Biomedical subjects
Publications and source records attributed to Dominique Chauvaud.
High myopia is the fifth cause of legal blindness in France. Myopic blindness is somewhat neglected, however, because it is poorly understood and untreatable. Certain mechanisms of this visual handicap have been elucidated by the use of new imaging technologies, raising new therapeutic possibilities.
BACKGROUND: To describe the indications for removal of Miragel episcleral buckles and to compare them with removed silicone sponges and solid silicone indentations. METHODS: Retrospective analysis of the charts of patients successfully treated for retinal detachment in whom the episcleral buckle was removed after surgery, with a minimal follow-up of 6 months. RESULTS: In a series of 90 eyes of 90 patients, including 38 cases of Miragel elements, 25 cases of solid silicone, and 27 cases of silicone sponge removal, the duration of indentation before removal was significantly longer with Miragel (91.9 months) than with solid silicone (10.6 months) and silicone sponges (18.6 months). In eyes treated with Miragel elements, swelling of the material with progressive limitation of ocular motility and protrusion of the buckle beneath the eyelids indicated its removal in 34 (89.5%) eyes. Infection of the buckle and erosion of the conjunctiva with an exposed indentation were significantly more common with silicone buckles. Overall, scleral perforation occurred in four (4.4%) eyes, and retinal redetachment occurred in eight (8.8%) eyes. CONCLUSION: Late swelling of Miragel buckling elements represents a common indication for buckle removal, significantly different from silicone indentations.
Diabetic retinopathy (DR) is the 5th cause of blindness in the population of less than 50 years old in industrialized countries. Sample survey showed a lack of detection of DR and a discrepancy between the medical practices and the guidelines during the follow-up. Moreover the number of ophthalmologists is decreasing and the number of diabetics increasing. Faced with this public health problem, an organization for detecting the DR is in progress: non mydriatic digital camera are used by non medical technicians connected with reading centres. Diabetic macular edema (DME) is the most common cause of visual impairment. Recently, optical coherence tomography (OCT), a new imaging tool has showed the role of vitreous tractions in some DME. OCT provides clear diagnostic elements for vitrectomy indications. Very recently, vitrectomy proved to be favorable in DME with vitreous tractions.
A step-by-step description of a surgical technique for episcleral Miragel buckle removal is reported. After dissection of the conjunctiva and the capsule surrounding the Miragel element, the extremity of the buckle is pulled out with a cryoprobe. The removal of Miragel episcleral buckle with the cryoprobe is a safe and effective technique with a low fragmentation rate and a reduction of the surgical risk related to the use of sharp forceps near a possibly weakened sclera. Procedure time seems also to be reduced.