F. Matonti

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.

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.

Efficacy and Safety of Intravitreal Dexamethasone Implant in Patients with Diabetic Macular Edema

Purpose: To evaluate the efficacy and safety of intravitreal implant of dexamethasone (Ozurdex®) in diabetic macular edema (DME). Methods: This was a retrospective multicenter noncomparative study. Seventy-eight patients with DME followed for at least 6 months were included (P1.5 Network). Best-corrected visual acuity (BCVA), central retinal thickness (CRT), intraocular pressure (IOP) and cataract progression were studied at baseline and then at 1, 2, 4 and 6 months. Results: The mean CRT decrease from baseline was 145.2 µm at 6 months. The mean BCVA improvement from baseline was 6.7 at 6 months. An increase in IOP was observed for 11.7% of patients, and all patients were managed by topical treatment. No glaucoma or cataract surgery was necessary, and no endophthalmitis was reported. Conclusions: One injection of Ozurdex has an anatomical and functional effectiveness for the treatment of DME. Side effects were rare and manageable in our practice.

Ozurdex in the management of the macular edema following retinal vein occlusion in clinical practice

when the primary tumour was diagnosed, a higher percentage than that was reported from Collaborative Ocular Melanoma Study (COMS) of <1% frequency (Diener-West et al. 2001). This may arise from selection bias, because our hospital is a tertiary referral centre, or from racial and ethnic disparity. All patients with metastasis died at a median of 5.0 months (range, 1–12) after detection of dissemination. The survival rate at 3 and 5 years after enucleation was 68% (95% confidence interval [CI], 48–88) and 53% (95% CI, 32–74), respectively (Fig. 1A). The rate 6 months after detection of metastasis was 31% (95% CI, 6–56; Fig. 1B). All three patients with ciliary body melanoma developed metastasis. Liver was the most common site of metastasis (12 ⁄12), followed by bone (5 ⁄12), lung (2 ⁄12), lymph nodes and brain (each 1 ⁄12). After detection of metastasis, three patients with a single site of metastasis survived 1, 6 and 10 months. Nine patients with two or more sites of metastases survived a median of 5 months (range, 3–12; p = 0.32). The 5-year survival rates for the four size categories T1–T4 were 100%, 75% (95% CI, 54–96), 31% (95% CI, 14– 48) and 26% (95% CI, 5–57), respectively (Fig. 1C), based on the American Joint Committee on Cancer (AJCC) tumour, node, metastasis (TNM 7th edition) criteria (AJCC 2010). The 5year survival rates for the four stages IIV were 100%, 56% (95% CI, 39–73), 42% (95% CI, 20–64) and 0%, respectively (Fig. 1D). These rates are lower than is given for the large material used to develop the TNM classification (AJCC 2010), partly because three patients had metastasis at diagnosis. Larger tumour size and non-spindle cell melanoma (epithelioid or mixed cell melanoma) were associated with shorter survival (log-rank test; p = 0.02 and p < 0.01). The 5-year survival rates for spindle and non-spindle cell melanoma (epithelioid or mixed cell melanoma) were 100% and 34% (Fig. 1E; 95% CI, 21–47). Age, gender and extraocular extension were not associated with survival in this small series (Table 1).

Étude rétrospective du traitement par Ozurdex ® dans l’œdème maculaire diabétique : MOZART study

PURPOSE To evaluate the efficiency and safety of intravitreal implant of 0.7mg dexamathasone in visual impairment due to diabetic macular edema (DME). MATERIALS AND METHODS This was a retrospective, multicenter, study. Seventy-four patients, with a mean age of 65 years, followed for at least 6 months (mean follow-up: 9.8 months) were included in 5 French eye clinics (P 1.5 collective). The mean systolic blood pressure was 138mmHg and the mean HbA1c was 7.2%. We monitored 2 systemic parameters: blood pressure and glycemic balance. Best-corrected visual acuity (BCVA), central retinal thickness (CRT, Spectralis OCT), intraocular pressure (IOP) and cataract progression are studied at baseline and then at 1, 2, 4 and 6 months. RESULTS The average CRT decrease was: 239μm at month 2 (M2) and 135μm at month 6 (M6). The mean improvement from baseline of BCVA is 8.5 letters at M2 and 7.6 letters at M6. A gain greater than 15 letters is found in 27% of patients at M6. For naive patients the BCVA is 71 letters versus 60 letters (P<0.05). Patients with a baseline CRT <500mmHg have a BCVA of 66 letters versus 57 letters (P<0.05). The mean rate injections was 1.2 at 6 months with an average of 5.4 months for reinjection. Ocular hypertension greater than 25mmHg, managed by topical treatment, is observed in 13.4% of patients. No glaucoma surgery was necessary. CONCLUSION Dexamethasone has an anatomical and functional effectiveness in the treatment of DME. Outcomes for naive patients and lower CRT suggest that the duration of diabetes mellitus and previous treatments are negative factors of recovery. Side effects are rare and manageable. Ozurdex(®) seems to be a treatment for visual impairment due to DME with a favorable safety profile. Patient follow-up must be adapted to half-life of the product with a control before M1 (intraocular pressure) and before M5 (DME recurrence, BCVA).

Effectiveness and safety of dexamethasone implants for postsurgical macular oedema including Irvine–Gass syndrome: the EPISODIC-2 study

Aim To assess the effectiveness and safety of intravitreal dexamethasone implants for treating post-surgical macular oedema, including Irvine-Gass syndrome refractory to first-line treatments. Methods Descriptive, observational, retrospective, consecutive, uncontrolled, multicentre, national case series. 50 patients were included in the study between March 2011 and June 2013 with a minimum 6 months follow-up. At baseline, each patient received a dexamethasone implant 0.7 mg (Ozurdex). Best-corrected visual acuity (BCVA), central subfield macular thickness (CSMT), and intraocular pressure (IOP) were measured at baseline and then monthly. The main outcome measure was the mean change in BCVA (in ETDRS letters (Early Treatment Diabetic Retinopathy Study): L) Results Baseline mean±SD BCVA was 55.7±15.4 L. At month 2, BCVA was 71.8±10.5 L and 61.2% of patients had an increase of more than 15 letters. Baseline mean CSMT was 544±117.2 μm and this decreased to 302 μm at month 2. Anatomic and functional recurrences were both first detected from month 3 and continued throughout follow-up, with values consistently above baseline. The peak in IOP was reached in month 1 with mean IOP of 15.3±4.6 mm Hg. Of the 39/50 patients followed up for 12 months, 49% received a second injection. The anatomic and functional response and safety patterns were similar to that obtained with the first intravitreal injection, demonstrating Ozurdex’s reproducibility. However, more than half of the patients followed-up for at least 1 year presented neither functional nor anatomical recurrence. Conclusions Ozurdex would appear to be an interesting alternative therapy for treating post-surgical macular oedema, including Irvine-Gass syndrome refractory to first-line treatments.

Long-term efficacy and safety of intravitreal dexamethasone implant for the treatment of diabetic macular edema.

Purpose To evaluate the long-term efficacy and safety of the dexamethasone intravitreal implant Ozurdex® in the treatment of diabetic macular edema (DME). Methods This was a retrospective noncomparative study. A total of 23 patients with DME followed for at least 12 months were included. All patients were treated with at least 2 Ozurdex® injections for the treatment of DME. Best-corrected visual acuity, central retinal thickness, intraocular pressure (IOP), and cataract progression were recorded over 12 months. Results From baseline, the mean decrease in central retinal thickness was 315.9 µm at the 12th month and the mean best-corrected visual acuity improvement from baseline was 8.7 letters. Ozurdex® is administered via the extended release system Novadur®. Its efficacy extends beyond 4 months with a single injection and permits allows good stabilization until the 12th month, with 2.13 injections during this period. An increase in IOP was observed in 13.1% of patients and all were managed using topical IOP-lowering medications. No glaucoma or cataract surgery was necessary, and no endophthalmitis was reported. Conclusions In real-life clinical practice, Ozurdex® has anatomical and functional effectiveness for the treatment of DME. Side effects were rare and manageable in our practice.

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.