Treatment of cystoid macular edema in homozygous twins with glutathione synthetase deficiency and retinal dystrophy.

Monozygotic twins with glutathione synthetase deficiency, progressive retinal dystrophy and cystoid macular edema were followed for foveal changes on optical coherence tomography under different treatment modalities. The purpose of the study is to show the effect of topical dorzolamide in conjunction with systemic acetazolamide in terms of decreasing macular edema in this specific disease. The results showed that systemic acetazolamide alone or in combination with topical dorzolamide decreased CME in both patients for a certain period of time. The result can be temporary sustained after treatment discontinuation. In conclusion, topical dorzolamide, in conjunction with systemic acetazolamide, could reduce cystoid macular edema in GSSD.

[New therapeutic approach of keratoconus with intracorneal ring segments aided by femtosecond laser (Tecnolas Perfect Vision): indications, operating technique and results]. / Nouvelle approche thérapeutique du kératocône par segments d'anneaux intracornéens assistés par laser femtoseconde (Tecnolas Perfect Vision) : indications, technique opératoire et résultats.

OBJECTIVE: To assess the results of intracorneal ring segment implantation assisted by the Tecnolas Perfect Vision(®) femtosecond laser (Heidelberg, Germany). SETTINGS: Retrospective observational study. METHODS: The patients were operated on with the Tecnolas Perfect Vision(®) femtosecond laser. The following parameters were evaluated before and after surgery: uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal topography, wavefront analysis, and central corneal thickness. The Wilcoxon test was used for statistical analysis. RESULTS: Seventeen eyes of 15 patients were included. The mean follow-up was 6.9±0.71 months. Significant improvement of UCVA and BCVA was observed in 82.35% (P=0.027) and 94.12% (P=0.003) of the eyes, respectively. The subjective refraction showed a significant decrease of the sphere from -10.29±5.54 to -6.5±5.03D (P=0.002). The subjective cylinder significantly decreased from 5.43±3.20 to 3.69±2.30D (P=0.026). The SAI also decreased significantly (P=0.011). CONCLUSION: Femtosecond-assisted intracorneal ring segment implantation is an effective treatment for corneal ectasia. Further studies are needed to improve surgical parameters and outcomes.

[New approach for determining the damage level of biological tissues using femtosecond laser: advantages and application to corneal surgery]. / Nouvelle approche de détermination du seuil d'endommagement de tissus biologiques par laser femtoseconde: intérêt et application à la chirurgie de la cornée.

INTRODUCTION: Optimization of femtosecond laser characteristics in corneal surgery is still needed to improve clinical results. In this study, we describe an original characterization technique able to measure laser damage of corneal tissues precisely and to provide complementary physical results on the laser-matter interaction. METHOD: A femtosecond laser was used to damage corneas not suitable for graft. The epithelium and the Bowman layer are exposed to a set of different single-shot fixed laser fluences. Optical microscopy can determine the probability of laser damage on the corneal surface. The high damage threshold (minimum fluence systematically damaging the cornea) roughly fixes the operating laser fluence conditions, while the low damage threshold sets the maximum laser fluence level preserving tissue integrity (safety level). RESULTS: We precisely evaluate the damage fluence threshold of a tissue, using a statistical approach coupled with optical microscopy analysis. This technique gives essential information on laser-tissue interaction with a high rate of confidence. For corneal epithelium and the Bowman layer, we determine the maximum laser fluence level preserving tissue integrity (safety level) and the minimum fluence level systematically damaging the tissue. High and low threshold fluences of epithelium and the Bowman layers are (5.6 ± 0.4 J/cm(2); 2.7 ± 0.1 J/cm(2)), and (7.1 ± 1.1 J/cm(2); 3.4 ± 0.1 J/cm(2)), respectively. CONCLUSION: These data constitute determinant parameters for clinical applications, since they determine a working window providing the minimal effective irradiation dose that is mandatory for the development of high-quality laser-cutting surgery processes with minimized side effects.

[Subretinal hemorrhage after intravitreal injection of anti-VEGF for age-related macular degeneration: a retrospective study]. / Hématomes maculaires après injections intravitréennes d'anti-VEGF pour dégénérescence maculaire liée à l'âge : série rétrospective.

INTRODUCTION: Prescription of anti-VEGF treatments have increased substantially over the past few years in treatment of wet age-related macular degeneration. We report the occurrence of macular hemorrhages after one year of use of anti-VEGF intravitreal injections, mainly for subfoveal choroidal neovascularization. MATERIAL AND METHODS: Four hundred forty five injections were given over one year (from 15 March 2007 to 15 March 2008), for age-related macular degeneration, retinal vascular occlusion, diabetic retinopathy, neovascular glaucoma, and idiopathic macular choroidal neovascularization; distributed as follows: 11.5% Bevacizumab, 18.6% Pegaptanib, 19.3% Triamcinolone, and 50.6% Ranibizumab. RESULTS: Six macular hemorrhages were observed, resulting in to a sharp decrease in visual acuity (20/400), with loss of five lines. All occurred after one injection of nonselective anti-VEGF (Ranibizumab) on already treated eyes (four previous injections on average, +/- photodynamic therapy). All were secondary to occult choroidal neovascularization or a large pigment epithelial detachment. Three patients presented a pigment epithelial tear. DISCUSSION: Anti-VEGF intravitreal injections can lead to pigment epithelial tears in case of large pigment epithelial detachment, especially with a small feeder vessel or with large occult choroidal neovascularization. The authors discuss the possible implications of anti-VEGF when macular hematoma occurs: retraction of choroidal neovascularization and alteration of physiological retinal vascularization. CONCLUSION: Macular hematoma affects visual prognosis in age-related macular degeneration. It may follow intravitreal anti-VEGF injection with large occult neovascularization, especially in previously treated eyes. Injection in large pigment epithelial detachment may cause a risk of epithelial tear. Other studies are necessary to evaluate the role of the nonselective anti-VEGF in the incidence of macular hematoma.

[Arcuate keratotomy for postkeratoplasty astigmatism by femtosecond laser]. / Incisions arciformes au laser femtoseconde pour correction de l'astigmatisme après kératoplastie transfixiante.

OBJECTIVE: Evaluation of the effectiveness of arcuate keratotomy performed with femtosecond laser for correction of postkeratoplasty astigmatism. METHODS: This retrospective clinical study included 11 eyes. All cases underwent arcuate keratotomy using femtosecond laser. Outcome measures included visual acuity and endothelial cell density as well as refractive, keratometric, and topographic astigmatism. The incision depth was also evaluated by OCT-3. RESULTS: With a mean follow-up of 7.4+/-6.7 months, uncorrected visual acuity was not modified and the mean best corrected visual acuity significantly improved from 1.68+/-1.59 lines (p=0.007). The mean preoperative refractive cylinder was 5.18+/-1.15D, decreasing to 3.41+/-1.93D (p=0.045) after laser-arcuate keratotomy. The reduction of preoperative keratometric (7.79+/-3.69D) and topographic (7.98+/-2.41D) astigmatism was higher, with a decrease to 4.81+/-2.52D (p=0.021) and 4.36+/-2.59D (p=0.005) postoperatively. Endothelial cell density was not modified after surgery. The difference between achieved and planned incision depth was -10.7+/-63.5mum. All cases were uncomplicated. DISCUSSION: Arcuate keratotomies performed with the femtosecond laser were effective in reducing postkeratoplasty astigmatism and has a number of advantages over conventional techniques. However, efficacy could be improved by a more accurate nomogram. CONCLUSION: Arcuate keratotomy performed with femtosecond laser is a relatively easy, safe, and effective means of treating postkeratoplasty astigmatism. Given our small sample, much larger series are needed to provide more confident estimates of astigmatism reduction proportions and to adjust correction parameters.

Endovascular treatment of idiopathic intracranial hypertension: clinical and radiologic outcome of 10 consecutive patients.

OBJECTIVE: To explore the relation between venous disease and idiopathic intracranial hypertension. BACKGROUND: Optic nerve sheath fenestration and ventricular shunting are the classic methods when medical treatment has failed. Idiopathic intracranial hypertension is caused by venous sinus obstruction in an unknown percentage of cases. Recently, endoluminal venous sinus stenting was proposed as an alternative treatment. METHODS: Ten consecutive patients with refractory idiopathic intracranial hypertension underwent examination with direct retrograde cerebral venography and manometry to characterize the morphologic features and venous pressures in their cerebral venous sinus. All patients demonstrated morphologic obstruction of the venous lateral sinuses. The CSF pressure was measured in all patients. The CSF pressure on lumbar puncture ranged from 27 to 45 mm Hg with normal composition. All patients had headache, and visual acuity loss was noted in eight patients. Funduscopic examination demonstrated papilledema for all patients. All patients had stenting of the venous sinuses. Intrasinus pressures were recorded before and after the procedure and correlated with clinical outcome. RESULTS: Intrasinus pressures were invariably reduced by stenting. For headache, six patients were rendered asymptomatic, two were improved, and two were unchanged after venous sinus stenting for a mean (+/- SD) follow-up of 17 +/- 10.1 months (range 6 to 36 months). Papilledema disappeared in all patients. In all cases, CSF pressure was normalized at 3-month follow-up. In all patients, direct retrograde cerebral venography or multidetector row CT angiography was performed at 6-month follow-up and demonstrated the absence of stent thrombosis. CONCLUSION: The importance of venous sinus disease in the etiology of idiopathic intracranial hypertension is probably underestimated. Patients with idiopathic intracranial hypertension in whom a venous sinus stenosis is demonstrated by a noninvasive radiologic workup should be evaluated with direct retrograde cerebral venography and manometry. In patients with a lesion of the venous sinuses who experienced medical treatment failure, endovascular stent placement seems to be an interesting alternative to classic surgical approaches.

[Risk factors for recurrent retinal detachment]. / Les facteurs de récidive du décollement de rétine.

Surgical treatment of inaugural retinal detachment achieves anatomical success in approximately 85%-90% of cases after one operation and up to 94%-96% after two or more operations. Recurrent detachment may occur more or less frequently after a variable lapse of time. Early recurrences occur within 6 weeks following the first surgery and late recurrences more than 6 weeks later. Insufficient treatment and proliferative vitreoretinopathy (PVR) are the main causes of early recurrence. Late recurrences are mainly caused by vitreous base traction, but the literature has few reports on these cases. Prevention of recurrence requires careful surgery and reasonable use of cryo while waiting for a proven pharmacological treatment of PVR.

[Femtosecond-assisted anterior lamellar keratoplasty]. / Kératoplastie lamellaire antérieure assistée par laser femtoseconde.

INTRODUCTION: Automated lamellar keratoplasty remains a challenging surgical technique because of surgical difficulties and is associated with a high rate of complications. The precision of the corneal cut at any corneal depth with the femtosecond laser is an important improvement in this technique. We report the first case of femtosecond-assisted anterior lamellar keratoplasty. MATERIAL AND METHODS: A 63-year-old woman with anterior stromal dystrophy underwent femtosecond laser-assisted ALTK on the left eye. A donor lenticula was prepared from a corneoscleral rim utilizing the Femtec 20/10 Perfectvision femtosecond laser device and an artificial anterior chamber (Moria, Antony, France). The anterior lamellar cut was also performed on the patient's eye with the femtosecond laser. RESULTS: Postoperative examinations showed a well-adapted graft with a clear interface. OCT III (Carl Zeiss Meditech, Dublin) measurements showed a corneal pachymetry of 713 microm associated with a regular posterior bed and a central thickness of 132 microm. DISCUSSION: Femtosecond laser corneal cutting may offer greater safety, reproducibility, predictability, and flexibility. The risks of irregular cutting and microperforation are reduced. A better graft congruence can limit the risk of secondary displacement and the smooth interface should improve visual results. CONCLUSION: Donor lenticulae and corneal cuttings performed with the Femtec 20/10 Perfectvision( femtosecond laser device can be used in the successful management of eyes requiring anterior lamellar keratoplasty. Further studies are needed to evaluate outcomes of this procedure.

[Medical treatment of macular edema]. / Traitement médical de l'oedème maculaire.

Macular edema was first described more than a century ago, and its medical treatment has made great progress thanks to recent pharmacological advances. Administration is topical, local (peri- or intraocular), or systemic. Nonsteroidal anti-inflammatory agents and corticosteroids are the mainstay therapy when inflammation is involved, as well as acetazolamide in many cases. More recently, molecules such as protein kinase-C- beta inhibitors and anti-VEGF agents are already or will soon be available, to add to our therapeutic armamentarium. Perhaps combination therapy will become popular, as is the case with age-related macular degeneration.

[Internal carotid artery dissection on arterial fibromuscular dysplasia causing a central retinal artery occlusion: a case report]. / Oblitération de l'artère centrale de la rétine secondaire à une dissection de la carotide interne sur fibrodysplasie artérielle.

INTRODUCTION: We report a case of a 66-year-old woman presenting a central retinal artery occlusion with no cardiovascular risk factor, with assessment using supra-aortic artery ultrasonography showing total internal carotid artery thrombosis. OBSERVATION: When vascular thrombosis risk factors are absent, more in-depth assessment such as a supra-aortic artery angioscan can provide the diagnosis of arterial dissection on arterial fibromuscular dysplasia. CONCLUSION: Central retinal artery occlusion is a rare but severe pathology. Therefore it is very important not to neglect the etiological assessment, because it can be the revealing element of a severe pathology.

[Bilateral corneal endothelial decompensation after postsepticemia coma]. / Décompensation endothéliale bilatérale après coma post septicémie à staphylocoque.

We report a case of unexplained bilateral corneal endothelial decompensation after a coma. A 71-year-old man with no medical history presented with bilateral endothelial decompensation that required penetrating keratoplasty of the left eye combined with cataract surgery. This coma was caused by septicemia originally due to staphylococcus infection following catheter placement in preparation for a CT scan. Visual acuity of the left eye was 20/400 and 20/100 in the right eye when the patient awoke from the coma. After examination, we noted only stromal thickening and Descemet membrane folds causing corneal edema predominating OS. The rest of the exam was normal. Six months after surgery, visual acuity improved to 20/25. The most probable physiopathological mechanism of this decompensation is an iatrogenic complication from drugs administered during the patient's stay in intensive care (oxacillin), but we cannot rule out direct aggression of a bacterium or its toxin or the decompensation of a preexisting pathology.

Molecular effects of cyclosporine and oncogenesis: a new model.

Cyclosporine A is the most commonly used immunosuppressive agent during organ transplantation. One of the most feared adverse effects of cyclosporine A is the appearance of de novo cancers. The mechanisms that lead to the genesis of such cancers are thought to be only related to a side effect of cyclosporine A: a depressed immune system. Here, we review different molecular effects induced by cyclosporine A (inhibition of DNA repair, synthesis of TGF Beta, induction of apoptosis of activated T cells, inhibition of apoptosis through the inhibition of the opening of the mitochondrial Permeability Transition Pore) and propose that cyclosporine A can promote the genesis and the spread of cancer not only because of immunosuppression but also because of its ability to facilitate DNA mutations accumulation, to diminish the clearance of altered cells and to transform cancer cells into aggressive cancer cells. This new insights into the mechanisms of genesis of cyclosporine A-related cancers should be taken into account to develop preventive strategies or new immunosuppressive strategies.

[Penicillium chrysogenum endophthalmitis: a case report]. / Endophtalmie à Penicillium chrysogenum: à propos d'un cas.

We report a case of Penicillium chrysogenum endophthalmitis after penetrating ocular trauma in a 9-year-old child, describing the initial management and the therapeutic adaptation after biopsy culture. After a review of endophthalmitis treatment, we discuss mycotic endophthalmitis treatment and recommend the use of intravitreal antibiotics. In this case, we used amphotericin B to treat the fungal disorder with success.

[Ocular metastasis of cutaneous melanoma]. / Métastase oculaire d'un mélanome cutané.

We report a case of vitreal metastases from cutaneous melanoma. We describe the clinical findings and the histological aspects of the lesions, which allows us to discuss the diagnosis of masquerade syndrome and highlight the diagnostic importance of vitreous biopsy.

[Description of palpebral involvement in Fraser's syndrome]. / Description des atteintes palpébrales au cours du syndrome de Fraser.

GOAL: Fraser's syndrome is a rare multiple malformation involving the eyes, with cryptophthalmos. In its complete form, cryptophthalmos is a serious malformation with absence of eyelids and palpebral fissure. A review of ophthalmological signs is presented. CASE REPORT: A case of Fraser's syndrome is presented. Ophthalmological and somatic examination as well as evolution are described. RESULTS: Incomplete cryptophthalmos with symblepharon and bilateral palpebral coloboma are present. Surgical treatment with palpebral reconstruction allowed preservation of visual acuity in one eye. DISCUSSION: Ophthalmological signs are present in 93% of cases. Eyelid involvement such as symblepharon, and partial or complete coloboma are relatively frequent, whereas cryptophthalmos in its complete form are much more rare. CONCLUSION: Treatment involves palpebral reconstructive surgery in order to preserve visual function.

[Surgical follow-up and importance of information and consent on behalf of patients undergoing esthetic blepharoplasty]. / Suites opératoires et importance de l'information et du consentement éclairé des patients dans les blépharoplasties esthétiques.

INTRODUCTION: Plastic surgery of the eyelids aims to improve the cosmetic aspect while correcting either an excess of palpebral skin, or an orbital septum dehiscence with fat porf2p4on in the palpebral spaces, after evaluation of horizontal and vertical palpebral laxity. PATIENTS AND METHODS: The authors describe follow-up of upper and lower lid blepharoplasty by cutaneous and conjunctival approaches respectively, with case descriptions and a review of the literature. RESULTS: A "calendar" is made of the different phases of healings, to the final aesthetic aspect desired. DISCUSSION: The patients wishes as to technique and results of blepharoplasty must be discussed and understood. The surgeon must forewarn of eventual per and postoperative complications (hemorrhage, infection), but also the usual follow-up (hematoma, edema, scarring ...). This allows to avoid aggravation of the patients "legitimate" worrying when he/she looks in the mirror! CONCLUSION: The authors underline the importance of patient information concerning the pre and postoperative aspects of aesthetic blepharoplasty.