Comparison of the IOL Master and Pentacam in the measurement of anterior segment parameters in patients with high myopia and cataracts.

PURPOSE: This study aimed to compare the differences between the Zeiss IOL Master and Oculus Pentacam in keratometry and central anterior chamber depth (ACD) measurements in patients with high myopia and cataracts. METHODS: Between January 2019 and December 2020, 89 patients (103 eyes) with cataracts and high myopia who underwent preoperative cataract evaluation at Nanchang First Hospital were selected for retrospective analysis. Keratometry (K1, K2) and ACD were measured with the IOL Master and Pentacam. Paired t-tests were performed to compare the differences, while the Bland-Altman method was used to evaluate the agreement. RESULTS: The K1 value was (43.15±2.44) D for the IOL Master and (42.98±2.47) D for the Pentacam, and the difference between the two instruments was statistically significant (P<0.01). The K2 value was (44.55±2.63) D for the IOL Master and (44.32±2.55) D for the Pentacam. The ACD was (3.44±0.33)mm for the IOL Master and (3.39±0.36)mm for the Pentacam. There were statistically significant differences between the two instruments in both keratometry and ACD (P<0.01). The absolute values of the maximum difference between the two instruments for K1 and K2 were 1.1 and 1.07; thus, the consistency of the two instruments with respect to this measurement was poor. However, the absolute value of the maximum difference between the two instruments for ACD was 0.34, so the consistency of the two instruments in relation to this measurement was good. CONCLUSIONS: Both the IOL Master and the Pentacam can be used in the measurement of keratometry and ACD in patients with high myopia and cataracts, but the keratometry measurements should be compared in clinical application.

Is Floppy Eyelid Syndrome predictive of Intraoperative Floppy Iris Syndrome? A prospective and translational study.

INTRODUCTION: Intraoperative floppy iris syndrome (IFIS) is defined as an excessive billowing of the iris during cataract surgery. Floppy eyelid syndrome is defined as an excessive hyperlaxity of the eyelids. Based in our daily experience, we suspected FES to be associated with IFIS. This association has been investigated. The goal of the study was to explore whether FES was predictive of IFIS. MATERIAL AND METHODS: We conducted a prospective observational single-center study at the University Hospital of Nice. IFIS and FES were investigated in patients undergoing cataract surgery from November 2019 to May 2021. In addition, tarsus and iris samples were harvested in 2 fresh cadavers, and Verhoeff staining was used to identify elastin fibers. RESULTS: We included 452 eyes (n=312 patients, 50.9% male) with a mean age of 71.7years (±11.4). IFIS was diagnosed in 88 (19.5%) patients, including 20 (4.4%) grade 1, 34 (7.5%) grade 2, and 33 (7.3%) grade 3. FES was diagnosed in 35 (7.7%) patients. PEX was found in 23 (5.1%) patients. On multivariate analysis, FES (P<0.001), pseudo exfoliation (P=0.017), intracameral dilatation (P<0.004), senior surgeons (P=0.009) and α1-ARA (P<0.001) were associated with IFIS. Elastin fibers were identified in small amounts in the tarsus samples but not in the iris samples. CONCLUSION: FES is predictive of IFIS. Surgeons should be aware of this association to prevent intraoperative complications.

Behavior of biometric parameters during clinical hours.

PURPOSE: To evaluate and quantify variation of biometric parameters - axial length (AL), anterior chamber depth (ACD), central corneal thickness (CCT) and white-to-white (WTW). METHODS: A population-based retrospective cohort study was performed on patients who underwent a biometry test prior to cataract surgery using the IOL Master 700 (Carl Zeiss Meditec, Jena, Germany) between the years 2017-2021. Differences in these parameters were evaluated between scans executed at different times of the day. RESULTS: 21,975 examinations of 8611 patients were included. Mean age was 70.50±12.56years. The mean time of the biometry exams was 10:52±1:23 AM. Measurements of AL, ACD, CCT and WTW were tested hourly and grouped between 7:00-9:00 AM and 12:00-03:00 PM. All the parameters showed a diurnal increase with a significance of P<0.001 (AL from 23.64±1.5 to 24.01±1.76mm; ACD from 3.29±0.67 to 3.35±0.64mm; CCT from 0.52±0.04 to 0.53±0.04µm and WTW from11.83±0.46 to 11.90±0.51mm). The most significant change was seen in AL. The difference between time groups remained significant in a generalized linear mixed model (P<0.001). CONCLUSIONS: There are fluctuations in AL, ACD, CCT, WTW measurements during office hours. These results raise questions about the significance of timing of the biometry exam and the effect on the ELP calculation.

Visual supplementation is an effective tool in cataract surgery counselling by eye-care practitioners.

BACKGROUND: Informed consent constitutes an important aspect of eye care. However, patients often experience difficulties understanding and retaining information presented to them during consultations. This study investigates the efficacy of pictorial aids in supplementing preoperative counselling of patients undergoing cataract surgery. METHODS: Patients attending routine pre-cataract surgery counselling were randomized to receive either a standard verbal consultation (control) or a verbal consultation with a digitalized pictorial aid illustrating key surgical steps (intervention). Patients were assessed after the consultation on their knowledge, satisfaction, anxiety and preparedness using an anonymous questionnaire. RESULTS: Seventy-six patients were recruited and randomized into the control and intervention groups. The intervention group attained better Knowledge Scores (control: 5 [2-6] vs. intervention: 6 [6]), and more patients "strongly agreed" that they were more prepared (control: 78.9% vs. intervention: 97.4%, P=0.028). A higher proportion of patients in the control group either "disagreed" or "neither disagree nor agreed (neutral)" that they were less worried (control: 15.8% vs. intervention: 0.0%, Fisher's Exact Test P=0.025). Although the consultation duration was shorter in the intervention group (21±4mins vs. 27±6mins, P<0.001), the use of digital pictorial aids during consultation resulted in more effective counselling with increased patient knowledge, easier decision-making process and reduced patient anxiety. CONCLUSION: Pictorial aids add to the repository of tools available to eye-care practitioners and are low-cost, easy to implement, and can effectively augment existing preoperative counselling processes to ensure accurate and effective preoperative counselling of patients.

Comparison of refractive outcomes obtained with two swept-source OCT-based optical biometers after cataract surgery: A study of 152 eyes.

PURPOSE: To compare two swept-source OCT optical biometers, the Anterion® (Heidelberg Engineering GmbH, Heidelberg, Germany) and the IOLMaster 700® (Carl Zeiss Meditec AG, Jena, Germany), in the analysis of biometric data, intraocular lens (IOL) calculation and postoperative spherical equivalent predictability. METHODS: This was a real-life, single-center, retrospective study including 152 eyes of 81 consecutive patients referred for cataract surgery. All patients were examined with the IOLMaster 700® and the Anterion®. Biometric data (axial length [AL], anterior chamber depth [ACD], mean keratometry [Km], K1 [flat keratometry], K2 [steep keratometry] and axis, TK1 [flat total keratometry], TK2 [steep total keratometry], central pachymetry, lens thickness [LT], white-to-white distance [WTW]), IOL calculation with the SRK/T formula, and postoperative refractive outcome at 1 month were compared. RESULTS: All biometric measurements were significantly different between the two biometers. Correlations were excellent for AL, pachymetry, ACD, LT and keratometry measurements, and for the IOL calculation (r>0.96, intraclass correlation coefficient=1). The IOL power for emmetropia was similar between both biometers when the SRK/T formula was used (20.84±3.24D versus 20.86±3.29D, P=0.61). The mean postoperative spherical equivalent prediction error calculated using the SRK/T formula was 0.03±0.5D for the IOLMaster 700® versus 0.01±0.47D for the Anterion® (P=0.12). CONCLUSIONS: This study showed excellent correlation and agreement for the biometric measurements and the IOL power calculation with the SRK/T formula between both biometers.

[Hyperbaric oxygen therapy and eye disease: Review of the literature]. / Oxygénothérapie hyperbare et maladies oculaires : une revue de la littérature.

Hyperbaric oxygen therapy consists of breathing 100% oxygen continuously or intermittently in a chamber at a pressure equal to or greater than 1.4 absolute atmospheres. Indicated for the emergency treatment of carbon monoxide poisoning and other medical-surgical pathologies such as gas embolism or necrotizing soft-tissue infections, various studies have shown a beneficial effect of hyperbaric oxygen therapy in certain ocular pathologies, notably of microcirculatory origin, such as central retinal artery occlusion or macular edema linked to retinal vein occlusions. In addition, hyperbaric oxygen might represent an alternative treatment for ocular quinine toxicity and might also be useful as an adjuvant to surgery and antibiotics in cases of periorbital necrotizing fasciitis. On the other hand, oxygen in high concentrations has toxic ocular effects due to the production of reactive oxygen derivatives.

[Intraoperative opacification of a scleral-fixated Carlevale (Soleko®) intraocular lens]. / Opacification peropératoire d'un implant fixé à la sclère Carlevale (Soleko®).

Thermal shock can cause intraoperative opacification of a Carlevale (Soleko®) implant. This is a rare phenomenon which resolves spontaneously. It is crucial to recognise this phenomenon in order to avoid unnecessary and potentially harmful explantation decisions for the patient.

[Blue light and intraocular lenses (IOLs): Beliefs and realities]. / Lumière bleue et implants intraoculaires : croyances et réalités.

The first intraocular lenses (IOLs) used for cataract surgery transmitted both ultraviolet (UV) radiation and visible light to the retina. Colorless UV-blocking IOLs were introduced and rapidly adopted in the 1980s. Yellow-tinted blue-blocking (also known as blue-filtering) IOLs were marketed in the early 1990s. Blue-blocking IOLs were intended to simulate age-related crystalline lens yellowing to reduce the cyanopsia that some patients experienced after cataract surgery. When blue-filtering IOLs were introduced in North America, however, blue-blocking chromophores were advocated as a way to protect patients from age-related macular degeneration (AMD) despite the lack of evidence that normal environmental light exposure causes AMD. The "blue light hazard" is a term that describes the experimental finding that acute, abnormally intense light exposures are potentially more phototoxic to the retina when short rather than long wavelengths are used. Thus, in brief exposures to intense light sources such as welding arcs, ultraviolet radiation is more hazardous than blue light, which is more hazardous than longer wavelength green or red light. International commissions have cautioned that the blue light hazard does not apply to normal indoor or outdoor light exposures. Nonetheless, the hazard is used for commercial purposes to suggest misleadingly that ambient environmental light can cause acute retinal phototoxicity and increase the risk of AMD. Very large epidemiological studies show that blue-blocking IOLs do not reduce the risk or progression of AMD. Additionally, blue-filtering IOLs or spectacles cannot decrease glare disability, because they decrease image and glare illuminance in the same proportion. Blue light is essential for older adults' scotopic photoreception needed to reduce the risk of nighttime falling and related injuries. It is also critical for circadian photoreception that is essential for good health, sleep and cognitive performance. Unfortunately, age-related pupillary miosis, retinal rod and ganglion cell photoreceptor degeneration and decreased outdoor activity all reduce the amount of healthful blue light available to older adults. Blue-restricting IOLs further reduce the available blue light at a time when older adults need it most. Patients and ophthalmologists are exposed to hypothesis-based advertisements for blue-filtering optical devices that suppress short wavelength light critical for vision in dim lighting and for good physical and mental health. Spectacle and intraocular lens selections should be based on scientific fact, not conjecture. Ideal IOLs should improve photoreception rather than limit it permanently. Practice efficiency, surgical convenience and physician-manufacturer relationships may eliminate a patient's opportunity to choose between colorless blue-transmitting IOLs and yellow-tinted, blue-restricting IOLs. Cataract surgeons ultimately determine whether their patients have the opportunity to make an informed choice about their future photoreception.

Effect of dry eye on the reliability of keratometry for cataract surgery planning.

PURPOSE: This study aimed to evaluate the effects of dry eye on the reproducibility of keratometry (K) measurements in patients presenting for cataract surgery. METHODS: A non-randomized controlled clinical study was performed. Eighty-three eyes of eighty-three patients with cataracts who were enrolled in our hospital from March 2020 to July 2020 were studied. The mean non-invasive tear film break-up time (NIBUT), corneal fluorescein staining score, and ocular surface disease (OSD) SPEED II questionnaire were measured and recorded prior to surgery, and the patients were assigned to a "dry eye" group (n=35) or a "non-dry eye" group (n=48). The K of the patients was measured twice by a Tomey OA-2000 (an average of three times each). The difference of the mean K (ΔKm) and astigmatism vector (ΔKvector) between the two measurements was calculated. The ΔKm and ΔKvector between the two groups were compared. The relationship between the measurement parameters of dry eyes and the accuracy of the preoperative K values was analyzed. RESULTS: ΔKm was 0.09 D [0.03; 0.19] in the non-dry eye control group and 0.28 D [0.18; 0.50] in the dry eye group, with a statistical difference between the two groups (P=0.005). The ΔKvector of the non-dry eye control group was 0.22 D [0.14; 0.42], and that of the dry eye group was 0.50 D [0.28; 1.06]. There was a significant difference between the two groups (P=0.010). Between the two groups, the percentage of the ΔKm and ΔKvector values greater than 0.5 D were statistically different (P<0.05). There was no significant difference in ΔKm between the groups with NIBUT>5s and NIBUT≤5s (P=0.537). There was no significant difference in ΔKm between groups≥2 and<2 on the OSD SPEED II questionnaire scores (P=0.442). CONCLUSION: Dry eye can affect the reliability of keratometry measurements before cataract surgery, thereby affecting the accuracy of intraocular lens power calculations. In cataract surgery planning, it is necessary to detect subjective and objective indicators of dry eye in patients and carry out effective intervention so as to avoid refractive errors caused by inaccurate keratometry measurements.

Rotational stability and clinical outcomes after implantation of a new monofocal toric intraocular lens with double C-loop design.

PURPOSE: To investigate rotational stability and visual outcomes of patients unilaterally or bilaterally implanted with a new monofocal toric intraocular lens (IOL). SETTING: Ophthalmology service, clinique Beausoleil, avenue de Lodève, Montpellier. DESIGN: Single-center retrospective study. METHODS: This study included patients who underwent routine cataract surgery with the PODEYE toric (BVI/PhysIOL SA, Liège, Belgium) IOL using the ZEISS CALLISTO eye®. Biometry and keratometry data, refractive outcomes, rotational stability, and astigmatism correction were recorded. IOL rotation was evaluated using an image analysis technique. Postoperative assessments were performed at 1 week, 1 month, and 4 to 6 months after surgery. RESULTS: Clinical outcomes of 102 patients (136 eyes) were analyzed. Patients had a mean age of 74 years. Of the included eyes, 25% had an axial length greater than 24.5mm. Median postoperative IOL rotation from baseline (surgery) was 2̊. With the exception of one outlier (15̊ rotation), IOL rotation was ≤ 6̊ (1 month) and ≤ 10̊ (4-6 months) in 100% of the eyes. No surgical IOL re-positioning was required. Median postoperative corrected distance visual acuity was -0.08 logMAR, and median postoperative subjective cylinder was between 0.25 and 0.50 D. CONCLUSION: The PODEYE toric IOL showed high rotational stability, allowing for correction of corneal astigmatism during cataract surgery.

Immediate sequential bilateral cataract surgery is a reasonable and safe option during a pandemic.

PURPOSE: To evaluate the preoperative and intraoperative features, intraoperative and postoperative complications and postoperative satisfaction of patients who underwent immediate sequential bilateral cataract surgery (ISBCS) during the COVID-19 pandemic. METHODS: The study included ISBCS patients from September 2021 through January 2022. Demographics, comorbidities, type of anesthesia (topical/general), intraoperative complications, postoperative refractive errors, and complications were examined. The one-month postoperative appointment included a patient satisfaction questionnaire. RESULTS: ISBCS was performed in 206 eyes of 103 patients. Intraoperative complications did not occur in 99 (96.1%) of ISBCS patients. No patients had visually significant corneal edema, wound leakage, endophthalmitis, or toxic anterior segment syndrome during postoperative follow-up. Final manifest spherical equivalent refraction was less than 1.00 D in all patients and less than 0.50 D in 70.7% of patients. In the questionnaire given to the patients at the one-month follow-up, 96.1% of patients did not change their preference for surgery on the same day. CONCLUSION: ISBCS provides an advantage during the pandemic period by reducing hospital visits, especially for the elderly population and patients with comorbidities. ISBCS is a safe and reasonable method that can be used during a pandemic due to the low rates of complications, the success of the refractive results, and the high patient satisfaction rates.

[Development of a chatbot (conversational app) for cataract surgery patients]. / Développement d'un chatbot (agent conversationnel) pour les patients en parcours de chirurgie de la cataracte.

INTRODUCTION: The goal of this study was to create and promote a type of chatbot or conversational app, for patients who need cataract surgery and to evaluate its acceptability. METHODS: Multicentric prospective clinical study in two phases. Phase I : distribution of a questionnaire of 20 questions (evaluating patients' knowledge about cataracts and cataract surgery and their expectations in terms of patient education). Statistical analysis was performed through factorial analysis with factor rotation and Cronbach's alpha calculation. Phase II : creation of a chatbot with a repertoire of question-answer sets. An acceptability analysis was performed using a second questionnaire inspired by the « SUS Score ¼. RESULTS: One hundred and six initial questionnaires were collected. The patients were mostly women (56.6 %), aged 60 to 79 years (81 %), retired (77.4 %), with no high school diploma (33.0 %), had never used a chatbot before (95.3 %) and were accustomed to using a smartphone (66.0 %). Patients evaluated their knowledge about cataracts as insufficient (51.8 %) and felt the need to receive additional information (81.1 %). The comprehensibility score of the first questionnaire was 91 (middle school level). The baseline data of the chatbot was composed of 316 questions with a median comprehensibility score of 101 (middle school level). The first test of the chatbot included 18 patients. The median connection time was 4min and 40seconds (standard deviation 6.6). The median of number of questions asked for each connection was 6.5 (standard deviation 6.7). Acceptability was good, with a mean Sus Score of 78.6/100 (standard deviation 11.9). CONCLUSION: This study shows the importance of information for cataract surgery patients. The creation of a chatbot for patients undergoing cataract surgery appears to be relevant in achieving this goal.

Pseudophakia as a surprising protective factor in neovascular age-related macular degeneration.

PURPOSE: To assess the impact of lens status on macular function among patients treated for neovascular age-related macular degeneration (nvAMD) in whom scheduled intravitreal injections were delayed. METHODS: We reviewed demographic and clinical data as well as macular optical coherence tomographic images of 34 patients (48 eyes) who did not follow their injection schedule during the first wave of COVID-19 in Israel. Functional worsening was defined as a loss of at least 0.1 in decimal best-corrected visual acuity (BCVA). Morphological worsening was defined as new or increased subretinal/intraretinal fluid or a new hemorrhage. OCT indices of quality were used as a measure for cataract density and progression. RESULTS: Pseudophakia was associated with a better functional outcome than phakic status: there was a loss of 0.06±0.12 vs. 0.15±0.10 decimal BCVA in the pseudophakic and phakic eyes, respectively (P=.001). A similar trend was observed for morphological changes over the same period: there was an increase in macular thickness of 9±26% vs.12±40%, respectively (P=0.79). During the first wave of COVID-19, the index of OCT quality remained stable for phakic eyes (26±3.6 before the first wave of COVID-19, 26±2.9 afterward; P=1) and pseudophakic eyes (30±2.4 before the first wave of COVID-19, 30±2.6 afterward; P=1). CONCLUSION: Pseudophakic eyes with nvAMD that missed their scheduled intravitreal injections experienced fewer morphological and functional complications than phakic eyes with nvAMD.

Efficacy of femtosecond laser for anterior capsulotomy in complex white cataracts.

OBJECTIVE: To determine the advantages and complication rate of capsulotomy performed with femtosecond laser in white complex cataract cases. STUDY DESIGN: Retrospective case series. PARTICIPANTS: Sixteen eyes of 16 patients. METHODS: This was a single-center retrospective review of white cataract surgery cases in which the femtosecond laser (LenSx, Alcon Laboratories, Fortworth, Texas, USA) was used between May 2019 and February 2021. Outcome measures included an assessment of the capsulotomy, identification of tags, surgical time, cumulative dispersed energy (CDE) and postoperative management. RESULTS: Sixteen eyes of 16 patients were included in this study; capsule tags occurred in six patients (37.5%). In 2 patients, the capsule presented small adhesions that were identified and removed. One patient presented a very significant contraction of the anterior capsule with an incomplete cut zone of 2 to 4hours. In a patient with nystagmus, the capsulotomy was performed without complications under peribulbar anesthesia. CONCLUSIONS: The femtosecond laser permitted capsulotomies of better shape, size and regularity in complex cases of white cataract and in combination with conditions such as nystagmus and prior corneal transplantation. The microadhesions and untreated areas were identified with trypan blue, which is essential to use in these cases to avoid associated complications.

Comparison of the accuracy of nine intraocular lens power calculation formulas using partial coherence interferometry.

Cataract surgery is the most performed procedure in the world. To achieve the target refraction, several intraocular lens (IOL) power calculation formulas have been developed to improve the accuracy of IOL power predictions. We compared the accuracy of 9 IOL power calculation formulas (SRK/T, Hoffer Q, Holladay 1, Haigis, Barrett Universal II, Kane, EVO 2.0, Ladas Super formula and Hill-RBF 3.0) using partial coherence interferometry (PCI). We collected data from patients who underwent uncomplicated cataract surgery with implantation of 1 of 3 IOL types currently used in our center. All preoperative biometric measurements were performed using PCI. Prediction errors (PE) were deduced from refractive outcomes evaluated 3 months after surgery. The mean prediction error (ME), mean absolute prediction error (MAE), median absolute prediction error (MedAE), and standard deviation of prediction error (SD) were calculated, as well as the percentage of eyes with a PE within ± 0.25, ± 0.50, ± 0.75 and ± 1.00D for each formula. We included 126 eyes of 126 patients. Kane achieved the lowest MAE and SD across the entire sample as well as the highest percentage of PE within ± 0.50D and was shown to be more accurate than Haigis and Hoffer Q (P<001). For an axial length of more than 26.0mm, EVO 2.0 and Barrett obtained the lowest MAEs, with EVO 2.0 and Kane showing a higher percentage of prediction at ±0.50D compared to old generation formulas except for SRK/T (P=04). All investigated formulas achieved good results; there was a tendency toward better outcomes with new generation formulas, especially in atypical eyes.

Presence of cataract in patients treated for retinoblastoma at the national institute of pediatrics in Mexico (2011-2021).

PURPOSE: The goal of this study is to describe the presence of secondary cataract in patients with retinoblastoma treated at the National Institute of Pediatrics of Mexico (INP) over the past 10 years. METHODS: This was a single center observational, retrospective and descriptive study. We included all eyes diagnosed with retinoblastoma and cataract between June 2011 and June 2021. RESULTS: In total, 833 records of patients diagnosed with Retinoblastoma at the National Institute of Pediatrics during the period between June 2011 and June 2021 were reviewed. Out of all of them, only 14 developed cataract (1.6%). The median age at retinoblastoma diagnosis was 10.5 months (Rank: 6-13 months), and the median age at cataract diagnosis was 51.5 months (Rank: 25-73 months). The majority (13, 92.9%) of the patients had bilateral involvement. 42% of the eyes were Stage D according to the international classification of retinoblastoma. Cryotherapy was applied in 57.1%, intravitreal chemotherapy in 85.7%, radiation therapy in 42.6%, and only 7.1% of cases were treated with intra-arterial chemotherapy. CONCLUSIONS: The presence of cataract in patients with retinoblastoma is a rare but important entity impacting the development of vision in children and detection of intraocular tumors. These probably occur late as a result of the multiple treatments to which the children have been subjected, without being able to determine in this study which is the risk factor most associated with the development of this pathology.

Spiral capsulorhexis technique with anterior chamber maintainer under continuous fluid pressure in intumescent cataracts and its clinical outcomes.

PURPOSE: To evaluate the efficacy of technique combining an anterior chamber maintainer (ACM) and spiral capsulorhexis under continuous fluid pressure in intumescent cataracts. METHODS: One hundred thirty-one eyes of 128 patients who underwent phacoemulsification and IOL implantation for intumescent white cataracts without a red reflex were included in the study. Group 1 consisted of 67 eyes of 65 patients who underwent spiral capsulorhexis with an ACM under continuous fluid pressure. Group 2 consisted of 64 eyes of 63 patients who underwent capsulorhexis after injection of viscoelastic material into the anterior chamber. Both groups were compared in terms of endothelial cell loss, intraoperative and postoperative complications. RESULTS: Progression to the periphery in the capsule not resulting in a radial tear was observed in 3 eyes in Group 1 and 11 eyes in Group 2 (P=0.019). While the type of radial tear known as the Argentinian flag sign was not observed in Group 1, it was observed in 8 eyes in Group 2 (P=0.003). Postoperative intraocular lens (IOL) decentration did not develop in any eye in group 1, but in 3 eyes in group 2 (P=0.11). CONCLUSION: The combination technique of an anterior chamber maintainer and spiral capsulorhexis provides a controlled and safe capsulorhexis and reduces intraoperative and postoperative complications in intumescent cataracts.

Trifascicular block with syncope triggered by preoperative mydriatic eye drops for cataract surgery.

We report the case of an 85-year-old patient who developed trifascicular block with syncope, triggered by preoperative eye drops for cataract surgery. This life-threatening situation reopens the debate over the necessity of having an anesthesiologist present during cataract surgery.

[National protocol for diagnosis and care of congenital aniridia: Summary for the attending physician]. / Protocole national de diagnostic et de soins (PNDS) de l'aniridie congénitale : synthèse pour le médecin traitant.

Congenital aniridia is a rare panocular disease defined by a national diagnostic and care protocol (PNDS) validated by the HAS. In most cases, it is due to an abnormality in the PAX6 gene, located at 11p13. Aniridia is a potentially blinding autosomal dominant disease with high penetrance. The prevalence varies from 1/40,000 births to 1/96,000 births. Approximately one third of cases are sporadic. Ocular involvement includes complete or partial absence of iris tissue, corneal opacification with neovascularization, glaucoma, cataract, foveal hypoplasia, optic disc hypoplasia and ptosis. These ocular disorders coexist to varying degrees and progress with age. Congenital aniridia manifests in the first months of life as nystagmus, visual impairment and photophobia. A syndromic form such as WAGR syndrome, WAGRO syndrome (due to the risk of renal Wilms tumor) or Gillespie syndrome (cerebellar ataxia) must be ruled out. Systemic associations may include diabetes, due to expression of the PAX6 gene in the pancreas, as well as other extraocular manifestations. Initial assessment is best carried out in a referral center specialized in rare ophthalmologic diseases, with annual follow-up. The management of progressive ocular involvement must be both proactive and responsive, with medical and surgical management. Visual impairment and photophobia result in disability, leading to difficulties in mobility, movement, communication, learning, fine motor skills, and autonomy, with consequences in personal, school, professional, socio-cultural and athletic life. Medico-socio-educational care involves a multidisciplinary team. Disability rehabilitation must be implemented to prevent and limit situations of handicap in activities of daily living, relying on the Commission for the Rights and Autonomy of People with Disabilities (CDAPH) within the Departmental House of People with Disabilities (MDPH). The general practitioner coordinates multidisciplinary medical and paramedical care.

[IOL choice predictability, 1-year visual outcome, and complications after cataract surgery in children]. / Prédictibilité du choix de l'implant, résultats visuels à 1 an et complications de la chirurgie de cataracte chez l'enfant.

PURPOSE: To measure the refraction 1year after cataract surgery in children as a function of under-correction of the implant power and to evaluate the visual prognosis and possible therapeutic challenges. PATIENTS AND METHODS: We conducted a retrospective study of 28 children (38 affected eyes) who underwent unilateral or bilateral cataract surgery with primary intraocular lens implantation over a one-year period of time. The age at the time of surgery was between 1month and 17years. RESULTS: Ten patients had bilateral cataracts (35%) and 18 patients unilateral (65%). Ten patients were between 0 and 2years of age, 10 patients between 2 and 6years of age, and 8 patients were over 6years old. 72 % of the cataracts were idiopathic. The cataracts were mainly cortico-nuclear (37%). Monocular acuity averaged 0.7 LogMAR (2/10) between 2 and 6years, and 0.2 LogMAR (6.3/10) after 6years. The percentage of under-correction was 31% between 0 and 2years, 12.2% between 2 and 6years, and 2.3% after 6years, for a mean under-correction of 15.2%. The power of the chosen implant after under-correction was 25 diopters on average. One year after surgery, visual acuity averaged 0.2 LogMAR (6.3/10) between 2 and 6years old,and 0.1 LogMAR (8/10) after 6years. The spherical equivalent remained globally stable after surgery (the mean postoperative value was+1.25 diopters). The highest rate of revision surgery occurred in the 0-2year-olds (40%). The most common complication was cellular proliferation (up to 80% of the 0-2year-olds). Only one case of ocular hypertension was noted. DISCUSSION: It is necessary to apply an under-correction of the intraocular lens power, decreasing with the age of the child. The gain in visual acuity is modest, and the main complication is cellular proliferation.