[Intravitreal anti-VEGF injections: The patient's experience]. / Injections intravitréennes d'anti-VEGF : ressenti du patient.

INTRODUCTION: Intravitreal anti-VEGF injections (IVI) represent a therapeutic revolution in the treatment of many retinal pathologies. Despite their safety and efficacy, some patients may experience significant discomfort and anxiety during the procedure. The goal of this study was to evaluate the experience of the patient receiving intravitreal anti-VEGF injections. METHODS: This was a prospective study to evaluate the experience of patients before, during and after intravitreal anti-VEGF injection. It included the evaluation of pain and fear by a visual analog scale from 0 to 10 (0 = absence of pain/fear). RESULTS: In total, 139 patients were included in our study, with a mean age of 57.5 ± 10.5 years. The pain assessment scores were higher during these steps of the procedure: insertion of the speculum, insertion of the needle and removal of the pre-cut drape. A feeling of fear was mainly expressed by the group of patients who had received fewer than three IVI. CONCLUSION: There is considerable variation in the patient experience during the various stages of the injection procedure and depending on the number of injections received. The use of a screw speculum, application of a cotton swab soaked in anesthetic, and application of the drape adhesive away from the eyebrow could improve the patient's tolerance and experience.

[Palpebral marginoplasty in the management of distichiasis: About 104 eyes]. / La marginoplastie palpébrale dans la prise en charge du distichiasis : à propos de 104 yeux.

Distichiasis is an anomaly of the of the eyelid margin characterized by the presence of a second row of eyelashes arising from the posterior lamella. It is a rare condition whose severity is related to corneal complications. There are two forms: congenital and acquired, the latter of which is the most frequent in our population, resulting mainly from chronic inflammation. There are several treatment modalities, the choice of which is up to the practitioner depending on the means at his or her disposal and the risk-benefit ratio. We report a series of 104 eyes (90 patients) undergoing surgery for distichiasis using the marginoplasty technique with labial mucosal autograft, collected between January 2000 and September 2021. The main indication was any distichiasis with more than seven lashes per eyelid. The mean age of the patients was 65.5 years. With a mean follow-up of over 24 months, a reduction in functional signs was noted in over 95% of cases. The success rate after marginoplasty with labial mucosal autograft alone was 82.7%. The recurrence rate was 17.3%, which patients underwent additional treatment by argon laser photoablation with very good final results (96% final success rate). Marginoplasty with labial mucosal autograft represents a technique of choice in distichiasis threatening the cornea, particularly in cases of distichiasis with a significant number of eyelashes to be treated.

[Argon laser trichiasis treatment: Technique, indications and results (report of 230 cases)]. / Traitement des cils trichiasiques au laser argon : technique, indications et résultats (à propos de 230 cas).

Trichiasis is a common misdirection of the eyelashes, creating a sharp point responsible for decreased vision, blepharospasm and corneal irritation. It may cause neurotrophic corneal disease leading to blindness. The etiology of trichiasis remains largely undetermined in our patient base. Treatment is based on pragmatic methods that take into account the ciliary ecosystem and the static and dynamic examination of the eyelids. For this, several therapeutic modalities exist: mechanical epilation, cryotherapy, surgery and electrolysis. Each of these techniques has its indications, advantages, and complications. Destruction of the lash follicles with argon laser has many advantages: it is an outpatient procedure, rapid, reproducible, well tolerated, and above all, effective in the long term. The aim of our study is to examine the advantages, technique, indications and results of argon laser trichiasis treatment. This was a retrospective study including 201 patients (230 eyelids) treated in our ophthalmology department over a period of 9years (from January 2011 to March 2020), all of whom were seen for various lash-related symptoms and treated with argon laser electrolysis. Results were considered satisfactory when no lash regrowth occurred within six months of the last laser session. Eighty-two percent of our patients (n=188) showed a good therapeutic response after the first session, 9% (n=21) needed an additional session, and only 6% of the patients (n=14) required a 3rd and/or 4th session, without resorting to surgery. The indications for this treatment should be limited to trichiasis of fewer than or equal to 7 per eyelid, without associated lid malposition (entropion), the treatment of which should be surgical and entirely different. Treatment of trichiasis with argon laser can be an alternative or complement to surgery. Results are excellent but require rigorous adherence to the technique and indications.

[Social media and its impact on ophthalmology training]. / Réseaux sociaux : quel impact sur la formation en ophtalmologie ?

For the past ten years or so, the emergence of social media has disrupted modes of communication and social interaction, in both the personal and professional arenas; it also plays a major role in medical education. The goal of our work is to assess the current degree of use of social media by ophthalmology residents and its effect on the learning process. Our results show that social media were used by all the residents interviewed; the mean time spent on social media was 3.08±1.98 hours per day, of which 1.08±1.014 minutes were devoted to education; over half of the residents use social media between one and two hours per day for medical education. YouTube is the most widely used social network for medical education, followed by Instagram and Facebook. Ninety-eight percent feel that social media can improve their training; 92% feel that social media may become increasingly more important in medical education.

[The effects of corneal cross-linking on intraocular pressure measurement in keratoconus]. / Les effets du cross-linking cornéen sur la mesure de pression intra-oculaire dans le kératocône.

Cross-linking (CXL) is a technique whose design aims to achieve a specific goal: to harden the corneal tissue of eyes with a progressive form of keratoconus. Other indications are being investigated, such as treatment of infectious keratitis and prevention of corneal ectasia post corneal ablative refractive surgery. Hardening the cornea means changing its biomechanical properties. The existence of true corneal hardening after CXL would inevitably result in an increase in measured intraocular pressure (IOP). This would have a considerable impact in the screening and follow-up of glaucoma patients who have undergone cross-linking because of the central role of IOP measurement in glaucomatous pathology.

[Anterior lamellar resection with lid margin split of the upper eyelid in the treatment of trachomatous entropion]. / Marginoplastie par recul de la lamelle antérieure dans le traitement de l'entropion trichiasis trachomateux de la paupière supérieure.

INTRODUCTION: The goal of this study is to assess functional and aesthetic results of anterior lamellar resection with lid margin splitting of the upper lid in the treatment of cicatricial trachomatous entropion. PATIENTS AND METHODS: Descriptive cross-sectional study of a series of 26 consecutive patients treated between January 2014 and December 2015. All patients were operated for cicatricial trachomatous entropion in our tertiary center using the technique of the anterior lamellar resection with lid margin splitting of the upper eyelid. All patients were followed for 6 to 12 months after surgery. The anatomical, functional and aesthetic results were evaluated six months after surgery. They were considered good if there was no recurrence of the entropion, no lashes in contact with the cornea and no associated eyelid complications. RESULTS: The mean age of the patients was 68.5±10 years with a male predominance (sex ratio=1.8). The average initial corrected visual acuity was 0.65±0.35 LogMAR, ranging from counting fingers at 1m to 6/10. Involvement was bilateral in 34.6% of cases. Correction of the cicatricial entropion was achieved in 24 patients (92.3% of cases) and full correction of misdirected lashes without any contact with the ocular surface was obtained in 23 patients (88.4% of cases). The lid margin was regular in 88.4% of cases. A significant improvement of the tear film and corneal surface was observed in 84.6% of patients. During the follow-up period, no cases of recurrent entropion were reported. DISCUSSION: Among the various surgical techniques, anterior lamellar resection with lid margin splitting is one that most respects the anatomy of the upper eyelid and allows precise intraoperative control of eyelid rotation and eversion of the misdirected lashes. Therefore, it reduces significantly the risk of recurrence and significantly enhances the aesthetic results of surgery. CONCLUSION: Anterior lamellar resection with lid margin splitting of the upper eyelid is a simple and effective technique that significantly improves the aesthetic result of cicatricial trachomatous entropion.

[Role of Köllner-Hughes tarsoconjunctival flap in the reconstruction of large eyelid defects]. / Intérêt du lambeau tarsoconjonctival de Köllner-Hughes dans la reconstruction des larges défects palpébraux.

PURPOSE: To evaluate the aesthetic and functional results of the Köllner-Hughes tarsoconjonctival flap technique for large defects of over three-quarter of the lower eyelid. PATIENTS AND METHODS: A retrospective descriptive study of a series of 15 patients treated between January 2013 and December 2015. We included all patients who underwent reconstructive surgery for a tumor involving more than three-quarter of the lower eyelid and sparing the canthi. Reconstruction of the lower eyelid defect was performed using Köllner-Hughes technique. RESULTS: The mean age of our patients was 65.7±8 years. The sex ratio was 1.5 with male predominance. All patients had well-differentiated basal cell carcinoma of the lower eyelid. The average size of the eyelid defect induced by the surgery was 18±4mm. Release of the tarsoconjonctival flap was performed after a period of 8 to 10 weeks after the reconstructive surgery. After a mean follow-up of 12±6 months, the aesthetic and functional results were satisfactory in 86.7% of cases especially in terms of eyelid closure and protection of the ocular surface. Complications included erythema of the newly formed free edge in 26.7% of cases, keratinization and hypertrophy of the free edge in 20% of cases, the deformation of the upper free edge with an associated entropion in 20% of cases and lower eyelid retraction in 6.67% of cases. Ocular surface disease such assuperficial punctate keratitis or dry eye was found in 13.4% of cases. DISCUSSION: Several authors have chosen the Köllner-Hughes technique to treat increasingly wide eyelid defects with very satisfactory results. Eyelid reconstruction with the Köllner and Hughes technique is a very attractive procedure because it offers several advantages. It is a quick and easy technique that covers wide defects over three-quarter of the lower eyelid well with very satisfactory cosmetic results and without significantly increasing morbidity at the donor site. In combination with additional procedures, this technique can totally reconstruct the lower eyelid. Despite all its benefits, the Köllner-Hughes tarsoconjonctival flap has some minor drawbacks, such as the need for two surgeries spaced a few weeks apart to open the palpebral fissure; therefore it is contraindicated for one-eyed patients and children because of the risk of amblyopia. CONCLUSION: The tarsoconjonctival flap as initially described by Köllner and Hughes was indicated in the reconstruction of moderate and medium-sized defects of the lower eyelid. In our practice, we can extend the indications of this technique to much larger defects than three-quarter of the lower eyelid, while ensuring satisfactory aesthetic results and minimal complications.

[Treatment of congenital ptosis by frontalis suspension with monofilament polypropylene suture: results of a study of 21 cases]. / Traitement du ptosis congénital par suspension au muscle frontal par fil de polypropylène : résultats d'une étude de 21 cas.

INTRODUCTION: Frontalis suspension of the upper eyelid using suture in the treatment of congenital ptosis has long been considered a temporary solution when there is a risk of amblyopia. It helps to clear the visual axis pending further surgery after the age of 4 years. Polypropylene suture (Prolene(®)), which is an inert material with optimum scarring properties and tensile strength and good knot stability, has shown very encouraging functional and aesthetic results and low recurrence rates. MATERIAL AND METHODS: Retrospective descriptive study of a series of 21 patients, between January 2008 and December 2012, with severe congenital ptosis and poor or no function of the levator muscle of the upper eyelid. RESULTS: In our series, the recurrence rate of ptosis was 14.3% with a mean follow-up of 25.9 ± 10.8 months. We found 3 cases of under-correction, and one case of granulomatous inflammation with infection. DISCUSSION: The use of polypropylene suture seems to be a very good alternative to conventional materials for suspension, such as fascia lata, temporalis fascia and polytetrafluoroethylene (PTFE or Goretex(®)). The advantages of this technique are the ease of removal, low cost and lower associated morbidity. CONCLUSION: Eyelid suspension with polypropylene suture is an easy, rapid, reversible and inexpensive technique. The results in the short and medium terms are very encouraging, and we need longer follow-up to evaluate the long-term results.

[Use of bevacizumab in the treatment of complicated proliferative diabetic retinopathy]. / Utilisation du bévacizumab dans le traitement de la rétinopathie diabétique proliférative compliquée.

INTRODUCTION: Diabetes is the leading cause of neovascular vitreoretinal proliferation. Several recent publications have appeared showing the efficacy and safety of intravitreal bevacizumab (IVT) in proliferative or complicated diabetic retinopathy (PDR), but with no consensus on the injected dose. We report the results of its use as adjuvant intravitreal injection (IVT) prior to posterior vitrectomy in the setting of complicated PDR. The goal of our work is to evaluate the benefits of and try to establish a protocol for proper use of intravitreal bevacizumab prior to vitrectomy for complicated PDR, so as to incorporate it in the management of this disease. PATIENTS AND METHODS: A prospective comparative study of series of patients hospitalized for severe complicated PDR requiring vitrectomy was spread over one year, from January 2011 to December 2011. Included patients were divided into two groups: group A: receiving an injection preoperatively at a dose of 1.25mg, and group B, which received an injection of bevacizumab at a dose of 0.75mg (with a time to surgery of either less than 3 days, more than 6, or 3 to 6). We analyzed the epidemiological characteristics, data from the initial eye examination and intraoperative complications and follow-up after vitrectomy. RESULTS: Thirty-five patients were included. We noted no significant difference in epidemiological characteristics between group A and B. Sixty percent of patients underwent surgery after a period of three to six days post-IVT. The reduction of neovascularization, decreased risk of bleeding and the facilitation of membrane peeling during surgery were significantly similar between group A and B. No complication related to the molecule and no recurrence, including bleeding, were noted throughout follow-up in both groups. CONCLUSION: We opt for a systematic use of anti-VEGF, particularly bevacizumab prior to all vitrectomies for complicated PDR. A 0.75mg dose at an interval of 3 to 6 days seems to be a good compromise between the desired effect and possible complications that may arise.