M. Saleh

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.

Quantification of cone loss after surgery for retinal detachment involving the macula using adaptive optics

Aims To image the cones in eyes with anatomically successful repair of retinal detachment (RD) involving the macula and in healthy fellow eyes using an adaptive optics (AO) camera and to correlate the results to clinical outcomes. Methods Twenty-one patients (42 eyes) operated for macula-off RD were imaged 6 weeks after surgery using an AO camera (RTX 1, Imagine Eyes, Orsay, France). Cone density (cells/mm2), spacing between cells (µm) and the percentage of cones with six neighbours were measured. Best-corrected visual acuity (BCVA) and thickness of the inner segment ellipsoid (ISe) band imaged by SD-optical coherence tomography were also measured. Results The parafoveal cone density was decreased in eyes operated for RD (mean±SD 14 576±4035/mm2) compared with fellow eyes (20 589±2350/mm2) (p=0.0001). There was also an increase in cone spacing (10.3±2.6 vs 8.0±1.0.9 µm, respectively, p<0.0001). The nearest-neighbour analysis revealed a reduction in the percentage of cones with six neighbours (36.5±4.2 vs 42.7±4.6%, p=0.0003). The ISe thickness, thinner in the operated eyes, was correlated to the cone density (r=0.62, p<0.0001). BCVA was significantly correlated to cone density (r=0.8, p<0.001). Conclusions There was a decrease in the cone density after RD with an estimated loss of one-third of the cones. Postoperative visual acuity was highly correlated with the cone density. AO may be a valuable prognostic tool after RD surgery.

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.

Evolution of Corneal Graft Survival Over a 30-Year Period and Comparison of Surgical Techniques: A Cohort Study

PURPOSE To compare graft survival between 3 10-year periods and according to surgical techniques performed in the last years. DESIGN Cohort study. METHODS setting: Regional center (Besançon University Hospital, France). PATIENTS All 1132 patients operated on between 1983 and 2014. Graft and patient baseline characteristics, risk factors for failure, surgical procedures, and postoperative corneal status were collected. MAIN OUTCOME MEASURES Five-year survival rate in the whole cohort; 1-year and 3-year survival rates, respectively, among 88 patients with endothelial dystrophy (ED) or postoperative bullous keratopathy (PBK) operated on using endothelial lamellar keratoplasty (ELK) or penetrating keratoplasty (PK), and among 56 patients with keratoconus operated on using anterior lamellar keratoplasty (ALK) or PK. RESULTS Between the 1983-1993 and the 2004-2014 periods, overall 5-year graft survival rate increased from 61.4% to 76.5% (P = .0004). The main prognostic factors were preoperative diagnosis, graft endothelial density, and postoperative lens status. After adjusting for these factors, difference in survival rates was no longer significant (hazard ratio 0.90 for the second and 1.17 for the third period, compared to the first, P = .4191). Only 1 graft failure, after PK, occurred among the 56 patients with keratoconus. Among the 88 patients with ED or PBK, the 1-year graft survival was higher with PK (90.6%) than with ELK (60.8%) (P = .0025) but no significance remained after adjustment (hazard ratio 3.22, P = .1304). CONCLUSIONS Despite numerous changes in graft procedures and surgical techniques, no noticeable improvement in graft survival was found during the last 30 years while taking into account other prognostic factors.

Mesure de la pression intraoculaire et de l’épaisseur cornéenne centrale d’enfants de zéro à dix ans sous anesthésie générale

INTRODUCTION The correlation between intraocular pressure (IOP) and age is poorly studied in children. Thus, the aims of our work are to determine the IOP and central corneal thickness (CCT) standards in children from 0 to 10 years of age and to examine the possible relationship between IOP, CCT and age. METHODS Three hundred and twenty eyes of 160 healthy subjects were examined between October 2007 and February 2009 under general anesthesia for eye muscle surgery. Three groups were analyzed: 0 to 2 years (n=30), 2 to 6 years (n=68) and older than 6-year-old (n=62). Measurement procedures included Perkins tonometry and contact pachymetry. RESULTS The mean IOP increased progressively with age (P<0.001). Caucasian children had higher IOP than non-Caucasian children (P<0.05). Gender and side were not significantly associated with IOP. There was no significant difference in CCT between the three groups of age. None of the following parameters were significantly associated with CCT: ethnicity, gender and side. CONCLUSIONS Correlation between IOP and CCT remains unclear during childhood. False reassurance might result if high IOP measurements are inappropriately adjusted downward in children with increased CCT.

Assessment of parafoveal cone density in patients taking hydroxychloroquine in the absence of clinically documented retinal toxicity.

To measure cone density in patients taking hydroxychloroquine (HCQ), with no clinical evidence of maculopathy.

Œdèmes maculaires sans diffusion angiographique

PURPOSE To study the OCT (optical coherence tomography) features of cases of unexplained macular edema, which were not combined with fluorescein leakage on angiography. PATIENTS AND METHOD We report a retrospective series of three patients who presented with visual acuity impairment due to unilateral macular thickening visible on OCT examination. All eyes studied underwent OCT and angiography and electrophysiological examinations. None of the patients had a medical record and none of the eyes studied was highly myopic. RESULTS OCT profiles shared characteristics of myopic foveoschisis or X-linked retinoschisis. No fluorescein leakage was detected on angiography. The electrooculogram was impaired in one eye while other electrophysiological investigations were normal in all eyes. DISCUSSION Most frequently, macular edemas are associated with a fluorescein leakage on angiography. Macular edemas without angiographic leakage may correspond to unilateral idiopathic retinoschisis or macular edemas, with an atypical mechanism of intraretinal fluid accumulation.

Article originalMesure de la pression intraoculaire et de l’épaisseur cornéenne centrale d’enfants de zéro à dix ans sous anesthésie généraleSedated intraocular pressure and corneal thickness standards in children from birth to 10 years of age

INTRODUCTION The correlation between intraocular pressure (IOP) and age is poorly studied in children. Thus, the aims of our work are to determine the IOP and central corneal thickness (CCT) standards in children from 0 to 10 years of age and to examine the possible relationship between IOP, CCT and age. METHODS Three hundred and twenty eyes of 160 healthy subjects were examined between October 2007 and February 2009 under general anesthesia for eye muscle surgery. Three groups were analyzed: 0 to 2 years (n=30), 2 to 6 years (n=68) and older than 6-year-old (n=62). Measurement procedures included Perkins tonometry and contact pachymetry. RESULTS The mean IOP increased progressively with age (P<0.001). Caucasian children had higher IOP than non-Caucasian children (P<0.05). Gender and side were not significantly associated with IOP. There was no significant difference in CCT between the three groups of age. None of the following parameters were significantly associated with CCT: ethnicity, gender and side. CONCLUSIONS Correlation between IOP and CCT remains unclear during childhood. False reassurance might result if high IOP measurements are inappropriately adjusted downward in children with increased CCT.

Étude de la réhabilitation visuelle après kératoplastie endothéliale manuelle

OBJECTIVES Evaluation and monitoring at 6 months after Descemets membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial dystrophy and study of factors influencing visual rehabilitation and postoperative quality of life. METHODS Prospective, consecutive, interventional study of 35 eyes of 32 patients with Fuchs endothelial dystrophy who underwent surgery from February 2015 to February 2016 by DMEK. Measurement at D10, M1, M3, M6 of visual acuity, graft endothelial cell density, pachymetry, and intraocular pressure, and performance at M6 of aberrometry, macular OCT and a quality of life survey (NEI-VFQ-25). Post-DMEK aberrations are compared to those from control patients selected for refractive surgery. RESULTS Visual acuity improvement at 6 months was statistically significant (P<0.0001), as well as pachymetry decrease (P<0.0001), endothelial cell loss (P<0.0001) and intraocular pressure increase (P=0.003). We observed a statistically significant difference between post-DMEK aberrations and those of control subjects for all aberrations from 2nd to 5th order. There were no postoperative correlations between visual acuity, pachymetry, intraocular pressure, or endothelial cell loss. The global quality of life score at six months was 87, corresponding to a good quality of life. We did not find a link between the global NEI-VFQ-25 score and visual acuity or visual aberrations. Ninety percent of patients surveyed reported a postoperative general improvement in quality of life at M6. CONCLUSION DMEK provides good visual rehabilitation and an improvement in quality of life for patients with Fuchs endothelial dystrophy. Higher order optical aberrations in these patients, although higher than in a healthy population, are negligible and have no impact on quality of vision or postoperative quality of life.

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.