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Summary Introduction The objective of this article is to describe the evolution of Schnyder dystrophy in 3 related patients of different ages and to highlight the discovery of a new mutation unidentified until now. Case report We present a series of 3 cases, all first-degree relatives with no suggestion of consanguinity , of different ages (30, 40 and 59 years) and two distinct generations (mother and children). Slit lamp examination revealed the same lesions in our three patients: an early-onset corneal arcus senilis , central corneal deposits, and a gray stromal haze in the two oldest subjects. The older the patient, the more numerous and dense were these lesions. The various anterior segment OCTs showed an increase in the number of hyperreflective opacities in the anterior stroma and, in the older subject, the appearance of many posterior shadows. Monitoring of pachymetry by Pentacam ® showed progressive age-related thickening. All three patients had dyslipidemia treated with statins or diet alone. In our case we proposed treatment only to subject A because of the significant impact on her visual acuity . Discussion Numerous clinical, para-clinical and genetic descriptions of this disease are found in the literature. Schnyder dystrophy is rare but not unheard of and may be discovered fortuitously or in the setting of decreased visual acuity. Genetic analysis of our family revealed a mutation of the UBIAD1 gene not described in the literature. UBIAD1 encodes the protein domain-containing UbiA prenyltransferase 1 which converts vitamin K1 into K2 and is involved in the cholesterol synthesis pathway. In the case of a mutation, it is no longer functional, leading to the accumulation of cholesterol crystals. Given the clinical context and the presence of this variant of the reference sequence in all relatives, its pathogenesis is strongly suspected in our family. The originality of our article is to present the progression of the same pathology in 3 patients with the same mutation at different ages and degrees of severity. This notion of progressive worsening and the need to treat late in the majority of cases are found in literature. Conclusion The discovery of a new variant within the UBAID1 gene suggests its pathogenesis in view of the clinical features available to us. The dystrophy is initially asymptomatic before the high number of deposits becomes disabling.

Summary Purpose To evaluate the biomechanical properties of the cornea and their impact on intraocular pressure (IOP) measurement after lamellar keratoplasty, compared to healthy eyes, using a non-contact tonometer with a Scheimpflug camera. Methods This study, from 2014 to 2015, included 22 primary DSAEK, 5 DALK, 6 DSAEK after PK, and 50 control eyes. Using a non-contact tonometer with a high-speed Scheimpflug camera (CORVIS ST, Oculus Optikgerate GmbH, Wetzlar, Germany), several biomechanical parameters were recorded, including radius at highest concavity (Rhc) and defomation amplitude (DA). Central corneal thickness (CCT) and uncorrected IOP, were also recorded. For the control eyes only, a corrected IOP was calculated, based on age, central corneal thickness, and biomechanical parameters. Results Rhc was significantly lower after DALK (Rhc = 5.54 ± 0.71, P = 0.007) and DSAEK (Rhc = 6.26 ± 0.77, P = 0.042) compared to control eyes (Rhc =6.82 ± 0.76). DA was higher after DALK and DSAEK, but not significantly (respectively 1.24 ± 0.09 P = 0.41 and 1.22 ± 0.15, P = 0.923) compared to normal eyes (1.18 ± 0.15). Uncorrected IOP was not significantly different between post-keratoplasty and control eyes. In control eyes, the corrected IOP (15.23 ± 1.88) was lower than the uncorrected IOP (16.10 ± 2.34); a statistically significant positive correlation between Rhc and CCT (R2 = 0.6020, P Conclusion Our study showed that, after lamellar keratoplasty, corneal biomechanics are altered. Corneas with higher ocular rigidity will show a lower DA and a higher Rhc.

Purpose To evaluate the use of cartilage as a potential graft material toward osteo-odontal tissue replacement in keratoprosthesis surgery. Methods We describe a modification of the osteo-odonto-keratoprosthesis surgery that involves the use of autologous auricular conchal cartilage graft (ACCG). In stage 1a, a full-thickness cheek mucosa graft was performed over the ocular surface. In stage 1b, ACCG was harvested via a retroauricular approach. An optical polymethyl-methacrylate cylinder was embedded into a double-layered fragment of cartilage and secured by cyanoacrylate glue. The graft is then placed in a infraorbital pocket. Stage 2, performed after 3 months, involved retrieval of the complex and implantation after reflection of the mucosal flap, corneal trephination, iris and lens removal and anterior vitrectomy. Results We report two cases of chondro-keratoprosthesis (CKPRO) who underwent surgery with up to 15 months of follow-up. Preoperatively, vision was limited to light perception (LP) in both cases. On patient 1, CKPRO was performed in the right eye and the postoperative visual acuity stay limited to LP related to preoperative retinal lesions. On patient 2, CKPRO was performed in the left eye and the vision was improved to 20/100 J6. No postoperative complications such as extrusion, epithelial downgrowth, retrocorneal membrane or endophtalmia were observed. Conclusions ACCG could be an interesting alternative to replace osteo-odontal graft in keratoprosthesis surgery. However, further comprehensive studies with larger sample size and longer follow-up are required. However longer follow-up and a higher number of patient are required to report postoperative complications incidence, survival and functional outcomes.

Purpose Iris intraocular implants were developed to manage congenital or traumatic iris defects. However, they are also used to change the color of patient eyes. The aim of this retrospective series was to report complications in patients managed in France after cosmetic implantation. Setting Ophthalmological institutions and private ophthalmologists in France. Design Multicenter retrospective observational study. Methods Questionnaires were sent to all ophthalmology departments in university hospitals and to private ophthalmologists. This questionnaire listed demographic and clinical data for each implanted eye with a focus on safety, the description of ocular complications (corneal edema, endothelial cell loss, increased intraocular pressure, and intraocular inflammation), and the therapeutic management implemented. Results Forty-four questionnaires (87 eyes) were collected, and ultimately, 33 questionnaires (65 eyes) were considered complete and analyzed. Two types of implants were identified. Of the 65 eyes analyzed, only 5 eyes (7.7%) did not experience any complication and 60 eyes (92.3%) had at least 1 complication. The most commonly reported complication was corneal decompensation (78.5%). The diagnosis of glaucoma was made in over half (52.3%) of the cases. Explantation was needed in 81.5% of cases. The mean final visual acuity was 0.45 ± 0.08 logarithm of the minimum angle of resolution (logMAR) (0 to 2 logMAR). Conclusions Several ocular complications with a decreased mean visual acuity were described in a young healthy population. In addition, patient information on the safety of this procedure appeared insufficient.

International audience; A very sensitive technique for quantifying corneal backscattered light which measures the angle-resolved light scattering throughout the reflected space is proposed. Its efficiency to detect different scattering states is compared to that of a technique currently used in hospitals: the Pentacam ®. This technique, based on analyzing the backscattered light close to the specular beam, is less sensitive and it is demonstrate first on agar-agar samples, for which the level of scattering is controlled. In a second time, both techniques are applied on corneal grafts and the first result is confirmed: the Pentacam ® detects an edema after the corneal graft has swollen by hundreds of micrometers; the proposed technique detects the change in scattering before the cornea start to swells. Since the scattering measurements are performed in the reflected space, this highly sensitive method could be applied to in-vivo analysis.

International audience; SIGNIFICANCE: The overall goal of this work is to validate a low vision aid system that uses gaze as a pointing tool and provides smart magnification. We conclude that smart visual enhancement techniques as well as gaze contingency should improve the efficiency of assistive technology for the visually impaired. PURPOSE: A low vision aid, using gaze-contingent visual enhancement and primarily intended to help reading with central vision loss, was recently designed and tested with simulated scotoma. Here, we present a validation of this system for face recognition in age-related macular degeneration patients. METHODS: Twelve individuals with binocular central vision loss were recruited and tested on a face identification-matching task. Gaze position was measured in real time, thanks to an eye tracker. In the visual enhancement condition, at any time during the screen exploration, the fixated face was segregated from background and considered as a region of interest that could be magnified into a region of augmented vision by the participant, if desired. In the natural exploration condition, participants also performed the matching task but without the visual aid. Response time and accuracy were analyzed with mixed-effects models to (1) compare the performance with and without visual aid and (2) estimate the usability of the system. RESULTS: On average, the percentage of correct response for the natural exploration condition was 41%. This value was significantly increased to 63% with visual enhancement (95% confidence interval, 45 to 78%). For the large majority of our participants (83%), this improvement was accompanied by moderate increase in response time, suggesting a real functional benefit for these individuals. CONCLUSIONS: Without visual enhancement, participants with age-related macular degeneration performed poorly, confirming their struggle for face recognition and the need to use efficient visual aids. Our system significantly improved face identification accuracy by 55%, proving to be helpful under laboratory conditions. Copyright (C) 2018 American Academy of Optometry

PURPOSE: To systematically compare the efficacy, predictability, safety, postoperative haze, pain scores, and epithelial healing time of four corneal surface ablation procedures. METHODS: PubMed, Embase, Cochrane Library, and the U.S. trial registry were searched up to June 2018. Randomized controlled trials were selected. Efficacy (uncorrected distance visual acuity of 20/20 or better), predictability (refractive spherical equivalent within ±0.50 diopters [D] of the target), and safety (loss of two or more lines of spectacle corrected distance visual acuity) were set as primary outcome measures. Haze, pain scores, and epithelial healing time were set as secondary outcome measures. RESULTS: Eighteen studies involving 1,423 eyes were included. According to the Grading of Recommendations Assessment, Development, and Evaluation, the quality of outcomes were moderate to high (70.6%). There were no differences in efficacy, predictability, safety, haze, day 1 pain, and epithelial healing time between treatments. Epithelial laser in situ keratomileusis (epi-LASIK) had statistically significantly higher pain scores on day 3 compared to photorefractive keratectomy (PRK) (weighted mean differences [WMD] = 2.2, 95% credible intervals [CrI] = 0.19 to 4.01) and transepithelial PRK (T-PRK) (WMD = 2.7, 95% CrI = 0.51 to 4.84). The surface under the cumulative ranking curve ranking results (best to worst) showed laser epithelial keratomileusis (LASEK) ranked highest for efficacy, predictability, safety, and day 1 pain scores. Epi-LASIK ranked best for grade 1 haze scores. T-PRK ranked best for haze of 0.5 or higher, haze scores day 3 pain scores, and epithelial healing time. CONCLUSIONS: Surface laser refractive surgeries are comparable in terms of efficacy, predictability, safety, and postoperative haze except for day 3 pain scores, with epi-LASIK being more painful compared to PRK and T-PRK. [ J Refract Surg . 2018;34(11):726–735.]

Resume Objectif L’objectif de notre etude etait d’evaluer l’efficacite d’un traitement par solution hyperosmolaire dans l’œdeme corneen. Materiel et methodes Il s’agit d’une etude prospective randomisee realisee chez des patients presentant un œdeme de cornee postoperatoire. Deux groupes ont ete constitues : le groupe 1 traite par solution hyperosmolaire au chlorure de sodium 5 % associe a du hyaluronate de sodium 0,15 % en plus du traitement postoperatoire pendant 1 mois ; le groupe 2 sans traitement anti-œdemateux. L’acuite visuelle, la pachymetrie et la densite corneenne etaient evaluees a j1, j7, M1, M3, M6. Resultats Quarante-quatre patients ont ete inclus dans le groupe 1 et 42 dans le groupe 2. L’acuite visuelle etait significativement meilleure dans le groupe 1 a j7 (0,84 logMAR vs 1,55 logMAR, p = 0,019, IC 95 % [−1,298 ;−0,128]), puis elle n’etait plus statistiquement differente a M1, M3 ou M6. La pachymetrie diminuait significativement a j7 dans le groupe 1 (baisse de 17 %, p = 0,04, IC 95 % [1,987 ; 258,305]), contrairement a celle du groupe 2 (p = 0,8, IC 95 % [−132,9 ; 161,8]), mais la difference entre les 2 groupes n’etait pas statistiquement significative (p = 0,11, IC 95 % [−16 ; 19,1]). Les densites corneennes n’etaient pas non plus significativement differentes entre les 2 groupes. Conclusion La solution hyperosmolaire chlorure de sodium 5 % montre un effet statistiquement significatif dans le traitement de l’œdeme corneen post-chirurgical se traduisant par une amelioration de l’acuite visuelle a j7, avec une tendance a la diminution de la pachymetrie.

Background: Evaluate the effectiveness of a hyperosmolar 5% sodium chloride treatment in corneal oedema. Design: This prospective, randomized study was conducted in a universitary ophthalmology department setting. Participants: 95 patients with post-operative corneal oedema were separated in 2 groups: 45 patients in group 1 treated with hypertonic eye drops; 50 patients in group 2 without anti-oedematous. Methods: Patients in group 1 were treated with 5% sodium chloride hypertonic eye drops associated with 0.15% sodium hyaluronate in addition to the classical post-operative treatment for 1 month; and patients in group 2 were only treated with classical post-operative treatment (antibiotic, corticosteroids and artificial tears). Main outcome measures: Visual acuity, pachymetry and density were measured at 1 day, 7 days, 1 month, 3 months and 6 months following surgery. Results: Visual acuity was significantly better in group 1 than in group 2 at 7 days (0.85 ± 0.64 logMAR vs. 1.46 ± 0.8 logMAR, p=0.024) and one month (0.42 ± 0.35 logMAR vs. 1.03 ± 0.86 logMAR, p=0.04) but was no longer different at three and six months. Pachymetry decreased significantly in 7 days in group 1 (decrease of 17%, p=0.04), contrary to group 2 (p=0.96), but the difference between the 2 groups was not statistically significant (p=0.15). Corneal density was also not significantly different between the two groups. Conclusion: 5% sodium chloride hypertonic eye drops reduces significantly post-operative corneal oedema treatment as shown by the improvement in visual acuity at one week and the downward trend in pachymetry.

International audience; We report a case of Acanthamoeba castellani keratitis in a person who wore contact lenses. The amebae hosted an ameba-resistant bacterial symbiont, provisionally named ``Attilina massiliensis,'' a yet undescribed alpha-Proteobacterium.

International audience; Recurrent herpes simplex keratitis (HSK) is a leading infectious cause of blindness in industrialized countries. Antiviral prophylaxis (AVP) may fail to prevent recurrence of HSK due to viral resistance, inadequate dosing, or poor patient compliance. In this prospective multicenter study, we enrolled immunocompetent patients with recurrent HSK despite AVP. Ocular samples were tested by PCR for herpes simplex virus 1 (HSV-1). HSV-1 drug resistance was assessed with a genotypic assay based on UL23 and UL30 gene sequencing. After curative full dose valacyclovir (VACV) treatment was started, peak and trough acyclovir (ACV) plasma concentrations were measured, and patient compliance to AVP was assessed with a questionnaire.The study sample was comprised of 43 patients. Six (14%) patients were positive for HSV-1 using PCR, of whom 5 (83%) harbored genotypically ACV-resistant (ACVR) virus, due to mutations in UL23 (n = 4) or UL30 (n = 1). Disease duration was statistically significantly longer in patients with viral resistance compared to other HSK patients [35.5 ± 23.4 years (range, 6.8–68.4 years) versus 11.1 ± 12.3 years (range, 0.8–56.3 year) respectively; Mann-Whitney p = 0.01)].While patients were treated with full dose VACV, trough ACV plasma concentrations were below the threshold for ACV sensitivity in 9.5% of cases, and compliance was poor in 5.3% of cases.To summarize, HSV-1 resistance to ACV seems to be a significant cause of failure of prophylaxis in patients with HSK and is associated with longer disease duration. Most PCR-positive samples contained genotypically ACVR virus and identification may aid in adapting treatment. Incomplete 24-h drug coverage may also explain some cases of failure of prophylaxis.

Postoperative visual acuity can be limited by post-keratoplasty astigmatism, even with a clear corneal graft. Astigmatism management can be performed by selective suture removal, adjustment of sutures, optical correction, photorefractive procedures, wedge resection, intra-ocular lens implantation, intracorneal ring segments, relaxing incisions with or without compression sutures and repeated keratoplasty. Relaxing incisions can be made in the graft, graft-host interface or host cornea. Despite the unpredictability of the method because the flat and steep meridians are usually not orthogonal after penetrating keratoplasty, with asymmetric power distribution, all the studies showed an overall reduction of refractive, keratometric or topographic astigmatism, ranging from 30% to 72% with manual or femtosecond-assisted techniques. Most patients with astigmatism higher than 6 diopters had residual cylinder less than or equal to 3 diopters, which can be treated by laser excimer ablation or secondary intraocular lens implantation.

Purpose Clinical assessment of AlphaCor keratoprosthesis and evaluation of surgical method to treat keratolysis in case of stromal necrosis occurrence. Methods This is a noncomparative, retrospective, interventional case series. The medical records of 12 eyes of 12 patients who underwent consecutive AlphaCor keratoprosthesis implantations were reviewed. Patients with severe bilateral corneal pathology unsuitable for a conventional corneal graft, a best-corrected visual acuity (BCVA) from light perception (LP) to 20/200, with no active ocular surface inflammation, controlled intraocular pressure prior to the surgery, and an unstimulated Schirmer test of >2.5 mm at 5 minutes were included. Postoperative medications included topical dexamethasone, ciprofloxacin, and 2% cyclosporine A. Main outcome measures included BCVA and complications occurrence. Results After a mean follow-up of 25 ± 12.3 months (range 2-38 months), 8 (66.7%) AlphaCor devices were retained. Postoperative BCVA ranged from LP to 20/63 (mean gain of 2.5 ± 3.1 lines). Seven cases of stromal melt (58.3%) occurred. Three were reversed to penetrating keratoplasty and 3 had a donor corneal layer fixated over the AlphaCor with satisfactory results (mean follow-up 23 ± 1.6 months). There were no instances of endophthalmitis, retinal detachment, or glaucoma exacerbation. Conclusions AlphaCor showed a low incidence of the classic keratoprosthesis complications but a high occurrence of recipient cornea necrosis. Corneal melts were successfully managed in 3 cases by lamellar corneal lenticule graft, thereby increasing the retention of AlphaCor and maintaining BCVA.

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.

International audience; Background: The repertoire of free-living protozoa in contact lens solutions is poorly known despite the fact that such protozoa may act as direct pathogens and may harbor intra-cellular pathogens. Methods: Between 2009 and 2014, the contact lens solutions collected from patients presenting at our Ophthalmology Department for clinically suspected keratitis, were cultured on non-nutrient agar examined by microscope for the presence of free-living protozoa. All protozoa were identified by 18S rRNA gene sequencing. Results: A total of 20 of 233 (8.6 %) contact lens solution specimens collected from 16 patients were cultured. Acanthamoeba amoeba in 16 solutions (80 %) collected from 12 patients and Colpoda steini, Cercozoa sp., Protostelium sp. and a eukaryotic more closely related to Vermamoeba sp., were each isolated in one solution. Cercozoa sp., Colpoda sp., Protostelium sp. and Vermamoeba sp. are reported for the first time as contaminating contact lens solutions. Conclusion: The repertoire of protozoa in contact lens solutions is larger than previously known.

International audience; Background: Chronic canaliculitis is often misdiagnosed as conjunctivitis, delaying proper documentation and management. Aggregatibacter aphrophillus has not been implicated in chronic canaliculitis. Case presentation: We report a case of unilateral chronic epiphora associated with chronic lacrimal canaliculitis resistant to prolonged topical antibiotic treatment in a 65-year-old woman without notable medical history. Canaculotomy, curettage with removal of concretions and tubing with silicone stent for six weeks resolved this chronic infection. Culturing lacrimal secretions and concretions yielded Aggregatibacter aphrophilus in pure culture. Histological analyses showed elongated seed clusters surrounded by neutrophils. Fluorescence in Situ Hybridization confirmed the presence of bacteria in two distinctive concretions. Conclusion: This first documented case of A. aphrophilus chronic lacrimal canaliculitis illustrates that optimal surgical management of chronic lacrimal canaliculitis allows for both accurate microbiological diagnosis and treatment.

International audience; PURPOSE. To describe and quantify a largely unnoticed oculomotor pattern that often occurs when patients with central field loss (CFL) read continuous text: Horizontal distribution of eye fixations dramatically varies across sentences and often reveals clusters. Also to statistically analyze the effect of this new factor on reading speed while controlling for the effect of saccadic amplitude (measured in letters per forward saccade, L/FS), an established oculomotor effect. METHODS. Quantification of nonuniformity of eye fixations (NUF factor) was based on statistical analysis of the curvature of fixation distributions. Linear mixed-effects analyses were performed to predict reading speed from oculomotor factors based on eye movements of 34 AMD and 4 Stargardt patients (better eye decimal acuity from 0.08 to 0.3). Single-line French sentences were read aloud by these patients, who all had a dense scotoma covering the fovea as assessed with MP1 microperimetry. RESULTS. Nonuniformity of fixations is a strong determinant of reading speed (-0.76 log units; 95% confidence interval [CI] [-0.86, -0.66]). This effect is not confounded with the effect of L/FS. The per sentence proportion of trials with clustering is predicted by the frequency of occurrence of the lowest-frequency word in each sentence. CONCLUSIONS. The NUF factor is a new oculomotor predictor of reading speed. This effect is independent of the effect of L/FS. Reading performance, as well as motivation to read, might be enhanced if new visual aids or automatic text simplification were used to reduce the occurrence of fixation clustering.

Purpose To assess the effectiveness, refractive outcomes, and quality of vision of central presbyopic laser in situ keratomileusis (LASIK) performed with the Custom Q algorithm (Wavelight EX500). Setting Ophthalmology Department, Hopital de la Timone, Marseille, France. Design Prospective cohort study. Methods This study was performed between February 2013 and January 2015. Patients with hyperopia were treated with central presbyopic LASIK. Distance, near, and intermediate visual acuities; objective and subjective refractions; Q factor; keratometry (K); corneal aberrations, and a quality-of-vision questionnaire were evaluated preoperatively and postoperatively. The dominant eye was treated with standard LASIK for distance vision and the nondominant eye for near vision using a Q factor modulation. Results The study comprised 138 eyes of 28 men and 41 women. The median age was 53.84 years ± 4.2 (SD). One year after surgery, the mean binocular uncorrected distance visual acuity was −0.04 ± 0.05 logMAR (20/20), the mean binocular uncorrected near visual acuity was 0.10 ± 0.08 logMAR (Jaeger 2), and the mean binocular uncorrected intermediate visual acuity was −0.13 ± 0.14 logMAR (20/20). The mean K in nondominant eyes was statistically higher than the mean K in dominant eyes (43.93 ± 1.77 diopters [D] versus 45.85 ± 1.47 D) ( P = .002). More than 95% of patients were satisfied 3 months after surgery, and at 6 months, 100% said they would recommend the surgery. Conclusion Central presbyopic LASIK with corneal asphericity modulation using the monovision correction algorithm was effective and safe for presbyopia treatment. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.

Background: Macular edema (ME) treatment has benefited from the recent intravitreal pharmacotherapy development of an intravitreal implant of dexamethasone (Ozurdex®, Allergan, Irvine, Calif., USA). However, its efficiency has never been illustrated beyond 3 injections. Case Presentation: We report the case of a 75-year-old woman with inferior branch vein occlusion, who, after laser photocoagulation treatment and recurrence after intravitreal injection of triamcinolone, benefited from 4 injections of Ozurdex. Her macular thickness and visual acuity (VA) progression were assessed for 17 months. Conclusions: This case report highlights the quick efficiency of Ozurdex on VA and ME with good reproducibility and tolerance, and without tachyphylaxis phenomenon. This is the first illustrated description of 4 consecutive injections for ME induced secondary to retinal vein occlusion.

International audience; Along with the lens, the cornea is the only transparent tissue in the human body. However, the development of an edema involves structural disturbances increasing light scattering and leading to the opacification of the cornea. Several mechanisms of transparency loss have been studied in the literature, but the whole phenomenon is complex and the part played by each scatterer is still unclear. We propose here to study human corneal grafts combining microscopic OCT imagery with far-field measurement of the scattered light in the reflected half-space. We introduce afterwards numerical calculations based on electromagnetic equations solved with first order approximation to link the observed microscopic-scale structural modifications with the intensity level of the scattered light, and to try and quantify the relationship between them.

Resume Introduction Les keratites infectieuses constituent une preoccupation majeure de sante pour les millions de porteurs de lentilles de contact, ainsi que pour leurs ophtalmologistes. Certains facteurs de risque infectieux sont bien connus (defaut d’hygiene, port permanent des lentilles…), d’autres sont seulement evoques, voire meconnus et gagneraient ainsi a etre demontres. Patients et methodes Une etude multicentrique prospective regroupant 12 centres hospitaliers universitaires francais (Besancon, Bordeaux, Dijon, Fort-de-France, Grenoble, Limoges, Lyon, Nancy, Nantes, Paris, Marseille et Strasbourg) comparant des patients souffrant d’une keratite infectieuse sous lentilles de contact (cas) a des porteurs sains de lentilles de contact (temoins) a l’aide d’un questionnaire standardise anonyme regroupant 51 items donnant des informations sur des facteurs de risques potentiels et developpe pour l’etude a ete debutee en juillet 2007. Resultats Deux cent cinquante-six cas et 113 temoins ont participe a cette etude. Une part importante des abces sous lentilles de contact est survenue sous lentilles cosmetiques (risque relatif [RR] : 16,5). Un delai de consultation chez l’ophtalmologiste superieur a un an (RR : 3,4) ou l’adaptation des lentilles par un non-ophtalmologiste (RR : 7,6) a entraine une augmentation du risque de survenue d’abces sous lentilles. Le non-respect des regles d’hygiene (lavage des mains : RR : 2,2 ; ou absence de rub and rinse : RR : 2,7) a aussi augmente le risque d’infection sous lentilles. Discussion Un questionnaire standardise, remis a tout patient presentant un abces de cornee sous lentilles de contact, semble etre un outil pertinent pour l’etude des facteurs de risque de keratite infectieuse sous lentilles de contact et l’education au bon maniement des lentilles de contact des porteurs.

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.

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.

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.

Retinal prostheses are promising tools for recovering visual functions in blind patients but, unfortunately, with still poor gains in visual acuity. Improving their resolution is thus a key challenge that warrants understanding its origin through appropriate animal models. Here, we provide a systematic comparison between visual and prosthetic activations of the rat primary visual cortex (V1). We established a precise V1 mapping as a functional benchmark to demonstrate that sub-retinal implants activate V1 at the appropriate position, scalable to a wide range of visual luminance, but with an aspect-ratio and an extent much larger than expected. Such distorted activation profile can be accounted for by the existence of two sources of diffusion, passive diffusion and activation of ganglion cells’ axons en passant. Reverse-engineered electrical pulses based on impedance spectroscopy is the only solution we tested that decreases the extent and aspect-ratio, providing a promising solution for clinical applications. DOI: http://dx.doi.org/10.7554/eLife.12687.001, eLife digest One of the most common causes of blindness is a disorder called retinitis pigmentosa. In a healthy eye, the surface at the back of the eye – called the retina – contains cells called photoreceptors that detect light and convert it into electrical signals for the brain to process. In people with retinitis pigmentosa, these photoreceptor cells die off gradually, which leads to loss of vision. The only treatment available for retinitis pigmentosa is to have an artificial retina implanted into the eye. The artificial retina consists of an array of tiny electrodes, which take over from the damaged photoreceptors and generate electrical signals. The person with the implant perceives these electrical signals as bright flashes called “phosphenes”. However, the phosphenes are too large and imprecise to provide the person with vision that is good enough for tasks such as walking unaided or reading. To find out why artificial retinas produce such poor resolution, Roux et al. compared how a rat’s brain responds to either natural visual stimuli or activation of implanted an array of micro-electrodes. Both the micro-electrodes and the natural stimuli activated the same areas of the brain. However, the micro-electrodes produced larger and more elongated patterns of activation. This is because the electrical currents generated by the micro-electrodes diffused throughout the retinal tissue and activated other neurons besides those intended. To overcome this problem, Roux et al. tested different ways of stimulating the micro-electrodes in order to identify those that induce the desired patterns of brain activity. This approach – known as reverse engineering – did indeed improve the performance of the micro-electrode array. The next step is to extend these findings, which were obtained in healthy rats, to non-human primates or animal models of retinitis pigmentosa to better understand the condition in humans. In addition, combining the current approach with other existing techniques should further improve the vision that can be achieved with artificial retinas. DOI: http://dx.doi.org/10.7554/eLife.12687.002

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 (

To report the results of correction of post-keratoplasty astigmatism by arcuate keratotomy performed with the Hanna arcitome (Moria).Service 5, Hôpital des 15-20, Paris VI University, Paris, France.Forty eyes operated on for post-keratoplasty astigmatism using the Hanna arcitome were retrospectively studied. Paired symmetrical arcuate keratotomies were performed on the graft button. Mean follow-up was 10.8 months +/- 11.2 (SD). Outcome measures included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and subjective refraction. For statistical analysis, visual acuity data were transformed into logMAR units. The refractive data were analyzed using the Alpins method.By a mean of 10.8 +/- 11.2 months after surgery, the UCVA had improved a mean of 0.28 +/- 0.46 lines, which was significant (P = .013). The BSCVA remained stable. The mean subjective cylinder was 8.84 +/- 3.00 diopters (D) preoperatively and 4.88 +/- 2.50 D postoperatively (P.001). The changes in postoperative subjective cylinder values correlated with preoperative cylinder values (r(s) = 0.584; P.0001). The subjective axis was modified by 20 degrees or less in 27 eyes (67.5%). The mean surgically induced astigmatism was 8.07 +/- 3.83 D and the mean correction index, 0.96 +/- 0.46. One microperforation occurred and required suturing. Incisions were off center in 1 case, and 2 patients had an allograft rejection after the procedure.Arcuate keratotomy performed with the Hanna arcitome was effective in reducing post-keratoplasty astigmatism. The device enabled safer, easier arcuate incisions than with manual techniques. However, predictability and efficacy could be improved by a more accurate nomogram.

PURPOSE: To evaluate the modification of corneal optical densitometry following photorefractive keratectomy (PRK) using Scheimpflug topography. METHODS: Corneal densitometry (0 to 100 grayscale units [GSU]), pachymetry, and keratometry were evaluated using a rotating Scheimpflug camera (Pentacam HR; Oculus Optikgeräte, GmbH, Wetzlar, Germany) at baseline and 1 and 3 months following PRK in myopic patients. Subjective refraction, uncorrected distance visual acuity, corrected distance visual acuity, and corneal haze (0 to 4 on common subjective scale) were evaluated preoperatively at baseline, 1 month, and 3 months. RESULTS: The study included 75 eyes (38 right eyes, 37 left). The preoperative mean spherical equivalent and cylinder were −2.28 ± 1.24 and 0.92 ± 0.65 diopters (D), respectively. Maximal corneal densitometry (central 4 mm) was 27.44 ± 1.93 GSU at baseline. At 1 month postoperatively, corneal haze with a mean clinical grade of 0.54 ± 0.45 ( P < .0001) was observed, associated with corneal densitometry increased to 29.69 ± 5.16 GSU ( P > .05). At 3 months postoperatively, mean clinical haze decreased to 0.11 ± 0.24 ( P < .0001) and was associated with a significant decrease ( P < .0001) in maximal densitometry (25.13 ± 3.42 GSU). CONCLUSIONS: Corneal densitometry could represent a useful objective measurement of postoperative mild corneal haze and aid in the rating and follow-up of refractive surgery. [ J Refract Surg. 2016;32(11):788–791.]

To the Editor: Amebic keratitis is an aggressive infection usually associated with soft contact lenses, and its poor outcome can lead to a corneal graft (1). Ameba can host ameba-resistant bacteria (2) and serve as a source for numerous organisms to exchange DNA, adapt to changing environments, and become pathogenic to the host (3). However, mixed keratitis caused by amebae in association with ameba-resistant pathogens is rarely seen. A 17-year-old woman who was myopic and had worn soft contact lenses for 3 years consulted our ophthalmology department for pain and redness of the left eye that had persisted for 2 weeks. No visual loss was reported, and a slit-lamp examination showed a millimetric epithelial defect associated with a round stromal infiltrate (Figure). No intraocular reaction was observed, and bacterial keratitis was diagnosed. Her condition improved after a 7-day topical fluoroquinolone treatment, and follow-up at 13 months showed only a slight superficial stromal scar. The patient reported that she had inappropriately worn monthly contact lenses for 3 months, cleaned and rinsed lenses with a commercial cleaning solution but diluted the solution with tap water, and washed her hands with tap water but did not dry them before handling the lenses. Figure Ameba-associated keratitis in a 17-year-old woman (contact lens wearer), France, showing a paracentral corneal scar (A) and recovery at 13-month follow-up (B). Original magnification ×10. Results of microbiologic analysis of a corneal scraping, which included molecular detection of ameba (18S rDNA), bacteria (16S rDNA), and herpesvirus (DNA polymerase), were negative. However, culture of contact lens storage case liquid in Page-modified Neff ameba saline enriched with heat-killed Enterobacter aerogenes (2) identified Pseudomonas fluorescens and Stenotrophomonas maltophilia, both of which were identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (4); Mycobacterium chelonae, which was identified by rpoB gene sequencing; and Acanthamoeba polyphaga, which was identified by partial 18S rDNA sequencing. Culturing this ameba in sterile peptone–yeast extract–glucose broth showed that it hosted 4 organisms. The first organism was a new intracellular Deltaproteobacterium provisionally named Candidatus Babela massiliensis (100% 16S rDNA sequence similarity with a reference strain [GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"GQ495224","term_id":"258674431","term_text":"GQ495224"}}GQ495224], which was susceptible to 200 μg/mL rifampin and resistant to 20 μg/mL ciprofloxacin). The second organism was a new, unnamed, gram-negative, ciprofloxacin-susceptible (20 μg/mL) Alphaproteobacterium bacillus with 99% 16S rDNA sequence similarity (GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"HM138368","term_id":"299780300","term_text":"HM138368"}}HM138368) with Candidatus Odyssella sp. and Acanthamoeba endosymbiont KA/E9 (5). The third organism was a new giant virus related to an A. polyphaga mimivirus (6) strain Lentille. The fourth organism was a new virophage referred to as Sputnik 2 (7). Acanthamoeba spp. are ubiquitous in tap water (2,5), including that used by contact lens wearers to wash hands before manipulating the lens (8). Tap water hosts many organisms, including bacteria (2,5); large DNA viruses (9); and the recently described Sputnik virophage, a virus that infects ameba-resistant large DNA viruses (10). We found 5 bacterial species, a giant virus, and a virophage in the contact lens storage case liquid for this patient. Although Acanthamoeba spp. and M. chelonae are well-described agents of keratitis, other ameba-resistant organisms have not been associated with keratitis. However, 1 of the 2 new ameba-resistant bacteria isolated from the contact lens storage case liquid had a 16S rDNA sequence similar to that of the endosymbiont of an Acanthamoeba species isolated from the corneal sampling of a patient with keratitis in South Korea (5). These data indicate the ubiquity of these emerging organisms and raise questions about roles of the ameba host and the symbiont as causative agents of keratitis. We therefore estimate that any of the organisms reported or any combination of these agents could have been involved in the keratitis that developed in the patient. Because the minute quantity of corneal scraping material prevented molecular detection, the relative contribution of each organism could not be specified. This case illustrates that culturing ameba from ocular specimens and contact lens storage case liquid is mandatory for determining the diversity of pathogens potentially responsible for ameba-associated infections, such as keratitis, in patients who wear contact lenses. Ameba-resistant organisms have complex reciprocal interactions with the host, reminiscent of the mafia behavior. The patient’s practice of not drying her hands after cleansing them with tap water and diluting the contact lens cleansing liquid with tap water may have provided a route for contamination of the contact lens fluid with ameba-resistant, tap water–borne organisms. Patients should be informed of the risk for keratitis caused by water-borne, amebal-resistant pathogens. They should also be educated to avoid contact with tap water when manipulating contact lenses, to dry hands after washing them with water and soap, or to use antiseptics containing >70% alcohol for hand disinfection before contact lens manipulation.