Efficacy and safety of intraocular folding sutureless scleral fixating lens versus iris-claw intraocular lens implantation.

PURPOSE: To compare the refractive outcomes of sutureless scleral-fixated Carlevale® intraocular lenses versus Artisan® iris-claw-fixated lenses in terms of surgically induced astigmatism. SETTING: We included patients from the Quinze-Vingts National Ophthalmology Hospital, Paris, from August 2020 to December 2020. DESIGN: This was a single-center retrospective study. METHODS: Each patient included had undergone surgery with a sutureless scleral-fixated Carlevale® foldable intraocular lens or an Artisan® iris-claw lens in the context of secondary implantation. Exclusion criteria included a history of retinal detachment or any other retinal disease. We analyzed postoperative refractive data three months after surgery for the Carlevale group and three months after removal of all sutures for the Artisan group. RESULTS: A total of 25 eyes of 25 patients were included in the Carlevale group and 37 eyes of 36 patients in the Artisan group. At three months, the best-corrected visual acuity was not statistically different, at 0.33(±0.35) and 0.32(±0.33) LogMAR, respectively (P=0.99), and surgically induced astigmatism was significantly lower in the Carlevale group, at 0.538 (±0.560) and 2.30 (±3.97) Diopters, respectively (P<0.001). CONCLUSIONS: In this first comparative study, Carlevale® intraocular lenses appear to offer better refractive accuracy and less induced astigmatism than Artisan® iris-claw lenses, without increasing mean surgical time.

[Late and sustained intraocular pressure elevation related to intravitreal anti-VEGF injections: Cases requiring filtering surgery (French translation of the article)]. / Hypertonie intraoculaire retardée liée aux injections intra-vitréennes répétées d'anti-VEGF : des cas nécessitant une chirurgie filtrante.

We report cases of delayed, sustained elevated intraocular pressure (IOP) associated with repeated intravitreal anti-VEGF injections (IVI), which ultimately resulted in the need for filtering surgery. Two of the three cases demonstrated severe IOP elevation despite maximal medical treatment following unilateral IVI and required urgent filtering surgery. Optic nerve involvement was severe in all three cases. These intravitreal injections were performed for exudative age-related macular degeneration (AMD), and the patients did not show any sign of glaucoma or ocular hypertension prior to the initiation of treatment. Elevated IOP secondary to intravitreal steroids is a well-known side effect, as is immediate transient IOP elevation associated with anti-VEGF injection. Late, sustained IOP elevation after repeated injections of anti-VEGF, described approximately ten years ago, is often underestimated. Its incidence is estimated between 2.1% and 13% according to studies and increases with the number of IVI (cumulative effect). The pathophysiologic process is becoming increasingly understood, and several risk factors for this chronic IOP elevation have been identified. Most often, it is a moderate IOP elevation for which topical monotherapy is sufficient, or sometimes two, three or four medications or even selective laser trabeculoplasty (SLT). However, filtering surgery may rarely be required. Our findings illustrate a little-described phenomenon: a sudden, severe, late IOP elevation in response to anti-VEGF by an "overflow" effect, requiring urgent filtering surgery.

[Boston Keratoprosthesis with temporal aponeurosis graft: A solution when there seems to be no more]. / Kératoprothèse de Boston avec greffe d'aponévrose temporale : une solution quand il semble ne plus y en avoir.

PURPOSE: To report cases of patients with severe bilateral corneal blindness and recurrent refractory perforation to keratoplasty and conventional treatment, for whom Boston keratoprosthesis (KP) was a satisfactory alternative when combined with a temporalis aponeurosis graft. DESCRIPTION OF CASES: The first patient had progressive Lyell syndrome with spontaneous corneal perforation. The second had a severe graft vs. host reaction with a persistent Seidel-positive descemetocele. Despite repeated penetrating keratoplasties, amniotic membrane (AM) transplantations, and buccal mucosal (BM) grafts, they both experienced recurrent corneal perforation. The only solution thus appeared to be Boston Type I KP surgery. One month postoperatively, the first patient had to receive a temporalis aponeurosis (TA) graft, due to thinning of the recipient graft. Six months postoperatively, his visual acuity (VA) was 1/10 without correction, and the corneal status had been stabilized. The second patient underwent KP and TA graft concurrently. Six months after surgery, VA was 2/10 uncorrected, and the local inflammation had been stabilized. OBSERVATION: Boston type I keratoprostheses constitute an alternative in cases of severe bilateral corneal blindness with perforation refractory to conventional treatment and surgery, with satisfactory visual results. DISCUSSION: Patients with preoperative severe ocular surface disease are at greater risk of postoperative keratolysis. For our patients with a higher risk, TA graft prevented corneal melt. TA seems to be more effective than AM or BM in preventing corneal thinning or melt. CONCLUSION: We would recommend performing a TA graft in combination with Boston KP surgery concurrently as first line treatment in eyes with severe ocular surface inflammation.

Late and sustained intraocular pressure elevation related to intravitreal anti-VEGF injections: Cases requiring filtering surgery.

We report cases of delayed, sustained elevated intraocular pressure (IOP) associated with repeated intravitreal anti-VEGF injections (IVI), which ultimately resulted in the need for filtering surgery. Two of the three cases demonstrated severe IOP elevation despite maximal medical treatment following unilateral IVI and required urgent filtering surgery. Optic nerve involvement was severe in all three cases. These intravitreal injections were performed for exudative age-related macular degeneration (AMD), and the patients did not show any sign of glaucoma or ocular hypertension prior to the initiation of treatment. Elevated IOP secondary to intravitreal steroids is a well-known side effect, as is immediate transient IOP elevation associated with anti-VEGF injection. Late, sustained IOP elevation after repeated injections of anti-VEGF, described approximately ten years ago, is often underestimated. Its incidence is estimated between 2.1 % and 13 % according to studies and increases with the number of IVI (cumulative effect). The pathophysiologic process is becoming increasingly understood, and several risk factors for this chronic IOP elevation have been identified. Most often, it is a moderate IOP elevation for which topical monotherapy is sufficient, or sometimes two, three or four medications or even selective laser trabeculoplasty (SLT). However, filtering surgery may rarely be required. Our findings illustrate a little-described phenomenon: a sudden, severe, late IOP elevation in response to anti-VEGF by an "overflow" effect, requiring urgent filtering surgery.

[Anterior chamber migration of a dexamethasone implant in a pseudophakic patient with a scleral-fixated posterior chamber intraocular lens]. / Migration d'un implant de dexaméthasone en chambre antérieure chez un patient pseudophaque porteur d'un implant de chambre postérieur suturé à la sclère.

We report the case of anterior chamber migration of a dexamethasone implant (Ozurdex(®)) in a 54-year-old woman with macular edema due to a central retinal vein occlusion. The patient had undergone complicated cataract surgery 5 years previously with a scleral-fixated posterior chamber lens implant. An uneventful intravitreal Ozurdex(®) implant injection was performed. One month later, the patient presented emergently with painless visual loss. Slit-lamp examination revealed the presence of discrete corneal edema associated with the implant in the anterior chamber. The implant was surgically removed from the anterior chamber 24 hours later with complete resolution of corneal edema.

[Intraocular foreign bodies (IOFB) of the posterior segment: retrospective analysis and management of 57 cases]. / Corps étrangers intraoculaires (CEIO) du segment postérieur : analyse rétrospective et prise en charge à propos de 57 cas.

PURPOSE: To determine the influence of prognostic factors and the type of tamponade agent in surgical management of intraocular foreign bodies (IOFBs) for better visual outcome. PATIENTS AND METHODS: Fifty-seven consecutive cases were retrospectively reviewed at the XV-XX National Hospital (Paris) between 1 January 2004 and 31 December 2007. Univariate and multivariate analyses were performed to identify prognostic variables. Several parameters were measured: pre- and postoperatively: best corrected visual acuity (BCVA), material and size of the foreign body, entry site, time from trauma to surgical removal, IOFB location, initial retinal detachment, choice of vitreous tamponade agent (none, gas, silicone oil), postoperative visual outcome, and complications (siderosis, endophthalmitis, and vitreoproliferative retinal detachment). RESULTS: Metal IOFBs accounted for the majority with 80.7% (n=46). The inferior retinal segment was the most frequent location found: 47.4% (n=27). Initial and final mean BCVAs were, respectively, 1.47 (±0.99) and 1.03 (±0.96) (LogMar scale). The mean follow-up was 20.7 months (range, 12-60 months). Initial retinal detachment was found in 24.56% (n=14), with a statically worse prognosis. The BCVA was better in the group with gas tamponade (n=16) than in the group with silicone tamponade (n=21) and the group without a tamponade agent (n=20). Initial BCVA was the most important predictive factor for final BCVA. Time to surgery was a predictive factor of final visual outcome with a cut-off in the first week. The scleral or corneoscleral entry site had a better prognosis than the corneal site. Five cases of siderosis (8.7%) related to delayed management and two cases of endophthalmitis (3.5%) were found (despite use of prophylactic systemic antibiotics). No statistical difference was found regarding the IOFB location on the retina, its size, or the material. Finally, the retina remained detached in nine cases (15.78%). A final BCVA of 20/40 or more was obtained in 39.3 and 17.5% had light perception or worse. CONCLUSION: The prognosis of an IOFB injury is for the most part uncertain due to a complex combination of parameters. Nevertheless, good postoperative results can be achieved without a silicone tamponade agent. The main prognostic factors related to better visual outcome were initial BCVA, time to surgery (first week), initially attached retina, and the scleral entry site. The main complications were vitreoproliferative retinal detachment, endophthalmitis, and siderosis. The location, type, and size of IOFBs were not statistically significant predictive factors in this study.

[Visante® OCT findings of Descemet membrane detachment after refractive lensectomy: A case report]. / Aspects en OCT Visante® de décollement descémétique après lensectomie réfractive : à propos d'un cas.

Descemet membrane detachment (DMD) is a rare complication that occurs mainly after cataract surgery. We report the case of a 55-years-old woman who underwent refractive lensectomy. The Day-1 postoperative examination was unremarkable, the Day-7 examination showed corneal oedema related to DMD, which was confirmed by Visante(®) OCT. An intracameral injection of SF6 expansive gas allowed the reapplication of the membrane and the receding of corneal oedema. Through this observation, we discuss the pathogenesis of this uncommon entity and the contribution of Visante(®) OCT.

[23-gauge transconjunctival sutureless vitrectomy: a retrospective study of 164 consecutive cases]. / Vitrectomie transconjonctivale 23-gauge: étude rétrospective de 164 cas consécutifs.

PURPOSE: To describe our initial experience and to evaluate the outcomes of patients treated with 23-gauge transconjunctival sutureless vitrectomy for a variety of vitreoretinal conditions. METHODS: A single-center, retrospective chart review of 164 consecutive 23-gauge vitrectomy cases done by five vitreoretinal surgeons at the CHNO des XV-XX from May 2006 through December 2007. The main outcome measures included visual acuity and intraoperative and postoperative complications. RESULTS: The mean follow-up duration was 145 days. Mean overall acuity improved from 20/410 (0.5/10) at baseline to 20/101 (2/10) (p<0.0001) and the improvement in visual acuity was statistically significant for patients with macular hole, epiretinal membranes, retinal detachment, nonclearing vitreous hemorrhage, and silicone oil removal. There was a single case of intraoperative retinal tear. There were no postoperative complications of endophthalmitis or choroidal effusion and three cases of hypotony, which resolved spontaneously. Thirty-six of 80 phakic eyes had worsening of cataract, 29 of which occurred in the 1st postoperative month. Twenty patients had cataract surgery during the follow-up. Postoperative retinal detachment occurred in two cases after surgery for nonclearing vitreous hemorrhage. Retinal re-detachment after surgery for retinal detachment occurred in nine of 66 cases (14%). CONCLUSIONS: Twenty-three-gauge transconjunctival sutureless vitrectomy is an effective surgical technique for a variety of vitreoretinal surgical indications. The safety and efficacy profile compared favorably with the published literature on 20-gauge surgery.

[Rare complication in microspherophakia surgery: early capsular contraction]. / Complication rare de la chirurgie de la microsphérophakie : rétraction capsulaire précoce.

INTRODUCTION: Microspherophakia is characterized by a decreasing equatorial diameter of the crystalline lens and a relative spherical shape objectivized by an increase in the diameter of the anteroposterior axis. This rare abnormality, leading to severe glaucoma and lenticular myopia, can be sporadic or inherited. OBSERVATION: We report the case of an 18-year-old woman with a history of bilateral angle-closure glaucoma consulting for recurring painful episodes with no relief from medical treatment. The clinical examination showed idiopathic microspherophakia, confirmed by crystalline lens diameter measures with B-scan biometry, associated with secondary glaucoma due to pupillary blockage even though bilateral iridotomy was achieved. A lens extraction was performed with a bag implantation, with no complications. Seven days after surgery, visual acuity dropped to 10/10 with no refractive error, but a major capsular contraction and a superior haptic luxation were noted. After a new surgery to reposition the haptic, at the end of 3 months the visual acuity was 10/10 without refractive error or hypertony. CONCLUSION: This report is an example of a rare crystalline lens disease that required lens extraction. Postoperative complications raise the problem of implantation in this pathology because of the small capsular bag diameters and the high rate of bag contraction. Using a capsular tension ring may prevent this complication but a ring was not placed in this case because of a particular anatomic condition (small bag).

[Atypical giant hidrocystoma of the eyelid]. / Un cas atypique d'hidrocystome palpébral géant.

Hidrocystoma belongs to benign tumors of sweat glands. It varies in size from a few millimeters to 1,5cm in rare cases. We report an atypical case of giant hidrocystoma of the eyelid. A 27-year-old woman consulted for a gradually progressing tumor of the right upper eyelid, with ptosis. The tumor was excised, and the histopathological exam revealed a giant hidrocystoma. The originality of this case lies in its atypical size and functional complications in a young patient.

[Arteriovenous malformation of the brain revealed through a visual blur and Adie's pupil]. / Tumeur vasculaire cérébrale révélée par un flou visuel concomitant à la découverte d'une pupille d'Adie.

INTRODUCTION: Arteriovenous malformations of the brain (BAVMs) are a relatively rare group involving intracranial vascular lesions (telangiectasia, cavernous malformation, venous anomaly). We report the case of a patient who presented an atypical visual symptomatology revealing a BAVM. OBSERVATION: A 48-year-old woman consulted for a recent bilateral visual blur. In darkness, discrete anisocoria appeared on the left eye. At the biomicroscopy light examination, we found areflexic semi-mydriasis (direct and consensual) on the left eye; the light reflex (direct and consensual) on the right eye was normal. During the accommodative reflex test the left pupil contracted. We propose the diagnosis of Adie's pupil, which was confirmed by the pilocarpine test (0.125%). We decided to examine the visual field because the symptomatology of the visual blur remained unexplained. The visual field showed a left homonymous inferior lateral scotoma. MRI showed a right occipital arteriovenous malformation. DISCUSSION: A quick examination could confuse painless anisocoria with a compression of the IIIrd intrinsic left nerve. This recent scotoma revealed BAVM progression. The natural history of BAVMs shows that the essential risk of these injuries is the onset of an intracranial hemorrhage. To reach a radical therapeutic decision, a cerebral arteriography clarifying the afferent and efferent vascularity of the nidus was carried out. CONCLUSION: This case is original in that it associates the concomitant discovery of a BAVM and Adie's pupil. Symptomatic BAVMs are extremely serious. Planning their treatment requires multidisciplinary cooperation in order to reduce the risk of mortality.

[Is cheating with automatic perimetry possible?]. / Peut-on tricher en périmétrie automatique?

INTRODUCTION: Automatic perimetry examination requires the patient's cooperation, but the programs used check response validity. This study evaluated the possibility of patient cheating on this examination. MATERIALS AND METHOD: This study investigated 27 visual fields of automatic perimetry with patients who had no ophthalmological history. Each subject had to reproduce a visual field loss that was observed for 5 minutes (two diffuse losses, five fields reflecting hemianopsia, four reflecting quadranopsia, two tubular losses, five nasal steps, nine absolute and arciform losses). The 24-2 Fastpac of the Humphrey field analyzer and the G2 of the Octopus perimeter were used for this study. RESULTS: Simple deficits were easy to reproduce, but visual field defects are often deeper and simulated test results tend to be too perfect. On the other hand, complex defects such as arciform scotoma or nasal steps were more difficult to reproduce. Visual field defect simulations were exaggerated beyond what was reasonable. CONCLUSION: This study reports on whether it is possible to cheat with automatic perimetry. The different parameters analyzed by computer programs are not able to detect cheating patients.