COMPARING INTRAVITREAL AIR AND GAS FOR THE TREATMENT OF VITREOMACULAR TRACTION.

PURPOSE: To compare the effect of intravitreal injections of air with gas on vitreomacular traction (VMT) release and attempt to analyze predictive factors for success. METHODS: The medical records of patients with symptomatic VMT undergoing intravitreal injections (0.3 mL) of either octafluoropropane (C3F8) or air were retrospectively reviewed. The VMT release (primary end point) and the best-corrected visual acuity (secondary end point) were noted 1 month after injection. At baseline and 1 month after the injection, a macular optical coherence tomography was performed. RESULTS: Twenty-four eyes of 22 patients were included. Vitreomacular traction was released in 10 cases, 7 among 11 C3F8-injected eyes (63%) and 3 among 13 air-injected eyes (23%) (P = 0.045). In eyes with released VMT, ETDRS improved from 61 ± 35 (0-100) to 65 ± 37 (0-100) 1 month after the injection (P = 0.03). All patients with VMT release had a horizontal vitreomacular adhesion of less than 600 µm. Five eyes (23%) underwent vitrectomy after the injection of gas or air. CONCLUSION: Posterior vitreous detachment in VMT can be observed with both air and gas injection with a low complication rate. The occurrence of VMT release observed with air seemed to be less frequent than that observed with gas.

Comparing Heads-Up versus Binocular Microscope Visualization Systems in Anterior and Posterior Segment Surgeries: A Retrospective Study.

BACKGROUND: Three-dimensional (3D) visualization systems, also known as heads-up systems, are now available for eye surgery and as with every new device there is need for a specific evaluation. OBJECTIVES: The aim of this study was to compare the efficiency, surgical comfort, and safety of a 3D visualization system to a standard binocular microscope (BM) in routine ophthalmologic procedures. METHOD: After a 4-week training period, a 3D visualization system (Ngenuity, Alcon®) available in one of the Robert Debré Hospital Ophthalmology Departments' operating rooms was compared to a standard BM (OPMI LUMIRA 700, Zeiss®), in the process of a call for new device evaluation. From December 2017 to March 2018, 5 surgeons and their respective residents were asked to fill in a questionnaire for all procedures. Before the surgery, the surgeon recorded: (i) the type of surgery (cataract [PK], retinal detachment [RD], epiretinal membrane peeling [ERM], macular hole, vitreous haemorrhage [VH]), (ii) the type of visualization system chosen (3D or BM), and (iii) the estimated surgical risk (low, intermediate, or high grade). At the end of the procedure, the primary surgeon recorded the remaining parameters, including: (i) surgery duration, (ii) intraoperative complications, (iii) percentage of endoillumination for posterior segment surgeries, (iv) status of the operator (senior or resident) and operator switch if necessary (senior only, resident only, or resident with help of the senior), and rated: (i) the visual comfort (low, normal, excellent), (ii) the operative fluency (low, normal, excellent), (iii) backaches (none, low, moderate, important), and (iv) headaches (range from 0 to 10). Age and sex were collected retrospectively. The procedures performed with 3D and BM were subsequently compared using univariate (χ2, Fisher, Wilcoxon) and multivariate analysis (generalized linear model), allowing us to identify parameters independently associated with PK surgery duration. RESULTS: A total of 102 valid questionnaires, relative to 73 PK and 29 vitreoretinal procedures, respectively, were analysed. As regards PK (3D, n = 25 vs. BM, n = 48), the mean age, sex ratio, surgical risk, intraoperative complications (1/25 vs. 4/48), visual comfort, backaches, and headaches were similar between the two systems. The use of 3D allowed faster PK surgeries (16.44 ± 4.36 vs. 21.44 ± 7.50 min; p = 0.007) and slightly enhanced the operative fluency. In vitreoretinal surgeries (3D, n = 14 vs. BM, n = 15), no obvious differences between the two visualization systems were observed, although the use of the 3D system was found to slightly decrease the operative fluency. Parameters independently associated with PK surgery duration were 3D visualization (ß = -4.4 ± 1.4; p = 0.002), high preoperative surgical risk (ß = 6.2 ± 2.4; p = 0.012), intraoperative complications (ß = 8.7 ± 2.6; p = 0.001), and surgeon status (ß = -4.4 ± 1.3; p = 0.001) in univariate and multivariate analysis. CONCLUSIONS: 3D visualization can be safely used in routine practice. It slightly improves the operative fluency, allowing faster PK surgery.

Comparison between multifocal ERG and C-Scan SD-OCT ("en face" OCT) in patients with a suspicion of antimalarial retinal toxicity: preliminary results.

PURPOSE: Pericentral visual field changes and disruption of the ellipsoid layer on spectral domain optical coherence tomography (SD-OCT) are the main features of antimalarial retinal toxicity. C-Scan OCT or "en face" enables a topographic frontal view of the changes observed within the different retinal layers in particular the ellipsoid layer. The aim of this prospective study was to compare multifocal ERG (mfERG) responses with the results of C-Scan OCT ("en face" OCT) in patients with abnormal visual field and to analyze relationships between the structural and functional abnormalities. METHODS: In 354 consecutive patients screened for antimalarial toxicity between January 1, 2014 and December 31, 2016, central visual field, mfERG recording, C-Scan OCT and short-wavelength fundus autofluorescent imaging were performed. RESULTS: Among the 17/354 patients with abnormal central visual field results, all presented with abnormalities on the mfERG at least in one eye. In 16/33 eyes, there was a good concordance between focal loss of the mfERG response and the disruption of the ellipsoid layer on C-Scan OCT. In one eye with characteristic changes in the ellipsoid layer on the C-Scan OCT, the mfERG was normal, whereas in three eyes the mfERG was abnormal in eyes with a normal C-Scan OCT. CONCLUSIONS: The contribution of the C-Scan OCT changes remains difficult to establish as there is no strict concordance with the local ERG responses. Although C-Scan OCT technology provides a new approach in analyzing focal abnormalities in the photoreceptor-retinal pigment epithelium interface, the sensitivity of this method compared with mfERG and other tests (central visual field, B-Scan OCT) needs to be evaluated. This study is still ongoing on a larger cohort.

Increased intravitreal glucose in rhegmatogenous retinal detachment.

PURPOSE: Altered glucose metabolism, along with low-grade inflammation, has been proposed to be involved in retinal detachment (RD)-induced cone loss. Here, we assessed intravitreal glucose and cytological profile in patients with macula-off RD. METHODS: Glucose concentration was analysed in vitreous samples from 137 non-diabetic patients undergoing vitrectomy for either primary macula-off RD (n = 73) or epiretinal membrane (ERM; n = 64). Cellularity was assessed in vitreous cytospin preparations by a semi-quantitative immunostaining approach. RESULTS: Intravitreal glucose concentration was higher in the RD group (2.28 mmol.L-1 n =73 vs 1.6 mmol.L-1 n = 64; p < 0.0001). Overall cellularity and density of macrophages were significantly higher in the vitreous of RD patients (respectively p = 0.003 and p < 0.0001). Among the RD patients, intravitreal glucose concentration correlated with macrophages density (p = 0.002): its levels remained significantly higher in eyes in which macrophages were innumerable compared to lower macrophages densities RD eyes (p = 0.0095). CONCLUSIONS: We observed a strong relationship between intravitreal glucose concentration and vitreous macrophage density. Additional indicators for vitreous glycation and low-grade inflammation should be further studied.

Descemet membrane detachment after Nd: YAG laser capsulotomy in a patient with fuchs dystrophy.

PURPOSE: Descemet membrane detachment (DMD) is uncommon. It most frequently occurs as a complication of intraocular surgery. The aim of this study was to report a case of DMD after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy in a patient with Fuchs dystrophy. METHODS: We describe the case of an 89-year-old man suffering from Fuchs dystrophy, who underwent cataract surgery on his left eye. Three years later, the patient presented with posterior capsule opacification, which was treated using Nd:YAG laser capsulotomy. The day after the procedure, the patient came back for emergency treatment because of an acute reduction in his vision caused by a DMD. RESULTS: Fifteen days after an initial treatment involving the injection of air into the anterior chamber coupled with ocular paracentesis, clinical examination revealed a significant improvement in visual acuity, reduction in corneal edema, and reattachment of Descemet membrane. These findings were confirmed using anterior segment optical coherence tomography. CONCLUSIONS: To our knowledge, this is the first reported case of DMD after Nd:YAG laser capsulotomy.