[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.

Corneal imaging of intrastromal femtosecond laser treatment for presbyopia (Intracor(®)).

PURPOSE: To evaluate anatomic appearance and corneal cellular modifications after monocular Intracor(®) procedure with two different anterior segment imaging techniques within the first postoperative year. PATIENTS AND METHODS: Four patients underwent an Intracor(®) procedure in one eye performed at Clinique de la vision, and corneal imaging was performed in Quinze-Vingts National Ophthalmology Hospital. Slit-lamp photography, confocal microscopy with Heidelberg retinal tomography (HRT) and anterior segment spectral-domain optical coherence tomography (OCT) were performed 2 days, and 1, 6, and 12 months after the procedure. RESULTS: Confocal microscopy showed strong cellular activation of keratocytes within the first postoperative month which diminished over time. The linear femtosecond incisions appeared as hyper-reflective regular lines and reflectivity decreased throughout the follow-up period. After 6 months, a fibrotic process with appearance of corneal scars was visible as small intrastromal hyper-reflective lines and thick hyper-reflective spicules around the incisions and remained stable over time. On spectral-domain OCT, the size and depth of the incisions decreased from the center to the periphery. Visibility of the corneal femtosecond incisions on OCT decreased from day 2 until they almost disappeared at 12 months. The incision angles seemed to curve progressively from the center to the periphery in their deep portion on the peripheral rings. CONCLUSION: Corneal cellular modifications found on HRT, anatomical features, and the sizes of the intrastromal rings, may provide valuable information on this new refractive technique.

[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.

[Review in geriatric medicine 2012]. / Gériatrie.

2012 brought additional evidence regarding the benefits of exercise in older persons in showing morbidity compression in those most active. Several studies invite to revise therapeutic targets in older diabetics, especially those with cognitive impairment or dementia where a value of 8 to 9% for HbAlc might be a good compromise. On the dementia side, a study suggests that biological and structural abnormalities associated with Alzheimer's disease might occur as early as 25 years before its first clinical manifestations. On the therapeutic side, ginkgo and the double therapy with memantine and donepezil did not make it in RCTs, and two studies about treatments for behavioral symptoms of dementia showed that interruption could be deleterious.

[Older people admitted to the emergency department after a fall: what to do?]. / Patients âgés admis aux urgences suite à une chute: que faire?

Falls in older people are frequent. Falls may lead to serious injuries and are associated with greater morbidity, mortality, and reduced overall functioning in the older population. Evidences exist regarding the beneficial effects of fall prevention programs. However, these interventions are rarely implemented in our health system. Older people admitted to the emergency department after a fall should get careful attention in order to initiate specific interventions to prevent new falls. This article provides a clinical assessment strategy to evaluate older persons after a fall and proposes an algorithm for discharge planning decision.

[Assessment of anterior segment anatomy by OCT after non penetrating deep sclerectomy]. / Analyse de l'architecture du segment antérieur par OCT après sclérectomie profonde non perforante.

PURPOSE: Thanks to recent progress in imaging techniques, the anatomy of the anterior segment can be measured accurately and noninvasively. The objective of this study was to assess early postoperative changes induced by non penetrating deep sclerectomy (NPDS) on anterior chamber depth, anterior chamber angle and central corneal thickness. PATIENTS AND METHODS: Twenty eyes of 20 patients with primary open-angle glaucoma (POAG) that underwent NPDS were studied. All patients underwent ophthalmologic examination including non invasive analysis of the anterior segment architecture. Visante(®) OCT was used to determine anterior chamber depth, central corneal thickness, scleral spur angle (SSA), angle opening distance at 500µm (AOD 500), and trabecular-iris space area at 500 µm (TISA 500) in the nasal and temporal quadrants. These evaluations were performed at 1 day preop, then day 1, day 7 and day 30 after surgery. RESULTS: Preoperatively, SSA, AOD 500 and TISA 500 were 37.24 ± 12.67°, 0.42 ± 0.25 mm and 0.15 ± 0.1 mm(2), respectively, in the nasal quadrant, and 39.62 ± 12.41°, 0.46 ± 0.25 mm and 0.16 ± 0.08 mm(2), respectively, in the temporal quadrant. Mean anterior chamber depth, central corneal thickness and intraocular pressure (IOP) were 3.09 ± 0.54 mm, 530 ± 34.3 µm and 20.43± 7.25 mmHg respectively. After NPDS, aside from IOP being significantly decreased on day 1 (5.57 ± 2.78 mmHg, P<0.0001), day 7 (8.2 ± 3.12 mmHg, P<0.0001) and day 30 (13.4 ± 3.47 mmHg, P=0.001), none of the other study parameters was significantly modified. CONCLUSION: No relationship was found between IOP and anterior chamber architecture after NPDS. NPDS appears to significantly reduce IOP while maintaining the architecture of the anterior chamber, and in particular, the anterior chamber angle.

[The Resident Assessment Instrument Home care: what primary care physician needs to know]. / Le Resident Assessment Instrument-Home-Care (RAI-Domicile): ce que le médecin de premier recours doit savoir.

Following the decision of the Swiss Association for Home Care Services to adopt the Resident Assessment Instrument (RAI), the RAI-Home Care is gradually implemented in all home care services in Switzerland. Based on a comprehensive geriatric assessment, the RAI not only allows to establish an individualized plan of care, but also generates quality indicators and a case-mix classification system that helps financing and planning resources. This article describes the five steps of the RAI-Home Care process and discusses the strengths, future and limitations of the RAI.

[Driving and cognitive impairment: how best to anticipate?]. / Conduite automobile et troubles cognitifs: comment anticiper?

Driving requires integrating multiple motor, sensory, and cognitive skills. As people age, cognition becomes increasingly vulnerable due to impairment and dementia. Older drivers suffering from dementia, even at an early stage, have been shown to be significantly more likely to develop unsafe driving. Primary care physicians have the difficult task to assess these persons' driving capacity. This paper briefly describes the consequences of altered cognition on driving capacity and proposes an algorithm to address this challenge.

[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.

[Review in geriatric medicine]. / Gériatrie.

In 2010, a study emphasizes the difficulty to predict disability trajectories in the last year of life. A meta analysis shows the effectiveness of post-acute geriatric rehabilitation in reducing functional decline after hospitalisation. Several studies evaluated pneumococcal and herpes zoster vaccines' efficacy. A short and simple intervention is effective in reducing benzodiazepine use. The effect of vitamine D on falls and fractures has been further evaluated in several studies. Diagnostic criteria for dementias, including Alzheimer's disease, are moving to better acknowledge their preclinical stages.

[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.

[Architectural analysis of clear corneal incisions using Visante OCT in acute postoperative endophthalmitis]. / Analyse architecturale des incisions cornéennes par OCT Visante au cours des endophtalmies aiguës après chirurgie de la cataracte.

PURPOSE: To analyze the architecture of clear corneal incisions after acute endophthalmitis following cataract surgery using anterior segment OCT (AS-OCT). PATIENTS AND METHODS: Fourteen eyes of 14 patients followed at the Quinze-Vingts National Ophthalmology Hospital for acute endophthalmitis following cataract surgery, between April and November 2008, were included in this study. All patients had a complete biomicroscopic examination and a Visante-OCT (Carl Zeiss Meditec AG) analysis of the corneal incision. The length, size (width), location, angle, architecture, and anatomic imperfections of the incisions were analyzed. RESULTS: Symptoms occurred 4+/-2.4 days after cataract surgery. The location of the incision was superior in 71.43% of cases, temporal in 21.43% and nasal in 7.14%. Incision size (width) was 3.2 mm in 42.86% of cases, 2.75 mm in 35.71%, and 3 mm in 21.43%. Two incisions were sutured (14.28%). Using AS-OCT, the mean incision length was 1.42+/-0.25 mm and the mean incision angle was 39+/-10.62 degrees . Three-step incisions were found in 35.71% of cases and endothelial gaping was found in 42.86 % of cases. CONCLUSION: A reduced incision length and inappropriate construction seemed to be determinant risk factors of endophthalmitis following cataract surgery. Other studies using a greater number of patients with an architectural analysis of clear corneal incisions are necessary to confirm these preliminary results.

[How to screen geriatric conditions in primary care?]. / Comment dépister les syndromes gériatriques au cabinet?

The ongoing aging of the population will lead to an increasing prevalence of chronic diseases and functional limitation. Preventative measures need to be promoted to prevent health care utilization and health costs explosion. Among these measures, those aimed at promoting early recognition of chronic conditions associated with functional decline, will have to be reinforced. This paper proposes simple, feasible, and efficient procedures to screen, in primary care practices, common geriatric conditions, as cognitive impairment, gait impairment, hearing and vision impairment or functional limitation.

[New diagnosis approaches: iridocorneal angle in optical coherence tomography]. / L'angle irido-cornéen en tomographie de coherence optique.

Gonioscopy remains a standard technique to evaluate anterior segment and iridocorneal angle. However, new imaging techniques, particularly high resolution optical coherence tomography (OCT), permit to optimally visualize the anterior segment. Use of OCT in glaucoma diagnosis and follow-up will increase with technical progress and new high speed ultrahigh-resolution OCT.

[Geriatry]. / Gériatrie.

This review discuss several studies published in 2007 that will modify current therapeutic attitudes. New evidence confirm that antipsychotics increase mortality in demented elderly persons with behavioral symptoms. Unfortunately, donepezil was no more effective than placebo to treat agitation in these patients. Aspirine, nonsteroidal anti-inflammatories, as well as supplementation with folate, vitamines B6 and B12 did not prove beneficial to prevent cognitive decline. Hormonal substitution with DHEA, testosterone, and growth hormone is ineffective as anti-aging medicine, while calcium and vitamin d'effectiveness was confirmed in fracture prevention. Finally, several studies report prognostic information that will prove important to improve preparation plan for future heat wave.

[Contribution of confocal microscopy and anterior chamber OCT to the study of corneal endothelial pathologies]. / Apport de la microscopie confocale in vivo et de la tomographie en cohérence optique de chambre antérieure pour l'étude des pathologies endothéliales cornéennes.

PURPOSE: To describe the appearance of various endothelial diseases with in vivo confocal microscopy and anterior chamber optical coherence tomography (AC OCT). METHODS: In this study, ten patients with five different corneal endothelial pathologies were evaluated. Three patients had cornea guttata, three had corneal endothelial precipitates, two had irido-corneo-endothelial (ICE) syndrome, one had endothelial folds, and one had breaks in the Descemet membrane. All patients had bilateral ophthalmologic examinations, in vivo confocal microscopy, and AC OCT analysis. RESULTS: In cases of cornea guttata, AC OCT showed a finely embossed line corresponding to the empty intercellular cavities found with in vivo confocal microscopy. Corneal endothelium precipitates had the aspect of round formations suspended with the endothelium. Iris atrophy and irido-corneal synechiae resulting from ICE syndrome were precisely visualized with the AC OCT. CONCLUSION: High-resolution images of the anterior segment could be obtained using the AC OCT. Associated with in vivo confocal microscopy, these two new imaging techniques provide a precise evaluation of endothelial pathologies.

[Utility of the Visante OCT in the follow-up of glaucoma surgery]. / Apport de l'OCT-Visante dans le suivi de la chirurgie du glaucome.

PURPOSE: To evaluate the utility of the Visante OCT in the follow-up of filtering surgery. MATERIAL: and methods: In this study, we evaluated 38 filtering blebs in 31 patients following trabeculectomy (4) and nonpenetrating deep sclerectomy (NPDS). In 11 cases, mitomycin C was used during surgery. In patients who underwent NPDS, a collagen implant was placed within the scleral site in eight eyes and seven eyes had goniopuncture during follow-up. All patients had complete ophthalmologic examination with morphological evaluation of the bleb and intraocular pressure measurement as well as Visante OCT evaluation. RESULTS: The trabeculectomy site as well as the trabeculodescemetic membrane (in NPDS), the scleral flap, the conjunctival flap, the iris, and the relationship between these structures were analyzed. Functioning blebs had a hyporeflective and irregular conjunctival tissue associated with a route for aqueous humor under the scleral flap from the anterior chamber toward the subconjunctival space. This filtration route was also observed within nonfunctioning encapsulated blebs. Flat and encapsulated nonfunctioning blebs had dense and hyperreflective conjunctival tissue. In the particular case of nonfunctioning flat blebs, there was no route for aqueous humor filtration under the scleral flap. CONCLUSION: The Visante OCT is a simple and noninvasive imaging technique with good resolution, allowing the analysis of morphologic changes occurring in eyes after filtering surgery.