Change of Capsulotomy Over 1 Year in Femtosecond Laser-Assisted Cataract Surgery and Its Impact on Visual Quality.

PURPOSE: To compare the shape of the capsulotomy, its change, and its impact on visual quality over 1 year using the femtosecond laser system from the manual technique. METHODS: In this two-center cross-sectional study from May 2012 to June 2013, each patient had femtosecond laser-assisted cataract surgery in one eye (FLACS group) and conventional phacoemulsification cataract surgery in the other eye (CPCS group). An evaluation of the capsulotomy was performed using retroillumination slit-lamp photographs at 7 days, 6 months, and 1 year after surgery. Effective lens position (ELP), refractive error, and corrected distance visual acuity (CDVA) were analyzed. RESULTS: Thirty-three patients were included in the study. Diameters of capsulorhexis were more precise and deviation surfaces were lower in the FLACS group than in the CPCS group at each evaluation (P < .05). Femtosecond laser capsulotomies were less modified over time than manual continuous curvilinear capsulorhexis. No significant differences were observed for CDVA, refractive error, and ELP between groups. CONCLUSIONS: More precise capsulotomy sizing can be achieved with the femtosecond laser compared to continuous curvilinear capsulorhexis. Femtosecond laser capsulotomies are less modified over time but did not improve ELP or visual quality. [J Refract Surg. 2017;33(1):44-49].

Uveitis in patients with late-stage cutaneous melanoma treated with vemurafenib.

IMPORTANCE: This case series highlights the risk of uveitis in patients treated with vemurafenib for unresectable or metastatic cutaneous melanoma. OBJECTIVE: To assess the occurrence and severity of uveitis as an adverse effect of vemurafenib therapy. DESIGN, SETTING, AND PATIENTS: In this observational small case series, data were collected successively from May 1, 2012, through February 31, 2013, from patients with clinical signs of ocular inflammation treated with vemurafenib at the Department of Ophthalmology, Cochin-Hôtel-Dieu Hospital. MAIN OUTCOMES AND MEASURES: Patients' demographics, vemurafenib dosages, and the intervals between the onset of treatment and the first ocular symptoms were recorded. The characteristics of ocular inflammatory manifestations were analyzed. The effect of the discontinuation of vemurafenib therapy on ocular manifestations was assessed, as well as the effect of rechallenging when vemurafenib was reintroduced. RESULTS: Seven patients (mean [SD] age, 74.7 [4.0] years) had uveitis. The vemurafenib dose was 960 mg twice per day in 6 patients and a half dose in 1 patient. The mean (SD) time until the appearance of ocular signs was 5.6 (2.3) months (range, 19 days to 7 months), and inflammation ranged from mild or low-grade anterior uveitis to severe explosive panuveitis complicated by retinal detachment. Signs of ocular inflammation were always bilateral. Optical coherence tomography revealed a macular edema in only 1 of the 7 patients. Clinical improvement occurred when vemurafenib therapy was stopped in 5 of 7 patients. The rechallenge at treatment reintroduction was positive in 2 of 7 patients. CONCLUSIONS AND RELEVANCE: This small case series highlights that uveitis can be a noteworthy adverse effect of vemurafenib therapy in patients with metastatic cutaneous melanoma. However, these cases of uveitis were usually restricted to the anterior segment and manageable with local corticosteroid therapy, which justified the continuation of vemurafenib therapy because the benefits regarding the patients' survival were greater than the risk to their vision.

Photorefractive keratectomy in patients with suspected keratoconus: five-year follow-up.

PURPOSE: To assess the long-range outcomes of photorefractive keratectomy (PRK) using functional and topographic criteria in myopic eyes with suspected keratoconus. SETTING: Rothschild Foundation, Paris, France. DESIGN: Retrospective interventional case series. METHODS: Eyes of patients classified as keratoconus suspects or keratoconus by the Corneal Navigator software of the OPD-Scan II device were included. They were treated with myopic PRK using an EC-5000 excimer laser between 2004 and 2007. The main outcome measures were refractive stability, mean corneal keratometry, mean central pachymetry, mean thinnest point value, and the occurrence of postoperative complications such as corneal ectasia. RESULTS: The study evaluated 62 eyes of 42 patients. The mean patient age was 34.6 years ± 15.1 (SD) and the mean spherical equivalent (SE), -3.96 ± 3.05 diopters (D). The mean central pachymetry was 529.4 ± 32.8 µm and the mean simulated keratometry, 45.75 ± 1.75 D. The percentage of similarity to keratoconus suspects or keratoconus was positive in all 62 eyes and exceeded a 50% similarity score in 30 eyes (48.4%). The mean follow-up was 4.8 ± 1.4 years. The mean magnitude of the SE was -0.53 ± 1.35 D over the follow-up. Two patients required glasses postoperatively because of significant myopic regression. No case of corneal ectasia was reported. CONCLUSION: Photorefractive keratectomy in eyes with suspected keratoconus based on a Placido neural network may be safe and effective for myopia and astigmatism in carefully selected patients.