Effect of interaction of macroaberrations and scattered light on objective quality of vision in pseudophakic eyes with aspheric monofocal intraocular lenses.

PURPOSE: To assess the impact of wavefront ocular aberrations on objective vision quality and depth of focus in pseudophakic patients. SETTING: University Hospital Bretonneau of Tours, Francois Rabelais Medicine Faculty of Tours, France. DESIGN: Cohort study. METHODS: Consecutive eyes having implantation of an aspheric monofocal intraocular lens (IOL) (Acri.Smart) were studied. Aberrometry measurements were performed under mesopic conditions with a 6.0 mm pupil using a Wavescan aberrometer. Objective evaluation of optical vision quality was performed using the Optical Quality Analysis System II. The 3 measurements were the modulation transfer function values (MTF cutoff); objective depth of focus, which was computed as the focus range at which Strehl ratio did not fall below 50% of the maximum; and the objective scatter index. RESULTS: Fifty-four eyes (30 patients) were enrolled. Six months postoperatively, MTF cutoff values were increased with decreasing total ocular spherical aberration, ocular trefoil, and 2nd-order astigmatism (P<.05). Objective depth of focus was positively correlated with 2nd-order astigmatism (r(2) = 0.171, P<.001) and total spherical aberration (r(2) = 0.091, P=.028). Objective scatter was more beneficial for depth of focus, with a significantly positive correlation with this parameter (r(2) = 0.28, P=.002), than compromising of optical quality (no significant correlation with MTF measurements in same multiple regression analysis). CONCLUSION: Three ocular aberrations (2nd-order astigmatism, trefoil, spherical aberration) seemed to interact with objective contrast sensitivity and depth of focus, whereas residual spherical aberration exerted opposite effects on image quality in individual patients.

Effect of residual ocular spherical aberration on objective and subjective quality of vision in pseudophakic eyes.

PURPOSE: To determine the level of residual spherical aberration that gives the best objective and subjective quality of image after cataract surgery with intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, CHU Bretonneau, Tours, France. DESIGN: Cohort study. METHODS: Six months after microincision (1.8 mm) cataract surgery with aspheric IOL implantation, total aberrations were computed using a Wavescan aberrometer. The modulation transfer function (MTF), Strehl ratio, and objective index of scattering were measured using the Objective Quality Analysis System. Objective depth of focus was computed as the focus range at which the Strehl ratio did not fall below 50% of maximum. Subjective depth of focus was calculated as the difference between the vergence of the punctum remotum and that of the punctum proximum. RESULTS: Thirty patients (54 eyes) were evaluated. The MTF cutoff values were higher with decreasing total ocular spherical aberration (r = 0.56; P < .05). Objective and subjective depth of focus were positively correlated with total spherical aberration (r = 0.26 and r = 0.46, respectively; P < .05). CONCLUSIONS: A final spherical aberration of zero obtained by compensation of IOL asphericity gave the greatest improvement in objective quality of vision and better MTF contrast. However, a final target ocular spherical aberration between 0.07 µm and 0.10 µm should be considered to be the best compromise between subjective depth of focus and objective contrast sensitivity. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Measurement of corneal aberrations for customisation of intraocular lens asphericity: impact on quality of vision after micro-incision cataract surgery.

AIMS: To compare the quality of vision of patients with customised aspheric intraocular lenses (IOL) versus patients implanted with zero-aberration IOL after a 1.8 mm micro-incision cataract surgery (MICS). METHODS: Fourty-three eyes were divided into two groups: 17 eyes (reference group) received zero aberration Acri.Smart 46LC and 26 eyes received a customised-aspheric IOL: either aspherical Acri.Smart 36A, generating a -0.18 microm SA compensation equivalent, or zero-aberration Acri.Smart 46LC. IOL asphericity was individually selected according to the corneal spherical aberration (SA) in order to produce a residual ocular SA close to +0.10 microm. Refraction, best-corrected visual acuity (BCVA), contrast sensitivities, ocular wavefront aberrations and objective quality of vision assessment were analysed 6 months after MICS. RESULTS: Postoperative BCVA was similar in both groups (p=0.58). Mesopic contrast sensitivities were significantly better in the custom group at intermediate and high spatial frequencies (p<0.001), while photopic contrast sensitivities were similar. Total SA was significantly lower in the custom group (Z(4)(0)=0.085+/-0.075 vs 0.261+/-0.091 microm, p<0.001), whereas no difference was found in preoperative corneal SA. Modulation transfer function cut-off frequency was higher in the custom group than in the reference group (34.3+/-8.1 vs 23.57+/-8.6 cycles per degree, respectively; p=0.008). CONCLUSION: Individual selection of IOL asphericity with a preoperative corneal SA measurement allowed control of final ocular SA. Such customisation improves mesopic contrast sensitivity, and leads to better objective quality of vision.

[0.05% cyclosporine a for treatment of chronic severe ocular surface disease]. / La ciclosporine A à 0,05 % dans les troubles chroniques sévères de la surface oculaire.

OBJECTIVE: To evaluate the effects of topical cyclosporin A on severe and corticodependent chronic ocular surface disorders (OSD), in immune inflammatory disease. DESIGN: Experimental study, Centre hospitalier universitaire (CHU) Bretonneau, Tours, France. PARTICIPANTS: Twenty-one patients diagnosed with dry eye syndrome secondary to vernal keratoconjunctivitis (7 cases), atopic keratoconjunctivitis (8 cases), and ocular rosacea (6 cases) were treated twice a day with a 0.05% cyclosporin ophthalmic emulsion. METHODS: Corneal and conjunctival staining, Oxford score, and symptoms severity assessment (OSDI score) were conducted from the beginning of the cyclosporin treatment up to the end of study. Other collected data included visual acuity, intraocular pressure measurements, an adverse effects questionnaire, and evaluation of the use of adjunctive corticosteroids therapy. RESULTS: Topical cyclosporin 0.05% gave significant long-term improvement of visual acuity (p = 0.018), symptoms severity (OSDI score, p = 0.001), corneal and conjunctival staining (van Bijesterveld score, p = 0.0003), and Oxford score (p = 0.0002). Topical cyclosporin allowed for less corticosteroid treatment in all cases (p = 0.04), and broke it off with no long-term recurrence in 15 cases (71%). No severe adverse effect occurred, but 3 patients (14%) stopped cyclosporin treatment because of increasing ocular symptoms. CONCLUSION: Given our results, topical cyclosporin represents a new well-tolerated treatment for severe and corticodependent chronic ocular surface disorders. In monotherapy or in association with a corticotherapy, topical cyclosporin could be efficient in any OSD involving immune-based inflammation.

Acute and late-onset optic atrophy due to a novel OPA1 mutation leading to a mitochondrial coupling defect.

PURPOSE: Autosomal dominant optic atrophy (ADOA, OMIM 165500), an inherited optic neuropathy that leads to retinal ganglion cell degeneration and reduced visual acuity during the early decades of life, is mainly associated with mutations in the OPA1 gene. Here we report a novel ADOA phenotype associated with a new pathogenic OPA1 gene mutation. METHODS: The patient, a 62-year-old woman, was referred for acute, painless, and severe visual loss in her right eye. Acute visual loss in her left eye occurred a year after initial presentation. MRI confirmed the diagnosis of isolated atrophic bilateral optic neuropathy. We performed DNA sequencing of the entire coding sequence and the exon/intron junctions of the OPA1 gene, and we searched for the mitochondrial DNA mutations responsible for Leber hereditary optic atrophy by sequencing entirely mitochondrial DNA. Mitochondrial respiratory chain complex activity and mitochondrial morphology were investigated in skin fibroblasts from the patient and controls. RESULTS: We identified a novel heterozygous missense mutation (c.2794C>T) in exon 27 of the OPA1 gene, resulting in an amino acid change (p.R932C) in the protein. This mutation, which affects a highly conserved amino acids, has not been previously reported, and was absent in 400 control chromosomes. Mitochondrial DNA sequence analysis did not reveal any mutation associated with Leber hereditary optic neuropathy or any pathogenic mutations. The investigation of skin fibroblasts from the patient revealed a coupling defect of oxidative phosphorylation and a larger proportion of short mitochondria than in controls. CONCLUSIONS: The presence of an OPA1 mutation indicates that this sporadic, late-onset acute case of optic neuropathy is related to ADOA and to a mitochondrial energetic defect. This suggests that the mutational screening of the OPA1 gene would be justified in atypical cases of optic nerve atrophy with no evident cause.

Unusual pharmacokinetics of intravitreal and systemic voriconazole in a patient with Scedosporium apiospermum endophthalmitis.

In this paper, we report a case of a post-traumatic Scedosporium endophthalmitis treated with a posterior vitrectomy, followed by intravitreal injections and systemic voriconazole. This is the second documented case of S. apiospermum endophthalmitis treated with voriconazole and the first case with intravitreal injections of voriconazole. A 29-year-old man developed endophthalmitis after being struck in the left eye by a chip from a swimming pool pump. Despite 3 weeks of prophylactic antibiotherapy, his visual acuity remained only for the perception of light and vitreous inflammation increased. A creamy-white fungal mass grew at the inferior peripheral retina and pars plana. The fungus was identified as S. apiospermum. Oral voriconazole, at 200 mg twice-daily, did not bring the infection under control, considering the low plasma and intravitreal concentrations. Before steady-state plasma voriconazole concentrations reached an efficacy level greater than minimum inhibitory concentration of Scedosporium, intravitreal injections of 64 ug/0.1 mL of voriconazole were initiated twice-weekly for 3 weeks. Administration of higher intravenous voriconazole doses (6 mg/kg b.i.d.) for 6 weeks was needed to achieve an antifungal effect without systemic dissemination.