RECURRENCES OF RETINAL DETACHMENT AFTER RETINECTOMY: Causes and Outcomes.

PURPOSE: To evaluate the different mechanisms of retinal detachment recurrence after retinectomy for rhegmatogenous retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR) and to study its outcome and prognosis. METHODS: Retrospective, multicenter study conducted between January 2009 and November 2016. Retrospective review of 56 patients with recurrent RD (RRD) after a first relaxing retinectomy. RESULTS: The secondary retinal attachment rate was 58.9% (33/56 cases). The various mechanisms of RRD were mainly related to PVR (52/56 cases: 93%). This PVR was anterior in 10 cases (21%), posterior in 31 cases (60%), and combined anterior and posterior in 11 cases (21%). The RRD mechanism was not PVR in 4 of the 56 cases. Some of the RRD mechanisms were specific to retinectomy: fibrosis of the edge of the retinectomy (26 cases: 46.4%), beyond-the-edge proliferation (8 cases: 14.3%), and severe inferior retinal folding (2 cases: 3.6%). In the 2 cases of severe inferior retinal folding, the retina could not be reattached. The anatomical outcome and the mechanism of RRD (anterior PVR, posterior PVR, or combined anterior and posterior PVR) were not correlated (P = 0.12). Visual acuity was significantly better only in patients with complete secondary success, that is, having an attached retina after silicone oil removal: mean preoperative visual acuity was 2.01 logarithm of the minimum angle of resolution versus 1.01 logarithm of the minimum angle of resolution postoperatively (P = 0.019). CONCLUSION: Proliferative vitreoretinopathy caused most of the recurrences, and the anatomical outcome did not depend on the type of PVR involved. Only complete secondary success (attached retina after silicone oil removal) was accompanied by visual acuity improvement.

Multimodal imaging of torpedo maculopathy including adaptive optics.

PURPOSE: The etiology of torpedo maculopathy remains unknown, but it has been recently suggested that it could represent a persistent defect in the development of the retinal pigment epithelium. As retinal pigment epithelium and photoreceptors form a functional unit, an alteration of photoreceptor distribution or function is predictable. The aim of this study is to describe multimodal imaging, including adaptive optics, in three cases of torpedo maculopathy, and discuss its pathogenesis. METHODS: Multimodal imaging is presented, including fundus photographs, optical coherence tomography, adaptive optics, autofluorescence, fluorescein angiography, and ultra-widefield retinal imaging in three cases of torpedo maculopathy. RESULTS: An oval-shaped well-delimited chorioretinal lesion both hypopigmented centrally and with a hyperpigmented border in the temporal macula, consistent with torpedo maculopathy, was observed in three patients. Optical coherence tomography showed a preservation of the inner retina, a mild atrophy of the outer retina, an alteration of the ellipsoid zone and of the retinal pigment epithelium layer, and a neurosensory detachment. These lesions were hypoautofluorescent with a hyperautofluorescent border. Fluorescein angiography showed a hyperfluorescence by window effect. Adaptive optics imaging showed an alteration of the cone mosaic within the lesions, with a lower cone density and a higher spacing between cones. CONCLUSION: The alteration of the cone mosaic suggested by adaptive optics in torpedo maculopathy has never been described and could be explained by the alteration of the retinal pigment epithelium. Our results support the existing hypothesis on the pathogenesis of torpedo maculopathy that a persistent defect in the development of the retinal pigment epithelium may be responsible for this clinical entity.

Bag-in-the-lens implantation helps avoid posterior synechiae of the iris after phacovitrectomy.

PURPOSE: To compare the rate of posterior synechiae of the iris (PSI) occurrence after phacovitrectomy between a group with lens-in-the-bag (LIB) implantation, that is, implantation in the capsular bag, and a group with bag-in-the-lens (BIL) implantation. SETTING: CHU de Caen, Department of Ophthalmology, Caen, France. DESIGN: Comparative retrospective study. METHODS: One hundred consecutive cases of phacovitrectomies conducted between May 2013 and July 2016 were included. A retrospective analysis of the occurrence rate of PSI in the LIB group and in the BIL group was performed, using multivariate analysis including multiple risk factors such as preoperative synechiae, proliferative diabetic retinopathy, use of 20-gauge vitrectomy, use of gas or silicone tamponade, and use of endophotocoagulation. RESULTS: One hundred eyes of 92 patients were included in this study (55 eyes in the LIB group and 45 in the BIL group). The occurrence of PSI was significantly lower in the BIL group with 1 case (2%) versus 22 cases (40%) in the LIB group (P < .001). Among the risk factors studied, preoperative synechiae and the use of retinal endophotocoagulation were almost significantly associated with the occurrence of PSI (P = .068 and P = .087, respectively). In the LIB group, these PSI led to 1 case of acute elevation of intraocular pressure by pupillary seclusion and the use of laser iridotomy in 8 cases. CONCLUSION: The use of BIL rather than LIB implantation in phacovitrectomy practically eliminates PSI.

A 5-Minute Interval between Two Dilating Eye Drops Increases Their Effect.

PURPOSE: Patients are usually advised to wait 5 minutes between eye drops. This delay supposedly allows the first drop not to be washed out by the second one, thereby increasing the combined effect. However, in the only experimental study conducted in humans on the concurrent administration of two different eye drops, the authors concluded that a 10-minute time interval between eye drops did not increase their combined effect. Our study was designed to address this puzzling observation. METHODS: Using digital photographs shot in photopic conditions in 40 eyes of 20 healthy volunteers, we compared relative pupil surface (i.e., pupil to iris surface area ratios) before and after the administration of one drop of 10% phenylephrine and one drop of 0.5% tropicamide either immediately or after a 5-minute time interval. RESULTS: Waiting 5 minutes yielded a 5.6% relative pupil surface gain (observer 1: P = .003, observer 2: P = .005) indicating an additional combined effect with a 5-minute time interval. CONCLUSIONS: These results show a detectable additive effect that is probably the result of methodological refinements including the challenging of the mydriasis by photopic conditions and the use of pupil and iris surface areas, which may show differences that would be undetectable in terms of diameter.

Combination of 5% phenylephrine and 0.5% tropicamide eyedrops for pupil dilation in neonates is twice as effective as 0.5% tropicamide eyedrops alone.

PURPOSE: Comparison of the efficacy of tropicamide eyedrops to the combination of 0.5% tropicamide and 5% phenylephrine eyedrops in order to achieve a proper dilation in premature infants undergoing screening for retinopathy of prematurity. METHODS: A prospective, randomized, double-blind study was conducted to compare the efficacy of two mydriatic regimens: one regimen consisting of three drops of 0.5% tropicamide (TTT regimen), the other regimen consisting of one drop of 5% phenylephrine and two drops of 0.5% tropicamide (PTT regimen). Thirty premature infants were enrolled and received both mydriatic regimens: one regimen in each eye. Outcomes were pupil dilation evaluated by the percentage of pupil diameter over cornea diameter, the percentage of pupil surface over cornea surface and the quality of the eye fundus examination. RESULTS: The percentage of pupil diameter over cornea diameter was 47.3% (±8.7) with the TTT regimen and 65.9% (±8.8) with the PTT regimen (p < 0.0001). The percentage of pupil surface over cornea surface was 23.1% (±8.3) with the TTT regimen and 43.8% (±7.3) with the PTT regimen (p < 0.0001). Thus, the pupil surface area was 1.9 times greater with the PTT than with the TTT regimen. Visualization of the retinal periphery was possible for 30 of 30 eyes dilated with the PTT regimen and for 16 of 30 eyes dilated with the TTT regimen (p < 0.0001). CONCLUSION: The dilated pupil surface area for the combination of 5% phenylephrine and 0.5% tropicamide was almost twice that for 0.5% tropicamide eyedrops alone and provided significantly superior quality of the eye fundus examination.

Preclinical assessment of scleral lens as a reservoir-based ocular therapeutic system.

PURPOSE: Bacterial keratitis is a sight threatening infection of the cornea which remains one of the most important potential complications of contact lens use. If the corneal ulcer is small, peripheral with no impending perforation present, intensive monotherapy with fluoroquinolones could be used. Therefore, a study was conducted with the objective to provide pharmacological data of the intra-ocular diffusion after administration of Ofloxacin using a scleral lens reservoir, as well as an evaluation of surface tolerability in rabbits. MATERIALS AND METHODS: Samples of corneas, aqueous humor and vitreous were collected to measure the drug levels of Ofloxacin using High Performance Liquid Chromatography. The corneas were examined by electron microscopy scanning and the eyeballs by light polarizing microscopy in order to evaluate surface tolerability. RESULTS: Ofloxacin levels found in the aqueous humor and cornea were higher than those previously reported. The mean Ofloxacin corneal levels exceeded the MIC (Minimum Inhibitory Concentration) for which 90% of isolates are indicated for all bacteria implicated in keratitis. CONCLUSION: To our knowledge, this is the first preclinical study assessing local tolerance and intra-ocular diffusion of Ofloxacin after administration using a scleral lens reservoir.

The Sclerotic Scatter Limbal Arc Is More Easily Elicited under Mesopic Rather Than Photopic Conditions.

INTRODUCTION: We aimed to determine the limbal lighting illuminance thresholds (LLITs) required to trigger perception of sclerotic scatter at the opposite non-illuminated limbus (i.e. perception of a light limbal scleral arc) under different levels of ambient lighting illuminance (ALI). MATERIAL AND METHODS: Twenty healthy volunteers were enrolled. The iris shade (light or dark) was graded by retrieving the median value of the pixels of a pre-determined zone of a gray-level iris photograph. Mean keratometry and central corneal pachymetry were recorded. Each subject was asked to lie down, and the ALI at eye level was set to mesopic values (10, 20, 40 lux), then photopic values (60, 80, 100, 150, 200 lux). For each ALI level, a light beam of gradually increasing illuminance was applied to the right temporal limbus until the LLIT was reached, i.e. the level required to produce the faint light arc that is characteristic of sclerotic scatter at the nasal limbus. RESULTS: After log-log transformation, a linear relationship between the logarithm of ALI and the logarithm of the LLIT was found (p<0.001), a 10% increase in ALI being associated with an average increase in the LLIT of 28.9%. Higher keratometry values were associated with higher LLIT values (p = 0.008) under low ALI levels, but the coefficient of the interaction was very small, representing a very limited effect. Iris shade and central corneal thickness values were not significantly associated with the LLIT. We also developed a censored linear model for ALI values ≤ 40 lux, showing a linear relationship between ALI and the LLIT, in which the LLIT value was 34.4 times greater than the ALI value. CONCLUSION: Sclerotic scatter is more easily elicited under mesopic conditions than under photopic conditions and requires the LLIT value to be much higher than the ALI value, i.e. it requires extreme contrast.

Trends and topics in eye disease research in PubMed from 2010 to 2014.

BACKGROUND: The purpose of this study is to provide a report on scientific production during the period 2010-2014 in order to identify the major topics as well as the predominant actors (journals, countries, continents) involved in the field of eye disease. METHODS: A PubMed search was carried out to extract articles related to eye diseases during the period 2010-2014. Data were downloaded and processed through developed PHP scripts for further analysis. RESULTS: A total of 62,123 articles were retrieved. A total of 3,368 different journals were found, and 19 journals were identified as "core journals" according to Braford's law. English was by far the predominant language. A total of 853,182 MeSH terms were found, representing an average of 13.73 (SD = 4.98) MeSH terms per article. Among these 853,182 MeSH terms, 14,689 different MeSH terms were identified. Vision Disorders, Glaucoma, Diabetic Retinopathy, Macular Degeneration, and Cataract were the most frequent five MeSH terms related to eye diseases. The analysis of the total number of publications showed that Europe and Asia were the most productive continents, and the USA and China the most productive countries. Interestingly, using the mean Five-Year Impact Factor, the two most productive continents were North America and Oceania. After adjustment for population, the overall ranking positions changed in favor of smaller countries (i.e. Iceland, Switzerland, Denmark, and New Zealand), while after adjustment for Gross Domestic Product (GDP), the overall ranking positions changed in favor of some developing countries (Malawi, Guatemala, Singapore). CONCLUSIONS: Due to the large number of articles included and the numerous parameters analyzed, this study provides a wide view of scientific productivity related to eye diseases during the period 2010-2014 and allows us to better understand this field.

Human rather than ape-like orbital morphology allows much greater lateral visual field expansion with eye abduction.

While convergent, the human orbit differs from that of non-human apes in that its lateral orbital margin is significantly more rearward. This rearward position does not obstruct the additional visual field gained through eye motion. This additional visual field is therefore considered to be wider in humans than in non-human apes. A mathematical model was designed to quantify this difference. The mathematical model is based on published computed tomography data in the human neuro-ocular plane (NOP) and on additional anatomical data from 100 human skulls and 120 non-human ape skulls (30 gibbons; 30 chimpanzees / bonobos; 30 orangutans; 30 gorillas). It is used to calculate temporal visual field eccentricity values in the NOP first in the primary position of gaze then for any eyeball rotation value in abduction up to 45° and any lateral orbital margin position between 85° and 115° relative to the sagittal plane. By varying the lateral orbital margin position, the human orbit can be made "non-human ape-like". In the Pan-like orbit, the orbital margin position (98.7°) was closest to the human orbit (107.1°). This modest 8.4° difference resulted in a large 21.1° difference in maximum lateral visual field eccentricity with eyeball abduction (Pan-like: 115°; human: 136.1°).

Unique human orbital morphology compared with that of apes.

Humans' and apes' convergent (front-facing) orbits allow a large overlap of monocular visual fields but are considered to limit the lateral visual field extent. However, humans can greatly expand their lateral visual fields using eye motion. This study aimed to assess whether the human orbital morphology was unique compared with that of apes in avoiding lateral visual field obstruction. The orbits of 100 human skulls and 120 ape skulls (30 gibbons; 30 orangutans; 30 gorillas; 30 chimpanzees and bonobos) were analyzed. The orbital width/height ratio was calculated. Two orbital angles representing orbital convergence and rearward position of the orbital margin respectively were recorded using a protractor and laser levels. Humans have the largest orbital width/height ratio (1.19; p < 0.001). Humans and gibbons have orbits which are significantly less convergent than those of chimpanzees/bonobos, gorillas and orangutans (p < 0.001). These elements suggest a morphology favoring lateral vision in humans. More specifically, the human orbit has a uniquely rearward temporal orbital margin (107.1°; p < 0.001), suitable for avoiding visual obstruction and promoting lateral visual field expansion through eye motion. Such an orbital morphology may have evolved mainly as an adaptation to open-country habitat and bipedal locomotion.

Eye motion increases temporal visual field extent.

PURPOSE: To study the impact of eye motion on visual field extent. METHODS: Visual fields were tested in 15 healthy volunteers with the Goldmann perimeter using a V4 test object, from seen to unseen, first in primary position of gaze, then allowing eye motion. Temporal points falling out of the cupola were tested again after a controlled nasal head rotation using a headband prototype fitted with a line-laser level having two orthogonal vial levels. Visual field surface areas (cm(2) ) were calculated as projections on a 30-cm virtual Goldmann cupola, whose extent would have been large enough to include all points. Reproducibility error of the method assessed by calculation of the relative difference between surface areas of 12 visual field tests and 12 visual field retests was estimated at 14%. Hertel exophthalmometry was recorded to study the influence of globe position on visual field extent. RESULTS: Binocular visual field surface area increased by 37% with eye motion (p-value=1.20·10(-9) ). This increase was highest (46%; p-value=1.2·10(-24) ) in the temporal quadrant. Median maximal visual field temporal eccentricity with eye motion was 128.3° (minimum: 109.5°; maximum: 137.7°) and more than 135° in four eyes of three subjects. Hertel exophthalmometry was positively linked to visual field temporal surface area with eye motion (p-value=0.013). CONCLUSIONS: Eye motion greatly expands the temporal visual field. This peculiarity is likely an adaptation to terrestrial life with upright bipedal locomotion and may save head movements through horizontal eyeball scanning.

Sunglasses with thick temples and frame constrict temporal visual field.

PURPOSE: Our aim was to compare the impact of two types of sunglasses on visual field and glare: one ("thick sunglasses") with a thick plastic frame and wide temples and one ("thin sunglasses") with a thin metal frame and thin temples. METHODS: Using the Goldmann perimeter, visual field surface areas (cm²) were calculated as projections on a 30-cm virtual cupola. A V4 test object was used, from seen to unseen, in 15 healthy volunteers in the primary position of gaze ("base visual field"), then allowing eye motion ("eye motion visual field") without glasses, then with "thin sunglasses," followed by "thick sunglasses." Visual field surface area differences greater than the 14% reproducibility error of the method and having a p < 0.05 were considered significant. A glare test was done using a surgical lighting system pointed at the eye(s) at different incidence angles. RESULTS: No significant "base visual field" or "eye motion visual field" surface area variations were noted when comparing tests done without glasses and with the "thin sunglasses." In contrast, a 22% "eye motion visual field" surface area decrease (p < 0.001) was noted when comparing tests done without glasses and with "thick sunglasses." This decrease was most severe in the temporal quadrant (-33%; p < 0.001). All subjects reported less lateral glare with the "thick sunglasses" than with the "thin sunglasses" (p < 0.001). CONCLUSIONS: The better protection from lateral glare offered by "thick sunglasses" is offset by the much poorer ability to use lateral space exploration; this results in a loss of most, if not all, of the additional visual field gained through eye motion.

Management of retinal detachment in Coats disease. Study of 15 cases.

PURPOSE: To correlate the final outcome with the initial presentation and treatment in Coats disease retinal detachment. METHODS: The records of 15 patients with retinal detachment were evaluated retrospectively regarding the age at the time of diagnosis, initial presentation, methods of treatment, visual and anatomic results, and complications. Changes in vision and retinal status were noted and correlated with the different methods of treatment to propose a therapeutic strategy. RESULTS: In 15 patients (15 eyes), with a mean follow-up of 28 months (range, 6 months to 7 years), Coats disease was diagnosed at a mean age of 3.4 years (range 3 months to 15 years). Primary management was laser photocoagulation in seven patients, cryotherapy in two, and vitreoretinal surgery in six. Additional treatment was necessary in nine patients of whom six had laser photocoagulation, one had cryotherapy, and two had vitreoretinal surgery. Visual stability was achieved in 12 cases. Anatomic improvement was achieved in 12 eyes (3 cases of phthisis bulbi). No enucleation was ultimately necessary. CONCLUSIONS: Carefully selected treatment can improve almost each eye with Coats disease complicated by retinal detachment. Although visual outcome is poor, anatomic improvement or stability is the main goal of the management.

Plica semilunaris temporal ectopia: evidence of primary nasal pterygia traction.

PURPOSE: To study whether plica semilunaris (PS) temporal ectopia is associated with primary nasal pterygia and whether such hypothetical ectopia is linked to with-the-rule astigmatism so that a discussion of the clinical and surgical implications of such possible findings might take place. METHODS: Cross-section observational study of 208 consecutive eyes of 152 cases and 169 eyes of 109 control subjects enrolled for 6 months. Four PS position grades were designed. Grade 1 features a grossly vertical PS position. Grades 2 and 3 involve temporal displacement and an abnormal PS tilt. Grade 4 involves PS obliteration with possible associated temporal caruncle dragging. Pterygium corneal encroachment, pterygium fleshiness, and manifest refraction were recorded. RESULTS: PS position was significantly displaced temporally in pterygium-affected eyes (P = 2 x 10(-4)). Corneal encroachment (P = 2.1 x 10(-5)), pterygium fleshiness (P = 2.7 x 10(-5)), and age (P = 1.3 x 10(-2)) were positively correlated with PS position grades > 1. The presence of with-the-rule astigmatism was significantly linked to PS position grades > 1 (P = 0.01). CONCLUSIONS: Primary nasal pterygia result in PS temporal ectopia, and PS position grades (more than grade 1) are linked to the presence of with-the-rule astigmatism. These findings are consistent with the exertion of tractional forces at both pterygium ends. In eye abduction, medial canthus structures (PS, caruncule) may be dragged temporally. Thus, pterygium-related corneal traction may not always significantly increase in eye abduction. PS temporal ectopia may influence the decision to remove PS during pterygium surgical excision.

Redistribution of the neurosensory retina in inferior limited macular translocation: an evaluation using image registration.

BACKGROUND: The present work aims to demonstrate the role of redistribution of the neurosensory retina (RNR)-that is, retinal tissue stretching and compression-in inferior limited macular translocation (LMT), to perform displacement mapping all over the area centralis, and to try and improve displacement evaluation precision. METHODS: Using piecewise linear image registration (through Matlab) on indocyanine green angiographic frames, we have evaluated the deformation (on both the retinal and choroido-scleral layer) of a pre-operative grid superimposed on the area centralis, plotted displacement vectors all over the area centralis, and calculated a scale ratio between pre- and post-operative frames. The scale ratio tests whether or not the same physical distance is represented by the same distance on these frames. RESULTS: The choroido-scleral layer is not deformed following surgery. The retinal layer shows areas of stretching and compression, demonstrating the RNR. Displacement vectors feature a rotating pattern around the optic disk (except if a macular fold exists) and a positive naso-temporal gradient. The median scale ratio is 3.8% (2.5% to 5.8%). CONCLUSIONS: LMT involves RNR accounting for inferior retinal displacement, despite the supposedly limited internal scleral shortening. Our study confirms that the optic disk temporal edge is the displacement axis (except if a macular fold exists). Our method, unaffected by a non-zero scale ratio, provides more precision than previously published.

Partially reversible quadruple sectoranopia caused by vascular steal due to an arteriovenous malformation.

BACKGROUND: Lateral, homonymous upper and lower field blind sectors sparing a horizontal zone define quadruple sectoranopia. This rare campimetric deficit involves ischemia or infarction of parts of the lateral geniculate body supplied by the distal anterior choroidal artery. METHODS: A 41-year-old patient presented with a complaint of blurred vision. Visual acuity was 20/20 on both sides. Visual field showed a left quadruple sectoranopia. CT scan, MRI, MRA and conventional angiography showed a right cerebral arteriovenous malformation supplied partly by the right anterior choroidal artery. Partial retinal nerve fiber layer atrophy matched to the campimetric deficit proved that some degree of infarction involved the lateral geniculate body. RESULTS: The arteriovenous malformation was treated with stereotactic radiosurgery. Two years after treatment, the nidus had completely disappeared. The campimetric deficit began improving from 19 months onwards after stereotactic radiosurgery. Twenty-eight months after treatment, the superior defect had completely reversed. CONCLUSIONS: Quadruple sectoranopia involves ischemia or infarction of parts of the lateral geniculate body supplied by the distal anterior choroidal artery. Following radio-induced angioma thrombosis, blood was no longer shunted away from the right lateral geniculate body, whose viable areas resumed their activity. Accordingly, a partial campimetric recovery occurred.

External ophthalmomyiasis caused by Dermatobia hominis. A retrospective study of nine cases and a review of the literature.

PURPOSE: To report nine cases of external ophthalmomyiasis caused by Dermatobia hominis. METHODS: Retrospective, non-comparative, interventional case series. Participants consisted of patients (n = 9) presenting at Cayenne Hospital between 1968 and 2003. The location and number of larvae, the larval stage, and the medical and surgical procedures applied were studied in each case. RESULTS: Seven patients had palpebral myiasis (including one with three larvae) and two had conjunctival myiasis. Every patient had palpebral oedema. The larval respiratory pore was located on the palpebral skin or free margin or on the conjunctiva. Movements were present within the lesion in at least three patients. Petroleum ointment or ivermectine solution was used in at least four patients to smother or kill the larvae. Extraction under local anaesthesia was possible in six patients, while three required general anaesthesia. CONCLUSION: Several larvae may be present in a patient. Topical ivermectine may help to kill the larvae before extraction is attempted.

Resolution of acute acquired comitant esotropia after suboccipital decompression for Chiari I malformation.

PURPOSE: To report a case of acute comitant esotropia successfully treated with suboccipital decompression in a 9-year-old male patient with Chiari I malformation. DESIGN: Interventional case report. METHODS: A 9-year-old male with Chiari I malformation had acute onset of diplopia, headache, and comitant esotropia. RESULTS: About 9 months after suboccipital decompression, diplopia resolved and there was near orthophoria on examination 15 months after surgery. CONCLUSION: In view of our case and after a review of literature, we advocate primary suboccipital decompression to treat acute comitant esotropia in patients with Chiari I malformation. A follow-up period of at least 1 year rather than 6 months seems necessary to assess surgery effects.