Biomedical subjects
Publications and source records attributed to J P Gerhard.
From 1964 to 1976, 20 cases of retrolental fibroplasia were recorded in the south of France while 38 cases were recorded in the north from 1970 to 1977. The more children are immature, the more they are liable to suffer from this disease. Etiological factors are apparently not limited to oxygen, which however plays the most important part in the process.
The periphery of the retina was examined with the use of contact lenses at the age of 5 years in children who were born prematurely and weighed less than 1,500 g at birth. In this retrospective series 65% of the children were found to have lesions similar to the classical findings in retrolental fibroplasia although only to a minor degree. Low oxygen levels with a short duration of the exposure cannot completely prevent these sequalae. This retinopathy which is limited to the periphery, may account for the frequency and severity of myopia in children who were premature. Later in childhood and more rarely retinal detachment or tears may occur which cause severe visual impairment.
Clinical study of postoperative choroidal detachment in about 60 patients. The following parameters have been analyzed: frequency, age of the patient, type of detachment, evolution and surgical technique. The prognosis has been discussed. The question is to know whether choroidal detachment is a minor accident or a major complication. The authors try to give an answer, keeping in mind the different parameters analyzed. A research on therapeutic possibilities has been carried out.
The value of scanning lies above all in the determination of the site, size and shape of orbital lesions and, where applicable, their relations with neighbouring extra or intra cerebral structures. But certain conditions such as exophthalmos during hyperthyroïdosis have characteristic scan findings. Even intra-ocular tumors are visible on elarged scanfilms. It nevertheless remains difficult to attempt to predict a histological diagnosis on the only basis of scan findings. Particular emphasis must be placed upon the contribution of techniques of treatment of the films obtained (enlargement, contrast media, histograms, lateral views) as well as the complementary use of phlebography and ultrasonography.
A national survey showed that retrolental fibroplasia still exists in France, as it does in other countries of the world. Retrolental fibroplasia is a condition that principally affects low birth weight premature babies in whom oxygen therapy has not been adequately controlled. The premature babies who have apnaeic attacks are most risk. Strict control of all oxygen therapy, preferably using continuous monitoring techniques together with other changes in the methods of treatment should reduce the incidence of this condition.
The retinal periphery of 60 premature children now between 5 and 8 years of age and with a weight at birth equal or less than 1,500 g has been investigated. In 20% of these children, pigmentary modifications were noted which were often associated with chorioretinal atrophy. Polymorphic vascular abnormalities were seen in 14% of the cases, i.e. sinuous vessels of irregular caliber or neovascularization. Abnormalities of the vitreous body were also noted in 12% of the patients with glial bags on the periphery and sometimes potentially dangerous tractions folds (4%). All these abnormalities could cause complications such as retinal tear, retinoschisis or retinal detachment. Even if these signs are discrete, they can later on be the source of complications. Refraction studies revealed 30% of myopic children. The most important group had myopias equal or higher than 8 d. The characteristics of the myopia of premature children are its constancy (all premature children are myopic at birth); its importance (it depends on birth weight and on the severity of the retinopathy), and its evolution (the myopia of premature children does not evolve or evolves very slightly).
A Study is described of a family in which four children of the same generation died during early childhood; three of them had an obvious hydrocephalus. Two of the latter could be examined clinically, and their eyes removed for pathology. One of them presented clinically bilateral leucocoria; histology showed a total detachment of a dysplastic retina, with absence of development of the vitreous. The other child had apparently normal eyes. Yet on microscopical examination there was a discrete retinal dysplasia without retinal detachment in both eyes, and a persistent hyaloid artery, in one. This association of hydrocephalus with retinal dysplasia is clinically and genetically different from other types of retinal dysplasia.
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Biometric modifications were observed on eyeballs operated upon using the indentation method of Lincoff. The biometric modification of the anteroposterieur axis of the eye was studied by an opticoechographic method. 30 eyeballs with retinal detachment were operated upon using the Lincoff method with silastic implants. The length of the eyeball is not modified. But the analysis of the results indicates a significant reduction of the depth of the anterior chamber. This is entirely neutralized by a slight augmentation of the axial length of the vitreous body. The orientation of the implant has an influence on the biometric data. If it is a radial one, the anteriorposterior axis is lengthened; when it is parallel to the limbus, there a shortening with a reduction in the depth of the anterior chamber.
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Four possibilities are offered to provide a good correction for aphakic individuals: no correction at all; spectacles; more than 60% adopt this solution, the contact lens which has optical, functional and aesthetic advantages. The intra-ocular lens (the best solution, but it is, not without complications). Since 1956 we have followed up 588 unilateral aphakians. Tolerance of contact lenses after one year is excellent: 61% wear the contact lenses 10-12 hrs. per day, 18% wear them 6-8 hrs. per day and 21% lost courage. There is a parallel between binocular vision and tolerance, which decreased over the years. Three factors are determinant here: state of binocular vision: many factors influence the quality of fusion: nature of the cataract, the moment of adaptation of the lens, loss of accommodation and anisoconie. Surrounding conditions e.g. dusty atmosphere also influence the tolerance; local state of the tissues. 15 years later, the situation has changed. 71.5% gave up the contact lenses completely and only 15% wear them 10-12 hrs. per day. The reasons of this abandonment are: diplopie, inflammation and local complications.
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Analysis of the results of 63 retinal detachments operated without drainage of the subretinal fluid. Three surgical techniques were used: scleral in folding, scleral pocket or extra scleral implants. Research of the factors which favoured the reabsorbtion of fluid. The cases who presented a particularly slow and late reabsorbtion of fluid were discussed and the different complications reviewed.
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