Evaluation of pterygium severity with en face anterior segment optical coherence tomography and correlations with in vivo confocal microscopy.

PURPOSE: To describe en face anterior segment optical coherence tomography (EF-OCT) characteristics of pterygia and their correlation with in vivo confocal microscopy (IVCM). PATIENTS AND METHODS: In this observational case series, we prospectively included 21 eyes of 17 subjects with pterygium. All subjects underwent detailed ophthalmic examination, anterior segment photography, an ocular surface disease index (OSDI) questionnaire, IVCM, and EF-OCT. Eyes were divided into two groups according to pterygium severity (Modified Pterygium Classification System) and OSDI score. EF-OCT images for both groups were analyzed for surface area of Fuchs Patches (FP). The IVCM activity score was based on the number of inflammatory cells, blood vessels, activated keratocytes and the appearance of the cornea/pterygium at the head of the pterygium. The correlations between EF-OCT and IVCM images were then analyzed and compared in both groups. RESULTS: EF-OCT permits clear visualization and evaluation of FPs and the border between the pterygium and the adjacent cornea. The severe pterygium group was characterized by irregular borders and larger FPs (0.13±0.06 mm2 versus 0.06±0.02 mm2 respectively) (P=0.003). The mean IVCM activity score was 2.36±0.81 in the severe pterygium group and 1.2±0.42 in the mild pterygium group (P=0.0013). There was a positive correlation between FP surface area and IVCM activity score. A larger FP surface area was associated with a higher activity score on IVCM. CONCLUSION: EF-OCT allows good evaluation of pterygium extension, borders and FP surface area. EF-OCT analysis of pterygium could represent a simple, non-invasive and reproducible method to evaluate pterygium severity and activity.

[Contribution of respiratory relaxation techniques during intravitreal injections: A pilot study]. / Apport des techniques de relaxation respiratoire au cours des injections intravitréennes : étude pilote.

PURPOSE: To study the effects of breathing techniques for anxiety, perceived pain, and patient satisfaction while receiving intravitreal injections. METHOD: This prospective, randomized clinical study included patients admitted for intravitreal anti-VEGF injections. They were randomized into two groups: a relaxation group who listened to a prerecorded relaxation breathing session before and during the injection, and a control group who received the injection without a relaxation session. Statistical analysis was then performed to assess the factors influencing satisfaction, anxiety, and perceived pain. RESULTS: We included one-hundred four patients in total: 52 in the relaxation group versus 52 in the control group. The relaxation group had a greater decrease in anxiety than the control group (P=0.03) but similar levels of pain (P=0.86). In total, 80.76% of patients in the relaxation group expressed the wish to have a relaxation session during their next injection. Multivariate analysis showed that the patient's usual level of stress as well as the relaxation session affected the level of anxiety experienced before the injection. CONCLUSION: Relaxation techniques before and during intravitreal injections decrease anxiety in patients without decreasing pain during IVT. Prerecorded relaxation breathing sessions are non-invasive, inexpensive, easy to set up, and reduce anxiety during intravitreal injections on an outpatient basis.

[What will cataract surgery look like in the future? Alternatives in the pipeline]. / Que sera la chirurgie de la cataracte du futur ? Alternatives et voies de développement.

Phacoemulsification is the most frequently performed surgery in the world. Over the past few years, this surgery seems to have reached a plateau with no further innovative breakthroughs. In this paper, we focus on alternatives techniques, the latest innovations, and the research and development pipeline in this field.

[Imaging of corneal dystrophies: Correlations between en face anterior segment OCT and in vivo confocal microscopy]. / Imagerie des dystrophies cornéennes : corrélations entre l'OCT en face de segment antérieur et la microscopie confocale in vivo.

PURPOSE: To evaluate the usefulness of en face Optical Coherence Tomography (OCT) for evaluation of corneal dystrophies and to describe correlations with in vivo confocal microscopy (IVCM). PATIENTS AND METHODS: Thirty-two eyes of 16 patients with 4 types of corneal dystrophies (epithelial basement membrane dystrophy, Fuchs dystrophy, Reis-Bücklers corneal dystrophy and Crocodile Shagreen dystrophy) were enrolled in this study. Axial and reconstructed en face scans were acquired using OCT. Images were then correlated to IVCM findings. RESULTS: En face OCT provided new insights into the structure, size and depth of corneal tissue alterations in various corneal dystrophies. OCT en face images were well correlated with IVCM features. Despite lower resolution than IVCM, en face OCT offers the advantages of being non-invasive and allowing the analysis of larger corneal areas. CONCLUSION: En face OCT provides useful new information in corneal dystrophies. This imaging technique will probably increase in popularity in the near future for the assessment of various anterior segment diseases.

["En face" anterior segment optical coherence tomography findings in acute corneal hydrops]. / Apport de l'OCT de segment antérieur « en face ¼ dans le kératocône aigu.

PURPOSE: To study the corneal morphological characteristics of acute hydrops by analyzing anterior segment optical coherence tomography (AS-OCT) "en face" images. PATIENTS AND METHODS: Four patients presenting with acute hydrops were examined at different stages, respectively after 1 day, 1 week, 3 weeks and 6 months. All patients had a complete ophthalmic evaluation including "en face" AS-OCT examination. In vivo confocal microscopy (IVCM) and histological analysis of the cornea obtained after penetrating keratoplasty were also performed in one patient. RESULTS: The "en face" AS-OCT showed that the early edema in acute hydrops corresponded to multiple epithelial microcysts associated with large intra-stromal lacunae. We also observed that, in association with the disappearance of the microcysts and lacunae, "en face" OCT demonstrated subepithelial scars in the form of weakly reflective, fine, interlaced linear opacities. These opacities subsequently increased in thickness resulting in a dense subepithelial network. These findings were consistent with the results of histological and IVCM studies. CONCLUSION: "En face" AS-OCT allows for precise study of the tissue changes occurring in acute corneal hydrops. Besides a better understanding of this rare complication of keratoconus, this new imaging technique may help clinicians to identify the corneal structural changes, which place keratoconus patients at risk of corneal hydrops.

[Smartphones in ophthalmology]. / Les smartphones en ophtalmologie.

INTRODUCTION: The increased utilization of medical applications for smartphones provides new opportunities for doctors, including ophthalmologists. In this study, we examined the availability of ophthalmological applications in the two largest smartphone app stores (Apple App store and Android Play Store) and then proposed a classification for smartphone ophthalmological applications according to their functionalities. MATERIALS AND METHODS: In November 2012, we searched the Apple App Store and the Android Play Store for ophthalmological themed applications, using numerous ophthalmological keywords. We excluded applications that were not ophthalmology-related. RESULTS: We identified 342 ophthalmological applications. There were two main categories in ophthalmological applications: those for ophthalmologists, and those for patients. DISCUSSION AND CONCLUSIONS: There are numerous benefits of smartphone use for ophthalmologists as well as their patients. Ophthalmological applications are turning cell phones into medical devices. In addition, smartphones may play a very important role in patient education, self-monitoring, and low-vision aids via magnifying systems.

[Sclerotomies analysis using Spectral Domain OCT in sutureless vitrectomies complicated by endophthalmitis]. / Analyse des sclérotomies par OCT Spectral-Domain au cours des vitrectomies sans suture compliquées d'endophtalmie.

INTRODUCTION: Transconjunctival sutureless vitrectomy is a recent advance in vitreoretinal surgery. Some authors have reported an increased risk of postoperative hypotony and endophthalmitis and recommend the creation of oblique incisions, intended to be self-sealing, so as to reduce these risks. However, there is still a debate about the best architecture for transconjunctival sutureless incisions. MATERIALS AND METHODS: We report two cases of acute endophthalmitis occurring after 23 and 25 gauge transconjunctival sutureless vitrectomy. We analyzed the scleral incisions using the anterior segment module of the Spectralis(®) OCT. To our knowledge, this is the first direct description of the appearance of sclerotomies associated with endophthalmitis. RESULTS: The anterior segment module of Spectralis(®) OCT permitted a high-resolution evaluation of the architecture of the scleral incisions. We found straight, gaping incisions with misaligned edges and vitreous incarceration. DISCUSSION: By way of these two case reports and a review of the literature, we discuss the contribution of anterior segment OCT in the analysis of scleral incision architecture in sutureless vitrectomy. Our findings are consistent with those reported in the literature. The presence of a direct incision, wound gap or edge misalignment are associated with an increased risk of early leakage and postoperative hypotony. CONCLUSIONS: The anterior segment module of the Spectralis(®) OCT is a valuable tool for non-invasive, painless and high-resolution documentation of sutureless vitrectomy incisions. It allows for causal analysis and better understanding of the conditions associated with endophthalmitis after sutureless vitrectomy.

[Visante® OCT findings of Descemet membrane detachment after refractive lensectomy: A case report]. / Aspects en OCT Visante® de décollement descémétique après lensectomie réfractive : à propos d'un cas.

Descemet membrane detachment (DMD) is a rare complication that occurs mainly after cataract surgery. We report the case of a 55-years-old woman who underwent refractive lensectomy. The Day-1 postoperative examination was unremarkable, the Day-7 examination showed corneal oedema related to DMD, which was confirmed by Visante(®) OCT. An intracameral injection of SF6 expansive gas allowed the reapplication of the membrane and the receding of corneal oedema. Through this observation, we discuss the pathogenesis of this uncommon entity and the contribution of Visante(®) OCT.

[SPA-2: semiology for phenotyping AMD: atrophic AMD]. / SPA-2 : sémiologie du phénotype de la dégénérescence maculaire liée à l'âge : forme atrophique.

PURPOSE: The determination of homogeneous subgroups of age-related macular degeneration (AMD) is necessary for clinical and genetic studies; therefore, the development of a simple, reproducible, and discriminating classification is essential. In this second part of our study (SPA-2), we evaluated a selected list of items for atrophic AMD based on color photographs of fundus, red-free frames, autofluorescence, fluorescein angiography, indocyanine angiography, and Spectral-Domain OCT. METHODS: Ten items for atrophy were chosen from the literature and clinical experience. Twenty eyes of 20 patients with atrophic AMD were included. For each patient, the grid was completed by five independent, experienced readers from our reading center and by an expert. The Kappa coefficient was calculated for each item. RESULTS: The greatest agreement between observers was found for the item "presence of atrophy" (Kappa=1). The worst concordance was recorded for the item "size of atrophy" (Kappa=-0.0286±0.0769 to 0.1813±0.0835). CONCLUSION: The classification of atrophic AMD is complex and currently not very consensual, hence the need for a discriminant and reproducible classification grid. The evaluation of our grid for atrophic AMD shows satisfactory agreement between observers for the majority of the items. Some modifications are proposed to make it more discriminant and reproducible.

[Acute bilateral angle-closure glaucoma induced by topiramate: contribution of Visante OCT]. / Crise bilatérale de glaucome aigu après traitement par topiramate : apport de l'OCT Visante.

INTRODUCTION: Topiramate, a sulfamate-substituted monosaccharide classically used as an antiepileptic medication, has been widely used since its recent indication for migraine prophylaxis. We report the case of a 68-year-old woman who developed bilateral acute glaucoma following topiramate migraine prophylaxis. OBSERVATION: A 68-year-old woman presented in the emergency department for ocular pain, redness, and bilateral reduced visual acuity associated with nausea and vomiting. Initial examination found a bilateral corneal edema with shallow anterior chambers and closed iridocorneal angles. Intraocular pressure was 40mmHg in the right eye and 45mmHg in the left eye. Ultrasound biomicroscopy diagnosed ciliochoroidal detachment and swollen ciliary processes with closed angles, which was also objectified using the Visante OCT. Topiramate treatment was interrupted and a local and general hypotonic treatment was started. After 4 days, examination showed deeper anterior chambers and normal intraocular pressures. Visante OCT and ocular echography follow-up examinations were normal, and Indoramin was prescribed for migraine prophylaxis with no relapse after 10 months. CONCLUSION: Bilateral acute angle-closure glaucoma is a possible complication of topiramate. Physicians and patients starting this therapy should be aware of this underestimated risk.