[Neovascular invasion of the endothelio-descemetic interface occurring after deep anterior lamellar keratoplasty]. / Invasion néovasculaire de l'interface endothélio-descemetique au décours d'une kératoplastie lamellaire antérieure profonde.

INTRODUCTION: The endothelio-descemetic interface (EDI) of a deep anterior lamellar keratoplasty (DALK) may become the locus of a neovascular proliferation. Bevacizumab (Avastin) is an antiangiogenic alternative available for curative treatment in deep corneal neovascularization. OBSERVATION: We report the case of a 49-year-old woman who had received two arcuate relaxing incisions for high astigmatism after DALK. She developed graft rejection associated with significant neovascular stromal invasion in the EDI of the graft-host interface. Two subconjunctival injections of bevacizumab 1 month apart as well as thermocauterization of the feeding vessel were necessary and effective. No recurrence has been observed after 2 years of follow-up. DISCUSSION: Corneal neovascularization can be a cause of DALK rejection. A combination of anti-antiangiogenic and physical methods may abort graft rejection and permanently restore graft function.

[Using the superficial temporal fascia flap in orbital surgery]. / Utilisation du lambeau de fascia temporalis superficialis en chirurgie orbitaire.

The superficial temporal fascia flap gives a fine malleable well vascularized tissue and can be used as a pedicled or a free flap to cover large areas of loss of substance. Its dissection needs a period of training. Its use in orbital surgery is rare. However when it is about an anophthalmic socket following radiotherapy with orbital retraction syndrome, it provides tissue of good quality. This could allow later reconstruction by mucous grafts. When used on cavities of exenteration it allows fast re-epithelialisation even post-radiotherapy, while allowing the monitoring of the cavity and in particular the early detection of any tumor recurrence. Its use is advantageous in unfavorable conditions especially after radiotherapy.

[Correction of irregular astigmatism with intracorneal ring segments]. / Correction des astigmatismes irréguliers par anneaux intra cornéens.

Management of irregular astigmatism with intracorneal rings segments is an intrastromal additive technique developed initially for myopia but eventually popularized for keratoconus and post LASIK ectasia. ICR's are indicated for rigid contact lens intolerance, as an alternative to corneal transplantation. The mechanism of action is complex and involves biomechanical changes leading to a centering and a flattening of the ectasia. The surgical procedure has become much easier thanks to the use of femtosecond lasers. Individualized implantation strategies, based on each patient's topographic and tomographic pattern, are constantly evolving. Patients' refraction and vision are usually improved in more than 70% of cases. Complications remain very rare. Intracorneal ring segments can often be combined with other types of keratoplasty, usually in a sequential fashion, so as to optimize functional results.

[Decreased visual acuity in young patients; Javal's ophthalmometer is still contributing]. / Baisse de l'acuité visuelle du sujet jeune ; l'ophtalmomètre de Javal est toujours contributif.

PURPOSE: The purpose of this study was to recall the advantages of the Javal ophthalmometer in screening keratoconus. PATIENTS AND METHODS: In three young patients with progressive visual loss, optic neuropathy was strongly suspected by their ophthalmologist despite a strictly normal neuro-ophthalmology record. The patients underwent an ophthalmic clinical examination at the Bordeaux University Hospital, which guided the paraclinical examination with corneal videotopography (Orbscan II(®), Bausch and Lomb) and the biomechanical properties of the cornea with the ocular response analyzer (ORA(®), Reichert). RESULTS: Visual acuity improved in all patients on the pinhole visual acuity test. The videotopography concluded in keratoconus in all three patients. The biomechanical parameters were abnormal. The patients were equipped successfully with hard contact lenses. CONCLUSION: Despite the latest technologies including videotopography and ORA(®), examination of the cornea with the Javal ophthalmometer remains a landmark of the eye examination and can assist in screening some keratoconus conditions and avoiding diagnostic uncertainties as well as inappropriate and expensive paraclinical examinations.

[Intraorbital foreign body]. / Un corps étranger intra-orbitaire.

INTRODUCTION: Perforative intraorbital injuries can be potentially serious, and management depends on the type of projectile and its intraorbital trajectory. Medical imaging is an imperative part of the initial assessment. OBSERVATION: We report the case of a wooden intraorbital foreign body (arrow), with no functional or anatomical consequences, with a remarkable intraorbital trajectory analyzed by CT. DISCUSSION: The two main risks of these injuries are first mechanical, with possible bulb, nerve, muscle or bone complications, and second infectious. The CT scan or better yet MRI imaging provide a detailed analysis of the projectile's intraorbital trajectory in the orbital cavity. Infectious complications are promoted by the fat cells present in the orbit and must be systematically controlled with wide-spectrum antibiotics.

Spin-lattice coupling, frustration, and magnetic order in multiferroic RMnO3.

We have performed high-resolution neutron diffraction and inelastic neutron scattering experiments in the frustrated multiferroic hexagonal compounds RMnO_{3} (R = Ho,Yb,Sc,Y), which provide evidence of a strong magnetoelastic coupling in the whole family. We can correlate the atomic positions, the type of magnetic structure, and the nature of the spin waves whatever the R ion and temperature. The key parameter is the position of the Mn ions in the unit cell with respect to a critical threshold of 1/3, which determines the sign of the coupling between Mn triangular planes.

Ultraslow polaron dynamics in low-doped manganites from (139)La NMR-NQR and muon spin rotation.

We report a (139)La NMR investigation of low-doped insulating manganite samples (LaMnO(3+delta) and La(1-y)Ca(y)MnO(3+delta)) as a function of temperature. A volume fraction with fast nuclear relaxations was revealed by the inhomogeneous loss of the NMR signal over a broad temperature interval. Comparison with muon spin rotation data demonstrates that the wipeout of the (139)La signal is mainly due to slowly fluctuating electric field gradients. This provides strong evidence for the slow diffusion of lattice excitations, identified with Jahn-Teller small polarons.