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Biomedical subjects

B Cochener

Publications and source records attributed to B Cochener.

36 records · Page 2Linked to original sources
PubMed1999

Retinal detachment after clear lens extraction for high myopia: seven-year follow-up.

OBJECTIVE: To prospectively evaluate the incidence of complications, particularly retinal detachment, 7 years after clear lens extraction (CLE) for myopia greater than -12 diopters (D). DESIGN: Extended follow-up of noncomparative case series. PARTICIPANTS: Fifty-two eyes of 30 patients with preoperative myopia greater than -12 D, best-corrected visual acuity (BCVA) of 20/100 or better, and intolerance of contact lenses. INTERVENTION: Patients with lattice degeneration, retinal tear, or hole underwent photocoagulation before CLE. The authors performed phacoemulsification through a 3.2-mm-wide incision using primary irrigation and aspiration, widened the incision to 6.5 mm, and implanted a one-piece polymethyl methacrylate intraocular lens (IOL). MAIN OUTCOME MEASURES: The BCVA, uncorrected visual acuity (UCVA), stability of spherical equivalent (SE), neodymium:YAG (Nd:YAG) capsulotomy rate, and complications (especially retinal detachment). RESULTS: At 7 years, the SEs of 29 eyes (59.1%) were within +/-1.0 D of emmetropia and 42 eyes (85.7%) were within +/-2.0 D. Mean SE was -1.01 D (+/-0.94). At 7 years, mean UCVA was 20/80 compared with 20/66 at 1 year. BCVA and UCVA were better in eyes with open capsules versus intact capsules. During the 7 years, 30 eyes (61.2%) required capsulotomy for opacification. Mean time for capsulotomy was 48.4 months after CLE. The authors performed ten argon laser retinal treatments after surgery, with all but one in the first postoperative year. The overall incidence of posterior vitreous detachment was 16.3%. The incidence of retinal detachment during the 7 years was 4 of 49 eyes, or 8.1% (vs. 2.0% at 4 years). One patient had bilateral retinal detachments. CONCLUSION: Despite advances in surgical technique, retinal detachment remains a major concern after CLE for high myopia. In the authors' series, the incidence of retinal detachment after CLE was nearly double that estimated for persons with myopia greater than -10 D who do not undergo surgery. Although CLE has advantages, including rapid and predictable visual rehabilitation, stable refraction, the ability to replace the IOL, and often superb optical quality with no irregular astigmatism, it is invasive and can result in severe vision loss. Long and continuous follow-up of the outcomes of CLE for high myopia is absolutely necessary before the authors can consider CLE as a routine option for patients with high myopia.

Adult↗
PubMed1999

Capsule contraction after continuous curvilinear capsulorhexis: poly(methyl methacrylate) versus silicone intraocular lenses.

PURPOSE: To evaluate the progressive contraction of the anterior capsule opening after in-the-bag implantation of 2 types of intraocular lenses (IOLs). SETTING: Department of Ophthalmology, University of Brest, Brest, France. METHODS: In this prospective study, 32 single-piece poly(methyl methacrylate) (PMMA) (Pharmacia 812 C) and 30 3-piece silicone IOLs with PMMA haptics (Allergan SI-40NB) were implanted in the bag after standardized phacoemulsification performed by the same surgeon. All patients were older than 70 years, and none had zonular weakness. The surface of continuous curvilinear capsulorhexis (CCC) was measured 1, 30, and 150 days postoperatively using a 3 charge-coupled device camera and a digitized computer analysis system. RESULTS: A significant progressive constriction was observed at 150 days in 70% in the silicone group and 32% in the PMMA group. In addition, CCC contraction was greater in silicone group (P < .05). The mean surface decrease was 4.20 mm2 in the silicone group and 1.53 mm2 in the PMMA group. There was no correlation between sex, age, initial capsulorhexis area, final capsule shrinkage. In some eyes, especially in those with a single-piece PMMA IOL (41%), there was no constriction, but fine changes in the capsule opening were seen. CONCLUSION: Evolutive anterior capsulorhexis modifications were observed in all patients; however, the contraction rate was statistically higher in the silicone group. These results suggest that silicone IOL implantation should be avoided in eyes at risk for CCC constriction.

Aged↗
PubMed1998

Excimer laser treatment of myopic astigmatism. A comparison of three ablation programs.

OBJECTIVE: The purpose of the study was to evaluate the precision, accuracy, and safety of three different modes of excimer laser surgery for myopic astigmatism. DESIGN: A prospective interventional case series. PARTICIPANTS: A total of 150 eyes with compound myopic astigmatism were treated. INTERVENTION: Ablation programs included the VISX Twenty/Twenty excimer laser using either the sequential mode (58 eyes) or the elliptical mode (54 eyes) and the Technolas-Chiron Keracor 116 hybrid scanning laser (38 eyes). MAIN OUTCOME MEASURES: Reduction in cylinder and sphere, vector analysis (polar values), uncorrected visual acuity, and best spectacle-corrected visual acuity were evaluated at 1, 6, and 12 months. RESULTS: By 12 months, sphere was reduced by 95.1%, 87.7%, and 75% in low-astigmatism eyes treated with the VISX sequential, VISX elliptical, and Technolas modes, respectively, and by 92.2%, 98%, and 77.6% in high-astigmatism eyes. By 12 months, cylinder was reduced by 51.5%, 72.2%, and 36.3% in low-astigmatism eyes and by 70%, 78%, and 45.6%, respectively, in high-astigmatism eyes. Vector analysis showed that the elliptical treatment produced more significant reductions in mean polar values than the other two treatments at various timepoints. CONCLUSION: These results suggest that the ablation approach may influence the clinical result.

Adult↗
PubMed1998

[Intra-corneal rings for the correction of weak myopias].

OBJECTIVES OF THE STUDY: Intra-stromal rings (ICR) represent a new method for low myopic correction. An indirect central flattening is induced by a peripheral steepening related to the segments. This surgery was recently approved in Europe, but is still under evaluation in the multicenter study controlled by the FDA (Food and Drug Administration). We took part in that protocol and report our results at one year follow-up. MATERIAL AND METHOD: Twenty-five patients were included in the study with 47 operated eyes and a follow-up between 3 to 18 months. Data relative to refractive results, quality of the vision and anatomic changes induced by intrastromal segments will be collected at the issue of a rigorous survey. RESULTS: At one year, non-corrected visual acuity was 20/40 or better in 100% and 20/20 in 60%. We noted no loss in best visual acuity and an improvement of one or two lines in 20% of operated eyes. No significative changes were observed concerning: intraocular pressure, corneal sensitivity, central pachymetry or corneal endothelium. Three eyes had to be explanted and recovered the preoperative refraction. No severe complications were observed. DISCUSSION: Analysis of results is in favor of the efficacy, predictability and reproductibility of the surgery, which might be better with rings of a diameter under 0.40 mm. Occurrence of postoperative astigmatism appears to constitute the main limit suggesting discussion on etiologic factors and modalities of treatment. CONCLUSION: This concept of intra-corneal rings appears particularly promising for correction of low myopia and maybe in the near future for correction of others ametropia, requiring design of new specific segments. Essential interest of this surgery is the respect of the central area and its potential reversibility.

Adult↗
PubMed1997

[Keratoconus, changes in corneal topography and allergy. Study of 3 groups of patients].

PURPOSE: To study the relation between keratoconus and atopy based on allergic prick tests, and the association of infraclinical keratoconus with atopy compared to "normal eyes". Simultaneously corneal topographic modifications have been researched to patients presenting an ocular atopy versus normal patients. MATERIAL AND METHOD: A videokeratoscope has been used for the selection of 22 keratoconic patients, 17 infraclinical keratoconic subjects and 22 patients with no ocular abnormality. Incidence of allergic phenomenon was assessed with two tests (Prick test, lacrymal total IgE dose). The videokeratoscopy was also performed in the research of corneal modifications in a group of 45 patients with an ocular atopy. RESULTS: The results of allergologic tests (positives Prick tests) showed a statistical significant difference between the keratoconus group (63.6%) and respectively the infraclinical keratoconus group (23.5%) and the normal eyes group (22.7%). No videotopographic picture of keratoconus and infraclinical keratoconus has been noted in patients with ocular atopy. CONCLUSION: Keratoconus is related to allergy. In this study, no association of allergy with infraclinical keratoconus was found. Further more, no videotopographic changes was observed in ocular allergic cases.

Adolescent↗
PubMed1997

[Is there a role for Excimer laser in the treatment of keratoconus?].

PURPOSE: In advanced keratoconus, when contact lenses become intolerant or provide insufficient vision, the only current available treatment is penetrating keratoplasty. But getting a graft takes a long time; we evaluated the eventual role of Excimer laser in taking care of those patients. MATERIAL AND METHODS: We present a series of 8 advanced keratoconus, at that time, intolerant to contact lens because of a major ectasia and/or apical opacities. An excimer photoablation, using the therapeutic or rarely the refractive one, was performed in order to flatten or resurface the cornea, allowing a new contact lens fitting. RESULTS: We noted no complication, except a denser and longer postoperative haze. Thanks to a good compliance, 4 patients benefited from a new contact lens fitting, leading to an optimal visual recovery. On the other hand, in 3 cases, a corneal graft had to be performed, without any side effect. An anatomo-pathologic analysis was achieved on the 3 corneal caps, giving some precisions about tissular changes. CONCLUSION: Excimer laser, under its therapeutic approach, might be an efficient treatment for advanced keratoconus, in conditions of cautious indications selection and of an inevitable coupling to contactology. Then, this surgery could delay or even avoid penetrating keratoplasty.

Adult↗
PubMed1996

Excimer laser photorefractive keratectomy to correct astigmatism.

PURPOSE: To evaluate the efficacy of excimer laser photorefractive keratectomy (PRK) to correct astigmatism. SETTING: Hôpital Morvan, Brest, France. METHODS: A 193 nm excimer laser was used to perform toric ablation with an expanding slit to flatten the cornea in the steeper meridian and/or to correct myopia with an iris diaphragm in 72 eyes (55 patients): 68 eyes for compound myopic astigmatism and 4 for astigmatism only. RESULTS: Preoperative cylinder was -2.14 diopters (D) +/- 1.99 (SD) (range -0.50 to -5.50 D); 6 months postoperatively, it was -1.75 +/- 1.34 D (range -0.25 to -5.25 D). Preoperative spherical equivalent was -5.33 +/- 3.22 D (range -0.25 to -14.50 D); 6 months postoperatively, it was -0.86 +/- 2.32 D (range 2.50 to -9.75 D). The axial error was within 30 degrees. Uncorrected visual acuity was 0.50 or better in 64.5% of patients. CONCLUSIONS: Overall patient satisfaction seemed the result of the myopic correction; cylindrical correction was incomplete. Future software refinements should improve the results. In particular, single elliptical ablation seems to offer theoretical advantages.

Adolescent↗
PubMed1996

Myopic photorefractive keratectomy in eyes with atypical inferior corneal steepening.

PURPOSE: To evaluate the visual and refractive results of photorefractive keratectomy (PRK) in eyes with atypical inferior corneal steepening (AICS). SETTING: Department of Ophthalmology, Hôpital Morvan, University of Breast, France. METHODS: Using videokeratopography, we screened 310 eyes that had PRK from November 1992 through November 1993 and found that 35 eyes exhibited topographic patterns consistent with AICS with no clinical findings. The results at 6 months and 1 year were compared with those of 185 eyes with normal topography treated concurrently. RESULTS: There were no statistically significant differences between the two groups in mean spherical equivalent, mean uncorrected visual acuity, and mean best spectacle-corrected visual acuity 6 months and 1 year after PRK. CONCLUSION: After 1 year, PRK in eyes with AICS appeared to give results similar to those in eyes with normal topography. Further follow-up is needed.

Adult↗
PubMed1995

Clinical results of excimer laser photorefractive keratectomy: a multicenter study of 265 eyes.

Efficacy, predictability, and safety of excimer laser photorefractive keratectomy were evaluated at centers in Paris and Brest, France. Photoablation was performed with the VISX laser on 265 eyes (151 at the Paris center and 114 at the Brest center). The eyes were clinically and statistically evaluated over a six month follow-up. Initial myopia ranged from -0.7 to -19.4 diopters (D) (mean spherical equivalent [SE] -5.9 D) in the Paris center and from -0.9 to -14.5 D (SE -4.5 D) in the Brest center. At both centers, the mean uncorrected visual acuity was worse than 20/200; over 90% of cases in each center had a best uncorrected visual acuity of 20/100 or worse. Results are reported globally and for subgroups of myopia: Group A, SE better than or equal to -3.0 D; Group B, SE worse than -3.0 D and better than or equal to -7.0 D; Group C, SE worse than -7.0 D. Uncorrected visual acuity was significantly improved in the patients followed for six months; 64% of Paris cases and 62% of Brest cases obtained an uncorrected visual acuity of 20/40 or better. Predictability of the treatment was good; 67% of Paris eyes and 74% of Brest eyes were less than 1.0 D from the intended correction after six months. The data suggest that the initial myopia affected the efficacy and predictability of the treatment; results in the mild to moderate myopia eyes were significantly better than results in the severe myopia eyes. One case of visual acuity regression (less than one line) was observed in the two groups. This was associated with corneal haze of moderate intensity.

Adult↗
PubMed1994

[Keratoconus and familial topographic corneal anomalies].

PURPOSE: Computer-assisted corneal topography, allows the detection of early abnormalities, including abortive or subclinical forms of keratoconus. So, it is possible to identify affected individuals with variable degrees, in family members of patients with keratoconus, to draw pedigrees, and to specify the mode of inheritance. METHODS: Computer-assisted digital videophotokeratoscope was used to map the corneas of 106 family members of 30 patients with keratoconus. RESULTS: Abnormalities observed included the inferior cornea markedly steeper than the superior cornea (I-S - 0.86 +/- 0.44 D) and a marked difference between the central corneal powers of the two eyes (delta PC = 0.72 +/- 0.22 D). However, there was no statistical difference with normal individuals for central corneal power. CONCLUSION: Pedigree analysis in these families suggests, in 50% of them, an autosomal dominant mode of inheritance. However, it is impossible to conclude for the other families, because of an insufficient number of cases.

Adult↗
PubMed1994

[Treatment by refractive photokeratectomy of undercorrections after radial keratotomy].

UNLABELLED: Residual myopia after radial keratotomy is one of the major problems of this technique, it may be corrected with laser keratectomy. MATERIALS AND METHODS: We present the results of nine eyes treated with photorefractive keratectomy, due to undercorrection after radial keratotomy. The photoablation was performed with the laser VISX 20/20, wavelength 193 mm, and concerned a residual spherical equivalent myopia (after RK) with an average of -2.00 diopters and a range of 0.87 to -3.75 D. RESULTS: Six months postoperatively, the average spherical equivalent refraction was no greater than -0.75 D and a range of -0.25 D to -2.12 D; 66.7% were within +/- 0.5 D of emmetropia, with a uncorrected visual acuity > 10/20. The best corrected visual acuity remained nearly the same. Postoperatively functional symptomatology and healing processus are comparable to the first intention of photoablation. CONCLUSION: The safety and effectiveness of laser Excimer photoablation seem to be demonstrated and this procedure could be used to complement RK.

Adult↗
PubMed1992

[Exfoliative syndrome and cataract surgery].

In the present prospective study, we compared the results of cataract surgery in two groups with or without exfoliation syndrome; 210 eyes were studied. The preoperative pupillary dilatation was smaller in the group with exfoliation syndrome (SE). We noticed a higher incidence of complications during planned extracapsular cataract extraction in patients with SE. A pupillary diameter smaller than 6 mm increases the incidence of capsulozonular rupture (22.5%) in these patients. After surgery, an inflammatory reaction and a transient increase in intraocular pressure were more frequent and the visual results were less favourable in the group with SE. The exfoliation syndrome is a major risk factor for cataract surgery. We recommend extracapsular extraction associated with a sector iridectomy when the pupillary diameter measures less than 6 mm.

Aged↗
PubMedDate not supplied

Inferior steepening is associated with thinning of the inferotemporal cornea.

PURPOSE: Videokeratography has enabled detection of inferior steepening patterns in patients thereby designated as keratoconus suspects. Since no information about the corneal thickness of these eyes is available, we studied several patients with such patterns, and compared the corneal thickness of their eyes with that of normals. METHODS: Three groups of patients who had undergone videokeratography were studied with ultrasonic pachymetry centrally and in four quadrants at the 3-mm clear zone: 44 eyes with true keratoconus, 23 eyes of individuals with inferior steepening of the cornea who were family members of patients with keratoconus; and 44 normal eyes never fitted with contact lenses. The corneal thickness of the eyes in the first two groups was then compared with that in the third using ANOVA and Student's t test. RESULTS: Corneal thickness in the normal eyes and in those with inferior steepening was similar in all except the inferotemporal quadrant. In this quadrant, the corneas of the eyes with inferior steepening were thinner than those of the normal eyes: 544 +/- 32 microns vs 581 +/- 30 microns (p < .05) CONCLUSION: Eyes with inferior steepening on videokeratography have thinner inferotemporal corneas than normal eyes.

Adult↗