M. Montard

Choroidal thickness measurement in children using optical coherence tomography.

Purpose: To measure choroidal thickness (CT) in children of various ages by using spectral optical coherence tomography with enhanced depth imaging and to investigate the association between subfoveal CT and ocular axial length, age, gender, weight, and height in children. Methods: Healthy children were prospectively included between May and August 2012. Optical coherence tomography with the enhanced depth imaging system (Spectralis, Heidelberg, Germany) was used for choroidal imaging at nine defined points of the macula of both eyes. Axial length was measured using IOLMaster (Carl Zeiss Meditec, Dublin, CA). Height, weight, and refraction were recorded. Interobserver agreement in readings was also assessed by the Bland–Altman Method. Results: Three hundred and forty-eight eyes from 174 children aged 3.5 years to 14.9 years were imaged. The mean subfoveal CT in right eyes was 341.96 ± 74.7 µm. Choroidal thickness increased with age (r = 0.24, P = 0.017), height, and weight but not with gender (P > 0.05). It was also inversely correlated to the axial length (r = 0.24, P = 0.001). The nasal choroid appeared thinner than in the temporal area (analysis of variance, P < 0.0001). Conclusion: In children, CT increases with age and is inversely correlated to axial length. There is a significant variation of CT between children of the same age.

Reliability of cone counts using an adaptive optics retinal camera

To assess the reproducibility and repeatability of cone imaging in healthy human eyes, using the RTx‐1 Adaptive Optics Retinal Camera and its proprietary cone‐counting software.

Sutureless intrascleral intraocular lens implantation after ocular trauma

Purpose To report the results and safety of sutureless intrascleral haptic fixation in traumatized eyes and to compare this procedure with retropupillary iris‐claw intraocular lens (IOL) fixation. Setting University Hospital of Strasbourg, Strasbourg, France. Design Interventional case series. Methods Patients with traumatic cataract and severely damaged capsular bags were divided into 2 groups (Group 1: intrascleral IOLs [Acrysof MN60 AC]; Group 2: retropupillary iris‐claw IOLs [Verisyse]). The main outcome was the final visual acuity. The surgically induced astigmatism (SIA) was calculated by the vectorial method. Results Twenty‐six eyes of 23 patients were studied, 8 eyes in Group 1 and 18 eyes in Group 2. The mean follow‐up was 14 months. There was no difference in corrected distance visual acuity (CDVA) at the time of the surgery (P>.05). The mean CDVA (logMAR) was 1.68 ± 1.15 (SD) preoperatively and 0.55 ± 0.9 postoperatively in Group 1 (P = .03) and 1.11 ± 1.13 and 0.32 ± 0.47, respectively, in Group 2 (P = .003). The final CDVA was not different between groups (P>.05). The mean SIA was 1.91 ± 1.66 diopters (D) in Group 1 and 2.74 ± 1.92 D in Group 2 (P>.05). No intraoperative complications occurred in Group 2; a haptic broke in Group 1. Macular edema occurred in both groups. Conclusions Sutureless intrascleral IOLs corrected posttraumatic aphakia. The SIA was comparable between groups. This procedure should be considered after trauma when other implantation techniques are not possible. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

T-cell repertoire of normal, rejected, and pathological corneas: phenotype and function.

The specific immune mechanisms of corneal graft rejection are not completely understood. Recently, the technique of growing T-cell lines from rejected allografts using recombinant IL-2 has enabled the cells involved in allograft rejection to be recognized. In the present study, this method was applied for the extraction and propagation of T lymphocytes from rejected, normal, and diseased corneas. T-cell lines could successfully be grown from rejected and normal corneas, but not from corneas with keratoconus or pseudophakic bullous keratopathy. The phenotypic repertoire of the grown cells was studied by FACS scan analysis. Rejected corneas were invaded by a mixture of activated CD4+ and CD8+ T-cell lines, with one population being predominant. In normal corneas only activated CD8+ cells with cytotoxic function were cultured. No cells were obtained from diseased corneas. The in vitro function of cell lines was assessed by primed lymphocyte testing. The present study shows that the technique of propagating invading T-cell lines from organ grafts can be applied to human corneas, offering a new approach to understanding the immunological mechanisms occurring inside this immune tissue.

Étude de la motilité pupillaire chez le sujet phaque porteur d’un implant Artisan®

But Rechercher et quantifier un eventuel retentissement sur la motilite pupillaire, induit par l’implant Artisan ® , chez les sujets phakes myopes forts. Methodes Nous avons mene une etude prospective non randomisee sur 21 yeux (11 patients) avec un recul minimum de 6 mois. Un pupillometre portatif de Colvard a ete employe afin de mesurer les diametres pupillaires pre-operatoires et post-operatoires en condition de luminance scotopique maximale (0 lux) et en condition photopique maximale simulee par l’instillation de pilocarpine 2 % jusqu’a l’obtention d’un myosis complet non reactif a la lumiere. L’amplitude du jeu pupillaire tant dans sa composante horizontale que verticale a ete ainsi quantifiee. Les variations ont ete analysees dans le temps pendant 11 mois segmentes en cinq periodes afin d’avoir une analyse statistiquement coherente, soumises au test de Student avec un p egal a 0,1. Resultats Des implantation, il existait une limitation de l’amplitude pupillaire portant sur les composantes horizontale et verticale du diametre pupillaire. Les possibilites de variations d’amplitudes selon l’axe horizontal sont passees de 4,3 ± 0,2 mm en pre-operatoire a 2,7 ± 0,5 mm au 9 e mois postoperatoire, et selon l’axe vertical de 4,46 ± 0,28 mm en pre-operatoire a 3,08 ± 0,89 mm au 9 e mois. Conclusion L’implant Artisan ® induit une limitation durable de la motilite pupillaire avec une deformation de type ovalaire selon l’axe d’arrimage des haptiques, qui s’observe seulement dans des conditions photopiques maximales.PURPOSE To assess the effect of the Artisan lens on pupillary motility in a highly phakic myopic population. PATIENTS AND METHODS Eleven patients (21 eyes) were enrolled in a nonrandomized prospective study between September 2002 and August 2003, with a 6- to 11-month follow-up. A portable Colvard pupillometer was used to measure pupil diameters before and after surgery under two different light conditions: one with scotopic surroundings with absolute darkness in the examination room and the other maximal simulated photopic surroundings, caused by the instillation of a pilocarpine 2% drug until a nonreactive myosis could be observed. Under such light conditions, both the horizontal and vertical pupil motion ranges were measured. Measures were then sorted into five temporal segments in order to have enough samples per temporal segment for a cohesive data analysis. Mean values and confidence intervals were then derived per temporal segment according to Students law. Constraints on the pupil motion range were identified. RESULTS After implantation of an Artisan lens, the pupil motion range was limited to both horizontal and vertical axes. For the horizontal axis, the motion range was 4.3+/-0.2mm (p=0.1) before claw implantation and was 2.7+/-0.5mm (p=0.1) 9 months after claw implantation. For the vertical axis, the motion range was 4.46+/-0.28mm before claw implantation and 3.08+/-0.89mm 9 months after claw implantation. CONCLUSIONS The Artisan lens durably restrains the pupil in its motion range and introduces a noticeable oval deformation under extreme light condition variations. This side effect is, however, not visible under regular conditions but only in maximal photopic surroundings.

Three-dimensional Printing of Optical Lenses and Ophthalmic Surgery: Challenges and Perspectives

PURPOSE To determine whether the historical Ridley lens could be reproduced with current three-dimensional lens printing technology. METHODS A reproduction of the Ridley lens was printed using the Printoptical Technology (LUXeXceL Group BV, Kruiningen, Netherlands). Photographs and electron microscopy images were taken. Dimensions, weight, anterior and posterior surface radius of curvature, optical transmission, back optical power, and surface analysis using interferometry were obtained. RESULTS The printed lens was 8.10 ± 0.01 mm in diameter, 2.50 ± 0.01 mm thick, and weighed 117 mg. The anterior radius of curvature was 14.63 ± 0.69 mm and the posterior radius of curvature was 10.88 ± 0.22 mm. The back focal length in air was 14.1 ± 0.4 mm. An average 75% transmission in the visible spectrum (400 to 700 nm) was achieved. Surface analysis showed significant surface roughness. CONCLUSIONS The printed reproduction of the Ridley lens was far from current clinical standards, but had the properties of a biconvex lens.

Neurofibromatose de type I segmentaire : à propos d’une localisation orbito-temporale

INTRODUCTION: Neurofibromatosis is a rare pathology with heterogeneous clinical presentation. OBSERVATION: We report a case of a right orbitotemporal plexiform neurofibroma in a 64-year-old woman with von Recklinghausens neurofibromatosis. A craniofacial CT scan, with injection, showed a heterogeneous tumor in front of the skull base and the temporoparietal bone with no intracranial extension but an extension into the maxillary sinus and nasal cavity. In summery, she presented orbitotemporal segmental neurofibromatosis type 1 because of the unilateral lesion. She had a first surgery to remove her jugal and preauricular tumor with an exenteration, which provided an eye histology. The histology found no Lisch nodules but a cellular proliferation causing choroidal hyperplasia. We noted neurofibromin on choroidal cells and normal cells in addition to pathologic cells (Schwann cells and melanocytes), meaning that two cell populations were obtained in the same tissue: a somatic mosaicism. DISCUSSION/CONCLUSION: We advance the hypothesis that there was a regulation of cellular growth in a particular microenvironment because of the absence of tumor. To identify and confirm the somatic mosaicism, we would need a FISH analysis (probes containing sequences of the NF1 gene with a probe specific for the chromosome 17 centromere).

Optical and morphological characterization of a 3D printed intraocular lens

Purpose Three‐dimensional printing (or “additive manufacturing”) is a technology which allows to create a three dimensional object by building it layer by successive layer. It is especially interesting for objects that are produced in little series and that require a high degree of customization, as it allows economies of scale and potentially unlimited design possibilities. Those characteristics are particularly relevant to intraocular lenses used in cataract surgery, in a personalized medicine approach. Despite technical barriers, additive manufacturing of good quality lenses without post‐processing is now achievable. We aimed to determine if the historical Ridley lens was able to be reproduced with current 3D lens printing technology.

624 Complication cornéenne grave d’un « floppy eyelid syndrome »

Introduction Il s’agit d’un patient de 49 ans aux antecedents de diabete, de surcharge ponderale et de syndrome de Gelineau, adresse par son ophtalmologiste traitant pour une ulceration corneenne recidivante de l’œil droit evoluant depuis 2 ans. Objectifs et Methodes Le patient s’est initialement presente avec une keratite filamenteuse traitee par des antibiotiques locaux permettant une cicatrisation rapide mais suivie d’une recidive une semaine apres. Les prelevements locaux et de chambre anterieure ne retrouverent aucun germe. Un traitement par des collyres renforces associes a de la desomedine fut instaure, suivi d’une corticotherapie locale des la cicatrisation obtenue. Son etat ne s’ameliore que de maniere transitoire avec de nombreuses recidives. Observation Le diagnostic de « floppy eyelid syndrom » fut retenu cliniquement devant la laxite palpebrale importante, bilaterale et asymetrique. En effet, le tarse s’eversait trop facilement lors du test de traction des paupieres superieures. La seconde manœuvre consistant a plicaturer le tarse entre ses doigts fut sans effort et retrouvait une sensation « caoutchouteuse » de ce dernier. L’hyperlaxite predomine du cote droit, cote de l’ulceration corneenne ainsi que de la position au sommeil du patient. Le patient a beneficie d’une cure chirurgicale bilaterale par une resection pentagonale de la lamelle posterieure. Discussion Ce syndrome est souvent associe au syndrome d’apnee du sommeil. Celui-ci est en effet lie a une hyperlaxite du tissu oropharynge comparable a l’hyperlaxite tarsale. Or ce patient est porteur d’un syndrome de Gelineau : il s’agit d’une maladie apparentee a l’apnee du sommeil caracterisee par l’association d’une narcolepsie a une catalepsie. Classiquement, les sujets atteints de la maladie souffrent d’une conjonctivite chronique papillaire. Les atteintes corneennes peuvent evoluer vers une ulceration vernale mais, exceptionnellement, vers une neo-vascularisation corneenne totale. Conclusion Le syndrome de flaccidite palpebrale est peu frequent, mais il faut savoir le reconnaitre car il peut entrainer des complications corneennes graves et son traitement chirurgical est relativement simple.

374 Le « syndrome du piercing » d’un implant phake clipsé à l’iris

Introduction Il s’agit d’un patient de 43 ans qui a presente un decentrage atypique bilateral de ses implantsrefractifs myopiques 20 mois apres la chirurgie. Objectifs et Methodes Ce patient presentait une myopie stable de – 9 dioptries aux deux yeux avec une intolerance au port de lentilles de contact. Il a beneficie en fevrier 2007 d’une chirurgie refractive avec pose d’implants de chambre anterieure clipses a l’iris type Artiflex® bilateraux. La chirurgie s’est deroulee sans incident. L’acuite visuelle post-operatoire a un mois est a 10/10e sans correction aux deux yeux. Il consulte en urgence un an et demi apres pour photophobie et baisse relative de son acuite visuelle. Observation A l’examen on note un decentrage inferieur des implants avec un œdeme corneen en regard. La patte superieure de chaque haptique a perfore l’iris de part en part, entrainant un glissement inferieur de l’implant. Celui-ci reste tout de meme suspendu mais decentre, a la maniere d’un « piercing ». Ce phenomene etait present de facon quasiment symetrique au niveau des deux yeux. Le patient a ete repris chirurgicalement en urgence pour limiter la souffrance corneenne. Les implants ont ete reamarres sans difficulte en renforcant l’attache irienne. Un mois apres la chirurgie, l’acuite visuelle remonte a 10/10e sans correction aux deux yeux avec un implant bien centre. Discussion De nombreux articles rapportent des cas de declipsage des implants fixes a l’iris notamment lors de traumatismes. Dans notre cas, l’implant a simplement perfore l’iris sans lâchage des haptiques et a donc ete partiellement retenu au niveau des coudes des haptiques. Aucune notion de traumatisme n’a ete retrouvee a l’interrogatoire. Il s’agit, a notre connaissance, du premier cas rapporte. Nous n’avons pas mis en evidence de facteurs de risque particulier, le patient ne prenant aucun traitement et l’iris semblant normal lors des deux interventions. Une question reste en suspend quant a savoir si le dessin des haptiques des implants Artisan® et Artiflex® est identique ? En effet ce type de complication n’a jamais ete decrit avec l’implant Artisan® malgre un recul important. Conclusion Le « piercing » de l’iris par un implant de chambre anterieure phake type Artiflex® est une complication rare. Elle est sans gravite, mais l’implant doit etre rapidement repositionne et clipse de maniere plus large a l’iris.