[Descemet's membrane detachment after phacoemulsification: Series of 9 cases]. / Décollement descemétique post-phakoémulsification : à propos de 9 cas.

PURPOSE: Descemet's membrane detachment (DMD) is a rare but potentially serious complication of cataract surgery. Although there are no consensual guidelines regarding the diagnosis or treatment of DMD, incorrect treatment may result in irreversible corneal changes with visual sequellae. The purpose of our study is to describe the diagnosis and treatment of DMD. METHODS: We report a series of 9 cases of DMD, their diagnosis, treatment and outcomes. We tested the HELP protocol retrospectively against our 9 real-life cases. RESULTS: Two cases recovered with simple medical management, 4 required air-bubble descemetopexy, and three required keratoplasty. Our study revealed that the main factor associated with poor outcomes is late diagnosis and management. CONCLUSION: Our series illustrates the importance of proactive management and timely diagnosis by performing anterior segment OCT in the setting of persistent postoperative corneal edema.

Low-power versus medium-power toric intraocular lenses in cataract surgery, about 110 eyes.

PURPOSE: To analyze the refractive predictability of low-power and medium-power toric intraocular lenses (IOL) during cataract surgery. METHODS: A retrospective case series. Patients with low and moderate degrees of astigmatism were treated with either an Alcon AcrySof IQ toric monofocal lens (SN6AT2 or SN6AT3) or a Zeiss toric monofocal lens (709 MP + 1 D or 709 MP + 1.5 D). They were divided into two groups: group 1 with low-power toric IOL (n = 40, SN6AT2 and 709 MP + 1), group 2 with medium-power toric IOL (n = 70, SN6AT3 and 709 MP + 1.5 D). Eyes were evaluated before and 1 month after surgery. Uncorrected distance visual acuity (UDVA), corneal and total astigmatism were compared pre- and postoperatively. Vector astigmatism analysis was evaluated using the Alpins method. IOL alignment was checked postoperatively at slit lamp under pupil dilatation and on photos using Eyesuite® software (Luneau®). RESULTS: More than three-quarters of the patients in each group attained a visual acuity of at least 0.1 LogMAR (0.8) without spectacles. The reduction of total astigmatism was significant in the two groups. The residual refractive astigmatism did not differ between the two groups (P = 0.64) and was less than 0.4 D. More than 80% of patients (82.5 vs 84.3%) presented a postoperative refractive spherical equivalent at ±0.50 D (P = 0.8). Vectorial astigmatism was significantly different in the two groups (0.43 D in group 1, vs 0.27 D in group 2; P = 0.03). CONCLUSION: This is the first study comparing the low- versus medium-power toric IOLs, the most widely used. This study suggests very good refractive results both with low- and medium-power toric IOLs with a single surgical procedure.

[Prospective, monocentric, uncontrolled study of efficacy, tolerance and adherence of cyclosporin 0.1 % for severe dry eye syndrome]. / Étude prospective, monocentrique, non contrôlée de l'efficacité, de la tolérance et de l'adhésion au traitement par ciclosporine 0,1 % au cours des sécheresses oculaires sévères.

PURPOSE: To evaluate the efficacy, tolerability and treatment adherence of Ikervis® (Santen, SAS) (ciclosporine 0.1 %) for first line therapy or following treatment with Restasis® (Allergan, Inc.) (ciclosporine 0.05 %) for severe dry eye syndrome. MATERIAL AND METHODS: A prospective, monocentric, uncontrolled study was conducted between January 2012 and March 2015 on 110 eyes of 55 patients with severe dry eye on first line therapy or previously treated with Restasis® who required the introduction of Ikervis®. Patients' quality of life was assessed before and after treatment was started using a standardized questionnaire (Ocular Surface Disease Index© [OSDI]), clinical efficacy was quantified at the slit lamp, by measurement of the Break Up time Test (BUT) and the Oxford classification. Tolerability and adherence to treatment were measured using a simple questionnaire. RESULTS: A total of 72 eyes of 37 patients were included. Etiologies of dry eye syndrome were dominated by Sjögren syndrome (32 %) and severe ocular surface conditions (48 %). The mean age was 57.7 years (±17.45) and mean follow-up was 458 days (±292). The mean BUT increased by 2.043seconds [1.522-2.563] (P<0.0001). Corneal/conjunctival involvement evaluated by the Oxford classification was also improved with a difference in level of 1.68 [1.290-2.071] (P<0.0001). Ocular Surface Disease Index© (OSDI) decreased by 21.7 [16.372-27.024] (P<0.0001). Treatment tolerability was moderate, with more than 50 % of patients experiencing pain on instillation. Overall satisfaction with treatment was good, with more than 60 % of patients feeling better after initiation of treatment. CONCLUSION: Ikervis® is an effective treatment of severe dry eye. Its indications tend to evolve towards less severe dry eye. However, the tolerability profile remains poor, and an improvement in this would be desirable.

[Toric lens implantation in cataract surgery: Automatic versus manual horizontal axis marking, analysis of 50 cases]. / Implantation torique : comparaison du marquage horizontal manuel versus automatique, à propos de 50 cas.

SUBJECT: The main objective of our study is to evaluate the contribution of automated conjunctival recognition in the alignment of toric implants by comparing the automatic alignment optimized with Callisto™ to the manual marking of the horizontal axis. MATERIALS AND METHODS: We performed a prospective, descriptive, and monocentric study on patients undergoing cataract surgery with toric implantation (Asphina 709 Zeiss), operated by a surgeon with good experience in toricity, between September 2016 and March 2017. We analyzed the agreement between the manual marking of the 0°-180° axis versus the one automatically generated by the Callisto™, as well as the alignment of the IOL and the refractive results at 1 month. RESULTS: We included 50 eyes of 26 patients. The corrected mean astigmatism was 1.9 D. The mean difference between the 2 axes was 4.7° [0°-12.3°]. Only 50 % of the preoperative manual markings were consistent with the automatic measurement (<5°). At one month, the average rotation recorded was 4.3° [0°-29°]. The alignment was identical for 70 % (n=35) of the IOL (≤5°). As for residual subjective astigmatism, it was on average 0.58 D. The mean visual acuity without correction was 8/10 and 55 % had 10/10 without correction. DISCUSSION: The refractive performance depends on the preoperative measurement, the correct alignment of the IOL and its stability in the bag. Our study shows the value of automatic conjunctival recognition in the determination of the axis of peroperative alignment, even in an experienced operator. This precision is essential for a good refractive result, especially since the residual astigmatism in case of misalignment will increase with the power of the implant. CONCLUSION: Our study shows excellent refractive results, whatever the initial astigmatism, using the automatic alignment. The precision of the toric implantation opens the way to the toric multifocal implantation under the best conditions.

Toric lens implantation in cataract surgery: Automated versus manual horizontal axis marking, analysis of 50 cases.

SUBJECT: The main objective of our study was to evaluate the contribution of automated conjunctival registration in the alignment of toric intraocular lenses by comparing automated registration optimized with Callisto® to manual marking of the horizontal axis. MATERIALS AND METHODS: We performed a prospective, descriptive, monocentric study on patients undergoing cataract surgery with a toric intraocular lens (Asphina 709 Zeiss), performed by a surgeon with good experience in toric implants, between September 2016 and March 2017. We analyzed the agreement between the manual marking of the 0-180° axis versus the one automatically generated by the Callisto™, as well as the alignment of the IOL and the refractive results at 1 month. RESULTS: We included 50 eyes of 38 patients. The mean corrected astigmatism was 1,9 D. The mean difference between the 2 axes was 4,7° [0-12.3°]. Only 50 % of the preoperative manual markings were consistent with the automated measurement (<5°). At one month, the mean rotation recorded was 4,3° [0-29°]. The alignment was identical for 70 % (n=35) of the IOLs (≤5°). As for residual subjective astigmatism, the mean was 0.58 D. The mean visual acuity without correction was 8/10 and 55 % saw 10/10 without correction. DISCUSSION: Refractive performance depends on preoperative measurement, correct alignment of the IOL and its stability in the bag. Our study shows the value of automated conjunctival registration in the determination of the intraoperative axis of alignment, even with an experienced surgeon. This precision is essential for a good refractive result, especially since residual astigmatism in the case of misalignment will increase with the power of the implant. CONCLUSION: Our study shows excellent refractive results, regardless of the initial astigmatism, using automated alignment. Precision of toric implantation opens the way to toric multifocal implantation under the best conditions.

[Evaluation of surgical simulation sessions of the French society of ophthalmology. A new surgical instruction method]. / Évaluation des sessions sur simulateurs chirurgicaux de la Société française d'ophtalmologie. Une nouvelle pédagogie chirurgicale.

INTRODUCTION: Since 2013, at the French society of ophthalmology (FSO) meetings, two simulators for intraocular surgeries have been available. The goal of this study was to assess the satisfaction of the participants in these organized training sessions. MATERIALS AND METHODS: A questionnaire was mailed to participants in the FSO sessions as well as those carried out during the annual congress. This questionnaire collected data on the participants and the practical modalities of the sessions, and assessed participants' feelings and satisfaction with these sessions. RESULTS: The participants in the SFO sessions were young members of the SFO (31.8±12.3 years). 53.8 % were in training, looking to improve a problematic surgical step (capsulorhexis in 51.5 %). They spent nearly 5hours on simulators (4.8hours) and were alone on a simulator 50 % of the time. The sessions held during the annual congress were used by older physicians (41.9±26.4 years) already in practice (66.6 %). The goal of such training was curiosity in a third of the cases (to try the simulators). The majority spent less than an hour on the devices and were at least two participants per machine. Despite these differences, participants cited a role for their surgical learning curve and recommended such training to their colleagues. CONCLUSIONS: The participants' enthusiasm for this new training technique is highlighted by the results of this study.

[Disc-fovea angle adjustment for peripallary retinal nerve fiber layer analysis by a spectral domain optical coherence tomography. Preliminary study]. / Analyse des fibres nerveuses rétiniennes péripapillaires ajustée selon l'angle papillo-maculaire en tomographie par cohérence optique en domaine spectral. Étude préliminaire.

INTRODUCTION: Circumpapillary retinal nerve fiber layer (cpRNFL) analysis by spectral domain optical coherence tomography (SD-OCT) has become essential for the assessment of glaucoma patients. The foveal projection is conventionally below the disc plane, creating an angle with the horizontal meridian, the disc-fovea angle. The purpose of this study is to evaluate the role of adjustment of cpRNFL analysis based on this angle. MATERIALS AND METHODS: This study concerns 40 control eyes and 55 eyes affected with and followed for primary open angle glaucoma (POAG). After precise localization of the optic disc center and the axis connecting it to the center of the fovea, a circular peripapillary scan is performed with Spectralis OCT (Heidelberg Engineering, Germany). The mean thickness in each of six papillary sectors and the global mean thickness of the cpRNFL were evaluated. The ROC (receiver operating characteristic) analysis evaluated the diagnostic capabilities of the various sectors before and after adjustment of the analysis for the disc-fovea angle. RESULTS: The disc-fovea angle was not different between the two groups (-7.0 ± 1.2° for controls vs. -6.6 ± 1.2° for POAG, P=0.70). There is a significant variance of this angle in both groups (the angle varies in the control group between -22.5° to +1.8° and in the POAG group between -18° to +2.4°). The global mean and inferior temporal (IT) thickness of the cpRNFL show the best diagnostic performance. Adjustment for disc-fovea angle does not increase the diagnostic accuracy of the various sectors analyzed. Although there is an increase in the area under the curve for the IT sector after adjustment, it is not statistically significant (0.910 ± 0.056 vs. 0.936 ± 0.045, P=0.06). CONCLUSIONS: There is a significant variation in disc-fovea angle. In this study, accounting for it does not significantly improve the diagnostic capabilities of cpRNFL in patients with POAG.

[A role for hypnosis in cataract surgery: Report of 171 procedures]. / Apport de l'hypnose dans la chirurgie de cataracte, à propos de 171 chirurgies.

OBJECTIVES: To study the effectiveness of relaxation hypnosis in outpatient cataract surgery. STUDY DESIGN: Prospective study of 171 patients undergoing cataract surgery under hypnosis, performed by the same nurse anesthetist. The procedures were performed by 2 senior surgeons, A and B (A=78 surgeries, and B=93 surgeries) under topical anesthesia and with a 2.2-mm mini-incision. The hypnosis group (n=102) was compared to a control group (n=69) according to quantitative, objective criteria: hemodynamic changes and the need for intravenous medication in operating room, as well as subjective, qualitative criteria: surgical comfort, effectiveness of hypnosis, and patient satisfaction. Subgroup analyses by surgeon, 1st and 2nd eye surgery, were performed. RESULTS: Hemodynamic parameters were not significantly different between the 2 groups: systolic blood pressure (P=0.06) and maximum heart rate (P=0.25). However, the use of intraoperative intravenous medication was significantly higher in the control group (49.3% versus 21.6%, P<0.001). The effectiveness of relaxation was scored at a mean of 5.25/6 by the nurse anesthetist. The patients in the hypnosis group reported a mean comfort rating of 8.4/10, and 100% were satisfied with this hypnosis experience. CONCLUSIONS: Preliminary results of this study are very positive for all three parties: patient/anesthetist/surgeon. They are leading to an expanded university training program for operating room personnel in order to improve quality of care and reduce premedication in elderly patients so as to facilitate their return to home.

[Post-traumatic endophthalmitis]. / Les endophtalmies post-traumatiques.

Post-traumatic endophthalmitis is a rare but serious complication of open globe injury, representing a major turning point for the patient's visual prognosis. Risk factors for this complication are lens capsule rupture, an intraocular foreign body, type of eye trauma and especially a delay in initial management of the trauma. Although Staphylococcus epidermidis is the most common organism, as in postoperative acute endophthalmitis, other microorganisms are more frequently represented and the multi-microbial involvement is common. The diagnosis can be difficult in the presence of inflammatory signs of trauma. Aside from rapid globe repair, neither preventive nor curative treatment have been well delineated. The class of antibiotics, the dosage, route of administration, as well as surgical treatment by vitrectomy remain topics of discussion.

[Evaluation of the new Canon HS-100 SD-OCT: Reproducibility of macular ganglion cell complex (GCC) thickness measurement in normal, hypertensive and glaucomatous eyes]. / Évaluation du nouvel OCT SD Canon HS-100: reproductibilité de la mesure de l'épaisseur du complexe cellulaire ganglionnaire maculaire pour des yeux normaux, hypertones et glaucomateux.

PURPOSE: To evaluate intra- and interobserver reproducibility of macular GCC thickness measurement by automated segmentation on the Canon HS-100 SD-OCT (Tokyo, Japan) in normal (N), hypertensive (OHT) and glaucomatous eyes. METHODS: A total of 179 eyes of 93 patients were included: 90 N, 28 OHT and 36 early glaucoma and 25 advanced glaucoma. All patients underwent a complete ophthalmologic exam, central corneal thickness and 24-2 standard automated perimetry (HFA SITA standard). Each of two observers performed three macular acquisitions with the Canon OCT HS-100. Acquisitions were analyzed with the Glaucoma 3D mode, which estimated the macular GCC thickness in global, superior and inferior hemisectors, and in eight separate macular areas. Reproducibility was assessed by intraclass correlation coefficient (ICC), coefficient of variation (CV) and test-retest variability (TRTV) calculated as 1.96 times the standard deviation. RESULTS: Mean GCC thickness was respectively 92.4 µm, 89.0 µm, 80.7 µm and 71.2 µm in N, OHT, early and advanced glaucomatous eyes. In all groups, intra- and interobserver reproducibility ranged respectively for ICC from 89.8 to 99.8% and from 90.2 to 99.4%, for CV from 0.43 to 1.95% and from 0.58 to 2.16% and for TRTV from 0.8 to 3.22 µm and from 1.04 to 3.53 µm. GCC thickness measurements using the new HS-100 SD-OCT were highly reproducible. However, in the advanced glaucoma group, while the reproducibility of GCC thickness measurement is good in the average, superior and inferior hemisectors of the macula, it was slightly less for the paracentral sectors, especially inferior. These sectors correspond generally to the areas most affected by glaucoma. CONCLUSION: The reproducibility of GCC thickness measurements using the new Canon HS-100 SD-OCT is high for normal, OHT, and glaucomatous eyes. It is thus a reliable and reproducible ancillary test available to the clinician for the examination of glaucomatous optic neuropathies.

[Ocular hypertension after intravitreal steroid injections: Clinical update as of 2015]. / Hypertonie oculaire après injections intra-vitréennes de corticoïdes, actualisation des connaissances en 2015.

Intravitreal injections are a therapeutic delivery method best suited to the treatment of retinal diseases. Recent years have been marked by the use of anti-VEGF agents as well as the arrival of sustained-release corticosteroid implants in France, replacing triamcinolone acetonide. A common complication of IVT steroids is secondary ocular hypertension (OHT) resulting from increased outflow resistance. This article summarizes current understanding. OHT induced by topical steroids has been described for 60 years. Intravitreal use also shows a temporary effect if the exposure is short, dose dependence, and varying incidence depending on the drug used. Sustained release formulations and discontinuing treatment have reduced the risk of induced OHT. Risk factors that induce OHT must be clearly identified prior to an injection. Most cases of OHT can be controlled medically, although differences exist between different drugs. In cases where it cannot be controlled, removal of the implant, selective laser trabeculoplasty, and filtration surgery can be discussed.

[New neuroretinal rim analysis with spectral domain optical coherence tomography, Spectralis (Heidelberg Engineering, Germany). Preliminary study]. / Une nouvelle analyse de l'anneau neuro-rétinien en tomographie par cohérence optique en domaine spectral, Spectralis (Heidelberg Engineering, Germany). Étude préliminaire.

INTRODUCTION: Clinical determination of the outer limits of the optic disk (OD) doesn't always correspond to the true anatomic limits of the optic nerve head (ONH) defined by the Bruch's membrane opening (BMO). A new index analyzing the OD with optical coherence tomography (OCT), "minimal rim width" (BMO-MRW), evaluates the smallest thickness of the neuroretinal rim between the BMO and the internal limiting membrane. The purpose of this study was to evaluate new software for automatic measurement of the BMO-MRW. MATERIALS AND METHODS: This study investigated 95 eyes: 40 control eyes and 55 eyes followed and treated for primary open angle glaucoma (42 early glaucoma, 7 moderate glaucoma and 6 advanced glaucoma). After a precise localization of the OD center, 24 radial scans of the ONH are taken with the Spectralis OCT (Heidelberg Engineering, Germany). From the 48 measurements of BMO-MRW, the mean thickness as well as that in each of the 6 papillary sectors of this new index are calculated. ROC curves analysis (receiver operating characteristic) was used to assess the diagnostic capabilities of the various parameters. RESULTS: Thicknesses of all parameters were statistically lower in glaucoma than in controls. The mean value and inferotemporal sector (IT) had the best diagnostic capabilities without significant difference between them (BMO-MRW-average = 0.890 ± 0.062, BMO-MRW-IT = 0.881 ± 0.066, P = 0.59). The area under the curve was lowest in the temporal sector (0.820 ± 086 statistically lower than the average value, P = 0.04). CONCLUSIONS: This preliminary study of a new automated analysis of the neuroretinal rim highlights the diagnostic value of the BMO-MRW index. This evaluation appears to be best correlated with the anatomy of the ONH with good diagnostic sensitivity.

[Optical quality after 2.2mm microincisional cataract surgery with bimanual I/A in 154 eyes]. / Qualité optique après phacoémulsification par mini-incision de 2,2mm associée à une I/A bimanuelle, à propos de 154 yeux.

PURPOSE: A prospective study to analyze the effects of 2.2mm microincisional coaxial phacoemulsification with bimanual irrigation/aspiration on the optical quality of the cornea and whole eye. METHODS: We compare two groups. Group A: 102 consecutive eyes undergoing this three-incision procedure and implanted with an Alcon® SN60WF IQ aspheric intraocular lens. Astigmatism, corneal and total asphericity, as well as H/B ratio were measured by OPD scann II, Nidek®, Japan, preoperatively (Day 0), 15 days postoperatively (Day 15) and 1 month postoperatively (M1). Group B: 52 eyes with corneal astigmatism greater than 1.25D, undergoing the same procedure but implanted with a Toric IOL (Alcon® Toric IQ SN6AT), followed in the same manner but with additional follow-up at 1 year. RESULTS: Corneal surgically induced astigmatism (SIA) was essentially neutral: 0.065D ± 0.86 at Day 30 in group A, and 0.06D ± 0.34 at 1 month and -0.008D ± 0.4 at 12 months in group B. Corneal topographic astigmatism underwent a mean axis shift of 29.95° ± 27.6 in group A compared to 5.3° ± 3.7 in Group B, and remained stable at 1 year. Corneal asphericity did not change significantly between Day 0 and 30 in either group. H/B ratio increased significantly in both groups, with a gain of 22 % to 24 % after surgery. CONCLUSIONS: This three-incision procedure does not degrade the optical quality of the cornea. Postoperative shift in the axis of astigmatism is only an issue in cases of low or asymmetric astigmatism and must be kept in mind for low-power toric IOL implantation.

[Diagnostic use of macular layer analysis by SD-OCT in primary open angle glaucoma]. / Capacités diagnostiques de l'analyse des différentes couches maculaires par SD-OCT dans le glaucome primitif à angle ouvert.

PURPOSE: The purpose of this study is to evaluate the diagnostic ability of segmentation of the various internal macular layers by spectral domain optical coherence tomography (Cirrus HD-OCT, Carl Zeiss Meditec (CZM), Dublin, CA, USA) and to compare it to that of the peripapillary retinal nerve fiber layer (cpRNFL) in primary open angle glaucoma (POAG). MATERIALS AND METHODS: This study included 252 eyes diagnosed with primary open angle glaucoma (POAG) (164 early POAG, 44 moderate POAG and 44 advanced POAG) and 223 eyes of control subjects. All patients underwent visual field testing (Humphrey Field Analyser, SITA-Standard 24-2, CZM), and SD-OCT imaging (Cirrus HD-OCT) of the macular and optic nerve head regions (ganglion cell analysis (GCA), macular cube 200×200; optic disc cube 200×200). OCT macular scans were segmented into macular nerve fiber layer (mNFL), ganglion cell layer with inner plexiform layer (GCIPL), outer retinal layers, and ganglion cell complex (GCC) (mNFL+GCIPL). Glaucoma discriminating ability was assessed using the area under the receiver operator characteristic curve (AUC) for all macular parameters and mean circumpapillary retinal nerve fibre layer (cpRNFL). RESULTS: For the entire POAG population of this study, the minimum GCIPL index provided greater diagnostic ability than the other parameters studied, with a statistically significant difference in their AUC (minimum GCIPL [0.887], mean GCIPL [0.865], GCC [0.863], cpRNFL [0.823], mean mNFL [0.786] and minimum mNFL [0.742]). The results were similar in the early POAG group but without any statistically significant difference with the cpRNFL parameter. In the moderate POAG group, the diagnostic ability was similar for all indices, whereas in the advanced POAG group, minimum GCIPL and GCC gave the largest AUC indices. DISCUSSION AND CONCLUSION: The minimum macular GCIPL is a new index obtained with the GCA algorithm of the Cirrus HD-OCT. It appears to have an excellent ability to detect glaucoma at every stage and demonstrates performance comparable to that of the cpRNFL parameter, in combination with which it may provide important complementary information for clinical practice.

[Analysis of macular ganglion cell complex (GCC) with spectral-domain optical coherence tomography (SD-OCT) in glaucoma]. / Analyse du complexe cellulaire ganglionnaire maculaire (GCC) en tomographie par cohérence optique (SD-OCT) dans le glaucome.

Early detection of ganglion cell loss is possible with new algorithms for the assessment of the Macular Ganglion Cell Complex (GCC) by SD-OCT. The various data acquisition protocols used by the various versions of software, as well as their accuracy and reproducibility, must be taken into account. Current results show similar ability to detect glaucoma as compared to Retinal Nerve Fiber Layer thickness (RNFL), with some limitations, possible artifacts, and interpretation pitfalls which must be taken into account. The role of the significance map and of various indices (Focal Loss Volume, Global Loss Volume, GCIPL minimum...); data obtained in the setting of various clinical entities (tilted disc, peripapillary atrophy, large and small optic discs, high myopia...); and detection of progression, especially in advanced glaucoma, underline the role of macular GCC analysis as a complementary method to peripapillary RNFL thickness. The diagnostic precision and better reproducibility of these new software protocols offer new perspectives in the detection and management of progression in various stages of the management of glaucomatous optic neuropathy.