Comparison of refractive outcomes obtained with two swept-source OCT-based optical biometers after cataract surgery: A study of 152 eyes.

PURPOSE: To compare two swept-source OCT optical biometers, the Anterion® (Heidelberg Engineering GmbH, Heidelberg, Germany) and the IOLMaster 700® (Carl Zeiss Meditec AG, Jena, Germany), in the analysis of biometric data, intraocular lens (IOL) calculation and postoperative spherical equivalent predictability. METHODS: This was a real-life, single-center, retrospective study including 152 eyes of 81 consecutive patients referred for cataract surgery. All patients were examined with the IOLMaster 700® and the Anterion®. Biometric data (axial length [AL], anterior chamber depth [ACD], mean keratometry [Km], K1 [flat keratometry], K2 [steep keratometry] and axis, TK1 [flat total keratometry], TK2 [steep total keratometry], central pachymetry, lens thickness [LT], white-to-white distance [WTW]), IOL calculation with the SRK/T formula, and postoperative refractive outcome at 1 month were compared. RESULTS: All biometric measurements were significantly different between the two biometers. Correlations were excellent for AL, pachymetry, ACD, LT and keratometry measurements, and for the IOL calculation (r>0.96, intraclass correlation coefficient=1). The IOL power for emmetropia was similar between both biometers when the SRK/T formula was used (20.84±3.24D versus 20.86±3.29D, P=0.61). The mean postoperative spherical equivalent prediction error calculated using the SRK/T formula was 0.03±0.5D for the IOLMaster 700® versus 0.01±0.47D for the Anterion® (P=0.12). CONCLUSIONS: This study showed excellent correlation and agreement for the biometric measurements and the IOL power calculation with the SRK/T formula between both biometers.

[Intraoperative opacification of a scleral-fixated Carlevale (Soleko®) intraocular lens]. / Opacification peropératoire d'un implant fixé à la sclère Carlevale (Soleko®).

Thermal shock can cause intraoperative opacification of a Carlevale (Soleko®) implant. This is a rare phenomenon which resolves spontaneously. It is crucial to recognise this phenomenon in order to avoid unnecessary and potentially harmful explantation decisions for the patient.

[Late steroid-induced ocular hypertension after intravitreal dexamethasone implants: A series of 20 cases]. / Hypertonie cortisonique tardive sous implants de dexaméthasone : à propos de 20 cas.

INTRODUCTION: Steroid-induced ocular hypertension (OHT) occurs in approximately one third of cases after dexamethasone implant (DEXi) injection. Among these, more than one fifth occur after the third DEXi intravitreal injection (IVI). Our goal was to analyze the clinical profiles of these late responders. MATERIAL AND METHODS: A real-life, retrospective, observational study was conducted to assess demographic characteristics and intraocular pressure (IOP) responses in late responders (IOP ≥ 21mmHg, n DEXi ≥ 4). The following parameters were analyzed: IOP 2 months after IVI and number of glaucoma medications needed. The IOP response compared to baseline was defined as low (< +6mmHg), moderate (≤ +15mmHg) or high (> 15mmHg). RESULTS: Late steroid-induced OHT occurred in 20.8% of cases. Twenty eyes (18 patients) were included. The mean duration of follow-up was 3.8±1.9 years. They received a mean number of 9.5±4.2 IVI. The first OHT peak, measured at 25.3±3.2mmHg (21-31), occurred after 6.8±2.3 IVI. Approximately 65% of OHT spikes occurred between the fourth and sixth IVI; 35% occurred later. At maximum, 1.7±1.0 glaucoma medications and 0.75±0.79 SLT procedures were required to control the OHT, with no filtering surgery required. The ratio of "low," "moderate," and "high" responders was 5%, 85% and 10% respectively. CONCLUSION: Late steroid-induced OHT occurs after at least 3 DEXi in one fifth of multi-injected patients, requiring long-term IOP monitoring. This case series identifies mostly moderate responder profiles, whose IOP rise often remains well-controlled with medical management or laser treatment (SLT).

[Intraocular pressure elevation and intravitreal steroid implant injection: State of the art in 2023. Recommendations of the French Glaucoma Society and French Ophthalmology Society [French version]]. / Hypertonie oculaire et injection intravitréenne d'implant de corticoïde, état de l'art en 2023. Recommandations françaises SFG/SFO [version française].

These are the recommendations of French glaucoma and retina experts on the management of ocular hypertension (OHT) observed in 1/3 of cases after intravitreal steroid implant injections. They are an update to the recommendations first published in 2017. There are two implants on the French market: the dexamethasone (DEXi) and fluocinolone acetonide (FAci) implants. It is important to know the pressure status before injecting a patient with a steroid implant. Monitoring of the IOP adapted to the specific drug is necessary throughout follow-up and reinjections. Real-life studies have made it possible to optimize the management algorithm by significantly increasing the safety of use of these implants. A corticosteroid test with DEXi is necessary before switching to FAci to optimize the pressure tolerance of the latter. In addition to topical glaucoma medications, SLT laser can be considered in the therapeutic arsenal for the management of steroid-induced OHT and future injections.

Ocular hypertension and intravitreal steroids injections, update in 2023. French guidelines of the French glaucoma society and the French ophthalmology society.

These guidelines are a consensus of French glaucoma and retina experts on the management of ocular hypertension (OHT) observed in a third of the cases after corticosteroid implant intravitreal injections. They update the first guidelines published in 2017. Two implants are marketed in France: the dexamethasone implant (DEXi) and the fluocinolone acetonide implant (FAci). It is essential to assess the pressure status before injecting a patient with a corticosteroid implant. A molecule-specific monitoring of the intraocular pressure is needed throughout the follow-up and at the time of reinjections. Real-life studies have allowed optimizing the management algorithm by significantly increasing the safety of these implants. Corticosteroid testing with DEXi should be performed before switching to FAci to optimize pressure tolerance of FAci. Beyond topical hypotensive treatments, selective laser trabeculoplasty may be considered in the therapeutic arsenal for the management of steroid-induced OHT and subsequent injections.

[Treatment of exudative age-related macular degeneration: Consensus of French experts for first-line treatment selection and the importance of long-term risk/benefit ratio]. / Consensus d'experts français sur les critères de choix d'un traitement de 1re intention dans la DMLA néovasculaire et importance du ratio bénéfice/risque à long terme.

Choosing a first-line treatment to optimize long-term outcomes is a major challenge for treating patients with neovascular age-related macular degeneration (AMD). The development of several new molecules makes it critical to identify the relevant factors to consider so as to provide an optimal risk-benefit ratio when initiating a treatment in naïve patients with neovascular AMD. This paper proposes a consensus established with the Delphi method (which includes a gradation in a consensus based on an analysis of the convergence rate of answers) to provide criteria that guide the ophthalmologist's decision for treatment initiation and follow-up in neovascular AMD patients. Fourteen questions were submitted to 93 French retina experts. Thirteen (93%) of the questions reached a consensus (≥50% of answers consensual). The criteria recommended to take into account were both efficacy and onset of action of the molecules, their safety, and the ability to decrease injection frequency. The primary criterion of expected efficacy of a molecule is a combination of the gain in visual acuity and resorption of retinal fluid. With regard to safety, experts recommend tighter follow-up for molecules currently in development, and at every scheduled visit, patients should be screened to identify early any potential adverse effects such as intraocular inflammation, retinal vasculitis or vascular occlusion. Experts also emphasize the importance of the packaging of the biological, with a preference toward prefilled syringes. Injection frequency is a key factor, and the authors recommended aiming for a maximal injection interval of 12 to 16 weeks. The stability of that maximum interval is also an important factor to consider in treatment selection.

[Treat-and-extend anti-angiogenic protocol in clinical practice for patients with exudative age-related macular degeneration: Consensus of French experts]. / Consensus d'experts français sur la mise en œuvre pratique du régime Treat-and-Extend par anti-angiogéniques chez les patients atteints de DMLA exsudative.

Optimizing treatment regimens for anti-angiogenic drugs is now a major issue in the management of patients with exudative AMD. The evolution of these approaches has led retinologists to favor so-called proactive administration regimens, such as Treat-and-Extend (T&E), which make it possible to anticipate recurrence and to plan intravitreal injections of anti-angiogenic drugs in advance. Nevertheless, a real need to standardize the application of this regimen has been identified. This article proposes a consensus based on the Delphi methodology, which might provide a guide for ophthalmologists to manage patients with exudative AMD using the T&E protocol. While some aspects remain debated to date, this article provides elements to guide the implementation of T&E. The experts recommend that a loading dose of 3 monthly injections should be administered before starting T&E. They also recommend adjusting the reinjection intervals by±2 weeks in a standardized fashion. The intervals are then decreased in the presence of anatomical and/or functional deterioration, maintained when the interval of recurrence is identified, and increased when anatomical and/or functional improvement is observed. A maximum interval between 3 and 4 months is recommended by the experts, with maintenance of the maximum interval for 1 year before considering a possible exit from the T&E protocol. In the event of a significant decrease in visual acuity related to the disease along with significant anatomical degradation, it is recommended to restart monthly injections. In the case of bilateral disease, when synchronized timing of injections for both eyes is desired, the experts recommend using the shorter of the two intervals.

[Descemet's membrane detachment after phacoemulsification: Series of 9 cases]. / Décollement descemétique post-phakoémulsification : à propos de 9 cas.

PURPOSE: Descemet's membrane detachment (DMD) is a rare but potentially serious complication of cataract surgery. Although there are no consensual guidelines regarding the diagnosis or treatment of DMD, incorrect treatment may result in irreversible corneal changes with visual sequellae. The purpose of our study is to describe the diagnosis and treatment of DMD. METHODS: We report a series of 9 cases of DMD, their diagnosis, treatment and outcomes. We tested the HELP protocol retrospectively against our 9 real-life cases. RESULTS: Two cases recovered with simple medical management, 4 required air-bubble descemetopexy, and three required keratoplasty. Our study revealed that the main factor associated with poor outcomes is late diagnosis and management. CONCLUSION: Our series illustrates the importance of proactive management and timely diagnosis by performing anterior segment OCT in the setting of persistent postoperative corneal edema.

Low-power versus medium-power toric intraocular lenses in cataract surgery, about 110 eyes.

PURPOSE: To analyze the refractive predictability of low-power and medium-power toric intraocular lenses (IOL) during cataract surgery. METHODS: A retrospective case series. Patients with low and moderate degrees of astigmatism were treated with either an Alcon AcrySof IQ toric monofocal lens (SN6AT2 or SN6AT3) or a Zeiss toric monofocal lens (709 MP + 1 D or 709 MP + 1.5 D). They were divided into two groups: group 1 with low-power toric IOL (n = 40, SN6AT2 and 709 MP + 1), group 2 with medium-power toric IOL (n = 70, SN6AT3 and 709 MP + 1.5 D). Eyes were evaluated before and 1 month after surgery. Uncorrected distance visual acuity (UDVA), corneal and total astigmatism were compared pre- and postoperatively. Vector astigmatism analysis was evaluated using the Alpins method. IOL alignment was checked postoperatively at slit lamp under pupil dilatation and on photos using Eyesuite® software (Luneau®). RESULTS: More than three-quarters of the patients in each group attained a visual acuity of at least 0.1 LogMAR (0.8) without spectacles. The reduction of total astigmatism was significant in the two groups. The residual refractive astigmatism did not differ between the two groups (P = 0.64) and was less than 0.4 D. More than 80% of patients (82.5 vs 84.3%) presented a postoperative refractive spherical equivalent at ±0.50 D (P = 0.8). Vectorial astigmatism was significantly different in the two groups (0.43 D in group 1, vs 0.27 D in group 2; P = 0.03). CONCLUSION: This is the first study comparing the low- versus medium-power toric IOLs, the most widely used. This study suggests very good refractive results both with low- and medium-power toric IOLs with a single surgical procedure.

[Prospective, monocentric, uncontrolled study of efficacy, tolerance and adherence of cyclosporin 0.1 % for severe dry eye syndrome]. / Étude prospective, monocentrique, non contrôlée de l'efficacité, de la tolérance et de l'adhésion au traitement par ciclosporine 0,1 % au cours des sécheresses oculaires sévères.

PURPOSE: To evaluate the efficacy, tolerability and treatment adherence of Ikervis® (Santen, SAS) (ciclosporine 0.1 %) for first line therapy or following treatment with Restasis® (Allergan, Inc.) (ciclosporine 0.05 %) for severe dry eye syndrome. MATERIAL AND METHODS: A prospective, monocentric, uncontrolled study was conducted between January 2012 and March 2015 on 110 eyes of 55 patients with severe dry eye on first line therapy or previously treated with Restasis® who required the introduction of Ikervis®. Patients' quality of life was assessed before and after treatment was started using a standardized questionnaire (Ocular Surface Disease Index© [OSDI]), clinical efficacy was quantified at the slit lamp, by measurement of the Break Up time Test (BUT) and the Oxford classification. Tolerability and adherence to treatment were measured using a simple questionnaire. RESULTS: A total of 72 eyes of 37 patients were included. Etiologies of dry eye syndrome were dominated by Sjögren syndrome (32 %) and severe ocular surface conditions (48 %). The mean age was 57.7 years (±17.45) and mean follow-up was 458 days (±292). The mean BUT increased by 2.043seconds [1.522-2.563] (P<0.0001). Corneal/conjunctival involvement evaluated by the Oxford classification was also improved with a difference in level of 1.68 [1.290-2.071] (P<0.0001). Ocular Surface Disease Index© (OSDI) decreased by 21.7 [16.372-27.024] (P<0.0001). Treatment tolerability was moderate, with more than 50 % of patients experiencing pain on instillation. Overall satisfaction with treatment was good, with more than 60 % of patients feeling better after initiation of treatment. CONCLUSION: Ikervis® is an effective treatment of severe dry eye. Its indications tend to evolve towards less severe dry eye. However, the tolerability profile remains poor, and an improvement in this would be desirable.

[Toric lens implantation in cataract surgery: Automatic versus manual horizontal axis marking, analysis of 50 cases]. / Implantation torique : comparaison du marquage horizontal manuel versus automatique, à propos de 50 cas.

SUBJECT: The main objective of our study is to evaluate the contribution of automated conjunctival recognition in the alignment of toric implants by comparing the automatic alignment optimized with Callisto™ to the manual marking of the horizontal axis. MATERIALS AND METHODS: We performed a prospective, descriptive, and monocentric study on patients undergoing cataract surgery with toric implantation (Asphina 709 Zeiss), operated by a surgeon with good experience in toricity, between September 2016 and March 2017. We analyzed the agreement between the manual marking of the 0°-180° axis versus the one automatically generated by the Callisto™, as well as the alignment of the IOL and the refractive results at 1 month. RESULTS: We included 50 eyes of 26 patients. The corrected mean astigmatism was 1.9 D. The mean difference between the 2 axes was 4.7° [0°-12.3°]. Only 50 % of the preoperative manual markings were consistent with the automatic measurement (<5°). At one month, the average rotation recorded was 4.3° [0°-29°]. The alignment was identical for 70 % (n=35) of the IOL (≤5°). As for residual subjective astigmatism, it was on average 0.58 D. The mean visual acuity without correction was 8/10 and 55 % had 10/10 without correction. DISCUSSION: The refractive performance depends on the preoperative measurement, the correct alignment of the IOL and its stability in the bag. Our study shows the value of automatic conjunctival recognition in the determination of the axis of peroperative alignment, even in an experienced operator. This precision is essential for a good refractive result, especially since the residual astigmatism in case of misalignment will increase with the power of the implant. CONCLUSION: Our study shows excellent refractive results, whatever the initial astigmatism, using the automatic alignment. The precision of the toric implantation opens the way to the toric multifocal implantation under the best conditions.

Toric lens implantation in cataract surgery: Automated versus manual horizontal axis marking, analysis of 50 cases.

SUBJECT: The main objective of our study was to evaluate the contribution of automated conjunctival registration in the alignment of toric intraocular lenses by comparing automated registration optimized with Callisto® to manual marking of the horizontal axis. MATERIALS AND METHODS: We performed a prospective, descriptive, monocentric study on patients undergoing cataract surgery with a toric intraocular lens (Asphina 709 Zeiss), performed by a surgeon with good experience in toric implants, between September 2016 and March 2017. We analyzed the agreement between the manual marking of the 0-180° axis versus the one automatically generated by the Callisto™, as well as the alignment of the IOL and the refractive results at 1 month. RESULTS: We included 50 eyes of 38 patients. The mean corrected astigmatism was 1,9 D. The mean difference between the 2 axes was 4,7° [0-12.3°]. Only 50 % of the preoperative manual markings were consistent with the automated measurement (<5°). At one month, the mean rotation recorded was 4,3° [0-29°]. The alignment was identical for 70 % (n=35) of the IOLs (≤5°). As for residual subjective astigmatism, the mean was 0.58 D. The mean visual acuity without correction was 8/10 and 55 % saw 10/10 without correction. DISCUSSION: Refractive performance depends on preoperative measurement, correct alignment of the IOL and its stability in the bag. Our study shows the value of automated conjunctival registration in the determination of the intraoperative axis of alignment, even with an experienced surgeon. This precision is essential for a good refractive result, especially since residual astigmatism in the case of misalignment will increase with the power of the implant. CONCLUSION: Our study shows excellent refractive results, regardless of the initial astigmatism, using automated alignment. Precision of toric implantation opens the way to toric multifocal implantation under the best conditions.

[Evaluation of surgical simulation sessions of the French society of ophthalmology. A new surgical instruction method]. / Évaluation des sessions sur simulateurs chirurgicaux de la Société française d'ophtalmologie. Une nouvelle pédagogie chirurgicale.

INTRODUCTION: Since 2013, at the French society of ophthalmology (FSO) meetings, two simulators for intraocular surgeries have been available. The goal of this study was to assess the satisfaction of the participants in these organized training sessions. MATERIALS AND METHODS: A questionnaire was mailed to participants in the FSO sessions as well as those carried out during the annual congress. This questionnaire collected data on the participants and the practical modalities of the sessions, and assessed participants' feelings and satisfaction with these sessions. RESULTS: The participants in the SFO sessions were young members of the SFO (31.8±12.3 years). 53.8 % were in training, looking to improve a problematic surgical step (capsulorhexis in 51.5 %). They spent nearly 5hours on simulators (4.8hours) and were alone on a simulator 50 % of the time. The sessions held during the annual congress were used by older physicians (41.9±26.4 years) already in practice (66.6 %). The goal of such training was curiosity in a third of the cases (to try the simulators). The majority spent less than an hour on the devices and were at least two participants per machine. Despite these differences, participants cited a role for their surgical learning curve and recommended such training to their colleagues. CONCLUSIONS: The participants' enthusiasm for this new training technique is highlighted by the results of this study.