Association of sensitive skin with sensitive corneas and sensitive eyelids.

BACKGROUND: Sensitive scalp or irritable bowel syndrome has been previously shown to be associated with sensitive skin. We wondered whether sensitive eyelids and sensitive eyes could also be associated with sensitive skin. METHODS: A cross-sectional epidemiological study was carried out on a representative sample of French people, according to the quota method, using a questionnaire. RESULTS: A total of 2048 subjects were included in the present study. Notably, 52.2% declared sensitive eyes, which was more frequent in women than in men. The subjects who reported sensitive eyes were more numerous according to the severity of skin sensitivity, the severity of sleep disorders and the presence of bright eyes. More than half of the subjects with sensitive eyes thought that they were sensitive to sun exposure, dust, computer or touch pads or dry air. The presence of sensitive eyelids was reported by 18.65% (more frequent in women) and was associated with sensitive skin and sensitive eyes, sun exposure and exposure to dust. CONCLUSION: This study is the first to investigate sensitive eyelids or sensitive eyes. Sensitive eyelids can be considered a localization of sensitive skin. The concept of sensitive eyes is not commonly used by ophthalmologists and remains to be more precisely defined.

A randomised study comparing performance and safety of Eyestil Plus® vs Vismed Multi® in moderate-to-severe dry eye syndrome patients.

PURPOSE: This clinical investigation compared the performance and safety of Eyestil Plus® (SIFI) and Vismed Multi® (TRB Chemedica) for reducing keratitis lesions in moderate-to-severe dry eye disease (DED) patients. MATERIALS AND METHODS: This was a randomised, double-blind, multicentre investigation. 96 adults (>18 years of age) with moderate-to-severe DED received Eyestil Plus® (N = 48) or Vismed Multi® (n = 48) 6 times daily for 3 months. The primary objective clinical performance after 1 month as global corneal and conjunctival staining scores. The secondary objectives were clinical performance after 3 months, tear film stability (tear break up time (TBUT), tear production (Schirmer test), patient-reported outcomes (PROs), investigator satisfaction, and safety. RESULTS: 96 participants were randomised to receive the clinical investigations' treatments, 82.3% of them were female and their mean age was 65.8 years. The non-inferiority of Eyestil Plus® for moderate-to-severe DED was demonstrated at 1 month. No statistical difference was found for any of the study's objectives: change at 1 and 3 months of the global corneal and conjunctival staining score (p-value = 0.506 and 0.661, respectively), change at 1 and 3 months (p-value = 0.538 and 0.302) for TBUT test; change at 3 months for Schirmer test (p-value = 0.540). There were no changes for PROs either. Investigator satisfaction was high for both products. 16.6% of the participants experienced adverse events. CONCLUSION: This clinical investigation showed the non-inferiority of Eyestil Plus® compared to Vismed Multi® regarding performance and safety in a moderate-to-severe DED population.

3-month post-procedural evaluation of a combined intense pulsed light and photo-biomodulation system in the treatment of meibomian gland dysfunction.

PURPOSE: Meibomian gland dysfunction (MGD) is the leading cause of dry eye syndrome. It is a frequent and underdiagnosed condition with a significant socioeconomic impact. We propose here the evaluation of a platform combining intense pulsed light and photo-biomodulation in the treatment of Meibomian gland dysfunction. METHODS: We conducted a retrospective study at Brest University Hospital analyzing a cohort of 74 eyes (37 patients) at 1 month and 3 months after a protocol of 3 Eye-Light® (Espansione Group, Italy) sessions 14 days apart between January 2019 and April 2020. The primary outcome was the change in OSDI quality of life score. Secondary outcomes were the SPEED questionnaire score; tear break-up time (BUT), Oxford score, non-invasive break-up time (NIBUT), lipid layer thickness, lacrimal meniscus height and Meibomian gland atrophy rate. Tolerance of the treatment was also evaluated. RESULTS: We found a significant improvement in OSDI scores at 1 month (-17.32; 95% CI (-25.84; -8.79), P<0.0001) and 3 months (-16.95; 95% CI (-25.26; -8.64), P<0.0001). The SPEED score, BUT, Oxford score, Meibomian gland atrophy and NIBUT were also statistically significantly improved. Tolerance to treatment was very good despite two cases of herpetic keratitis, which resolved on treatment. CONCLUSION: Treatment with the Eye-Light® in three sessions every two weeks significantly reduced symptoms and ocular surface damage in patients with MGD. This data suggests that the use of Eye-Light® may represent a good option for patients with MGD.

Impact of virtual reality headset use on eye blinking and lipid layer thickness.

PURPOSE: Blinking plays an important role in protecting the eyes, and the use of computers has been associated with a reduction in the blink rate. The goal of this study was to evaluate the effect of a virtual reality headset on blinking and lipid layer thickness and to compare these data to those associated with a conventional desktop monitor. METHODS: Two experiments were performed to compare the effect of 20minutes of use of a virtual reality headset (FOVE) and 20minutes of use of a desktop monitor on the frequency and length of blinks (experiment 1, 15 participants) and on the thickness of the lipid layer as measured by Lipiview (experiment 2, 12 participants). RESULTS: In the first experiment, the blink rate [F(1.83)=4.3, P=0.04, ß=0.36] and duration [F(1.83)=13, P=0.001, ß=0.35] increased with time under both conditions, but no statistical difference was found between the two conditions (headset vs. desktop monitor) either for blink rate [rmANOVA F(1.11)=0.01, P=0.92; headset: 15.1 blinks, 95% CI: 12.6 to 17.6 blinks; desktop: 14.6 blinks, 95% CI: 13.6 to 15.7 blinks] or for blink duration [rmANOVA F(1.11)=4.534, P=0.06; headset: 205.75ms, 95% CI: 200.9 to 210.6ms; desktop: 202.82ms, 95% CI: 198.2 to 207.5ms]. However, strong individual variations were observed. Evaluation of simulator sickness and visual fatigue by questionnaire showed no significant differences between the two conditions (SSQ simulator sickness questionnaire: V=46, P=0.62; VFQ visual fatigue questionnaire: V=15.5, P=0.13). In the second experiment, the lipid layer thickness increased significantly after use of the VR headset [F(1.18)=11.03, P=0.004, headset: 76.2nm, desktop: 58.8nm]. CONCLUSION: In terms of recommendations, the effect of virtual reality headsets on blink duration and frequency during a moderate exposure (20minutes) is comparable to that of a conventional desktop monitor. However, the strong individual variations observed, the lack of reliable tests to evaluate this individual sensitivity, and the significant increase in lipid layer thickness in experiment 2 suggest the value of a more detailed investigation, in particular with consideration of a longer exposure time and other tear film parameters.

Healing of resistant corneal neurotrophic ulcers using a matrix regenerating agent.

PURPOSE: To assess the success rate of a matrix regenerating agent (RGTA) in the treatment of chronic corneal ulcers resistant to conventional treatments. METHODS: Uncontrolled prospective observational study in patients with corneal neurotrophic ulcer (Stage 2 or 3 of the Mackie classification), unresponsive to standard medical or surgical treatments and managed with RGTA as an adjunctive treatment. Corneal ulcers were evaluated using slit-lamp examination and optical coherence tomography after 2 weeks, 1 month, 2 months and 3 months. Success was defined as complete corneal healing. RESULTS: RGTA was administered to 20 patients (20 eyes) with chronic corneal ulcers of various causes, including keratoplasty (7 eyes, 35.0%), herpetic keratitis (5 eyes, 25.0%) and intracorneal ring (3 eyes, 15.0%). Total corneal healing was observed in 13/20 patients (65.0%) within 1 to 3 months. RGTA was discontinued due to partial healing/ulcer stagnation in 6 patients (30.0%), and aggravation of the ulcer in 1 patient (5.0%). Relapses were reported in 4 patients (20.0%) several months after cessation of RGTA treatment. No adverse reactions were noted. CONCLUSIONS: In the event of failure of conventional treatments, RGTA may be an alternative medical treatment for patients with chronic corneal ulcers, avoiding the need to resort to surgical treatment.

Cascaded multi-scale convolutional encoder-decoders for breast mass segmentation in high-resolution mammograms.

This paper addresses breast mass segmentation from high-resolution mammograms. To cope with strong class imbalance, huge diversity of size, shape, texture and contour as well as limited receptive field, mass segmentation is achieved through a multi-scale cascade of deep convolutional encoder-decoders without any pre-detection scheme. Multi-scale information is integrated using auto-context to make long-range spatial context arising from lower scale impact training at higher resolution. The pipeline is trained end-to-end to benefit from simultaneous segmentation refinement performed at each level. It incorporates transfer learning and fine tuning from DDSM-CBIS to INbreast datasets to further improve mass delineations. The comprehensive evaluation provided for high-resolution INbreast images highlights promising model generalizability against standard encoder-decoder strategies.

[Assessment of a 3D digital orthoptic test platform]. / Évaluation d'une plateforme d'orthoptie numérique 3D.

PURPOSE: To compare standard orthoptic tests with a novel digital 3D orthoptic platform, 3DeltaEasy(©) from Orthoptica(®). MATERIALS AND METHODS: This study tests the 3D digital orthoptics platform, 3DeltaEasy(©) from Orthoptica(®) and compares it to the corresponding standard orthoptic tests. This platform consists of a computer equipped with dedicated software, a video projector and 3D liquid crystal glasses. Three tests were compared: Wirt test, measurement of horizontal and vertical phorias, and the horizontal fusional amplitude in convergence and divergence. A total of 102 subjects, 53 males (52 %) and 49 females (48 %), aged between 9 years and 72 years (mean age 33±16.4 years) were examined at the ophthalmologic department of the Brest Hospital (France) and included in this observational cross-sectional study. Subjects recruited in this study were patients requiring orthoptic screening or therapy. Patients without their optimal visual corrections were excluded. All patients underwent both ophthalmological and orthoptic examination including Wirt fly stereotest with polarizing spectacles, cover tests to evaluate and measure the horizontal and vertical deviation of the lines of sight, horizontal vergence ranges using prism bar and their equivalent tests implemented in the digital 3D orthoptic tests 3DeltaEasy(©) from Orthoptica(®). RESULTS: All data were processed using MedCalc Statistical Software version 14.12.0 (MedCalc Software bvba, Ostend, Belgium). The main result of this study is that 3DeltaEasy(©) and the classical Wirt test are correlated (Spearman's coefficient of rank correlation: ρ=0.74; P<0.0001), cover tests are equivalent for intermediate and far vision (paired t-test; P=0.46 and P=0.51), and horizontal and vertical vergence range are comparable for distance vision (paired t-test; P=0.34 and P=0.94). CONCLUSION: New digital 3D tools could easily substitute for some orthoptic tests with better ergonomics. Eventually, by increasing the number of tests performed, it could substitute for nearly all tests.

[Endoscopy-guided 20-G vitrectomy in severe endophthalmitis: Report of 18 cases and literature review]. / Vitrectomie endoscopique 20Ga dans les endophtalmies sévères : série de 18 cas et revue de la littérature.

OBJECTIVE: To report the anatomical and functional outcomes after endoscopy-guided vitrectomy in a series of cases of severe endophthalmitis. Also to identify and compare the outcomes of two different modes of clinical presentation. PATIENTS AND METHODS: Retrospective case study, single center; all patients who underwent endoscopic 20Ga vitrectomy (Endo optiks E4 system) for severe endophthalmitis were included. For each case, data were recorded for: etiology, surgical indication, preoperative and postoperative visual acuity, comorbidity factors and postoperative complications, and whether any additional surgery was performed. Two groups were distinguished according to their initial mode of presentation; results were then compared in terms of complications and visual prognosis to those found in the literature. RESULTS: Eighteen patients were included, with mean age 62±19years. Severe endophthalmitis was initially obvious for 8 cases (group 1). For 10 cases, disease progression had been considered unfavorable despite adequate medical treatment (group 2). There was no statistically significant difference between the two groups (P=0.55). Endophthalmitis occurred: after intravitreal injections (4 cases), after intraocular foreign body (n=2), after cataract surgery (n=5), following a trabeculectomy (n=2), after epiretinal membrane peeling (n=3), 1 case caused by a corneal infection and 1 case of endogenous leptospirosis. Mean follow-up was 13.7months. The surgical technique was a complete 20Ga vitrectomy under endoscopic visual control. The mean operative time was 70±27minutes. The causative organism was identified in 72% of cases in vitreous humor samples, among which 77% were gram-positive organisms. The infection was controlled in 89% of cases, and these patients have recovered useful visual acuity. CONCLUSION: The value of endoscopic visualization in ophthalmology has been proven for 30 S. aureus years, but its miniaturization enhances the current enthusiasm for the use of this instrumentation. When visualization is compromised, endoscopic guided vitrectomy is very useful and may assist the surgeon in the management of these difficult cases. Our anatomical and functional outcomes are encouraging, but we must keep in mind the poor long-term prognosis of severe endophthalmitis.

Inferior steepening is associated with thinning of the inferotemporal cornea.

PURPOSE: Videokeratography has enabled detection of inferior steepening patterns in patients thereby designated as keratoconus suspects. Since no information about the corneal thickness of these eyes is available, we studied several patients with such patterns, and compared the corneal thickness of their eyes with that of normals. METHODS: Three groups of patients who had undergone videokeratography were studied with ultrasonic pachymetry centrally and in four quadrants at the 3-mm clear zone: 44 eyes with true keratoconus, 23 eyes of individuals with inferior steepening of the cornea who were family members of patients with keratoconus; and 44 normal eyes never fitted with contact lenses. The corneal thickness of the eyes in the first two groups was then compared with that in the third using ANOVA and Student's t test. RESULTS: Corneal thickness in the normal eyes and in those with inferior steepening was similar in all except the inferotemporal quadrant. In this quadrant, the corneas of the eyes with inferior steepening were thinner than those of the normal eyes: 544 +/- 32 microns vs 581 +/- 30 microns (p < .05) CONCLUSION: Eyes with inferior steepening on videokeratography have thinner inferotemporal corneas than normal eyes.

Correcting keratoconus with intracorneal rings.

PURPOSE: To evaluate the potential of intrastromal corneal ring technology (Intacs, KeraVision) to correct keratoconus without central corneal scarring. SETTING: Department of Ophthalmology, Brest University Hospital, Brest, France. METHODS: In this prospective, noncomparative, interventional case series, Intacs segments were implanted in 10 keratoconic eyes with clear central corneas and contact lens intolerance after corneal pachymetry was checked. Segment thicknesses varied based on corneal topography analysis. RESULTS: No intraoperative complications occurred. The mean follow-up was 10.6 months. Postoperative results revealed a reduction in astigmatism and spherical correction and an increase in topographical regularity and increased uncorrected visual acuity. CONCLUSION: Intacs technology can reduce the corneal steepening and astigmatism associated with keratoconus.

Effect of intrastromal corneal ring segment shift on clinical outcome: one year results for low myopia.

PURPOSE: To evaluate the effect of intrastromal corneal ring segment (ICRS) shift on clinical outcome. SETTING: Chu Morvan Ophthalmology Service, Brest, France. METHODS: Forty-seven eyes with myopia from -1.0 to -5.0 diopters (D) had ICRS surgery according to United States Food and Drug Administration protocol using a 2-segment implant design. Visual acuity, refractive, videotopographic, and biomicroscopic results in eyes that did not have contact between segments (Group A, n = 26) and in eyes that did have contact (Group B, n = 21) were compared. RESULTS: Soon after surgery, migration of and subsequent contact between the implant segments occurred in 21 eyes (45%). Contact between the inferior ends was most common, occurring in 19 eyes; in the remaining 2 eyes, the superior ends of the implant touched. Superior contact was associated with superficial channels, wound-healing problems, and ICRS explantation. No segment shift was observed after the first postoperative week. No significant differences in visual acuity, qualitative vision, or density of intrastromal deposits were noted between the 2 groups. However, at 6 months there was more induced with-the-rule cylinder in Group B (mean +1.3 D +/- 0.7 [SD]) than in Group A (mean +0.7 +/- 0.5 D). Astigmatism was clinically significant in only 3 cases at 3 months. CONCLUSIONS: Induced cylinder remains a limitation of the ICRS procedure, and segment contact appears to influence the rate of induced cylinder. Overall, however, the ICRS procedure produces promising results. Research efforts are underway to address induced cylinder and channel deposits associated with ICRS surgery.

Capsule contraction after continuous curvilinear capsulorhexis: poly(methyl methacrylate) versus silicone intraocular lenses.

PURPOSE: To evaluate the progressive contraction of the anterior capsule opening after in-the-bag implantation of 2 types of intraocular lenses (IOLs). SETTING: Department of Ophthalmology, University of Brest, Brest, France. METHODS: In this prospective study, 32 single-piece poly(methyl methacrylate) (PMMA) (Pharmacia 812 C) and 30 3-piece silicone IOLs with PMMA haptics (Allergan SI-40NB) were implanted in the bag after standardized phacoemulsification performed by the same surgeon. All patients were older than 70 years, and none had zonular weakness. The surface of continuous curvilinear capsulorhexis (CCC) was measured 1, 30, and 150 days postoperatively using a 3 charge-coupled device camera and a digitized computer analysis system. RESULTS: A significant progressive constriction was observed at 150 days in 70% in the silicone group and 32% in the PMMA group. In addition, CCC contraction was greater in silicone group (P < .05). The mean surface decrease was 4.20 mm2 in the silicone group and 1.53 mm2 in the PMMA group. There was no correlation between sex, age, initial capsulorhexis area, final capsule shrinkage. In some eyes, especially in those with a single-piece PMMA IOL (41%), there was no constriction, but fine changes in the capsule opening were seen. CONCLUSION: Evolutive anterior capsulorhexis modifications were observed in all patients; however, the contraction rate was statistically higher in the silicone group. These results suggest that silicone IOL implantation should be avoided in eyes at risk for CCC constriction.

Excimer laser photorefractive keratectomy to correct astigmatism.

PURPOSE: To evaluate the efficacy of excimer laser photorefractive keratectomy (PRK) to correct astigmatism. SETTING: Hôpital Morvan, Brest, France. METHODS: A 193 nm excimer laser was used to perform toric ablation with an expanding slit to flatten the cornea in the steeper meridian and/or to correct myopia with an iris diaphragm in 72 eyes (55 patients): 68 eyes for compound myopic astigmatism and 4 for astigmatism only. RESULTS: Preoperative cylinder was -2.14 diopters (D) +/- 1.99 (SD) (range -0.50 to -5.50 D); 6 months postoperatively, it was -1.75 +/- 1.34 D (range -0.25 to -5.25 D). Preoperative spherical equivalent was -5.33 +/- 3.22 D (range -0.25 to -14.50 D); 6 months postoperatively, it was -0.86 +/- 2.32 D (range 2.50 to -9.75 D). The axial error was within 30 degrees. Uncorrected visual acuity was 0.50 or better in 64.5% of patients. CONCLUSIONS: Overall patient satisfaction seemed the result of the myopic correction; cylindrical correction was incomplete. Future software refinements should improve the results. In particular, single elliptical ablation seems to offer theoretical advantages.

Myopic photorefractive keratectomy in eyes with atypical inferior corneal steepening.

PURPOSE: To evaluate the visual and refractive results of photorefractive keratectomy (PRK) in eyes with atypical inferior corneal steepening (AICS). SETTING: Department of Ophthalmology, Hôpital Morvan, University of Breast, France. METHODS: Using videokeratopography, we screened 310 eyes that had PRK from November 1992 through November 1993 and found that 35 eyes exhibited topographic patterns consistent with AICS with no clinical findings. The results at 6 months and 1 year were compared with those of 185 eyes with normal topography treated concurrently. RESULTS: There were no statistically significant differences between the two groups in mean spherical equivalent, mean uncorrected visual acuity, and mean best spectacle-corrected visual acuity 6 months and 1 year after PRK. CONCLUSION: After 1 year, PRK in eyes with AICS appeared to give results similar to those in eyes with normal topography. Further follow-up is needed.

Clinical results of excimer laser photorefractive keratectomy: a multicenter study of 265 eyes.

Efficacy, predictability, and safety of excimer laser photorefractive keratectomy were evaluated at centers in Paris and Brest, France. Photoablation was performed with the VISX laser on 265 eyes (151 at the Paris center and 114 at the Brest center). The eyes were clinically and statistically evaluated over a six month follow-up. Initial myopia ranged from -0.7 to -19.4 diopters (D) (mean spherical equivalent [SE] -5.9 D) in the Paris center and from -0.9 to -14.5 D (SE -4.5 D) in the Brest center. At both centers, the mean uncorrected visual acuity was worse than 20/200; over 90% of cases in each center had a best uncorrected visual acuity of 20/100 or worse. Results are reported globally and for subgroups of myopia: Group A, SE better than or equal to -3.0 D; Group B, SE worse than -3.0 D and better than or equal to -7.0 D; Group C, SE worse than -7.0 D. Uncorrected visual acuity was significantly improved in the patients followed for six months; 64% of Paris cases and 62% of Brest cases obtained an uncorrected visual acuity of 20/40 or better. Predictability of the treatment was good; 67% of Paris eyes and 74% of Brest eyes were less than 1.0 D from the intended correction after six months. The data suggest that the initial myopia affected the efficacy and predictability of the treatment; results in the mild to moderate myopia eyes were significantly better than results in the severe myopia eyes. One case of visual acuity regression (less than one line) was observed in the two groups. This was associated with corneal haze of moderate intensity.

[Modeling the eye based on simulated refractive surgery]. / Modélisation de l'oeil en vue de simulations de chirurgies réfractives.

PURPOSE: To achieve three-dimensional modelizing of the eyeball (morphological and mechanical behavior) in order to simulate the impact of various refractive surgery techniques and to study the normal and pathological states of the eye. METHOD: Rebuilding the ocular shell is based on different kinds of imaging (MRI, ultrasound) including information provided by video topography. Image data are treated using suitable numerized filters that allow automatic segmentations of ocular globus edges. Reconstruction is based on specific mathematical functions (B-splines). The mechanical behavior of a reconstructed model is simulated by solving equations of linearized elasticity with the finitude elements method. RESULTS: Numerous simulations mimmed different refractive surgical techniques and, then validated the model. In addition, simulations of various pathologies allowed us to verify certain clinical hypotheses. CONCLUSION: This work, although still experimental, demonstrates the advantages of such simulations and will allow novice physicians an easier approach to different surgical techniques and will help them understand their effect. Furthermore, it might be useful for simulation of new surgical concepts even before their in vivo evaluation.

[Bilateral papilledema in young women: two case reports of benign intracranial hypertension?]. / OEdème papillaire bilatéral chez la femme jeune.

We report two cases of bilateral papilledema in young women. The first patient was 15 years old and had experienced headaches and vomiting for one month, but no visual loss. Cerebral tomodensitometry results were normal, but lumbar puncture showed increased pressure and normal biology. Benign intracranial hypertension was diagnosed. Recent treatment with minocycline for acne vulgaris was the only etiology. Papilledema was totally regressed at 6 weeks, after interruption of the antibiotic treatment. A prescription of acetazolamide was added for a short period of 10 days. The second patient, aged 29 years, presented bilateral papilledema with severe visual loss, with vision limited to light perception with mydriasis of the right eye. Lumbar puncture was not indicated because of a hypophyseal microadenoma revealed on MRI investigation. No other associated abnormalities were observed, in particular, no cerebral sinus thrombosis. Corticotherapy using prednisolone for 72 hours had no clinical effect. Fast visual recovery was obtained with intravenous acetazolamide therapy and was completely resolved at 2 months. Right visual field defects persisted. Minocycline and obesity are recognized as precipitating factors in pseudotumor cerebri syndrome. The literature advocates consideration of surgical treatment by optic nerve sheath fenestration if antiedematous treatment has no effect and the eye is nearly blind.

[Intra-corneal rings for the correction of weak myopias]. / Les anneaux intracornéens pour la correction des faibles myopies.

OBJECTIVES OF THE STUDY: Intra-stromal rings (ICR) represent a new method for low myopic correction. An indirect central flattening is induced by a peripheral steepening related to the segments. This surgery was recently approved in Europe, but is still under evaluation in the multicenter study controlled by the FDA (Food and Drug Administration). We took part in that protocol and report our results at one year follow-up. MATERIAL AND METHOD: Twenty-five patients were included in the study with 47 operated eyes and a follow-up between 3 to 18 months. Data relative to refractive results, quality of the vision and anatomic changes induced by intrastromal segments will be collected at the issue of a rigorous survey. RESULTS: At one year, non-corrected visual acuity was 20/40 or better in 100% and 20/20 in 60%. We noted no loss in best visual acuity and an improvement of one or two lines in 20% of operated eyes. No significative changes were observed concerning: intraocular pressure, corneal sensitivity, central pachymetry or corneal endothelium. Three eyes had to be explanted and recovered the preoperative refraction. No severe complications were observed. DISCUSSION: Analysis of results is in favor of the efficacy, predictability and reproductibility of the surgery, which might be better with rings of a diameter under 0.40 mm. Occurrence of postoperative astigmatism appears to constitute the main limit suggesting discussion on etiologic factors and modalities of treatment. CONCLUSION: This concept of intra-corneal rings appears particularly promising for correction of low myopia and maybe in the near future for correction of others ametropia, requiring design of new specific segments. Essential interest of this surgery is the respect of the central area and its potential reversibility.

[Keratoconus and familial topographic corneal anomalies]. / Kératocône et anomalies topographiques cornéennes familiales.

PURPOSE: Computer-assisted corneal topography, allows the detection of early abnormalities, including abortive or subclinical forms of keratoconus. So, it is possible to identify affected individuals with variable degrees, in family members of patients with keratoconus, to draw pedigrees, and to specify the mode of inheritance. METHODS: Computer-assisted digital videophotokeratoscope was used to map the corneas of 106 family members of 30 patients with keratoconus. RESULTS: Abnormalities observed included the inferior cornea markedly steeper than the superior cornea (I-S - 0.86 +/- 0.44 D) and a marked difference between the central corneal powers of the two eyes (delta PC = 0.72 +/- 0.22 D). However, there was no statistical difference with normal individuals for central corneal power. CONCLUSION: Pedigree analysis in these families suggests, in 50% of them, an autosomal dominant mode of inheritance. However, it is impossible to conclude for the other families, because of an insufficient number of cases.

[Treatment by refractive photokeratectomy of undercorrections after radial keratotomy]. / Traitement par photokératectomie réfractive des sous corrections après kératotomie radiaire.

UNLABELLED: Residual myopia after radial keratotomy is one of the major problems of this technique, it may be corrected with laser keratectomy. MATERIALS AND METHODS: We present the results of nine eyes treated with photorefractive keratectomy, due to undercorrection after radial keratotomy. The photoablation was performed with the laser VISX 20/20, wavelength 193 mm, and concerned a residual spherical equivalent myopia (after RK) with an average of -2.00 diopters and a range of 0.87 to -3.75 D. RESULTS: Six months postoperatively, the average spherical equivalent refraction was no greater than -0.75 D and a range of -0.25 D to -2.12 D; 66.7% were within +/- 0.5 D of emmetropia, with a uncorrected visual acuity > 10/20. The best corrected visual acuity remained nearly the same. Postoperatively functional symptomatology and healing processus are comparable to the first intention of photoablation. CONCLUSION: The safety and effectiveness of laser Excimer photoablation seem to be demonstrated and this procedure could be used to complement RK.