[Comparison of two different surgical treatments of presbyopia for hyperopic patients over 55 years old: Presbylasik (Supracor) and Prelex (presbyopic lens exchange)]. / Chirurgie de la presbytie chez l'hypermétrope de plus de 55ans : comparaison entre Presbylasik (Supracor) et Prelex (presbyopic lens exchange).

INTRODUCTION: The management of presbyopic patients is a medical, surgical and economic issue. We wondered which procedure, whether a Presbylasik technique called Regular Supracor or the intraocular surgery of clear lens replacement by a trifocal diffractive lens (presbyopic lens exchange [Prelex]), provided the best results (in visual acuity and satisfaction) for our hyperopic and presbyopic patients between 55 and 70. The aim of this study was to compare the safety and efficacy of the two techniques (at one week and three months) and to assess patients' quality of life. METHODS: This study is a retrospective monocentric clinical trial conducted between June 2011 and March 2014, on 21 hyperopic presbyopic patients (mean age 60.9 years), in the "hôpital d'instruction des armées-Percy" (Clamart); 13 patients underwent the corneal treatment of Presbylasik (with the Intralase FS60 femtosecond laser [AMO, USA] and the Technolas 217P excimer laser [Technolas Perfect Vision, GmbH] following the Zyoptix Tissue-Saving algorithm adjusted with a nomogram and the Regular Supracor mode), and 8 patients underwent clear lens extraction (Prelex), through bimanual phacoemulsification and implantation of diffractive trifocal intraocular lenses (Finevision Micro F, PhysIOL(*)). RESULTS: Mean uncorrected binocular distance and near vision visual acuity in the Supracor group were respectively 0.03 (-0.2-0.1) LogMar and 0.23 (0.06-0.36) one week postoperatively and 0.031 (-0.2-0.1) and 0,166 (0.06-0.36) three months postoperatively. In the Prelex group, the mean uncorrected one week binocular VA was 0.025 (0-0.1) for distance vision and 0.165 (0.06-0.18) for near distance and the three months visual acuity was 0 (-0.1-0.1) and 0.105 (0.06-0.18) for distance and near vision. All Prelex patients were spectacle-free at all distances, whereas 4 Supracor patients required spectacles for near vision postoperatively. Seven of 11 patients in the Supracor group and 100% of the Prelex patients were completely satisfied. Both groups experienced halos, but patients reported more halos in the Prelex group (75%). One eye required intraocular lens exchange and four eyes (16.7%) required a new corneal procedure in the Supracor group. CONCLUSION: Both surgeries are safe and effective modalities in the management of hyperopic and presbyopic patients. However, the Prelex procedure seems to be more appropriate for patients over 55 years of age.

[Management of presbyopic hyperopes by centered presbyLASIK]. / Prise en charge de patients hypermétropes presbytes par chirurgie cornéenne de type presbylasik centré.

PURPOSE: To evaluate efficacy and patient satisfaction of presbyopic hyperopes treated with centered PresbyLASIK (multifocality centered on near vision) by the SUPRACOR technique (Technolas Perfect Vision). MATERIALS AND METHODS: This is a retrospective study carried out at Percy Army Teaching Hospital from September 2011 through September 2013. Fifty-nine eyes of 29 patients were included and underwent PresbyLASIK. Study parameters included uncorrected binocular distance (DVA) and near (NVA) visual acuity, aberrometry, central corneal curvature by corneal topography (bump), and patient satisfaction (questionnaire). RESULTS: Mean uncorrected binocular visual acuity was found to be 0.09 logmar for DVA and 0.22 for NVA on post-operative day one, 0.04 logmar for DVA and 0.17 for NVA at 1 month post-operatively, 0.15 logmar for DVA and 0.19 for NVA at 3 months post-operatively, and -0.02 logmar for DVA and 0.18 for NVA at 6 months post-operatively. Mean central corneal curvature was found to be 2.56±0.9 diopters. There were significantly more higher-order aberrations in the central 5mm post-operatively (P<0.01). Among the patients undergoing bilateral SUPRACOR LASIK, 79% were entirely satisfied with the surgery, and all patients would recommend the procedure to their family and friends. Eighty-six percent of these patients acheived total spectacle independence at distance and near. CONCLUSION: SUPRACOR PresbyLASIK is a method of choice in overcoming spectacle dependence in presbyopic hyperopes.

[Efficacy and tolerability of highly crosslinked hyaluronic acid injections in the management of the enophthalmous orbit]. / Efficacité et tolérance des injections d'acide hyaluronique hautement réticulé dans la prise en charge des énophtalmies.

OBJECTIVE: Evaluation of the efficacy and tolerability of highly crosslinked hyaluronic acid injections in treating the enophthalmous orbit. METHODS: Retrospective study of 11 enophthalmic patients who received an intraorbital injection of Juvederm(®) Voluma between June 2007 and October 2008. The mean follow-up was 19 months (range 12-25 months). RESULTS: Twelve orbits of 11 patients were treated, including nine with post-enucleation socket syndrome (PESS). Volume loss was corrected in 66.67% of cases (eight orbits) with only one intraorbital injection. Two patients requested an additional injection, achieving a final success rate of 83.33%. A rate of 16.67% (two orbits) developed some bruising, mild swelling and hypersensivity at the injection site within 24 hours of administration of the filler, representing minor, temporary side-effects of which the patients had been forewarned. Persistent edema was noted in 16.67% of cases, likely due to an overcorrection of ptosis, and ptosis was exacerbated in 16.67% of cases (two orbits). One ptosis was corrected after several months, with no particular difficulties related to the hyaluronic acid. No additional complications were identified. CONCLUSION: Juvederm(®) Voluma appears to be an effective filler for reduction of enophthalmos with a single intraorbital injection. In our experience, this product seems to have a longer duration of action than reported by the manufacturer and appears to perform like a semi-permanent or even permanent filler.

[Post-traumatic carotid cavernous fistula: report of two cases]. / Fistule carotido-caverneuse post-traumatique: à propos de deux cas.

Carotid cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The authors reported the clinical presentation and therapeutic procedure of two cases. The physician has to be aware of this diagnosis when a patient is referred for a posttraumatic exophthalmia. The medical behaviour is multidisciplinary (ENT, ophthalmologist, radiologist and neurosurgeon). The imaging of choice is the angiography but angio-MRI and angio-CT can help to confirm the diagnosis. The endovascular embolization is the treatment of choice. It presents an acceptable risk of complication and a low risk of failure. In this paper the authors report 2 posttraumatic CCF cases treated with success by endovascular embolization.

[Practical assessment. Ocular hypertension]. / Bilan en pratique. L'hypertonie oculaire isolée.

In cases of high intraocular pressure, the patient's hypertension must first be confirmed and its characteristics delineated with a diurnal IOP curve or at least several different measures. Central corneal thickness should be measured, since a thin cornea is a risk factor of progression toward glaucomatous neuropathy. Later, the optic nerve head and retinal nerve fibers should be tested (HRT, GDx, and OCT), to determine whether the ocular hypertension is associated with other findings, and visual field analysis should be carried out (standard automated perimetry, blue-yellow perimetry, FDT), completed by a search for associated risk factors. Therapeutic decisions will be based on this workup, keeping in mind that in the majority of cases, monitoring and information are sufficient but necessary; treatment should, however, be initiated in cases of ocular hypertension with a high risk of progression.

[Diagnostic laser in glaucoma: scanning laser polarimetry (GDx VCC) and confocal scanning laser tomography (HRT)]. / Les lasers diagnostiques dans le glaucome: la polarimétrie à balayage laser (GDx VCC) et la tomographie confocale par balayage laser (HRT).

Automated structural measurements of retinal nerve fibers and optic nerve head are possible with new lasers providing objective and reproductible data for analysis. Scanning laser polarimetry (GDx VCC), based on retardation of polarized light, assesses peripapillary nerve fiber layer thickness. Confocal scanning laser tomography yields precise topographic maps of the optic disc and peripapillary retina. The advantages, applications for glaucoma detection, both in a screening setting as well as for monitoring progression, limitations and pitfalls need to be well known and results should be analyzed with clinical data.

[Corneal burns and matrix metalloproteinases (MMP-2 and -9): the effects of human amniotic membrane transplantation]. / Brûlures cornéennes et métalloprotéases: influence des greffes de membranes amniotiques.

PURPOSE: Human amniotic membranes have recently been used in ophthalmology to restore deleted ocular surface after burns. Matrix metalloproteinases-2 and -9 have been implicated in the development of neovascularization. In this study, MMP-2 and MMP-9 expression was analyzed by in situ zymography on rabbit corneal chemical burns with and without human amniotic membrane graft. METHOD: Corneal neovascularization was induced in 10 Fauve de Bourgogne rabbits by means of a heptanol chemical burn on controlled deep keratotomy using a Chiron ALK-E corneal shaper. Half of rabbits received acute amniotic membrane transplantation 30mn after chemical burn; the remaining five rabbits received medical treatment. In situ zymography is a recent nondestructive technique which preserved the fine morphological details of the cornea and showed the active enzyme location in different corneal layers. The MMP-2 and -9 substrate was gelatin, which was detected by fluorescent microscopy. RESULTS: There was an overexpression of MMP-2 and -9 in corneal burns versus control corneas. Expression of MMP-2 and -9 was low in corneal burn without amniotic membrane graft. Following amniotic membrane transplantation, MMP-2 and -9 were strongly expressed and clinical neovascularization and inflammation decreased. Active enzymes were located in epithelium layers in the uncovered group. In the covered group, the active enzymes were located in the anterior and posterior stromal layers. CONCLUSION: The results support a role for MMP-2 and MMP-9 in corneal burn neovascularization. Amniotic membrane transplantation can play a protective role by up-regulation of their biological expression.

[Value of a new non-contact biometer for intraocular crystalline lens power calculation]. / Intérêt d'un nouveau biomètre non-contact pour le calcul de la puissance des lentilles intra-oculaires cristalliniennes.

PURPOSE: One of cataract surgery's current imperatives involves refraction: the power of the lens implant must be calculated as accurately as possible. Here we present a new method of biometric ocular measurement using the partial optical consistency interferometer. MATERIAL AND METHODS: This investigation studied the axial length measurement of 100 eyes. Five measurements were taken with a classic echobiometric contact technique using the ultrasonic mode; 5 others were taken with the infrared noncontact technique (IOL Master, Zeiss Humphrey). The latter technique is based on interferometric biometry with optical consistency and measurements were taken with an infrared luminous ray. With extreme rapidity and no contact, the device provides a complete biometry, including axial length, keratometry, and anterior chamber depth. It includes a built-in computer. RESULTS: Comparing the ultrasonic and infrared measurements emphasizes the precision and particularly the high reproducibility of the infrared method. The standard deviations of the samples were significantly lower for the 100 measurements. Its limitations depends on the type of cataract since success was not obtained for certain posterior subcapsular opacities. DISCUSSION: This new method of performing a biometry with a partial consistency interferometer contributes a number of advantages: speed, its noninvasive nature with no contact, the high reproducibility of the exam, as well as precise measurements as shown by the difference in the standard deviations of the two methods. CONCLUSION: Biometry using the optical consistency interferometer seems to be a reliable, reproducible, and precise technique that brings great precision for the calculation of the power of the intraocular implant in cataract surgery.

[New medical treatments of glaucoma. New strategies?]. / Nouveaux traitements médicaux dans le glaucome. Nouvelles stratégies?

Several new classes of ocular hypotonia medications have recently become available. These include the topical treatments carbonic anhydrase inhibitors, the alpha-2 agonists, the prostaglandin analogues, and a fixed combination of beta-blockers and carbonic anhydrase inhibitors. With an equal or superior efficacy than beta-blockers, these new treatments must be reconsidered as first-line therapy in glaucoma. The long-term safety profile of antiglaucomatous drugs plays an important role in the new trends of medical treatment. These data, better known and detailed over time by clinical experience, are changing our habits and advancing therapeutic strategies for a more effective treatment, better suited to the individual, thus allowing the best quality of life possible.

[Contribution of MRI in the dynamic study of the lacrimal outflow system]. / Apport de l'IRM dans l'étude dynamique des voies lacrymales d'excrétion.

PURPOSE: To evaluate a new magnetic resonance imaging protocol for dynamic study of the lacrimal outflow system and to use this protocol to search for problems in patients with an assumed permeable outflow system who develop epiphora. PATIENTS AND METHODS: A prospective study of nine patients, including 2 asymptomatic controls was conducted. The magnetic resonance protocol included, gadolinium instillation into the conjunctival cul-de-sac, 3D gradient-echo T1-weighted acquisition, 2 mm thick images passing through the nasolacrimal duct, dynamic acquisition after gadolinium instillation for timing dye progression through the outflow system. RESULTS: Similar results were obtained for the two control subjects with lacrimal transit time of a median 100 seconds. Three distinct events were individualized gadolinium arrival in the lacrimal sac (t1), at the extremity of the bony portion of the lacrimal duct (té), and the extremity of the mucosal portion of the duct (t3). Patients with an assumed permeable outflow system who had epiphora show results intermediary between passed dye and total blockage of the dye within the lacrimal sac. CONCLUSION: The study of the lacrimal outflow system using this new magnetic resonance imaging protocol contributes to the physiological study of tear evacuation and could be useful for quantitative assessment of lacrimal stenosis, particularly interesting for therapeutic guidance.

[Diffusion if lidocaine after intracameral injection]. / Diffusion de la lidocaïne après injection intracamérulaire.

PURPOSE: To determine the lidocaine diffusion space, we compared lidocaine aquous humor concentration in topical anesthesia with 1% lidocaine intracameral injection and in peribulbar anesthesia with 2% lidocaine prior phacoemulsification. MATERIAL AND METHOD: A gas chromatography technique of analyzing 100 microliters aqueous humor was used to detect the presence of lidocaine prior to phakoemulsification cataract surgery in two groups of patients: group A: after peribulbar anesthesia with 10 ml 2% lidocaine, group B: after 1% tetracaine topical anesthesia and 0.5 ml intracameral injection of 1% preservative-free lidocaine. The intracameral volume was estimated mathematically in group B. Endothelial cells loss was analyzed in two groups with non contact specular microscopy. RESULTS: Lidocaine was detected in aqueous humor with a good reliability. The mean concentration after intracameral injection was 6,300 micrograms/ml and was higher than after peribulbar injection. This concentration was near than theorical intracameral rate, suggesting that there was no diffusion in the posterior segment. There was no significant difference in the 2 groups in endothelial cells loss. CONCLUSION: Intracameral injection of lidocaine is an effective technique to anesthetize intracameral structures without diffusion in posterior segment prior to phakoemulsification.

[Intracameral lidocaine and phacoemulsification under topical anesthesia. Apropos of 80 operations]. / Lidocaïne intracamérulaire et phacoémulsification sous anesthésie topique. A propos de 80 interventions.

PURPOSE: To evaluate the advantage of intracameral unpreserved lidocaine for patient comfort during phacoemulsification under topical anesthesia. METHODS: In this prospective study, we performed 80 phacoemulsifications under topical anesthesia, with tetracaine 1% drops, 10 minutes before and at the start of surgery: 40 patients received 0.3 cc balanced salt solution (BSS) intracameral injection; 40 patients received 0.3 cc unpreserved lidocaine 1% intracameral injection. The same surgical procedure was performed in both groups: 3.2 mm temporal corneal self-sealing incision, capsulorhexis, foldable polyHEMA IOL implantation into the capsular bag. There was no intravenous sedation. RESULTS: Forty-eight percent (19) in the BSS group and 70% (28) in the lidocaine group felt no pain. 10% (4) in the BSS group reported sharp pain during phacoemulsification. During IOL insertion, no pain was reported by 48% (19) in the BSS group, and 75% (30) in the lidocaine group; 10% (4) in the BSS group felt severe pain (significant difference: p < 0.05). Endothelial cell loss was 6% in the BSS group, and 6.4% in the lidocaine group (non significant difference). CONCLUSION: Intracameral lidocaine is safe and effective in decreasing discomfort among patients undergoing phacoemulsification under topical anesthesia.

[Radial keratotomy for the treatment of Excimer laser undercorrections]. / Kératotomie radiaire pour le traitement des sous-corrections après le laser Excimer.

BACKGROUND: Effectiveness of radial keratotomy for undercorrections following photorefractive keratectomy. METHODS: Twenty myopic eyes from minus 4.75 to minus 8.25 were treated by Excimer laser photorefractive keratectomy and regressed to a mean myopic refraction of minus 2.20 +/- 0.81 after a follow-up of 10 to 22 months (mean: 16.25). Radial keratotomy was performed using Hoffmann Fyodorov Thornton nomogram. Blade depth was set according to pachymetry performed before surgery under microscopic examination, paracentrally on the meridian of each incision. RESULTS: Postoperative results were evaluated after 6 to 20 months follow-up. After radial keratotomy mean refractive error was minus 0.30 +/- 0.43 and minus 0.32 +/- 0.25 at 3-6 and 6-12 months respectively. Visual acuity, without correction, was prior to radial keratotomy: 2.18 +/- 0.99; 8.125 +/- 0.6 at 3-6 months and 8.43 +/- 1.57 at 6-12 months after radial keratotomy. CONCLUSION: Radial keratotomy appears to be a safe, simple and predictible technique to treat undercorrections following Excimer laser photokeratectomy.

[Corneal blindness in tropical areas]. / La cécité d'origine cornéenne en milieu tropical.

Corneal disease is the second most common cause of blindness in tropical countries after cataract. It mainly strikes children who are exposed to numerous infectious agents against which they are unprotected due to the absence of basic health care. In high risk groups, the incidence of childhood corneal-related blindness is more than 20 times higher than in developed countries. There are many causes of corneal-related blindness. Endemic trachoma persists in some areas and inflammatory forms can lead to blindness. Eradication requires instillation of antibiotics in the eye, improvement of sanitary conditions, and campaigns against promiscuity. Xerophthalmia can induce blindness by perforation of the cornea in children with vitamin A deficiency. Measles, herpes simplex keratitis, and corneal ulcer that progresses to bacterial or fungal infections, or to amebic keratitis are also major causes of corneal-related blindness. The incidence of onchocerciasis is decreasing thanks to treatment with ivermectin and programs to control simulium. Neonatal gonococcal ophthalmia and leprosy-associated ocular disease can also lead to blindness. This overview of the various causes illustrates the close correlation between the level of life and living conditions and the occurrence of corneal-related blindness in tropical areas.

[Ocular complications of intracarotid chemotherapies with nitrosourea agents]. / Complications oculaires des chimiothérapies intracarotidiennes par nitroso-urées.

The authors report ocular complications in intracarotid chemotherapy with Nitrosyl-urea on 39 patients with intracerebral malignant tumor (anaplastic astrocytoma). Internal carotid infusion catheter was in infra-ophthalmic position. They also report 13 ocular complications (33% of cases) as arterial retinal occlusions essentially, ipsilateral to catheter site. Their study and literature revue emphasize five ocular toxicity factors; intracarotid catheter position, type of drug, its quantity, its solubility and solvent, the rate of infusion.