[Severe bacterial keratitis. A clinical, epidemiologic, and microbiologic study]. / Kératites bactériennes sévères. Etude épidémiologique, clinique et microbiologique.

INTRODUCTION: The aim of this study was to report the epidemiologic and microbiologic features and to define the risk factors of hospitalized cases of bacterial keratitis in the Toulouse University Hospital Center of Ophthalmology (France). METHODS: This was a retrospective study including all cases of serious bacterial keratitis hospitalized between January 2006 and November 2007. Epidemiologic, microbiologic, and clinical factors such as age, reasons for hospitalization, visual loss, and risk factors were described. RESULTS: Sixty-seven patients were hospitalized during this period, with a mean age of 46 years. The two most frequent clinical features for hospitalization were the area of stromal infiltrate (63%) and central corneal localization (61%). A local risk factor was identified in 92.5% of cases in decreasing order: contact lens wear (49%), keratopathy (16%), corneal injury (12%), and corneal surgery (7%). Sixteen percent had immunodeficiency from the most part because of diabetes and Gougerot-Sjögen's syndrome. Bacterial samples were positive in 57% of cases. Gram-negative bacteria were often isolated (45%) among contact lens wearers. After 3 months, the final visual acuity improved in 85% of the eyes studied. DISCUSSION: Contact lens wear, even if it was the leading risk factor of serious bacterial keratitis requiring hospitalization, was not a negative prognosis factor in our study. CONCLUSION: Factors such as a low preoperative visual acuity, age, and the size of the initial infiltrate have a poor prognosis and immunodeficiency is the predisposing factor associated with the worst final visual acuity.

[Deep anterior lamellar keratoplasty in the surgical treatment of keratoconus. A 1-year follow-up]. / Kératoplastie lamellaire antérieure profonde dans le traitement chirurgical du kératocône. Recul de plus d'un an.

OBJECTIVE: To evaluate the results of deep anterior lamellar keratoplasty (DALK) using dissection with air or with a viscoelastic substance in the surgical treatment of keratoconus as an alternative to penetrating keratoplasty. MATERIAL AND METHODS: This prospective monocentric noncomparative study involved patients with contact lens-intolerant keratoconus operated on between February 2001 and September 2002. Deep lamellar dissection was performed either by air injection into the cornea to create a white emphysema of the stroma or by viscoelastic injection. This allows the surgeon to separate Descemet's membrane from the posterior stroma using the air-to-endothelium interface. Previously, aqueous humor was replaced by air in the anterior chamber to visualize the posterior corneal surface. A full-thickness allogenic corneal button was sutured into the recipient bed, after stripping its Descemet's membrane. RESULTS: Fifteen eyes of 15 patients (mean age, 41.2 years) underwent DALK. The mean preoperative visual acuity was 0.11+/-0.06. At 1 year, the mean best corrected visual acuity was 0.47+/-0.16 (p<0.001). Mean keratometric astigmatism was reduced from 6.97+/-3.3 D to 2.77+/-1.76 D at 1 year (p<0.001). Specular microscopy 3 months postoperatively revealed average endothelial cell counts of 2018+/-662/mm2, while 1 month preoperatively this value was 2604+/-235/mm2 (cell loss, 22.5%; p>0.05). Perforation of Descemet's membrane during surgery occurred in five eyes (33.3%). Two cases were converted to penetrating keratoplasty. There was no endothelial rejection. CONCLUSION: In this series, DALK appears to be a promising procedure for treatment of keratoconus with encouraging refractive outcome, no progressive primary graft failure, and no allogenic endothelial graft rejection. DALK is an interesting alternative for penetrating keratoplasty even if it is technically more difficult.

[Comparison of visual results and quality of vision between two multifocal intraocular lenses. Multifocal silicone and bifocal PMMA]. / Résultats comparatifs visuels et qualité de vision de deux implants multifocaux. Silicone multifocal et PMMA bifocal]

PURPOSE: To compare visual results and quality of vision of two multifocal intraocular lenses (IOL): SA 40 N silicone zonal-progressive multifocal IOL and P 359 TUV PMMA bifocal IOL. METHODS: 46 eyes were operated on for cataract. 24 IOL SA 40 N (group 1) and 22 IOL P 359 (group 2) were implanted. Evaluation of visual results was performed between the first and the third month postoperatively. The quality of vision was explored in both groups by using two tests of contrast sensitivity, an automated visual field and a questionnaire dealing with patient satisfaction and presence of halos and glare. RESULTS: Postoperatively, a myopic shift was noted with a statistical significant difference in the group 2 (p<0.05). The predictability was good in both groups (mean refractive error<1 D). Mean corrected distance visual acuity was similar in-groups 1 and 2 (0.6). Mean distance-corrected near visual acuity was statistically better in the group 2 (p<0.05). We noted in both groups a loss of contrast sensitivity statistically more important in the group 2 (p<0.001). Where the automated perimetry is concerned, no statistical differences were encountered. 35% of patients (group 1) and 29% (group 2) were very satisfied with the results of their surgery. Halos and glare were noted in 8% (group 1) and 9% (group 2) of the patients. CONCLUSION: The new concept of multifocality is increasing in practice of cataract surgery because of the reduction of spectacle dependency and the high level of patient satisfaction. However, the occurrence of halos and glare suggest a limitation of these indications of multifocal IOL, particularly for night driving patients.

Pain relief with intracameral mepivacaine during phacoemulsification.

AIM: To assess the efficacy and safety of an intraoperative intracameral injection of mepivacaine, administered when patients experienced pain during the course of cataract surgery under topical anaesthesia. METHODS: This is a prospective placebo controlled double masked randomised clinical trial. 50 eyes were included; 25 receiving the active compound and 25 receiving placebo. Mepivacaine (2%, 0.4 ml) or placebo was administered intraoperatively under the iris of the patients who experienced pain during the course of phacoemulsification in spite of previous topical anaesthesia. Efficacy was evaluated by the patients themselves using a five point subjective pain rating scale, the Keele verbal pain chart. Safety was measured by assessing intraocular inflammation (clinical evaluation and laser flare meter), intraocular pressure, and endothelial cell count. RESULTS: The pain rating score significantly diminished after intracameral injection in the mepivacaine group (mean 3.0 (95% CI 2.6-3.4) v 0.8 (0.3-1.3), p<10(-4))) while remaining unchanged in the placebo group (2.9 (2.6-3.2) v 2.9 (2.5-3. 3)), the mean reduction in pain score being significantly different between the two groups (p<10(-4)). There was no indication of increased postoperative ocular inflammation, intraocular pressure change, or endothelial cell loss. CONCLUSIONS: These results suggest that it may not be necessary to systematically add intracameral anaesthesia with topical anaesthesia for cataract surgery. An intraoperative intracameral injection, performed only in patients who happen to suffer during surgery, is safe and effective.

[Predictability of intraocular lens power calculation in the treatment of cataracts in children]. / La prédictibilité du calcul de la puissance de l'implant dans le traitement de la cataracte chez l'enfant.

PURPOSE: To evaluate the predictability of intraocular lens (IOL) power calculation taking in account the changing refraction in children operated on for congenital cataract with primary posterior chamber IOL implantation. METHODS: We compared the predicted (PR) and objective (OR) refraction in 89 eyes of 70 children (1 month to 16 years) (1989 to 1995) at 1 month and 3 years after cataract surgery. The eyes were divided in 4 groups. Group A: < 1 year; Group B: 1 year to 3 years; Group C: 3 years to 5 years; Group D: > 5 years. For patients operated on before 3 years of age, we used a modified SRK II formula with the aim of achieving an undercorrection (85% of SRK II value in group A, 95% of SRK II value in group B). RESULTS: The average objective refraction (OR) and the average error (AE = (OR)-(PR)) were respectively at 1 month and 3 years after surgery for the Group A: (OR: +3.5 D/-1.8 D) (AE: -1 D/-6.4 D); Group B: (OR: +1.3 D/-1.3 D) (AE: -0.9 D/-3.6 D); Group C: (OR: -0.2 D/-1.4 D) (AE: +0.1 D/-1.1 D); Group D (OR: +0.1 D/-1 D) (AE: +0.8 D/-0.4 D). CONCLUSION: At 1 month after surgery, the predictability of IOL power calculation appears accurate with a refractive error between -1 D and +0.8 D in the four groups. However we noted an increase in refractive error at 3 years with a progressive myopic shift, specially in the eyes operated on before 1 year of life which had the greatest change in axial length.

[Predictability of amblyopia in ametropic children. Apropos of 96 cases]. / La prédictibilité de l'amblyopie chez l'enfant amétrope. A propos de 96 cas.

PURPOSE: The aim of this cross-sectional retrospective study was to analyze the predictability of amblyopia in children with myopic and hyperopic unilateral and bilateral ametropia. MATERIALS AND METHODS: One hundred and sixty two eyes of 96 children, (mean age: 8.6 years), were included in this work. Mean visual acuities and significant refractive errors were estimated for all the cases. The frequency of amblyopia and strabismus was studied in cases without amblyopia and in cases with medium and high grade amblyopia. RESULTS: Mean visual acuities were significantly higher in cases of bilateral myopia (p < 0.001) and hyperopia (p < 0.05) compared with unilateral ametropia. The frequency of myopic eyes (p < 0.01), eyes with high grade of myopia (p < 0.002) and anisomyopic eyes (p < 0.001) was significantly higher in cases of high amblyopia compared with cases without amblyopia. Strabismus (p < 0.05) were also significantly more frequent in cases of high amblyopia as well as in cases of myopic eyes (p < 0.01). Moreover, in the group of high amblyopia, 6 cases (6/7) had developed an intolerance for contact lenses. CONCLUSIONS: The risk of developing high grade amblyopia appeared significantly associated with unilateral medium and high level myopia. Strabismus and difficulties with good correction of anisometropia by contact lenses or spectacle appeared to be predisposing factors. This observation would suggest the indication of refractive surgery might be useful in these particular cases. To conclude, this study emphasizes the importance of early treatment of ametropia to reduce the incidence of amblyopia in children.

Visual outcome after paediatric cataract surgery: is age a major factor?

AIMS: To determine functional results after unilateral and bilateral cataract surgery in children with different aphakic optical correction. METHODS: In this retrospective study, we evaluated visual acuity and binocular vision in 107 children who underwent cataract surgery during the 10 year period from 1985 to 1995. Aphakia was corrected by an intracapsular intraocular lens (IOL), spectacles or contact lenses. RESULTS: Mean visual acuity was > 20/40 (< 0.3 log MAR) with normal binocular vision in 58 children over 7 months of age operated on for bilateral cataracts. Pseudophakic eyes regained visual acuity > 20/63 (< 0.5 log MAR) more often (90%) than aphakic eyes (46%) (p < 0.001). Binocular vision was also achieved more often after IOL implantation (p < 0.001). Visual outcome of early bilateral cataracts was less satisfactory in children with abnormal foveolar function. For 49 children who had surgery for unilateral cataracts, prognosis was poor when surgery was performed before the age of 7 months. For cataract surgery in older children (> or = 7 months) mean visual acuities were better with IOL implantation (p < 0.05). CONCLUSION: Cataract surgery with unilateral and bilateral IOL implantation can provide a beneficial effect on final visual outcome in children who are operated on before abnormal foveolar function develops.