J. Colin

Long-term blood pressure and age-related macular degeneration: the ALIENOR study.

PURPOSEnTo explore the association of AMD with long-term average blood pressure (BP) parameters, including pulse pressure (PP).nnnMETHODSnThe ALIENOR study is a population-based study on age-related eye diseases in 963 residents of Bordeaux, France, aged 73 years or older. AMD was graded from nonmydriatic color retinal photographs, in three exclusive stages: no AMD (1015 eyes), large soft distinct drusen and/or large soft indistinct drusen and/or reticular drusen and/or pigmentary abnormalities (early AMD, 276 eyes), and late AMD (66 eyes). BP parameters were measured at four occasions over a 7-year period. PP was defined as systolic BP minus diastolic BP. Associations of AMD with BP parameters were estimated using generalized estimating equation logistic regressions. Statistical analyses included 702 subjects (1357 eyes) with complete data.nnnRESULTSnAfter adjustment for age, sex, educational level, smoking, body mass index, plasma HDL and LDL cholesterol, CFH Y402H, ApoE2, ApoE4, and ARMS2 A69S polymorphisms, elevated PP was significantly associated with an increased risk of late AMD (odds ratio [OR] = 1.37 for a 10-mm Hg increase, 95% confidence interval [CI]: 1.03-1.82). Associations were similar for late atrophic and late neovascular AMD (OR = 1.39, 95% CI: 1.01-1.92, P = 0.04, and OR = 1.43, 95% CI: 0.90-2.23, P = 0.13, respectively). Association with early AMD was in the same direction but did not reach statistical significance (OR = 1.12, 95% CI: 0.98-1.28). Early and late AMD were not significantly associated with systolic or diastolic BP, hypertension, or use of antihypertensive medications.nnnCONCLUSIONSnThis study suggests that high PP may be associated with increased risk for AMD.

Comparaison entre le Lasik au laser femtoseconde et le Lasik au microkératome mécanique : prédictibilité des découpes, biomécanique cornéenne et aberrations optiques

OBJECTIVESnTo compare the predictability of flap thickness, high-order optic aberrations (HOAs), and biomechanical properties of cornea between patients treated by Lasik with mechanical microkeratome versus patients treated by FemtoLasik.nnnSETTINGnDepartment of ophthalmology, Pellegrin University Hospital, Bordeaux, France.nnnPATIENTS AND METHODSnWe conducted a retrospective study on 53 myopic patients who underwent Lasik with either mechanical microkeratome (MK group) or femtosecond laser (FS group). Refraction, central corneal thickness, high-order optic aberrations (HOAs), corneal hysteresis (CH), and corneal resistance factor (CRF), were analysed pre- and postoperatively in both groups. The central corneal thickness was measured with OCT-Visante(®) (Carl-Zeiss, Meditec), biomechanical parameters with ORA(®) (Reichert), and optical aberrations with the Wave Scan(®) (AMO) aberrometer.nnnRESULTSnWe included 44 eyes of 22 patients in the MK group and 62 eyes of 31 patients in the FS group. Preoperatively, the mean best-corrected visual acuity was 0.95 in both groups. In the MK group, the flap was significantly thicker than expected (162/130 μm), but in the FS group, there was no significant difference (117/120 μm). The biomechanical properties of the cornea were lower in both groups independently of the flap cutting technique. The HOAs increased after Lasik and were not influenced by the flap cutting technique.nnnCONCLUSIONnNeither mechanical microkeratome, nor femtosecond laser for flap creation, increases HOAs and the biomechanical changes of the cornea, according to ORA(®), significantly after Lasik.

Dystrophie granuleuse de type Groenouw 1 traitée par kératoplastie lamellaire antérieure profonde : analyses histologique et tomographique par cohérence optique

Granular corneal dystrophy is a rare autosomal dominant disease. It is characterized by breadcrumb-like granular opacities in the central corneal stroma. The mutation has been localized in the TGFβI gene, which codes for keratoepithelin, an adhesion protein found in corneal epithelium and stroma. We report the case of granular corneal dystrophy in a 60-year-old man complaining of reduced visual acuity. Slit-lamp examination revealed multiple opacities in the central stroma of his left eye, and recurrent deposits in his other eye 13xa0years after penetrating keratoplasty. An anterior segment optical coherence tomography (Visante(®) OCT) was used to determine the location of deposits, then a deep anterior lamellar keratoplasty was performed in his left eye. The depth of the deposits revealed by Visante(®) OCT correlated well with the postsurgical histological findings. Visante(®) OCT can therefore help choose between phototherapeutic keratectomy and lamellar keratoplasty, techniques that are less invasive than penetrating keratoplasty, which is advantageous since this dystrophy is known to recur after surgery.

Correction des astigmatismes irréguliers par anneaux intra cornéens

Management of irregular astigmatism with intracorneal rings segments is an intrastromal additive technique developed initially for myopia but eventually popularized for keratoconus and post LASIK ectasia. ICRs are indicated for rigid contact lens intolerance, as an alternative to corneal transplantation. The mechanism of action is complex and involves biomechanical changes leading to a centering and a flattening of the ectasia. The surgical procedure has become much easier thanks to the use of femtosecond lasers. Individualized implantation strategies, based on each patients topographic and tomographic pattern, are constantly evolving. Patients refraction and vision are usually improved in more than 70% of cases. Complications remain very rare. Intracorneal ring segments can often be combined with other types of keratoplasty, usually in a sequential fashion, so as to optimize functional results.

Prise en charge chirurgicale d'une effusion uvéale chez un patient nanophtalme, à propos d'un cas.

La nanophtalmie est une affection congénitale caractérisée par une très courte longueur axiale (< 20,5 mm) mais la valeur maximale de celle-ci n’est pas clairement définie [1], une hypermétropie forte, essentiellement axile, mais avec un cristallin de volume normal, disproportionné par rapport à la petite taille de l’œil entraînant une chambre antérieure étroite et un iris convexe, associé à un épaississement scléral [2]. L’incidence du glaucome par fermeture de l’angle est plus élevée, de même que celle de l’effusion uvéale spontanée, du glaucome malin et du décollement de rétine non rhegmatogène en postopératoire [3,4]. Nous rapportons le cas d’un syndrome d’effusion uvéale spontanée traitée par sclérectomies équatoriales chez un homme atteint de nanophtalmie.

Revue généraleLes profils de photoablation cornéenne en chirurgie réfractive. Partie 1 : la quête de l’excellenceAblation profiles in refractive surgery. Part 1: In search of excellence

PURPOSEnTo provide an overview of the clinical results of various ablation profiles and discuss their technical characteristics and limitations.nnnMATERIALS AND METHODSnLiterature review.nnnRESULTSnWith the emergence of wavefront technology, new photoablation profiles have been developed, allowing for customization of refractive treatments and reduction of nocturnal visual symptoms, which adversely affect the reputation of refractive surgery. Over the past decade, several comparative studies have been published in the literature aiming to demonstrate either the superiority of wavefront-guided correction over conventional, or one laser platform over another. However, has an ideal treatment algorithm really emerged from these studies? Does one ablation profile clearly demonstrate superiority over another, in terms of visual performance?nnnCONCLUSIONnDespite technological advances as well as improved visual results for custom versus conventional photoablation, the promise of excellence in visual performance has not been achieved with these various technologies. The concept of an individualized eye model has emerged recently, based on an optical ray tracing algorithm, and could theoretically provide an ideal ablation profile, thus fulfilling the promise of supernormal vision.

Les profils de photoablation cornéenne en chirurgie réfractive. Partie 1 : la quête de l’excellence

PURPOSEnTo provide an overview of the clinical results of various ablation profiles and discuss their technical characteristics and limitations.nnnMATERIALS AND METHODSnLiterature review.nnnRESULTSnWith the emergence of wavefront technology, new photoablation profiles have been developed, allowing for customization of refractive treatments and reduction of nocturnal visual symptoms, which adversely affect the reputation of refractive surgery. Over the past decade, several comparative studies have been published in the literature aiming to demonstrate either the superiority of wavefront-guided correction over conventional, or one laser platform over another. However, has an ideal treatment algorithm really emerged from these studies? Does one ablation profile clearly demonstrate superiority over another, in terms of visual performance?nnnCONCLUSIONnDespite technological advances as well as improved visual results for custom versus conventional photoablation, the promise of excellence in visual performance has not been achieved with these various technologies. The concept of an individualized eye model has emerged recently, based on an optical ray tracing algorithm, and could theoretically provide an ideal ablation profile, thus fulfilling the promise of supernormal vision.

Hydrops cornéen spontanément résolutif en quatre semaines chez un patient de 16 ans porteur d'un kératocône

Le kératocône est une maladie rare au cours de laquelle la survenue d’un hydrops cornéen reste exceptionnelle. Ce kératocône « aigu » est secondaire à une brèche endothéliodescemétique qui entraîne une infiltration aqueuse massive du stroma cornéen. Le plus souvent la régression est spontanée en quelques semaines, comme c’est le cas ici pour ce patient de 16 ans dont l’hydrops a disparu en un mois.

520 Apport de la microscopie confocale dans la prise en charge des abcès de cornée.

Objectif Interet de la microscopie confocale dans le diagnostic microbiologique des abces de cornee. Materiels et Methodes 6 patients hospitalises pour des keratites infectieuses ont beneficie, avant tout traitement, de prelevements a visee bacteriologique, parasitologique, mycologique et virologique, et d’une microscopie confocale in vivo a l’aide du module corneen du Heidelberg Retina Tomograph II ® (Rostock Cornea Module ® ). Une biopsie de cornee a secondairement ete realisee pour 2 des patients. Resultats Dans 2 cas, la microscopie confocale a mis en evidence des images rondes hyper reflectives, a double paroi, de 30 um de diametre, evoquant des kystes amibiens. Dans 2 cas, la microscopie confocale a retrouve des images de filaments intra-stromaux de 200 um de long avec des embranchements, ressemblant a des hyphes de filaments. Pour un autre cas, d’evolution defavorable sous traitement, l’imagerie a montre de fins filaments hyper reflectifs en peripherie de l’infiltrat. Les prelevements initiaux etaient negatifs chez tous ces patients. Une biopsie de cornee realisee chez 2 d’entre eux a confirme la presence d’Acanthamoeba pour l’un et de Nocardia abscessus pour l’autre, apres mise en culture sur milieux speciaux. Dans tous les cas, l’evolution a ete favorable sous le traitement probabiliste mis en place, guide par l’imagerie. Dans 1 cas, la microscopie confocale a retrouve une desorganisation stromale et des cellules dendritiques, sans image ressemblant a des microorganismes. La Polymerase Chain Reaction a Herpes Simplex Virus est revenue positive. Discussion Dans les keratites infectieuses, le prelevement initial ne permet pas toujours un diagnostic etiologique rapide, et reste parfois negatif. Dans notre serie de cas cliniques, la microscopie confocale a permis de guider la prise en charge diagnostique (biopsie, culture sur milieux speciaux) et therapeutique plus precocement. Conclusion La microscopie confocale, technique d’imagerie non invasive et non douloureuse, est un outil d’aide au diagnostic, complementaire au prelevement microbiologique, particulierement en cas de suspicion de keratite amibienne ou mycotique. Elle permet une prise en charge adaptee et plus precoce de ces infections.

250 Comparaison de LASIK par microkératome ou par Laser Femtoseconde : profondeur de découpe du capot, biomécanique cornéenne et aberrométrie

Introduction Notre etude compare l’impact de la technique de decoupe du capot corneen realise soit par microkeratome Moria M2 calibre a 130xa0μ versus le laser Intralase calibre a 120xa0μ. Materiels et Methodes La profondeur reelle de decoupe a ete mesuree a l’aide d’un OCT de segment anterieur. La biomecanique corneenne a ete evaluee par l’Ocular Response Analyzer (comparaison de la variation des valeurs CH et CRF entre pre et post-operatoire dans les deux groupes). Nous avons compare la variation des aberrations comatiques et spheriques apres LASIK en differenciant les traitements standards ou customisees. 64 yeux de 32 patients traites par le meme operateur ont ete inclus en 2 groupes microkeratome (44 yeux) et laser Intralase (20 yeux) et ont ete evalue a un mois post-operatoire. Observation La profondeur moyenne de decoupe est de 162 μ pour le groupe microkeratome (significativement different de l’epaisseur souhaitee de 130xa0μ) et de 117xa0μ dans le groupe laser Intralase (significativement non different de l’epaisseur calibree de 120xa0μ). Concernant l’ORA, il n’existe pas de difference significative entre les 2 groupes pour le CRF (pxa0=xa00.09) et pour le CH (pxa0=xa00.3) dans la comparaison de la moyenne des variations entre pre-operatoire et post-operatoire. Discussion Dans l’etude de l’aberrometrie : dans le groupe laser Intralase et microkeratome, il n’existe pas de difference significative de variation des aberrations comatiques (procedures standards pxa0=xa00.95 ou customisees pxa0=xa00.15). Pour les aberrations spheriques, dans la comparaison entre les 2 groupes microkeratome et laser Intralase, la difference n’est pas significative dans le sous-groupe des procedures customisees (pxa0=xa00.31), mais lors des procedures standards, les aberrations spheriques semblent etre induite de facon plus importante dans le groupe microkeratome (pxa0=xa00.05). Conclusion La decoupe du capot corneen par laser Intralase permet une predictibilite plus grande de la profondeur que celle obtenue par microkeratome. Il n’existe pas de difference pour les parametres etudies de l’ORA entre les groupes microkeratome et laser Intralase. Concernant les aberrations induites le MK induit plus d’aberrations spheriques au sein de la population etudiee. Il serait necessaire d’inclure plus de patients et de poursuivre le suivi a 6 mois pour verifier le caractere stable de cette difference.