[Predictors of quality of life in refractive surgery]

PURPOSE

To investigate predictors of quality of life in refractive surgery: psychological status, quality of vision, visual acuity, and patient satisfaction.

METHODS

In a prospective study, 143 patients were evaluated preoperatively and after the third postoperative month using the same questionnaire. Quality of vision, visual acuity, well-being, self-esteem, coping, and patient satisfaction were analyzed with 47 parameters. Refractive procedures included PRK, LASIK, and phakic IOL. Four groups of low (G1), medium (G2), and high myopia (G3) and hyperopia (G4) were individualized to compare the results.

RESULTS

We noted a mean postoperative best corrected visual acuity (BCVA) of 20/25 or more for the G1, G2, and G4 groups. For the G3 group, the mean BCVA was increased, with a gain of two Snellen Lines from 20/50 to 20/32. Postoperative patient satisfaction improved, with a significant difference (p<0.05) in all groups. We noted no significant difference in all myopic groups in well-being and no significant decrease in G4. Concerning self-esteem and coping, scores improved, with a significant difference in G3 group (p<0.05). Quality of vision was directly correlated with improvement of quality of life (psychological status), satisfaction scores, and BCVA preoperatively and postoperatively in all patients, but no correlation was noted between visual acuity and patient satisfaction.

CONCLUSION

In spite of good refractive results, modification of patient satisfaction depends on quality of vision and quality of life (psychological status) scores. These results give us a new tool that provides useful additional information in refractive surgery.

[Corneoscleral involvement in congenital erythropoietic porphyria. Günther disease]

Congenital erythropoietic porphyria (CEP) is an extremely rare autosomal recessively inherited disorder characterized by mutilating cutaneous photosensitivity and abnormal porphyrin heme synthesis in bone marrow. The present report describes a typical case of CEP with cornea involvement and scleromalacia in areas exposed to sunlight. The results obtained by conjunctival impression cytology are reported.

[Comparison of visual results and quality of vision between two multifocal intraocular lenses. Multifocal silicone and bifocal PMMA]

PURPOSE

To compare visual results and quality of vision of two multifocal intraocular lenses (IOL): SA 40 N silicone zonal-progressive multifocal IOL and P 359 TUV PMMA bifocal IOL.

METHODS

46 eyes were operated on for cataract. 24 IOL SA 40 N (group 1) and 22 IOL P 359 (group 2) were implanted. Evaluation of visual results was performed between the first and the third month postoperatively. The quality of vision was explored in both groups by using two tests of contrast sensitivity, an automated visual field and a questionnaire dealing with patient satisfaction and presence of halos and glare.

RESULTS

Postoperatively, a myopic shift was noted with a statistical significant difference in the group 2 (p<0.05). The predictability was good in both groups (mean refractive error<1 D). Mean corrected distance visual acuity was similar in-groups 1 and 2 (0.6). Mean distance-corrected near visual acuity was statistically better in the group 2 (p<0.05). We noted in both groups a loss of contrast sensitivity statistically more important in the group 2 (p<0.001). Where the automated perimetry is concerned, no statistical differences were encountered. 35% of patients (group 1) and 29% (group 2) were very satisfied with the results of their surgery. Halos and glare were noted in 8% (group 1) and 9% (group 2) of the patients.

CONCLUSION

The new concept of multifocality is increasing in practice of cataract surgery because of the reduction of spectacle dependency and the high level of patient satisfaction. However, the occurrence of halos and glare suggest a limitation of these indications of multifocal IOL, particularly for night driving patients.

[Predictability of intraocular lens power calculation in the treatment of cataracts in children]

PURPOSE

To evaluate the predictability of intraocular lens (IOL) power calculation taking in account the changing refraction in children operated on for congenital cataract with primary posterior chamber IOL implantation.

METHODS

We compared the predicted (PR) and objective (OR) refraction in 89 eyes of 70 children (1 month to 16 years) (1989 to 1995) at 1 month and 3 years after cataract surgery. The eyes were divided in 4 groups. Group A: < 1 year; Group B: 1 year to 3 years; Group C: 3 years to 5 years; Group D: > 5 years. For patients operated on before 3 years of age, we used a modified SRK II formula with the aim of achieving an undercorrection (85% of SRK II value in group A, 95% of SRK II value in group B).

RESULTS

The average objective refraction (OR) and the average error (AE = (OR)-(PR)) were respectively at 1 month and 3 years after surgery for the Group A: (OR: +3.5 D/-1.8 D) (AE: -1 D/-6.4 D); Group B: (OR: +1.3 D/-1.3 D) (AE: -0.9 D/-3.6 D); Group C: (OR: -0.2 D/-1.4 D) (AE: +0.1 D/-1.1 D); Group D (OR: +0.1 D/-1 D) (AE: +0.8 D/-0.4 D).

CONCLUSION

At 1 month after surgery, the predictability of IOL power calculation appears accurate with a refractive error between -1 D and +0.8 D in the four groups. However we noted an increase in refractive error at 3 years with a progressive myopic shift, specially in the eyes operated on before 1 year of life which had the greatest change in axial length.

[Predictability of amblyopia in ametropic children. Apropos of 96 cases]

PURPOSE

The aim of this cross-sectional retrospective study was to analyze the predictability of amblyopia in children with myopic and hyperopic unilateral and bilateral ametropia.

MATERIALS AND METHODS

One hundred and sixty two eyes of 96 children, (mean age: 8.6 years), were included in this work. Mean visual acuities and significant refractive errors were estimated for all the cases. The frequency of amblyopia and strabismus was studied in cases without amblyopia and in cases with medium and high grade amblyopia.

RESULTS

Mean visual acuities were significantly higher in cases of bilateral myopia (p < 0.001) and hyperopia (p < 0.05) compared with unilateral ametropia. The frequency of myopic eyes (p < 0.01), eyes with high grade of myopia (p < 0.002) and anisomyopic eyes (p < 0.001) was significantly higher in cases of high amblyopia compared with cases without amblyopia. Strabismus (p < 0.05) were also significantly more frequent in cases of high amblyopia as well as in cases of myopic eyes (p < 0.01). Moreover, in the group of high amblyopia, 6 cases (6/7) had developed an intolerance for contact lenses.

CONCLUSIONS

The risk of developing high grade amblyopia appeared significantly associated with unilateral medium and high level myopia. Strabismus and difficulties with good correction of anisometropia by contact lenses or spectacle appeared to be predisposing factors. This observation would suggest the indication of refractive surgery might be useful in these particular cases. To conclude, this study emphasizes the importance of early treatment of ametropia to reduce the incidence of amblyopia in children.

[Acute orbital myositis and idiopathic inflammatory pseudotumor in children: three cases]

Orbital pseudo-tumors account for approximately 8% of the orbital tumors. They are scarcely described in children and raise diagnostic dilemas, especially when they present as an isolated extra-ocular muscle swelling called idiopathic orbital myositis (IOM).

CASE REPORTS

A diagnosis of inflammatory orbital pseudotumors (IOPT) was made in three children aged 7, 13 and 14 years from clinical and CT scan and/or MRI findings associated with histological data in two of them. Two of these IOPT presented as IOM. Analysis was made in a effort to eliminate intra-orbital tumors, especially rhabdomyosarcoma.

CONCLUSION

The abrupt onset of the orbital signs, often related in the literature, was not a specific diagnostic criterion regarding to embryonic rhabdomyosarcoma. The inconstant presence of inflammatory signs and the absence of local osseous defect could be more discriminating. Although diagnostic procedure, including histological documentation, was difficult, even dangerous, surgical biopsy should be recommended. Eventually, considering the mandatory multidisciplinary care, steroid therapy response should be evaluated as a diagnostic test.

Comparison of fluorine-surface-modified and unmodified lenses for implantation in pediatric aphakia

PURPOSE

To compare the postoperative reaction in pediatric aphakic eyes to intercapsular intraocular lens (IOL) implantation with fluorine-modified poly(methyl methacrylate) (PMMA) IOLs and with unmodified IOLs.

SETTING

Pediatric Ophthalmology Unit, Purpan University Hospital, Toulouse, France.

METHODS

In this retrospective study, 107 consecutive eyes in 82 children were operated on for cataracts and intercapsular implantation. From January 1985 to December 1993, 87 eyes (Group 1) received an all-poly(methyl methacrylate) (PMMA), single-piece IOL; during 1994, 20 eyes (Group 2) received an IOL of the same design that had been fluorine surface modified. Mean age of the patients was 64.5 months (range 15 days to 16 years). Postoperatively, each group was monitored for immediate inflammatory response from the first to the eighth day and for secondary cicatricial response from 6 months to 1 year.

RESULTS

There was no significant difference between the two groups in the early inflammatory response. Secondary cicatricial reaction was found more often in Group 1 in all age subgroups (P < .01), but especially 1 to 4 years (P < .02).

CONCLUSION

Fluorine modification of PMMA IOLs is an effective and safe method to reduce the cicatricial response when IOL implantation is used to correct pediatric aphakia.

Structural and ultrastructural changes in the developmental process of premature infants' and children's corneas

Seven corneas ranging in age from 20 weeks of gestation to 6 months after birth were studied and changes observed in five layers. The epithelium thickens through the addition of new cellular layers and the enlargement of cells. The way junctional complexes develop with age is described. The way the collagen fibrils in Bowman's layer is arranged changes over time. The layer arrangement and orientation of the stroma's collagen fibrils are described at different stages of development. The keratocytes progressively flatten out and gather together. The thickness of Descemet's membrane increases from 0.6 m at 20 weeks of gestation to 4 m at 6 months. During the prenatal period, the banded layer appears with cross-linking bridges. The nonbanded layer appears after birth. Several changes were found in the endothelium: flattening out of the initially cube-shaped cells and changes in the intercellular junctions that can be seen from 20 weeks of fetal life. At 20 and 25 weeks of gestation, two layers of cells were observed in the corneal midperiphery. The adult structure of the cornea was reached at about 6 months after birth.

Roles of extracellular and cytoplasmic domains of the prolactin receptor in signal transduction to milk protein genes

We have previously shown that the long form of the PRL receptor is able to activate milk protein gene transcription. In the present study, we have determined the respective contribution of the extracellular and the intracellular domains of this receptor to transcriptional activation of a milk protein gene by PRL. The membrane-anchored intracellular domain (pTMI) expressed alone was devoid of PRL binding activity, as expected, and did not constitutively stimulate expression of the target gene. The extracellular domain (pE), expressed alone as a soluble receptor form, binds PRL with 10-fold higher affinity than the full-length membrane receptor. This form was also unable to stimulate the expression of the reporter gene. However, expression of both mutants (pE + pTMI) in the same cell partially restored the ability of PRL to activate the beta-lactoglobulin promoter. Replacement of cysteine 184 by a serine in the extracellular domain of the receptor impairs this restoration of the biological response. However, introduction of the same mutation in the full-length receptor did not affect its functional activity. These results indicate that the membrane-anchored cytoplasmic domain of the PRL receptor has no constitutive activity, and that coexpression of individual extracellular and intracellular domains leads to restoration of receptor function. We propose that restoration may be the result of reconstitution of the holoreceptor through disulfide bonding, or it may be the result of interaction of the extracellular region with an external transducing molecule.

The Nb2 form of prolactin receptor is able to activate a milk protein gene promoter

We have recently cloned a cDNA encoding a mutant form of PRL receptor (PRL-R) from Nb2 cells, a PRL-dependent T lymphocyte-derived cell line. This cDNA is identical to the long form of the rat PRL-R, except for a deletion of 594 base pairs in the cytoplasmic domain, resulting in a mature receptor protein of 393 amino acids. Although a segment containing three cytoplasmic regions of moderate to high amino acid sequence identity with members of the PRL/GH receptor family is missing in this receptor form, the region of highest (70%) identity is retained. In the following studies, a homologous functional assay was developed to test the activity of three forms of receptor with respect to their ability to transmit a lactogenic signal. In this system, CHO cells were transiently transfected with a construct containing 2300 base pairs of the 5'-flanking sequence of the rat beta-casein gene fused to the chloramphenicol acetyltransferase (CAT) gene and an expression vector containing the various forms of rat PRL-R cDNA. The transfected cells were grown in serum-free medium in the absence or presence of PRL. In cells transfected with the long form of the PRL-R and beta-casein/CAT construct, a 7.2- +/- 0.9-fold induction (n = 3) of CAT activity was seen when cells were cultured in the presence of 400 ng/ml PRL and 1 micrograms/ml hydrocortisone. This level of stimulation was similar to that observed for the ovine beta-lactoglobulin/CAT construct in which a 5.7- +/- 1.2-fold (n = 3) effect was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Prolactin stimulates milk protein promoter in CHO cells cotransfected with prolactin receptor cDNA

A functional biological system was developed by cotransfecting mammalian cell lines with the cDNA of the prolactin receptor (PRL-R) and a fusion gene containing the promoter of the milk protein, ovine beta-lactoglobulin linked to the coding sequence of the chloramphenicol acetyltransferase (CAT) gene. Surprisingly, this system is effective even if a non-mammary cell line is used, since Chinese hamster ovary (CHO) cells transfected both transiently and stably with PRL-R cDNA respond to PRL, as observed by stimulation of the reporter gene. This newly developed system should help precisely define the functional domains of both the PRL-R molecule and of the regulatory elements of a PRL target gene.

Identification of a cDNA encoding a long form of prolactin receptor in human hepatoma and breast cancer cells

Human PRL receptor cDNA clones from hepatoma (Hep G2) and breast cancer (T-47D) libraries were isolated by using a rat PRL receptor cDNA probe. The nucleotide sequence predicts a mature protein of 598 amino acids with a much longer cytoplasmic domain than the rat liver PRL receptor. Although this extended region has additional segments of localized sequence identity with the human GH receptor, there is no identity with any consensus sequences known to be involved in hormonal signal transduction. This cDNA will be a valuable tool to better understand the role of PRL in the development and growth of human breast cancer.

Identification and sequence analysis of a second form of prolactin receptor by molecular cloning of complementary DNA from rabbit mammary gland

Two lambda gt11 clones containing fragments of cDNA encoding the prolactin receptor from rabbit mammary gland were isolated using a rat liver prolactin receptor cDNA probe. An 1848-base-pair open reading frame encodes a mature prolactin-binding protein of 592 amino acids that contains three domains: (i) the extracellular, amino-terminal, prolactin-binding region of 210 residues; (ii) the transmembrane region of 24 residues; and (iii) the intracellular, carboxyl-terminal domain of 358 residues. This latter domain is much longer than the cytoplasmic domain (57 residues) previously described for the rat liver prolactin receptor. In addition, the sequence identity of this form of prolactin receptor with the growth hormone receptor is extended in the cytoplasmic domain.