Femtosecond laser-assisted decagonal penetrating keratoplasty.

PURPOSE: To assess the use of a new polygonal trephination pattern for penetrating keratoplasty (PK) assisted by femtosecond laser. DESIGN: Prospective, nonrandomized clinical study. METHODS: Sixteen eyes underwent decagonal PK. Nine had Fuchs dystrophy, 4 had pseudophakic bullous keratopathy, 1 had experienced trauma, 1 had corneal amyloidosis, and 1 had keratoconus. A Femtec (Tecnolas PerfectVision) laser was used to create decagonal penetrating cuts on both donor and recipient corneas. All patients were evaluated for uncorrected visual acuity, best spectacle-corrected visual acuity, pachymetry, topography, and endothelial cell density. Scanning electron microscopy was performed on corneal tissue after surgery. RESULTS: All eyes were treated successfully without intraoperative complications. The mean follow-up ± standard deviation was 9.75 ± 3.5 months. Mean postoperative best spectacle-corrected visual acuity was 20/53, and there was a significant improvement in both uncorrected visual acuity (P = .0019) and best spectacle-corrected visual acuity (P = .001). At 6 months, mean ± standard deviation manifest astigmatism was 1.90 ± 1.20 diopters. Mean endothelial cell density was 1502 ± 458 cells/mm². Scanning electron microscopy displayed straight decagonal cut margins and minor remaining tissue bridges. CONCLUSIONS: Use of the decagonal trephination profile was effective and safe to perform PK. Short-term visual results and refractive results are encouraging compared with those of conventional PK studies. Longer-term follow-up and comparative studies are necessary to determine precisely advantages the and optimal surgical settings of this technique.

Inhibition of corneal neovascularization after alkali burn: comparison of different doses of bevacizumab in monotherapy or associated with dexamethasone.

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 slitlamp 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.

Optic nerve compression by an intraorbital megadolichoectatic ophtalmic artery.

A 47-year-old woman, physically active, presented with a history of progressive isolated right eye visual loss (20/200). Ophtalmological examination with Goldmann's perimetry showed a Marcus Gunn pupil, an optic disc temporal pallor and a central scotoma on the affected eye. CT scan and cerebral angiography demonstrated an abnormally wide and elongated (megadolichoectatic) intraorbital ophthalmic artery responsible for optic nerve compression in the optic canal. Pulse steroid therapy was chosen and allowed recuperation of right eye visual acuity to 20/20. A 3-months' follow-up was decided and to date, 1 year later, she fell back to 20/40 with a normal right eye visual field. The authors compare these clinical and radiological findings with intraorbital aneurysms and discuss the therapeutic options for this extremely rare form of vascular disease.

Vitrectomy may prevent the occurrence of diabetic macular oedema.

PURPOSE: This study aimed to demonstrate that vitrectomy may prevent the occurrence of diabetic macular oedema (DMO). METHODS: Three patients with diabetes type 1 underwent vitrectomy in one eye to treat complications of proliferative diabetic retinopathy. RESULTS: During follow-up, all patients suffered unilateral macular oedema in the non-vitrectomized eye as a result of general metabolic changes. In two of these patients, the DMO resolved with management of the underlying medical condition. CONCLUSIONS: These case reports suggest the vitreous may play a role in the occurrence of DMO associated with general risk factors. Further studies are needed to increase understanding of the mechanisms involved in the development and progression of DMO.

Correction of postkeratoplasty astigmatism by femtosecond laser compared with mechanized astigmatic keratotomy.

PURPOSE: To compare the effectiveness of arcuate keratotomy (AK) performed with a femtosecond laser (FSL) or Hanna keratome (Moria, Anthony, France) for correction of postkeratoplasty astigmatism. DESIGN: Prospective, randomized study. METHODS: This clinical study included 20 eyes. Two groups of 10 eyes underwent AK using an FLS or keratome. Refractive and keratometric astigmatism were evaluated before surgery and 6 months after surgery. The astigmatic changes in the 2 groups were measured through arithmetic and vector analysis (Alpins method). RESULTS: Six months after surgery, the mean uncorrected and corrected visual acuities did not change significantly. The mean preoperative refractive cylinder was 8.6 +/- 3.0 diopters (D) and 6.7 +/- 2.1 D, decreasing to 3.9 +/- 2.4 D and 4.7 +/- 2.4 D after laser AK and mechanized AK, respectively. The mean arithmetic change was significantly higher after laser AK, with a decrease of -55.4 +/- 20.7% (P = .011). Vector analysis showed a systematic undercorrection of astigmatism in both groups with a refractive correction index of 0.82 and 0.90 after laser AK and mechanized AK, respectively. Although no statistically significant differences were detected, a wider spread of angle of error and an almost significant difference of mean absolute angle of error (P = .052) suggest a larger misalignment of treatment during mechanized AK. All cases were uncomplicated after laser AK, 1 microperforation occurred and 1 case with off-center incisions occurred after mechanized AK. CONCLUSIONS: AK performed with the femtosecond laser was effective in reducing postkeratoplasty astigmatism and has some advantages over conventional techniques. However, efficacy could be improved by a more accurate nomogram and alignment of treatment.

Short-term results of penetrating keratoplasty performed with the Femtec femtosecond laser.

PURPOSE: To evaluate the use of the Femtec femtosecond (fs) laser for penetrating keratoplasty (PK) in the treatment of corneal diseases. DESIGN: Prospective, nonrandomized clinical study. METHODS: Nine eyes of nine patients underwent surgery for PK. Five had pseudophakic bullous keratopathy, three had Fuchs dystrophy, and one presented in a keratoconus patient. A Femtec (20/10 PerfectVision; GmbH, Heidelberg, Germany) fs laser was used to create penetrating cuts on donor and recipient corneas. All patients were evaluated for uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), pachymetry, topography, and endothelial cell density (ECD). Scanning electron microscopy (SEM) was performed on corneal tissue after surgery. RESULTS: All eyes were treated successfully without intraoperative complications. The mean follow-up was 6 +/- 3 months. At the last postoperative examination mean BSCVA was 20/69 and there was a significant improvement (P = .08) in both UCVA and BSCVA. Mean astigmatism was 2.9 +/- 1.2 diopters. Mean ECD was 1194 +/- 465 cells/mm(2) with a mean cell loss after surgery of 49.8% +/- 19.8%. SEM displayed smooth rectilinear cut margins and minor remaining tissue bridges. One patient presented a retinal detachment three months after surgery that was successfully treated and two subjects showed an allograft rejection. CONCLUSION: Use of the Femtec fs laser was effective and safe to perform PK. Short-term visual results and refractive results are analogous to conventional PK or other fs laser-assisted PK studies. Longer-term follow-up of additional cases is necessary to precisely quantify the endothelial cell loss after fs surgery.

Corneal endothelial cell loss after cataract extraction by using ultrasound phacoemulsification versus a fluid-based system.

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.

Semi-automated detection of the foveal avascular zone in fluorescein angiograms in diabetes mellitus.

BACKGROUND: The foveal avascular zone (FAZ) is known to enlarge in diabetic retinopathy. In a preliminary study, the authors applied a region growing algorithm to fluorescein angiograms to detect the FAZ in a semi-automated fashion. METHODS: The FAZ in 44 fluorescein angiograms of 44 eyes of 41 patients with diabetic retinopathy underwent manual outlining, then analysis with the region growing function of the ENVI image analysis software. The same algorithm was applied after median filtering of the images. RESULTS: Correlation coefficient was 0.98 between the first two authors, 0.89 between the first author and semi-automated detection before median filtering and 0.91 after median filtering. Average surface areas however, were smaller with semi-automated detection (1951 pixels before and 2226 pixels after median filtering) than with manual detection (3032 pixels). CONCLUSIONS: Semi-automated detection of the FAZ is possible, but refinements need to be made in angiogram quality and/or image pretreatment to improve results.

Screening for retinopathy of prematurity: results of a retrospective 3-year study of 502 infants.

PURPOSE: To describe the surveillance, results of screening, and treatment of retinopathy of prematurity (ROP) in a university hospital setting in southeast France. PATIENTS AND METHODS: Five hundred two premature infants were included in the screening protocol between January 1997 and December 1999. Criteria for inclusion in the study were a gestational age of 32 weeks or younger, a birth weight of less than 1,501 g, or both. The first fundus examination was performed between 4 and 6 weeks of life. Thereafter, fundus examination was performed in the absence of ROP every 2 weeks until complete retinal vasculature developed, gestational age of 50 weeks, or death. Examination was weekly in cases of retinopathy, biweekly if progression was ascertained, and less frequent only if regression was evident. Hospital records were reviewed to assess the presence or absence and eventual degree of ROP. RESULTS: Stage 1 was observed in 32 infants, and stage 2 in 11 infants; all of these cases regressed. Three cases of bilateral stage 3 (two threshold and one prethreshold) disease underwent diode laser peripheral retinal ablation and regressed. One infant with bilateral stage 3 disease who underwent peripheral cryoablative surgery progressed to stage 4A in one eye and 4B in the other eye and then underwent scleral buckling surgery in the second eye. CONCLUSIONS: Despite survival increasing with improved neonatal intensive care, the incidence of ROP does not appear to be increasing. In our center, the incidence appears to be lower than previously reported.

Toxoplasma gondii retinochoroiditis after cardiac transplantation.

PURPOSE: To report 4 cases of Toxoplasma gondii retinochoroiditis in patients having recently undergone cardiac transplantation. METHODS: Review of medical records for 4 patients presenting retinochoroiditis and evidence of T. gondii infection. RESULTS: Patient ranged in age from 25 to 53 years. Ocular symptoms began between 3 and 6 months after transplantation. All patients were under immunosuppressive therapy. Foci of retinochoroiditis were observed unilaterally in three patients and bilaterally in one. Intraocular inflammation was minimal in all cases. Serologic responses were highly suggestive of T. gondii as the etiology in all cases; other causes (CMV retinitis and syphilis) were actively sought and were not found. All patients underwent classic therapy. The three unilateral cases evolved favorably, but the bilateral case, seen late, showed extensive macular scarring. CONCLUSION: Infectious retinochoroiditis is a potentially blinding complication seen after cardiac transplantation, justifying close clinical and serological surveillance or, in certain cases such as mismatched donors, anti-parasitic prophylaxis.