[Induced astigmatism after corneal suture removal after cataract surgery]. / Évolution de l'astigmatisme après ablation d'une suture cornéenne pour chirurgie de la cataracte.

PURPOSE: To evaluate the time until astigmatic stabilization after corneal suture removal after cataract surgery. METHODS: A prospective study was performed on 13 patients who had undergone cataract surgery by phacoemulsification with 2.4mm incision, for whom it was felt necessary to remove a corneal suture. A specular corneal topography was performed by OPD Scan before removal, immediately after, then 10, 20, 30 minutes and 15 days later. For each acquisition, the keratometric readings at the steepest (Kmax) and the flattest (Kmin) meridians (central at 1.15 mm from corneal center, intermediate at 2.30 mm and peripheral at 3.30 mm) and the amount of corneal astigmatism were measured. RESULTS: Corneal topography of 13 patients was acquired. Mean age was 70 ± 12 years. Mean time after cataract surgery was 23 ± 14 days. The greatest change in Kmax occurred within the first minutes following suture removal for the central and intermediate cornea (mean variation of -4.38% and -4.59% of initial Kmax respectively, i.e. -2.04 D ± 3.14 D et -2.15 D ± 3.11 D) whereas it was observed between 0 and 10 minutes for the peripheral area (mean 1.57% of Kmax after suture removal i.e. 0.96 D ± 1.85 D). Mean change in corneal astigmatism between 30 minutes and day 15 was 0.08 D ± 0.31 D (3.6% of baseline). When suture removal was performed between 7 and 10 days postoperatively, mean change was 0.16 D ± 0.24 D, whereas it was 0.03 D ± 0.34 D when performed after four weeks. CONCLUSION: Keratometric readings vary only slightly beyond the first 30 minutes after suture removal. These results suggest that the refraction could be accurately measured the same day as suture removal, with no additional follow-up absolutely necessary in order to prescribe the final spectacles.

[Corneal manifestations of measles in the unvaccinated adult: two typical cases during an epidemic]. / Manifestations cornéennes de la rougeole chez l'adulte non vacciné : deux cas typiques en période d'épidémie.

Measles is a disease due to morbillivirus, which belongs to the paramyxoviridae subfamily. It affects mostly young patients, and evolves through four phases: incubation, invasion, eruption and desquamation. Ophthalmic manifestations may occur during the invasive and eruptive phases. Conjunctivitis is the most common ophthalmologic manifestation and is often asymptomatic. Measles keratitis is the most concerning manifestation, with possible corneal ulcer, bacterial superinfection and corneal perforation. We report two cases of acute keratitis occurring during the eruptive phase of measles in two unvaccinated young adults. The involvement was central and strictly epithelial in both patients. The outcome was favorable with symptomatic treatment.

[Management of herpes zoster neurotrophic ulcer using a new matrix therapy agent (RGTA): A case report]. / Utilisation d'un agent biodégradable de la régénération tissulaire (RGTA) dans le traitement d'un ulcère trophique résistant d'origine zostérienne : à propos d'un cas.

Neurotrophic keratopathy is a potential consequence of herpes simplex virus (HSV) or varicella zoster virus (VZV) infection. The treatment is based on artificial tears and the withdrawal of preserved eye drops or other types of epitheliotoxic topical medicines. Autologous serum or amniotic membrane transplantation may also be used in severe cases, but their cost and safety are still under debate. We report a case of a patient with a history of herpes zoster ophthalmicus, who developed a persistent epithelial ulcer after cataract surgery, with no improvement despite 3 weeks of artificial tears (eight drops per day). A new ophthalmologic solution based on a regenerating agent (RGTA, Cacicol20(®)) was then used, with a dosage of two eye drops per week for 6 weeks. Improvement was observed 1 week later, and complete healing was obtained in less than 3 weeks, with no side effects. This heparin mimetic, which may stimulate extracellular matrix healing, may be a possible alternative therapy to autologous serum or amniotic membrane transplantation in severe neurotrophic ulcer. However, randomized studies are necessary to validate this observation.

[Hypertony and uveitis: 103 cases of uveitis]. / Uvéite et hypertonie : à propos de 103 patients.

PURPOSE: To determine the prevalence of high intraocular pressure (HIOP) in 103 patients. METHODS: One hundred and three consecutive patients referred to our department for uveitis were included. Files were retrospectively analyzed for age at time of presentation, gender, type of uveitis (as defined by International Uveitis Study Group) and etiology, time of HIOP (primary or secondary to treatment), and associated filtering surgical procedure. Intraocular pressure (IOP) was measured using Goldmann applanation tonometry and HIOP was defined as intraocular pressure 21 mm Hg or higher. RESULTS: Among these patients, 36% of uveitis cases were related to a concomitant infectious disease (herpetic disease in 20% of cases and herpes zoster in 4%). No significant difference in age or gender was found between groups. At least one episode of HIOP was found during the acute phase of the disease in 27 patients (26.2%): anterior uveitis accounted for 74% of patients. Most hypertensive cases were associated with herpetic disease (37%), whereas steroid-induced HIOP was suspected in only two patients (7.4%). HIOP was controlled by topical hypotensive treatment in 74.1% of patients, and a filtering surgical procedure was found necessary in seven patients (25.9%). CONCLUSION: This retrospective study confirms that HIOP is a major complication of uveitis, especially in those involving the anterior chamber of the eye and/or related to viruses. Most cases responded rapidly to combined topical steroids/antiglaucomatous therapy.

[Traumatic peri-ocular injuries: closing wounds using 2-octyl-cyanoacrylate medical glue]. / Suture des plaies orbito-palpébrales traumatiques par colle dermo-adhésive : sécurité, modalités pratiques, résultats esthétiques.

INTRODUCTION: Periocular injuries are a common reason for emergency ophthalmology consultations. Their treatment raises specific problems related to skin sensitivity and mobility as well as the ocular safety of the procedure, notably in children. The properties and method of use of synthetic adhesive Dermabond adhesive make it a useful tool for the treatment of these injuries. However, no study to date has evaluated this tool in terms of its efficacy, safety, and esthetic results. PATIENTS AND METHOD: This prospective study included all patients presenting with linear, superficial, or deep wounds to the eyelid and/or eyebrows, consulting an emergency department over a 3-month period. It comprised the clinical and photographic follow-up of each patient. Of these patients, those receiving treatment with synthetic adhesive were selected on the basis of specific criteria. RESULTS: The study population comprised seven patients (four of them children) presenting with six wounds to the eyelid, and two to the eyebrow. This adhesive was applied to four patients. Their mean follow-up was 22 days. No events threatening their safety were reported while using this adhesive, particularly in the children. Its immediate efficacy and comfort for the patient were deemed highly satisfactory. The esthetic outcome after 1 month could not be assessed. CONCLUSION: Use of Dermabond synthetic adhesive is an effective, practical, and safe technique for the treatment of wounds to the eyelid and eyebrows. It was particularly appreciated in children.