24-Hour Monitoring of Intraocular Pressure Fluctuations Using a Contact Lens Sensor: Diagnostic Performance for Glaucoma Progression.

Purpose: The purpose of this study was to compare 24-hour intraocular pressure (IOP) related fluctuations monitoring between 2 groups of visual field progression rates in patients with open angle glaucoma (OAG). Methods: Cross-sectional study performed at Bordeaux University Hospital. Twenty-four-hour monitoring was performed using a contact lens sensor (CLS; Triggerfish; SENSIMED, Etagnières, Switzerland). Progression rate was calculated using a linear regression of the mean deviation (MD) parameter of the visual field test (Octopus; HAAG-STREIT, Switzerland). Patients were allocated into two groups: group 1 with an MD progression rate <-0.5 dB/year and group 2 with an MD progression rate ≥-0.5 dB/year. An automatic signal-processing program was developed and a frequency filtering of the monitoring by wavelet transform analysis was used to compare the output signal between the two groups. A multivariate classifier was performed for prediction of the faster progression group. Results: Fifty-four eyes of 54 patients were included. The mean progression rate was -1.09 ± 0.60 dB/year in group 1 (n = 22) and -0.12 ± 0.13 dB/year in group 2 (n = 32). Twenty-four-hour magnitude and absolute area under the monitoring curve were significantly higher in group 1 than in group 2 (group 1: 343.1 ± 62.3 millivolts [mVs] and 8.28 ± 2.10 mVs, respectively, group 2: 274.0 ± 75.0 mV and 6.82 ± 2.70 mVs respectively, P < 0.05). Magnitude and area under the wavelet curve for short frequency periods ranging from 60 to 220 minutes were also significantly higher in group 1 (P < 0.05). Conclusions: The 24-hour IOP related fluctuations characteristics, as assessed by a CLS, may act as a risk factor for progression in OAG. In association with other predictive factors of glaucoma progression, the CLS may help adjust treatment strategy earlier.

LIFELONG PROGRESSIVE RETINAL ATROPHIC LESIONS IN A PATIENT WITH PARTIAL ACQUIRED LIPODYSTROPHY (BARRAQUER-SIMONS SYNDROME).

PURPOSE: To report a case of lifelong progressive retinal atrophic lesions in a patient with partial acquired lipodystrophy, that is, Barraquer-Simons syndrome. METHODS: Case report. RESULTS: A 67-year-old female patient with Barraquer-Simons syndrome was referred for progressive visual loss. Barraquer-Simons syndrome is a rare acquired partial lipodystrophy characterized by a loss of subcutaneous fat in the upper half of the body. Fundus examination disclosed posterior atrophic lesions, particularly evident on autofluorescence images, and their progression as compared to a previous examination performed nine years earlier. Multimodal imaging confirmed the posterior atrophic lesions without any associated exudative signs and highlighted the extension of atrophic areas in the periphery. CONCLUSION: We here report for the first time a documented progressive retinal atrophy associated with Barraquer-Simons syndrome. Drusen and neovascular complications have already been described in previous reports, but no long-term follow-up was available until the present case to observe such dramatic evolution of the retinal lesions.

Vision-related quality of life and dependency in French keratoconus patients: Impact study.

PURPOSE: To assess the quality of life in French keratoconus patients. SETTING: Fifty-seven Keratoconus National Reference Centers across France. DESIGN: Prospective case series. METHODS: Patients completed the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) and a French validated questionnaire on disability and dependency from February to June 2012 when they came for an ophthalmic examination at 57 participating centers across France. An ocular examination including refraction, corneal topography, pachymetry, and slitlamp biomicroscopy was performed. The composite or global NEI VFQ-25 score and the proportion of patients who were dependent (defined by the difficulties with activities of daily living) because of keratoconus were the main evaluation criteria in this study. RESULTS: The study comprised 550 keratoconus patients. Women, corrected distance visual acuity worse than 20/40, steep keratometry higher than 52.0 diopters, history of surgery (corneal transplant, intrastromal corneal ring segments, or corneal crosslinking), and more severe keratoconus according to the Amsler-Krumeich classification were associated with an increasingly negative impact on quality of life (overall scores are significantly lower). Moreover, 4.9% of participants reported having changed their jobs because of keratoconus and 7.8% received keratoconus-related disability. Sixty-nine (12.5%) patients reported having difficulties with activities of daily living and are considered dependent. CONCLUSION: Keratoconus was associated with a significant reduction in quality of life but it did not result in social exclusion.

Anterior capsule contraction treated by femtosecond laser capsulotomy.

PURPOSE: To describe a new method to treat severe anterior capsule contraction using a femtosecond laser anterior capsulotomy. METHODS: Case report. RESULTS: A 48-year-old woman with a history of myotonic dystrophy experienced a severe contraction of the anterior capsule following an uneventful phacoemulsification cataract surgery with a hydrophilic acrylic intraocular lens implanted in the capsular bag. A femtosecond laser anterior capsulotomy was performed using a non-applanating fluid-filled interface. The spectral-domain optical coherence tomography imaging system associated with the laser enabled precise centration and location of the capsulotomy with a posterior cut located between the anterior surface of the intraocular lens and the anterior capsule inner surface. The free-floating capsulotomy was easily removed after the laser procedure, and 8 days postoperatively visual acuity recovered and myopic shift regressed with an intraocular lens centered in the capsular bag. CONCLUSIONS: Femtosecond laser assisted by a high-resolution imaging system appears to be a safe and efficient treatment for severe anterior capsule contraction.