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Purpose: To evaluate the initial experience of four experienced vitreoretinal surgeons, in France, with a three-dimensional (3-D) system, and to explore the potential advantages and disadvantages o...

Purpose The incidence and severity of diabetes is particularly high in the French overseas territories (FOT). The RECIF study evaluated real life management of diabetic macular oedema (DME) treated by aflibercept in FOT. Methods A prospective, noncomparative, multicentric, non-interventional, study that evaluated functional and anatomical results of patients treated by aflibercept. Twelve retina specialists working in French Polynesia, La Reunion, Guadeloupe and Martinique participated in the study. Results 67 eyes of 57 patients were followed for 12 months. Average VA gain was 7.8 ETDRS letters. 29.9% of eyes gained at least 15 letters, 6% lost 15 letters or more. 67.2% of eyes achieved visual acuity of 70 letters or better. Average central retinal thickness decrease was 115.3 µm. The mean number of injections during the 1st year of treatment was 4.9. 69% of eyes had a loading dose of at least three-monthly injections. 3 eyes were switched to steroid injections during the follow-up for lack of efficacy. Conclusion This study confirmed the efficacy of intravitreal treatment of DME by aflibercept, in the French overseas territories. This evaluation of real-life management of DME underlines the importance of improvement of patient education and collaboration with referring physicians.

AimsClinical outcomes of diabetic macular edema (DME) have been widely described, but data on diabetic retinopathy perceptions by diabetes patients are limited. The aim of this survey was to explore the lived experience, knowledge, fears and expectations about disease, and treatment in patients with diabetes and macular edema treated with intravitreal injections (IVTI) and to characterize patient profiles.MethodsCross-sectional survey including a preliminary qualitative phase (20 patients with DME, treated or treatment-naive, 5 female and 15 male, age 36–74 years) followed by a quantitative survey (116 patients treated with IVTI for DME). Data ASKIA Analyze (version 5.3.3.5) was used for descriptive statistics, and R software (version 3.4.1) for multiple correspondence analysis.ResultsThe qualitative phase identified the wording used by patients and information helpful to propose modalities of response in the quantitative phase. In the quantitative survey (116 patients, mean age 66.6 years), most patients were treated with anti-vascular endothelial growth factor. Overall, 71.9% reported that the disease negatively affected their daily activities and 33.1% considered that regular visits to the ophthalmologist were disrupting their life. Treatment expectations differed significantly between patients in terms of disease experience (visit and injection schedules), fears and feelings, and relationship with physicians, allowing three patient profiles to be identified: “Worried” patients (n = 45) felt isolated and were worried about the need for repeated treatment and possible side effects. They were mainly active men aged 2 years; “Curious” patients (n = 21) experienced insufficient support and requested more information on their disease and existing treatments. They were mainly single women aged 60–69 years; “Passive” patients (n = 50) felt sufficiently informed by their ophthalmologist and were not concerned by DME. They were older (mean age: 70 years) and mainly type 2 diabetic men.ConclusionsPatients with diabetes and macular edema treated with IVTI form a heterogeneous group regarding fears and expectations. Different patient profiles were identified and need to be confirmed in larger studies. A better understanding of psychological profiles may optimize compliance of diabetic patients.

PurposePeripheral exudative haemorrhagic chorioretinopathy (PEHCR) is a rare disorder that is often misdiagnosed. The aim of this study was to better characterise PEHCR and to assess treatment options.Material and methodsRetrospective multicentric chart review.ResultsOf 84 eyes (69 patients) with PEHCR referred between 2005 and 2017, the most common referral diagnosis was choroidal melanoma (41.3%). Bilateral involvement was found in 21.7% of cases. Haemorrhagic retinal pigment epithelium detachment was the most common peripheral lesion (53.6%). Maculopathy was associated with peripheral lesions in 65.8% of cases. PEHCR lesions were mostly heterogeneous (58.8%) on B-scan ultrasonography. Choroidal neovascularisation was found in 10 eyes (26.3%) out of 38 eyes that underwent fluorescein angiography. Polyps were observed in 14 eyes (58.3%) out of 24 eyes that underwent indocyanine green angiography. Fifty-one eyes were treated (62.2%). Intravitreal injections (IVTI) of antivascular endothelial growth factor (VEGF) were the most used treatment (36.6%) before laser photocoagulation, photodynamic therapy, vitrectomy and cryotherapy. Only vitrectomy improved visual acuity. Most lesions (65.6%) regressed at the last follow-up visit.ConclusionIn case of PEHCR, multimodal imaging is useful to avoid misdiagnosis, to characterise PEHCR lesions and to guide treatment strategies. Regression of PEHCR lesions was observed in two-thirds of the patients. Vitrectomy improved visual acuity. More than a third of patients underwent anti-VEGF IVTI. Further studies are needed to assess IVTI’s efficacy.

Background To report a case of complete progressive visual recovery and healing of outer retinal layers after vitrectomy for foveal detachment associated with optic disc pit. Case presentation Optical coherence tomography (OCT) follow-up was performed on a 15-year-old boy with deep optic disc pit and foveal detachment, before and for 10 years after vitrectomy with gas. The foveal detachment was successfully reattached with complete reapplication of the retina. OCT scans showed a progressive long-term retinal healing with reappearance of the ellipsoid line and visual acuity improved from 20/100 before surgery to 20/25, 10 years after surgery. Conclusions Photoreceptor regeneration after foveal detachment surgery has been already described only in zebrafish but never humans. However, we highlight with this case that in humans, a healing process of the outer retinal layers can occur with reappearance of the ellipsoid zone on OCT. This healing process may take several years and allow a complete functional restoration.

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Resume Objectif Evaluation clinique de la keratoprothese Alphacor™ chez les patients a haut risque de rejet d’allogreffe de cornee. Design Etude retrospective. Patients et methode L’implantation de l’Alphacor™ a ete realisee selon une technique chirurgicale en deux phases avec une insertion intrastromale puis une exposition secondaire de l’optique apres un intervalle de six mois. Les parametres evalues etaient l’acuite visuelle et la survenue de complications postoperatoires. Resultats Quatorze implantations ont ete realisees. Le suivi moyen etait de 15,6 ± 5,6 mois (de deux a 24 mois). Le gain d’acuite visuelle moyen etait de 2,5 ± 3,1 lignes (de 0 a +11 lignes). Vingt et un pour cent des patients presentaient une acuite superieure ou egale a 1/10. Sept patients (50 %) ont presente une necrose stromale dont un cas (7,1 %) d’extrusion definitive de la prothese, trois cas (21,4 %) ont necessite la realisation d’une keratoplastie transfixiante architectonique et chez trois patients, une greffe lamellaire a ete realisee. Le taux de retention a l’issue du suivi etait de 71,4 %. Trois patients (21,4 %) ont developpe une membrane retroprothetique. Un patient (7,1 %) a developpe une endophtalmie tardive. Conclusion L’Alphacor™ est une alternative therapeutique chez les patients presentant une cecite corneenne et avec une faible probabilite de survie d’une allogreffe de cornee. Il est capital de prendre en consideration au cours de l’evaluation preoperatoire, les principaux facteurs limitant de cette keratoprothese dans ses indications et des etudes complementaires sont necessaires afin de preciser et determiner la technique chirurgicale optimale d’implantation ainsi que l’efficacite des traitements postoperatoires.

We report the cases of two patients presenting with unilateral Kyrieleis arteritis complicating severe posterior uveitis, one secondary to toxoplasmosis and the other in the context of Behcet's disease. The treatment response was favorable with complete visual recovery in both cases. Kyrieleis arteritis has been described since 1933, but its pathogenesis is still unknown. However, it appears to be more of a periarteritis than an actual arteritis. It is classically associated with posterior uveitis without a direct correlation with disease severity.

Resume But Nous rapportons les premiers resultats de l’utilisation des segments d’anneaux intracorneens (Intacs™) assistes par laser femtoseconde Tecnolas 20/10 Perfect Vision® (Tecnolas Perfect Vision®, Heidelberg, Allemagne). Patients et methodes Il s’agit d’une etude retrospective. Tous les yeux ont ete operes a l’aide du laser femtoseconde Tecnolas Perfect Vision®. Nous avons evalue en pre- et postoperatoire : l’acuite visuelle non corrigee (AVNC), la meilleure acuite visuelle corrigee (MAVC), la topographie corneenne speculaire, l’analyse aberrometrique et la pachymetrie corneenne centrale. Les donnees ont ete analysees grâce au test de Wilcoxon. Resultats Dix-sept yeux de 15 patients ont ete inclus. Le suivi moyen a ete de 6,9 ± 0,71 mois. L’AVNC et la MAVC ont augmente significativement dans 82,35 % (p = 0,027) et 94,12 % (p = 0,003) des cas respectivement. La sphere et le cylindre subjectif ont diminue significativement de −10,29 ± 5,54 a −6,5 ± 5,03 D (p = 0,002) et de 5,43 ± 3,20 a 3,69 ± 2,30 D (p = 0,026) respectivement. L’indice d’asymetrie de surface (SAI) a diminue de facon significative (p = 0,011). Conclusion Le traitement des ectasies corneennes par implantation d’anneaux intracorneens assistee par laser femtoseconde est une technique efficace. La poursuite de l’optimisation des parametres chirurgicaux devrait permettre de poursuivre l’amelioration des resultats.

Resume Introduction L’optimisation de la qualite de la dissection stromale du tissu corneen par laser femtoseconde est encore necessaire afin d’ameliorer les resultats cliniques. Nous proposons ici une methode originale de caracterisation de l’interaction laser-tissu permettant d’evaluer precisement le seuil de dommage du tissu corneen. Methode Un laser femtoseconde est utilise pour endommager des cornees humaines non validees pour la greffe. Celles-ci sont exposees au laser sur dix sites differents a fluence fixee en regime monotir. La fluence est ensuite incrementee et la procedure de test repetee. Un examen par microscopie optique permet de denombrer les impacts et de determiner la probabilite d’endommagement. Cette demarche permet de deduire la fluence maximale pour laquelle un endommagement n’est jamais detecte (probabilite egale a 0) et la fluence minimale pour laquelle un endommagement est detecte de maniere systematique (probabilite egale a 1). Resultats Nous avons determine ainsi le niveau maximal de fluence laser, pour l’epithelium et la membrane de Bowman, pour lequel l’integrite des tissus est preservee (« niveau de securite ») et le niveau de fluence minimale pour lequel l’endommagement des tissus est systematique. Les seuils de fluence hauts et bas des couches epitheliales et de la membrane de Bowman sont de (5,6 ± 0,4 J/cm 2 ; 2,7 ± 0,1 J/cm 2 ) et (7,1 ± 1,1 J/cm 2 ; 3,4 ± 0,1 J/cm 2 ) respectivement. Conclusion Ces donnees sont capitales pour les applications cliniques, car elles determinent une « fenetre de travail » permettant de preciser la dose minimale efficace d’irradiation laser, afin d’obtenir d’une dissection chirurgicale de haute qualite avec des effets secondaires minimises.

Resume Introduction L’hypertension intracrânienne idiopathique (HTIC) est une pathologie rare, mais potentiellement cecitante, caracterisee par des cephalees invalidantes associees a des troubles visuels survenant souvent chez des femmes jeunes en surpoids. L’œdeme papillaire est le principal signe ophtalmologique et sa persistance conduit a l’atrophie optique en quelques mois. Si la physiopathologie est partiellement connue, il est de plus en plus admis qu’une stenose veineuse sur un ou les deux sinus lateraux peut participer a l’elevation de la pression du liquide cephalorachidien par l’intermediaire de l’elevation des pressions veineuses cerebrales. Le but de notre etude est de suivre l’evolution de l’œdeme papillaire en OCT, apres mise en place d’un stent endosinusien dans le sinus lateral par voie femorale. Patients et methode Nous avons mene une etude retrospective, chez dix patientes atteintes d’hypertension intracrânienne idiopathique suivies dans notre service entre mars 2006 et avril 2008. Nous avons realise, pour les dix patientes la mesure en OCT stratus (Carl Zeiss Meditec, Dublin, CA) de l’epaisseur de la couche des fibres nerveuses, par une acquisition centree sur la papille de chaque œil, avec le programme RNFL 3.4. Cet examen a ete effectue a chaque œil, une fois avant la mise en place d’un ou de plusieurs stents endosinusiens dans un sinus veineux lateral, et trois fois apres. Le parametre etudie etait la valeur moyenne de cette epaisseur (RNFL thickness average). Resultats Dans cette serie de dix patientes, une diminution significative de l’epaisseur de la couche des fibres nerveuses etait constatee apres traitement endosinusien, ainsi qu’une normalisation de ce parametre en moins de trois mois chez toutes les patientes dont le recul est suffisant (huit sur dix). Conclusion Meme si la physiopathologie de l’HTIC est discutee, notre etude suggere que le traitement de stenose du sinus lateral retentissant sur les pressions cerebrales veineuses d’amont peut conduire a une regression de l’œdeme papillaire mesure en OCT. La place eventuelle et l’innocuite de ce traitement doivent etre precisees par des etudes de plus grande envergure.

Central retinal vein occlusion (CRVO) leads to poor visual outcome in most eyes. Abnormal hemorheology was suspected to play a major role in its pathogenesis. CRVO treatment is still a matter of debate but several studies have pointed out the efficacy of isovolumic hemodilution. The aim of this study was to assess the feasibility and efficacy of hemodilution using automated erythrocytapheresis in recent-onset CRVO.In this prospective randomized controlled multicenter study, 61 consecutive CRVO patients were enrolled when they met the following criteria: CRVO lasting for 3 weeks or less, visual acuity ranging from 20/200 to 20/32, age between 18 and 85 years, no diabetes, no uncontrolled systemic hypertension, no antiplatelet or anticoagulant therapy, hematocrit higher than 38%, and signed informed consent. Patients were randomly assigned to the hemodilution group (n = 31) or to the control group (n = 30). Hemodilution therapy consisted of one session of erythrocytapheresis on outpatient basis, followed by additional session(s) for 6 weeks if needed. Target hematocrit was 35%. Follow-up was 12 months.No statistical differences in age, associated risk factors, or CRVO characteristics were observed at baseline between both groups. Mean visual acuity was equivalent to 20/80 in the hemodilution group and to 20/63 in the control group (non-significant difference). In the treated group, mean number of hemodilution sessions was 3.3 (range, 1 to 6), and no major side-effects occurred. At the 12-month follow-up visit, 64.5% of the hemodilution group had visual acuity of 20/40 or better compared to 40% of the control group (p = .048). Visual change was a gain of 1.7 ETDRS line in the hemodilution group versus a loss of 2.3 lines in the control group (p = .007). There was less conversion into an ischemic form in the hemodilution group (11%) than in the control group (50%, p = .004). Mean final retinal thickness was 289 μm in the hemodilution group versus 401 μm in the control group (p = .068).This multicenter controlled randomized study demonstrated that automated erythrocytapheresis is a safe and effective tool for performing hemodilution and confirmed that hemodilution therapy can improve the final prognosis of CRVO when applied in the early phase of the disease.

Resume Introduction De faibles taux de luteine et zeaxanthine dans le sang ou l’alimentation sont associes a un risque accru de degenerescence maculaire lie a l’âge. Ces molecules dont l’apport est assure par l’alimentation constituent le pigment maculaire. Patients et Methodes Les patients inclus dans cette etude pilote francaise ont ete repartis en quatre groupes : « Resultats L’evaluation des densites optiques du pigment maculaire en fonction des habitudes alimentaires et des groupes montrait que celle-ci etait plus faible dans le groupe « Conclusion L’analyse des densites optiques moyennes mesurees par l’appareil MPS 9000 QuantifEYE™ en fonction des habitudes alimentaires confirme l’impact de la prise d’un complement alimentaire sur celle-ci, notamment chez les patients âges de 50 ans et plus avec drusen qu’ils presentent ou non des neovaisseaux.

Background: To compare the effects of different doses of bevacizumab with both saline and dexamethasone on inflammatory angiogenesis in the rat cornea induced by small chemical lesions. Methods: Corneal chemical cauterization was performed on 24 rats. Animals were divided randomly into six groups and received a daily subconjunctival injection for 7 days of: balanced salt solution 0.1 mL or dexamethasone phosphate 4 mg/day or bevacizumab 2.5 mg/day, 3.75 mg/day, 5.0 mg/day or bevacizumab 5.0 mg/day + dexamethasone phosphate 4 mg/day. Clinical examination under slit lamp was performed daily for 7 days to evaluate corneal opacity and vessel size evolution. Computer-assisted quantitative image analysis was used to measure the total corneal area covered by neovascularization. Results: At final examination, the dexamethasone, bevacizumab 5.0 mg/day and dexamethasone + bevacizumab groups showed a significant lowering in corneal opacity score as compared with control (P = 0.024, P = 0.006 and P = 0.013, respectively). Also, a significant reduction on new vessels size score was observed. Surface of corneal neovascularization was significantly reduced in dexamethasone, bevacizumab 5.0 mg/day and dexamethasone + bevacizumab groups compared with control (P = 0.045, P = 0.047 and P = 0.044, respectively). Conclusion: Our study demonstrates the ability of a 5.0 mg/day bevacizumab subconjunctival injection, in monotherapy or associated with dexamethasone, to cause a short-term involution of corneal neovascularization after corneal alkali burn. Combination of both of these treatments may have advantages to monotherapy approaches.

Resume Introduction L’imagerie par coherence optique est une technologie employee depuis de nombreuses annees dans le domaine de l’imagerie du segment anterieur. Jusqu’a present, il s’agissait d’une technologie « Time Domain » qui permettait d’atteindre une definition des structures oculaires proche de celle de l’histologie. Actuellement, avec l’apparition d’une nouvelle generation d’appareil utilisant le domaine spectral, il est possible de realiser des images en tres haute definition dont la precision est inegalee. Materiel et methode Nous avons utilise un 3D OCT-1000® (Topcon, Tokyo, Japon) parametre afin d’obtenir des images en haute definition et en trois dimensions des structures irido-corneennes. Resultats Nous presentons un recueil d’images pouvant etre obtenues par cette technique. Discussion A partir d’un outil initialement exclusivement dedie a l’imagerie retinienne et du glaucome, il est possible d’obtenir une analyse du segment anterieur d’excellente qualite aussi bien en haute definition qu’en trois dimensions, ceci augmentant par la meme l’interet d’acquerir un tel appareil du fait de sa grande polyvalence. Conclusion L’interet du 3D OCT-1000® pour l’analyse du segment anterieur ne doit pas etre neglige par les utilisateurs de cet appareil qui a deja fait ses preuves pour l’analyse du segment posterieur et qui, grâce a quelques parametrages, permet de realiser des images de qualite et en trois dimensions du segment anterieur, et ce en une seule acquisition.

Resume But Evaluer l’efficacite du laser femtoseconde pour la realisation de keratotomies arciformes afin de corriger un astigmatisme apres greffe de cornee. Methode Onze yeux ont ete inclus dans cette etude retrospective. Tous les yeux ont beneficie de deux keratotomies arciformes realisees a l’aide d’un laser femtoseconde. L’acuite visuelle, la densite cellulaire endotheliale et l’astigmatisme refractif, keratometrique et topographique ont ete evalues en pre- et postoperatoire. La profondeur des incisions a ete mesuree par OCT-3. Resultats Le suivi postoperatoire moyen etait de 7,4 ± 6,7 mois. L’acuite visuelle non corrigee n’etait pas modifiee alors qu’un gain significatif ( p = 0,007 ) de 1,68 ± 1,59 ligne de meilleure acuite visuelle corrigee etait observe. L’astigmatisme subjectif moyen preoperatoire etait de 5,18 ± 1,15 D et de 3,41 ± 1,93 D ( p = 0,045 ) apres keratotomies arciformes. L’astigmatisme keratometrique (7,79 ± 3,69 D) et topographique (7,98 ± 2,41 D) preoperatoires atteignaient 4,81 ± 2,52 D ( p = 0,021 ) et 4,36 ± 2,59 D ( p = 0,005 ) respectivement apres chirurgie. La densite endotheliale n’etait pas modifiee. On constatait un decalage moyen entre la profondeur prevue et mesuree des incisions de 10,7 ± 63,5 μm vers la surface corneenne. Aucune complication n’etait observee. Discussion Les keratotomies arciformes realisees a l’aide d’un laser femtoseconde sont efficaces pour la correction des astigmatismes post-keratoplastie, ameliorent la securite et la precision chirurgicale. L’efficacite pourra etre amelioree par le developpement de nomogrammes de traitement adaptes. Conclusion Les keratotomies arciformes assistees par laser femtoseconde sont efficaces, sures et de realisation aisee pour la correction des astigmatismes post-keratoplastie. Cependant, il sera necessaire de completer notre serie afin d’ajuster les parametres de traitement et d’optimiser la reduction de l’astigmatisme.

Anterior segment analysis using OCT3 F. Matonti, L. Hoffart, O. Prost Magnin, F. Coulibaly, M. Catanese, G. Alessi, H. Proust, B. Ridings, J. Conrath Purpose: Optical coherence tomography has been used for many years, in particular in the field of the retinal imaging, and is a promising technique in the analysis of the anterior segment, providing a similar resolution to histology for ocular tissue. Material and methods: We present a collection of images obtained with the OCT3 (Carl Zeiss Meditec, Dublin, CA), with parameters set to obtain good-quality images of the iris and corneal structures. Results: The OCT provides detailed analysis of the cornea, precise assessment of the dimensions and locations of corneal lesions – in the anterior-posterior plane as well as transversally or obliquely – with 10-µm precision, and the study of the iridocorneal angle and its dynamics. Discussion: Using the highly precise OCT3 for retinal imaging, it is possible to obtain good-quality anterior segment imaging, which makes the device highly versatile and thus increases reasons for acquiring this type of apparatus. Conclusions: OCT3 users should not neglect this potential of the device, already in wide use for examining the retina.

PURPOSE To compare in vivo corneal endothelial cell loss (ECL) after fluid-based versus ultrasound phacoemulsification. METHODS In this prospective randomized study, 2 groups of 21 patients underwent phacoemulsification with ultrasound (group 1) or a fluid-based system (group 2). A "divide and conquer" method with capsular bag lens implantation was performed. Cataracts graded up to nuclear opalescence 4.9 in Lens Opacities Classification System III (LOCS III) only were included. Endothelial cell density (ECD), percent hexagonality, endothelial cell area (ECA), coefficient of variation in cell size, and central corneal pachymetry were measured preoperatively, 7 days, 1 month, and 3 months after surgery. Statistical analysis was performed by using a 2-tailed Student t test. RESULTS Average nuclear opalescence was identical in both groups (P = 0.908). Mean ECD was 1867 +/- 451 and 2031 +/- 400 cells/mm at 3 months postoperatively. Mean ECL was 498 +/- 415 (20.6% +/- 17.1%) and 302 +/- 302 cells/mm (13.3% +/- 13.2%) at 7 days, 589 +/- 342 (24.3% +/- 14%) and 254 +/- 214 cells/mm (11.2% +/- 9.1%) at 1 month, and 555 +/- 340 (22.9% +/- 14%) and 247 +/- 208 cells/mm (10.9% +/- 9.1%) at 3 months in groups 1 and 2, respectively. ECL was significantly lower for group 1 than for group 2 (P < 0.001) after the first postoperative month. A significant increase in ECA was also observed at the first and third (P = 0.012) postoperative months. CONCLUSIONS Our study showed significantly lower ECL after phacoemulsification for a fluid-based versus an ultrasound system. The fluid-based method was safer than conventional ultrasound in cataract surgery, with a nuclear opalescence graded up to 4.9 in the LOCS III classification.

Introduction. We used high-field (3T) functional magnetic resonance imaging (fMRI) to map the retinotopic organization of human cortical areas. Methods. Retinotopic maps were reconstructed using existing mapping techniques. Stimuli were made of a rotating wedge stimulus, which provided angular coordinate maps, and an expanding or contracting ring, which provided eccentricity coordinate maps. Stimuli consisted of a grey background alternating with a flickering checkerboard. A Brucker 3T scanner equipped with a head coil and a custom optical system was used to acquire sets of echoplanar images of 20 occipital coronal slices within a RT of 2.111 ms and an 8 mm(3) voxel resolution. Surface models of each subject's occipital lobes were constructed using the Brainvisa software from a sagittal T1 -weighted image with a 1 mm(3) voxel resolution. The cortical models were then inflated to obtain unfolded surfaces. Statistical analyses of the functional data were made under SPM99, and the response amplitudes were finally assigned to the cortical reconstructed surfaces. Results. We identified boundaries between different early visual areas (V1, V2, V3) using eccentricity and polar angle retinotopic maps and detection of reversals in the representation of the polar angle. Both complete maps and reversals corresponding to the V1/V2 borders were clearly visible with a single recording session. Also, we were able to compare data from subjects across various fMRI acquisitions and found that there was a strong correlation between maps acquired at different sessions for the same subject. Conclusions: We developed a quick (

Introduction Les keratoplasties lamellaires anterieures sont de realisation delicate et l’utilisation du laser femtoseconde dans cette indication doit permettre d’en ameliorer les resultats anatomiques et fonctionnels. Nous rapportons le premier cas de keratoplastie lamellaire anterieure assistee par un laser femtoseconde. Observation Il s’agit d’une patiente âgee de 63 ans, presentant une dystrophie corneenne anterieure de Francois, traitee par keratoplastie lamellaire anterieure assistee par laser femtoseconde ( Femtec 20/10 Perfect Vision ® ). Une decoupe corneenne lamellaire par laser femtoseconde a ete realisee a 400 μm de profondeur sur un greffon corneen, positionne sur une chambre anterieure artificielle ( Moria ® , France ), puis sur la cornee receveuse du patient. Resultats Au cours de la periode postoperatoire, le lenticule corneen etait parfaitement adapte au lit receveur avec une interface claire. L’evaluation en OCT III (Carl Zeiss Meditech, Dublin) a permis de constater une pachymetrie centrale de 713 μm avec un lit receveur extremement regulier et une epaisseur centrale de 132 μm. Discussion Les decoupes corneennes assistees par laser femtoseconde doivent en comparaison avec les decoupes mecanisees ameliorer la securite operatoire, la reproductibilite, et la predictibilite des decoupes obtenues. Une meilleure congruence du greffon limite le risque de deplacement secondaire et la meilleure regularite de l’interface doit ameliorer le resultat fonctionnel. Conclusion Les keratoplasties lamellaires anterieures assistees par laser femtoseconde Femtec 20/10 Perfectvision ® presentent de nombreux avantages pour la prise en charge des pathologies corneennes necessitant une keratoplastie lamellaire anterieure. Des etudes comparatives, multicentriques, et randomisees sont necessaires afin d’evaluer les resultats de cette technique.

Purpose To report the incidence and characteristics of endophthalmitis after intravitreal injections of anti–vascular endothelial growth factor agents or corticosteroids and to describe the clinical and bacteriologic characteristics, management, and outcome of these eyes with acute endophthalmitis in France. Design Retrospective, nationwide multicenter case series. Methods From January 2, 2008 to June 30, 2013, a total of 316 576 intravitreal injections from 25 French ophthalmic centers were included. For each center, the number of intravitreal injections was determined using billing codes and the injection protocol was recorded. A registry and hospital records were reviewed to identify patients treated for endophthalmitis after injection during the same time period. The main outcome measures were the incidence of clinical endophthalmitis and visual acuity of endophthalmitis cases. Results During the study period, 65 cases of presumed endophthalmitis were found, giving an overall incidence of 0.021% (2.1 in 10 000 injections) (95% confidence interval [CI], 0.016%–0.026%). The median number of days from injection to presentation was 4 [1–26] days. The most common symptom was vision loss. Bacterial identification was achieved in 43.4%. The most frequent pathogens were gram-positive bacteria (91.3%), including coagulase-negative Staphylococcus in 78.3%. Neither the interval between injection and presentation for endophthalmitis nor the clinical signs differentiated culture-positive from culture-negative cases. In multivariate analysis, the use of a disposable conjunctival mould assist device and the use of prophylaxis with an antibiotic or antiseptic were significantly associated with an increased incidence of endophthalmitis ( P = .001). The majority of patients had worse visual acuity after 3 months of follow-up when compared with acuity before endophthalmitis. Conclusions The incidence of presumed endophthalmitis after intravitreal injections of anti–vascular endothelial growth factors or corticosteroids was low and the prognosis poor. Prevention and management remain challenging. It remains to be determined whether the findings of this study are relevant for other countries using different techniques for intravitreal injections.

Background: The foveal avascular zone (FAZ) is known to enlarge in diabetic retinopathy. In a preliminary study, the authors applied a region growing algorithm to fluorescein angiograms to detect the FAZ in a semi-automated fashion. Methods: The FAZ in 44 fluorescein angiograms of 44 eyes of 41 patients with diabetic retinopathy underwent manual outlining, then analysis with the region growing function of the ENVI image analysis software. The same algorithm was applied after median filtering of the images. Results: Correlation coefficient was 0.98 between the first two authors, 0.89 between the first author and semi-automated detection before median filtering and 0.91 after median filtering. Average surface areas however, were smaller with semi-automated detection (1951 pixels before and 2226 pixels after median filtering) than with manual detection (3032 pixels). Conclusions: Semi-automated detection of the FAZ is possible, but refinements need to be made in angiogram quality and/or image pretreatment to improve results.

But L’objectif de cette etude est l’evaluation prospective de la formation a la technique de phacoexerese par phacosection d’un ophtalmologiste malgache maitrisant deja l’extraction extracapsulaire. Materiel et methode Dans le cadre du programme Sight First de lutte contre la cecite a Madagascar, l’ophtalmologiste de Majunga a selectionne des patients atteints de cataracte blanche totale. Ces derniers ont ete operes par phacosection en utilisant le materiel habituel de l’hopital local, auquel etaient ajoutes d’une part, les deux instruments specifiques de la phacosection et d’autre part, du materiel jetable supplementaire (couteaux de 3,2 mm et produits visco-elastiques). L’anesthesie etait peribulbaire avec oculo-pression. Les controles post operatoires (acuite visuelle et etat corneen) etaient effectues a J1, J7 et J30. Resultats Quarante-quatre cataractes ont ete operees. Les sept premieres ont ete realisees par le formateur aide par le stagiaire et les vingt-six suivantes par le stagiaire aide par le formateur. Nous avons note cinq complications peroperatoires : deux ruptures capsulaires posterieures (dont une au cours de l’implantation) et trois cataractes ayant necessite une reprise operatoire avec lavage de masses residuelles. En postoperatoire, nous retrouvons peu d’astigmatisme induit, une bonne recuperation visuelle et a J30 toutes les cornees limpides. Discussion Les resultats sont tout a fait acceptables pour cette periode d’apprentissage, avec seulement deux complications notables (dont une non liee a la technique operatoire), et une bonne rehabilitation visuelle en moins de quinze jours. Cette technique par petite incision a permis d’une part, de reduire l’astigmatisme induit, et d’autre part, de traiter sans risque des cataractes blanches totales (quel que soit l’operateur). Conclusion La petite incision, grâce a la phacosection, est donc possible pour les cataractes difficiles en milieu tropical avec un cout additionnel faible et en toute securite. De plus, la formation d’un chirurgien maitrisant l’extraction extracapsulaire semble rapide et sans risque pour les patients.

Nous rapportons un cas d’occlusion de branche veineuse retinienne decouverte chez une patiente de 28 ans, revelatrice d’une maladie de Takayasu. L’examen somatique retrouve une asymetrie de la tension arterielle humerale et un souffle abdominal ; le bilan biologique montre un syndrome inflammatoire et l’aortographie abdominale une stenose majeure de l’artere mesenterique superieure. Trois parmi les six criteres diagnostiques de la maladie de Takayasu sont presents chez notre patiente. Elle est le seul cas de maladie de Takayasu releve dans la litterature ayant pour manifestation inaugurale une occlusion de branche veineuse retinienne. Il est a rajouter aux autre cas de manifestations inaugurales atypiques de la maladie de Takayasu, comme la neuropathie optique ischemique anterieure aigue. Chez une patiente de 28 ans, une occlusion de branche veineuse est une manifestation suffisamment rare pour justifier une exploration clinique et paraclinique approfondie.

To report 4 cases of Toxoplasma gondii retinochoroiditis in patients having recently undergone cardiac transplantation. Review of medical records for 4 patients presenting retinochoroiditis and evidence of T. gondii infection. Patient ranged in age from 25 to 53 years. Ocular symptoms began between 3 and 6 months after transplantation. All patients were under immunosuppressive therapy. Foci of retinochoroiditis were observed unilaterally in three patients and bilaterally in one. Intraocular inflammation was minimal in all cases. Serologic responses were highly suggestive of T. gondii as the etiology in all cases; other causes (CMV retinitis and syphilis) were actively sought and were not found. All patients underwent classic therapy. The three unilateral cases evolved favorably, but the bilateral case, seen late, showed extensive macular scarring. Infectious retinochoroiditis is a potentially blinding complication seen after cardiac transplantation, justifying close clinical and serological surveillance or, in certain cases such as mismatched donors, anti-parasitic prophylaxis.

Purpose. To report three further cases of Alstrom syndrome and to present a review of the literature. Methods. Three siblings, two brothers and a sister, are described. They had complete ophthalmologic examination with retinography and fluoroscein angiography. They also underwent general and metabolic examination and genetic study. Results. Alstrom syndrome is a rare autosomal recessive disorder characterized by atypical retinal pigmentary degeneration, sensorineural hearing loss, obesity, non-insulin-dependent diabetes mellitus, and chronic nephropathy. The diagnosis is based on clinical, biologic (hyperglycemia with hyperinsulinism), and genetic criteria (autosomal recessive disorder on chromosome 2). Conclusion. Blindness, hearing loss, complications of diabetes, and renal failure confirm the gravity of this syndrome. The prognosis regarding survival is correlated with the severity of renal failure.

This paper deals with image processing of numerical retinal angiograms in order to facilitate diagnosis and follow-up in age-related macular degeneration (AMD) which is currently the main cause of blindness in industrialized countries. A computerized scheme using principally mathematical morphology operators is proposed for detecting and counting drusen, which are precursor lesions of the ocular fundus. In order to check the feasibility of this approach, results relative to 58 retinal images are compared with those given by three retinal specialists independently. From manual counting measures it is found that interobserver correlation coefficients lie in the range 0.71-0.78. On the other hand, a correlation coefficient of 0.89 is obtained when the average of the three expert countings is compared with the drusen number given by the computerized method. This coefficient is improved from 0.89 to 0.93 by processing only frames captured immediately after the appearance of a dye consecutive to intravenous sodium fluorescein injection. Compared to the manual analysis which is, among other things, tedious and time consuming, the computerized analysis is both quicker and more objective. Validation by the practitioner is however necessary, given possible detection errors. The proposed computerized scheme for detecting and counting drusen may be easily automated and so should prove useful in clinical studies which involve high volume analysis of retinal angiograms.

A 47-year-old woman, physically active, presented with a history of progressive isolated right eye visual loss (20/200). Ophtalmological examination with Goldmann's perimetry showed a Marcus Gunn pupil, an optic disc temporal pallor and a central scotoma on the affected eye. CT scan and cerebral angiography demonstrated an abnormally wide and elongated (megadolichoectatic) intraorbital ophthalmic artery responsible for optic nerve compression in the optic canal. Pulse steroid therapy was chosen and allowed recuperation of right eye visual acuity to 20/20. A 3-months' follow-up was decided and to date, 1 year later, she fell back to 20/40 with a normal right eye visual field. The authors compare these clinical and radiological findings with intraorbital aneurysms and discuss the therapeutic options for this extremely rare form of vascular disease.

Nous rapportons le cas d’un homme, âge de 71 ans, ayant presente une decompensation endotheliale bilaterale de cause inexpliquee au reveil d’un coma. Ce coma etait du a une septicemie a staphylocoque a point de depart cutanee suite a la pose d’un catheter en vue de la realisation d’un scanner. Le patient n’avait pas d’antecedents medicaux, ni de pathologie ophtalmologique preexistante. L’acuite visuelle au reveil etait de 1/20e P20 a l’œil gauche et 2/10e P8 a l’œil droit. A la lampe a fente, etaient notes un epaississement stromal et des plis de la membrane de Descemet responsables d’un flou corneen bilateral predominant a gauche. Le reste de l’examen ophtalmologique et notamment le fond d’œil etaient normaux. Une keratoplastie transfixiante a l’œil gauche combinee a une chirurgie de la cataracte fut effectuee. L’acuite visuelle a 6 mois postoperatoire etait de 9/10e P2. Cette decompensation endotheliale bilaterale reste pour l’instant inexpliquee avec certitude. Toutefois, en dehors d’une decompensation d’une pathologie infraclinique preexistante au coma et compte tenu de la toxicite connue chez l’animal de l’oxacilline (bristopen®), l’hypothese d’une toxicite corneenne iatrogene est la plus probable.

Clinical examination of patients affected by plagiocephaly or trigonocephaly reveals evident malformation of the orbits, and the ocular repercussions are pronounced when children are operated on at an advanced age. Since it is generally accepted that binocular vision is fully developed by approximately 6 months of age, a late correction of plagiocephalic or trigonocephalic skull deformities may be an obstacle to the development of normal visual function. For the present report we investigated astigmatism and strabismus in 53 children, 39 of whom were operated on for plagiocephaly and 14 for trigonocephaly. Traction on the ocular globe induced by the bony deformation caused by the craniosynostosis may explain astigmatism and strabismus.

We report a case of Penicillium chrysogenum endophthalmitis after penetrating ocular trauma in a 9-year-old child, describing the initial management and the therapeutic adaptation after biopsy culture. After a review of endophthalmitis treatment, we discuss mycotic endophthalmitis treatment and recommend the use of intravitreal antibiotics. In this case, we used amphotericin B to treat the fungal disorder with success.

Nous rapportons le cas d’une infiltration metastatique vitreenne isolee d’origine cutanee. Nous decrivons les elements cliniques et paracliniques permettant de conduire au diagnostic. Cette observation nous permet de faire le point sur les pseudo-uveites et de souligner une nouvelle fois l’importance de la vitrectomie diagnostique dans ce contexte.

Purpose To describe characteristics of a delivery device of endothelial graft using in endothelial keratoplasty procedure (Descemet Stripping Endothelial Keraplasty, DSAEK) and to report clinical results. Methods 20 patients are including in our prospective non-randomised study. Patients were benefited of a DSAEK by an experienced surgeon. The dissection of the endothelial graft were realised after removal epithelium and cutting a cornea anterior hat of 350μm by a microkeratom (Moria France). Grafts are inserted by the Endosaver® (Ocular System Inc USA) by a 4 mm incision and applied by a buffering of a air bubble in the anterior segment after a peripheral iridotomy. Authors reports experiences with this device and the density of endothelial cells after 6 month. Results Any failure of the graft was reported. The diminution of endothelial cells was correlated to the thickness of the graft and situated between 26% and 31% depending on pachymetry (50-120 μm and 120-150μm).49% of patients had more than 20/40 at 6 month. Conclusion our study showed the interest of Endosaver® on endothelial grafts to reduce the incision and the diminution of endothelial cells on DSAEK.

The suitability of a corneal graft for transplant surgery is based on different criteria. It may be rejected in particular due to a loss of transparency, directly linked to its scattering properties. Then, these become an important parameter. The aim of this paper is to quantify the influence of the cornea thickness and of the epithelial layer on scattering properties. The origin of scattering is discussed based on polarimetric analysis of scattered field (surface and/or bulk) and on full-field optical coherence tomography imaging (structural information).

The cornea is the single human tissue being transparent. This unique property may be explained by the particular structure of the cornea, but the precise role of each of its constituents remains unsolved. On other matter, prior to corneal transplant, graft must be evaluated during a sorting procedure where a technician assesses of its transparency quality. Nevertheless, this criterion remains subjective and qualitative. This study proposes to combine 3D imagery using Full-Field Optical Coherence Tomography jointly with angular resolved scattering measurement to achieve a quantitative transparency characterization of the cornea. The OCT provides micrometric resolution structural information about the cornea, and we observe the evolution occurring when oedema develops within the tissue. Scattering properties are evaluated and compared parallely, as the transparency of the graft. A close link between the scattering intensity level of the cornea and its thickness is highlighted through this study. Furthermore, the three-dimensional imagery offers a view over the structural modifications leading to a change in transparency, and the combination with scattering properties measurement provides clues over the characteristic scale of scatterers to consider for a better understanding of corneal transparency evolution. Achieving an objective and quantified parameter for the transparency would be helpful for a more efficient corneal graft sorting, and may be able to detect the presence of localized wounds as the ones related to a previous refractive surgery. However, the study of graft nearly eligible for corneal transplant would be needed to confirm the results this study presents.

To compare the effects of different doses of bevacizumab with both saline and dexamethasone on inflammatory angiogenesis in the rat cornea induced by small chemical lesions.Corneal chemical cauterization was performed on 24 rats. Animals were divided randomly into six groups and received a daily subconjunctival injection for 7 days of: balanced salt solution 0.1 mL or dexamethasone phosphate 4 mg/day or bevacizumab 2.5 mg/day, 3.75 mg/day, 5.0 mg/day or bevacizumab 5.0 mg/day + dexamethasone phosphate 4 mg/day. Clinical examination under slitlamp was performed daily for 7 days to evaluate corneal opacity and vessel size evolution. Computer assisted quantitative image analysis was used to measure the total corneal area covered by neovascularization.At final examination, the dexamethasone, bevacizumab 5.0 mg/day and dexamethasone + bevacizumab groups showed a significant lowering in corneal opacity score as compared with control (P = 0.024, P = 0.006 and P = 0.013, respectively). Also, a significant reduction on new vessels size score was observed. Surface of corneal neovascularization was significantly reduced in dexamethasone, bevacizumab 5.0 mg/day and dexamethasone + bevacizumab groups compared with control (P =0.045, P = 0.047 and P = 0.044, respectively).Our study demonstrates the ability of a 5.0 mg/day bevacizumab subconjunctival injection, in monotherapy or associated with dexamethasone, to cause a short-term involution of corneal neovascularization after corneal alkali burn. Combination of both of these treatments may have advantages to monotherapy approaches.

Micrometer scale resolution full-field optical coherence tomography (FF-OCT) is developed for imaging human graft corneas. Three-dimensional (3-D) images with ultrahigh resolution (respectively, 1 and 1.5 µm in the axial and transverse directions), comparable to traditional histological sections, are obtained allowing the visualization of the cells and the precise structure of the different layers that compose the tissue. The sensitivity of our device enables imaging the entire thickness of the cornea, even in edematous corneas more than 800 µm thick. Furthermore, we provide tomographic 3-D images of laser incisions inside the tissue at various depths without slicing the studied corneas. The effects of laser ablations can be observed, along various optical sections, directly in the bulk of the sample with high accuracy, providing information on the interface quality and also imaging tiny changes of the tissue structure. FF-OCT appears to be a powerful tool for subcellular imaging of the corneal structure and pathologies on the entire thickness of the tissue as well as interface quality and changes in the collagen structure due to laser incisions on ex vivo human cornea.

Purpose To assess the use of a new polygonal trephination pattern for penetrating keratoplasty (PK) assisted by femtosecond laser. Design Prospective, nonrandomized clinical study. Methods Sixteen eyes underwent decagonal PK. Nine had Fuchs dystrophy, 4 had pseudophakic bullous keratopathy, 1 had experienced trauma, 1 had corneal amyloidosis, and 1 had keratoconus. A Femtec (Tecnolas PerfectVision) laser was used to create decagonal penetrating cuts on both donor and recipient corneas. All patients were evaluated for uncorrected visual acuity, best spectacle-corrected visual acuity, pachymetry, topography, and endothelial cell density. Scanning electron microscopy was performed on corneal tissue after surgery. Results All eyes were treated successfully without intraoperative complications. The mean follow-up ± standard deviation was 9.75 ± 3.5 months. Mean postoperative best spectacle-corrected visual acuity was 20/53, and there was a significant improvement in both uncorrected visual acuity ( P = .0019) and best spectacle-corrected visual acuity ( P = .001). At 6 months, mean ± standard deviation manifest astigmatism was 1.90 ± 1.20 diopters. Mean endothelial cell density was 1502 ± 458 cells/mm 2 . Scanning electron microscopy displayed straight decagonal cut margins and minor remaining tissue bridges. Conclusions Use of the decagonal trephination profile was effective and safe to perform PK. Short-term visual results and refractive results are encouraging compared with those of conventional PK studies. Longer-term follow-up and comparative studies are necessary to determine precisely advantages the and optimal surgical settings of this technique.

International audience; PURPOSE. It has been suggested that crowding, the adverse low-level effect due to the proximity of adjacent stimuli, explains slow reading in low-vision patients with absolute macular scotomas. According to this hypothesis, crowding in the vertical dimension should be released by increasing the vertical spacing between lines of text. However, studies with different experimental paradigms and only a few observers have given discrepant results on this question. The purpose of this study was to investigate this issue with a large number of patients whose macular function was carefully assessed. METHODS. MP1 microperimetry examination was performed for each low-vision patient. Only eyes with an absolute macular scotoma and no foveal sparing (61 patients with AMD, 90 eyes; four patients with Stargardt disease, eight eyes) were included. Maximal reading speed was assessed for each eye with French sentences designed on the MNREAD test principles. RESULTS. The effect of interline spacing on maximal reading speed (MRS) was significant although small; average MRS increased by 7.1 words/min from standard to double interline spacing. The effect was weak irrespective of PRL distance from the fovea and scotoma area and regardless of whether an eccentric island of functional vision was present within the scotoma. CONCLUSIONS. Increasing interline spacing is advisable only for very slow readers (