Application of a practical amniotic membrane ring made on-site for restoration of ocular surface health in dry eye disease.

PURPOSE: Dry eye disease (DED) is one of the most common ocular surface disorders worldwide. Despite different underlying pathogenic processes, DED is characterized by ocular surface inflammation, which in turn induces further damage to the corneal epithelium and its underlying structures. Amniotic membrane transplants are known to have potent anti-inflammatory effects and also have the ability to enhance epithelial healing. In this study, we aimed to evaluate the clinical efficacy of amniotic membrane ring (AMR) application in treating refractory dry eye disease. METHODS: A retrospective analysis of 22 patients treated with contact lens-like amniotic membrane rings was performed. This amniotic membrane ring was formed using an aspiration catheter covered by a large piece of amniotic membrane graft. The amniotic membrane was sutured to the catheter using eight sutures. In this way, a customized amniotic membrane ring was prepared for each patient. Patients' demographics, symptoms, use of medications, conjunctival inflammation, corneal staining, and visual acuity were compared before and after treatment. In addition, the amniotic membrane retention duration, the amniotic membrane's effect on ocular surface healing, follow-up time, and complications were evaluated. RESULTS: Twenty-eight eyes of 22 patients (18 females and 4 males) aged 53.32±13.36 (6-73) years were included. The AMR retention duration ranged from 5 to 16 days, with a mean of 11±3.09 days, at which time the amniotic membrane had dissolved or been removed inadvertently by the patient. Discomfort with the ring was seen in 1 of 28 eyes (3.6%). The patients reported symptomatic relief for a period of 3.64±1.25 months. Symptomatic relief was accompanied by a reduction of OSDI scores (from 63.39±17.24 to 33.19±12.45) (P<0.001), use of topical medications (from 4.21±1.03 to 2.42±0.50) (P<0.001), conjunctival hyperemia (from 1.57±1.19 to 0.35±0.48) (P<0.001), corneal staining (from 2.89±1.16 to 0.57±0.74) (P<0.001), and improvement in visual acuity (from 0.23±0.16 to 0.16±0.25 logMAR) (P=0.001). CONCLUSIONS: Amniotic membrane ring treatment might be used to treat refractory dry eye disease. This technique has an economic advantage over other commercially available amniotic bandage tissues and can be easily removed and replaced during a follow-up examination.

COVID-19 pandemic and impact of universal face mask wear on ocular surface health and risk of infection.

Universal mask wear is an effective public health intervention to reduce SARS-Cov-2 transmission, especially in enclosed public spaces and healthcare environments. Concerns have been raised about possible transmission of the SARS-Cov-2 through ocular secretions, leading to enhanced protective measures during ophthalmic procedures. However, there is some evidence for air jets from the upper edge of the surgical mask to the ocular surface, especially when the mask is not well fit. Prolonged airflow towards the ocular surface during expiration may alter tear-film stability, leading to hyperosmolarity and ocular surface inflammation. This also raises the question of whether the ocular surface is contaminated with oral flora from airflow directed toward the eyes, thus increasing the risk of ocular infection. Herein we review the impact of patient face mask wear on the ocular surface, eyelids and risk of ocular infection, particularly during ocular surgery. There is some evidence for increased incidence of dry eye or eyelid disease during periods of mandatory face mask wear. While high daily exposure is consistent with a direct association, this should be mitigated by various cofounding factors which could also affect the ocular health during the COVID-19 pandemic. An increased risk of post-intravitreal injection endophthalmitis, possibly due to face mask wear by the patient, including culture-positive endophthalmitis, has been reported in one retrospective study. Several measures have been shown to prevent or limit the risk of developing dry eye disease or exacerbation, eyelid cyst, and ocular infection during intravitreal injections.

[Quality of life survey of 3,738 patients treated with intravitreal injections for age-related macular degeneration]. / Enquête de qualité de vie auprès de 3738 patients traités par injections intravitréennes pour leur dégénérescence maculaire liée à l'âge.

PURPOSE: To evaluate the peri- and post-intravitreal injection (IVI) symptoms reported by patients who have been repeatedly injected for age-related macular degeneration (AMD) and to analyze these according to the protocols of the injector. MATERIALS AND METHODS: Multi-center, cross-sectional, consecutive, analytical survey. RESULTS: The IVI protocols of 106 injectors differed in terms of the number of instillations of povidone-iodine, its contact time, and rinsing of the ocular surface post-injection. In total, 3,738 patients responded to the survey, 60.1% of whom were women; 36.4% had received more than 20 IVIs; 50.7% of patients reported irritation upon application of povidone-iodine. Post-IVI, depending on the symptom in question, between 44.8% and 57.4% of patients reported symptoms of ocular surface change. The number of instillations of povidone-iodine, its contact time with the ocular surface, and abundant rinsing post-IVI increased the immediate symptoms. Patients who received more IVIs were more prone to experiencing gritty eyes, and the incidence of acute pain increased in patients who had previously received over 20 IVIs. Women and patients previously treated for dry eye or glaucoma were at greater risk of worse symptoms. CONCLUSION: Comparing injecting centers' practices with patients' self-assessments showed an aggravation of symptoms of ocular surface changes related to povidone-iodine. This survey contributes to providing data for the implementation of a protocol to improve the quality of life of patients injected repeatedly for AMD.

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.

[Corneal epithelial biomechanics: Resistance to stress and role in healing and remodeling]. / Biomécanique de l'épithélium cornéen : résistance au stress et implications dans la cicatrisation et le remodelage.

The corneal epithelium is one of the first tissue barriers of the eye against the environment. In recent years, many studies provided better knowledge of its healing, its behavior and its essential role in the optical system of the eye. At the crossroads of basic science and clinical medicine, the study of the mechanical stresses applied to the cornea makes it possible to learn the behavior of epithelial cells and better understand ocular surface disease. We describe herein the current knowledge about the adhesion systems of the corneal epithelium and their resistance to mechanical stress. We will also describe the involvement of these mechanisms in corneal healing and their role in epithelial dynamics. Adhesion molecules of the epithelial cells, especially hemidesmosomes, allow the tissue cohesion required to maintain the integrity of the corneal epithelium against the shearing forces of the eyelids as well as external forces. Their regeneration after a corneal injury is mandatory for the restoration of a healthy epithelium. Mechanotransduction plays a significant role in regulating epithelial cell behavior, and the study of the epithelium's response to mechanical forces helps to better understand the evolution of epithelial profiles after refractive surgery. A better understanding of corneal epithelial biomechanics could also help improve future therapies, particularly in the field of tissue engineering.

[Ocular surface disease in glaucoma patients: Expert opinion and management algorithm in Algeria]. / Atteinte de la surface oculaire chez les patients glaucomateux : avis d'experts et algorithme de prise en charge en Algérie.

INTRODUCTION: The main goal of treatment for any glaucoma patient is to reduce the intraocular pressure. Unfortunately, the long-term use of glaucoma medications causes deleterious effects on the ocular surface, leading to impaired quality of life and failed glaucoma surgery. In addition, adverse effects of medications are a barrier to adherence and compliance, and this directly affects efficacy. It is therefore essential to regularly assess the ocular surface of glaucoma patients in order to detect any signs of damage early and act accordingly. Although the TFOS DEWS 2 now offers a strategy for diagnosing ocular surface pathologies, some examinations are unfortunately not feasible in Algeria due to lack of time and/or knowledge on the part of some ophthalmologists or are simply inaccessible to others. METHODS: Algerian experts (members of the ACOS club) met for the purpose of proposing an algorithm for the management of Algerian glaucoma patients, based on the recommendations of the DEWS, their own practice and the results of a preliminary national survey of ophthalmologists. RESULTS: The proposed algorithm allows evaluation of the ocular surface of the glaucoma patient in current practice by any Algerian ophthalmologist. CONCLUSION: Management of glaucoma patients should include a systematic examination of the ocular surface. The choice of treatment should be determined by the ocular surface condition of the glaucoma patient.

Conjunctival conveyance of SARS-CoV-2 in asymptomatic and non-severe symptomatic COVID-19 patients.

INTRODUCTION: The prevalence of ocular conveyance of SARS-CoV-2 has been well described for severe/hospitalized cases, but scarcely reported in asymptomatic and non-severe patients, who are unaware that they are carriers. MATERIAL & METHODS: This prospective cross-sectional study quantitatively evaluated SARS-CoV-2 shedding on the ocular surface (OS). Conjunctival testing was suggested to all hospital personnel being screened by nasopharyngeal (NP) SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR). Disease symptoms were evaluated using a standardized questionnaire and telephone follow-up 6±3 months later for disease evolution (recovery with/without severe disease). RESULTS: Four hundred and eighty seven patients were included. From 46 NP SARS-CoV-2-positive subjects (cycle threshold [CT]=24.2±7.1), 13% tested positive at the OS (CT=36.4±2.8). Most SARS-CoV-2-positive subjects were symptomatic (n=40, 87%), while 6 were asymptomatic (being tested as contact cases). Systemic symptoms were not significantly different in OS-positive vs OS-negative subjects, although headache tended to be more frequent in OS-positives (83% vs 54%, P=0.06). None of the OS-positive subjects reported ocular symptoms and none developed severe disease requiring hospitalization or oxygen therapy. CONCLUSION: SARS-CoV-2 shedding at the OS may occur in asymptomatic and non-severe COVID-19 individuals (including those absent of ocular symptoms). However, the high RT-PCR CT values attained may indicate a low risk of transmissibility via this route.

[From ocular itching to eye rubbing: a review of the literature]. / Du prurit aux frottements oculaires : une revue de la littérature.

Ocular itching and eye rubbing are frequent complaints in an ophthalmology practice. Numerous studies address the consequences of eye rubbing, such as keratoconus. However, there are few studies concerning the pathophysiology of itching, its transmission pathways, or its interactions with eye rubbing. Through this literature review, we will address the various clinical, physiological and therapeutic aspects of this pair of symptoms with a variety of ocular consequences. We will then describe the state of the art in itching and scratching in dermatology, in order to draw a parallel between these two vicious cycles. A better understanding of the pathophysiology of ocular itching and eye rubbing, as well as new studies based on dermatological data, might allow more appropriate clinical management of our patients and their symptoms.

[Ocular surface and outdoor air pollution: A systematic review]. / Surface oculaire et pollution environnementale extérieure : revue systématisée de la littérature.

INTRODUCTION: Air pollution has steadily increased for several decades, with widely studied effects on human health, including increased mortality, incidence of stroke, respiratory and allergic disease. However, the effects of pollution on the ocular surface, in direct contact with the outside world, have been less precisely studied. MATERIALS AND METHODS: We conducted a literature review of articles on the subject published from 1966 to October 2020. Among the 661 articles identified, 33 were retained. Ocular surface disease associated with pollution included non-specific conjunctivitis, dry eye disease, blepharitis, and allergic conjunctivitis. The studied pollutants were particulate matter less than 2.5µm and 10µm (PM2.5, PM10), ozone (O3), nitrogen dioxide (NO2), carbon monoxide (CO) and sulfur dioxide (SO2). Certain air quality parameters such as temperature and relative humidity were also studied. RESULTS: Among the markers of air pollution possibly associated with ophthalmic disease, NO2 and SO2 appear to be the most frequent and highly correlated. High temperatures and low humidity levels also appear to be aggravating factors for the ocular surface. However, due to the heterogeneity of the studies, the results must be interpreted with caution. Indeed, the methodology and the results of the various studies are sometimes contradictory. The inclusion of patients, the analysis of environmental data, and the correlation between these two elements indeed raise numerous methodological questions. CONCLUSION: Air pollution control would appear essential, as well as the development of new studies based on reliable methods of studying the environmental and its clinical effects.

GPR-68 in human lacrimal gland. Detection and possible role in the pathogenesis of dry eye disease.

INTRODUCTION: In parallel to ocular surface disease in dry eye there is often a dysfunctionality of the lacrimal gland apparatus. The functionality of the lacrimal gland is of major importance for maintenance of ocular surface integrity and health, even in conditions of enhanced stimulation and secretion requirements. Such enhanced secretion demands can push the lacrimal gland to its limits, with maximized tear fluid secretion and increased flow through the lacrimal ducts. The goal of this study was to investigate whether G protein-coupled receptor GPR-68 is present in the lacrimal gland, as this protein has recently been shown to be sensitive to flow rate and osmolarity. METHODS: For this purpose, de-identified sections of human lacrimal gland tissue were stained for the presence of G protein-coupled receptor 68 with specific antibodies using immunohistochemistry. RESULTS: Specific staining was detected in the acini and ducts of human lacrimal gland. In the ducts, the specific staining was found around the lumen of the ducts. In the acini, the specific staining was observed more towards the lumen but also intercellularly between the acinar cells. DISCUSSION: The detection of G protein-coupled receptor GPR-68 in the lacrimal gland, especially around the lumen of the ducts, raises the question about its function and purpose. Activation of GPR68 leads to modification of various cell functions and is associated with regulation of inflammation. Accordingly, enhanced, secretion-induced, augmentation of flow might exert fluid flow stress on the ducts and acini. This might lead to transient, localized activation of GPR-68 and secondary inflammation within the gland. Depending on the intensity, continuity or repetitive nature of the stimuli, exhaustion of the lacrimal gland secretion capacity might follow, and chronicity of the inflammation in the parenchyma as well as around the ducts might be a consequence. CONCLUSION: G protein-coupled receptor GPR-68, sensitive to flow, is present in the human lacrimal gland. Increased flow, triggered by sensations such as are typical for dry eye, might lead to local inflammation. It is possible that these sensations might serve as a better indicator for the need and success of therapy than the clinical signs of dry eye disease, at least in the early stages of the disease.

Effects of systemic anti-androgen drugs on the ocular surface.

PURPOSE: To investigate the effect of systemic anti-androgen drugs on tear function tests and the ocular surface. METHODS: Sixty-four male subjects were included in this study. Subjects who were on anti-androgen treatment for prostate cancer (Group A, n: 31) and those who had received only surgical treatment for prostate cancer (Group B, n: 17) were recruited from the department of urology. Age-matched subjects who had never received anti-androgen treatment (Group C, n: 16) constituted the control group. Group A was divided into two subgroups according to the number of anti-androgen drugs used (Group A1: one drug, Group A2: two drugs). All cases underwent a complete ocular examination, including tear film break up time (TBUT), corneal and conjunctival staining, Schirmer 1 test, conjunctival impression cytology, and ocular surface disease index (OSDI) questionnaire. RESULTS: The mean Schirmer's values were 6.87mm, 11.41mm, and 13.03mm in Groups A, B, and C, respectively (P=0.001). TBUT was 5.45±2.01, 9.85±2.52 and 9.81±1.96seconds in Groups A, B, and C, respectively (P=0.001). Schirmer and TBUT were significantly lower, and corneal staining and OSDI questionnaire scores were higher in Group A compared to groups B and C (P<0.01). Conjunctival impression cytology results according to the Nelson grading system revealed no statistically significant difference between the groups (P=0.422). CONCLUSION: Anti-androgen drugs alter tear function tests, cause increased corneal and conjunctival staining scores and worsen complaints of dry eye in patients with prostate cancer.

[Glaucomatous trabeculum: An inflammatory trabeculopathy? [French translation]]. / Trabéculum glaucomateux : une trabéculopathie inflammatoire ?

Glaucoma is an optic neuropathy in which the primary risk factor is increased intraocular pressure (IOP), attributed to increased resistance to trabecular outflow of aqueous humor (AH). This resistance is believed to result from trabecular degeneration secondary to chronic oxidative stress and cellular senescence but may also involve inflammatory mechanisms whose roles are little known. In fact, inflammatory processes play a major role in the pathophysiology of glaucoma to varying degrees, affecting all structures of the eye, including the ocular surface, the anterior and posterior segments, and even the visual pathways of the brain. These processes are thought to result from dysfunction of a regulatory, protective para-inflammation, becoming chronic and harmful in glaucoma. While the mechanisms of the retinal inflammation which accelerates the degeneration of retinal ganglion cells (RGC) as well as the inflammation of the ocular surface aggravated by long-term use of preserved glaucoma eye drops have been described for several years, very little is known about the pathophysiology of trabecular inflammation in glaucoma. The objective of this literature review is to provide a synthesis of knowledge on the roles and mechanisms of inflammation in both the healthy and glaucomatous trabecular meshwork, as well as its role in the pathophysiology of glaucoma. Therefore, after a review of the mechanisms of cellular senescence and oxidative stress - sources of trabecular inflammation, we will approach the study of the expression and roles of the main inflammatory mediators within the trabecular meshwork. Finally, we will discuss current knowledge on the toxicity of glaucoma eye drops and their preservatives on the ocular surface and trabecular meshwork as well as their role in trabecular inflammation.

Evaluation of the Ocular Surface, Conjunctival Impression Cytology and Meibomian Gland Dropout in Patients with Familial Mediterranean Fever.

PURPOSE: Familial Mediterranean fever (FMF) is an idiopathic disease with chronic inflammation. We aimed to determine the changes caused by the chronic inflammatory nature of FMF on the ocular surface, meibomian glands (MG), and conjunctiva via conjunctival impression cytology (CIC). MATERIAL-METHOD: Forty-two FMF patients with a mean age of 11.93±3.92 years and 36 control patients with a mean age of 11.83±3.38 years were included in the study. Ocular surface anomalies of the patients were evaluated using Schirmer II, TBUT and OSDI. MG function (meibum quality), morphology (meiboography), and CIC were evaluated. RESULTS: Although there was a significant difference between the groups in terms of Schirmer II and TBUT, OSDI scores did not significantly differ (P=0.022, 0.010, and 0.099 respectively), and no significant dry eye sign was observed in either group. There was significant difference between the groups in terms of the percent area of MG dropout, MG density, meiboscore (P=0.020, 0.023, and 0.031 respectively), but no significant difference was observed in relation to MG quality (P=0.650). Although conjunctival impression cytology was of a higher grade in the patients with FMF according to Nelson's classification, no significant difference was observed between the groups (P=0.109). CONCLUSION: Although there was a decrease in the number of MGs in FMF patients, no significant deterioration was observed in conjunctival cytology. In these patients, tear film stability may deteriorate in particular. Clinicians should be aware of the possibility of ocular surface disease secondary to MG dropout in patients with FMF.

Relationship between OSDI score and biomicroscopic ocular surface damages in glaucomatous patients treated with preserved antiglaucomatous eye drops.

PURPOSE: Our goal was to identify factors that may influence the OSDI score, in particular, ocular surface damage in patients on preserved glaucoma eye drops. METHODS: This was a cross-sectional study of 155 glaucoma patients treated with preserved glaucoma eye drops. They all completed the "Ocular Surface Disease Index" (OSDI) questionnaire and underwent complete ophthalmological examination with precise evaluation of the status of the ocular surface. The assessment included Shirmer I testing, tear break up time (TBUT), eyelid, conjunctival and corneal examination with fluorescein and lissamine green staining. We analyzed factors that may influence the OSDI score and its relationship with the biomicroscopic signs. RESULTS: Benzalkonium chloride (BAK) was used in 80% of cases. The OSDI score was≥13 in 61.3% of cases and classified as severe in 22.6% of cases. The biomicroscopic signs of ocular surface disease were at least minimal in 87.1% of cases. The severity of the OSDI score was statistically associated with patient age (P<0.001), treatment duration (P<0.001), multiple medications (P=0.011), and use of BAK (P=0.004). Blepharitis (P=0.013), Meibomian gland dysfunction (P=0.039), corneal neovascularization (P=0.025) and superficial punctate keratitis (SPK) (P=0.044) were retained as predictors of a pathological OSDI score. A disparity between the severity of symptoms and biomicroscopic signs was noted. CONCLUSION: Symptoms and clinical signs are complementary for assessment of the various aspects of ocular surface disease. OSDI score is correlated with ethnicity, glaucoma treatment duration, number of medications, BAK use and clinical ocular surface changes, especially SPK.

[Corneal perforation with tyrosine kinase inhibitor chemotherapy: REGORAFENIB]. / Perforation cornéenne sous chimiothérapie inhibiteur des tyrosines kinases : REGORAFENIB.

INTRODUCTION: Tyrosine kinase inhibitors (TKIs) are active in a variety of metastatic cancers. They have a good general tolerance with mainly hepatic and dermatological side effects. Rarely, ophthalmologic side effects may occur: eyelash abnormalities, eyelids abnormalities, disorders of the ocular surface with ocular dryness or even corneal erosions that can even lead to perforation. Regorafenib is a new oral multi-targeted tyrosine kinase inhibitor that inhibits multiple protein kinases, including those involved in tumor angiogenesis, oncogenesis and tumor microenvironment. CASE DESCRIPTION: We describe, to the best of our knowledge, the first case of complicated bilateral ulcers of corneal perforation in a patient under REGORAFENIB. OBSERVATION: 20-year-old patient with metastatic chondrosarcomas of the pelvis, mandible and thorax received chemotherapy with REGORAFENIB. A few weeks after initiation of treatment, he experienced an increased dry eye syndrome associated with bilateral corneal ulcers complicated by perforation. Despite discontinuation of chemotherapy and maximal medical and surgical treatment (iterative amniotic membrane grafts and corneal transplantation), the progression was unfavorable. DISCUSSION: This is the first known case of corneal perforation under REGORAFENIB. The pathophysiology is multifactorial. On the one hand, this chemotherapy targets angiogenesis (VEGFR), oncogenesis (KIT, RET, RAF1, BRAF) and the tumor microenvironment (PDGFR, FGFR). On the other hand, other triggers are added, namely mixed dry eye syndrome, hypovitaminosis A (anorexia), the neurotrophic component, as well as the toxicity of chemotherapy via tears. CONCLUSION: First described case of corneal perforation under REGORAFENIB, non-regressive at the end of chemotherapy, and despite medical and surgical treatments. Ophthalmologic surveillance is therefore necessary for patients under chemotherapy with tyrosine kinase inhibitors, as serious ocular complications, especially corneal ones, may occur.

Scleral contact lenses: Visual outcomes and tolerance. A prospective study about 98 eyes.

PURPOSE: To assess the improvement in visual acuity (VA), tolerance and quality of life of patients after scleral contact lens (SCL) fitting. MATERIAL AND METHODS: We carried out a prospective observational study conducted from April 2016 to August 2017. Patients fitted with SCL were included. For the purpose of this study, we analyzed VA and quality of life score (NEI-VFQ25) after 6 months of use. RESULTS: We identified 98 eyes of 56 patients; the major indication for SCL fitting was keratoconus in 64.3%; the other indications were post-penetrating keratoplasty, other irregular astigmatism, severe ametropia and ocular surface disease. The mean follow-up was 10.71 months. The mean daily wearing time was 9.89±1.63 hours. Best corrected Visual acuity "BCVA" (baseline 1.11±0.37 in the right eye and 1.13±0.42 LogMar in the left eye) improved to 0.19±0.20 and 0.23±0.38 LogMar respectively in the right and left eyes after SCL wear (P=0.000). The scores on the various subscales of the NEI-VFQ 25 questionnaire were significantly higher 6 months after SCL fitting, with a mean score of 87.28±9.87 with SCL versus 39.94±11.33 without these lenses (P=0.000). In our group, no complications related to the SCL wear occurred, except for the occurrence of "loose conjunctival tissue" at the inferior limbus in one patient. DISCUSSION: Our results complement those of several large series published on this subject. The best visual acuities were reported after correction of irregular astigmatism, in particular keratoconus. Therefore, SCL fitting has become an alternative or a precursor to penetrating keratoplasty in patients with advanced keratoconus. In the case of ocular surface disease, in addition to the improvement in VA, the comfort and recovery of the homeostasis of the ocular surface is greater, with fewer wearing complications. Hence, their inclusion in the therapeutic arsenal for severe ocular surface disease alongside the conventional treatment options. CONCLUSION: SCL have proven their efficacy and safety in the optical correction of irregular corneas and in the management of ocular surface problems. Additional studies are needed to compare the many lenses currently available and assess optimal fitting strategies for each type of scleral lens for easier fitting procedures and better wearing comfort.

[SARS-CoV-2, COVID-19 and the eye: An update on published data]. / SARS-CoV-2, COVID-19 et œil : le point sur les données publiées.

The COVID-19 pandemic has dramatically changed our daily lives as ophthalmologists. This general review firstly provides a better understanding of the virus responsible for the pandemic: the SARS-CoV-2, and the clinical manifestations of the COVID-19 disease. The second part is detailing the pathophysiology, clinical signs and challenges of ocular involvement, which seems rare and not functionally severe, but which may be a potential source of contamination. Finally, we discuss the preventive measures that need to be implemented in our daily practice to avoid any viral dissemination.

[In vivo Meibomian gland imaging techniques: A review of the literature (French translation of the article)]. / Les techniques d'imagerie in vivo des glandes de Meibomius : une revue de la littérature.

Meibomian gland dysfunction (MGD) encompasses a group of complex pathologies of the ocular surface. They represent one of the main etiologies of dry eye but also one of the leading causes of consultation in ophthalmology. Conventional clinical tests (dry eye symptoms, tear film rupture time, glandular expressiveness assessment, or Schirmer's test) allow only an indirect assessment of Meibomian gland function and physiology. Various in vivo investigation methods have therefore been developed to image the meibomian glands such as meibography, optical coherence tomography, ultrasound or in vivo confocal microscopy. Some are accessible in clinical practice, while others remain in the field of clinical research. All these techniques aim to develop a direct structural analysis of the Meibomian glands to help in the diagnosis of DGM but also to better understand the pathophysiology of Meibomian glands. This review of the literature aims to provide an overview of existing imaging modalities and their interest in the evaluation of Meibomian glands and MGD.

Management of dry eye disease to optimize cataract surgery outcomes: Two tables for a daily clinical practice.

The increase in life expectancy has resulted in a greater number of patients presenting for cataract surgery as well as an increasing prevalence of dry eye disease (DED) symptoms or signs noted in these patients. Low grade and/or non-symptomatic DED is common and can be exacerbated after surgery. DED can induce errors in IOL power calculation. DED can impair the visual prognosis and patient comfort after cataract surgery, leading to dissatisfaction of both the patient and the surgeon. Hence, preoperative evaluation for DED for all cataract candidates is crucial to mitigate these risks. To optimize clinical efficiency during the screening examination, we propose a strategy of three levels of DED screening, according to a patient's risk of DED given his or her history. We also propose a summary of the main clinical points before, during and after cataract surgery in eyes with DED.

[Contribution of break up time in the diagnosis and the treatment of dry eye syndrome in tropic area: about 234 patients in Abidjan]. / Contribution du break up time au diagnostic et à la prise en charge du syndrome sec oculaire en milieu tropical : à propos de 234 yeux à Abidjan.

INTRODUCTION: Dry eye disease (DED) can be evaluated clinically by the tear film break up time (BUT). There is a discrepancy between symptoms in relationship with dry eye disease and objectives measures of BUT. So we tried to evaluate the reliability of BUT in the diagnosis and treatment of this disease in black African people. METHODS: We carried out a prospective study of 6 months where melanoderms adults presenting subjective symptoms of dry eye disease according a questionnaire of 7 items were included. Then the measure of BUT is performed after ocular instillation of fluorescein eyedrop. This measured is done by recording the time elapsed from the last complete palpebral blink to the appearance of the first dry spot. Patients with subjective symptoms and time of BUT lower than 10seconds were called concordants (suffering really of DED). The discrepant group was represented by a BUT upper than 10seconds despite the fact that these patients answered positively to the questionnaire. RESULTS: This survey included 234 patients and the average age was 49.1 years. Sex-ratio was 0.68 and we noticed predominance of BUT between 5 and 10seconds in 42.3% of cases. Subjective symptoms were strengthened clinically by a BUT lower to 10seconds in 149 patients. Therefore, the reliability of BUT as clinic tool for the diagnosis after symptoms in relationship with DED was 63.7%. In the group of concordants, women were more likely than men to experience symptoms of DED (P=0.0005). Age upper than 50 years and computer usage were risk factors of DED (P<0.01). DISCUSSION: Dry eye disease is a multifactorial affection of tear and ocular surface frequently seen in female and people using computer and older than 50. The reliability of BUT near to 65% is a reason to perform this test in our daily practice. CONCLUSION: Tear BUT is a reliable clinical test which must be performed systematically to assess the diagnosis of DED in black African people.