Treatment of cystoid macular edema in homozygous twins with glutathione synthetase deficiency and retinal dystrophy.

Monozygotic twins with glutathione synthetase deficiency, progressive retinal dystrophy and cystoid macular edema were followed for foveal changes on optical coherence tomography under different treatment modalities. The purpose of the study is to show the effect of topical dorzolamide in conjunction with systemic acetazolamide in terms of decreasing macular edema in this specific disease. The results showed that systemic acetazolamide alone or in combination with topical dorzolamide decreased CME in both patients for a certain period of time. The result can be temporary sustained after treatment discontinuation. In conclusion, topical dorzolamide, in conjunction with systemic acetazolamide, could reduce cystoid macular edema in GSSD.

[Alphacor keratoprosthesis: device, surgical technique and clinical outcomes]. / La kératoprothèse Alphacor : dispositif, technique chirurgicale et résultats cliniques.

PURPOSE: Clinical evaluation of Alphacor keratoprosthesis in patients at high risk of corneal allograft rejection. DESIGN: Retrospective case series. PATIENTS AND METHODS: Alphacor implantation was performed via a two-step procedure with intrastromal insertion followed by secondary exposure of the optic after 6 months. Visual acuity and occurrence of postoperative complications were evaluated. RESULTS: Fourteen eyes of 14 patients underwent Alphacor keratoprosthesis implantation. Mean follow-up was 15.6 ± 5.6 months (from 2 to 24 months). Postoperative mean visual acuity gain was 2.5 ± 3.1 lines (from 0 to +11 lines). Visual acuity was superior or equal to 20/200 in 21% of cases. Seven cases of stromal melt (50%) occurred, of which one case (7.1%) experienced spontaneous extrusion of the implant, three cases (21.4%) required tectonic penetrating keratoplasty, and three patients underwent lamellar keratoplasty on top of the implant. Three cases (21.4%) of retroprosthetic membrane were observed and successfully managed. One patient (7.1%) developed late endophthalmitis. CONCLUSION: Alphacor is an alternative to corneal allograft in cases of corneal blindness at high risk of allograft failure. Throughout the preoperative evaluation, it is imperative to take into account the limitations of this keratoprosthesis in terms of indications, and additional studies are necessary in order to determine and refine the optimal surgical technique for implantation as well as the efficacy of postoperative treatments.

[Kyrieleis arteritis: report of two cases and literature review]. / Artérite de Kyrieleis : présentation de deux cas et revue de la littérature.

We report the cases of two patients presenting with unilateral Kyrieleis arteritis complicating severe posterior uveitis, one secondary to toxoplasmosis and the other in the context of Behçet's disease. The treatment response was favorable with complete visual recovery in both cases. Kyrieleis arteritis has been described since 1933, but its pathogenesis is still unknown. However, it appears to be more of a periarteritis than an actual arteritis. It is classically associated with posterior uveitis without a direct correlation with disease severity.

[Angioid streaks]. / Les stries angioïdes.

Angioid streaks represent breaks in Bruch's membrane, appearing as dark or reddish radial streaks eminating from the optic disc. Usually asymptomatic, these streaks may develop neovascularisation and lead to a maculopathy with marked loss of vision. Some associations with systemic disease are classically described, especially pseudoxanthoma elasticum. This condition may involve cardiovascular complications. A mutation has been found in the ABCC6 gene, which encodes for a membrane transport protein involved in the synthesis of the extracellular matrix. Imaging allows for visualization of the extent of the streaks, and autofluorescence is particularly informative. Spectral domain OCT may also demonstrate early breaks in Bruch's membrane. Neovascular complications, previously responsible for inevitable visual impairment at some point after their occurrence, are now managed by intravitreal injections of anti-VEGFs with clear efficacity. The ophthalmologist must be aware of this condition, in order to guide the patient towards a systemic work-up if necessary, and also to insure quick and targeted treatment in the case of neovascular complications.

[Which lenses to use for examination of the vitreous and how to use them properly]. / Quelles lentilles d'examen et comment les utiliser correctement ?

The vitreous is examined with the slit lamp, either alone for observation of the anterior third of the vitreous body or by placement of a lens between the slit lamp and the patient's eye for observation of the rest. Several types of lens are available, both convex and concave, with or without contact, allowing for observation of the different parts of the vitreous and retina. Rules concerning positioning of the slit lamp, the lens, and the patient must be followed to obtain the maximum amount of information.

[New therapeutic approach of keratoconus with intracorneal ring segments aided by femtosecond laser (Tecnolas Perfect Vision): indications, operating technique and results]. / Nouvelle approche thérapeutique du kératocône par segments d'anneaux intracornéens assistés par laser femtoseconde (Tecnolas Perfect Vision) : indications, technique opératoire et résultats.

OBJECTIVE: To assess the results of intracorneal ring segment implantation assisted by the Tecnolas Perfect Vision(®) femtosecond laser (Heidelberg, Germany). SETTINGS: Retrospective observational study. METHODS: The patients were operated on with the Tecnolas Perfect Vision(®) femtosecond laser. The following parameters were evaluated before and after surgery: uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal topography, wavefront analysis, and central corneal thickness. The Wilcoxon test was used for statistical analysis. RESULTS: Seventeen eyes of 15 patients were included. The mean follow-up was 6.9±0.71 months. Significant improvement of UCVA and BCVA was observed in 82.35% (P=0.027) and 94.12% (P=0.003) of the eyes, respectively. The subjective refraction showed a significant decrease of the sphere from -10.29±5.54 to -6.5±5.03D (P=0.002). The subjective cylinder significantly decreased from 5.43±3.20 to 3.69±2.30D (P=0.026). The SAI also decreased significantly (P=0.011). CONCLUSION: Femtosecond-assisted intracorneal ring segment implantation is an effective treatment for corneal ectasia. Further studies are needed to improve surgical parameters and outcomes.

[Optical coherence tomography in following up papilledema in idiopathic intracranial hypertension treated with lateral sinus stent placement]. / Évolution en tomographie par cohérence optique de l'œdème papillaire dans l'hypertension intracrânienne idiopathique traitée par mise en place de stent endosinusien du sinus latéral.

OBJECTIVE: To quantify the course of papilledema using the OCT 3 Stratus (Carl Zeiss Meditec, Dublin, CA, USA) after lateral sinus stent placement in patients with idiopathic intracranial hypertension (IIH). METHODS: Ten consecutive patients with a diagnosis of IIH underwent OCT examination before and after lateral sinus stenting, between March 2006 and April 2008, in Timone Hospital's Ophthalmology Department (Marseille, France). All patients had criteria for IIH (International Headache Society, 2004) and sinus abnormalities were diagnosed using three-dimensional rotational gadolinium-enhanced MR venography. In all cases, a direct retrograde cerebral venography with manometry was performed. We used the Cordis PRECISE® RX Nitinol Stent system (ref. 10136245-3, Johnson & Johnson), 30-40 mm in length and 8 mm in diameter, all placed by a single operator via a femoral venous puncture. For each eye, the mean retinal nerve fiber layer thickness was noted using the RNFL Thickness (3.4) strategy, before stenting, and three times after stent placement. The other parameters considered were age, sex, weight, height and body mass index. RESULTS: A significant decrease in retinal nerve fiber layer thickness was observed after stent placement. This parameter was considered normal 3 months after stent placement for eight of ten patients. CONCLUSION: Even though this pathology remains misunderstood, we observed a significant decrease in papilledema in IIH after lateral sinus stent placement, suggesting that high intracranial venous pressure could play a role in this pathology.

[New approach for determining the damage level of biological tissues using femtosecond laser: advantages and application to corneal surgery]. / Nouvelle approche de détermination du seuil d'endommagement de tissus biologiques par laser femtoseconde: intérêt et application à la chirurgie de la cornée.

INTRODUCTION: Optimization of femtosecond laser characteristics in corneal surgery is still needed to improve clinical results. In this study, we describe an original characterization technique able to measure laser damage of corneal tissues precisely and to provide complementary physical results on the laser-matter interaction. METHOD: A femtosecond laser was used to damage corneas not suitable for graft. The epithelium and the Bowman layer are exposed to a set of different single-shot fixed laser fluences. Optical microscopy can determine the probability of laser damage on the corneal surface. The high damage threshold (minimum fluence systematically damaging the cornea) roughly fixes the operating laser fluence conditions, while the low damage threshold sets the maximum laser fluence level preserving tissue integrity (safety level). RESULTS: We precisely evaluate the damage fluence threshold of a tissue, using a statistical approach coupled with optical microscopy analysis. This technique gives essential information on laser-tissue interaction with a high rate of confidence. For corneal epithelium and the Bowman layer, we determine the maximum laser fluence level preserving tissue integrity (safety level) and the minimum fluence level systematically damaging the tissue. High and low threshold fluences of epithelium and the Bowman layers are (5.6 ± 0.4 J/cm(2); 2.7 ± 0.1 J/cm(2)), and (7.1 ± 1.1 J/cm(2); 3.4 ± 0.1 J/cm(2)), respectively. CONCLUSION: These data constitute determinant parameters for clinical applications, since they determine a working window providing the minimal effective irradiation dose that is mandatory for the development of high-quality laser-cutting surgery processes with minimized side effects.

[Impact of eating habits on macular pathology assessed by macular pigment optical density measure]. / Impact des habitudes nutritionnelles sur la pathologie maculaire évalué par mesure de la densité optique du pigment maculaire.

INTRODUCTION: Low levels of lutein and zeaxanthin in blood or food are associated with an increased risk of age-related macular degeneration (AMD). These molecules, provided by food, form the macular pigment. PATIENTS AND METHODS: Patients included in this pilot study where categorized into four groups : (1) < 50 years with drusen, (2) > or = 50 years without drusen, (3) > or = 50 years with drusen, and (4) > or = 50 years with drusen and neovascularization. During consultation, macular pigment optical density was measured and information on pathology and eating habits were collected. RESULTS: Assessment of macular pigment optical density considering eating habits and groups showed that it was lower in group 1 patients when they ate less than five portions of fruits and vegetables per day and less than two portions of cabbage, broccoli, pepper, corn, or spinach a week. In groups 3 and 4, food supplement intake was related to an increase in optical density. Food supplements were consumed by 58.5 % of patients in group 4. CONCLUSION: Analysis of mean optical density measured by the MPS 9000 QuantifEYE considering eating habits confirmed the impact of food supplement intake on optical density, especially in patients > or = 50 years with drusen and with or without neovascularization.

[Spectral-domain optical coherence tomography in anterior segment imaging: the 3rd dimension]. / Tomographie par cohérence optique en domaine spectral du segment antérieur: la 3e dimension.

PURPOSE: Anterior segment imaging using optical coherence tomography (OCT) time domain technology has been used for many years. When it appeared, it was a promising technique in the analysis of the anterior segment, making it possible to reach a definition of the ocular structures comparable with histology. Now with new-generation OCT, it is possible to perform high-definition and three-dimensional imaging. MATERIAL AND METHOD: A 3D OCT-1000 (Topcon, Tokyo, Japan) parameterized to obtain high-definition and 3D imaging of the iridocorneal structures. RESULTS: We present a collection of images obtained using this technique. DISCUSSION: Based on a very sophisticated tool for retinal and glaucoma imagery, it is now possible to obtain very-high-quality imaging of the anterior segment, which, with its great versatility, increases the value of acquiring this type of device. CONCLUSIONS: The potential of 3D OCT-1000, already a very good exam for the posterior segment, and the only one to perform anterior segment three-dimensional imaging in a single acquisition, should not be neglected.

[Subretinal hemorrhage after intravitreal injection of anti-VEGF for age-related macular degeneration: a retrospective study]. / Hématomes maculaires après injections intravitréennes d'anti-VEGF pour dégénérescence maculaire liée à l'âge : série rétrospective.

INTRODUCTION: Prescription of anti-VEGF treatments have increased substantially over the past few years in treatment of wet age-related macular degeneration. We report the occurrence of macular hemorrhages after one year of use of anti-VEGF intravitreal injections, mainly for subfoveal choroidal neovascularization. MATERIAL AND METHODS: Four hundred forty five injections were given over one year (from 15 March 2007 to 15 March 2008), for age-related macular degeneration, retinal vascular occlusion, diabetic retinopathy, neovascular glaucoma, and idiopathic macular choroidal neovascularization; distributed as follows: 11.5% Bevacizumab, 18.6% Pegaptanib, 19.3% Triamcinolone, and 50.6% Ranibizumab. RESULTS: Six macular hemorrhages were observed, resulting in to a sharp decrease in visual acuity (20/400), with loss of five lines. All occurred after one injection of nonselective anti-VEGF (Ranibizumab) on already treated eyes (four previous injections on average, +/- photodynamic therapy). All were secondary to occult choroidal neovascularization or a large pigment epithelial detachment. Three patients presented a pigment epithelial tear. DISCUSSION: Anti-VEGF intravitreal injections can lead to pigment epithelial tears in case of large pigment epithelial detachment, especially with a small feeder vessel or with large occult choroidal neovascularization. The authors discuss the possible implications of anti-VEGF when macular hematoma occurs: retraction of choroidal neovascularization and alteration of physiological retinal vascularization. CONCLUSION: Macular hematoma affects visual prognosis in age-related macular degeneration. It may follow intravitreal anti-VEGF injection with large occult neovascularization, especially in previously treated eyes. Injection in large pigment epithelial detachment may cause a risk of epithelial tear. Other studies are necessary to evaluate the role of the nonselective anti-VEGF in the incidence of macular hematoma.

[Arcuate keratotomy for postkeratoplasty astigmatism by femtosecond laser]. / Incisions arciformes au laser femtoseconde pour correction de l'astigmatisme après kératoplastie transfixiante.

OBJECTIVE: Evaluation of the effectiveness of arcuate keratotomy performed with femtosecond laser for correction of postkeratoplasty astigmatism. METHODS: This retrospective clinical study included 11 eyes. All cases underwent arcuate keratotomy using femtosecond laser. Outcome measures included visual acuity and endothelial cell density as well as refractive, keratometric, and topographic astigmatism. The incision depth was also evaluated by OCT-3. RESULTS: With a mean follow-up of 7.4+/-6.7 months, uncorrected visual acuity was not modified and the mean best corrected visual acuity significantly improved from 1.68+/-1.59 lines (p=0.007). The mean preoperative refractive cylinder was 5.18+/-1.15D, decreasing to 3.41+/-1.93D (p=0.045) after laser-arcuate keratotomy. The reduction of preoperative keratometric (7.79+/-3.69D) and topographic (7.98+/-2.41D) astigmatism was higher, with a decrease to 4.81+/-2.52D (p=0.021) and 4.36+/-2.59D (p=0.005) postoperatively. Endothelial cell density was not modified after surgery. The difference between achieved and planned incision depth was -10.7+/-63.5mum. All cases were uncomplicated. DISCUSSION: Arcuate keratotomies performed with the femtosecond laser were effective in reducing postkeratoplasty astigmatism and has a number of advantages over conventional techniques. However, efficacy could be improved by a more accurate nomogram. CONCLUSION: Arcuate keratotomy performed with femtosecond laser is a relatively easy, safe, and effective means of treating postkeratoplasty astigmatism. Given our small sample, much larger series are needed to provide more confident estimates of astigmatism reduction proportions and to adjust correction parameters.

[A 3T fMRI study of cortical projection of visual scotomas: preliminary results]. / Etude en IRM fonctionnelle 3T de la projection corticale de scotomes rétiniens: résultats préliminaires.

AIM: We used functional magnetic resonance imaging (fMRI) to precisely measure both the localization and size of the cortical projections of artificial scotomas in healthy subjects as well as the size of a reversible retinal scotoma in a patient with central serous chorioretinopathy (CSCR). METHODS: Using a 3T MRI scanner, anatomical and functional data were acquired on two healthy subjects and a patient with CSCR. Retinotopic maps were first reconstructed using phase mapping techniques. Next, a block paradigm consisting of a grey background alternating with a full-field, flickering checkerboard was used to stimulate the complete central (19.5 degrees) visual field. A condition with artificial peri-foveal scotomas of different sizes and eccentricities was interleaved in healthy subjects. Differential maps were computed to obtain the cortical representation (size and location) of artificial scotomas. Full-field functional data were also acquired in the CSRC patient, at the acute stage and after recovery. RESULTS: Cortical projections of each scotoma were identified using differential maps and carefully characterized with quantitative analysis: the measured cortical positions of the inactivated cortical zones were compared with the known radius and eccentricity values in the scotomas in the visual field. We also compared the size of the inactivated cortical zones to the known size of scotomas. However, we found a consistent relationship between the size of the scotomas and their cortical projections, albeit with the absolute size smaller than expected from known cortical magnification factors. The cortical deactivation zone was also observed in the CRSC patient, which disappeared at recovery stage. CONCLUSIONS: Cortical retinotopic mapping can be performed successfully for both artificial and retinal scotomas. This study can serve as a basis for the future investigation of cortical plasticity in the visual cortex.

[Anterior segment analysis using OCT3]. / Méthodologie d'analyse du segment antérieur par OCT-3.

PURPOSE: Optical coherence tomography has been used for many years, in particular in the field of the retinal imaging, and is a promising technique in the analysis of the anterior segment, providing a similar resolution to histology for ocular tissue. MATERIAL AND METHODS: We present a collection of images obtained with the OCT3 (Carl Zeiss Meditec, Dublin, CA), with parameters set to obtain good-quality images of the iris and corneal structures. RESULTS: The OCT provides detailed analysis of the cornea, precise assessment of the dimensions and locations of corneal lesions - in the anterior-posterior plane as well as transversally or obliquely - with 10-microm precision, and the study of the iridocorneal angle and its dynamics. DISCUSSION: Using the highly precise OCT3 for retinal imaging, it is possible to obtain good-quality anterior segment imaging, which makes the device highly versatile and thus increases reasons for acquiring this type of apparatus. CONCLUSIONS: OCT3 users should not neglect this potential of the device, already in wide use for examining the retina.