Corneal Endothelial Cell Loss After Endocapsular and Supracapsular Phacoemulsification: The PERCEPOLIS Randomized Clinical Trial.

PURPOSE: Subluxation techniques are superior to divide-and-conquer in procedure duration, pain, and ultrasound quantity, but their safety in endothelial cell loss (ECL) is unclear. This randomized single-blind noninferiority clinical trial aimed to determine whether subluxation supracapsular phacoemulsification techniques are inferior to a reference endocapsular technique (divide-and-conquer) regarding postoperative corneal ECL. METHODS: Patients (aged18 years or older) with greater than +0.2 logarithm of the minimum angle of resolution best spectacle-corrected visual acuity and normal to severe density cataract were randomized to subluxation or divide-and-conquer phacoemulsification in 2015 to 2016. Follow-up with ophthalmic tests was conducted on day 4 and months 1, 3, and 12. The primary study outcome was ECL at all time points. Secondary study end points were operative variables, including effective phaco time and procedure duration. A clinically relevant noninferiority ECL limit was established on the basis of the literature. RESULTS: In total, 292 patients (mean age, 73 yrs; 59% female) were randomized and underwent subluxation (n = 148) or divide-and-conquer (n = 144). Day 4 and month 1, 3, and 12 data were available for 243, 270, 275, and 198 patients, respectively. The unexpectedly high dropout at 12 months meant that the 12-month ECL data could only be assessed qualitatively. Surgery was successful in all patients. Subluxation was noninferior to divide-and-conquer in ECL. Effective phaco times were similar, but subluxation associated with shorter procedure duration. CONCLUSIONS: The subluxation technique was noninferior to divide-and-conquer regarding postoperative ECL, at least in the first 3 months, and associated with reduced intervention time. Subluxation techniques may be suitable alternatives to endocapsular techniques.Clinical Trial Registration-URL: ClinicalTrials.gov. Unique identifier: NCT02535819.

Incidence of Dacryocystorhinostomy (DCR) in France: A Nationwide Study over the 2010-2019 Period.

BACKGROUND: To assess the annual incidence, surgical technique preferred (i.e. external versus endonasal) and the characteristics of patients undergoing a Dacryocystorhinostomy (DCR) in France over a 10-year-period. METHODS: A national observational cohort study was conducted in France between January 2010 and December 2019. Data were collected from the national PMSI (Programme de Médicalisation des Sytèmes d'Information) database provided by the CNAM (Caisse Nationale de l'Assurance Maladie). All patients undergoing a DCR were included. RESULTS: Twenty-one thousand one hundred ninety-nine patients, with a mean age of 70.4 years, were included. A female predominance (78%) was noted. The mean annual number of DCRs was 2481 (2366-2633), corresponding to a mean incidence of 3.8 per 100,000 person-years. This number remained stable over the study period (p = .966). Of the 24,808 DCRs, external DCRs were more prevalent compared to endonasal procedures (70.8% vs. 29.2%, p = .0001). Six hundred and fifteen (2.5%) associated acts were performed intraoperatively, mainly during endonasal DCR (96.3%). A total of 10,857 (43.8%) silicone stents were placed intraoperatively. Bicanalicular silicone stenting was preferred over the monocanalicular stenting. All the regions performed more likely external DCR except the Île-de-France area where endonasal DCR was performed in 75.6% of procedures. DCRs were mainly performed by an ophthalmologist (80%). CONCLUSION: The mean annual incidence of external and endonasal DCRs remained stable over the study period. Endonasal DCR was more likely performed by the otorhinolaryngologists, emphasizing the need to develop personalized endonasal training in the ophthalmology residency program.

Visibility and Depth of the Stromal Demarcation Line After Corneal Collagen Cross-Linking Using Anterior Segment Optical Coherence Tomography: Comparison Between Isoosmolar and Hypoosmolar Riboflavin.

PURPOSE: To evaluate and compare visibility and depth of the stromal demarcation line (DL) created after corneal collagen cross-linking (CXL) using anterior segment optical coherence tomography (AS-OCT) between 2 groups: CXL with isoosmolar and hypoosmolar riboflavin. METHODS: In this retrospective study performed at Metz-Thionville Regional Hospital, consecutive patients with progressive keratoconus underwent CXL using an accelerated protocol (10 min, 9 mW/cm ultraviolet-A). AS-OCT (RS-3000, Nidek) was performed at 1 month after surgery, with stromal DL visibility graded. The corneal demarcation line depth (DLD) was also measured. RESULTS: Seventy-five eyes of 58 patients with a mean age of 25.2 ± 9.1 years were enrolled in the study. Preoperative mean anterior Kmax was 57.4 ± 5.4 D. The mean thinnest pachymetry was 474.3 ± 35.7 µm. The mean depth of the stromal DL on 1-month optical coherence tomography evaluation was 331.2 ± 62.7 µm. A DL was visible (grades 1 and 2) in 54 (72%) treated eyes. A positive correlation was found between patient age and the DLD: deeper lines were found in older patients [r = 0.38, P = 0.005, confidence interval 95% (0.12; 0.58)]. Forty-one patients were included in the isoosmolar group and 34 in the hypoosmolar group: neither visibility nor DLD was significantly different between groups. The mean depth was 334.5 ± 67.5 µm and 328.1 ± 59.0 µm in the isoosmolar and hypoosmolar groups, respectively (P = 0.82). A DL was visible (grades 1 and 2) in 26 eyes (63.4%) and 28 eyes (82.4%) in the isoosmolar and hypoosmolar groups, respectively (P = 0.12). CONCLUSIONS: The use of isoosmolar or hypoosmolar riboflavin does not significantly modify the depth or visibility of the stromal DL 1 month after accelerated CXL on AS-OCT evaluation.