[A randomized study of subconjonctival bevacizumab (Avastin®) injection for corneal neovascularization]. / Étude randomisée de l'injection sous-conjonctivale de bévacizumab (Avastin®) dans la néo-vascularisation cornéenne.

PURPOSE: The goal of this phase III, comparative, multicentric, randomized, double-blinded clinical trial was to investigate the superiority of subconjunctival bevacizumab injections versus placebo in the treatment of corneal neovascularization. PATIENTS AND METHODS: We included 38 eyes (38 patients) with corneal neovascularization. Twenty patients received bevacizumab and 18 placebos. Patients received 3 monthly injections of either 5mg (0.2mL) bevacizumab or placebo. The main criteria of success was reduction of the surface area of corneal neovascularization after 3months (M3) versus baseline, as measured using semi-automatic analysis of color photographs. RESULTS: The percentage of neovascularized corneal surface decreased by -8.6%±32.8 with bevacizumab, versus -2.6%±20.8 with placebo (p=0.5284). Four patients were determined to be responders (reduction of more than 30%), 3 in the bevacizumab group and 1 in the placebo group, all with neovascularization of less than 1year duration. When restricting the analysis to neovascularization of less than 1 year duration, the difference approached the threshold for significance (-31.8%±42.4 in the bevacizumab group and -0.9%±23.1 in the placebo group) (p=0.0637), as well as the number of responders (3/6 in the bevacizumab group versus 1/10 in the placebo group) (p=0.1181). No serious adverse event was reported. CONCLUSION: This study shows the efficacy of subconjunctival bevacizumab injection in the reduction of neovascularized corneal surface area versus placebo, but only when the neovascularization has been present less than 1year. Nevertheless, the study did not attain the statistical power to pass the threshold of significance.

[Current treatments for corneal neovascularization]. / Traitements actuels de la néovascularisation cornéenne.

The extension of blood vessels into the normally avascular stroma defines corneal neovascularization. Though this phenomenon, pathophysiological and clinical features are well characterized, therapeutic modalities have been hindered by a lack of safe, efficacious and non-controversial treatments. In this literature review, we focus on available therapeutic options in light of recent evidence provided by animal and clinical studies. First, this review will focus on pharmacological treatments that target angiogenesis. The low cost and market availability of bevacizumab make it the first anti-angiogenic therapy choice, and it has demonstrable efficacy in reducing corneal neovascularization when administered topically or subconjunctivally. However, novel anti-angiogenic molecules targeting the intracellular pathways of angiogenesis (siRNA, antisense oligonucleotides) provide a promising alternative. Laser therapy (direct photocoagulation or photo-dynamic therapy) and fine needle diathermy also find a place in the treatment of stabilized corneal neovascularization alone or in association with anti-angiogenic therapy. Additionally, ocular surface reconstruction using amniotic membrane graft or limbal stem cell transplantation is essential when corneal neovascularization is secondary to primary or acquired limbal deficiency.

Visual outcomes with flow-diverter stents covering the ophthalmic artery for treatment of internal carotid artery aneurysms.

BACKGROUND AND PURPOSE: Flow-diverting stents can be used to treat intracranial aneurysms that are not amenable to treatment with coils. We analyzed ophthalmic consequences due to coverage of the origin of the ophthalmic artery by flow-diverting stents for the treatment of internal carotid artery aneurysms. MATERIALS AND METHODS: From April 2009 to April 2013, the clinical and angiographic outcomes of all 28 patients treated for aneurysms with flow-diverting stents covering the origin of the ophthalmic artery were prospectively collected. The origin of the ophthalmic artery in relation to the target aneurysm was classified by using a 4-type classification. A complete ophthalmic examination was performed by a single ophthalmologist 48 hours before and 1 week after covering the ophthalmic artery. RESULTS: Ophthalmic artery patency was normal at the end of endovascular treatment in 24/28 cases (85.7%). With extensive ophthalmic examinations, 11 patients (39.3%) showed new ophthalmic complications. Patients with the ophthalmic artery originating from the aneurysm sac were at high risk for retinal emboli (4/5, 80%). Patients with the ophthalmic artery originating from the inner curve of the carotid siphon were at high risk for optic nerve ischemic atrophy (3/4, 75%). CONCLUSIONS: This prospective study shows that covering the ophthalmic artery with a flow-diverting stent is not without potential complications. Ophthalmic complications can occur but are often not diagnosed. The anatomic disposition of the ophthalmic artery in relation to the carotid siphon and aneurysm should be clearly understood because some configurations have a higher risk. When not required, covering of the ophthalmic artery by flow-diverting stents should be avoided.

[Imaging and quantification of corneal neovascularization]. / Imagerie et quantification de la néovascularisation cornéenne.

Corneal neovascularization is defined as the invasion of vessels into the normally avascular clear corneal stroma, secondary to acute or chronic tissue injury. In addition to decreasing visual acuity, vascularity introduces circulating immune cells, reducing corneal immune privilege and the graft survival of subsequent keratoplasty. Thus, reducing neovascularization has become a recent therapeutic target in order to increase the success of corneal transplantation. Comparing the effects of antiangiogenic drugs assumes that we are able to quantify corneal neovascularization before and after treatment. In the first part of this literature review, we present the various methods to document neovessels (color photos, fluorescein and indocyanine green anterior segment angiography, in vivo confocal microscopy). Next, we report methods to classify and quantify corneal neovascularization.

[Corneal neovascularization: epidemiological, physiopathological, and clinical features]. / Néovascularisation cornéenne : aspects épidémiologiques, physiopathologiques et cliniques.

Corneal neovascularization is defined as the presence of vessels within the normally avascular corneal stroma. This physiopathological process is the consequence of local hyper-expression of pro-angiogenic factors in response to tissue damage. These new vessels (neovessels), initially immature and poorly developed, predispose the cornea to lipid exudation, inflammation, and scarring. Additionally, the influx of vascular cells into the stroma induces a loss of the cornea's immune privilege, resulting in a higher rate of graft rejection. In this literature review, we touch on epidemiological, physiopathological, and clinical aspects of corneal neovascularization, as well as secondary complications.

[Sutureless scleral intraocular lens fixation: report of nine cases and literature review]. / Implants à fixation sclérale sans suture : série de neuf cas et revue de la littérature.

PURPOSE: To report the results of a technique of sutureless intrascleral fixation of a three-piece foldable hydrophobic acrylic posterior chamber intraocular lens (PC IOL) in the absence of capsular support and to compare our results to those reported in the literature. MATERIALS AND METHODS: We report a single-center (Limoges University Medical Center) retrospective series of nine patients with deficient posterior capsular support who underwent sutureless sulcus fixation of a hydrophobic acrylic Tecnis Aspheric(®) model ZA9003 (AMO, Inc.) PCIOL using permanent incarceration of the haptics in scleral tunnels parallel to the limbus, between November 2010 and November 2011. All patients were evaluated for surgical indications, pre- and postoperative refractive status (visual acuity and corneal cylinder), and intra- and postoperative complications. RESULTS: We included six men and three women with post-traumatic subluxed IOL's in three cases and lack of iris and capsular support secondary to traumatic corneoscleral wounds in six cases. Mean age was 63.22 ± 18.79 years. Posterior vitrectomy was performed in all cases. Mean 3-month postoperative visual acuity was 0.42 ± 0.16 LogMAR, and mean corneal postoperative astigmatism was 1.39 ± 0.78 diopters. Complications included IOL decentration of 1.5mm in one case, haptic rupture requiring intraoperative IOL exchange in one case, and transitory postoperative macular edema in two cases. DISCUSSION: Artificial intraocular lens implantation in the absence of capsular support is always a surgical challenge. Currently, the two most widely used approaches include fixation to the iris by suturing or iris claw, and fixation to the sclera with sutures. However, these techniques require wide corneal or scleral incisions resulting in significant postoperative astigmatism. Furthermore, iris fixation is impossible in cases of significant iris trauma, and scleral sutures are often technically difficult and expose the patient to late IOL dislocation or tilt. Sutureless intrascleral fixation of foldable hydrophobic acrylic three-piece IOL's inserted through a conventional sub-2.8mm clear corneal incision is a recent technique. This technique is compatible with cases of iris trauma and allows sutureless fixation of the haptics in scleral tunnels parallel to the limbus, while minimizing the risk of postoperative astigmatism. In addition, it allows the repositioning of IOL's dislocated into the vitreous without re-opening the corneal incision. Complications are mainly related to IOL manipulation and positioning. CONCLUSIONS: Results obtained after sutureless intrascleral PCIOL implantation showed good visual outcomes with minimal complications in eyes with deficient capsular support.

[Imaging features of cavernous hemangiomas of the orbit]. / Aspect des hémangiomes caverneux intraorbitaires.

Cavernous hemangioma is the most frequent benign tumor of the orbit. The clinical presentation is that of a slowly progressive intra-orbital mass with variable degree of exophthalmos. CT typically demonstrates the presence of a well defined oval or rounded shaped mass but MRI provides superior evaluation of the orbit. The tumor is intra-conal in 80% of cases and usually shows T1W hypo-isointensity, T2W hyperintensity and heterogeneous contrast enhancement that becomes more homogeneous on delayed imaging (5 minutes).