Emmanuel Barreau

Biometry and intraocular lens power calculation results with a new optical biometry device: Comparison with the gold standard

Purpose To evaluate the agreement in axial length (AL), keratometry (K), anterior chamber depth (ACD) measurements; intraocular lens (IOL) power calculations; and predictability using a new partial coherence interferometry (PCI) optical biometer (AL‐Scan) and a reference (gold standard) PCI optical biometer (IOLMaster 500). Setting Service d’Ophtalmologie, Hopital Bicêtre, APHP Université, Paris, France. Design Evaluation of a diagnostic device. Methods One eye of consecutive patients scheduled for cataract surgery was measured. Biometry was performed with the new biometer and the reference biometer. Comparisons were performed for AL, average K at 2.4 mm, ACD, IOL power calculations with the Haigis and SRK/T formulas, and postoperative predictability of the devices. A P value less than 0.05 was statistically significant. Results The study enrolled 50 patients (mean age 72.6 years ± 4.2 SEM). There was a good correlation between biometers for AL, K, and ACD measurements (r = 0.999, r = 0.933, and r = 0.701, respectively) and between IOL power calculation with the Haigis formula (r = 0.972) and the SRK/T formula (r = 0.981). The mean absolute error (MAE) in IOL power prediction was 0.42 ± 0.08 diopter (D) with the new biometer and 0.44 ± 0.08 D with the reference biometer. The MAE was 0.20 D with the Haigis formula and 0.19 with the SRK/T formula (P = .36). Conclusion The new PCI biometer provided valid measurements compared with the current gold standard, indicating that the new device can be used for IOL power calculations for routine cataract surgery. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Impairment of Lacrimal Secretion in the Unaffected Fellow Eye of Patients with Recurrent Unilateral Herpetic Keratitis

PURPOSE To assess the impact of recurrent unilateral herpetic keratitis (HK) on the tear secretion of the unaffected fellow eye. DESIGN Prospective, noninterventional study. PARTICIPANTS AND CONTROLS Thirty-five patients with a history of recurrent unilateral HK (clinically quiescent for at least 3 months) (HK group) and 35 patients who were age- and sex-matched with no history of corneal disease (control group). METHODS Tear osmolarity, tear instability (tear break-up time [TBUT]), tear reflex (Schirmers I test), and central corneal sensitivity with the Cochet-Bonnet esthesiometer (Luneau, France) were measured in the HK and control groups. MAIN OUTCOME MEASURES Tear osmolarity, TBUT, Schirmers I, and central corneal sensitivity were compared between the affected and unaffected eyes of the HK and control groups. RESULTS Tear osmolarity and tear secretion reflex were similar between the affected and unaffected eyes of the HK group. Corneal sensitivity and TBUT were statistically lower in the affected eyes compared with the unaffected eyes in the HK group (P = 0.001 and P<0.001, respectively). The central corneal sensitivity of unaffected eyes in the HK group was not significantly different from that in the control group (P>0.05). The tear stability and tear secretion reflex were decreased and tear osmolarity was increased in the unaffected eyes of the HK group compared with the control group (P<0.05, all cases). The difference between unaffected and control eyes varied according to the type of HK. All 4 tests were modified in patients with neurotrophic keratitis (KN). In the keratouveitis subgroup, only corneal sensitivity was normal, whereas Schirmers I results were also normal in patients with archipelago keratitis. Tear osmolarity was consistently affected in both eyes of herpetic patients. CONCLUSIONS Tear function is impaired in the unaffected eyes of patients with unilateral recurrent HK, even when the disease is apparently quiescent. The higher severity of results in the unaffected fellow eye of patients with KN in comparison with other herpes subgroups suggests that recurrent HK induces a reduction in the afferent pathways of the tear secretion reflex from the affected eye, leading to tear dysfunction in the unaffected eye. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Diffusion Tensor Magnetic Resonance Imaging of Trigeminal Nerves in Relapsing Herpetic Keratouveitis

Background Corneal hypoesthesia is the landmark of HSV and VZV keratitis and can lead to neurotrophic keratitis. Diffusion tensor imaging (DTI) is a new magnetic resonance imaging (MRI) derived technique, which offers possibilities to study axonal architecture. We aimed at assessing the potential impact of recurrent HSV or VZV-related keratitis on the axonal architecture of trigeminal nerves using DTI. Design Prospective non-interventional study. Participants Twelve patients and 24 controls. Methods DTI using MRI of the trigeminal fibers and corneal esthesiometry using the Cochet-Bonnet esthesiometer were acquired for patients affected by unilateral and recurrent HSV or VZV-related keratitis (3 months after the last corneal inflammatory event), and control subjects with no history of ocular or neuronal disease affecting the trigeminal pathways. Main Outcome Measures Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were compared between the 2 eyes of both patients and controls, and correlated with corneal esthesiometry. Results FA was lower in the trigeminal fibers ipsilateral to the affected eye compared to the non-affected side (0.39±0.02 versus 0.46±0.04, P=0.03). This difference was more important than the intra-individual variability observed in controls. Concomitantly, the asymmetry in ADC results was significantly correlated with the loss of corneal sensitivity in the affected eye. Conclusions Corneal hypoesthesia related to HSV and VZV keratitis is associated with persistent modifications in the architecture and functionality of the trigeminal fibers. These results add further explanation to the pathogenesis of HSV and VZV-induced neurotrophic keratitis, which may occur despite an apparent quiescence of the disease.

Optical aberrations in patients with recurrent herpes simplex keratitis and apparently normal vision.

Aims To analyse high-order aberrations (HOA), modulation transfer function (MTF) and Strehl ratio in patients with a history of herpes simplex keratitis (HSK) and apparently normal vision. Methods Fifteen patients with a history of recurrent unilateral HSK and normal Snellen visual acuity (0 logMAR) were enrolled. Eyes with HSK (HSK group) were statistically compared with normal fellow eyes (Control group). HOA, MTF and Strehl ratio were measured using the OPD-SCAN II (Nidek Co, Gamagori, Japan) aberrometer. Measures were performed at least 3 months after the last episode of herpes. Statistical significance was indicated by p<0.05. Results Despite apparently normal vision in both eyes (as assessed by routine visual acuity charts), significantly higher total HOA, trefoil and tetrafoil were present in the HSK group compared with the Control group. The MTF and strehl ratio were lower in the HSK group compared with the Control group. In the HSK group, eyes with corneal opacities tended to present with greater optical aberrations than eyes with a clear cornea. Conclusions Using patients as their own controls, the outcomes of this study indicate that eyes with recurrent HSK with no apparent decrease in visual acuity (0 logMAR) have significantly greater optical aberrations than eyes with no past history of herpetic disease. This outcome may explain some visual complaints of HSK patients, such as a decrease in contrast quality or reduced colour perception, compared with the unaffected contralateral eye despite apparently normal vision in both eyes.

Retinal emboli in cholesterol crystal embolism.

Cholesterol crystal embolism (CCE) is a rare and severe multisystemic disorder. It results from a massive release of cholesterol crystals from widespread atherosclerotic disease. The main difference with atherosclerosis is the severity and the quantity of the embolic events that occur during the course of the disease, eventually leading to multivisceral failure and death. The symptoms are multiple and make it a diagnostic challenge. Fundoscopic examination can be of great help, showing retinal emboli in up to 25% of the cases, and has been rarely described in the ophthalmologic literature. We report the case of a 77-year-old man with acute renal failure after coronarography. Retinal emboli seen in the fundus confirmed the diagnosis of cholesterol crystal embolism and thus prevented any further invasive investigations. In this case, anticoagulants must be stopped and any further endovascular procedure proscribed. Although impossible for this patient, peritoneal dialysis should be preferred to hemodialysis because it does not need any anticoagulation. Systemic corticosteroid can be used in the acute phase. Fundoscopic examination should be performed each time cholesterol crystal embolism is suspected. When typical emboli are seen in the retina, it permits avoiding invasive investigations and saving precious time for the management of this potentially lethal disease.

Ocular manifestations of transthyretin-related familial amyloid polyneuropathy

Background Ocular manifestations of transthyretin-related familial amyloid polyneuropathy (TTR-FAP) mainly include keratoconjunctivitis sicca, secondary glaucoma and vitreous deposits. Because liver transplantation (LT) and symptomatic treatments greatly improve life expectancy of patients, ocular involvement is becoming a more frequent challenge to address. We aimed at studying the prevalence and the clinical characteristics of ocular manifestations of TTR-FAP.

Retinal Vasculitis Revealing Immunoglobulin G Subclass Deficiency

Immunoglobulin G (IgG) subclass deficiency is a rare primary immunodeficiency syndrome characterized by recurrent infections and autoimmune disorders. However, there have been no reports of ocular involvement, either inflammatory or infectious, in association with IgG subclass deficiency. The authors report the first case of retinal vasculitis that led to the diagnosis of IgG subclass deficiency, in a patient with a history of inflammatory bowel disease and recurrent infections of previously unknown origin.

Apports du ranibizumab dans le traitement des télangiectasies maculaires de type 2 non néovascularisées

Les télangiectasies maculaires idiopathiques (TMI) se définissent comme des altérations uniou bilatérales des capillaires juxtafovéolaires, qui deviennent dilatés, tortueux et anormalement perméables. Elles affectent le plus souvent des sujets âgés de 40 à 60 ans et peuvent se compliquer d’œdème maculaire cystoïde, de néovascularisation choroïdienne et d’atrophie maculaire. Plusieurs classifications ont été proposées [1] ; le traitement des formes les plus classiques est bien codifié : injection d’inhibiteurs du facteur de croissance vasculaire (anti-VEGF) [2], cependant, il n’existe pas de consensus thérapeutique pour les formes non compliquées de TMI de type 2. En particulier, la place des anti-VEGF reste à préciser. Nous rapportons un cas de TMI de type 2 non néovascularisées traitées avec succès par injection intra-vitréenne d’anti-VEGF.

Retinal and choroidal vascular abnormalities in TTR-FAP

Methods This monocentric observational study was conducted at the French National Reference Center for TTR-FAP. Genetically confirmed TTR-FAP patients with suspected retinal and/or choroidal vascular abnormalities underwent fluorescein and indocyanine green angiography. Sensorimotor polyneuropathy (SPN) was staged with the Polyneuropathy Disability (PND) score, vegetative neuropathy was staged with the Compound Autonomic Dysfunction Test (CADT). Medical and surgical treatments were analyzed for all patients.