Tuck-in tenon patch graft for giant full-thickness macular holes.

PURPOSE: To report the results of using autologous Tenon patch grafts for managing giant full-thickness macular holes (FTMHs) when other alternatives are not applicable. METHODS: The same surgical technique was performed in all three cases. Briefly, a small fragment of Tenon's tissue was collected. The graft was introduced through a 23G trocar and released over the macular hole under a bubble of PFCL. The patch is delicately pushed towards the edges of the hole to slide underneath. The PFCL bubble is then actively aspirated next to the optic disc. Tamponade with gas or silicone oil is subsequently injected, with care taken to minimize fluid turbulence during the procedure. RESULTS: The outcomes of autologous Tenon patch grafts in three giant FTMHs are reported. In the first case, silicone oil tamponade was injected, in the second, C2F6 gas was injected. And in the third case, that of a woman with advanced glaucoma, no tamponade was left in the eye. No adverse effects were observed during or after the procedures. Closure of the macular hole and functional improvement were documented during the follow-up period in all three cases. CONCLUSION: With a follow-up of up to 6 months, the Tenon patch graft appeared to be a promising technique for managing complex cases of FTMH. Additional studies to investigate long-term outcomes and determine the most appropriate indications are warranted.

Potential bioremediation of lead and phenol by sunflower seed husk and rice straw-based biochar hybridized with bacterial consortium: a kinetic study.

Environmental pollution is a global phenomenon and troublesome fact that poses a grave risk to all living entities. Via coupling carbonaceous feedstocks with outstanding microbial activity, kinetic experiments were established using the consortium of Proteus mirabilis and Raoultella planticola, biochar-derived sunflower seed husk (SHB) and rice straw (RSB), and their composites, which investigated at 30 °C (150 rpm) to eliminate 700 mg L-1 lead (120 h) and phenol (168 h) from synthetic wastewater. The derived biochars physicochemical properties of were studied. According to adsorption capacity (qe), consortium-SHB composites and consortium-RSB composites removed lead completely (70 mg g-1) within 48 h and 66 h, respectively. Besides, phenol was remediated entirely after 42 h and 48 h by both composite systems (69.90 mg g-1), respectively, comparing with bacterial consortium only or parent SHB and RSB. Moreover, four kinetic models were studied to describe the bioremediation process. Fractional power and Elovich models could be recommended for describing the adsorption kinetics for lead and phenol removal by the studied biomaterials with high correlation coefficient (R2 ≥ 0.91 for Pb2+ and ≥ 0.93 for phenol) and lower residual root mean square error (RMSE) and chi-square (X2). Overall, bacterial consortium-biochar composites exhibited greater remediation of lead and phenol than the sum of each single bacterial consortium and biochar systems; reflecting synergistic interaction of adsorptive capability of biochar and metabolic performance of bacterial consortium, as denoted by scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). The current study addressed the successful design of employing functional remediating consortium immobilized on waste biomass-derived biochar as a conducive alternative eco-sorbent and economic platform to detoxify organic and inorganic pollutants.

Influences of Mg-activation on sugarcane bagasse biochar characteristics and its PNP removing potentials from contaminated water.

Biochar as a substitute eco-friendly and low-cost adsorbent is introduced for removing p-nitrophenol (PNP) one of the most important chemical contaminant that recognized as the main metabolite in many pesticides and an intermediate compound in many industries. Physicochemical characteristics of sugarcane bagasse biochar (SCBB) and its Mg-activation (ASCBB) generated at 500 °C for 30 min were investigate. Batch kinetic experiment was conducted (200 mg L-1 PNP) to evaluate sorption efficiency of both tested biochars. To study the reaction behavior of PNP adsorption on ASCBB, solution pH and isotherm experiment of different concentrations and dosages were as investigated. The results show that ASCBB had a higher biochar yield, ash content, pH, molar ratios (H/C and O/C), surface area, pore volume, mean pore diameter, and specific and thick wall structure than SCBB. The efficiency of ASCBB to remove PNP was higher than SCBB which reached 51.98% in the first 1 min., and pH 7 achieved the optimum adsorption. Pseudo-second-order model examination exhibited well fitted to explain the adsorption results depending on R2 value (1.00). The adsorption isotherm results were well described by the Elovich and Freundlich models depending on the R2, qm and n values, which means the formation of a multilayer of PNP on the ASCBB surface through the chemisorption reaction. The calculated qm (144.93 mg g-1) of 1g L-1 was relatively close with experimental value (142.03 mg g-1). The PNP adsorption mechanism on both biochar types was electrostatic attraction, hydrogen bonding, and π-π stacking interactions, which were confirmed by studying the surface reactions before and after adsorption. Overall, the current study provided a successful waste biomass-derived biochar as a conducive alternative eco-sorbent to eliminate p-nitrophenol from wastewater.

To investigate treat and extend versus pro re nata regimen in neovascular age-related macular degeneration: results from the IDEM study.

PURPOSE: The purpose of this study is to report the 24-month outcomes of a pro re nata (PRN) compared with a treat and extend (T&E) regimen in patients previously treated for neovascular age-related macular degeneration (nAMD). METHODS: This was a 2-year prospective, single-center study. Previously treated patients for nAMD were randomized into two regimen groups: T&E and PRN groups. Main outcome measured was change in best corrected visual acuity (BCVA) from baseline to month 24. Secondary outcomes encompassed anatomical features such as central retinal thickness (CRT), number of intravitreal injections (IVI), and visits required. RESULTS: A total of 124 eyes received the T&E (n = 61) or PRN (n = 63) regimen. At month 24, the mean BCVA change was -4.4 early treatment diabetic retinopathy study (ETDRS) letters (T&E) and -3.4 ETDRS letters (PRN), with a difference of +1.1 ETDRS letters (95% CI [-2.25]; p = 0.006). The mean change in CRT was -10.6 µm (T&E) and -7.9 µm (PRN), with a difference of +2.6 µm (95% CI [+19.2]; p = 0.004). The T&E group had received a mean of +4.6 more injections (95% CI [-7.06; -2.12]; p < 0.001) at month 24. CONCLUSION: There was statistically proven non-inferiority between the PRN and T&E regimens in terms of visual and anatomical outcomes at 24 months, with significantly more IVI administered in the T&E regimen.

Characteristics of open eye injuries in the Beirut Port explosion.

INTRODUCTION: On the 4th of August 2020 an ammonium nitrate explosion took place at the Port of Beirut in Lebanon. The aim of this study was to present the open eye injuries caused by the Beirut Port blast, and to describe their characteristics and visual outcomes at 6 months. METHODS: Patients who suffered from open globe injuries during the Beirut port explosion were recruited. Characteristics of the ocular injuries and best corrected distance visual acuity (BCVA) were recorded at presentation and at 6 months. RESULTS: All included eyes (23 eyes of 19 patients) suffered from penetrating open globe injuries secondary to glass material and were operated by globe exploration + primary repair. Four of the 19 patients suffered from bilateral injuries none of whom suffered from legal blindness. BCVA at presentation was hand motion or worse in 21 of 23 eyes (91%). Seven of 23 eyes (30%) had expulsive loss of intraocular tissue, 4 of 23 eyes (17%) had retinal detachment and 4 of 23 eyes (17%) had traumatic cataracts. Ocular trama score (OTS) had a mean +/- standard deviation (SD) of 61 +/- 12. Eleven of 23 eyes (48%) had zone 2 ocular injuries and 10 of 23 eyes (43%) had zone 3 ocular injuries. At 6 months follow-up 15 of 23 eyes (65%) had a BCVA of less than 20/200. All patients with Grade 2 OTS, zone 3 injuries, expulsive loss of intraocular tissue and retinal detachment had BCVA of less than 20/200 at 6 months. CONCLUSION: Open eye injuries secondary to explosions occur most frequently due to glass fragments. Most of the victims were indoors, near windows and less than 500m away of the explosion site at the time of the blast. The majority of victims have very low BCVA, a low OTS and a high ocular ZOI at presentation which reflects the danger of open globe injuries secondary to blasts. A high ZOI, a low OTS, the expulsive loss of intraocular tissue and retinal detachment seem to be predictors of worse VA at 6 months.

Functional and anatomical outcomes after successful repair of macula-off retinal detachment: a 12-month follow-up of the DOREFA study.

PURPOSE: To report visual and anatomical outcomes and determine predictors of good visual acuity (VA) recovery after macula-off rhegmatogenous retinal detachment (RD). METHODS: Prospective multicentre study including 115 eyes from 115 patients successfully operated on for RD, with assessment of VA and spectral-domain optical coherence tomography (SD-OCT) macular images at 1, 3, 6 and 12 months after surgery. RESULTS: Over the follow-up period, VA significantly improved from median [IQR] 62 [46; 72] ETDRS letters at 1 month to 75 [67; 80] ETDRS letters at 12 months (p < 0.001) with a concomitant decreased number of eyes with any SD-OCT lesions (p < 0.001). The presence of subretinal fluid (SRF) significantly decreased (p < 0.001), as did the number of photoreceptor (PR) layer lesions (p = 0.04). At 12 months, lesions in the PR layer and poor VA recovery were significantly associated with a longer time to surgery (p = 0.007 and p < 0.001, respectively). The rate of patients without PR lesions increased from 40.9% at 1 month to 60.0% at 6 months and 73.9% at 12 months (p < 0.001). The incidence of epiretinal membrane (ERM) significantly increased (p < 0.001), while cystoid macular oedema (CME) remained stable over time. Visual acuity (VA) at 3 months postoperatively was a good reflection of final VA recovery (p < 0.001). CONCLUSION: Visual acuity (VA) improved in parallel with the decreasing number of eyes with SD-OCT lesions after macula-off rhegmatogenous RD. A long time to surgery was the only preoperative factor associated with poor VA recovery after retinal detachment surgery.

Predictive factors for exudation of quiescent choroidal neovessels detected by OCT angiography in the fellow eyes of eyes treated for a neovascular age-related macular degeneration.

BACKGROUND: To identify predictive factors for exudation for quiescent choroidal neovessels (qCNV) in the fellow eyes of eyes treated for a neovascular age-related macular degeneration (AMD). METHODS: Prospective observational study. One hundred and forty-four contralateral eyes of 144 patients treated for wet AMD were analysed. At a baseline visit, multimodal imaging including dye angiographies and optical coherence tomography angiography (OCT-A) was performed in order to detect qCNV. Patients were followed up for 12 months with a monthly assessment. The manifestation of any type of exudation (either intra- or subretinal fluid or hyperreflective subretinal material) was monitored. RESULTS: The prevalence of qCNV in the treatment-naive eyes was 15.9% with an incidence over a 12-month period of 2.8%. In total, 40.7% of the overall neovessels remained stable with no sign of exudation, while 59.3% presented some fluid during the follow-up. A statistically significant relationship was established for the following variables preceding the exudation: increase in central macular thickness (OR = 116; 95% CI [4.74; 50530] p = 0.038), increase in pigment epithelial detachment height (OR = 1.76; 95% CI [1.17; 3.18] p = 0.021) and width (OR = 1.53; 95% CI [1.12; 2.62] p = 0.042), increase in neovessels' surface on OCT-A (OR = 6.32; 95% CI [1.62; 51.0] p = 0.033), emergence of a branching pattern (OR = 7.50; 95% CI[1.37; 61.5] p = 0.032) and appearance of a hypointense halo surrounding the lesion (OR = 10.00; 95% CI [1.41; 206] p = 0.048). CONCLUSIONS: The risk of exudation in the treatment-naive fellow eyes of eyes treated for neovascular AMD was notably increased in the presence of qCNV. The biomarkers identified will help to detect their activation in order to ensure prompt antiangiogenic therapy.

EVALUATION OF PHOTORECEPTORS, RETINAL CAPILLARY PLEXUSES, AND CHORIOCAPILLARIS IN PATIENTS WITH BIRDSHOT CHORIORETINOPATHY.

PURPOSE: To assess the status of the cone photoreceptors using adaptive optics flood illumination ophthalmoscopy in patients with birdshot chorioretinopathy and to study their relationship with optical coherence tomography (OCT) angiography. METHODS: Seventeen patients with birdshot chorioretinopathy were studied using standard automated perimetry, color vision testing, fluorescein angiography, indocyanine green angiography, spectral domain OCT, enhanced depth imaging OCT, and adaptive optics flood illumination ophthalmoscopy (rtx1, Imagine Eyes, Orsay, France) in a 90 × 90-µm area at 1.5° temporal of the fovea and OCT angiography (Spectralis OCT2, Heidelberg Engineering, Heidelberg, Germany). For adaptive optics flood illumination ophthalmoscopy, spectral domain OCT, and OCT angiography, a control group of 12 healthy patients (12 eyes) matched for age, sex, and refractive error was included. RESULTS: After excluding low-quality adaptive optics flood illumination ophthalmoscopy images, 12 eyes (12 patients, 7 women, mean age 53.5 ± 10.8 years) were analyzed. Best-corrected visual acuity was 0.01 ± 0.03 LogMAR (20/25 Snellen equivalent), and foveal threshold at standard automated perimetry was 35.2 ± 3.0. Cone density at 1.5° of the fovea in the birdshot chorioretinopathy group (11,435.25 ± 4,342.9 cells/mm) was significantly smaller than in the control group (24,594.04 ± 4,764.3 cells/mm, P < 0.001). In the same area, birdshot chorioretinopathy eyes showed disruption of the ellipsoid/interdigitation zone and vascular abnormalities, such as capillary loops (58.3%), increased superficial intercapillary spaces (75%), increased deep intercapillary spaces (58.3%), capillary dilations (58.3%), telangiectatic vessels (66.6%), and absence of choriocapillary flow (58%). Cone density at 1.5° was associated with duration of the disease (Spearman's rho -0.8, P = 0.01), although it was not associated with OCT angiography abnormalities in the same area. CONCLUSION: Birdshot chorioretinopathy can result in a reduction in cone density and development of macular vascular abnormalities even in the presence of preserved visual function.

Short-Term Progression of Diabetic Hard Exudates Monitored with High-Resolution Camera.

PURPOSE: To assess the progression of diabetic hard exudates over an 8-week period, using a high-resolution adaptive optics camera. DESIGN: Prospective observational study. METHODS: Five eyes of three patients presenting diabetic maculopathy with hard exudates were studied. An area of clinically visible exudates was imaged sequentially using SD-OCT and high-resolution flood illumination adaptive optics for 2 months, on a weekly basis. A time-lapse video was obtained for each eye studied. Changes in terms of surface, number of free elements (foci), and central macular thickness were recorded. RESULTS: Short-term modifications in terms of disposition, size, and number of exudates were observed. Two patterns of progression were identified: two eyes showed exudate dislocation concomitant with the regression of the underlying macular edema, with hard exudates being progressively replaced by a multitude of smaller foci. These exudates were labeled resorption exudates. In three other eyes with persistent diabetic macular edema, foci aggregated into larger exudates. CONCLUSION: Diabetic hard exudate changes occurred over a short period of time but were not assessable clinically. Adaptive optics was able to document these subtle changes precisely. Further studies using this imaging modality may improve our understanding of the natural history of exudates and eventually help assess the efficacy of the various treatments available such as lipid-lowering drugs and anti-VEGFs injections.

Impact of Metamorphopsia on Quality of Life after Successful Retinal Detachment Surgery.

PURPOSE: To determine the impact of metamorphopsia on quality of life after successful retinal detachment (RD) surgery and to determine which retinal changes are related to the most severe distortions. DESIGN: This was a prospective, observational, consecutive study. METHODS: The study included 58 eyes of 58 consecutive patients who underwent successful RD surgery. At 6 months postoperatively, the incidence and severity of metamorphopsia were assessed by a quality-of-life questionnaire. Microstructure retinal changes were studied with spectral domain optical coherence tomography (OCT). The questionnaire score was compared with pre- and postoperative OCT findings. RESULTS: Overall, 20 patients (34.5%) had metamorphopsia. Outer retinal folds (ORFs) and the macular status before surgery, together with postoperative ORFs and decrease in ellipsoid and/or interdigitation photoreceptor zone reflectivity, were identified as risk factors of developing metamorphopsia (relative risk, 1.7-4.8). The most severe visual distortions were associated with ORFs. CONCLUSION: Metamorphopsia is a frequent occurrence after RD surgery and its impact on patients' quality of life appears to be limited. While it may be difficult to prevent photoreceptor loss occurring after surgery, limiting postoperative ORFs may be helpful in reducing their incidence.

Corneal transplantation trends in France from 2004 to 2015: A 12-year review.

PURPOSE: The aim of this study was to report the 12-year longitudinal trends in indication and corneal transplantation techniques in France from 2004 to 2015. RESULTS: The records of all corneal transplantations performed from 2004 to 2015 in France were retrospectively reviewed. The patient indications and types of transplant performed were analyzed. A total of 46,658 corneal transplantations were performed between 2004 and 2015, with 34,187 (73.3%) penetrating keratoplasty and 10,452 (22.4%) lamellar keratoplasty. The leading surgical indications were secondary endothelial failure (24.3%), keratoconus (18.8%), regraft (13.5%), and Fuchs endothelial corneal dystrophy (15.1%). Endothelial keratoplasty became the preferred technique for endothelial diseases and deep anterior lamellar keratoplasty the preferred technique for keratoconus, surpassing penetrating keratoplasty in 2013. CONCLUSION: Secondary endothelial failure is the top indication for performing a keratoplasty over the 12-year period. There was a shift from penetrating keratoplasty to endothelial keratoplasty performed for Fuchs endothelial corneal dystrophy and secondary endothelial failure, and to deep anterior lamellar keratoplasty, performed for keratoconus. This highlights an important shift in managing corneal diseases toward the application of selective and more conservative surgeries and changes in indications in corneal transplantation.

Visual outcomes of the second eye in keratoconic patients who have a corneal graft in the first eye: analysis at 12 years.

PURPOSE: To analyze demographic, clinical, and keratometric outcomes of the second eye in keratoconic patients when the first eye has already been grafted, initially and finally at 12 years. METHODS: Retrospective analysis of initial and 12 years visual and keratometric outcomes of the second eye in keratoconic patients when the first one has already been grafted. RESULTS: A total of 107 patients were included: 66 patients were analyzed at the beginning of the follow-up and at 12 years. There were no statistically significant differences with regard to the correction method from the beginning to the end of the follow-up; 3% of patients underwent crosslinking and 4.5% an intracorneal ring segments implantation. There was no significant progress in corneal opacities (1.5% vs 3.0% at 12 years) or visual comfort (90.9% vs 87.9%). The mean values of best-corrected visual acuity (BCVA) (0.69 vs 0.71 at 12 years, on a decimal scale), cylinder (-2.64 D vs -3.13 D), spherical equivalent, and keratometry (46.34 D vs. 46.49 D) had not significantly changed during the follow-up period. During the follow-up, 41 patients (38.3%) received a penetrating or lamellar keratoplasty on the contralateral eye (63% in the 5 years after the first corneal graft). At the time of the keratoplasty procedure, corneal opacities were seen in 7 patients (17.1%), mean BCVA was 0.26 ± 0.16, spherical equivalent mean was -3.70 D, mean cylinder was 3.89 D, mean keratometry values were 52.65 ± 6.80 D, and mean pachymetry value was 335.50 µm. CONCLUSIONS: This study suggests that the period of risk of keratoplasty in the second eye is significant in the first 5 years following the first keratoplasty. New therapeutic treatments have been made available, allowing for stabilization of the keratoconus decreasing the impact of transplantation.

Retinal Reflectivity Measurement for Cone Impairment Estimation and Visual Assessment After Diabetic Macular Edema Resolution (RECOVER-DME).

Purpose: Photoreceptor loss has been suspected of being involved in incomplete visual recovery after diabetic macular edema (DME) resolution. Recent studies have shown that cone density in the perifoveal area could be estimated by in vivo measurements of the outer retinal reflectivity on optical coherence tomography (OCT). The main objective of this study was to assess the photoreceptor layer reflectivity after DME resolution and to determine its relationship with final visual acuity (VA). Methods: In this cross-sectional case-control study, 77 eyes of 58 patients were divided into three groups: a first group (n = 34) encompassed eyes with resolved DME (R-DME), a second group (n = 24) corresponded to diabetic eyes without DME (no-DME), and a third group (n = 19) comprised a control group of nondiabetic healthy eyes. Outer retinal reflectivity was measured on volumetric spectral-domain (SD)-OCT scans acquired 3 months after DME resolution, from the photoreceptor ellipsoid zone (EZ) and the retinal pigment epithelium (RPE). Results: The mean DME duration was 26.5 ± 13.4 months in the R-DME group. EZ reflectivity was 19.8% lower (P < 0.0001) in this group compared to diabetic eyes without DME and 26.5% lower (P < 0.0001) than in nondiabetic control eyes. Reflectivity was 7.8% lower in the no-DME group compared to controls (P < 0.0001). RPE reflectivity was comparable among the three groups (P > 0.05). VA was significantly correlated with EZ reflectivity in diabetic patients (r2 = 0.57; P < 0.0001). Reflectivity tended to decrease with prolonged DME duration without reaching statistical significance (P = 0.10). Conclusions: DME significantly impacts the photoreceptor layer. This impairment can be estimated by measuring outer retinal reflectivity on OCT images after edema resorption. We also provide evidence that in diabetic eyes without a history of DME, there is early photoreceptor loss, or at least outer segment (OS) disorganization, in addition to the inner retinal degeneration reported previously. This suggests the neurodegenerative process in diabetes. This quantitative approach may help monitor neuroprotective strategies to rescue photoreceptor cells in diabetic eyes.

Quantitative analysis of photoreceptor layer reflectivity on en-face optical coherence tomography as an estimator of cone density.

BACKGROUND: To investigate whether outer retinal reflectivity on en-face Optical coherence tomography (OCT) can be considered as an estimator of cone density measured in the same area. METHODS: Forty-one points of comparisons were studied in 9 eyes (n = 6 patients) presenting maculopathies with various degrees of impairment of the photoreceptor layer. The inner segment ellipsoid zone (EZ), interdigitation zone (IZ), and retinal pigment epithelium (RPE) reflectivity were measured on coronal reconstruction of the photoreceptor layer using homemade dedicated software (Matlab, MathWorks Inc., Natick, USA). The cone metrics were measured in the same perifoveal region of interest using a high-resolution flood illumination adaptive optics camera. A semi-automatic cone counting method was adopted and all photoreceptor densities provided by the manufacturer's software were recounted manually by two experienced readers. RESULTS: Mean manual cone count was 21,522 ± 6700 (range, 5908-31,233 cells/mm2). Both EZ and IZ reflectivity values were closely correlated with cone density in the area studied (r2: 0.80 and 0.62, respectively; p < 0.0001). CONCLUSION: Outer retinal reflectivity on en-face optical coherence tomography correlates well with photoreceptor density. This cone density estimation method based on retinal reflectivity could have interesting applications in the exploration and management of maculopathies.

Three-dimensional Printing of Optical Lenses and Ophthalmic Surgery: Challenges and Perspectives.

PURPOSE: To determine whether the historical Ridley lens could be reproduced with current three-dimensional lens printing technology. METHODS: A reproduction of the Ridley lens was printed using the Printoptical Technology (LUXeXceL Group BV, Kruiningen, Netherlands). Photographs and electron microscopy images were taken. Dimensions, weight, anterior and posterior surface radius of curvature, optical transmission, back optical power, and surface analysis using interferometry were obtained. RESULTS: The printed lens was 8.10 ± 0.01 mm in diameter, 2.50 ± 0.01 mm thick, and weighed 117 mg. The anterior radius of curvature was 14.63 ± 0.69 mm and the posterior radius of curvature was 10.88 ± 0.22 mm. The back focal length in air was 14.1 ± 0.4 mm. An average 75% transmission in the visible spectrum (400 to 700 nm) was achieved. Surface analysis showed significant surface roughness. CONCLUSIONS: The printed reproduction of the Ridley lens was far from current clinical standards, but had the properties of a biconvex lens.

Vitreous Microparticle Shedding in Retinal Detachment: A Prospective Comparative Study.

PURPOSE: Microparticles (MPs) are membrane-derived vesicles measuring less than 1 µm in diameter. They are shed from nearly every activated or preapoptotic cell and may exhibit biologic activities in inflammation or apoptosis settings. The main purpose of this study was to determine whether MP shedding was higher in the vitreous of patients with retinal detachment (RD). METHODS: This was a prospective, comparative study. Levels of vitreous MPs (including phosphatidylserine [PS]-expressing MPs, photoreceptor cell-derived MPs, and photoreceptor cell-derived MPs expressing PS) and soluble proinflammatory factors (i.e., monocyte chemoattractant protein-1, intercellular adhesion molecule-1, and IL-6) were analyzed by flow cytometry. Samples were obtained from 49 eyes undergoing RD surgery and 41 control eyes. RESULTS: Vitreous levels of all the MPs studied were significantly increased in the RD group. Vitreous MP levels were correlated with levels of at least one proinflammatory factor depending on MP subsets. Concerning clinical parameters, vitreous PS-expressing MP and PS-expressing photoreceptor cell-derived MP levels were higher depending on the duration of RD at surgery, the detached retina surface, and the macula status and were found more sensitive than proinflammatory factors only for the duration of RD at surgery. CONCLUSIONS: Vitreous concentrations of MPs (mainly derived from photoreceptor cells) are higher after rhegmatogenous RD and found to be correlated with soluble proinflammatory factors.

Evolution of Corneal Graft Survival Over a 30-Year Period and Comparison of Surgical Techniques: A Cohort Study.

PURPOSE: To compare graft survival between 3 10-year periods and according to surgical techniques performed in the last years. DESIGN: Cohort study. METHODS: setting: Regional center (Besançon University Hospital, France). PATIENTS: All 1132 patients operated on between 1983 and 2014. Graft and patient baseline characteristics, risk factors for failure, surgical procedures, and postoperative corneal status were collected. MAIN OUTCOME MEASURES: Five-year survival rate in the whole cohort; 1-year and 3-year survival rates, respectively, among 88 patients with endothelial dystrophy (ED) or postoperative bullous keratopathy (PBK) operated on using endothelial lamellar keratoplasty (ELK) or penetrating keratoplasty (PK), and among 56 patients with keratoconus operated on using anterior lamellar keratoplasty (ALK) or PK. RESULTS: Between the 1983-1993 and the 2004-2014 periods, overall 5-year graft survival rate increased from 61.4% to 76.5% (P = .0004). The main prognostic factors were preoperative diagnosis, graft endothelial density, and postoperative lens status. After adjusting for these factors, difference in survival rates was no longer significant (hazard ratio 0.90 for the second and 1.17 for the third period, compared to the first, P = .4191). Only 1 graft failure, after PK, occurred among the 56 patients with keratoconus. Among the 88 patients with ED or PBK, the 1-year graft survival was higher with PK (90.6%) than with ELK (60.8%) (P = .0025) but no significance remained after adjustment (hazard ratio 3.22, P = .1304). CONCLUSIONS: Despite numerous changes in graft procedures and surgical techniques, no noticeable improvement in graft survival was found during the last 30 years while taking into account other prognostic factors.

Reflectivity of the outer retina on spectral-domain optical coherence tomography as a predictor of photoreceptor cone density.

PURPOSE: To investigate the relationship between outer retinal reflectivity on spectral-domain optical coherence tomography and cone density in the corresponding area. DESIGN: Prospective cross-sectional observational study. METHODS: In this institutional-based study, 20 eyes of 10 patients presenting maculopathies with various degrees of impairment of the photoreceptor layer (central serous chorioretinopathy, chronic central serous chorioretinopathy, maculopathy associated with hydroxychloroquine, and healthy eyes) were studied. Selection criteria were intended to ensure good image quality. Inner segment ellipsoid band reflectivity, global retinal reflectivity, and relative inner segment ellipsoid reflectivity (defined as the ratio of inner segment ellipsoid band reflectivity on overall retinal reflectivity) were measured on a longitudinal reflectance profile extracted from the spectral-domain optical coherence tomography B-scan. The cone metrics were measured in the same region of interest, located in the perifoveal area, using an adaptive optics retinal camera. RESULTS: Inner segment ellipsoid and relative ellipsoid reflectivity were closely correlated with cone density (Pearson r: 0.72 and 0.70, respectively, P < .01). CONCLUSION: Outer retinal reflectivity on the transversal optical coherence tomography scan can be correlated to adaptive optics in terms of photoreceptor density. This quantitative approach using optical coherence tomography images could have important implications in the management of maculopathies.

Assessment of parafoveal cone density in patients taking hydroxychloroquine in the absence of clinically documented retinal toxicity.

PURPOSE: To measure cone density in patients taking hydroxychloroquine (HCQ), with no clinical evidence of maculopathy. METHODS: Patients visiting for HCQ macular toxicity screening in the Besançon University Hospital Ophthalmology Department (France) were studied. They underwent routine examination including spectral-domain optical coherence tomography, fundus autofluorescence and multifocal electroretinogram to detect HCQ-induced retinal toxicity. Cone metrics (density, spacing and percentage of cones with six neighbours) were obtained using an adaptive optics camera (RTX1, Imagine Eyes, Orsay, France). The region of interest corresponded to a 0.3° × 0.3° square placed nasally and temporally at 2° of eccentricity from the fovea. RESULTS: Forty eyes of 23 patients were studied. The majority of the patients (21/23) were female. They were aged from 25 to 60 years (mean age ± SD: 40.1 years ± 10). The cumulative dose for HCQ ranged from 24 to 2160 g (777 ± 558 g). None of them displayed HCQ toxicity on screening tests. Bivariate analysis showed moderate cone loss with escalating doses of HCQ (linear regression, r² = 0.23, p = 0.018). Cone spacing also increased with increasing cumulative dose (r² = 0.17, p = 0.008). Cone packing remained unchanged (p > 0.05). Multivariate analysis showed that age and cumulative dose were additive and independent factors of cone dropout. CONCLUSIONS: In this pilot study, we observed moderate cone loss as HCQ cumulative doses increased. The early detection of parafoveal cone metric changes may represent the earliest sign of HCQ macular toxicity during screening.

Evaluation of microbial contamination of corneal transplants: one-year report from a French regional eye bank.

PURPOSE: The aim of this study was to report the rate of corneal transplant microbial contamination in a single major eye bank and to identify the contributive factors. METHODS: The contamination rate of 1156 organ-cultured corneas harvested in 2010 in a single eye bank (EFS Bourgogne Franche-Comté, Besançon, France) was studied together with the following factors: age, sex, tissue-recovery method (single or multiorgan donors), death-to-excision time, excision-to-reception time, cause of death, positive serology, and endothelial cell count. Student t test for quantitative data was used for statistical comparisons between groups. Qualitative data were assessed using the χ test. RESULTS: The contamination rate was 5.5%. Most contaminations were of bacterial origin (77.9%), with Staphylococcus species (62.3%) being predominant. Fungal contaminations (19.1%) were dominated by Candida species (76.9%). Death resulting from cancer was related to a higher risk of corneal contamination (P < 0.001). The other factors were not related to an increased risk of contamination. CONCLUSIONS: The rate of microbiological contamination of corneal transplants remains low. However, special caution should be exercised with grafts collected from patients dying from cancer. To minimize this risk, further studies on the antibacterial effect of the conservation media should be conducted in the context of increased bacterial resistance.