Ex vivo porcine model for eye, eyelid, and orbit movement analysis of 4-mm ferromagnetic foreign bodies in MRI.

PURPOSE: Ferromagnetic foreign bodies (FFB) present during magnetic resonance imaging (MRI) explorations can lead to tissue injury due to movement, especially in and around the eyes. Ferromagnetic foreign bodies located in the intraocular area, eyelids, and orbit are thus prohibited from undergoing MRI. The aim of the study was to analyze movement of 4-mm ferromagnetic foreign bodies in MRI in the eye, eyelid, and orbit using computed tomography (CT) scan. METHOD: We developed a porcine model using 12 quarters of fresh porcine heads. Each porcine head included one whole orbit with the ocular globe, orbital fat, muscles, and eyelids. Four-millimeter FFB were implanted in the eye within 2 days post-slaughter, and images were acquired within 5 days post-slaughter. Four-millimeter FFB movement was analyzed after 1.5-Tesla (T) MRI. Four locations were tested: intravitreous, suprachoroidal, intraorbital fat, and intrapalpebral. Movement analysis was assessed using computed tomography (CT) scan. RESULTS: The intravitreous ferromagnetic ball moved 14.0 ± 8.8 mm (p < 0.01), the suprachoroidal ball moved 16.8 ± 5.4 mm (p < 0.01), the intraorbital fat ball moved 5.8 ± 0.9 mm (p > 0.05), and the intrapalpebral ball moved 2.0 ± 0.4 mm (p > 0.05). CONCLUSION: The ex vivo porcine model was able to study FFB movement. The 4-mm ferromagnetic balls moved in intravitreous and in suprachoroidal locations after MRI.

[Feedback on ophthalmologic telemedicine in a nursing home]. / La télé-ophtalmologie en EHPAD : retour d'expérience.

INTRODUCTION: Ophthalmologic care needings increase whereas the numbers of ophthalmologist decrease. Oldest people who are often vulnerable and dependent populations are particularly affected in difficulty to access to health services. To resolve the problem, the use of telemedicine in ophthalmology could be an alternative. MATERIALS AND METHODS: From June 2018 to November 2018, patients from Janzé Hospital (Ille et Vilaine) did an ophthalmologic teleconsultation during their stay. Teleconsultation was based on visual acuity, intraocular pressure measurement, wild-field retinophotography and optical coherence tomography performed by an orthoptist and a videoconference with an ophthalmologist. RESULTS: Sixty-seven patients underwent teleconsultation (60 % women, 40 % men). Mean age was 83 (standard deviation±8). Fifty-four percent (36) of consultations were complete. Retinophotography was missing in 45 % of cases (30) and optical coherence tomography in 53 % of cases (35). Ophtalmologic pathologies were detected in 37 patients (55 %) and we start medical care in 14 (38 %) of the patients. We gave glasses prescription to 45 % (30) of the patients. Eighteen percent (10) of the patients required a physical consultation. LogMar distance visual acuity was significantly improved from 0.67 (±0.76) to 0.52 (±0.72) (P<0.0001) and LogMar near visual acuity was significantly improved from 0.68 (±0.84) to 0.53 (±0.76) (P<0.0001). Low vision proportion was significantly decreased from 54 % to 39 % (P=0.02; OR=1.86; IC95 % [1.06-3.28]) after our intervention. DISCUSSION: This experiment gives the opportunity to old, vulnerable and dependent population that has no longer access to classical consultation to access eye care. At the same time, consultation informs the nursing home caregivers about the visual health status and provides environment improvement. CONCLUSION: Teleconsultation is an alternative to classical consultation especially in dependent population. This experiment could be a starting point to the development of this solution in social health-care institutions.

Feedback on ophthalmologic telemedicine in a nursing home.

INTRODUCTION: The need for ophthalmologist appointments is increasing, while the number of practitioners is decreasing. Elderly patients, who may be dependent and isolated, are the most affected by this barrier to care. In order to get around this obstacle, telemedicine visits might be an alternative. MATERIALS AND METHODS: From June 2018 to November 2018, patients in the housing facility for dependent elderly individuals (EHPAD) at the Janzé (Ille-et-Vilaine) Medical Centre participated in an ophthalmology telemedicine visit during their stay. The telemedicine visit included measurement of visual acuity, intraocular pressure, wide field fundus photography, and optical coherence tomography (OCT) performed by a technician, and a videoconference with an ophthalmologist. RESULTS: Sixty-seven patients aged 83±8 years (60% women and 40% men) underwent a telemedicine visit. The visit was completed in 36 (54%) cases. The fundus photography was not performed in 30 (45%) cases, and the OCT was not performed in 35 (53%) cases. We diagnosed an ophthalmologic disease in 37 (55%) patients, with medical management having begun in 14 (38%) of them. A prescription for corrective lenses was given in 30 patients (45%). Following our visit, mean logMar visual acuity experienced a statistically significant improvement from 0.67 (±0.76) to 0.52 (±0.72) (P<0.0001) for distance vision and from 0.68 (±0.84) to 0.53 (±0.76) (P<0.0001) for near vision. Eighteen per cent of patients (10) required transportation to an in-person ophthalmologist visit for continued management. With regard to low vision, the proportion of low-vision eyes experienced a statistically significant decrease from 54% to 39% [P=0.02; OR=1.86; 95% CI (1.06-3.28)] following our visit. DISCUSSION: This experiment allowed an isolated, dependent patient population without access to classic office visits to gain access to clinical care. In addition to providing eye care to the patients, the visit increased awareness amongst the caregivers of the vision status of the residents, allowing them to adapt their environment accordingly. CONCLUSION: Telemedicine is an alternative to classic physician visits, particularly for very dependent, institutionalised patients. This experiment might serve as a point of departure for generalised adoption of these solutions within extended care facilities.

[Telemedicine monitoring for AMD patients]. / Suivi en télémédecine des patients atteints de DMLA.

INTRODUCTION: AMD follow-up is a public health issue in developed countries due to aging of the population and medical demographics. Telemedicine may be a means of improving follow-up. PURPOSE: To compare the agreement between telemedicine and in-person consultations in terms of indications for intravitreal injections in exudative AMD patients. MATERIALS AND METHODS: From January 2017 to April 2017, AMD patients followed on a PRN protocol at a single center, Rennes university medical center, were included. The telemedicine evaluation was read by two anonymous experts on the basis of the medical record including visual acuity and fundus photographs. The agreement between conventional follow-up and telemedicine in terms of indications for intravitreal injections, as well as interobserver agreement, were tested with the Cohen's kappa coefficient using SAS statistical software V9.4 (SAS Institute, Cary, NC). RESULTS: In total, 104 eyes corresponding to 57 consultations for 42 patients were analyzed. The mean age was 82.12 years (standard deviation±6.4). Recommendations for anti-VEGF were similar between the standard and telemedicine visits in 97 % of cases. The Kappa coefficient was 0.8861 [0.76; 1.00], P<0.0001 for agreement between telemedicine and in-person consultation. The Kappa coefficient was 0.8441 [0.70; 0.99], P<0.0001 for interobserver agreement. We observed 5 cases of disagreement between the two observers. DISCUSSION: The concordance was very good in our study. The few cases of disagreement resulted mainly from poorly interpretable examinations due to poor image quality, major macular changes in patients with a prior examination, and the fact that only a single cut was analyzed. CONCLUSION: AMD monitoring by telemedicine seems promising and reliable. This approach would allow better follow-up of patients with difficult access to care.

[Corneal topography in practice]. / Topographie cornéenne en pratique.

Corneal surface analysis is now more and more accurate. Corneal topography is a gold standard in corneal pathology follow-up: keratoconus, corneal grafts, orthokeratology. In refractive surgery, cornea ectasia post-Lasik must be avoided. Analyzing anterior and posterior surface can detect forme fruste keratoconus FFKC. Topography allows also better predictability of premium intraocular implants surgery. Topography is key examination and its interpretation is essential.

Corneal topography in clinical practice.

Developments in corneal topography allow for increasingly precise, detailed analysis of the corneal surface. This test is becoming indispensable in the treatment of complex corneas: keratoconus, corneal transplants, orthokeratology, etc. In refractive surgery, the combined analysis of the anterior and posterior cornea has permitted better screening for forme fruste keratoconus at risk for post-LASIK ectasia. Topography also assists in the calculation of premium intraocular lenses. Topography is an indispensable test for analyzing and following corneal disease.