Jean-Louis Arné

AcrySof Phakic Angle-supported Intraocular Lens for the Correction of Moderate-to-High Myopia: One-Year Results of a Multicenter European Study

PURPOSEnTo investigate the safety and effectiveness of the AcrySof phakic angle-supported intraocular lens (IOL) (Alcon Laboratories, Inc., Fort Worth, TX) for correction of moderate-to-high myopia in adults.nnnDESIGNnOne-year interim analysis of a phase 3, nonrandomized, open-label, prospective, multicenter European clinical study.nnnPARTICIPANTSnA total of 190 subjects (190 eyes) with moderate-to-high myopia. The preoperative mean manifest refraction spherical equivalent (MRSE) was -10.38 diopters (D) +/-2.43 standard deviation (SD).nnnMETHODSnUnilateral implantation of the AcrySof phakic angle-supported IOL.nnnMAIN OUTCOME MEASURESnBest spectacle-corrected visual acuity (BSCVA), uncorrected distance visual acuity (UCVA), predictability and stability of MRSE, adverse events, and endothelial cell density.nnnRESULTSnOf 190 subjects enrolled, 161 completed the 1-year postoperative visit. No subjects lost > or =2 lines BSCVA. A UCVA of 20/20 or better was achieved by 57.8%; 99.4% had 20/40 or better. A BSCVA of 20/32 or better was achieved by 100% of subjects; 85.7% had 20/20 or better. The mean MRSE was -0.23 D (+/-0.50 D: -2.50 to 0.75 D). Residual refractive error was within +/-1.0 D from the target for 95.7% of subjects and within +/-0.5 D for 72.7% of subjects. The overall mean percentage change in central endothelial cell density 1 year after surgery was -4.77+/-8.04% (n = 139). No pupil ovalization, pupillary block, or retinal detachment events were observed.nnnCONCLUSIONSnThe AcrySof phakic angle-supported IOL yielded excellent refractive correction and predictability with acceptable safety in subjects with moderate-to-high myopia. These 1-year interim analysis findings demonstrate preliminary support for the safety and efficacy of this IOL.

Localization of acidic fibroblast growth factor in proliferative vitreoretinopathy membranes

The pathogenesis of proliferative vitreoretinopathy (PVR) membranes remains poorly understood. We have studied the presence of acidic fibroblast growth factor (aFGF), a potent mitogen for many cells, within these membranes. We have used affinity purified monospecific anti-aFGF polyclonal antibodies, in conjunction with highly sensitive immunofluorescence techniques. The labelling was exclusively localized to cell bodies and was absent from the extracellular matrix. Double labelling techniques revealed that all cytokeratin positive cells (probably pigmented epithelial cells) and macrophages contained aFGF-like immunoreactivity, whilst glial cells were unlabelled. Appropriate controls indicated the specificity of the antibodies. Hence, the presence of this mitogenic molecule within certain cell types constituting PVR membranes may contribute to the pathogenesis.

Descemet stripping automated endothelial keratoplasty in a child with descemet membrane breaks after forceps delivery.

Purpose: To report the use of Descemet stripping automated endothelial keratoplasty (DSAEK) and to treat visual loss in Descemet membrane (DM) breaks after forceps delivery. Methods: An 8-year-old boy presented with unilateral DM ruptures secondary to forceps delivery. Central, vertically oriented DM breaks significantly decreased visual acuity. Preoperative visual acuity was 20/80. A DSAEK was performed, the DM and endothelium were stripped from the recipient, and an 8.5-mm-diameter donor button consisting of posterior stroma and healthy endothelium was folded and implanted through a 5-mm incision. An air bubble was used to press the donor tissue against the recipient cornea, allowing it to attach without sutures. Results: Graft dislocation in the early postoperative period required surgical repositioning of the donor lenticule, which led to excellent anatomic and functional outcomes. There was a significant and rapid improvement of the best-corrected visual acuity, which was 20/50 at the first month and 20/32 at the seventh month postoperatively. Conclusions: To our knowledge, this is the first report of a DSAEK in a child with DM tears after forceps delivery. Selective replacement of posterior corneal layers with DSAEK might be a promising alternative to penetrating keratoplasty to successfully treat endothelial or DM lesions during childhood.

Fixed dilated pupil (urrets-zavalia syndrome) and anterior subcapsular cataract formation after descemet stripping endothelial keratoplasty.

Purpose: To report a fixed dilated pupil and anterior subcapsular cataract formation following Descemet stripping endothelial keratoplasty (DSAEK). Methods: A 47-year-old man with Fuchs endothelial dystrophy underwent DSAEK of the right eye. The preoperative slit lamp examination was normal. Mydriatic drops were used at the end of procedure. Results: Postoperatively, the pupil remained fixed and dilated with no right direct or consensual response to light, or constriction during accommodation throughout a 1-year follow-up period. Slit lamp examination after air resorption revealed a transient anterior subcapsular cataract and posterior synechiae. Based on these findings, a diagnosis of Urrets-Zavalia syndrome was made. Conclusion: To our knowledge, this is the first report of Urrets-Zavalia syndrome after DSAEK.

Whole exome sequencing identifies a mutation for a novel form of corneal intraepithelial dyskeratosis

Background Corneal intraepithelial dyskeratosis is an extremely rare condition. The classical form, affecting Native American Haliwa-Saponi tribe members, is called hereditary benign intraepithelial dyskeratosis (HBID). Herein, we present a new form of corneal intraepithelial dyskeratosis for which we identified the causative gene by using deep sequencing technology. Methods and results A seven member Caucasian French family with two corneal intraepithelial dyskeratosis affected individuals (6-year-old proband and his mother) was ascertained. The proband presented with bilateral complete corneal opacification and dyskeratosis. Palmoplantar hyperkeratosis and laryngeal dyskeratosis were associated with the phenotype. Histopathology studies of cornea and vocal cord biopsies showed dyskeratotic keratinisation. Quantitative PCR ruled out 4q35 duplication, classically described in HBID cases. Next generation sequencing with mean coverage of 50× using the Illumina Hi Seq and whole exome capture processing was performed. Sequence reads were aligned, and screened for single nucleotide variants and insertion/deletion calls. In-house pipeline filtering analyses and comparisons with available databases were performed. A novel missense mutation M77T was discovered for the gene NLRP1 which maps to chromosome 17p13.2. This was a de novo mutation in the probands mother, following segregation in the family, and not found in 738 control DNA samples. NLRP1 expression was determined in adult corneal epithelium. The amino acid change was found to destabilise significantly the protein structure. Conclusions We describe a new corneal intraepithelial dyskeratosis and how we identified its causative gene. The NLRP1 gene product is implicated in inflammation, autoimmune disorders, and caspase mediated apoptosis. NLRP1 polymorphisms are associated with various diseases.

Severe endothelial cell loss following uneventful angle-supported phakic intraocular lens implantation for high myopia

&NA; Endothelial decompensation is a serious complication of phakic intraocular lens (pIOL) implantation and is a major concern during the postoperative period. We report 3 eyes in which the same foldable angle‐supported pIOL was implanted to correct high myopia. Rapid and severe postoperative endothelial cell loss occurred in all 3 eyes. An over‐sized pIOL that induced excessive vaulting into the anterior chamber was the main risk factor. In 2 eyes, the pIOL was explanted uneventfully; 1 eye required Descemets stripping automated endothelial keratoplasty because of total endothelial decompensation. These cases illustrate the importance of accurate sizing of foldable angle‐supported anterior chamber pIOLs to avoid excessive vaulting. They also highlight the importance of regular follow‐up and preventive pIOL explantation as soon as significant endothelial cell loss is detected.

A randomized comparison of pupil-centered versus vertex-centered ablation in LASIK correction of hyperopia.

PURPOSEnTo compare visual and optical outcomes of pupil-centered vs vertex-centered ablation in patients undergoing laser-assisted in situ keratomileusis (LASIK) for hyperopia.nnnDESIGNnRandomized, double-masked, prospective, single-center trial.nnnMETHODSnnnnSETTINGnInstitutional practice.nnnSTUDY POPULATIONnSixty eyes of 30 patients with low and moderate hyperopia. Intervention procedure: Eyes underwent LASIK (Allegretto excimer laser). In 30 eyes, the ablation was centered on the pupil, while in the 30 other eyes the ablation was centered on the corneal reflex.nnnMAIN OUTCOME MEASURESnPrimary outcome measure was the safety index. Main secondary outcome measures were efficacy index, manifest refraction, uncorrected visual acuity, best spectacle-corrected visual acuity (BCVA), and ocular high-order aberrations for a 6-mm pupil size.nnnRESULTSnAt 3 months postoperatively, the safety index was 0.99 ± 0.04 in the pupil-centered group and 0.99 ± 0.08 in the vertex-centered group (P = .97). The efficacy index was also similar for both groups: 0.96 ± 0.05 in pupil-centered eyes and 0.93 ± 0.09 in vertex-centered eyes (P = .31). Optical aberrations were similar for pupil-centered and vertex-centered eyes. Considering only eyes showing large pupil decentration, we found a tendency for better visual results in favor of pupil-centered eyes in terms of safety index and a slight but significant increase of coma in vertex-centered eyes.nnnCONCLUSIONnLASIK is an effective procedure for treatment of hyperopia. Pupil-centered and vertex-centered treatments provide similar visual and optical outcomes. However, in eyes showing large temporal pupil decentration, pupil-centered ablation seemed to produce a lower amount of coma and, as a consequence, a reduced loss of BCVA compared with vertex-centered patients.

Esotropias that totally resolve under general anesthesia treated exclusively with bilateral fadenoperation.

Purpose: Fadenoperation has been proven to be an efficient method to treat convergence excess because it treats medial rectus (MR) overaction. We wanted to evaluate its efficiency in esotropias that totally disappear under anesthesia, regardless of the amount of deviation in waking hours. Methods: Included were 122 successive cases of children of ages 3 to 16 years with esotropia that completely disappears under general anesthesia (GA), representing 26.25% of all patients with esotropia that had surgery between August 2002 and July 2004. They all received a fadenoperation (retroequatorial strapping) of both MR without recession with a 5/0 nylon suture. Results: Patients were evaluated between 27 and 51 months postoperatively. Mean initial deviation was 21 prism dioptres (PD) at distance and 31 PD at near fixation. Of the 122 cases, 102 (83.6%) showed stable postoperative deviation between +8 and –8 PD, 7 showed exotropias (< 20 PD), and 13 showed esotropias (< 20 PD). These results were found without correlation to preoperative angle of deviation, ametropia, age at surgery, or association with vertical surgery. Conclusion: Our results suggest that fadenoperation of MR is an option to treat esotropias that disappear under anesthesia. The retroequatorial strapping we use seems safer than classical fadenoperation. We believe that the position of the eyes under GA should be considered for the surgical approach of esotropias.

Risk factors for development of choroidal detachment after scleral buckling procedure.

PURPOSEnTo determine risk factors of choroidal detachment after scleral buckling procedure for treatment of retinal detachment.nnnDESIGNnRetrospective chart review.nnnMETHODSnThe authors performed a retrospective study of 69 consecutive cases of retinal detachment from January 2007 to January 2008 treated by scleral buckling surgery. Two groups of patients were defined according to the absence or apparition of choroidal detachment, and a comparison of several parameters between these 2 groups was performed.nnnRESULTSnFifteen patients developed a choroidal detachment. The study found an average higher level of systolic blood pressure during surgery in the group with choroidal detachment than in the absence group (127.3 vs 119.1 mm Hg; P = .008). The authors also observed a statistically significant difference between the 2 groups when comparing the intraoperative peak value of systolic blood pressure (149.3 vs 138.5 mm Hg; P = .019). Finally, in the group that developed choroidal detachment, there were statistically more patients with high myopia (P = .02).nnnCONCLUSIONnThis study highlights that the 2 main risk factors for development of choroidal detachment during scleral buckling surgery are high blood pressure during the intervention and the existence of high myopia.

Conduite automobile et aptitude visuelle chez 100 patients âgés de plus de 60 ans

OBJECTIVE: To evaluate visual capacity and automobile driving in a sample of individuals over 60 years of age based on the visual function criteria as defined in the 29 May 1997 French Journal Officiel. MATERIAL AND METHODS: Drivers over 60 years of age were included in a prospective monocentric epidemiological study between January and March 2005. Binocular visual acuity and monocular visual acuity were measured in subjects with their optical corrections. Binocular or monocular visual field was tested depending on visual acuity results. Etiologies of visual acuity loss and visual field impairment of each eye were recorded in patients who did not meet the required criteria. RESULTS: One hundred patients were included (mean age, 70.7 years +/- 7.12 years). Twenty-nine patients did not meet the required criteria (29%; 95% confidence interval=[20.1;37.9]). On these 29 patients, 20 (69%; 95% CI=[52.2;85.8]) were unfit for driving an automobile with potential reversibility, whereas nine (31%; 95% CI=[14.2;47.8]) were permanently unfit from a visual point of view. CONCLUSION: The frequency with which patients ignore their poor distance visual acuity and the possibility of reversing the problem make it clear that the ophthalmologist has a role to play in detecting and informing patients. Language: fr