[Imaging of corneal dystrophies: Correlations between en face anterior segment OCT and in vivo confocal microscopy]. / Imagerie des dystrophies cornéennes : corrélations entre l'OCT en face de segment antérieur et la microscopie confocale in vivo.

PURPOSE: To evaluate the usefulness of en face Optical Coherence Tomography (OCT) for evaluation of corneal dystrophies and to describe correlations with in vivo confocal microscopy (IVCM). PATIENTS AND METHODS: Thirty-two eyes of 16 patients with 4 types of corneal dystrophies (epithelial basement membrane dystrophy, Fuchs dystrophy, Reis-Bücklers corneal dystrophy and Crocodile Shagreen dystrophy) were enrolled in this study. Axial and reconstructed en face scans were acquired using OCT. Images were then correlated to IVCM findings. RESULTS: En face OCT provided new insights into the structure, size and depth of corneal tissue alterations in various corneal dystrophies. OCT en face images were well correlated with IVCM features. Despite lower resolution than IVCM, en face OCT offers the advantages of being non-invasive and allowing the analysis of larger corneal areas. CONCLUSION: En face OCT provides useful new information in corneal dystrophies. This imaging technique will probably increase in popularity in the near future for the assessment of various anterior segment diseases.

Corneal imaging of intrastromal femtosecond laser treatment for presbyopia (Intracor(®)).

PURPOSE: To evaluate anatomic appearance and corneal cellular modifications after monocular Intracor(®) procedure with two different anterior segment imaging techniques within the first postoperative year. PATIENTS AND METHODS: Four patients underwent an Intracor(®) procedure in one eye performed at Clinique de la vision, and corneal imaging was performed in Quinze-Vingts National Ophthalmology Hospital. Slit-lamp photography, confocal microscopy with Heidelberg retinal tomography (HRT) and anterior segment spectral-domain optical coherence tomography (OCT) were performed 2 days, and 1, 6, and 12 months after the procedure. RESULTS: Confocal microscopy showed strong cellular activation of keratocytes within the first postoperative month which diminished over time. The linear femtosecond incisions appeared as hyper-reflective regular lines and reflectivity decreased throughout the follow-up period. After 6 months, a fibrotic process with appearance of corneal scars was visible as small intrastromal hyper-reflective lines and thick hyper-reflective spicules around the incisions and remained stable over time. On spectral-domain OCT, the size and depth of the incisions decreased from the center to the periphery. Visibility of the corneal femtosecond incisions on OCT decreased from day 2 until they almost disappeared at 12 months. The incision angles seemed to curve progressively from the center to the periphery in their deep portion on the peripheral rings. CONCLUSION: Corneal cellular modifications found on HRT, anatomical features, and the sizes of the intrastromal rings, may provide valuable information on this new refractive technique.

[Smartphones in ophthalmology]. / Les smartphones en ophtalmologie.

INTRODUCTION: The increased utilization of medical applications for smartphones provides new opportunities for doctors, including ophthalmologists. In this study, we examined the availability of ophthalmological applications in the two largest smartphone app stores (Apple App store and Android Play Store) and then proposed a classification for smartphone ophthalmological applications according to their functionalities. MATERIALS AND METHODS: In November 2012, we searched the Apple App Store and the Android Play Store for ophthalmological themed applications, using numerous ophthalmological keywords. We excluded applications that were not ophthalmology-related. RESULTS: We identified 342 ophthalmological applications. There were two main categories in ophthalmological applications: those for ophthalmologists, and those for patients. DISCUSSION AND CONCLUSIONS: There are numerous benefits of smartphone use for ophthalmologists as well as their patients. Ophthalmological applications are turning cell phones into medical devices. In addition, smartphones may play a very important role in patient education, self-monitoring, and low-vision aids via magnifying systems.

[Acute bilateral angle-closure glaucoma induced by topiramate: contribution of Visante OCT]. / Crise bilatérale de glaucome aigu après traitement par topiramate : apport de l'OCT Visante.

INTRODUCTION: Topiramate, a sulfamate-substituted monosaccharide classically used as an antiepileptic medication, has been widely used since its recent indication for migraine prophylaxis. We report the case of a 68-year-old woman who developed bilateral acute glaucoma following topiramate migraine prophylaxis. OBSERVATION: A 68-year-old woman presented in the emergency department for ocular pain, redness, and bilateral reduced visual acuity associated with nausea and vomiting. Initial examination found a bilateral corneal edema with shallow anterior chambers and closed iridocorneal angles. Intraocular pressure was 40mmHg in the right eye and 45mmHg in the left eye. Ultrasound biomicroscopy diagnosed ciliochoroidal detachment and swollen ciliary processes with closed angles, which was also objectified using the Visante OCT. Topiramate treatment was interrupted and a local and general hypotonic treatment was started. After 4 days, examination showed deeper anterior chambers and normal intraocular pressures. Visante OCT and ocular echography follow-up examinations were normal, and Indoramin was prescribed for migraine prophylaxis with no relapse after 10 months. CONCLUSION: Bilateral acute angle-closure glaucoma is a possible complication of topiramate. Physicians and patients starting this therapy should be aware of this underestimated risk.

[New diagnosis approaches: iridocorneal angle in optical coherence tomography]. / L'angle irido-cornéen en tomographie de coherence optique.

Gonioscopy remains a standard technique to evaluate anterior segment and iridocorneal angle. However, new imaging techniques, particularly high resolution optical coherence tomography (OCT), permit to optimally visualize the anterior segment. Use of OCT in glaucoma diagnosis and follow-up will increase with technical progress and new high speed ultrahigh-resolution OCT.

[Contribution of confocal microscopy and anterior chamber OCT to the study of corneal endothelial pathologies]. / Apport de la microscopie confocale in vivo et de la tomographie en cohérence optique de chambre antérieure pour l'étude des pathologies endothéliales cornéennes.

PURPOSE: To describe the appearance of various endothelial diseases with in vivo confocal microscopy and anterior chamber optical coherence tomography (AC OCT). METHODS: In this study, ten patients with five different corneal endothelial pathologies were evaluated. Three patients had cornea guttata, three had corneal endothelial precipitates, two had irido-corneo-endothelial (ICE) syndrome, one had endothelial folds, and one had breaks in the Descemet membrane. All patients had bilateral ophthalmologic examinations, in vivo confocal microscopy, and AC OCT analysis. RESULTS: In cases of cornea guttata, AC OCT showed a finely embossed line corresponding to the empty intercellular cavities found with in vivo confocal microscopy. Corneal endothelium precipitates had the aspect of round formations suspended with the endothelium. Iris atrophy and irido-corneal synechiae resulting from ICE syndrome were precisely visualized with the AC OCT. CONCLUSION: High-resolution images of the anterior segment could be obtained using the AC OCT. Associated with in vivo confocal microscopy, these two new imaging techniques provide a precise evaluation of endothelial pathologies.

[Utility of the Visante OCT in the follow-up of glaucoma surgery]. / Apport de l'OCT-Visante dans le suivi de la chirurgie du glaucome.

PURPOSE: To evaluate the utility of the Visante OCT in the follow-up of filtering surgery. MATERIAL: and methods: In this study, we evaluated 38 filtering blebs in 31 patients following trabeculectomy (4) and nonpenetrating deep sclerectomy (NPDS). In 11 cases, mitomycin C was used during surgery. In patients who underwent NPDS, a collagen implant was placed within the scleral site in eight eyes and seven eyes had goniopuncture during follow-up. All patients had complete ophthalmologic examination with morphological evaluation of the bleb and intraocular pressure measurement as well as Visante OCT evaluation. RESULTS: The trabeculectomy site as well as the trabeculodescemetic membrane (in NPDS), the scleral flap, the conjunctival flap, the iris, and the relationship between these structures were analyzed. Functioning blebs had a hyporeflective and irregular conjunctival tissue associated with a route for aqueous humor under the scleral flap from the anterior chamber toward the subconjunctival space. This filtration route was also observed within nonfunctioning encapsulated blebs. Flat and encapsulated nonfunctioning blebs had dense and hyperreflective conjunctival tissue. In the particular case of nonfunctioning flat blebs, there was no route for aqueous humor filtration under the scleral flap. CONCLUSION: The Visante OCT is a simple and noninvasive imaging technique with good resolution, allowing the analysis of morphologic changes occurring in eyes after filtering surgery.

[Ultrasound biomicroscopy and physiopathology of congenital iris cysts]. / Ultrabiomicroscopie et physiopathologie des kystes iriens congénitaux.

AIMS: Iris epithelial cysts, congenital or acquired, are rare tumors of the anterior chamber. The use of ultrasound biomicroscopy (UBM) and high-resolution echography (50 MHz) specified the diagnosis and confirmed the developmental hypothesis. METHODS: UBM examination with general anesthesia can provide very good vision of cysts and iris structure similar to histological examination. Successive slices are systematically produced. We report two cases: one in a 3-month-old boy with a pupillary type of pigment epithelial cyst and one in a 23-month-old boy with stromal iris cyst provides new information on iris cysts. RESULTS: UBM can clearly differentiate two types of cyst, with results similar to histological slice examination. UBM slices of iris edge cysts show small cellular parietal groups with stromal echogenicity, with no visible tissular continuity. The stromal cyst has no particularity and no echogenicity. DISCUSSION: The pupillary type of pigment epithelial cyst was generally recognized very early. The great majority of primary iris cysts, particularly those that arise from the iris pigment epithelial layers, are stable lesions that rarely progress or cause visual complications. Their slow progression could be explained by embryological history. Based on a comparison between the aspects of the two observations, the absence of enlargement of the cyst could be explained by the developmental mechanism. CONCLUSION: The advantage of the UBM in diagnosis is confirmed for very young patients, but also in developmental investigations. These case reports also corroborate the migration cellular theory during eye development to explain the appearance of the pupillary type of pigment epithelial cyst.

[Congenital cataract: general review]. / Cataracte congénitale.

Cataract is a loss of lens transparency because of a protein alteration. Etiopathogenesis is poorly understood but new mutations of different developmental genes involved are found in 25% of cases. Frequency of onset, particularly when different ocular development anomalies occur, is related to the lens induction phenomena on the eye's anterior segment structure during embryologic development. Genetic transmission is often found on the dominant autosomal mode. Diagnosis is based on a complete and detailed examination of the eye, often with general anaesthesia. This condition predisposes children to later, sometimes serious amblyopia. Different clinical aspects can be observed: from cataract with ocular and/or systemic anomalies to polymalformative syndrome, skeletal, dermatological, neurological, metabolic, and genetic or chromosomal diseases. A general systematic pediatric examination is necessary. Congenital cataract requires first and foremost early diagnosis and a search for all etiologies. Surgical treatment is adapted case by case but it has progressed with the quality of today's intraocular lenses even if systematic implantation continues to be debated. Life-long monitoring is absolutely necessary.