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M Muraine

Publications and source records attributed to M Muraine.

At least 19 recordsLinked to original sources
PubMed2006

[Surgical management of nontraumatic corneal perforations: an 8-year retrospective study].

PURPOSE: Treatment of nontraumatic corneal perforation is a difficult task. The aim of our study was to retrospectively analyze predisposing conditions leading to perforation, surgical treatments, and visual outcomes. METHODS: Fifty-six patients were admitted in our department for a nontraumatic corneal perforation between 1997 and 2004. Mean patient age was 69 years (range, 16-95 years) and the mean follow-up was 20.5 months (range, 6-96 months). RESULTS: The diseases associated with perforations were neurotrophic ulcer in 24 cases (43%), peripheral immunologic ulcer in ten cases (18%), dry eye in six cases (11%), and infectious keratitis in seven cases (13%). All patients had specific adapted medical treatment before surgery. As a first procedure, we used cyanoacrylate glue in 14 cases (50% anatomic success), multilayer amniotic membrane transplantation in 23 cases (100% anatomic success), conjunctival flap in six cases, peripheral lamellar graft in three cases (33% anatomic success), emergency penetrating keratoplasty in 13 cases (31% anatomic success), and one patient's eye had to be eviscerated. Several surgical procedures were necessary in 16 cases (28%), nine patients needing total conjunctival flap at the end. We were able to achieve tectonic stability in 91% of eyes and 32% of patients recovered useful visual acuity between 20/400 and 20/50. CONCLUSION: Amniotic membrane transplantation is an effective method for managing corneal perforations and usually does not need a further reconstructive procedure. Visual outcome is poor when peripheral or central keratoplasty are needed. We recommend a conjunctival flap when descemetocele or perforation recurs despite previous surgical management.

Adolescent↗
PubMed2006

[Advantages of amniotic membrane transplantation in eye surface diseases].

Amniotic membrane transplantation is now a widely adopted technique in the field of eye surface diseases. Depending on the indication, the amniotic membrane can be used as either a graft or a patch. When used as a graft, the amniotic membrane serves as a substrate for regrowth of deficient epithelium; the aim is to integrate this membrane. The basal membrane reinforces the adhesion and differentiation of the corneal epithelial cells, facilitates their migration, and prevents their apoptosis. When used as a patch, the amniotic membrane is sutured epithelium-down so as to maximize the concentration of biological factors delivered by this membrane: the membrane covers the diseased cornea and acts as a biological bandage and analgesic. The best indications for amniotic membrane grafts are acute chemical burns and trophic corneal ulcers refractory to all medical treatment. When these ulcers are perforated or in the early stages of perforation, it is best to use multiple layers of amniotic membrane, restoring the thickness of the cornea. In cases of confirmed limbal deficiency, amniotic membrane grafts may be a useful complement to the necessary limbal stem cell grafts. In the future, amniotic membranes will provide an indispensable support for the expansion of cultured stem cells. Amniotic membrane grafts may also be used to reconstruct the conjunctiva following the exeresis of symblepharons or conjunctival tumors. However, the use of this technique is currently limited to diseases with little inflammation and no extensive fibrosis.

Amnion↗
PubMed2006

[Intraocular fluids analysis for etiologic diagnosis of presumed infectious uveitis].

PURPOSE: To study the etiologic distribution of patients with presumed infectious uveitis who underwent ocular fluid analysis. PATIENTS AND METHODS: We retrospectively analyzed vitreous and or aqueous humor samples of patients with presumed infectious uveitis, referred to the department of Ophthalmology of the University Hospital of Rouen, France, between January 1997 and June 2004. We excluded patients with postsurgical or endogenous endophthalmitis. We noted clinical features and intraocular sample analysis methods for each pathogen. RESULTS: The study included 42 patients, 24 men and 18 women, aged between 6 and 79 years (mean, 39.5 years). Uveitis was unilateral in 88% of cases and bilateral in 12%. Posterior uveitis was predominant (52%), followed by panuveitis (24%), anterior (14%), and intermediate uveitis (10%). Aqueous humor and vitreous analysis confirmed etiological diagnosis for 13 of 41 patients (31%) and three of six cases (50%), respectively. Inflammation was controlled or stabilized in all cases. The most pejorative visual outcome was observed for candidiasis and viral retinitis. Positivity of intraocular samples was variable, depending on the suspected pathogen, with results similar to those reported in other studies. DISCUSSION: Atypical features in potential infectious uveitis justify ocular paracentesis or vitrectomy, which are more efficient since molecular biological tools have become available. Sensitivity of aqueous humor analysis is high for posterior uveitis and suspicion of viral retinitis. New molecular variants applied to ocular samples will improve the etiological diagnosis of infectious uveitis, particularly for pathogens that are difficult to culture, such as fungi and bacteria.

Adolescent↗
PubMed2004

[Amniotic-membrane and limbic stem-cell transplantation in the management of ocular burns].

Severe ocular burns are potentially blinding injuries. During the first month, ocular surface destruction is caused by a vicious circle of complications that may result in the pathological state of total limbal stem-cell deficiency. Amniotic membrane transplantation can be considered an early, if not immediate, surgical procedure to promote epithelialization and calm inflammation so that scarring-induced sequelae can be prevented in the chronic stage. However, when partial or total limbal stem-cell deficiency involves one or both eyes, corneal surface reconstruction relies on transplantation of autologous limbal stem cells, an allogenic source of limbal stem cells or corneal epithelial stem-cell transplantation. In this late stage, amniotic-membrane transplantation may improve prognosis of keratolimbal allograft and is useful in the treatment of symblepharons.

Biological Dressings↗
PubMed2002

Analysing the various obstacles to cornea postmortem procurement.

AIMS: In many countries the number of corneal donations is far too low to graft all patients on waiting lists within reasonable time. The aim of this study was to define specifically what practical changes are to be implemented to fully meet corneal graft demand. METHODS: The list of potential donors drawn by the coordination team from 1 January to 31 December 1999 was compared with that of all patients who had died during the same period. In each identified record, the parameters which permitted or precluded effective collection of cornea specimens were analysed, and the reasons why other records were not identified were investigated. RESULTS: Among the 1112 patients who died in 1999, coordinating nurses were able to identify 451 records (40.5 %) including 329 patients aged between 18 and 85 years (29.5%). After excluding 184 patients (55.9 %) who presented with medical contraindications, the coordinating nurses were able to meet the relatives of only 55 out of 145 patients (38%) and obtained their agreement in 39 cases (71% approval rate). Therefore, relatives' refusal was the cause for the absence of collection in only 5.5% of cases (16/290). The number of corneas procured amounted to 11.8% of identified records and 3.5% of all deceased patients. CONCLUSION: French law and regulations regarding tissue collection are based on consent presumption but it requires that verifications be made with the relatives to ensure that potential donors were not, before their death, opposed to such tissue procurement. That provision implies a high degree of organisation on the part of coordinating teams. It was demonstrated that donation shortage is no longer the result of relatives' refusal but rather because of logistical difficulties (potential donors not identified and problems in reaching relatives). It appears necessary therefore to strengthen coordinating teams with sufficient staff levels for wider donor identification. Those teams should also find ways to keep closer contact with relatives, so as to meet the maximum transparency targets required by public opinion and regulations and to graft all patients awaiting corneal transplantation.

Adolescent↗
PubMed2001

Deep lamellar keratoplasty as surgical management of anterior and posterior segment injuries to the eye.

PURPOSE: To report on the feasibility of combined deep lamellar keratoplasty and vitreoretinal surgery in one patient with corneal opacity associated with retinal detachment. METHODS: A 35-year-old man presented with a major hematocornea and retinal detachment after experiencing a right ocular trauma with corneoscleral wound 1 month earlier. We elected to perform deep lamellar keratoplasty to perform vitreoretinal surgery through the bared Descemet's membrane within the same surgical procedure. RESULTS: Deep lamellar keratoplasty offered perfect visibility of the anterior and posterior segments of the eye through the bared Descemet's membrane during the 4-hour operation. Descemet's membrane was resilient enough to maintain remarkable tightness of the anterior chamber throughout vitreoretinal surgery procedures (vitrectomy, peeling of epiretinal membranes, encircling scleral buckling). Unfortunately, despite our efforts and extended operative time, the retina could not be restored to its position because of the high baseline level of ocular impairment. CONCLUSION: The combined procedure (deep lamellar keratoplasty and pars plana vitrectomy) appeared to be a good and feasible alternative to the temporary keratoprosthesis usually applied in that situation.

Adult↗
PubMed2001

[Amniotic membrane graft in ocular surface disease. Prospective study with 31 cases].

INTRODUCTION: Amniotic membrane's unique combination of properties including the facilitation of migration of epithelial cells, the reinforcement of basal cellular adhesion and the encouragement of epithelial differentiation [6] together with its ability to modulate stromal scarring and its anti-inflammatory and anti-bacterial activity has led to its use in the treatment of ocular surface pathology as well as an adjunct to stem cell grafts of the corneal limbus [6-4]. We report a prospective study of 30 patients so treated. MATERIAL AND METHODS: We studied 31 eyes of 30 patients subjected to amniotic membrane grafts between September 1999 and May 2000. There were 25 men and 5 women with an average age of 60.1 (range 25-86) years who were followed for a mean of 7.7 (range 4-11) months. 5 groups (A to D) were observed: A: 6 eyes. Small chronic ulcers without limbal involvement. B: 4 eyes. Ulcers of at least 75% corneal area or occupying 75% of the limbus. C: 9 eyes. Corneal burns. D: 8 eyes. Painful bullous corneal dystrophies unresponsive to other treatment. E: 4 eyes. Symblepharons. Amniotic membrane was placed on the corneal lesion, epithelial surface externally [6, 15], trimmed and sutured with interrupted 10/0 nylon, removed at one month. In two patients (11, 12) inflamed conjunctiva was recessed and amnion sutured to the recessed margin. For the bullous dystrophies we removed all the corneal epithelium and either sutured the amnion to peri-limbal conjunctiva (4 eyes) or to the limbus (4 eyes). For the symblepharons the conjunctiva was dissected to reform the fornix which was lined with amniotic membrane, sutured with 8/0 vicryl. Patients were reviewed regularity. RESULTS: Group A: All healed within 15 days, in most with dissolution of the amnion over 2-3 months although some persisted, covered with corneal epithelium. An eye with a Descemetocoele and one with a microperforation both healed. Vision improved more than two lines in 4 of 6 eyes. Group B: 2 of 4 eyes healed, one despite detachment of the membrane after 15 days. One eye was salvaged by tarsorrhaphy over a fresh keratoplasty after perforation of a neuroparalytic ulcer on failure of three successive amnion grafts. The final cornea vascularised despite an amnion graft for a meta-herpetic ulcer. Group C: 2 of 9 eyes had limbal damage in one quadrant but 7 had vessels in at least three-quarters of the circumference. One (15) also had a limbal autograft. 3 of 9 eyes healed satisfactorily with more than 2/10 improvement in acuity in each case. 2 showed further neovascularisation despite surface healing. One old chemical burn healed satisfactorily but vascularisation remained 5 eyes failed to heal with lysis of the graft, the patient who had a limbal autograft developed a vascular pannus, and in 4 eyes neovascularisation progressed to cover the entire cornea. Group D: 3 eyes settled with loss of symptoms but in 5 the graft detached within 15 days. All eyes where the membrane had been sutured to the conjunctiva beyond the limbus failed whilst 3 of 4 in which it had been sutured anterior to the limbus succeeded, leaving a persistent whitish membrane under the epithelium. Group E: We were able to reconstruct the cul de sac in 3 out of 4 eyes. In one patient with recurrent pterygium good ocular movement was restored, previously limited by scarring. One with associated ocular surface damage from a thermal burn failed by scarring of the cul de sac a month after surgery. DISCUSSION: Our best results were in persistent trophic ulcers of the cornea (Groups A and B) with a success rate of 80%, comparable to those of others [49, 37, 38]. The ready availability of amniotic membrane in our facility makes amniotic membrane transplantation the main secondary treatment for such lesions, especially because of the visual improvement we obtained. Because we did not observe any improvement in corneal thickness after this treatment we advise its early use before significant stromal lysis. The technique was not sufficient to control the effect of corneal anaesthesia in two eyes [40] or in chemical burns suggesting that amniotic membrane alone is insufficient to promote corneal healing in the absence of limbal stem cells. Nevertheless, three eyes did benefit. It has been suggested [13] that the anti-apoptotic function of amnion may prevent stem cell loss in such eyes [42], thus it appears logical to offer an amniotic membrane graft first, before stem cell transplantation, which may entrain complications in the donor eye if autografted [43] or because of the rejection risk of an allograft. It may be that an amniotic membrane graft simply becomes a holding procedure allowing time to settle the eye so as to allow secondary procedures to address the underlying cause of further damage. Our treatment of bullous dystrophy only succeeded on confining the graft to within the limbus, 3 out of 4 eyes becoming comfortable. By contrast we found amniotic membrane helpful in reconstructing symblepharons in the absence of local inflammation. CONCLUSION: Amniotic membrane grafting is a simple and straightforward surgical technique which should form part of the therapeutic arsenal for the treatment of ocular surface disease. Indications for the technique need further clarification for it is evident that it cannot correct all secondary pathology associated with limbal destruction. It is certainly preferable to conjunctival advancement and has proved useful in the reconstruction of the cul-de-sac.

Adult↗
PubMed2001

[Conjunctivo-corneal complex choristoma. Report of an anatomoclinical study].

Complex choristomas are very rare ocular tumors. We report a case of a 3-month-old infant who was referred to us because of a left congenital conjunctivo-corneal protruding mass. Total excision removing 2/3 of the limbus was performed and replaced simultaneously by a limbal autograft. Histopathological examination of the excised choristoma revealed many pilosebaceous follicules in the conjunctival tissue, keratinized epithelium, lacrimal glands, and differentiated cartilage.

Choristoma↗
PubMed2001

[Optic biometry in intraocular lense calculation for cataract surgery. Comparison with usual methods].

PURPOSE: To compare axial length and intraocular lens power calculated from three biometry methods, then to study refractive postoperative results to assess the predictive value of each method. MATERIAL AND METHODS: This prospective study included 40 eyes planned for cataract surgery. Two skilled operators participated in this study: One for the surgery and the other for the biometry and measurement of intraocular lens power. For intraocular lens power, we used the optic biometer from Zeiss and the echograph B Ultrascan from Alcon. IOL power calculation was performed using the usual mathematical formulas based on 3 biometry methods. 1--keratometry measurement, anterior chamber depth (ACD), and axial length using optical biometry; 2--keratometry measurement using the Javal keratometer and biometry using the B mode ultrasonography; 3--keratometry measurement using the Javal keratometer and biometry using A mode ultrasonography. RESULTS: The average age of our patients was 69.5 years old, ranging from 52 to 81 years old. The average axial length was 23.46 mm with, ranging from 20 to 32.73 mm. The average keratometry with optic biometry was 43.97 diopters +/- 1.44 versus 43.84 diopters +/- 1.45 with the Javal keratometer. 40 eyes were examined and there were 4 failures (10%) for axial length measurement by optic biometry because the cataract was very dense. Biometric preoperative results with the 3 methods show that there was a statistically significant difference between the A mode and the B mode optic biometry (P < 0.006). On the other and, there was no statistical difference between optic biometry and the B mode. CONCLUSION: Optic biometry has a number of advantages. This is new method, is non invasive, easy to use, with no contact, and it is reliable. Results with this method are more precise than with ultrasonic biometry. For high myopia, optic biometry is a very valuable method. Its limits are total cataract and intraocular opacities; in these cases ultrasonic biometry is the best method.

Aged↗
PubMed2000

SDF-1 activity on microvascular endothelial cells: consequences on angiogenesis in in vitro and in vivo models.

The chemokine stromal cell-derived factor-1 (SDF-1) has been shown to be involved in cell migration. As the receptor CXCR-4 is expressed on endothelial cells and upregulated by angiogenic factors, we were prompted to study the effect of SDF-1 on angiogenesis in endothelial cells from microvasculature. This study demonstrates that SDF-1 induces an angiogenic effect in vitro, primarily in a tridimensional fibrin gel. The increase in capillary tube formation was evident after a 10-day incubation with SDF-1. This was associated with a mild increase in VEGF production by microvascular endothelial cells (ELISA and rt-PCR) and a potent chemotactic effect. SDF-1 also induced an in vivo angiogenic activity as shown in the model of the rabbit corneal pocket. However, the angiogenesis was located in an area rich in inflammatory cells. The results of our study suggest that these data underline the potential role of SDF-1 in angiogenesis as the microvascular endothelial cells were greatly involved in this process.

Animals↗
PubMed2000

Peribulbar anesthesia and sub-Tenon injection for vitreoretinal surgery: 300 cases.

BACKGROUND AND OBJECTIVES: We carried out a prospective study in order to evaluate the efficacy and safety of peribulbar anaesthesia supplemented by a sub-Tenon injection in case of inadequate analgesia during vitreoretinal surgery. METHODS: We performed 300 consecutive vitreoretinal procedures. Patients received a mean volume of 17+/-4.5 ml of a mixture of etidocaine 1%, bupivacaine 0.50% and hyaluronidase (25 UI/ml). Supplementation was represented by a sub-Tenon infiltration of lidocaine 2% (2 or 3 ml). This volume was not included in the mean volume. RESULTS: Analgesia was adequate throughout surgery without any supplementation in 85% of cases and with a sub-Tenon infiltration in 99%. Akinesia was complete in 82%, mild in 15% and absent in 3% of cases. The sub-Tenon injection was performed immediately before starting the procedure in 58% of cases and during the surgery with a delay of 80+/-21 min in 42%. Eleven patients (3.66%) were agitated during surgery and two of them needed a general anaesthesia to allow for the procedure. Generalised epilepsy was encountered in two patients (0.66%) immediately after the peribulbar injection in one patient and 15 min later in the other. The systolic blood pressure severely decreased between 60 to 70 mm Hg 40 min after the accomplishment of the peribulbar in 2 patients and at 90 min in 2 others. CONCLUSION: Our results demonstrate that peribulbar anaesthesia alone offers excellent analgesia in 85% of patients and supplemented by a sub-Tenon injection in 99%.

Adult↗
PubMed2000

The interview with the donor's family before postmortem cornea procurement.

PURPOSE: Asking the family of a deceased patient to consider eye donation is one of the most difficult aspects of the donation process. The aim of this prospective study was to describe the content of interviews with the families of potential donors and to analyze their reactions to improve the process of eye donation. METHODS: We consecutively met with 151 families of suitable corneal donors at the Rouen University Hospital. All interviews with donor families were analyzed using a preestablished questionnaire. RESULTS: In only 17.9% of cases was the family aware of the potential donor's last will. In 77.7% of these cases, the patient wished to donate. Procurement rate was 71.5%. This acceptance was mostly facilitated by the awareness and motivation of the hospital staff, the experience of the physician, and the 13.3-h period of time allowed after the donor's death. The commitment on the part of the ophthalmologist to carry out optimal anatomical restoration was a very important point for 32% of families who accepted donation. Twenty-one percent of families asked for a delay for reflection. This delay helped to obtain a positive response in 72.7% of cases and even sometimes helped families to reconsider a previously negative position (14% of initial refusals). CONCLUSION: We demonstrate that a high positive response (71.5%) can be obtained from the donor's family when a trained and motivated group manages the post-mortem cornea donation request.

Adult↗
PubMed2000

[Limbal autograft transplantation, eight consecutive cases].

BACKGROUND: Limbal autograft transplantation is the procedure of choice in the management of ocular surface disorders secondary to stem cells deficiency. The aim of our study was to investigate the indications, results and limits of this infrequent surgery. METHODS: Limbal autograft transplantation was performed in 8 patients and the mean follow-up period was 11 months. Limbal stem cell deficiency was due to chemical burns in 4 patients, history of prior surgery extending to the limbus in 2 patients, chronic limbitis with dystichiasis in one patient and persistent corneal epithelial defect after keratoplasty in one case. RESULTS: In 6 out of 8 cases, the stability of the ocular surface normalized and comfort significantly improved. Four of these patients had increased visual acuity after surgery. Two patients who presented with severe alkali burn did not respond well to limbal autotransplantation. CONCLUSION: Limbal autograft transplantation is a reliable and effective procedure in limbal stem cells deficiencies. New associate procedures such as amniotic membrane transplantation will however be necessary to improve the prognosis of very severe corneal surface disorders.

Adolescent↗
PubMed2000

[Phacoemulsification following radial keratotomy. Topographic and refractive analysis concerning an 18-month period (apropos of a case)].

We followed a 45-year-old man who underwent clear cornea phacoemulsification cataract extraction 3 years after radial keratotomy during an 18 month period. We report early and late refractive analysis and corneal topography during the followup period. The patient experienced an hyperopic shift which was different from the aim of 5 diopters due to an early corneal flattening of 3 diopters and an underestimation of the IOL power of 2 diopters using SRKII calculation formula. Corneal flattening regressed after 3 weeks. We recommend that these patients should be informed of an eventual early hyperopic shift and late refractive error, that Binkhorst II or Hoffer-Q intraocular lens calculation formulas be used and keratometry measurements be obtained from computerized videokeratography.

Corneal Topography↗
PubMed2000

[Technique of harvesting and preparation of amniotic membranes].

Amniotic membrane transplantation is a promising surgical technique for clinical management of ocular surface diseases. According to the first published results, the ease with which this highly available tissue can be prepared and preserved makes this technique very attractive. The aim of our study is to report procurement procedures and the preparation technique for amniotic membrane in accordance with the French tissue transplantation legislation.

Amnion↗