Biomedical subjects

B Lafaut

Publications and source records attributed to B Lafaut.

9 recordsLinked to original sources

PubMed2002

[Macular translocation with 360 degree retinotomy in the treatment if exudative macular degeneration. Functional and angiographic results].

BACKGROUND: During surgical extraction of choroidal neovascular membranes (CNV) in age-related macular degeneration (AMD), the defective foveal retinal pigment epithelium (RPE) is removed. Subsequent translocation of the foveal neural retina to adjacent healthy RPE should result in stabilization and possibly improvement of visual acuity. METHODS: A prospective case series was carried out using controlled surgery and examination protocols with examinations made at fixed intervals. The surgical procedures combine counterrotation of the globe, phacoemulsification and implantation of a posterior chamber lens, complete vitrectomy, induction of a total retinal detachment, 360 degrees anterior retinotomy, removal of the subfoveal neovascular complex, foveal translocation outside the RPE defect, reattachment of the retina using F6H8, peripheral laser retinopexy and temporary silicone oil tamponade. PATIENTS: Macular translocation surgery was performed on 100 patients between December 1997 and December 1999. All patients had experienced recent visual loss due to exudative AMD and of these, 26 patients had major macular subretinal hemorrhage, 39 patients had occult and 25 patients classic subfoveal choroidal neovascularization. The preoperative findings in the remaining patients included tears in the pigment epithelium (n = 4), polypoidal choroidal vasculopathy (n = 1), recurrent subfoveal CNV following laser therapy (n = 2) and deep retinal vascular anomalous complexes (n = 3). RESULTS: A total of 97 patients completed the 12-month examination. Visual acuity increased by 15 or more ETDRS chart letters in 24 patients, remained stable in 42 patients and deteriorated by 15 or more EDTRS chart letters in 34 patients 12 months postoperatively. The silicone oil tamponade was removed in 97 patients, in 10 patients, silicone oil had to be reinjected because of severe complications. A secondary procedure was necessary in 25 patients, primary PVR was observed in 9 eyes, secondary PVR developed in 10 eyes, a macular pucker in 5 eyes and a macular hole in 1 patient. Other postoperative complications included persistent hypotonia, macular edema, IOL dislocation, keratopathy and recurrent CNV (n = 3). CONCLUSIONS: Macular translocation is a technically demanding operation, which requires a considerable learning curve. Although the procedure has a high rate of surgical and postoperative complications, the functional and anatomical results appear to be promising for selected patients with subfoveal CNV secondary to AMD.

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PubMed2002

Three-dimensional posterior segment ultrasonography: clinical experience.

PURPOSE: To introduce a commercially available three-dimensional ultrasonography unit into everyday clinical practice and to evaluate the qualitative and quantitative information of the acquired images and to clarify the indications for 3-D echography. MATERIALS AND METHODS: 3-D scanning was performed on 59 referred patients with indications for conventional B/A-scan. On 7 patients with an intraocular mass with well-delineated borders 10 repeated volume measurements were carried out. RESULTS: The duration of the ultrasound examination was extended with 8-10 min. 3-D echography offered images of unique perspectives, not previously available with conventional B-scan. The digital technology allowed easy (re)evaluation and follow-up. The coefficient of variation of the repeated volume measurements was less than 5% for all the patients. The standard deviations ranged from 2.22 to 4.75 mm3. CONCLUSIONS: At its current level of technological development 3-D posterior segment ultrasonogaphy left the status of an entirely research laboratory tool and entered the clinical practice. Nevertheless 3-D imaging is neither a rival nor a substitute of conventional B-scan since it is static and needs time intervals for reconstruction. However 3-D ultrasonography is a useful clinical supplement to conventional B/A echography in departments to which a substantial number of complicated cases (esp. intraocular tumours) is referred. It enables volume measurements with good intraobserver reproducibility and is excellent for teaching and training purposes of ophthalmology residents.

Eye Diseases↗

PubMed2001

Features of age-related macular degeneration on optical coherence tomography.

PURPOSE: To describe Optical Coherence Tomographic (OCT) findings in age-related macular lesions. PATIENTS AND METHODS: We selected 6 patients with characteristic features of age-related macular disease on OCT, 4 of whom presented with Choroidal New Vessels (CNV). OCT is analogous to ultrasound, except that light is used instead of sound. The reflected light is analysed with the technique of low-coherence interferometry. RESULTS: Classic CNV present with well-defined boundaries on OCT, whereas occult CNV can present with well- or poorly defined boundaries. Findings in Chronic Central Serous Chorioretinopathy (CSCR) and Adult Onset Vitelliform Dystrophy (AOVD) need angiographic correlation when compared to findings in CNV. CONCLUSION: OCT cannot replace conventional diagnostic techniques in exsudative Age-related Macular Degeneration. Although it accurately depicts associated changes and especially the associated serous detachment in macular disease, the imaging of neovascular membranes faces limited penetration and resolution. The interpretation of the tomograms requires further clinico-histological correlation.

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PubMed2000

Transplantation of autologous iris pigment epithelium after removal of choroidal neovascular membranes.

BACKGROUND: Transplantation of autologous iris pigment epithelium (IPE) into the subretinal space has been suggested as one approach for the treatment of age-related macular degeneration, as well as for other conditions in which loss of retinal pigment epithelium (RPE) occurs. Surgical removal of choroidal neovascular membranes is associated with traumatic loss of the RPE cell layer, disruption of the integrity of the photoreceptor-RPE complex, and limited visual outcome. OBJECTIVE: To examine whether IPE cells can substitute for RPE cells to be transplanted to the subretinal space of patients with either RPE degenerative disease or traumatic loss of the RPE cell layer after subretinal surgery. METHODS: Autologous IPE cells were transplanted to the subretinal space in 20 consecutive patients undergoing removal of subretinal fibrovascular membranes using pars plana vitrectomy. Autologous IPE cells were harvested by iridectomy, isolated, and transplanted directly to the subretinal spaces. Transplants were evaluated for 6 to 11 months by funduscopy, fluorescein angiography, and scanning laser ophthalmoscopic (SLO) microperimetry. RESULTS: For the entire follow-up period, no evidence of any immunologic response was observed. Revisional surgery was necessary in 3 patients because of complications (rhegmatogenous retinal detachment [n = 1]; proliferative vitreoretinopathy [n = 1]; and macular pucker [n = 1]); 1 patient did not receive IPE cells. Five of 19 phakic eyes underwent cataract surgery; in 1 case this was combined with the vitrectomy. Five patients showed improved visual acuity of 3 to 4 lines, 13 patients had stable visual acuity (+/-2 lines), and 2 patients had reduced visual acuity of 6 lines. CONCLUSIONS: In this pilot study, the transplantation of autologous IPE cells was done as an addition to conventional surgical excision of choroidal neovascular membranes. Transplanted cells were well tolerated in the subretinal space and did not adversely affect the function of the photoreceptors, since improvement or stable visual acuity was observed in 18 patients after IPE transplantation. These results suggest that autologous IPE cells may be used as a substitute for autologous RPE cells to transplant to the subretinal space to treat age-related macular degeneration.

Adult↗

PubMed2000

Oculocerebral non-Hodgkin's lymphoma with uveal involvement: development of an epibulbar tumor after vitrectomy.

Primary ocular lymphoma is the ocular manifestation of primary oculocerebral non-Hodgkin's lymphoma. We describe a 79-year-old woman with a 7-year history of bilateral uveitis and subsequent central nervous system lymphomas. Repeated diagnostic vitrectomy during the following 5 years failed to demonstrate intraocular lymphoma cells. Within 9 months after the second vitrectomy, an epibulbar tumor developed in the limbal region of the left eye at the site of the sclerotomy. The eye, blind and painful due to secondary angle-closure glaucoma, was enucleated. Histopathologically, the globe showed a diffuse large B-cell non-Hodgkin's lymphoma extending from the ciliary body outward through the sclerotomy. We conclude that, following vitrectomy, a primary ocular lymphoma may extend through the sclerotomy lesion and present as an epibulbar tumor. Uveal involvement may occur in oculocerebral non-Hodgkin's lymphoma.

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PubMed2000

[Significance of postoperative face-down positioning after surgery for idiopathic macular holes: consecutive case-control study].

BACKGROUND: Postoperative face-down positioning is considered to be a critical part in macular hole surgery with short-acting gas. However, the significance of this posturing remains uncertain using long-acting gas tamponade. PATIENTS AND METHODS: Fifty consecutive eyes with idiopathic full-thickness macular holes underwent macular hole surgery with a follow up time of 6-12 months. The results of a cohort (25 eyes) with complete C3F8 (16%) vitreous fill without posturing was compared to a cohort (25 eyes) with SF6 (20%) with strict postoperative face-down positioning for two weeks. RESULTS: With SF6 tamponade the anatomic success rate was 64% in the C3F8 cohort a complete closure was achieved in 88%. In the SF6 cohort, visual recovery of three lines or better was attained in 44%, resulting in a visual acuity of 20/50 or better in 12%. The mean postoperative visual acuity was 20/125 with a mean rise of 1.4 lines. In the C3F8 cohort, 72% improved for at least three lines with a mean postoperative visual acuity of 20/63 and a mean visual recovery of 3.3 lines. Visual acuity of 20/50 or better was noted in 48% of eyes. CONCLUSION: The significantly higher success rate using C3F8 tamponade without positioning compared to SF6 gas tamponade with positioning confirms the cumulative tamponade duration being a crucial factor in macular hole surgery. Using a tamponade with short-acting gas only strict postoperative positioning ensures the contact of the gas bubble with foveal tissue and gains significance with reducing bubble size. While a potential for significant visual recovery in certain cases is evident, all in all a broad variability of the postoperative success rate can be stated. In contrast, even in supine position C3F8 attains a continuous tamponade enforcing a sufficient glial wound healing without any positioning.

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PubMed1999

Indocyanine green angiography of retinal pigment epithelial tears.

PURPOSE: To investigate the fluorescein and indocyanine green (ICG) features before and after retinal pigment epithelial tear. METHODS: Fluorescein and ICG videoangiography were performed in 30 patients affected by age-related macular degeneration either complicated by tear of the retinal pigment epithelium (25 eyes) or by pigment epithelial detachment with pretear characteristics (5 eyes). RESULTS: At the pretear stage fluorescein angiography (FA) showed in all cases signs of occult CNV associated with delayed, slow and uneven filling of the pigment epithelium detachment. In 2 eyes the ICG filling of the retinal pigment epithelial detachment was seen. Progression to the tear stage was seen in 4 eyes where a CNV was evident on ICG angiography; in two eyes within one month after laser photocoagulation. At the tear stage FA showed an area of marked hyperfluorescence with well defined margins. Adjacent to the exposed area the torn RPE was markedly hypofluorescent during all angiographic phases. The bare choroid was always hypo or normofluorescent on ICG angiography. The torn retinal pigment epithelium showed moderate hypofluorescence. The exact seat and extension of CNVs could be visualized in 20 cases (67%; 95% C.I., 50-84%) with ICG angiography vs. 6 cases (20%; 95% C.I., 6-34%) with FA (p<0.001). CONCLUSIONS: ICG angiography did not add anything substantial to the analysis of frank tears. The most useful application of ICG angiography in this disease is the visualization of the seat and extension of the associated CNV In fact, it is well known that laser treatment of a pigment epithelial detachment at the pretear stage may facilitate the development of a tear of the RPE.

Aged↗

PubMed1998

Multiple evanescent white dot syndrome.

UNLABELLED: The indocyanine green angiographic appearance in the Multiple Evanescent White Dot Syndrome is described in a young female patient, presenting with bilateral involvement. Multiple hypofluorescent dots in the posterior pole of the right eye, and a hypofluorescent peripapillary ring in both eyes were the characteristic findings at initial examination. Six weeks later, there was only a small, dense, dark ring around both optic nerves. CONCLUSION: The ICG angiography suggests a much more extensive choroidal involvement in MEWDS than is indicated by functional evaluation. The hypofluorescence around the optic disc could be related to the persistence of an enlarged blind spot.

Adult↗

PubMed1995

Radiation choroidal vasculopathy: an indocyanine green angiography study.

An indocyanine green angiography (ICG-A) study of choroidal vasculature in the irradiated peritumoral zone in 16 eyes treated with 106Ru/106Rh brachytherapy for choroidal melanoma was performed between 4 and 72 months following treatment. The earliest changes observed were peritumoral atrophy of the retinal pigment epithelium and choriocapillaries. With time, the larger choroidal vessels progressively became non-perfused. There was only minimal staining of the smaller vessels. However, at 2 years or more after radiotherapy the larger choroidal vessels showed progressive vascular wall staining with ICG ('perivasculitis') associated with continuing closure. Previous histopathological studies of radiation damage to the choroid have demonstrated atrophy and occlusion of the vasculature but have shown no evidence of vasculitis. It is suggested that ICG staining of the choroidal vascular wall in radiation choroidopathy is due to radiation-induced endothelial cell loss or dysfunction rather than a true vasculitis. Subsequent progression results in vascular occlusion, and development of new clusters of abnormal choroidal vessels.

Angiography↗