Search

Resume Introduction Les keratoprotheses offrent une alternative therapeutique aux patients ayant une cecite corneenne bilaterale et ne pouvant pas beneficier d’une allogreffe de cornee. Le but de ce travail etait d’evaluer l’interet et les limites de la keratoprothese de Boston. Materiel et methodes Sept patients ont beneficie de l’implantation unilaterale d’une keratoprothese de Boston de type I entre decembre 2012 et novembre 2016. Les donnees suivantes ont ete recueillies : l’indication chirurgicale, l’acuite visuelle preoperatoire, postoperatoire a J1, J7, J30, 6 mois et 12 mois, les complications et le traitement postoperatoire. Resultats L’âge moyen d’implantation etait de 58,7 ± 23,4 ans. L’indication chirurgicale correspondait a 1 cas d’aniridie bilaterale congenitale, 2 cas de brulure chimique et 4 decompensations du greffon apres keratoplasties multiples. L’acuite visuelle preoperatoire etait limitee a « perception lumineuse positive » dans 6 cas et « voit bouger la main » dans un cas. Un gain d’acuite visuelle a ete observe chez 4 patients, ce qui correspondait a un gain moyen de 1,53 logMAR au dernier controle. L’acuite visuelle postoperatoire etait en moyenne de 2,33 logMAR. Tous les patients ont constate une amelioration de leur qualite de vie et de leur autonomie. Discussion La selection des patients doit etre faite avec soin, en privilegiant les patients ayant un potentiel fonctionnel conserve et un suivi postoperatoire rapproche possible, afin de garantir la meilleure reussite possible du traitement. Conclusion La keratoprothese de Boston permet un gain de vision et une meilleure qualite de vie pour des patients souffrant d’une cecite corneenne bilaterale.

Resume Introduction La secheresse oculaire est une pathologie plurifactorielle de la surface oculaire dont la frequence elevee, le retentissement significatif sur la qualite de vie et sur la vision, ainsi que le cout financier, en font un veritable probleme de sante publique. Si le traitement des formes minimes a moderees est generalement simple et efficace, celui des formes severes est souvent decevant. L’utilisation de collyres a base de serum autologue (CSA) represente une alternative therapeutique envisageable pour les cas les plus severes. L’objectif de notre etude est d’evaluer l’efficacite du traitement par CSA a long-terme chez des patients presentant des syndromes secs isoles refractaires aux traitements conventionnels ou secondaires a d’autres pathologies generales telles que le syndrome de Gougerot-Sjogren et la maladie du greffon contre l’hote (GVH), ou a des pathologies oculaires telles que les keratites neurotrophiques, les brulures chimiques et les pemphigoides cicatricielles oculaires. Patients et methodes Il s’agit d’une etude observationnelle retrospective monocentrique menee sur 47 patients, soit 83 yeux traites par collyre de serum autologue a l’Assistance Publique-Hopitaux de Marseille entre avril 2014 et avril 2017 pour syndrome sec oculaire severe isole ou secondaire. Les symptomes subjectifs des patients (score ocular surface disease index [OSDI]), leur degre de satisfaction ainsi que les effets secondaires ont ete recueillis a l’aide de questionnaires. Le break up time (BUT) et le score de Schirmer ont ete notes. Une evaluation clinique fondee sur un test de coloration corneenne a la fluoresceine (score Oxford) est realisee avant le traitement par CSA a P0 puis selon 5 periodicites : P1 (entre 1 et 3 mois), P2 (3 et 9 mois), P3 (9 a 15 mois) et P4 (15 mois a 24 mois), P5 (> 24 mois). Resultats Sur les 83 yeux traites, l’âge moyen etait de 54,39 ans ± 21,56 dont 20 hommes (42,55 %) et 27 femmes (57,44 %), les indications de traitement comprenaient principalement 25,53 % de GVH, 21,27 % de syndromes secs oculaires severes primitifs et 19,14 % de syndrome de Goujerot-Sjogren primaire. Le suivi moyen a ete de 9,82 mois ± 15,50. La variation du score OSDI entre P0 et P1 montre une diminution de 19,32 points ± 29,37 (p Discussion Des analyses biologiques complementaires sur la composition des CSA sont en cours afin de mettre en evidence des facteurs predictifs d’efficacite. Ainsi, les patients non repondeurs au traitement par CSA pourraient repondre aux collyres de serum allogenique, fabriques a partir de sang peripherique preleve chez un donneur sain a partir de sang de cordon. Conclusion Sur cette premiere serie de 83 yeux traites par CSA, une efficacite clinique a ete notee chez la majorite des patients. Aucune complication infectieuse n’a ete rapportee et le taux de satisfaction a ete tres eleve.

Resume Objectifs Evaluer l’efficacite et la surete d’un protocole de crosslinking du collagene corneen rapide dans le cadre de la prevention de l’evolution du keratocone. Materiel et methode Etude retrospective de mars 2013 a mars 2015 incluant des patients presentant un keratocone evolutif ayant beneficie d’un crosslinking corneen rapide. Les evaluations pre- et postoperatoires (a 1, 3 et 6 mois) comprenaient : mesure de l’acuite visuelle de loin sans (AVSC) et avec correction, (AVC), biomicroscopie, topographie corneenne d’elevation (keratometrie maximale et moyenne, pachymetrie minimale, densitometrie) et recueil des effets indesirables. Resultats Cent dix yeux de 84 patients ont ete inclus. A m6, on observait une augmentation de l’acuite visuelle de loin corrigee (AVC) avec une amelioration modeste de l’ordre de 0,069 ± 0,15 logMAR (p = 0,009). L’acuite visuelle non corrigee etait inchangee. La pachymetrie corneenne minimale moyenne preoperatoire etait de 455 μm et de 449 μm a m6 (p 0,1). Nous rapportons un cas de keratite infectieuse postoperatoire ainsi que l’induction d’une uveite anterieure aigue non granulomateuse chez des patients sans antecedents opthalmologiques particuliers. Discussion Nos resultats sont similaires a ceux rapportes dans la litterature avec les protocoles de crosslinking conventionnels. Conclusions Le crosslinking corneen rapide apparait comme une alternative therapeutique fiable et efficace dans le traitement du keratocone avec une duree de realisation raccourcie.

Resume Introduction L’objectif de notre etude etait d’evaluer l’evolution des greffons corneens lamellaires apres greffe endotheliale par Descemet stripping automated endothelial keratoplasty (DSAEK) et l’influence de leurs caracteristiques sur les resultats cliniques et fonctionnels. Materiels et methodes Il s’agit d’une etude prospective, dans laquelle ont ete inclus 74 patients operes de greffe endotheliale par technique de DSAEK. Les greffons corneens provenaient de l’etablissement francais du sang et ont ete livres dans un milieu de conservation contenant un agent de deturgescence (Corneajet® ou Stemalpha 3®). La pachymetrie du greffon corneen etait mesuree ex vivo par pachymetrie ultrasonique avant la dissection puis apres la 1e ou la 2e decoupe, le cas echeant. L’acuite visuelle corrigee en logMAR, la pachymetrie totale et du greffon, mesurees en OCT du segment anterieur (Spectralis® HRA + SDOCT, Heidelberg engineering, Inc., Heidelberg, Allemagne) et la densite corneenne (Pentacam®, Oculus, Inc., Wetzlar, Allemagne) etaient relevees chez le patient en preoperatoire, a j5, M1, M3, M6, M9 et M12. Resultats Au total, 74 greffons corneens, issus de donneurs âges de 69,7 ± 13,3 ans en moyenne [37 a 92 ans] ont ete greffes chez 67 patients âges de 70,3 ± 12,1 ans. La pachymetrie predissection etait statistiquement plus elevee en cas de duree courte de deturgescence (r = −0,383, p = 0,001). Pour une meme duree de deturgescence, la pachymetrie predissection etait statistiquement plus elevee dans le milieu Stemalpha 3® (691 ± 89 μm pour le Corneajet® vs. 760 ± 100 μm pour le Stemalpha 3®, p = 0,01), avec une meme pachymetrie finale (168 ± 31 μm vs. 166 ± 25 μm, p = 0,833). La pachymetrie du greffon et la pachymetrie corneenne totale diminuaient significativement entre la mesure preoperatoire et M12 (168 ± 29 μm vs. 92 ± 57 μm, p = 0,0008 et 665 ± 124 μm vs. 566 ± 73 μm, p = 0,027 respectivement). La densite endotheliale preoperatoire (2938 ± 418 cellules/mm2) n’etait pas correlee a l’acuite visuelle postoperatoire. Il existe une correlation positive entre l’acuite visuelle a j5 et l’âge du donneur (r = 0,3, p = 0,04). L’acuite visuelle postoperatoire etait correlee positivement a l’acuite visuelle preoperatoire (p Discussion Le milieu de conservation influence la pachymetrie predissection sans consequence sur les resultats cliniques. Dans notre etude, l’acuite visuelle preoperatoire et l’âge du donneur sont correles a l’acuite visuelle apres DSAEK. Conclusion Bien que le jeune âge du donneur soit lie a une meilleure acuite visuelle a j5, les autres caracteristiques du donneur n’ont pas d’influence sur les resultats cliniques.

Resume Objectif Evaluer l’efficacite de l’eplerenone, un antagoniste des recepteurs aux mineralocorticoides, dans le traitement de la chorioretinite sereuse centrale (CRSC) chronique. Materiels et methodes Une etude retrospective a ete realisee chez 27 patients traites par eplerenone pour une CRSC chronique evoluant depuis au moins 3 mois. Pour chaque patient, l’acuite visuelle et l’OCT maculaire (epaisseur centrale de la retine, taille du decollement sereux retinien (DSR), epaisseur centrale choroidienne) etaient evalues avant traitement, puis a 1 et 3 mois. En cas de disparition complete du DSR a 1 mois, le traitement etait interrompu et un controle etait realise a 3 mois. Resultats L’epaisseur centrale de la retine etait de 371,6 μm (266–573 μm) avant traitement. Une nette diminution de l’epaisseur centrale retinienne ainsi que de la taille du DSR etaient constatees a un mois chez 20 patients (74 %, epaisseur centrale moyenne : 322,6 μm, p = 0,01), avec une amelioration de l’acuite visuelle chez tous ces patients. Le controle a 3 mois retrouvait egalement une diminution du DSR et de l’epaisseur centrale moyenne (294,3 μm, p = 0,002). Six patients presentaient une disparition complete du DSR a un mois, sans recidive a 3 mois. Six autres patients presentaient une disparition complete du DSR a trois mois. Aucun effet secondaire necessitant l’arret du traitement n’a ete constate. Conclusion Dans notre etude, l’eplerenone a ete associe a une regression de l’epaisseur centrale retinienne et de la taille du DSR. L’eplerenone semble etre un traitement efficace et bien tolere de la CRSC chronique, avec une action probable sur les mecanismes physiopathologiques de cette pathologie.

Resume Objectif Evaluer et comparer l’efficacite d’une injection sous-conjonctivale de bevacizumab et de la phototherapie dynamique (PDT) ou de leur association sur la reduction de la neovascularisation corneenne. Methode Series de cas comparant sept yeux de 7 patients presentant une neovascularisation corneenne secondaire. Les patients etaient randomises en trois groupes : le groupe A recevait une seule injection sous-conjonctivale de bevacizumab de 10 mg (0,4 mL), le groupe B une seance de PDT avec verteporfine (6 mg/m2) sur la zone neovascularisee et le groupe C un traitement combine associant une injection sous-conjonctivale de bevacizumab a une seance de PDT realisees a 7 jours d’intervalle. Les modifications morphologiques de la neovascularisation corneenne ont ete evaluees par analyse semi-automatique de photographies biomicroscopiques numeriques avant traitement, puis a 1 mois et 6 mois apres le debut du traitement. Resultats Il a ete observe chez l’ensemble des patients une regression de la surface corneenne neovascularisee a 1 mois. La surface neovascularisee, tous les groupes confondus, a montre une diminution au premier mois apres traitement et cette evolution s’est poursuivie jusqu’au 6emois. On note une reduction de la surface corneenne neovascularisee de 34,05 ± 8,28 % dans le groupe traite par injections sous-conjonctivales de bevacizumab (groupe A), de 42,06 ± 28,36 % dans le groupe traite par PDT seule (groupe B) et de 51,67 ± 18,93 % dans le groupe traite par therapie combinee (groupe C) a 6 mois. Une procedure combinee associant une injection sous-conjonctivale suivie a 7 jours d’une seance de PDT montre une tendance a la superiorite de ce traitement combine dans la regression de la neovascularisation corneenne. Aucun effet secondaire local ou systemique grave n’a ete releve. Conclusion Les resultats a moyen terme montrent que la therapie combinee par injection sous-conjonctivale de bevacizumab et PDT aurait tendance a etre plus efficace sur les neovaisseaux corneens par rapport aux monotherapies. Elle permettrait d’ameliorer le pronostic des keratoplasties transfixiantes. Une etude randomisee, multicentrique, incluant un effectif plus important est necessaire.

Keratoprostheses offer a therapeutic alternative to patients with bilateral corneal blindness who cannot undergo corneal allograft. The goal of this work was to evaluate the indications and limitations of Boston keratoprosthesis.Seven patients underwent unilateral implantation of a Boston type I keratoprosthesis between December 2012 and November 2016. The following data were collected: surgical indication, preoperative visual acuity, postoperative visual acuity at D1, D7, D30, 6 months and 12 months, complications and postoperative treatment.The mean age of implantation was 58.7±23.4 years. The surgical indications included 1 case of congenital bilateral aniridia, 2 cases of chemical burn and 4 graft decompensations after multiple keratoplasties. Preoperative visual acuity was limited to "light perception" in 6 cases and "hand motion" in one case. A gain in visual acuity was observed in 4 patients, which corresponded to a mean gain of 1.53 logMAR at last follow-up. Postoperative visual acuity averaged 2.33 logMAR. All patients experienced an improvement in their quality of life and independence.Patients should be selected carefully, favoring patients with a remaining functional potential and able to engage in close postoperative follow-up, in order to ensure the best possible treatment success.Boston keratoprosthesis provides improved vision and improved quality of life for patients suffering from bilateral corneal blindness.

Dry eye disease is a multifactorial pathology of the ocular surface. The high incidence of this pathology, as well as its significant impact on quality of life and vision and its financial cost, makes it a real public health problem. While the treatment of mild cases is generally simple and effective, treatment of severe forms is often disappointing. The use of autologous serum tears (AST) represents a therapeutic alternative for the most severe cases. The purpose of our study is to evaluate the efficacy of long-term AST treatment in patients with severe dry eye disease refractory to conventional treatment or secondary to systemic diseases such as Sjögren's syndrome or Graft versus Host disease (GVH), or ocular pathologies such as neurotrophic keratitis, chemical burns and ocular cicatricial pemphigoid.This is a monocentric retrospective observational study conducted on 47 patients, with 83 eyes treated with autologous serum eye drops for isolated or secondary dry eye disease at the Marseille Public Hospitals between April 2014 and April 2017. The patients' subjective symptoms (ocular surface disease index [OSDI] score), their degree of satisfaction and the side effects were collected using questionnaires. Tear Break Up Time (BUT) and Schirmer scores were noted. A clinical evaluation based on fluorescein staining (Oxford score) was carried out prior to treatment with AST at P0 followed by 5 periods: P1 (between 1 and 3 months), P2 (3 to 9 months), P3 (9 to 15 months), P4 (15 months to 24 months), and P5 (24 months).Out of the 83 eyes treated, the mean age was 54.39±21.56. There were 20 males (42.55 %) and 27 females (57.44 %); treatment indications consisted mainly of 25.53 % GVH, 21.27 % severe dry eye disease and 19.14 % Sjögren syndrome. The mean duration of follow-up was 9.82 months±15.50. The OSDI score decreased by 19.32 points±29.37 (P0.05) between P0 and P1 and by 23.06 points±18.41 (P0.05) between P0 and P4. The Oxford clinical score showed a significant decrease by the third month of treatment, between P0 and P2, by 1.32 points±1.76 (P0.05). The Schirmer test and the BUT also showed an improvement in dry eye symptoms over time with AST, significantly at P1 (P0.05).Complementary biological analyzes on the composition of AST are under way in order to identify predictive factors of effectiveness; patients not responding to AST treatment might respond to allogeneic serum from healthy donor cord blood.On this first series of 83 eyes treated with ASD, clinical efficacy was noted in most of the patients. No infectious complications were reported, and the satisfaction rate was very high.

Resume Introduction Selon la litterature, le traitement de la retinopathie de Valsalva (RV) par laser est recommande lorsque l’hemorragie maculaire n’a pas regresse apres trois semaines d’evolution. Patient et methodes Nous rapportons cinq cas de RV traitees precocement (≤ 24 h) par membranotomie au laser Nd:YAG (ML). Un examen clinique a ete effectue avant et apres ML (j1, j7, M1, M3 et M6). Enfin, une analyse par tomographie en coherence optique (OCT) a ete realisee afin de determiner la localisation precise de l’hemorragie maculaire. Resultats Une bonne recuperation visuelle a ete obtenue precocement apres ML avec un benefice stable a six mois. L’hemorragie etait localisee en retrohyaloidien et sous la membrane limitante interne (MLI) chez deux patients et exclusivement sous la MLI chez trois patients. Discussion La revue de la litterature et notre etude confirment les bons resultats fonctionnels chez les patients traites par ML dans le cadre d’une RV. De plus, tres peu d’effets secondaires sont rapportes apres ce type de traitement comparativement a l’evolution naturelle de la maladie qui peut certes regresser spontanement, mais expose a un risque de fibrose preretinienne secondaire. Cependant, pour beneficier d’une efficacite optimale, le traitement devrait etre realise le plus precocement possible afin de ne pas etre confronte a un caillotage de l’hematome, empechant toute evacuation secondaire par laser. Conclusion La ML dans la RV est une technique efficace, sure et peu couteuse comparativement a la prise en charge chirurgicale de ces patients presentant un hematome premaculaire persistant apres une periode d’observation simple.

To evaluate the safety and efficacy of accelerated corneal collagen crosslinking on stabilization of progressive keratoconus.This was a retrospective study from March 2013 to March 2015. Patients with progressive keratoconus who underwent accelerated corneal collagen crosslinking were included. Visual acuity with and without correction, biomicroscopy, corneal elevation topography (maximum and mean keratometry values, minimum pachymetry, densitometry) and side effects were recorded at baseline and at 1, 3 and 6 months (M).One hundred and ten eyes of 84 patients were included. At month 6, we found an improvement in corrected distance visual acuity (CDVA) with a small improvment of 0.069±0.15 logMAR (P=0.009). Uncorrected distance visual acuity remained unchanged. The mean minimum corneal pachymetry was 455μm at baseline and 449μm at m6 (P0.001). There was no statistically significant difference between pre- and postoperative mean keratometry values (M1, M3, M6). We likewise found no difference in maximum keratometry between pre- and postoperative values at M1, M3 and M6 (P0.1). With regard to safety, we report 1 case of postoperative infectious keratitis and 1 case of anterior non-granulomatous uveitis after treatment in patients without any known past ocular history.The results we found in this study after accelerated corneal crosslinking are similar to those with conventional crosslinking protocols published in the literature.High irradiance accelerated corneal collagen crosslinking appears to be a reliable and effective therapeutic alternative for progressive keratoconus, allowing for a more brief procedure.

The purpose of our study was to evaluate the progression of lamellar corneal grafts after endothelial keratoplasty by Descemet stripping automated endothelial keratoplasty (DSAEK) and the effect of their characteristics on the clinical and functional results.This was a prospective study in which 74 patients who had undergone endothelial keratoplasty by DSAEK were included. The corneal grafts were obtained from a French tissue bank and were delivered in a preservation medium containing a deturgescent agent (CorneajetOverall, 74 corneal grafts, from donors of mean age 69.7±13.3 years (37 to 92 years) were transplanted into 67 patients aged 70.3±12.1 years. Predissection pachymetry was statistically significantly thicker in the case of short deturgescence time (r=-0.383, P=0.001). For the same deturgescence time, predissection pachymetry was statistically significantly thicker in the Stemalpha 3The preservation medium affects predissection pachymetry with no consequence on clinical results. In our study, preoperative visual acuity and donor age were correlated with visual acuity after DSAEK.Although donor age was associated with better visual acuity at D5, the other donor characteristics had no effect on clinical results.

The increasing number of channels offered by new Microelectrode Array (MEA) systems raises the problem of data handling and analysis in real time. The goal of the RETINE project is to develop a new MEA system, called NeuroPXI, offering 256 channels with online features for MEA data recording, processing and stimulation. This system is a complete redesign of the ASIC-based BioMEA system developed previously. NeuroPXI is based on a front-end device featuring integrated electronics handling signal amplification and current-mode stimulation, and a back-end device handling real-time data processing and 2D spatiotemporal stimulus generation. Initial tests of this system have been performed on mouse spinal cord networks in which waves of activity were successfully recorded. Further tests of NeuroPXI, performed on rats, will consist first, in recording activity waves in the newborn retina and second, in patterned retinal stimulation combined with optical cortical recordings of the primary visual cortex. Such experiments have recently been conducted using the BioMEA system with standard pulse stimuli, and will be repeated with the NeuroPXI system to include more complex 2D-pattern stimuli.

Resume Le laser femtoseconde permet de corriger les astigmatismes congenitaux ou postchirurgicaux par la realisation de keratotomies. Nous utilisons un nomogramme de correction optimise qui permet d’obtenir un resultat refractif superieur et plus predictible en comparaison avec les techniques incisionnelles manuelles. Les incisions arciformes realisees a l’aide d’un laser femtoseconde permettent une reduction de plus de 50 % du cylindre preoperatoire. Neanmoins, l’efficacite pourra encore etre amelioree par le perfectionnement des nomogrammes specifiques au laser femtoseconde.

To evaluate the efficacy of eplerenone, a mineralocorticoid receptor antagonist, in the treatment of chronic central serous chorioretinopathy (CSCR).We conducted a retrospective study of 27 patients treated with eplerenone for chronic CSCR of at least 3 months duration. For each patient, visual acuity and macular OCT (central retinal thickness, height of foveal subretinal fluid (SRF), central choroidal thickness) were evaluated before treatment and at 1 month and 3 months. In the case of complete disappearance of SRF at 1 month, treatment was discontinued and follow-up was performed at 3 months.Central retinal thickness was 371.6μm (266-573μm) before treatment. A clear decrease in retinal central thickness and height of SRF was observed at 1 month in 74% of patients (20 of 27 patients, central retinal thickness: 322.6μm at 1 month, P=0.01), with improvement of visual acuity in all of these patients. Follow-up at 3 months also found a decrease in SRF and central retinal thickness (294.3μm, P=0.002). Six patients had complete resolution of SRF at 1 month, without recurrence at 3 months. Six other patients had complete resolution of SRF at 3 months. No side effects requiring treatment discontinuation were observed.In our study, eplerenone was associated with regression of central retinal thickness and height of SRF. Eplerenone appears to be a safe and effective treatment for chronic CSCR, with a probable mechanism of action on the pathophysiology of this disease.

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’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.

Resume Introduction De realisation aisee, le nombre de prescriptions d’anti-VEGF a fortement augmente ces dernieres annees en traitement de pathologies exsudatives maculaires. Nous rapportons la survenue d’hemorragies maculaires apres un an d’injections intravitreennes (IVT) d’anti-VEGF, principalement pour degenerescence maculaire liee a l’âge. Materiel et methode Du 15 mars 2007 au 15 mars 2008, 445 IVT ont ete realisees pour degenerescence maculaire liee a l’âge, occlusion vasculaire retinienne, retinopathie diabetique, glaucome neovasculaire et neovascularisations maculaires idiopathique et secondaire. Il s’agissait de bevacizumab dans 11,5 % des cas, de pegaptanib dans 18,6 % des cas, de triamcinolone dans 19,3 % des cas, et de ranibizumab dans 50,6 % des cas. Resultats Quatre accidents hemorragiques maculaires, fortement prejudiciables sur l’acuite visuelle des patients (20/400) avec une perte moyenne de cinq lignes, ont ete releves, soit une incidence de 0,9 %. Deux autres patients, adresses pour les memes symptomes, ont ete inclus dans l’etude. Dans tous les cas, un anti-VEGF non selectif (ranibizumab) avait ete injecte sur des yeux deja traites (4 IVT auparavant en moyenne, ± une seance de phototherapie dynamique). Chez tous les patients, etaient notes soit une neovascularisation occulte soit un decollement de l’epithelium pigmentaire vascularise de grande taille. Trois patients presentaient une dechirure de l’epithelium pigmentaire. Discussion Les IVT d’anti-VEGF peuvent favoriser la survenue de dechirure epitheliale sur des decollements de grande taille de l’epithelium pigmentaire nourris par un neovaisseau individualise de petite taille et sur de larges plaques de neovascularisation occulte. Une implication possible des anti-VEGF dans la survenue des hemorragies maculaires par deux mecanismes est evoquee : une retraction de plaque neovasculaire et une possible alteration de la vascularisation physiologique. Conclusion Complication redoutable de la degenerescence maculaire liee a l’âge, l’hematome maculaire pourrait survenir apres IVT d’anti-VEGF sur de vastes lesions occultes, deja traitees auparavant. Les decollements de grande taille de l’epithelium pigmentaire presentent un risque accru de dechirure epitheliale post-IVT. La prudence s’impose face a l’implication de la non-selectivite de l’anti-VEGF utilise (ranibizumab) dans les accidents decrits.

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.

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.

To evaluate the effectiveness of a hyperosmolar medication in corneal edema.This was a prospective randomized study, performed in patients with post-operative corneal edema. Two groups were created: group 1 treated with hypertonic eye drops of 5% sodium chloride with 0.15% sodium hyaluronate in addition to the usual post-operative treatment for 1 month; group 2 without treatment for edema. Visual acuity, pachymetry and corneal density were measured at 1 day, 1 week, 1 month, 3 months and 6 months following surgery.Forty-four patients were included in group 1 and 42 in group 2. Visual acuity was significantly better in group 1 than in group 2 at 7 days (0.84 logMAR vs 1.55 logMAR, P=0.019 CI 95% [-1.298;-0.128]) and was no longer different at one month, three and six months. Pachymetry decreased significantly in 7 days in group 1 (decrease of 17%, P=0.04, CI 95% [1.987; 258.305]), compared to group 2 (P=0.8, CI 95% [-132.9; 161.8]), but the difference between the 2 groups was not statistically significant (P=0.11, CI 95% [-16; 19.1]). Corneal density was also not significantly different between the two groups.Five percent sodium chloride hypertonic eye drops show a statistically significant reduction in post-operative corneal edema as shown by the improvement in visual acuity at one week and the downward trend in pachymetry.

To evaluate and compare the efficacy of subconjunctival bevacizumab injections alone, photodynamic therapy alone and combined treatments for reduction of corneal neovascularization.This study was conducted as a prospective case series. A total of seven eyes of 7 patients with corneal neovascularization caused by ocular surface disorders including fungal infectious keratitis and penetrating keratoplasty were included in the study. Patients were randomized into the three following groups: patients in group A received a single subconjunctival injection of 10mg (0.4mL) of bevacizumab, patients in group B were treated with photodynamic therapy with verteporfin (6mg/m(2)) to the neovascularized area and those in group C received a subconjunctival injection of bevacizumab and photodynamic therapy 7 days later. Morphological changes in neovascularization were evaluated over 6 months using slit-lamp biomicroscopy and digital corneal photography. A computer-assisted semi-automatic analysis of the area of corneal neovascularization was performed with Image J software.Recession of corneal vessels was observed in all eyes at 1 month post-treatment. The neovascularized surface area in all groups combined showed a decrease in the first month after treatment and this decrease continued up to the 6th month. The surface area of corneal neovascularization decreased by 34.05±8.28% in group A (subconjunctival injection of bevacizumab), by 42.06±28.36% in group B (photodynamic therapy with verteporfin) and by 51.67±18.93% in group C (combined subconjunctival injection of bevacizumab and photodynamic therapy). A combined treatment consisting of a subconjunctival injection followed by a PDT session 7 days later might be more effective for the treatment of corneal neovascularisation. No serious local or systemic adverse events were observed.Our medium-term results suggest that combined subconjunctival injection of bevacizumab and photodynamic therapy with verteporfin might be used safely and effectively to reduce corneal neovascularization surface. This combined therapy may show a tendency toward greater efficacy than the individual monotherapies. Controlled prospective randomized multicentric trials with a larger sample size are necessary to assess long-term efficacy and to confirm these results.

Some oxides with the scheelite structure are well known mixed ionic and electronic conductors. This structure family, with the general composition ABO4, can be described as a layer structure derivative of the fluorite structure. The relations between the structural and the electrical transport properties of these materials have been investigated. The model system used in this work was BiVO4, which shows both electronic and ionic conduction.

The development of a solid state thin film lithium battery system needs a detailed investigation of the electrolyte as well as the electrodes. The realisation of a total solid state battery includes the assumption, that the interfacial contact between the electrodes and the electrolyte is as good as possible. The interfacial resistance should be low for an easily intercalation or deintercalation of lithium at the electrodes and the ionic conductivity of the electrolyte should be high.

Materials with the scheelite structure exhibit mixed ionic and electronic conductivity, and are of interest as oxidation catalysts. Scheelite materials, with the general composition ABO4 are also possible candidates for use as electrolytes or cathode materials in solid oxide fuel cells. Our work on the scheelite system, based on BiVO4, shows that both ionic and electronic components of the conductivity can be modified by doping this material. Both A and B site doping have been investigated in the range of 5 mol% dopant concentration. The A cation was replaced by Ca2+ and Ce4+, and the B site by Mn4+ and Mo6+. The phase purity was verified by XRD methods. The total and partial conductivities of pure and doped BiVO4 were investigated by use of the emf technique and ac impedance spectroscopy. Measurements were made between 550° C and 700° C and the oxygen gradient in the emf cell was established by oxygen and air gas flows with specified flow rates and oxygen partial pressure.

According to the literature, the treatment of retinopathy of Valsalva (VR) by laser is recommended when the macular hemorrhage has not regressed after 3 weeks.We report five cases of VR treated early (≤ 24 hours) by Nd:YAG laser membranotomy (LM). Clinical examination was performed before and after LM (D1, D7, M1, M3 and M6). Optical coherence tomography (OCT) analysis was performed to determine the precise location of the macular hemorrhage.Good visual recovery was obtained early by LM with a stable outcome at 6 months. The hemorrhage was located under the internal limiting membrane (ILM) and posterior hyaloid in two patients and only under the ILM in three patients.The literature review and our study confirm the good functional results for patients treated by LM for VR. Furthermore, very few side effects are reported with this type of treatment compared with the natural course of the disease, which may certainly regress spontaneously, but carries a risk of secondary preretinal fibrosis. However, to obtain optimal efficacy, the treatment should be carried out as soon as possible, in order to avoid clotting of the hematoma, preventing any subsequent evacuation by laser.LM for VR is an effective, safe and inexpensive technique compared to the surgical management of these patients presenting with a persistant premacular hematoma after a period of observation.

Clinical evaluation of Alphacor keratoprosthesis in patients at high risk of corneal allograft rejection.Retrospective case series.Alphacor implantation was performed via a two-step procedure with intrastromal insertion followed by secondary exposure of the optic after 6 months. Visual acuity and occurrence of postoperative complications were evaluated.Fourteen eyes of 14 patients underwent Alphacor keratoprosthesis implantation. Mean follow-up was 15.6 ± 5.6 months (from 2 to 24 months). Postoperative mean visual acuity gain was 2.5 ± 3.1 lines (from 0 to +11 lines). Visual acuity was superior or equal to 20/200 in 21% of cases. Seven cases of stromal melt (50%) occurred, of which one case (7.1%) experienced spontaneous extrusion of the implant, three cases (21.4%) required tectonic penetrating keratoplasty, and three patients underwent lamellar keratoplasty on top of the implant. Three cases (21.4%) of retroprosthetic membrane were observed and successfully managed. One patient (7.1%) developed late endophthalmitis.Alphacor is an alternative to corneal allograft in cases of corneal blindness at high risk of allograft failure. Throughout the preoperative evaluation, it is imperative to take into account the limitations of this keratoprosthesis in terms of indications, and additional studies are necessary in order to determine and refine the optimal surgical technique for implantation as well as the efficacy of postoperative treatments.

Through the creation of astigmatic keratotomies, femtosecond laser can correct congenital or post-surgical astigmatism. We have been using an optimized treatment nomogram, which offers superior and more predictable results than manual incisional techniques. Femtosecond arcuate incisions allow a reduction of over 50% of the preoperative astigmatism. Nonetheless, the efficacy can likely be improved further by refining these nomograms specific to the femtosecond laser.

International audience; We report measurements of crater diameter and surface ablation threshold as a function of laser fluence in porcine corneal stroma and fused silica with pulse durations of 7 fs (2.7 optical cycles), 30 fs and 100 fs at 800 nm. For laser pulses with Gaussian radial intensity profile, we show experimentally that the square of the crater diameter is a linear function of the logarithm of the fluence in fused silica, while it is closer to a linear function of the fluence in corneal stroma. Extrapolating these relations to zero diameter indicates that for both media the minimum fluence required for surface ablation is reduced with shorter pulse duration. A simple theoretical model suggests that this effect is due to a more significant contribution of photoionization as the laser pulse duration shortens. (C) 2010 Optical Society of America

Optimization of femtosecond laser characteristics in corneal surgery is still needed to improve clinical results. In this study, we describe an original characterization technique able to measure laser damage of corneal tissues precisely and to provide complementary physical results on the laser-matter interaction.A femtosecond laser was used to damage corneas not suitable for graft. The epithelium and the Bowman layer are exposed to a set of different single-shot fixed laser fluences. Optical microscopy can determine the probability of laser damage on the corneal surface. The high damage threshold (minimum fluence systematically damaging the cornea) roughly fixes the operating laser fluence conditions, while the low damage threshold sets the maximum laser fluence level preserving tissue integrity (safety level).We precisely evaluate the damage fluence threshold of a tissue, using a statistical approach coupled with optical microscopy analysis. This technique gives essential information on laser-tissue interaction with a high rate of confidence. For corneal epithelium and the Bowman layer, we determine the maximum laser fluence level preserving tissue integrity (safety level) and the minimum fluence level systematically damaging the tissue. High and low threshold fluences of epithelium and the Bowman layers are (5.6 ± 0.4 J/cm(2); 2.7 ± 0.1 J/cm(2)), and (7.1 ± 1.1 J/cm(2); 3.4 ± 0.1 J/cm(2)), respectively.These data constitute determinant parameters for clinical applications, since they determine a working window providing the minimal effective irradiation dose that is mandatory for the development of high-quality laser-cutting surgery processes with minimized side effects.

microbial keratitis is a significant health concern for the one million wearers of contact lenses and their ophthalmologists, with some potentially modifiable risk factors. The number of risk factors for contact lens-related microbial keratitis has been described, but many of them still remain assumed or unknown. a multicenter prospective case-control study was conducted in 12 French university hospitals (Besançon, Bordeaux, Dijon, Fort-de-France, Grenoble, Limoges, Lyon, Nancy, Nantes, Paris, Marseille and Strasbourg) beginning in July 2007 on contact lens wearers presenting with microbial keratitis and on healthy contact lens wearers. Patients and healthy wearers were interviewed using a 51-item anonymous standardized questionnaire to determine subject demographics and contact lens wear history. two hundred and fifty-six patients with microbial keratitis were included. One hundred and thirteen healthy contact lenses wearers were surveyed. Cosmetic contact lens wear highly increased the relative risk (RR) of microbial keratitis (RR, 16.5). Time since the last visit to an ophthalmologist longer than 1 year (RR, 3.4) or prescription by someone other than an ophthalmologist (RR, 7.6) also increased the risk of microbial keratitis. Education on lens care and handling was deficient (hand washing: RR, 2.2; rub and rinse: RR, 2.7). a standardized questionnaire is a powerful tool to determine risk factors for contact lens-related microbial keratitis, but also to analyze individual mistakes in contact lenses use and care.

To assess the results of intracorneal ring segment implantation assisted by the Tecnolas Perfect Vision(®) femtosecond laser (Heidelberg, Germany).Retrospective observational study.The patients were operated on with the Tecnolas Perfect Vision(®) femtosecond laser. The following parameters were evaluated before and after surgery: uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal topography, wavefront analysis, and central corneal thickness. The Wilcoxon test was used for statistical analysis.Seventeen eyes of 15 patients were included. The mean follow-up was 6.9±0.71 months. Significant improvement of UCVA and BCVA was observed in 82.35% (P=0.027) and 94.12% (P=0.003) of the eyes, respectively. The subjective refraction showed a significant decrease of the sphere from -10.29±5.54 to -6.5±5.03D (P=0.002). The subjective cylinder significantly decreased from 5.43±3.20 to 3.69±2.30D (P=0.026). The SAI also decreased significantly (P=0.011).Femtosecond-assisted intracorneal ring segment implantation is an effective treatment for corneal ectasia. Further studies are needed to improve surgical parameters and outcomes.

To quantify the course of papilledema using the OCT 3 Stratus (Carl Zeiss Meditec, Dublin, CA, USA) after lateral sinus stent placement in patients with idiopathic intracranial hypertension (IIH).Ten consecutive patients with a diagnosis of IIH underwent OCT examination before and after lateral sinus stenting, between March 2006 and April 2008, in Timone Hospital's Ophthalmology Department (Marseille, France). All patients had criteria for IIH (International Headache Society, 2004) and sinus abnormalities were diagnosed using three-dimensional rotational gadolinium-enhanced MR venography. In all cases, a direct retrograde cerebral venography with manometry was performed. We used the Cordis PRECISE® RX Nitinol Stent system (ref. 10136245-3, JohnsonJohnson), 30-40 mm in length and 8 mm in diameter, all placed by a single operator via a femoral venous puncture. For each eye, the mean retinal nerve fiber layer thickness was noted using the RNFL Thickness (3.4) strategy, before stenting, and three times after stent placement. The other parameters considered were age, sex, weight, height and body mass index.A significant decrease in retinal nerve fiber layer thickness was observed after stent placement. This parameter was considered normal 3 months after stent placement for eight of ten patients.Even though this pathology remains misunderstood, we observed a significant decrease in papilledema in IIH after lateral sinus stent placement, suggesting that high intracranial venous pressure could play a role in this pathology.

Femtosecond lasers find important applications in the field of eye surgery, providing the advantage of combined high ablation precision and minimized collateral tissue effects [1,2]. The most promising applications for femtosecond laser eye surgery are in corneal surgery. Besides the well-known LASIK process, ultrashort lasers are highly relevant for corneal transplantations (penetrating keratoplasty) [3]. Optimal postoperative outcome is dependent on the regularity of the cut and a well matched donor button and recipient bed. The ultimate aim is thus to provide stronger wound healing by increasing wound adaptation and to reduce corneal astigmatism by performing the same cut profile on the receiver and corneal button.

Anterior segment imaging using optical coherence tomography (OCT) time domain technology has been used for many years. When it appeared, it was a promising technique in the analysis of the anterior segment, making it possible to reach a definition of the ocular structures comparable with histology. Now with new-generation OCT, it is possible to perform high-definition and three-dimensional imaging.A 3D OCT-1000 (Topcon, Tokyo, Japan) parameterized to obtain high-definition and 3D imaging of the iridocorneal structures.We present a collection of images obtained using this technique.Based on a very sophisticated tool for retinal and glaucoma imagery, it is now possible to obtain very-high-quality imaging of the anterior segment, which, with its great versatility, increases the value of acquiring this type of device.The potential of 3D OCT-1000, already a very good exam for the posterior segment, and the only one to perform anterior segment three-dimensional imaging in a single acquisition, should not be neglected.