Effect of dry eye on the reliability of keratometry for cataract surgery planning.

PURPOSE: This study aimed to evaluate the effects of dry eye on the reproducibility of keratometry (K) measurements in patients presenting for cataract surgery. METHODS: A non-randomized controlled clinical study was performed. Eighty-three eyes of eighty-three patients with cataracts who were enrolled in our hospital from March 2020 to July 2020 were studied. The mean non-invasive tear film break-up time (NIBUT), corneal fluorescein staining score, and ocular surface disease (OSD) SPEED II questionnaire were measured and recorded prior to surgery, and the patients were assigned to a "dry eye" group (n=35) or a "non-dry eye" group (n=48). The K of the patients was measured twice by a Tomey OA-2000 (an average of three times each). The difference of the mean K (ΔKm) and astigmatism vector (ΔKvector) between the two measurements was calculated. The ΔKm and ΔKvector between the two groups were compared. The relationship between the measurement parameters of dry eyes and the accuracy of the preoperative K values was analyzed. RESULTS: ΔKm was 0.09 D [0.03; 0.19] in the non-dry eye control group and 0.28 D [0.18; 0.50] in the dry eye group, with a statistical difference between the two groups (P=0.005). The ΔKvector of the non-dry eye control group was 0.22 D [0.14; 0.42], and that of the dry eye group was 0.50 D [0.28; 1.06]. There was a significant difference between the two groups (P=0.010). Between the two groups, the percentage of the ΔKm and ΔKvector values greater than 0.5 D were statistically different (P<0.05). There was no significant difference in ΔKm between the groups with NIBUT>5s and NIBUT≤5s (P=0.537). There was no significant difference in ΔKm between groups≥2 and<2 on the OSD SPEED II questionnaire scores (P=0.442). CONCLUSION: Dry eye can affect the reliability of keratometry measurements before cataract surgery, thereby affecting the accuracy of intraocular lens power calculations. In cataract surgery planning, it is necessary to detect subjective and objective indicators of dry eye in patients and carry out effective intervention so as to avoid refractive errors caused by inaccurate keratometry measurements.

[A pragmatic comparison of fetal biometry curves]. / Comparaison pragmatique des courbes de biométries fœtales élémentaires.

INTRODUCTION: The fetal biometrics charts recommended in France for ultrasound screening include measurements of head circumference (HC), biparietal diameter (BIP), abdominal circumference (AC) and femur length (FL). New international growth standards have been recommended since 2022. The aim of this work is to quantitatively describe the differences between these biometric curves. METHODS: The biometry curves from the French College for Fetal Ultrasound, OMS and INTERGROWTH-21 are pragmatically compared based on their original quantile regression equations (superposition and quantification of differences in millimeters and in proportion) for different percentiles of clinical interest. RESULTS: Compared with the new charts, CFEF underestimates HC<-3DS and AC<10eP. The proportions of differences between the CFEF and INTERGROWTH-21 or WHO curves always remained <5%. The proportions of difference of the 3rd percentile of HC and FL, 10th and 90th percentile of AC were always lower than 2%, 2%, 5% and 4% respectively, between OMS and INTERGROWTH-21. CONCLUSION: The switch to prescriptive standards suggests an improvement in the detection of fetuses with AC<10th percentile, an improvement in the detection of prenatal onset microcephaly, with no argument for a decrease in the detection rate of severe constitutional bone disease or modification of obstetrical guidelines.

Changes of ocular biometry in eyes with posterior chamber phakic intraocular lens implantation.

OBJECTIVE: To evaluate changes in biometric variables and intraocular lens (IOL) calculation results after posterior chamber phakic IOL (PCPIOL) implantation. METHODS: This retrospective, observational study included 65 eyes of 38 patients who underwent PCPIOL (EVO Visian ICL) implantation for correction of myopia. Prior to and a minimum of one year (mean 14.9 months) after EVO Visian ICL implantation, biometric variables and IOL calculation results were compared. Optical biometry, including anterior chamber depth, axial length, flat, steep, and mean keratometry values and IOL calculation results for the Holladay 2, Hoffer Q, Haigis, and SRK/T formulas were measured using the IOLMaster 700 SWEPT Source OCT biometer. MAIN RESULTS: The mean anterior chamber depth decreased from 3.70±0.22mm to 3.34±0.39mm, the mean axial length increased from 26.61±1.61mm to 26.71±1.66mm, and the mean flat keratometry changed from 42.82±1.86 D to 42.73±1.83 D. These changes were statistically significant. The mean IOL power calculation also revealed a statistically significant decrease with all four formulas (ranging from 0.19 D to 0.30 D) after PCPIOL implantation. CONCLUSIONS: Biometric variables and IOL calculation results showed statistically significant changes one year after EVO Visian ICL implantations. However, IOL power calculations yielded a decrease of less than 0.50 D, inducing much less refractive deviation in the spectacle plane; and the change was primarily related to an increase in AL measurements. IOL power calculations in eyes with EVO Visian ICL in situ provided satisfactory and reliable results.

How do the amblyopic and fellow eyes differ in adults?

OBJECTIVE: To investigate the differences between the amblyopic eye and the fellow eye in adults with anisometropic amblyopia. MATERIALS AND METHODS: Measurements of the central macular thickness [CMT], subfoveal choroidal thickness [SFCT], and retinal nerve fiber layer [RNFL] in patients with anisometropic amblyopia were obtained using optical coherence tomography [OCT]. Axial length [AL], anterior chamber depth [ACD], and central corneal thickness [CCT] were measured with optical biometry. All 12 parameters were compared between the amblyopic eye [Group 1] and the fellow eye [Group 2]. RESULTS: A total of 110 eyes of 55 patients [9 myopic, 46 hypermetropic] were analyzed retrospectively. The ages of the patients ranged from 17 to 55 years, with a mean of 30.8±10.7 years. 56.4% [n=31] of the patients were female, and 43.6% [n=24] were male. The mean spherical equivalent [SE] was 1.96±3.79 in Group 1 and 1.28±2.45 in Group 2. SFCT was 312.00±53.03 in Group 1 and 283.47±51.91 in Group 2. AL was 22.53±1.40 in Group 1 and 22.79±1.18 in Group 2. SE, SFCT, and AL were statistically significantly different between the two groups. There was no difference between the two groups in terms of CMT, RNFL, ACD and CCT values. CONCLUSION: In adults with anisometric amblyopia, the SFCT of the amblyopic eye is greater than that of the fellow eye. The choroid plays an important role in the nutrition of the retinal layers, the development of ocular function and refractive error, and its development may be affected by the refractive error. Since the majority of our patients were hyperopic, the AL was found to be shorter in the amblyopic eye. CMT, RNFL, ACD and CCT values were the similar in both groups. There was no clinically significant relationship between biometric parameters and OCT parameters.

Photoscreener results with and without cycloplegia and their reliability according to biometric parameters.

PURPOSE: Our goal in this study is to compare the results of a photoscreener (Plusoptix A12C) with and without cycloplegia and to investigate its reliability as a function of biometric parameters. METHODS: In total, 250 eyes of 125 children with a mean age of 6.77±1.59years were included in the study. The results of cycloplegic and noncycloplegic Plusoptix A12C measurements and autorefractometer with cycloplegia (CA) were compared. The spherical equivalent (SE) differences between CA and noncycloplegic Plusoptix A12C measurements (NPO) with CA and cycloplegic Plusoptix A12C measurements (CPO) were compared with axial length (AL), anterior chamber depth (ACD), corneal radius of curvature (CR), mean keratometry (meanK) and axial length/corneal radius of curvature ratio (AL/CR) values. The relationships between these were examined. RESULTS: According to amblyopia risk factors (ARFs) based on the criteria in the 2013 AAPOS guidelines, 33 eyes (13%) in the NPO results and 34 eyes (13.6%) in the CPO results were found to be at risk for amblyopia. According to the CA results, the NPO had 67.3% sensitivity and 94.5% specificity, and the CPO 69.4% sensitivity and 89.1% specificity in detecting the values of refractive amblyopia factors determined by the AAPOS. In regard to refraction values determined by the AAPOS for amblyopia, according to CA results, the NPO had 71.4% sensitivity and 88.4% specificity in detecting myopia; 33.3% sensitivity and 93.6% specificity in detecting hyperopia; and 79.4% specificity and 71.2% sensitivity in detecting astigmatism. With regard to refraction values determined by the AAPOS for amblyopia, according to CA results, the CPO had 80.9% sensitivity and 90% specificity in detecting myopia; 13.3% sensitivity and 89.2% specificity in detecting hyperopia; and 44.9% sensitivity and 30.8% specificity in detecting astigmatism. When the SE differences between the CA and NPO values were compared with biometric parameters, a negative correlation was observed with ACD, AL, and especially AL/CR ratio. CONCLUSION: Both the NPO and CPO showed moderate sensitivity and high specificity in detecting ARFs based on the criteria in the 2013 AAPOS guidelines. Sensitivity for detecting hyperopic risk factors was lower than for myopia and astigmatism. The CPO has no additional clinical advantage. A negative correlation was found between biometric parameters and NPO results. Thus, the NPO is more reliable in myopic children with higher axial lengths, deeper anterior chambers, and increased AL/CR ratios.

Evaluation of the agreement of optical biometry and Scheimpflug corneal topography with different axial lengths.

PURPOSE: To compare anterior segment parameters evaluated with optical low coherence reflectometry and combined Scheimpflug-Placido disc topography in eyes with different axial lengths. METHODS: Deux cent quatre patients were divided into 3 groups according to their axial lengths. Central corneal thickness (CCT), anterior chamber depth (AD), mean keratometry value (K mean) and white-to-white distances (WTW) obtained from both devices were compared. All measurements were performed 3 times and averaged. RESULTS: In group 1, a significant difference was detected between the two devices for CCT, WTW and Kmean measurements (P<0.001, P<0.001, p:0.005 respectively). In group 2, a significant difference was detected between the two devices for WTW measurement (P<0.001). In group 3, a significant difference was detected between the two devices for CCT and WTW measurement (P<0.001, P<0.001 respectively). In the Bland-Altman analysis, there was no match for Kmean obtained with both devices in group 1. In group 2, there was no agreement for AD obtained with both devices. In group 3, there was no match for AD, WTW or Kmean values obtained with both devices. CONCLUSION: Some anterior segment parameters are not suitable for interchangeability in eyes with different axial lengths evaluated by Lenstar and Sirius anterior segment imaging systems. When planning critical surgery and treatment, more attention should be paid to measurements in eyes of different axial lengths.

[Skills assessment for the practice of fetal ultrasound biometry: Prospective validation of the OSAUS METHOD score]. / Évaluation des compétences pour la pratique de la biométrie échographique fœtale : validation prospective du score OSAUS METHOD.

OBJECTIVES: To develop and validate a customized variant for fetal biometry of the generic OSAUS score (Objective Structured Assessment of Ultrasound Skills) METHODS: The 5-points OSAUS METHOD grid was elaborated by defining five target skills specific to fetal biometry for each thematic item of the generic score. The level of skills of 43 trainees was prospectively assessed during an ultrasound examination by using this grid. The results of the "novice" level group (experience<10 ultrasounds) were compared to those of the "intermediate" level group (experience≥10 ultrasounds) (I). The reached/non-reached skills ratio within the different items composing the score allowed the identification of priority areas of improvement (II). Previously published distribution and actual distribution of ratings according to the generic pass/fail score were compared (III). RESULTS: Median scores of "novices" (n=29) and "intermediates" (n=14) groups were statistically different, 1.87 (±0.75) and 3.31 (±0.83) (P=1.85-5), respectively and corresponded to the pre-existing experience (I). A lower ratio of reached skill allowed the identification of "documentation of the examination" item as a priority area of improvement for both groups (II). The relevance of the pass/fail score is consolidated, even if an overlap was observed between novices and intermediates groups (III). CONCLUSIONS: The relevancy and feasibility of using OSAUS scoring method for fetal biometry are supported. In addition, the possibility of comparisons with generic OSAUS remains.

Biometry data and prevalence of corneal astigmatism in caucasian spanish candidates for cataract surgery.

PURPOSE: To describe ocular biometric parameters and the prevalence of corneal astigmatism as well as age and gender correlations in a population of cataract surgery candidates and to estimate the number of eyes that would be candidates for a toric intraocular lens (IOL). METHODS: In consecutive patients requiring cataract surgery over a one-year period (June 2016 to June 2017), the following optical biometry measurements were performed on an IOLMaster 700 or Lenstar 900: axial length (AL), anterior chamber depth (ACD), lens thickness (LT), mean keratometry (K), flat keratometry (K1), steep keratometry (K2), corneal astigmatism (Cyl) and white-to-white diameter (WTW). Descriptive statistics for the demographic and biometric data were analyzed. RESULTS: The study sample included 6111 eyes of 3332 patients (59.3% women), with a mean age of 74.78±9.7years. The means of the compiled data are as follows: AL 23.58±1.55mm, ACD 3.08±0.41mm, LT 4.55±0.52mm,K 44.15±1.54 diopters (D), K1 43.64±1.57 D, K2 44.69±1.61 D, Cyl 1.0±0.81. D and WTW 11.88±0.46mm. The male patients had significantly larger eyes (higher AL, ACD and WTW) and flatter corneas (lower flat and steep K). Older patients had significantly lower AL, ACD and WTW, while their LT values were higher. Corneas became significantly steeper with age. 60.5% of eyes had less than 1 D of corneal astigmatism, while 3.1% had ≥3.0 D. CONCLUSIONS: Less than 1 D of corneal astigmatism was present in the majority of cataract surgery candidates. 3.1% of eyes were candidates for a toric IOL. This study provides useful information on inventory requirements for planning hospital resources.

Effect of 0.01% atropine eye drops on choroidal thickness in myopic children.

PURPOSE: To examine the effects of low-dose atropine on the choroidal thickness (CT) of young children in Shanghai, China, as well as the ocular biometrics of myopic patients. METHODS: A total of 59 eyes of 35 myopic children had subfoveal CT and ocular biometry measurements taken before and after 2weeks, 4weeks, and 8weeks of treatment with 0.01% atropine. All eyes were measured using swept-source optical coherence tomography. CT and changes in it were also recorded. RESULTS: The choroid exhibited significant and continuous thickening under the fovea after patients were treated with 0.01% atropine. The magnitude of change in CT varied with the location and with the duration of treatment. The greatest change was observed in the fovea. There was no significant relationship between changes in subfoveal CT and axial length. CONCLUSIONS: Using 0.01% atropine eye drops significantly increased CT in eyes of young myopic children, by variable magnitude depending upon location.

[Training in fetal ultrasound biometry: Prospective assesment of Objective Structured Assessment of Ultrasound Skills (OSAUS) efficiency]. / Apprentissage de la biométrie échographique fœtale : évaluation prospective de la performance de l'Objective Structured Assessment of Ultrasound Skills (OSAUS).

BACKGROUND: Fetal biometry quality directly influences obstetrical care relevance. However, obstetrician proficiencies are heterogeneous in particular during initial training. OBJECTIVES: To assess the predictive value of OSAUS scale to identify operators with enough command to perform a valid estimation of fetal weight (EFW) (I). This study also assesses OSAUS intra-operator inter-exams variability (II) and pass/fail score relevancy (III). METHODS: Lecturers in Nancy University Hospital assessed trainees' proficiency for EWF systematically and prospectively through OSAUS scale. The trainee assessment was performed right after the one of the senior operator (reference EFW) on three consecutive patients during standard care ultrasounds. To ensure variability in proficiency within the sample, previous practice was taken into account during enrollment ("novices" and "intermediates" for<20 and 20 past exams, respectively). Correlation between mean OSAUS and validity of EFW (a valid EFW was defined by a difference with the reference EWF<0.8 Z-score) and variability between consecutive assessments were assessed. RESULTS: The study population was constituted of 8 "novice" and 8 "intermediate" trainees. Association between OSAUS and EFW validity was significant (P<0.03) (I). Intra-operator inter-exams variability was majored in the "novice" group (coefficients of variation were 25% vs. 10% in "novice" and "intermediate" group respectively) (II). Within the sample, specificity and positive predictive value of a pass/fail score OSAUS>3.5 to predict EFW validity were 77% and 71%, respectively (III). CONCLUSION: A 3.5 OSAUS pass/fail score could provide a relevant threshold to estimate operator proficiency in assessing fetal biometry in an autonomous and secure way.

[Is Holladay 2 formula acurate enough for calculating intraocular lens power in non-standard eyes?] / Intérêt de la formule Holladay 2 dans le calcul de la puissance de l'implant intraoculaire pour les yeux de biométrie hors normes.

PURPOSE: To evaluate the benefit of the Holladay 2 formula versus the 3rd generation formulae in calculating the IOL power in eyes with non-standard axial length or keratometry before cataract surgery. PATIENTS: Retrospectiv study from January to December 2015. The inclusion critaeria were axial length (AL) <22mm or >26mm, or average keratometry <42 D or >46 D, dividing the patients in 4 groups respectively. The 7 parameters required to calculate the Holladay 2 formula were collected. The final refractive result was turned into spherical equivalent to calculate the optimal power retrospectively. Then, the results obtained using the other formulae were compared with the optimal IOL power. RESULTS: One hundred and twenty-six eyes operated by two surgeons were included. In the high AL group (n=32), the SRK/T was the most accurate formula; regarding the low AL group (n=36), the Hoffer Q and Holladay 2 formulae performed better; for the steep cornea group (n=27), the Hoffer Q, Haigis, Holladay 1 and 2 formulae were not different; last, the Holladay 1 and 2 were more accurate in the flat cornea group (n=33). CONCLUSION: In our study, the Holladay 2 formula does not seem to be better than the others for calculating IOL power in non-standard eyes. Preoperative eye features in such non-standard cases should be taken into account before the surgery to choose the more suitable formula.

[Report from the CFEF seminar on fetal biometry (June 2017)]. / Compte rendu du séminaire de travail du Collège français d'échographie fœtal (CFEF) sur les référentiels et standards de biométrie fœtale. Juin 2017.

This article reports the conclusions and recommendations resulting from the seminar organized in Paris on June 15, 2017 by the scientific committee of the French College of Fetal Ultrasound (CFEF). The purpose of this meeting was to audit the practices in screening for SGA and IUGR fetuses in France and to discuss ways to improve ultrasound screening. A review of charts, references, standards and common practices was performed. The potential new biometric tools applicable in France were reviewed and analyzed. Eventually, options and recommendations for improvement are proposed.

Improving students' ability to perform a standardized foetal biometry plane using ultrasound simulators.

OBJECTIVE: The objective of this study is to assess progress made in the ultrasound (US) measurement of femur length (FL) by students after one hour of training on US obstetric simulators. MATERIALS AND METHODS: Medical residents and midwives registered for the 2016 French national foetal US diploma were invited to a 1-hour US training course with simulators. The time to acquire the FL plane with changing foetal presentation was prospectively measured before and after the training. Every image was recorded, and quality criteria were assessed. RESULTS: Thirty new learners trained in foetal US were evaluated. The time needed to measure the FL was significantly shorter in the post-test versus the pre-test (86s versus 125, P=0.015). The quality criteria were statistically similar before and after training regarding the angle to horizontal (10.0° versus 9.6°, P=0.84) and FL (31.3mm versus 32.0mm, P=0.15). CONCLUSION: The time needed to obtain the FL plane was reduced by 30% after a 1-hour US simulation training session.

Effect of pharmacological pupil dilation on measurements and iol power calculation made using the new swept-source optical coherence tomography-based optical biometer.

PURPOSE: To determine whether pupil dilation affects biometric measurements and intraocular lens (IOL) power calculation made using the new swept-source optical coherence tomography-based optical biometer (IOLMaster 700©; Carl Zeiss Meditec, Jena, Germany). PROCEDURES: Eighty-one eyes of 81 patients evaluated for cataract surgery were prospectively examined using the IOLMaster 700© before and after pupil dilation with tropicamide 1%. The measurements made were: axial length (AL), central corneal thickness (CCT), aqueous chamber depth (ACD), lens thickness (LT), mean keratometry (MK), white-to-white distance (WTW) and pupil diameter (PD). Holladay II and SRK/T formulas were used to calculate IOL power. Agreement between measurement modes (with and without dilation) was assessed through intraclass correlation coefficients (ICC) and Bland-Altman plots. RESULTS: Mean patient age was 75.17±7.54 years (range: 57-92). Of the variables determined, CCT, ACD, LT and WTW varied significantly according to pupil dilation. Excellent intraobserver correlation was observed between measurements made before and after pupil dilation. Mean IOL power calculation using the Holladay 2 and SRK/T formulas were unmodified by pupil dilation. CONCLUSIONS: The use of pupil dilation produces statistical yet not clinically significant differences in some IOLMaster 700© measurements. However, it does not affect mean IOL power calculation.

[Fetal transcerebellar diameter measured in screening ultrasound: Feasibility and reproducibility]. / Mesure du diamètre transverse du cervelet en échographie de dépistage : faisabilité et fiabilité.

OBJECTIVE: The aim of the study was to evaluate feasibility and reproducibility of fetal transcerebellar diameter measurement during second and third trimester ultrasound mass screening by junior and senior physicians. MATERIALS AND METHODS: A monocentric prospective study was conducted at the tertiary care teaching hospital in Lyon, including patients undergoing their second or third trimester planned ultrasound exam. For each patient, a resident and a senior practitioner measured each fetal transcerebellar diameter, during a blinded experiment, according to the transcerebellar plane described by the International Society of Ultrasound in Obstetrics and Gynecology. Images have been scored on 4 criteria. The inter-observer variability for transcerebellar diameter and image quality was assessed using an intra-class correlation coefficient. Image quality has been analyzed according to pregnancy term and to fetal presentation. RESULTS: Sixty-six patients were included, 44 patients before and 22 patients after 30 weeks. Inter-observer variability of transcerebellar diameter measurement was 0.4%. Inter-observer variability of image quality was 13.5%. Image quality was not significantly different between seniors and residents (P=0.06). Gestational age and fetal presentation did not affect significantly image quality (P=0.42) and (P=0.64) respectively. CONCLUSION: Transcerebellar diameter measurement during mass screening is simple and reliable. Posterior fossa abnormalities can be explored through its measurement.

[Successful phacoemulsification in vitrectomized eyes: technical considerations]. / Comment réussir sa phaco-émulsification sur œil vitrectomisé ? Particularités techniques.

Cataract surgery after pars plana vitrectomy significantly improves visual acuity in 85% of cases, limited by retinal comorbidity and surgical complications. However, despite recent advances, this surgery remains a special challenge. Indeed, the surgeon must be aware of its many pitfalls and often adapt his surgical technique to avoid the 10% rate of intraoperative complications reported in the literature - ten times higher than for the non-vitrectomized eye. During the postoperative period, the most common complication is posterior capsule opacification, which may require early laser capsulotomy.