[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.

[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.

[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.

[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.

[Bilateral exophthalmos diabetes insipidus: Erdheim-Chester disease. Clinical and radiological findings]. / Exophtalmie bilatérale-diabète insipide: la maladie d'Erdheim-Chester.

The authors report a case of a 61-year-old man presenting bilateral exophthalmos and diabetes insipidus. A retro-orbital biopsy revealed nonspecific fibrocollagenic infiltration. The diagnosis of Erdheim-Chester disease was evoked when a multivisceral affection (retroperitoneal and mediastinal periaortic fibrosis) with specific bone localization became evident. The histopatholgical study of a bone biopsy showed xanthogranulomatous infiltration. The patient died a few months later of an intercurrent infection.

Simple, reliable and fast spectrofluorometric method for determination of plasma Verteporfin (Visudyne) levels during photodynamic therapy for choroidal neovascularization.

Photodynamic therapy with Verteporfin, a potent photosensitizer dye, is a very effective treatment for age related macular degeneration due to choroidal neovascularization. Photodynamic therapy offers the potential for selective tissue injury in part attributable to preferential localization of Verteporfin, administrated by intravenous infusion, to the choroidal neovascularization complex and irradiation of the complex with non-laser thermal light at 690 nm resulting in at least temporary thrombosis and vessel closure. Verteporfin is a benzoporphyrin derivative monoacid ring A formulated as a unilamellar liposome. In the blood Verteporfin is associated with lipoprotein fractions and is rapidly cleared via a receptor-mediated uptake mechanism due the high expression of LDL receptors in neovascular tissues. Verteporfin was undetectable in plasma 24 hr after infusion of the recommended dose: 6 mg/m2 of body surface area. The main side effect is photosensitivity of skin which is usually short-lived (24-48 hr) with a low incidence (2.3%). As skin photosensitivity depends on circulating rather than tissue drug levels, we investigate the possibility of developing a simple, fast and reliable spectrofluorometric method to measure plasma Verteporfin levels. Fluorescence emission spectrum (550-750 nm) of 1:10 saline diluted plasma with lambda exc=430 nm showed a characteristic emission peak at 692 nm, the height being proportional to the Verteporfin levels. The sensitivity is around 100 ng/ml and the pharmacokinetics of Verteporfin has been studied from 0 to 5 hr after infusion in six patients older than 65 years with age-related macular degeneration.

Comparative morphology of epicorneal conjunctival membranes in rabbits and human pterygium.

A rarely described ocular lesion in the rabbit is presented following the observation of four cases. It is a membrane of conjunctival origin that advances progressively, without adhering, towards the center of the cornea. Clinically the lesion in rabbits looks like pterygium in man, but with several differences: in rabbits, the conjunctival fold is absolutely free and does not penetrate into the superficial corneal layers. It originates from all the limbal circumference in a symetric growth. The cornea itself remains unaltered. The fold consists of fibroblasts and collagen. The microscopic findings suggest the lesion is possibly of a collagenous dysplasia.

[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.

[Brown syndrome: current status]. / Syndrome de Brown: actualités.

PURPOSE: Brown's syndrome is a form of anatomical strabismus, or retraction syndrome. It is defined by active and passive limitation of upward gaze in adduction in the field of action of the inferior oblique muscle. The etiology of Brown's syndrome remains unknown. The defect lies at the level of the superior oblique's tendonis trajectory via the trochlea. We studied the frequency of clinical signs and results after surgery in patients presenting congenital Brown's syndrome. PATIENTS AND METHODS: Our study involved 18 children. They all underwent complete ophthalmological examination with orthoptic testing, pre and postoperatively. RESULTS: Neither sidedness nor predominance of sex was noted. Compensatory head posture was noted in 7 of 18 cases. Limitation of upward gaze in adduction was a constant finding, with a positive duction test. Eleven cases underwent superior oblique recession. Results of surgery were satisfactory, with resolution of compensatory head posture in over 80% of cases. CONCLUSION: The etiology of congenital Brown's syndrome remains unknown. The different surgical techniques give inconstant results. Operative indication is decided only when in the presence of well defined clinical manifestations: CHP, deviation in primary position with alteration of binocular vision.

Diffuse choroidal hemangioma: report of a clinicopathological study in a 4-year-old boy.

The authors examined the clinicopathologic features of a 4-year-old boy with a diffuse choroidal hemangioma, yet without any features of the Sturge-Weber syndrome. The tumor occurred as a grayish intraocular mass with an overlying retinal detachment and was highly reflective in the ultrasonic examination. After contrast, the CT scan revealed diffuse thickening of the ocular wall associated with an enhanced irregular orbital mass. The pathologic examination revealed a cavernous hemangioma involving the entire choroid with extrascleral extension. Diffuse choroidal hemangioma occurring in childhood and unrelated to the Sturge-Weber syndrome is a rare condition that should be included in the differential diagnosis of retinoblastoma.

[Changes in the visual fields following filtering surgery in advanced glaucoma]. / Modification du champ visuel au décours des interventions filtrantes dans les glaucomes évolués.

The authors report about the results of a preliminary study concerning the changes of glaucomatous field after glaucoma filtering surgery in patients with advanced glaucoma. Mesopic campimetry had been selected because of its precision for central field defects. The first results appear to be favourable. No patient lost central vision suddenly after surgery. The authors have tried to research predictive risk factors. The factors that seem to be the most important to consider are the preoperative campimetric shape and the angle anatomy.

[Early postoperative campimetric outcome after trabecular surgery of chronic advanced glaucoma]. / Evolution campimétrique post-opératoire précoce après chirurgie filtrante dans les glaucomes chroniques évolués.

The authors report about the results of a preliminary study concerning the changes of glaucomatous visual field just after glaucoma filtering surgery in patients with advanced glaucoma. The visual field was established preoperatively, then 7 and 30 days in post operative period. Mesopic campimetry had been selected because of its precision for central field defects. The results appear to be favourable with 13 improvements 14 stabilizations, and 7 aggravations without loss of central vision. The authors have tried to determine predictive risk factors. The most important one are preoperative campimetric shape, angle anatomy, refraction and cardiovascular diseases.