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Purpose: To demonstrate the non-inferiority of a stand-alone unidirectional airflow system, the SurgiCube (Surgi-Cube International BV), for cataract surgery compared to a conventional operating theater (OT)., Methods: This was a retrospective and comparative cross-sectional study conducted at the Rothschild Foundation, Paris, France. All patients who underwent cataract surgery using the SurgiCube between February 2020 and February 2023 were included and compared to a separate group of patients with cataract surgery performed in a conventional OT and under topical anesthesia during the same period. Patients with less than 1 month of follow-up after surgery were excluded. We collected relevant information from the patient's medical records. Main outcome measures, incidence of endophthalmitis, intraoperative and postoperative complication incidence, 1-month logarithm of minimum angle of resolution (logMAR) visual acuity and intraocular pressure, and operating times were analyzed., Results: A total of 1,901 eyes in the SurgiCube group were compared to 5,474 eyes in the OT group. The occurrence of endophthalmitis was 0.05% (n = 1) in the SurgiCube group versus 0.07% (n = 4) in the OT group ( P = 1.00; odds ratio = 0.72 [95% CI = 0.01 to 7.28]). The percentage of procedures with at least one perioperative complication was 2.6% in the SurgiCube group and 2.7% in the OT group ( P = .87; odds ratio = 0.96 [95% CI = 0.68 to 1.34]). The percentage of procedures with a postoperative complication was 6.31% in the SurgiCube group and 6.6% in the OT group ( P = .59; odds ratio = 0.94 [95% CI = 0.75 to 1.17]. Average visual acuity at 30 days was 0.04 logMAR in the SurgiCube group and 0.07 logMAR in the OT group ( P = .62). The average operating times were 16.8 and 19.7 minutes for the SurgiCube and OT groups, respectively ( P < .001). The average occupation room times were 26.2 and 32.3 minutes for the SurgiCube and OT groups, respectively ( P < .001)., Conclusions: Cataract surgery in the SurgiCube seems to be non-inferior to cataract surgery in a conventional OT. [ J Refract Surg . 2024;40(11):e884-e891.] ., Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

Purpose: The aim of this study was to report long-term follow-up of eyes undergoing Descemet stripping only (DSO)., Methods: This was a retrospective study including 26 eyes of 20 patients undergoing DSO between December 2015 and November 2022. Eligibility criteria included peripheral endothelial cell count (ECC) >1000 cells/mm 2 and symptoms caused by central guttata. Patients underwent a central circular 4-mm descemetorhexis using a reverse Sinskey hook and a pair of descemetorhexis forceps using a peeling technique. Three parameters were measured before surgery and at last follow-up: best-corrected visual acuity (BCVA), central corneal thickness (CCT), and ECC measured centrally and at the periphery., Results: The mean age was 73 ± 9 years [52-90 years]. The average follow-up period was 23.7 ± 24.8 months [3-84]. Twenty-two eyes responded to DSO with 20 female eyes (91%) and 2 male eyes (9%). The mean postoperative BCVA improved from 0.3 ± 0.17 logMAR to 0.09 ± 0.13 logMAR ( P value <0.05). The mean postoperative CCT decreased from 588 ± 41 μm to 546 ± 50 μm ( P -value <0.05). The mean postoperative central ECC was 780 ± 257 cells/mm 2 [484-1500]. Peripheral ECC decreased postoperatively (1837 ± 407 cells/mm 2 preoperatively to 864 ± 340 cells/mm 2 postoperatively, P value >0.05). Peripheral endothelial cell polymegathism was stable (average of 26.8% ± 6.8% preoperatively and 30.2% ± 14% postoperatively). Average peripheral endothelial cells polymorphism decreased postoperatively (63.1 ± 20.5% preoperatively to 33% ± 25% postoperatively, P value >0.05). Four eyes did not show improvement after DSO and underwent Descemet membrane endothelial keratoplasty surgery. There were 3 men (75%) and 1 women (25%). The preoperative trend was for nonresponders to have lower BCVA, higher CCT, more abnormal peripheral polymorphism, and polymegathism., Conclusions: The results of this study, with up to 7 years follow up, demonstrate the durability of DSO., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Financial disclosures/conflicts of interest: None reported.

Purpose: In this work, we present a new machine learning method based on the transformer neural network to detect eye rubbing using a smartwatch in a real-life setting. In ophthalmology, the accurate detection and prevention of eye rubbing could reduce incidence and progression of ectasic disorders, such as keratoconus, and to prevent blindness., Methods: Our approach leverages the state-of-the-art capabilities of the transformer network, widely recognized for its success in the field of natural language processing (NLP). We evaluate our method against several baselines using a newly collected dataset, which consist of data from smartwatch sensors associated with various hand-face interactions., Results: The current algorithm achieves an eye-rubbing detection accuracy greater than 80% with minimal (20 minutes) and up to 97% with moderate (3 hours) user-specific fine-tuning., Conclusions: This research contributes to advancing eye-rubbing detection and establishes the groundwork for further studies in hand-face interactions monitoring using smartwatches., Translational Relevance: This experiment is a proof-of-concept that eye-rubbing detection is effectively detectable and distinguishable from other similar hand gestures, solely through a wrist-worn device and could lead to further studies and patient education in keratoconus management.

Purpose: To describe a new technique for preparing corneal allogenic ring segments (CAIRSs) using femtosecond laser technology., Setting: Hospital Foundation Adolphe de Rothschild-Noémie de Rothschild institute, Paris, France., Design: Preclinical study conducted on human corneal grafts., Methods: The corneal grafts were mounted on an artificial chamber pressurizer (ACP) with preset constant pressure, and the FSL was used to create a circular annulus with specific dimensions. The resulting CAIRSs were analyzed for their thickness and width after air drying., Results: A total of 25 CAIRSs were prepared using the FSL. The mean width and thickness of the CAIRSs were 803 ± 77 μm and 83 ± 16 μm, respectively. Statistical analysis revealed no significant differences in width among the various quadrants of each CAIRS or between different CAIRSs. Significantly thicker CAIRSs were obtained with a higher ACP pressure., Conclusions: The technique of CAIRS preparation using FSL technology and controlled artificial anterior chamber pressure demonstrated reproducibility and precision. This approach holds the potential for customizing and personalizing CAIRSs based on individual corneal characteristics., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To combine objective machine-derived corneal parameters obtained with new swept-source optical coherence tomography (SS-OCT) tomographer (Anterion) to differentiate between normal (N), keratoconus (KC) and forme fruste KC (FFKC)., Setting: Laser Center, Hôpital Fondation Adolphe de Rothschild, Paris, France., Design: Retrospective study., Methods: 281 eyes of 281 patients were included and divided into 3 groups: N (n = 156), FFKC (n = 43), and KC (n = 82). Eyes were included in each group based on objective evaluation using Nidek Corneal Navigator, and subjective evaluation by authors. The SS-OCT system provided anterior and posterior corneal surface and pachymetry derived variables. The training set was composed of 143 eyes (95 N, 43 FFKC). Discriminant analysis was used to determine the group of an observation based on a set of variables. The obtained formula was tested in the validation set composed of 61 N and 82 KC., Results: Among curvature parameters, the FFKC had significantly higher irregularity index at 3 mm and 5 mm, higher inferior-superior index, higher SteepK-OppositeK index and inferiorly decentered posterior steepest keratometry. Among thickness parameters: central pachymetry, thinnest pachymetry, percentage of thickness increase from center to periphery, and inferior decentration of the thinnest point were statistically different between groups. Combination of multiple variables into a discriminant function (F1) included 5 parameters and reached an area under the receiver operating characteristic curve (AUROC) of 0.95 (sensitivity = 75%, specificity = 98.5%) for detection of FFKC. F1 differentiates N from KC with AUROC = 0.99 (sensitivity = 99%, specificity = 99%)., Conclusions: Combining anterior and posterior curvatures variables along with pachymetric data obtained from SS-OCT allowed automated detection of early KC and KC with very good accuracy (87% and 99.5% respectively)., (Copyright © 2023 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: The aim of this study was to determine the mechanisms leading to the refractive shift and intraocular lens calculation error induced by Descemet membrane endothelial keratoplasty (DMEK), using ocular biometry and corneal elevation tomography data., Methods: This is a retrospective, monocentric cohort study. Eyes which underwent uncomplicated DMEK surgery with available pre-DMEK and post-DMEK Scheimpflug rotating camera data (Pentacam, Oculus, Wetzlar, Germany) were considered for inclusion with an age-matched control group of healthy corneas. Cataract surgery data were collected for triple-DMEK cases. DMEK-induced refractive shift (DIRS) and intraocular lens calculation error (DICE) were calculated. Pearson r correlation coefficient was calculated between each corneal parameter variation and both DIRS and DICE., Results: DIRS was calculable for 49 eyes from 43 patients. It was 30.61% neutral, 53.06% hyperopic (36.73% > 1D), and 16.32% myopic (6.12% > 1 D). DICE was calculable for 30 eyes of 26 patients: It was 46.67% neutral, 40.00% hyperopic (10.00% > 1D), and 13.33% myopic (3.33% > 1D). DIRS and DICE were mainly associated with variations in PRC/ARC ratio, anterior average radii of curvature (ARC), posterior average radii of curvature (PRC), and posterior Q., Conclusions: Our results suggest that ARC variations, PRC/ARC ratio variations, PRC variations, and posterior Q variations are the most influential parameters for both DIRS and DICE. We suggest that a distinction between those different phenomenons, both currently described as "hyperopic shift" in the literature, should be made by researchers and clinicians., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: To study the progression of keratoconus after cessation of eye rubbing with a minimum follow up of three-years., Design: Retrospective, monocentric, longitudinal cohort study of keratoconus patients with a minimum of 3 years follow-up., Participants: One hundred fifty three eyes of seventy-seven consecutive patients with keratoconus were included., Methods: Initial examination consisted of anterior and posterior segment evaluation using slit-lamp biomicroscopy. At the initial visit, patients were thoroughly informed of their pathology and instructed to stop rubbing their eyes. Eye rubbing cessation was assessed at all the follow-up visits at 6 months, 1 year, 2 years, 3 years, and yearly afterward. Corneal topography using the Pentacam® (Oculus®, Wetzlar, Germany) was used to obtain maximum and average anterior keratometry readings (Kmax and Kmean), as well as thinnest pachymetry (Pachymin, μm) in both eyes., Main Outcome Measures: The main outcomes measured were maximum keratometry (Kmax), mean keratometry (Kmean), and thinnest pachymetry (Pachymin) values at various time points to assess for keratoconus progression. Keratoconus progression was defined as a significant augmentation of Kmax (>1D), Kmean (>1D), or significant diminution of Pachymin (>5%) throughout the total follow-up duration., Results: One hundred fifty three eyes of seventy-seven patients (75.3% males) aged 26.4 years old, were followed for an average of 53 months. Over the course of the follow-up, there was no statistically significant variation of ∆Kmax (+0.04 ± 0.87; p  = 0.34), ∆ Kmean (+0.30 ± 0.67; p  = 0.27) nor ∆Pachymin (-4.36 ± 11.88; p  = 0.64). Among the 26 of the 153 eyes which had at least one criterion of KC progression, 25 admitted continuing eye rubbing, or other at-risk behaviors., Conclusion: This study suggests that a significant proportion of keratoconus patients are likely to remain stable if close monitoring and strict ARB cessation are achieved, without the need for further intervention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Mazharian, Flamant, Elahi, Panthier, Rampat and Gatinel.)

Purpose: The study aimed to assess the safety and the non-inferiority of cataract surgery outside an operating room using the Surgicube ® , a mobile laminar airflow (LAF) device., Settings: This single-center study was conducted at the Rothschild Foundation, Paris, France., Design: This is a retrospective cross-sectional study., Methods: All patients operated on for cataracts using the Surgicube ® between February 2020 and February 2021 were included and controlled by a cohort of patients operated on for cataracts in the traditional theater during the same period. Patients with a postoperative follow-up of less than 1 month were excluded. Data collection was carried out using the patient's medical record. The primary endpoint was the evaluation of the number of endophthalmitis in the two groups. The secondary judgment criteria were the analysis of the various complications and the Logmar visual acuity at 1 month in the two groups. All the patients underwent an OCT retinal examination., Results: A total of 923 randomized patients who underwent cataract surgery between 2020 and 2021 have been included in the study. Among them, 448 patients were operated on using the Surgicube, and 475 patients underwent surgery in the traditional operating room using the same lens phacoemulsification technique. There are no significant differences between the two groups ( p > 0.05)., Conclusion: Cataract surgery using the Surgicube ® outside a conventional operating room seems non-inferior to conventional scrub., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Artus, Fabro, Cochereau, Caputo, Tadayoni, Vignal, Galatoire, Salviat, Gatinel and Panthier.)

Purpose: To report the repeatability, level of agreement, and correlation of 2 swept-source optical coherence tomography (SS-OCT) biometers, the IOLMaster 700 (biometer A) and the ANTERION (biometer B)., Setting: Rothschild Foundation Hospital, Paris, France., Design: Prospective comparative case series., Methods: Consecutive patients who attended for cataract assessment had SS-OCT biometry performed with the reference, biometer A, and biometer B. Axial length, mean keratometry, central corneal thickness, anterior chamber depth, lens thickness, and corneal diameter measurements (white-to-white [WTW] distance) were measured. The intraoperator repeatability was calculated using analysis of variance and repeatability limits. Correlations were assessed, and the level of agreement between the biometers was represented with the Bland-Altman method., Results: The study comprised 63 patients (125 eyes). There was a statistically significant difference between the 2 biometers in all measurements (P < .05). All repeatability measurements were very high, as were the level of correlation and level of agreement between biometer A and biometer B for all parameters., Conclusions: Biometer B provided good agreement and repeatability compared with biometer A; however, all parameters were not interchangeable, particularly, the WTW measurement and the high keratometric values., (Copyright © 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: The diagnosis of cataract is mostly clinical and there is a lack of objective and specific tool to detect and grade it automatically. The goal of this study was to develop and validate a deep learning model to detect and localize cataract on Swept Source Optical Coherance Tomography (SS-OCT) images., Methods: We trained a convolutional network to detect cataract at the pixel level from 504 SS-OCT images of clear lens and cataract patients. The model was then validated on 1326 different images of 114 patients. The output of the model is a map repreenting the probability of cataract for each pixel of the image. We calculated the Cataract Fraction (CF), defined as the number of pixel classified as "cataract" divided by the number of pixel representing the lens for each image. Receiver Operating Characteristic Curves were plotted. Area Under the Curve (ROC AUC) sensitivity and specitivity to detect cataract were calculated., Results: In the validsation set, mean CF was 0.024 ± 0.077 and 0.479 ± 0.230 (p < 0.001). ROC AUC was 0.98 with an optimal CF threshold of 0.14. Using that threshold, sensitivity and specificity to detect cataract were 94.4% and 94.7%, respectively., Conclusion: We developed an automatic detection tool for cataract on SS-OCT images. Probability maps of cataract on the images provide an additional tool to help the physician in its diagnosis and surgical planning., Competing Interests: Conflicts of interest The authors have no conlict of interest., (Copyright © 2022 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose : To evaluate the effect of intracameral cefuroxime on graft endothelial cell loss after simple Descemet Membrane Endothelial Keratoplasty (DMEK) and combined DMEK and cataract surgery. Materials and Methods : Single-center retrospective comparative analysis. One hundred and three patients were included, 31 in the cefuroxime group and 72 in the non-cefuroxime (NC) group. Best Spectacle-Corrected Visual Acuity (BSCVA), endothelial cell density (ECD) of the graft measured by specular microscopy, and the recipient's pachymetry were recorded pre-operatively and at 1, 3, and 6 months after surgery. Results : In the cefuroxime group, BSCVA was 0.22 ± 0.27 LogMAR, 0.15 ± 0.24 LogMAR and 0.07 ± 0.22, respectively, at 1, 3, and 6 months after surgery with no significant differences found when compared to the NC group ( p > .05). Anatomical outcomes were similar as mean pachymetry decreased from 599 ± 51 µm preoperatively to 511 ± 30 µm at 6 months after surgery in the cefuroxime group and from 607 ± 67 µm preoperatively to 519 ± 32 µm at 6 months in the NC group ( p = .25). Endothelial cell loss was comparable between both groups: 33.4% versus 33.6% at 1 month ( p = .97), 37.4% versus 34.9% at 3 months ( p = .68) and 41.6% versus 38.3% at 6 months ( p = .42) in the cefuroxime and NC groups, respectively. The rates of rebubbling, graft rejection, and cystoid macular edema were not significantly higher in the cefuroxime group. Conclusion : The use of intracameral cefuroxime during simple or combined DMEK did not lead to higher graft endothelial cell loss.

Purpose: To assess the feasibility of Descemet membrane endothelial keratoplasty (DMEK) surgery using the glasses-assisted 3-dimensional (3D) display system NGENUITY (Alcon Laboratories, Fort Worth, TX) and to compare with standard DMEK surgery by using a conventional operating microscope., Methods: Twelve consecutive cases of DMEK surgery were performed using the glasses-assisted 3D display system NGENUITY (Alcon) and matched with similar cases performed by using the OPMI-Lumera 700 surgical microscope (Carl Zeiss Meditec, Jena, Germany) in this prospective cross-sectional study realized at the Rothschild Foundation, Paris, France. DMEK graft preparation time, graft unfolding time, time to perform the descemetorhexis (DM), and overall surgical time were recorded. Best corrected visual acuity, endothelial cell density of the donor tissue measured by specular microscopy, and the recipient's central corneal thickness were recorded preoperatively and again at 1 and 3 months postoperatively., Results: In the 3D group, time to perform the graft preparation, DM, and global surgical time were significantly higher in the 3D group than in the conventional groups (17 minutes 36 seconds ± 3 minutes 13 seconds and 14 minutes 50 seconds ± 1 minutes 28 seconds, P = 0.04; 6 minutes 18 seconds ± 2 minutes 30 seconds vs. 3 minutes 50 seconds ± 2 minutes 8 seconds, P = 0.03; and 31 minutes 30 seconds ± 6 minutes 10 seconds vs. 24 minutes 10 seconds ± 3 minutes 26 seconds, respectively, P = 0.05). The time to unfold the graft was higher, although not significantly so, in the 3D group compared with the conventional group (5 minutes 15 seconds ± 2 minutes 40 seconds vs. 4 minutes 40 seconds ± 2 minutes 25 seconds, P = 0.89). Mean central corneal thickness decreased about 168 ± 82 μm at 3 months after surgery in the 3D group and about 228 ± 123 μm in the conventional group without significant difference (P = 0.60). Best corrected visual acuity in the 3D group was 0.33 ± 0.32 LogMAR at 3 months after surgery with no significant differences found when compared with conventional surgery. The percent endothelial cell loss from preoperative at 3 months was 35% in the 3D group and 26% in the conventional group, respectively, with no significant difference (P > 0.05)., Conclusions: Performing DMEK surgery using a 3D display system is feasible; however, it is more challenging and the total surgical time is longer. This method would certainly be useful for instructional courses.

Purpose: To evaluate eye rubbing and sleeping position in patients with Unilateral or Highly Asymmetric Keratoconus (UHAKC)., Methods: Case-control study of consecutive UHAKC patients diagnosed at the Rothschild Foundation. Controls were age- and sex-matched, randomly selected refractive surgery clinic patients. Patients self-administered questionnaires regarding their family history of keratoconus, eye rubbing, and sleeping habits. All the eyes underwent a comprehensive ocular examination. Logistic regression was used to analyze univariate and multivariate data to identify risk factors for keratoconus., Results: Thirty-three UHAKC patients and 64 controls were included. Univariate analyses showed that daytime eye rubbing [OR = 172.78], in the morning [OR = 24.3], or in eyes with the steepest keratometry [OR = 21.7] were significantly different between groups. Allergy [OR = 2.94], red eyes in the morning [OR = 6.36], and sleeping on stomach/sides [OR = 14.31] or on the same side as the steepest keratometry [OR = 94.72] were also significantly different. The multivariate model also showed statistical significance for most factors including daytime eye rubbing [OR = 134.96], in the morning [OR = 24.86], in the steepest eye [OR = 27.56], and sleeping on stomach/sides [OR = 65.02] or on the steepest side [OR = 144.02]. A univariate analysis in UHAKC group, comparing the worse and better eye, showed that eye rubbing [OR = 162.14] and sleeping position [OR = 99.74] were significantly (p < 0.001) associated with the worse eye., Conclusion: Our data suggests that vigorous eye rubbing and incorrect sleeping position are associated with UHAKC. This is especially true in rubbing the most afflicted eye, and contributory sleep position, including positions placing pressure on the eye with the steepest keratometry.

Purpose: To evaluate vision-related quality of life in keratoconus patients and associated impact of keratoconus severity indicators using the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25)., Methods: This was a prospective cross-sectional study carried out from November 1, 2014, to April 30, 2015, in the corneal service of the Hôtel-Dieu hospital, Paris, France. A hundred and one keratoconus patients were consecutively enrolled. Participants completed a French-validated version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Manifest refraction, maximum keratometry value, and corneal thinnest point were recorded. Associations between clinical and demographic factors, previous medical or surgical treatment, and NEI-VFQ-25 scale scores were evaluated., Results: Vision-related quality of life was no better in patients managed with rigid gas permeable contact lens, collagen cross-linking, or intracorneal ring segment implantation, compared with untreated patients. In advanced keratoconus (stages II, III, and IV of Amsler-Krumeich classification), rigid gas permeable contact lens wearers had better general vision but more ocular pain. Distance-corrected visual acuity worse than 20/40, mean refractive cylinder > 2.5 diopters, and corneal thinnest point < 460 μm in the better eye were associated with a lower vision-related quality of life. In multivariate analysis, only the uncorrected and distance-corrected visual acuity of the better eye remained significantly correlated with vision-related quality of life., Conclusions: Low distance-corrected visual acuity in the better eye was the strongest predictor of low vision-related quality of life.

Purpose: To assess a revised version of an objective cataract grading method based on the lens densitometry on swept-source optical coherence tomography (SS-OCT) scans., Setting: Rothschild Foundation, Paris, France., Design: Prospective case series., Methods: All patients seeking a cataract evaluation and consenting to study participation were included. Exclusion criteria were a history of ocular surgery, cornea or retina disorders, and ocular dryness. The average lens densitometry (ALD) was measured on SS-OCT scans (IOLMaster 700) using an algorithm developed with MATLAB software. The ocular scatter index (OSI), measured using a double-pass aberrometer (Optical Quality Analysis System); Pentacam nucleus staging (PNS) score; and mean PNS were also measured and compared with the ALD measurements., Results: Two hundred eighty-five eyes (195 with cataract; 90 controls) of 155 patients aged 20 to 93 years (mean 56.5 years ± 21 [SD]) were included. The ALD measurements were repeatable (P = .99, analysis of variance). The repeatability limit was 2.50 pixel units. The ALD correlated with the OSI (r 2  = 0.41, P < .01) and PNS score (r 2  = 0.65, P < .01). An ALD greater than 73.8 pixel units was the cutoff threshold for cataract, with 96.2% sensitivity and 91.3% specificity. Discriminant analysis produced a model combining visual acuity and the mean ALD with an area under the receiver operating characteristic curve of 0.975 (P < .001), where the mean ALD had the highest coefficient., Conclusions: Using the automated algorithm based on SS-OCT ALD measurements was a repeatable, reliable objective cataract grading method. When the ALD is greater than 73.8 pixel units, it is reasonable to discuss cataract surgery in symptomatic patients., (Copyright © 2019. Published by Elsevier Inc.)

Purpose: To describe an original technique to unfold the graft in vitrectomized eyes undergoing Descemet membrane endothelial keratoplasty (DMEK)., Methods: We performed a retrospective chart and video review of successive cases presenting with corneal decompensation in vitrectomized eyes or aphakic eyes in which DMEK or combined DMEK/scleral-fixated intraocular lens implantation was indicated and in which a specific technique [Cornea-Press (C-Press)] was used to unfold the graft. C-Press is characterized by corneal indentation intended to artificially shallow the anterior chamber and allow the graft to unroll. Best spectacle-corrected visual acuity, central corneal thickness, the time of graft unfolding, endothelial cell count, and the incidence of intraoperative/postoperative complications were analyzed., Results: Eleven eyes of 11 patients (8 men, mean age: 73 ± 12 years) were included. Corrected distance visual acuity (logarithm of the minimum angle of resolution) improved from 1.44 ± 0.23 preoperatively to 0.77 ± 0.36 6 months postoperatively (P < 0.001). Central corneal thickness (CCT) decreased from 644 ± 79 preoperatively to 516 ± 49 μm 6 months postoperatively. The graft unfolding time was 4.4 ± 2.5 minutes. Mean endothelial cell density was 2762 ± 192 preoperatively and 1872 ± 324 cells/mm 6 months postoperatively. No eye showed intraoperative complications. Rebubbling for partial detachment was needed in 2 cases (18%)., Conclusions: The C-Press technique enables likely safe and reproducible DMEK surgery in vitrectomized eyes. Further clinical studies with a large number of patients and longer follow-up are required to confirm our preliminary results.

Purpose: To demonstrate the feasibility of Descemet membrane endothelial keratoplasty (DMEK) performed after previous penetrating keratoplasty (PK) failure and to describe primary outcomes., Methods: Twenty-eight eyes of 28 patients who underwent DMEK after primary PK failure between January 2013 and November 2017 were included in this single-center retrospective study. Best spectacle-corrected visual acuity, endothelial cell density, and the recipient's central corneal thickness were recorded preoperatively and at 1, 3, and 6 months after surgery., Results: The main indications for primary PK were keratoconus (32%), Fuchs dystrophy (18%), and pseudophakic bullous keratopathy (14%). After a 6-month follow-up, best spectacle-corrected visual acuity was significantly improved in 26 patients (93%) with a mean gain of +0.59 ± 0.47 LogMAR (P < 0.0004). Mean pachymetry reduction was 110 ± 108 μm (P < 0.00003) at 6 months. Mean endothelial cell density was 2016 ± 288 cells/mm (P < 0.006), (24% decrease compared with preoperative values). Graft detachment (>1/3) was observed in 14 cases (50%) and rebubbling was needed (100% effective) during the first 2 weeks after surgery. Elevated intraocular pressure was reported in 5 cases. No early graft rejections were reported., Conclusions: In case of previous PK failure, DMEK is an alternative treatment to re-PK. A longer follow-up to ensure the long-term viability of the graft is needed.

Purpose: To assess a new objective cataract grading method based on lens densitometry on swept-source optical coherence tomography (SS-OCT) scans provided by the IOLMaster 700., Settings: Rothschild Foundation, Paris, France., Design: Prospective case series., Methods: All patients consulting for cataract evaluation who provided their consent to participate in the study were included. A history of eye surgery, corneal or retinal disorders, and ocular dryness were exclusion criteria. The average lens densitometry was measured with SS-OCT scans using ImageJ software. The ocular scatter index (OSI) measured with a double-pass aberrometer (Optical Quality Analysis System), the Pentacam nucleus staging (hereafter referred to as nuclear staging) score, and mean nuclear staging were also measured and compared with the mean lens densitometry., Results: One hundred ten eyes (51 with cataract and 59 controls) were included. The average lens densitometry measurements were repeatable (P = .99, analysis of variance). The repeatability limit was 2.50 pixel units. The average lens density was correlated with the OSI (r 2  = 0.52, P < .01), nuclear staging score (r 2  = 0.75, P < .01), and mean nuclear staging (r 2  = 0.41, P < .01). An average lens density greater than 82.9 pixel units was the cutoff threshold for cataract, with a sensitivity of 73.9% and a specificity of 91.2%., Conclusions: The average lens density measured by SS-OCT was a repeatable and reliable objective cataract grading method. It was correlated with OSI measurement. If the average lens density was greater than 82.9 pixel units and the patient reported visual impairment, cataract surgery might be discussed., (Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the learning curve for graft preparation and graft unrolling during Descemet membrane endothelial keratoplasty (DMEK) and to assess the evolution of visual acuity gain and percentage cell loss with experience., Methods: The first 109 DMEK procedures performed by a single surgeon (A.S.) at the Rothschild Foundation Ophthalmology Hospital in Paris, France, between March 2012 and November 2014 were included. Best-corrected visual acuity and endothelial cell density were recorded preoperatively and again 1 week, 1 month, 3 months, and 6 months after DMEK. Donor age and ECC were registered. Graft preparation time and graft unrolling time were assessed using video recording. Incidence and types of complications were noted., Results: The number of cases necessary to reach 90% of the plateau of the learning curve was 68 for preparation time and 46 for unrolling time in this model. There was no correlation between the best-corrected visual acuity gain at 6 months postsurgery and the learning curve. The percentage cell loss was found to be significantly lower with experience (R = 0.17, P = 0.0011)., Conclusions: Surgical experience allowed faster graft preparation and faster unrolling time in DMEK. Neither experience nor percentage cell loss influenced postoperative visual acuity gain. The number of procedures needed to reach a good standard of care was estimated to be 50 in our patient database.

Purpose: To compare the shape of the capsulotomy, its change, and its impact on visual quality over 1 year using the femtosecond laser system from the manual technique., Methods: In this two-center cross-sectional study from May 2012 to June 2013, each patient had femtosecond laser-assisted cataract surgery in one eye (FLACS group) and conventional phacoemulsification cataract surgery in the other eye (CPCS group). An evaluation of the capsulotomy was performed using retroillumination slit-lamp photographs at 7 days, 6 months, and 1 year after surgery. Effective lens position (ELP), refractive error, and corrected distance visual acuity (CDVA) were analyzed., Results: Thirty-three patients were included in the study. Diameters of capsulorhexis were more precise and deviation surfaces were lower in the FLACS group than in the CPCS group at each evaluation (P < .05). Femtosecond laser capsulotomies were less modified over time than manual continuous curvilinear capsulorhexis. No significant differences were observed for CDVA, refractive error, and ELP between groups., Conclusions: More precise capsulotomy sizing can be achieved with the femtosecond laser compared to continuous curvilinear capsulorhexis. Femtosecond laser capsulotomies are less modified over time but did not improve ELP or visual quality. [J Refract Surg. 2017;33(1):44-49]., (Copyright 2017, SLACK Incorporated.)

Purpose: To evaluate the clinical impact of implanting donor tissue torn during preparation for the Descemet membrane endothelial keratoplasty procedure., Methods: In this single-center retrospective analysis of consecutive cases, 10 cases with torn donor tissue from one surgeon's caseload of 175 procedures were analyzed and compared with control cases. Best-corrected visual acuity, endothelial cell density of the donor tissue measured by specular microscopy, and the recipient's central corneal thickness were recorded preoperatively and again 1, 3, and 6 months after surgery., Results: In the torn graft group, mean central corneal thickness decreased from 660 ± 81 μm preoperatively to 520 ± 36 μm at 6 months after surgery. central corneal thickness was higher at 1 month but decreased faster between 1 and 3 months in the torn graft group compared with the controls (-86 ± 50.2 μm and -12.6 ± 25.5 μm, respectively, P = 0.04). Best-corrected visual acuity in the torn graft group was 0.25 ± 0.23 logMAR, 0.21 ± 0.20 logMAR, and 0.16 ± 0.16, respectively, at 1, 3, and 6 months after surgery with no significant differences found when compared with controls. The percent endothelial cell loss between the preoperative and 1-month postoperative values was significantly higher in the torn graft group than in the controls (32.3% and 24.6%, respectively, P = 0.04) but was identical at 6 months (35.7% in the torn graft group and 34.8% in the control group)., Conclusions: Anatomical recovery was shown to be slower in patients who received torn donor tissue, but long-term clinical outcomes were similar in both groups.

Purpose: To assess intraobserver and interobserver agreement among physicians with different degrees of clinical experience, using a novel fundus autofluorescence semiautomated software for quantification of geographic atrophy in clinical setting., Methods: Fundus autofluorescence frames (excitation: 488 nm; emission: 500-700 nm) of 29 eyes (20 patients; mean age, 79.6 ± 6.2 years) with geographic atrophy secondary to age-related macular degeneration, and no signs of choroidal neovascularization, were analyzed using Region Finder, a semiautomated software embedded in Spectralis (Heidelberg Engineering, Heidelberg, Germany). For each study eye, semiautomated atrophy identification and quantification were independently performed, twice (in a 2-week time frame), by 3 readers with different degrees of clinical experience (2 fellows, and 1 resident). Intraobserver and interobserver agreements were assessed., Results: Mean difference in intraobserver agreement (Bland-Altman statistics) ranged from -0.17 mm² to 0.13 mm². Intraobserver agreement was excellent until the geographic atrophy threshold value of 15.72 mm². Variability correlated with the size of atrophy. Mean difference in interobserver agreement (Bland-Altman statistics) ranged from -0.25 mm² to 0.27 mm², with no significant difference between senior and junior readers. Multifocal lesion or foveal involvement in atrophy was not the cause of disagreement., Conclusion: Region Finder is a reliable tool for the identification and quantification of geographic atrophy in patients with age-related macular degeneration, in a clinical setting even when performed by junior reader.