["En face" optical coherence tomography for multiple evanescent white dot syndrome]. / Apport de l'imagerie « en face ¼ en tomographie par cohérence optique dans le syndrome des taches blanches évanescentes multiples.

INTRODUCTION: Multiple evanescent white dot syndrome (MEWDS) is a rare, usually unilateral, retinal disease associated with transient loss of vision. Its pathogenesis remains elusive. The purpose of this study was to determine the spatial location of the lesions in the neurosensory retina of a patient with MEWDS, using a new technology, i.e. "en face" optical coherence tomography ("en face" OCT). METHODS: A 21-year-old woman presenting with bilateral MEWDS underwent Cirrus(®) OCT with advanced "en face" reconstructions of the various retinal layers and inner choroid, fluorescein angiography, and infracyanine green angiography (ICGA). RESULTS: During the acute stage of MEWDS, advanced "en face" visualization mode of the IS/OS photoreceptor junction and the inner choroid showed areas of strong signal attenuation, forming a spot pattern identical to that of the hypofluorescent IGCA dots. One month later, visual acuity returned to 20/25 in both eyes and the reflectivity map of the IS/OS junction and inner choroid displayed no areas of signal attenuation. CONCLUSION: "En face" OCT is a new, noninvasive technology, capable of visualizing specific attenuation of the IS/OS junction in MEWDS, which form a spot pattern identical to those revealed by ICGA.

[Comparison of Lasik with femtosecond laser versus Lasik with mechanical microkeratome: predictability of flap depth, corneal biomechanical effects and optical aberrations]. / Comparaison entre le Lasik au laser femtoseconde et le Lasik au microkératome mécanique: prédictibilité des découpes, biomécanique cornéenne et aberrations optiques.

OBJECTIVES: To compare the predictability of flap thickness, high-order optic aberrations (HOAs), and biomechanical properties of cornea between patients treated by Lasik with mechanical microkeratome versus patients treated by FemtoLasik. SETTING: Department of ophthalmology, Pellegrin University Hospital, Bordeaux, France. PATIENTS AND METHODS: We conducted a retrospective study on 53 myopic patients who underwent Lasik with either mechanical microkeratome (MK group) or femtosecond laser (FS group). Refraction, central corneal thickness, high-order optic aberrations (HOAs), corneal hysteresis (CH), and corneal resistance factor (CRF), were analysed pre- and postoperatively in both groups. The central corneal thickness was measured with OCT-Visante(®) (Carl-Zeiss, Meditec), biomechanical parameters with ORA(®) (Reichert), and optical aberrations with the Wave Scan(®) (AMO) aberrometer. RESULTS: We included 44 eyes of 22 patients in the MK group and 62 eyes of 31 patients in the FS group. Preoperatively, the mean best-corrected visual acuity was 0.95 in both groups. In the MK group, the flap was significantly thicker than expected (162/130 µm), but in the FS group, there was no significant difference (117/120 µm). The biomechanical properties of the cornea were lower in both groups independently of the flap cutting technique. The HOAs increased after Lasik and were not influenced by the flap cutting technique. CONCLUSION: Neither mechanical microkeratome, nor femtosecond laser for flap creation, increases HOAs and the biomechanical changes of the cornea, according to ORA(®), significantly after Lasik.

Symptomatic bone disorders in HIV-infected patients: incidence in the Aquitaine cohort (1999-2002).

BACKGROUND: Since the inception of highly active antiretroviral therapy (HAART), mortality among HIV-infected patients has decreased, but this has been accompanied by the appearance of several complications. OBJECTIVES: To estimate the incidence of symptomatic bone disorders in HIV-infected patients of the Aquitaine cohort (from south-west France) for the period 1999-2002, and to describe cases. METHODS: We retrospectively studied the records of 2700 patients of the Aquitaine cohort, which was derived from a hospital-based surveillance system of HIV infection in France. All cases of symptomatic bone disorders diagnosed from 1 January 1999 to 30 June 2002 were reviewed. RESULTS: Fourteen cases of bone disorders were diagnosed, eight cases of aseptic osteonecrosis and six cases of severe osteoporosis, representing incidences of 0.3/1000 patient-years [95% confidence interval (CI): 0.14-0.62] and 0.22/1000 patient-years (95% CI: 0.09-0.52), respectively. All patients with aseptic osteonecrosis were male, while all but one with osteoporosis were female. The ages of patients ranged from 36 to 54 years for osteonecrosis and from 39 to 50 for severe osteoporosis. At the time of clinical diagnosis, all patients were treated with nucleoside reverse transcriptase inhibitors (duration of treatment ranging from 19 to 123 months for osteonecrosis and from 46 to 132 months for severe osteoporosis). Ten patients were treated with nonnucleoside reverse transcriptase inhibitors [duration of treatment ranging from 6 to 31 months for osteonecrosis (n=6) and from 4 to 29 months for severe osteoporosis (n=4)]. Thirteen patients were treated with protease inhibitors [duration of treatment ranging from 12 to 62 months for osteonecrosis (n=8) and from 3 to 44 months for severe osteoporosis (n=5)]. All osteonecrosis and five osteoporosis patients had at least one known risk factor or comorbidity associated with the bone disorder occurrence. CONCLUSIONS: In our study, the aetiology of clinical bone disorders seemed to be multifactorial, as almost all the patients had at least one possible risk factor in addition to HAART exposure.