B. Ridings

Correction of Postkeratoplasty Astigmatism by Femtosecond Laser Compared with Mechanized Astigmatic Keratotomy

PURPOSE To compare the effectiveness of arcuate keratotomy (AK) performed with a femtosecond laser (FSL) or Hanna keratome (Moria, Anthony, France) for correction of postkeratoplasty astigmatism. DESIGN Prospective, randomized study. METHODS This clinical study included 20 eyes. Two groups of 10 eyes underwent AK using an FLS or keratome. Refractive and keratometric astigmatism were evaluated before surgery and 6 months after surgery. The astigmatic changes in the 2 groups were measured through arithmetic and vector analysis (Alpins method). RESULTS Six months after surgery, the mean uncorrected and corrected visual acuities did not change significantly. The mean preoperative refractive cylinder was 8.6 +/- 3.0 diopters (D) and 6.7 +/- 2.1 D, decreasing to 3.9 +/- 2.4 D and 4.7 +/- 2.4 D after laser AK and mechanized AK, respectively. The mean arithmetic change was significantly higher after laser AK, with a decrease of -55.4 +/- 20.7% (P = .011). Vector analysis showed a systematic undercorrection of astigmatism in both groups with a refractive correction index of 0.82 and 0.90 after laser AK and mechanized AK, respectively. Although no statistically significant differences were detected, a wider spread of angle of error and an almost significant difference of mean absolute angle of error (P = .052) suggest a larger misalignment of treatment during mechanized AK. All cases were uncomplicated after laser AK, 1 microperforation occurred and 1 case with off-center incisions occurred after mechanized AK. CONCLUSIONS AK performed with the femtosecond laser was effective in reducing postkeratoplasty astigmatism and has some advantages over conventional techniques. However, efficacy could be improved by a more accurate nomogram and alignment of treatment.

Corneal endothelial cell loss after cataract extraction by using ultrasound phacoemulsification versus a fluid-based system.

Purpose: To compare in vivo corneal endothelial cell loss (ECL) after fluid-based versus ultrasound phacoemulsification. Methods: In this prospective randomized study, 2 groups of 21 patients underwent phacoemulsification with ultrasound (group 1) or a fluid-based system (group 2). A “divide and conquer” method with capsular bag lens implantation was performed. Cataracts graded up to nuclear opalescence 4.9 in Lens Opacities Classification System III (LOCS III) only were included. Endothelial cell density (ECD), percent hexagonality, endothelial cell area (ECA), coefficient of variation in cell size, and central corneal pachymetry were measured preoperatively, 7 days, 1 month, and 3 months after surgery. Statistical analysis was performed by using a 2-tailed Student t test. Results: Average nuclear opalescence was identical in both groups (P = 0.908). Mean ECD was 1867 ± 451 and 2031 ± 400 cells/mm2 at 3 months postoperatively. Mean ECL was 498 ± 415 (20.6% ± 17.1%) and 302 ± 302 cells/mm2 (13.3% ± 13.2%) at 7 days, 589 ± 342 (24.3% ± 14%) and 254 ± 214 cells/mm2 (11.2% ± 9.1%) at 1 month, and 555 ± 340 (22.9% ± 14%) and 247 ± 208 cells/mm2 (10.9% ± 9.1%) at 3 months in groups 1 and 2, respectively. ECL was significantly lower for group 1 than for group 2 (P < 0.001) after the first postoperative month. A significant increase in ECA was also observed at the first and third (P = 0.012) postoperative months. Conclusions: Our study showed significantly lower ECL after phacoemulsification for a fluid-based versus an ultrasound system. The fluid-based method was safer than conventional ultrasound in cataract surgery, with a nuclear opalescence graded up to 4.9 in the LOCS III classification.

Short-term Results of Penetrating Keratoplasty Performed with the Femtec Femtosecond Laser

PURPOSE To evaluate the use of the Femtec femtosecond (fs) laser for penetrating keratoplasty (PK) in the treatment of corneal diseases. DESIGN Prospective, nonrandomized clinical study. METHODS Nine eyes of nine patients underwent surgery for PK. Five had pseudophakic bullous keratopathy, three had Fuchs dystrophy, and one presented in a keratoconus patient. A Femtec (20/10 PerfectVision; GmbH, Heidelberg, Germany) fs laser was used to create penetrating cuts on donor and recipient corneas. All patients were evaluated for uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), pachymetry, topography, and endothelial cell density (ECD). Scanning electron microscopy (SEM) was performed on corneal tissue after surgery. RESULTS All eyes were treated successfully without intraoperative complications. The mean follow-up was 6 +/- 3 months. At the last postoperative examination mean BSCVA was 20/69 and there was a significant improvement (P = .08) in both UCVA and BSCVA. Mean astigmatism was 2.9 +/- 1.2 diopters. Mean ECD was 1194 +/- 465 cells/mm(2) with a mean cell loss after surgery of 49.8% +/- 19.8%. SEM displayed smooth rectilinear cut margins and minor remaining tissue bridges. One patient presented a retinal detachment three months after surgery that was successfully treated and two subjects showed an allograft rejection. CONCLUSION Use of the Femtec fs laser was effective and safe to perform PK. Short-term visual results and refractive results are analogous to conventional PK or other fs laser-assisted PK studies. Longer-term follow-up of additional cases is necessary to precisely quantify the endothelial cell loss after fs surgery.

Inhibition of corneal neovascularization after alkali burn: comparison of different doses of bevacizumab in monotherapy or associated with dexamethasone.

Background:  To compare the effects of different doses of bevacizumab with both saline and dexamethasone on inflammatory angiogenesis in the rat cornea induced by small chemical lesions.

Kératoplastie lamellaire antérieure assistée par laser femtoseconde

Introduction Les keratoplasties lamellaires anterieures sont de realisation delicate et l’utilisation du laser femtoseconde dans cette indication doit permettre d’en ameliorer les resultats anatomiques et fonctionnels. Nous rapportons le premier cas de keratoplastie lamellaire anterieure assistee par un laser femtoseconde. Observation Il s’agit d’une patiente âgee de 63 ans, presentant une dystrophie corneenne anterieure de Francois, traitee par keratoplastie lamellaire anterieure assistee par laser femtoseconde ( Femtec 20/10 Perfect Vision ® ). Une decoupe corneenne lamellaire par laser femtoseconde a ete realisee a 400 μm de profondeur sur un greffon corneen, positionne sur une chambre anterieure artificielle ( Moria ® , France ), puis sur la cornee receveuse du patient. Resultats Au cours de la periode postoperatoire, le lenticule corneen etait parfaitement adapte au lit receveur avec une interface claire. L’evaluation en OCT III (Carl Zeiss Meditech, Dublin) a permis de constater une pachymetrie centrale de 713 μm avec un lit receveur extremement regulier et une epaisseur centrale de 132 μm. Discussion Les decoupes corneennes assistees par laser femtoseconde doivent en comparaison avec les decoupes mecanisees ameliorer la securite operatoire, la reproductibilite, et la predictibilite des decoupes obtenues. Une meilleure congruence du greffon limite le risque de deplacement secondaire et la meilleure regularite de l’interface doit ameliorer le resultat fonctionnel. Conclusion Les keratoplasties lamellaires anterieures assistees par laser femtoseconde Femtec 20/10 Perfectvision ® presentent de nombreux avantages pour la prise en charge des pathologies corneennes necessitant une keratoplastie lamellaire anterieure. Des etudes comparatives, multicentriques, et randomisees sont necessaires afin d’evaluer les resultats de cette technique.

Semi-automated detection of the foveal avascular zone in fluorescein angiograms in diabetes mellitus.

Background:  The foveal avascular zone (FAZ) is known to enlarge in diabetic retinopathy. In a preliminary study, the authors applied a region growing algorithm to fluorescein angiograms to detect the FAZ in a semi‐automated fashion.

Femtosecond Laser―Assisted Decagonal Penetrating Keratoplasty

PURPOSE To assess the use of a new polygonal trephination pattern for penetrating keratoplasty (PK) assisted by femtosecond laser. DESIGN Prospective, nonrandomized clinical study. METHODS Sixteen eyes underwent decagonal PK. Nine had Fuchs dystrophy, 4 had pseudophakic bullous keratopathy, 1 had experienced trauma, 1 had corneal amyloidosis, and 1 had keratoconus. A Femtec (Tecnolas PerfectVision) laser was used to create decagonal penetrating cuts on both donor and recipient corneas. All patients were evaluated for uncorrected visual acuity, best spectacle-corrected visual acuity, pachymetry, topography, and endothelial cell density. Scanning electron microscopy was performed on corneal tissue after surgery. RESULTS All eyes were treated successfully without intraoperative complications. The mean follow-up ± standard deviation was 9.75 ± 3.5 months. Mean postoperative best spectacle-corrected visual acuity was 20/53, and there was a significant improvement in both uncorrected visual acuity (P = .0019) and best spectacle-corrected visual acuity (P = .001). At 6 months, mean ± standard deviation manifest astigmatism was 1.90 ± 1.20 diopters. Mean endothelial cell density was 1502 ± 458 cells/mm². Scanning electron microscopy displayed straight decagonal cut margins and minor remaining tissue bridges. CONCLUSIONS Use of the decagonal trephination profile was effective and safe to perform PK. Short-term visual results and refractive results are encouraging compared with those of conventional PK studies. Longer-term follow-up and comparative studies are necessary to determine precisely advantages the and optimal surgical settings of this technique.

Occlusion de branche veineuse rétinienne révélatrice d’une maladie de Takayasu

Nous rapportons un cas d’occlusion de branche veineuse retinienne decouverte chez une patiente de 28 ans, revelatrice d’une maladie de Takayasu. L’examen somatique retrouve une asymetrie de la tension arterielle humerale et un souffle abdominal ; le bilan biologique montre un syndrome inflammatoire et l’aortographie abdominale une stenose majeure de l’artere mesenterique superieure. Trois parmi les six criteres diagnostiques de la maladie de Takayasu sont presents chez notre patiente. Elle est le seul cas de maladie de Takayasu releve dans la litterature ayant pour manifestation inaugurale une occlusion de branche veineuse retinienne. Il est a rajouter aux autre cas de manifestations inaugurales atypiques de la maladie de Takayasu, comme la neuropathie optique ischemique anterieure aigue. Chez une patiente de 28 ans, une occlusion de branche veineuse est une manifestation suffisamment rare pour justifier une exploration clinique et paraclinique approfondie.

Caterpillar setae–induced acute anterior uveitis: a case report

PURPOSE To report uveitis secondary to ocular penetration of caterpillar hairs (setae). METHODS Case report. A documented attack of acute anterior uveitis was caused by initially overlooked penetration of caterpillar setae. RESULTS A 66-year-old man presenting with unilateral hypertensive keratouveitis was treated with antiherpes simplex medication (along with local anti-inflammatory and cycloplegic agents) after anterior chamber paracentesis and serologic testing. Laboratory testing was negative. Resolution occurred after 5 days, and corneal clearing showed a predescemetic caterpillar seta. CONCLUSION Patient history taken in an anterior uveitis setting should include gardening habits and searching for possible exposure to insects or arachnids.

Tomographie par cohérence optique en domaine spectral du segment antérieur : la 3e dimension

PURPOSE Anterior segment imaging using optical coherence tomography (OCT) time domain technology has been used for many years. When it appeared, it was a promising technique in the analysis of the anterior segment, making it possible to reach a definition of the ocular structures comparable with histology. Now with new-generation OCT, it is possible to perform high-definition and three-dimensional imaging. MATERIAL AND METHOD A 3D OCT-1000 (Topcon, Tokyo, Japan) parameterized to obtain high-definition and 3D imaging of the iridocorneal structures. RESULTS We present a collection of images obtained using this technique. DISCUSSION Based on a very sophisticated tool for retinal and glaucoma imagery, it is now possible to obtain very-high-quality imaging of the anterior segment, which, with its great versatility, increases the value of acquiring this type of device. CONCLUSIONS The potential of 3D OCT-1000, already a very good exam for the posterior segment, and the only one to perform anterior segment three-dimensional imaging in a single acquisition, should not be neglected.