FIL-SSF Carlevale intraocular lens for sutureless scleral fixation: 7 recommendations from a serie of 72 cases. MICA study (Multicentric Study of the Carlevale IOL).

PURPOSE: Lacking a standard technique, the surgical management of aphakia without capsular support remains to be optimized. The goal of this study is to analyze results for the Carlevale FIL-SSF intraocular lens and propose surgical recommendations. PATIENTS AND METHODS: The P1.5 Collective performed a retrospective analysis, with a minimum follow-up of 6 months, of the records of 72 implantations of the Carlevale FIL-SSF intraocular lens, specifically designed for sutureless scleral fixation in the ciliary sulcus. RESULTS: The most common indication was exchange of a posterior chamber intraocular lens (70.8%). The surgery lasted a mean of 53.4minutes due to the creation of scleral flaps. The implant was damaged in 12.5% of cases. Visual acuity was improved in 83.3% of cases. The postoperative spherical equivalent was -0.3 diopters, with no change in corneal astigmatism. The implant was centered and stable in all cases. Two cases (2.8%) of cystoid macular edema were observed and resolved over six months. DISCUSSION: A number of advantages of the Carlevale FIL-SSF intraocular lens make it a safe and effective solution for correction of aphakia in the absence of capsular support. It requires a longer than usual surgical procedure, and the implant must be handled with care. From their experience, the authors propose 7 recommendations to accelerate the learning curve. CONCLUSION: In light of the results of this study, we propose the Carlevale FIL-SSF intraocular lens as the new standard for the correction of aphakia without capsular support, but other studies are necessary to determine its exact place within the heirarchy of other available techniques.

[Treatment of macular hematoma complicating AMD by vitrectomy, subretinal r-TPA injection, intravitreal injection of bevacizumab combined with gas tamponade: Report of 4 cases]. / Traitement des hématomes maculaires compliquant la DMLA par vitrectomie, injection sous-rétinienne r-TPA, injection intravitréenne de bévacizumab associé à un tamponnement par gaz : à propos de 4 cas.

INTRODUCTION: The occurrence of a subretinal hematoma in age-related macular degeneration (AMD) is a serious complication that can impact the visual prognosis with a poor functional recovery. The management of this complication remains controversial. Several therapeutic methods have been described. We report the results of four patients treated with a protocol combining: vitrectomy, subretinal injection of r-TPA 0.025mg/0.3ml, intravitreal injection of 0.05ml of bevacizumab and retinal tamponade with 20% SF6 gas. PATIENTS AND METHODS: Our series consists of four patients with a submacular hematoma complicating AMD, included in succession between October 2013 and October 2014 and treated with the same treatment protocol and by the same surgeon. All patients underwent surgery within eight days after the onset of the macular hematoma. Patients with a consultation period longer than eight days did not undergo this treatment. Face down postoperative positioning was then carried out for seven days by the patients. RESULTS: We observed a shift in the macular hematoma in the four patients, which allowed the identification of secondary neovascularization responsible for the bleeding. The visual acuity improved in three patients from hand motion (HM) preoperatively to 2/10 at one month postoperatively. One patient maintained visual acuity 1/20 during the entire follow-up despite almost complete resorption of the subretinal hematoma. These visual acuities were stable at 6 months postoperatively. DISCUSSION: Macular subretinal hematoma can cause severe visual loss by several mechanisms. The blood accumulates between the neurosensory retina and the retinal pigment epithelium, which causes a toxic effect on the surrounding tissues, thus resulting in a loss of photoreceptors and cellular destruction in the pigment epithelium and choriocapillaris, evolving into a fibroglial scar. CONCLUSION: The therapeutic evaluation of this protocol in our series of four patients gives a favorable result. We observed an improvement in visual acuity in 3/4 of cases. This surgical technique appears to be effective in the treatment of this complication of AMD. However, a study on a larger scale is needed to confirm these results.

[Posterior capsule opacification]. / La cataracte secondaire.

Posterior capsule opacification (PCO) is the most common complication after cataract surgery, with an incidence of 30%. It tends to be considered a normal event in the natural history of cataract surgery. Better understanding of its pathophysiology and advancement of intraocular lens material and design along with the improvement of phacoemulsification technique have contributed to decrease the incidence of PCO. Although treatment by Nd: YAG laser posterior capsulotomy is quick and non-invasive, the opening of the posterior capsule may be associated with numerous complications. Prevention remains the best measure for controlling this pathology.

[An update on the use of tissue adhesives in ophthalmology]. / Mise au point sur l'utilisation des colles tissulaires en ophtalmologie.

Tissue adhesives have a long history of use in almost all surgical disciplines, both as an alternative and a complement to sutures. Nevertheless, ophthalmologists have restricted knowledge of their potential applications; consequently, tissue adhesives have been underutilized so far. This review discusses the most relevant clinical and experimental advances in the use of tissue adhesives in ophthalmology and details the characteristics and properties of the glues. Among the currently available adhesives, synthetic glues are mainly represented by cyanoacrylates and biologic glues by fibrin-based adhesives. Cyanoacrylate-based glues are especially useful for treating perforated or preperforated corneal ulcers and performing temporary tarsorrhaphy. Fibrin-based glues have the largest field of application, as they can be used in corneal perforations and are being widely used in pterygium surgery and conjunctival surgery. We also reviewed other anecdotic applications of these adhesives. Novel biomaterials such as biodendrimers, polyethylene glycols, modified chondroitin sulfates, and acrylic copolymers show promising results in the experimental field, and one product has been on the market for a short period of time.

Hypopyon uveitis (without scleritis) a manifestation symptom of relapsing polychondritis.

We report an atypical ocular symptom, hypopyon uveitis without scleritis encountered in relapsing polychondritis. Relapsing polychondritis should be considered in the differential diagnosis of sterile hypopyon uveitis.

Unusual iris metastasis from anal cancer: a case report.

We report a case of anal cancer with iris metastasis and summarize the iris metastasis literature. A 69 years old woman with a history of anal cancer presented with a visual field loss. Slit lamp examination showed a pink ovular mass on the iris of the left eye which was typical of iris metastasis. Because of worse prognosis of metastatic cancer and any ocular complications, the patient was treated by radiotherapy which allowed a clinical improvement. A review of medical records was performed to assess the clinical presentation, diagnosis and treatment. Anal carcinoma can metastasize to the iris. Radiotherapy allows a good local control of tumour but the prognosis depends on systemic disease which is generally bad.

Results of surgery on macular holes that develop after rhegmatogenous retinal detachment.

AIMS: To evaluate the characterics and surgical prognosis of macular holes that develop after rhegmatogenous retinal detachment repair. DESIGN: Retrospective, interventional, consecutive case series. METHODS: The case records of nine patients who developed a new full-thickness macular hole after prior RD repair were reviewed over 6 years. Optical coherence tomography (OCT) confirmed these holes. They were offered surgical repair with a median follow-up of 13.3 months (1-63 months). Main outcomes included preoperative vitreo-macular status, OCT evaluation and postoperative visual acuity. RESULTS: 1007 eyes underwent surgery for prior retinal detachment between August 1999 and September 2005. Nine eyes developed a full-thickness macular hole (prevalence 0.9%): five developed after scleral buckling surgery, one after pneumatic retinopexy and three after primary vitrectomy. The mean time to macular hole diagnosis after RD was 2.9 months (0.5-18). All patients underwent macular hole surgery by the same surgeon. At 1 month, macular hole repair was noticed in eight eyes. In this group, visual acuity at a median of 11.9 months of follow-up was 20/125 (20/400 - 20/63). Three eyes had an improvement of more than three Snellen lines. CONCLUSIONS: Macular holes developing after RD repair is a rare complication (less than 1%). Its physiopathological mechanisms are not well known. Conventional macular hole surgery including pars plana vitrectomy, inconstant internal limiting membrane delamination and long-acting gas tamponade seems to achieve to macular reattachment (89%). The visual outcome seems conditioned by the macular status noticed during the RD.

[Surgical results of retinal detachment with unseen retinal breaks]. / Résultats chirurgicaux des décollements de rétine sans déhiscence visible.

BACKGROUND: The treatment of retinal detachment (RD) with unseen breaks has not been clearly defined. The aim of this study was to evaluate surgical results of these RDs using two different techniques. PATIENTS AND METHODS: We conducted a retrospective study including consecutively operated RDs in our department between 2001 and 2006. Twenty-two RDs were identified. In eight eyes (36.4%), conventional scleral buckling was performed (with or without subretinal fluid drainage). In 14 eyes (63.6%), vitrectomy associated with cryopexy or endolaser impact was performed. Circumferential buckling was achieved in ten cases. RESULTS: These operated patients account for 2.5% of the RDs followed up in our department between January 2001 and June 2006 (887 patients). The eyes were predominantly pseudophakic (86.4%), with inferior RD (59.1%). The patients had described functional signs for a mean of 56 days (2-240 days). Sixteen eyes (73%) were reattached after the primary procedure. The primary reattachment rates at 1 month were 37.5% in the scleral buckling group versus 86.4% in the vitrectomized group. The final retinal reattachment rate was 86.4%. CONCLUSIONS: In our study, the situation where breaks are unseen during retinal detachment surgery is uncommon (2.5%), occurring most often with inferior retinal detachment in pseudophakic eyes. This seems to indicate better retina reattachment after vitrectomy associated with a circumferential buckling in first intention. However, a study including a larger number of patients would be necessary to confirm our results.