[Influence of cataract surgery on Meibomian gland dysfunction (French translation of the article)]. / Influence de la chirurgie de la cataracte sur le dysfonctionnement meibomien.

PURPOSE: To evaluate the influence of cataract surgery on meibomian gland dysfunction, in particular on postoperative functional symptoms. PATIENTS AND METHODS: Thirty patients who underwent cataract surgery were included in the study. A clinical examination (OSDI questionnaire, measurement of tear break up time [TBUT], corneal staining, meibomian gland expressibility test) and a paraclinical evaluation (loss of Meibomius glands [LMG] measured using ImageJ on meibography, conjunctival redness and non-invasive tear break up time [NIK-BUT]) were performed preoperatively and at 1 month and 3 months after phacoemulsification. RESULTS: TBUT and meibomian gland expressibility were worsened at 1 month and 3 months postoperatively (P<0.05). LMG was significantly more important for the upper eyelid and the mean at 1 month (33.1±15.2 P=0.02; 28.5±15.6 P=0.025, respectively) and 3 months postoperatively (36.5±17.4 P=0.0005; 31.2±17.4 P=0.0002, respectively) than preoperative values (29.4±15.3; 26±15, respectively). There was a significant correlation between LMG on the upper eyelid preoperatively and the OSDI score at 1 month postoperatively (R=0.37; P=0.05). CONCLUSION: The meibomian gland loss in the upper eyelid is associated with an increased postoperative ocular discomfort score. Alterations in the meibomian gland expressibility and TBUT persist for up to 3 months postoperatively suggesting a direct role of cataract surgery by an obstructive mechanism.

Influence of cataract surgery on Meibomian gland dysfunction.

PURPOSE: To evaluate the influence of cataract surgery on Meibomian gland dysfunction, in particular on postoperative functional symptoms. PATIENTS AND METHODS: Thirty patients who underwent cataract surgery were included in the study. A clinical examination (OSDI questionnaire, measurement of tear break-up time (TBUT), corneal staining, Meibomian gland expression test) and a paraclinical evaluation (Meibomian gland loss [MGL] measured using ImageJ on Meibography, conjunctival hyperemia and non-invasive keratograph break-up time [NIK-BUT]) were performed preoperatively and at 1month and 3months after phacoemulsification. RESULTS: TBUT and Meibomian gland expressibility were worsened at 1month and 3months postoperatively (P<0.05). MGL was significantly higher for the upper eyelid and the mean at 1month (33.1±15.2, P=0.02; 28.5±15.6, P=0.025, respectively) and 3months postoperatively (36.5±17.4, P=0.0005; 31.2±17.4, P=0.0002, respectively) than preoperative values (29.4±15.3; 26±15, respectively). There was a significant correlation between MGL on the upper eyelid preoperatively and the OSDI score at 1month postoperatively (R=0.37; P=0.05). CONCLUSION: Meibomian gland loss in the upper eyelid is associated with an increased early postoperative ocular discomfort score. Alterations in Meibomian gland expressibility and TBUT persist for up to 3months postoperatively, suggesting a direct role of cataract surgery by an obstructive mechanism.

[The search for electrophysiological predictors of visual comfort after presbyopia correction with contact lenses]. / Recherche d'indices électrophysiologiques de confort visuel après correction de la presbytie par lentilles de contact.

Starting at 40 years of age, prespyopia affects a quarter of the world population. Many techniques of presbyopia surgery have emerged in recent years. The purpose of this study was to compare monovision and multifocality and to identify clinical and electrophysiological predictive markers of visual comfort for each correction available in clinical practice. Ten presbyopic patients participated in this study. Patients received monovision and multifocal correction using contact lenses for three weeks each in a random order. A clinical evaluation (visual acuity, TNO test, binocular contrast sensitivity and quality of vision questionnaires) and an electrophysiological evaluation (monocular and binocular pattern VEP with multiple spatial frequencies: 60, 30 and 15') were performed before and after each correction modality. The P100 was significantly wider and slightly earlier after binocular compared to monocular stimulation at T0. The TNO stereopsis score decreased significantly after correction. No other significant differences, either on clinical or electrophysiological criteria, were found between the two modes of correction. Several significant correlations were found between the stereoacuity difference depending upon correction and evoked potentials by binocular pattern at T0. The larger the stereoacuity difference (better stereoacuity with multifocal compensation), the longer the latency of the P100 using 60' checks (R=0.82; P=0.004) and the greater the amplitude of the N75 using 30' (R=0.652; P=0.04). Our study found no differences between the 2 types of correction, but it highlights a benefit of VEP used in current practice and measurement of the P100 wave, the best indicator of stereopsis and the most consistent, to predict visual comfort after compensation presbyopia.

[Objective assessment of the functional impact of dry eye severity on the quality of vision by double-pass aberrometry]. / Évaluation objective de l'impact fonctionnel de la sévérité de la sécheresse oculaire sur la qualité de vision par aberrométrie double passage.

PURPOSE: To assess the functional impact of the severity of dry eye on the quality of vision by measuring an Objective Scatter Index (OSI) using double pass aberrometry. PATIENTS AND METHODS: Twenty-eight patients (56 eyes) with dry eye syndromes of varying severity participated in this study. A double-pass aberrometer was used to measure the dynamic changes in the OSI for 20 seconds. The mean and standard deviations of the OSI and the number of blinks occurring during the examination were compared as a function of the clinical severity of dry eye disease. RESULTS: The mean OSI increased with the severity of dry eye syndrome with a significant difference for stages 3 (P<0.01) and 4 (P<0.001) compared to stages 1 and 2, without a significant difference based on age (P>0.8) or visual acuity (P>0.2). Standard deviation of the OSI also increased with the severity of dry eye disease, with a significant difference for stages 3 (P<0.01) and 4 (P<0.0001) compared to stages 1 and 2, with no significant increase in the number of blinks (P>0.2). The values of the OSI standard deviation represented the dynamic nature of aberrometric changes related to the instability of the tear film. CONCLUSION: Quality of vision of patients deteriorated in relation to the severity of their dry eye. The analysis of OSI standard deviation appears to be an objective way to assess the intensity of subjective visual disturbances reported by patients with dry eye syndrome. It also provides a new tool to assess the severity of damage to the ocular surface.

[Ocular and neuro-ophthalmic manifestations of sarcoidosis: retrospective study of 30 cases]. / Sarcoïdose oculaire et neuro-ophtalmologique: étude rétrospective sur 30 cas.

INTRODUCTION: The purpose of this study was to describe the diagnostic strategy and therapeutic approach when sarcoidosis of the visual pathways is suspected, by way of a descriptive study of sarcoidosis patients in the ophthalmology services in Tours, Rennes and Angers. PATIENTS AND METHODS: A multicenter, retrospective chart review was performed for 30 patients diagnosed with sarcoidosis and followed at the university hospitals of Tours, Rennes and Angers between January 1997 and August 2011. The diagnosis of sarcoidosis was based on a combination of clinical and ancillary tests, including pathologic confirmation and/or hyperlymphocytosis with a CD4/CD8 ratio greater than 5 on bronchoalveolar lavage. RESULTS: We identified 30 patients with ocular and/or neuro-ophthalmic sarcoidosis (25 female [83%], five male [17%], median age 48 years (36-87). Histologic confirmation of epithelioid granuloma was obtained in 24 (80%) of the 30 included patients. Sarcoid uveitis was present in 83% of patients; neurosarcoidosis was found in 37% of patients. Additional complaints at presentation included dyspnea (31%), arthralgia (41%), myalgia (24%) and paresthesia (27%). Bilateral ocular involvement was found in 89% of cases. In 83% of patients, there was an active anterior uveitis on slit lamp examination at initial presentation. Funduscopic abnormalities included vitritis in 67%, snowbanking in 13%, snowballs in 27% and disc edema in 30%. Eight patients (27%) had retinal vasculitis and nine patients (30%) were diagnosed with multifocal choroiditis on angiography. An elevated angiotensin-converting enzyme was present in 13 (52%) of 25 patients tested, with an average of 71 (range 36-241). Evidence of sarcoidosis was present on chest CT in 22 (79%) of 28 patients. Neuroimaging abnormalities on brain MRI were found in eight of ten tested patients. The 10 IU tuberculin skin test was negative in all tested patients (12). Median lymphocytosis in the bronchoalveolar lavage fluid (BALF) was 0.3 (0.2-0.7) in the 15 tested patients. BALF CD4/CD8 ratio was positive in all tested patients (12). Oral corticosteroids were initiated at 1mg/kg per day and then tapered in 20 (67%) of 30 patients. Median duration of steroid treatment was 12 months (5-127), resulting in rapid improvement in 84% of cases. However, nearly half of patients experienced a recurrence of the disease. CONCLUSION: Positive diagnosis of sarcoidosis requires a careful history and clinical examination, ancillary testing, and collaboration among several medical specialties. Normal angiotensin-converting enzyme levels do not rule out the diagnosis, since in our series, they were normal in almost half the cases. The tests with highest sensitivity included: a negative tuberculin skin test (100%), an elevated CD4/CD8 ratio in the BALF (100%), radiographic evidence of sarcoidosis on chest CT (79%) and brain MRI (80%). Other factors contributing to the diagnosis were: female gender (83%), age over 40 (67%), arthralgia (41%), asthenia (50%), vitritis (67%) and multifocal choroiditis (30%). In our study, treatment with corticosteroids resulted in significant improvement in over 80% of patients.

[Use of "mix-and-match" aspheric intraocular lenses in cataract surgery to enhance depth of field and stereoscopic performance]. / Intérêt d'une bascule d'asphéricité pour une plus grande multifocalité dans la chirurgie de la cataracte.

INTRODUCTION: One of the remaining challenges in cataract surgery is to compensate for lost accommodative function. The purpose of our study is to evaluate reading ability with a combination of two different aspheric intraocular lenses. PATIENTS AND METHODS: This retrospective study included 40 eyes (20 patients). The control group (28 eyes, 14 patients) received two negative aspheric intraocular lenses (Acrismart 36A(®), Carl Zeiss Meditec), while the aspheric-optimized group (12 eyes, six patients) received an AcriSmart 36A(®) in the dominant eye and a zero-aspheric intraocular lens (Acrismart 46 LC(®), Carl Zeiss Meditec) in the fellow eye. Patients with corneal asphericity between 0.15 and 0.30 µm and a bilateral monocular postoperative visual acuity of at least 20/20 were eligible for inclusion. Uncorrected and best corrected visual acuity was measured for near, intermediate and distance vision. Corneal and total higher-order aberrations, monocular and binocular defocus curve, and stereoscopic performance were assessed. RESULTS: Postoperative spherical equivalent and best corrected distance visual acuity were not significantly different between the two groups (P=0.11 and P=0.82 respectively). However, the aspheric-optimized group (36A(®)/46 LC(®)) exhibited better near and intermediate visual acuity (P<0.05), and better stereoscopic vision (P=0.027). DISCUSSION: The depth of field results in pseudophakes implanted with "mix-and-match" aspheric lenses demonstrates that the binocular combination of two different aspheric profiles seems to improve near vision without affecting stereoscopic vision.

[Impact of higher-order aberrations on accommodation in phakic presbyopic patients]. / Influence des aberrations optiques d'ordre élevé sur la capacité accommodative des patients présentant une presbytie débutante.

PURPOSE: To assess the relationship and respective contribution of ocular higher-order aberrations (HOAs) on residual accommodative performance in presbyopic patients. PATIENTS AND METHODS: We enrolled 20 patients (40 eyes) without ophthalmological pathology, between 48 and 58 years old, with a best-corrected visual acuity more than 10/10. Total aberrations were computed using the Wavescan Aberrometer (AMO, USA). The defocus curve and near visual acuity (30 and 50 cm) were measured. The relationship between accommodation ability and HOAs was evaluated aiming at a linear relationship with a simple regression analysis and with a multiple linear regression analysis (including manifest refraction, ocular aberrations, and age). RESULTS: Even if age and manifest refraction were correlated with accommodative ability, ocular coma seemed to be correlated with near visual acuity without addition and with minimal addition for reading P1.5 at 30 cm (respectively, r(2)=0.117 with P=0.035 and r(2)=0.163 with P=0.012). Total spherical aberration appeared to be correlated with minimal addition (r(2)=0.12 with P=0.032). DISCUSSION: Ocular aberrations (coma and spherical aberration) are correlated with accommodative performance in presbyopic patients, independently of age and manifest refraction. CONCLUSION: Ocular aberrations appeared to be a stimulus for accommodation but may also influence quality of accommodative reply.

[Effects of spherical aberration on objective optical quality after microincision cataract surgery]. / Analyse objective de la qualité de vision en fonction de l'asphéricité post-opératoire d'une chirurgie micro-incisionnelle de la cataracte.

PURPOSE: To assess the impact of spherical aberration (SA) on clinical ocular performance and the objective quality of vision in pseudophakic patients. METHODS: Twenty-five consecutive eyes were divided into two groups: 13 eyes received an aspherical AcriSmart 36A intraocular lens (IOL) (Carl Zeiss Meditec, USA) generating a negative SA and 12 eyes received a zero-aberration AcriSmart 46 LC IOL (Carl Zeiss Meditec, USA). Postoperative evaluations were conducted 6 months after 1.8-mm microincision cataract surgery and included wavefront aberration analysis (Wavescan, AMO, USA) and objective quality of vision (Objective Quality Analysis System, Visiometrics, Spain). RESULTS: Best corrected visual acuity (BCVA) was not different in the two groups (p=0.89). Total spherical aberration was significantly less with the 36A IOL (0.075 +/- 0.05 microm versus 0.20 +/- 0.05 microm; p=0.0002). The 36A IOL induced better objective image quality with an average MTF of 32.7+/-9.6 c/deg versus 23.8+/-8.1 c/deg with the 46LC, p=0.0002. The 36A IOL group had 1 D less depth of focus than the 46LC IOL group: 1.3+/-0.59 and 2.27+/-0.63 D, respectively. For the whole population, the depth of focus appeared to be correlated with SA (r(2)=0.40, p=0.002) and with trefoil (r(2)=0.53, p=0.001). CONCLUSION: Aspheric IOLs objectively improved the quality of vision with greater MTF values. Reduction of aberrations may be also be responsible for reduced depth of focus with the 36A IOLs. However, residual trefoil aberrations may be advantageous for depth of focus.

[Long-chain 3-hydroxyacyl CoA dehydrogenase deficiency and choroidal neovascularization]. / Néovascularisation choroïdienne au cours d'un déficit en Long-Chain 3-Hydroxyacyl CoA Dehydrogenase (LCHAD).

We report the case of a 9-year-old girl with a long-chain 3-hydroxyacyl CoA dehydrogenase (LCHAD) deficiency. This enzyme participates in mitochondrial fatty acid B-oxidation. Genetic fatty acid oxidation defects induce cellular energetic deficiency, and thus early life-threatening manifestations. An appropriate diet prevents these severe disorders. Nevertheless, LCHAD deficiency is the only B-oxidation enzymatic disorder that induces a chorioretinopathy, predominating at the posterior pole. We describe the first case of bilateral macular choroidal neovascularization. One eye presented a fibrovascular lesion. The other eye presented an active neovascularization stabilized by two dynamic phototherapies. The specificity of choroidal degeneration related to LCHAD deficiency remains unknown. Reviewing of literature and biochemical mechanisms suggests that fatty acid oxidative stress rather than a mitochondrial energetic defect is involved. For practical purposes, this report emphasizes the importance of ophthalmological follow-up of these patients.

[Use of MEOPA during nasolacrimal duct probing in children]. / Utilisation du mélange protoxyde d'azote-oxygène lors du sondage des voies lacrymales chez l'enfant.

BACKGROUND: Congenital nasolacrimal duct obstruction affects more than 6% of newborns. Whereas some recommend nasolacrimal probing under general anesthesia from 1 year of age when the condition does not spontaneously resolve, some decide in favor of early probing from 4 to 6 months of age with topical anesthesia. We present nasolacrimal probing with inhalation of MEOPA, an equimolar mixture of nitrous oxide and oxygen, as a therapeutic alternative. PATIENTS AND METHODS: We conducted a descriptive, prospective study including 63 children (75 eyes) who had nasolacrimal duct probing with inhalation of MEOPA between March 2005 and March 2006, in consultation. Efficacy was estimated by the observation of medical staff and parents and by the feasibility of the probing procedure. RESULTS: Children were 4-28 months old (mean age, 11.5 months). Symptoms resolved spontaneously in 79% of cases after only one probing. No incident was observed. In case of failure, probing with nasolacrimal intubation with nasal endoscopy and general anesthesia was done (21% of cases, mean age, 17.5 months). DISCUSSION: Administration of MEOPA, by inhalation with a facial mask, is already used for minor pediatric surgical procedures. It is simple to use, fast, low-risk, inexpensive, and effective. CONCLUSION: Use of MEOPA in nasolacrimal duct probing in children could be a good alternative, making it possible to alleviate pain in the youngest children and general anesthesia in the oldest.

[Visual function after cataract surgery in patients with an aspherical lens without spherical aberration]. / Quels bénéfices visuels peut-on attendre d'un implant sans aberration sphérique dans la chirurgie de la cataracte?

PURPOSE: To assess the quality of vision in pseudophakic patients with aspheric intraocular lens (IOL) without spherical aberration compared to patients with spherical IOL. METHODS: Twenty-four patients (48 eyes) undergoing cataract surgery were randomly divided into two groups: 12 patients received an aspheric IOL in both eyes and 12 received spherical IOLs. The integrity of ocular functions was assessed with clinical examination and multifocal electroretinogram. Postoperative evaluations were conducted 3 months after surgery. Refraction, best-corrected visual acuity, contrast sensitivities, and wavefront ocular aberrations were analyzed. Patient-centered visual functions were evaluated according to the Activities of Daily Vision Scale. RESULTS: The ADVS score was better in the aspheric IOL group (p=0.01), particularly concerning the best-corrected near vision (p=0.006). Refraction and BCVA were similar. Contrast sensitivities in photopic conditions was better in the aspherical IOL group (p<0.001). Higher-order aberration was not different, except from spherical aberration (p=0.022). CONCLUSION: Patients with the aspherical IOLs felt they had better quality of vision, particularly near vision, compared with the spherical IOL group. These patient-centered benefits were associated with better photopic contrast sensitivity and reduced spherical aberration.

[Epidemiology for retinopathy of prematurity: risk factors in the Tours hospital (France)]. / Etude épidémiologique de la rétinopathie du prématuré: les facteurs de risque au CHU de Tours.

BACKGROUND: A prospective analysis of the incidence of retinopathy of prematurity (ROP) by documenting clinical perinatal characteristics of affected infants, in an attempt to describe risk factors for ROP. MATERIALS AND METHODS: Between March 2002 and April 2004, 161 infants, with a gestational age under 31 weeks and/or a birth weight under 1500 g, were screened according to CRYO-ROP guidelines, using direct ophthalmoscopy with a Layden contact lens. Risk factors for ROP were analyzed with the Student and Fischer tests. RESULTS: ROP developed in 15% of the cases studied, with one out of five at prethreshold or threshold levels of ROP. Gestational age at birth (p<0.0001), low birth weight (p<0.0001), the length of the infant's stay in the neonatal intensive care unit (p<0.0001), the duration of mechanical ventilation (p<0.0001), the duration of oxygen provided (p<0.0001), blood transfusions (p<0.0001), hyaline membrane disease (p=0.0257), and bronchodysplasia (p=0.0012) were significant risk factors for ROP. CONCLUSION: Despite progress in neonatal intensive care, ROP persists and can be explained by greater and greater prematurity and earlier screening. Effective screening, done between 4 and 6 weeks of life, taking risk factors into account, can improve prognosis.

[Ophthalmologic signs in mucopolysaccharidoses: two case reports]. / Un point d'appel ophtalmologique à l'origine du diagnostic de deux cas de mucopolysaccharidose.

BACKGROUND: The mucopolysaccharidoses (MPS) form a group of heterogeneous hereditary lysosomal storage diseases, distinguished by facial dysmorphy in gargoyle-like facies. The enzymatic deficiency involves the degradation of glycosaminoglycans, whose accumulation manifests in severe general and ophthalmologic problems. CASES REPORT: We report the cases of two 18-month-old girls consulting for corneal clouding and photophobia. The diagnosis was made based on the facial dysmorphy, then biologically corroborated: Scheie's syndrome (MPS type I-S) and Hurler's syndrome (MPS type I-H). The corneal clouding was isolated or associated with bilateral disc swelling. Enzyme replacement therapy was instituted in both cases while waiting for bone marrow transplantation, with a better prognosis in the first case because of the type of MPS and the less severe neurological involvement. DISCUSSION: The accumulation of glycosaminoglycans in ocular tissues can involve stromal opacities, glaucoma, retinopathy, and optic nerve swelling. Whereas the ophthalmological involvement is often secondary, it can lead the ophthalmologist to the diagnosis of MPS. The early diagnosis of MPS, before the onset of neurological signs, is vital, since treatment can stop disease progression. CONCLUSION: Better knowledge of the clinical signs of MPS on the part of the ophthalmologists could improve the prognosis of these patients.

[Quality of vision after cataract surgery in patients with prolate aspherical lens]. / Qualité de vision des patients porteurs d'un implant asphérique prolate après chirurgie de la cataracte.

PURPOSE: To assess the quality of vision in pseudophakic patients with a prolate aspherical intraocular lens (IOL) compared to patients with a spherical IOL. PATIENTS AND METHODS: Twenty patients undergoing cataract surgery were divided into two groups according to the type of IOL: ten prolate aspherical IOLs (TECNIS Z9000, AMO, USA) and ten spherical IOLs (911 CeeOn Edge, AMO, USA). The integrity of ocular functions was assessed with clinical examination and multifocal electroretinogram. Contrast sensitivities were tested preoperatively in photopic, mesopic, and glared conditions. Postoperative examinations included refractive evaluation before and after mydriasis, pupil diameter, contrast sensitivities, and wavefront aberration analysis. RESULTS: Postoperative best-corrected visual acuity was 0.95 +/- 0.13 for the TECNIS group vs 0.98 +/- 0.11 for the 911 group (p=0.32). Refractive evaluation revealed mydriasis myopic shift in patients with the 911 IOL (- 0.10+/-0.30 D for the TECNIS group vs - 0.68+/-0.21 D for the 911 group, p=0.002). Mesopic contrast sensitivity was improved in the TECNIS group regarding medium and high spatial frequencies (p=0.003 and p=0.002, respectively), whereas photopic and glared contrast sensitivities were equal in both groups. RMS for high-order aberrations was 0.36 +/- 0.07 microm in the TECNIS group vs 0.33 +/- 0.19 microm in the 911 group (p=0.21), and spherical aberration was lower in patients with TECNIS IOL (Z40=0.03+/-0.06 microm vs 0.20+/-0.14 microm, for the TECNIS group and the 911 group, respectively, p=0.029). CONCLUSION: Combining contrast sensitivities and wavefront aberration analysis provided an objective assessment of the quality of vision in pseudophakic patients. Using prolate aspherical IOL could reduce spherical aberration and improve visual acuity, especially in mesopic conditions.

[The central visual field in flicker stimulation]. / Champ visuel central en stimulation Flicker.

The authors reported their results of flicker visual field in ganzfeld and 17 central points with 3, 8, 15 and 35 Hertz flicker. They tested 4 groups of control subjects and 12 patients with glaucoma. The flicker visual field may be a useful aid in determining campimetric abnormalities for glaucoma patients with normal static perimetry.

[Epidemiology of pediatric paracetamol poisoning (retrospective analysis of calls received by the Poison Control Center of Tours)]. / Epidémiologie des intoxications au paracétamol en pédiatrie (analyse rétrospective des appels reçus au Centre Anti-Poisons de Tours).

The authors analysed 101 phone calls received in 3 years and 8 months at the Poison Control Center of Tours for paracetamol poisoning in children under 15 years of age. 70% of children were between 1 and 5 years old, 15% under 1 year and 15% over 5 years old. The kind of poisoning differ according to age: iatrogenic in 93% of cases under 1 year old (medication given by parents; error in dosage); accidental in 85% of cases between 1 and 5 years old and "willful" poisoning (43%) or accidental (36%) over 5 years old. The average quantity of ingested paracetamol was low (58mg/kg). The delay before phone call from an individual or a doctor was usually quite short. The neurologic or digestive signs were present in 12% of the children. The outcome was uneventful in all cases indicating that this form of poisoning is being in childrens.