), aphakic glaucoma (5 eyes), after silicone surgery (5 eyes), neovascular glaucoma (4 eyes), traumatic glaucoma (4 eyes), secondary glaucoma (3 eyes), Sturge-Weber-Krabbe (2 eyes) and open angle glaucoma (2 eyes). Their study with a mean follow up of 2.5 years shows an overall success rate of 60%. The success is defined as an ocular tension less than or equal to 22 mmHg in the absence of serious complications. All the encountered complications are mentioned. Phtysis occurred in not more than 3% of cases (1 eye). They establish a comparison with the published results and complications of the other cyclodestructive procedures: Sonocare, transcleral laser Yag, transcleral laser Ruby and cyclocryotherapy. This comparison does not prove the superiority of these other procedures with regard to the non penetrating cyclodiathermy. They conclude that this non penetrating cyclodiathermy is a non expensive procedure which still have its good therapeutic value.

Introduction Les grands reculs du muscle droit inferieur sont parfois indispensables pour traiter des extensions de la tete, notamment dans les syndromes de fibrose congenitale des muscles oculomoteurs. Cette technique peut parfois s’accompagner d’une retraction de la paupiere inferieure disgracieuse, mais egalement penalisante sur le plan fonctionnel en entrainant une souffrance corneenne. Objectifs et Methodes Nous rapportons les cas de deux patients ayant presente une retraction de paupiere inferieure dans les suites d’une chirurgie de strabisme. Un patient âge de neuf ans, presentant un syndrome de fibrose congenitale, a ete opere d’une hypotropie par recul des muscles droits inferieurs. Une retraction de la paupiere inferieure s’est developpee d’un cote dans les suites operatoires, responsables d’une lagophtalmie et d’une keratite inferieure. Une patiente âgee de 20 ans, presentant une myopie forte, a developpe dans les suites d’une operation pour hypertension intra crânienne congenitale, une paralysie du III avec decalage vertical important. Un recul du muscle droit inferieur associe a un renforcement du droit superieur a ete realise. Les suites ont ete marquees par une retraction de paupiere inferieure responsable d’une gene esthetique. Resultats Le traitement de la retraction palpebrale a consiste en un relâchement de la lamelle des retracteurs. Son effet a ete apprecie au moyen de photos pre-, per- et post-operatoires. Discussion La lamelle des retracteurs est un muscle en continuite avec le ligament de Lockwood, structure fibreuse en contact avec le muscle droit inferieur et le muscle oblique inferieur. Le recul du muscle droit inferieur est responsable d’un deplacement de ce ligament vers l’arriere et d’une retraction palpebrale. Le relâchement de la lamelle des retracteurs permet de reduire la retraction palpebrale. Conclusion La retraction palpebrale inferieure n’est pas toujours evitable dans les reculs importants du muscle droit inferieur, mais son traitement est possible dans le meme temps operatoire ou en post-operatoire. La technique est simple et reproductible.

Benign isolated VI nerve palsy in children is a rare but now well-established clinical entity. The diagnosis is essentially an exclusion one. We report nine additional cases. The evolution is discussed, with reference to the literature.

The authors report 19 cases of posterior retinal and tears treated by endodiathermy after vitrectomy. Nine cases were iatrogenic with a retinal break occurring during an intravitreal procedure. The remaining 10 cases were non-iatrogenic. A flat or reapplied retina is a prerequisite for achieving an adequate chorioretinal adhesion by endodiathermy. Short-term internal tamponade by intravitreal gas is recommended in cases with tears and no detachment, whereas, longer term tamponade with intravitreal silicone is preferable when the retina is detached. This method can be used when external retinopexy becomes impractical for lesions too far posterior, or when endophotocoagulation cannot be performed.

The present study is a two year-follow up of 105 eyes (including 27 aphakic eyes), operated on retinal detachment by silicone oil injection after pars plana vitrectomy. This procedure was chosen either as an initial treatment (37 eyes) or after a classical treatment by external indentation had failed (68 eyes). All cases of retinal detachment were of bad prognosis: macular hole, massive periretinal proliferation, isolated or associated with a tear. Cases of vitrectomy with silicone injection for proliferative retinopathy due to diabetes or hemoglobinopathy were excluded. Operations were performed under a surgical microscope with the help of a corneal contact lens (Goldmann, Kl oti or O' Malley ). Functional and anatomical results, as well as complications, were evaluated at least 2 years after treatment. In 24,7% of cases, vision was improved as compared to preoperative visual acuity. Cataract was a constant complication in all phakic eyes, as silicone oil had not been removed within the first 6 months. Intraocular hypertension developed frequently both in phakic and in aphakic eyes (29,5 and 33% of cases, respectively) and responded poorly to medical or surgical treatment. Other complications occurred less frequently. They were corneal edema, conjunctival hyperemia and uveitis. Pain imposed the evisceration of 2 eyes. These complications were the consequence of silicone oil toxicity and/or the mechanical effects of intraocular oil. Besides treatment-associated complications, early (36 during the first 6 months) as well as late (2 between the 12th and 18th months) recurrences of retinal detachment were observed. In contrast to these fair functional results, anatomical results were good in most cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Forty-seven patients with retinal detachment treated by vitrectomy and silicone oil injection benefited from semi-premature ablation of the oil: after a mean of 5 months for supple retinal detachments and 6 1/2 months for those associated with vitreoretinal proliferation. Ablation was performed after obtaining a solid chorioretinal scar by cryopexy or endodiathermy, usually combined with laser panphotocoagulation. The technique used for ablation is described. After follow up for from 9 months to 3 1/2 years (mean 18 months) two-thirds of the patients had flat retinas. Recurrences developed usually during the first month. An explanation for these relapses is proposed.

We report here a case of sarcoidosis, observed in a 12 year-old algerian girl. When the child was examined, at an advanced stage of the disease, her clinical condition was very critical, associating blindness, cachexia, hepatic and splenic enlargement, and major hypercalcaemia. Though chest roentgenograms were normal, the results of both functional pulmonary tests and broncho-alveolar lavage were pathologic. The diagnosis of sarcoidosis was confirmed by the finding of an elevated level of Angiotensin-converting enzyme, and by histologic lesions observed in liver, kidney and conjunctiva biopsies. The corticosteroid treatment improved the general condition, but it failed to better the visual state.

The anterior transcorneal approach, using Klötis apparatus, was employed to conduct phacophagia in 29 eyes. This transcorneal approach to an ectopic lens is sufficient if care is taken to place the keratotomy on the meridian opposite to that of the lens displacement. Patients have been followed up for from 1 to 5 years and anatomical results are excellent; no complications have been reported, but this technique cannot be employed in patients over 30 years of age. Indications and contraindications for this method are discussed, together with the advantages and inconveniences of other techniques: discussion-aspiration and phacophagia through the pars plana.

Among oculomotor disturbances, the cyclotorsions are difficult to quantify. The most accurate and objective method seems to be the retinophotography, which give the measure of the displacement of the fovea relative to the horizontal line lying through the papillary center. The authors have compared this measure over 16 eyes, before and after inferior oblique weakening. A reduction of the cyclotorsion is established in all cases. However, no correlation has been noted between this result and the pre-surgical state.