FIL-SSF Carlevale intraocular lens for sutureless scleral fixation: 7 recommendations from a serie of 72 cases. MICA study (Multicentric Study of the Carlevale IOL).

PURPOSE: Lacking a standard technique, the surgical management of aphakia without capsular support remains to be optimized. The goal of this study is to analyze results for the Carlevale FIL-SSF intraocular lens and propose surgical recommendations. PATIENTS AND METHODS: The P1.5 Collective performed a retrospective analysis, with a minimum follow-up of 6 months, of the records of 72 implantations of the Carlevale FIL-SSF intraocular lens, specifically designed for sutureless scleral fixation in the ciliary sulcus. RESULTS: The most common indication was exchange of a posterior chamber intraocular lens (70.8%). The surgery lasted a mean of 53.4minutes due to the creation of scleral flaps. The implant was damaged in 12.5% of cases. Visual acuity was improved in 83.3% of cases. The postoperative spherical equivalent was -0.3 diopters, with no change in corneal astigmatism. The implant was centered and stable in all cases. Two cases (2.8%) of cystoid macular edema were observed and resolved over six months. DISCUSSION: A number of advantages of the Carlevale FIL-SSF intraocular lens make it a safe and effective solution for correction of aphakia in the absence of capsular support. It requires a longer than usual surgical procedure, and the implant must be handled with care. From their experience, the authors propose 7 recommendations to accelerate the learning curve. CONCLUSION: In light of the results of this study, we propose the Carlevale FIL-SSF intraocular lens as the new standard for the correction of aphakia without capsular support, but other studies are necessary to determine its exact place within the heirarchy of other available techniques.

Home vision monitoring in patients with maculopathy: Real-life study of the OdySight application.

INTRODUCTION: The goal of the present study was to analyze the implementation and clinical efficacy of OdySight, a mobile medical application for the remote monitoring of patients with maculopathy. MATERIALS AND METHODS: In all, 60 patients with edematous maculopathies receiving traditional clinical treatment (PRN or Treat & Extend) were provided with OdySight to detect changes in visual acuity from home. To determine both the feasibility and reliability of the application, its use by patients (both testing and game play), as well as the processing of alerts by the clinical team, were analyzed during the first year. RESULTS: The female-to-male ratio was 3:2, with a mean age of 64 years. 52% of patients presented with age-related macular degeneration, 31% with high myopia, 11% with retinal vein occlusion, and 6% with diabetic maculopathy. The conversion rate (defined as the percentage of patients completing at least one test following prescription) and the nine-month retention rate (percentage of active patients) were 61% and 24% respectively. Patients aged 50 to 70 years and those whose use of the app included game play represent 75% of active patients at 9 months. The 22 active patients performed 483 visual acuity tests, completed 1,667 game sessions, and underwent 77 in-person consultations. During the trial period, the clinical team processed 19 alerts, on average in fewer than 6 days. Decreases in visual acuity were detected with a sensitivity of 92% and specificity of 99%. DISCUSSION: The use of connected and mobile devices today is widespread, as is interest in mobile medical applications. Long-term treatments for maculopathies can be a difficult burden to bear, both for patients and healthcare practitioners. Overcoming the challenges associated with the successful remote detection of recurrences thus represents a significant opportunity for improving patient care. The implementation of novel digital tools requires the cooperation of the clinical team as a whole, to both inform and motivate patients. OdySight demonstrates satisfactory detection rates, thanks to reliable and reproducible home testing, and can thus serve as a supplementary tool for patients whose consultations are often spaced several months apart. Implementation can be nonetheless improved by facilitating alert processing, a goal which necessitates active adaptation of clinical practices. In general, active patients were very satisfied with this personalized service. CONCLUSION: Improved medical support, plus the amusing nature of the tests and games, both bolster long-term use of the OdySight app. The application allows for the remote monitoring of changes in visual acuity and affords patients and practitioners an added level of protection, particularly during long intervals between treatments and at the end of a treatment course. To ensure proper implementation, clinics should focus on reinforcing and modernizing the clinical pathway, from patient intake to the injection room.

[Multicenter Ozurdex® assessment for diabetic macular edema: MOZART study]. / Étude rétrospective du traitement par Ozurdex® dans l'œdème maculaire diabétique: MOZART study.

PURPOSE: To evaluate the efficiency and safety of intravitreal implant of 0.7mg dexamathasone in visual impairment due to diabetic macular edema (DME). MATERIALS AND METHODS: This was a retrospective, multicenter, study. Seventy-four patients, with a mean age of 65 years, followed for at least 6 months (mean follow-up: 9.8 months) were included in 5 French eye clinics (P 1.5 collective). The mean systolic blood pressure was 138mmHg and the mean HbA1c was 7.2%. We monitored 2 systemic parameters: blood pressure and glycemic balance. Best-corrected visual acuity (BCVA), central retinal thickness (CRT, Spectralis OCT), intraocular pressure (IOP) and cataract progression are studied at baseline and then at 1, 2, 4 and 6 months. RESULTS: The average CRT decrease was: 239µm at month 2 (M2) and 135µm at month 6 (M6). The mean improvement from baseline of BCVA is 8.5 letters at M2 and 7.6 letters at M6. A gain greater than 15 letters is found in 27% of patients at M6. For naive patients the BCVA is 71 letters versus 60 letters (P<0.05). Patients with a baseline CRT <500mmHg have a BCVA of 66 letters versus 57 letters (P<0.05). The mean rate injections was 1.2 at 6 months with an average of 5.4 months for reinjection. Ocular hypertension greater than 25mmHg, managed by topical treatment, is observed in 13.4% of patients. No glaucoma surgery was necessary. CONCLUSION: Dexamethasone has an anatomical and functional effectiveness in the treatment of DME. Outcomes for naive patients and lower CRT suggest that the duration of diabetes mellitus and previous treatments are negative factors of recovery. Side effects are rare and manageable. Ozurdex(®) seems to be a treatment for visual impairment due to DME with a favorable safety profile. Patient follow-up must be adapted to half-life of the product with a control before M1 (intraocular pressure) and before M5 (DME recurrence, BCVA).

[Anatomical and functional prognosis of secondary retinal detachments after sutureless macular surgery]. / Pronostic anatomique et fonctionnel des décollements de rétine secondaires après chirurgie maculaire sans suture.

PURPOSE: To evaluate the incidence, characteristics and risk factors for rhegmatogenous complications of transconjunctival sutureless 23-gauge vitrectomy (TSV) in macular surgery. The results were correlated with those reported in the literature. METHODS: Multicentric retrospective study of a cohort of patients undergoing macular surgery by 23-gauge TSV between January 2009 and June 2010. RESULTS: Four hundred and seventy-four patients divided into: epiretinal membrane (MEM) (n=279), vitreomacular traction (n=65) and idiopathic macular hole n=130. Forty-three percent of patients were pseudophakic. Posterior vitreous detachment (PVD) was absent in 60% of cases and was therefore systematically performed intraoperatively. It was seen that 1.7% of patients developed retinal tears and 2.7% retinal detachment with a higher incidence in the vitreomacular traction (VMT) group and the group in which the PVD was performed intraoperatively. Rhegmatogenous lesions were localized mainly in the inferior retina in the macular hole group. DISCUSSION: Results are consistent with the TSV literature. Their location does not appear to be related to the sclerotomies or handedness as in 20-gauge surgery, probably due to sclerotomy trocars. Localization of rhegmatogenous lesions in the inferior retina in macular hole surgery suggests a role of gas in this subgroup. In addition to instrument-retinal touch, the performance of a surgical PVD represents a major independent risk factor for retinal detachment (RD). CONCLUSION: Even with limited macular surgery, it is essential to check the retinal periphery for 360 degrees, especially for VMT and intraoperative PVD, and especially inferiorly in the case of gas tamponnade.

[Perivenular whitening in central retinal vein occlusion demonstrated by "en-face" OCT]. / Mise en évidence du blanc périveinulaire, par OCT « en-face ¼, dans le cadre d'une OVCR.

We report the case of a patient with a central vein occlusion associated with perivenular whitening. The "en-face" spectral domain OCT precisely demonstrated the ischemic area. This case underscores the utility of the "en-face" mode in the follow-up CRVO.

[Anatomical and functional repercussions of internal limiting membrane peeling in epiretinal membrane surgery]. / Retentissements anatomique et fonctionnel du pelage de limitante interne dans la chirurgie de membrane épirétinienne.

We report the case of a 67-year-old woman who underwent epiretinal membrane surgery with internal limiting membrane peeling via a 23-gauge vitrectomy. Postoperative OCT and fundus photography revealed two forms of cicatrization: a dissociation of the retinal nerve fiber layer (DONFL) over the entire area of internal limiting membrane peeling, and an arcuate zone of retinal nerve fiber layer swelling (SANFL) at the site where the peeling had been initiated. Functionally, the patient demonstrated improved postoperative near acuity and a decrease in metamorphopsia. Mean retinal sensitivity measured by MP1 microperimetry at 3months was reduced by more than 30%. Microscotomata are more marked in the zone of inititation of peeling.

[Ethmoidal mucocele after transpalpebral bony orbital decompression]. / Mucocèle ethmoïdale après décompression orbitaire osseuse transpalpébrale.

We report a case of a late ethmoidal mucocele occurring after transpalpebral bony orbital decompression. A 39-year-old man presented with a recurrence of a right-sided proptosis without signs of orbital inflammation. The patient had undergone bilateral transpalpebral bony orbital decompression for dysthyroid orbitopathy 2 years prior. Orbital CT scan showed a large mucocele in the supero-lateral right ethmoidal sinus with lateral extension to the medial rectus. The patient was therefore referred to an ear, nose and throat (ENT) surgeon, who performed an anterior ethmoidectomy with marsupialization and drainage of the mucocele via an endoscopic approach. A complete postoperative resolution of proptosis was observed without recurrence of the mucocele to date, approximately 6 months postoperative. Sinus complications occurring after orbital decompression may include sinusitis, hematoma, imploding antrum syndrome and mucoceles. Recurrent proptosis secondary to an ethmoidal mucocele is a rare event after bony orbital decompression surgery, with only two cases reported in the international literature. Management requires ophthalmologic diagnosis and collaboration between the ophthalmologist and otorhinolaryngologist.

[Serous central chorioretinopathy and tadalafil: a case report]. / Choriorétinite séreuse centrale et tadalafil, à propos d'un cas.

We report a case of central serous chorioretinopathy in a 46-year-old man with no risk factors except for erectile dysfunction agent use: Tadalafil (Cialis(®)). An association between tadalafil and central serous chorioretinopathy could involve phosphodiesterase type 5 inhibitors and be a risk factor of central serous chorioretinopathy.

[Bilateral retinal detachment in Hallermann-Streiff-François syndrome: a case report]. / Décollement de rétine bilatéral dans le syndrome d'Hallermann-Streiff-François : à propos d'un cas.

We report the case of a patient with Hallermann-Streiff-François syndrome, with typical presentation of white bilateral cataract. The surgical treatment showed morphological retinal abnormalities, which resulted in an exudative retinal detachment. This case underscores the importance of paying special attention during surgical treatment of cataract in this type of patient.

[Congenital glaucoma: future of vision and pressure. Results of an 11-year study]. / Glaucome congénital : devenir visuel et pressionnel. Résultats d'une étude sur 11 ans.

AIM: To study the future of vision and IOP in congenital glaucoma. MATERIAL AND METHODS: We studied 33 eyes from 20 separate patients divided into two groups: group one consisted of 19 eyes with isolated trabeculodysgenesis and group two 14 eyes associated with Sturge-Weber-Krabbe syndrome, angiomatosis, or Peters syndrome. All patients underwent filtering surgery between 1995 and 2006. We studied a number of different forms of surgery; visual acuity after amblyopia treatment (> or =5/10, good; 4/10-2/10, average; < or =1/10, poor), objective refraction, and intraocular pressure (<16 mmHg, good; > or =16 mmHg, poor). RESULTS: We found that 54.8% of the patients had visual acuity 5/10 or greater and 44.2% between 4 and the ability to perceive light. Objective refraction was emmetropic in 19.4% (group 1, 60%; group 2, 40%), myopic in 53.8% (group 1, 28.5%; group 2, 71%), and hyperopic in 26.9% of cases (100%, group 1). All patients underwent surgery (45.5% deep sclerectomy and 54.5% trabeculectomy); 39.4% of the patients underwent more than one type of surgery (the number of operations is a prognosis factor for visual acuity). IOP was less than 19 mmHg in 87.9% of eyes. DISCUSSION: Visual acuity, refractive errors, and IOP depend on the type of congenital glaucoma. Isolated trabeculodysgenesis seems to give a better prognosis. CONCLUSION: If early diagnosis and treatment occur, visual acuity that is 5/10 or less can be expected for more than 50% of patients; therefore their visual future seems to be better.

[Orbital pseudotumors and Riedel's thyroiditis: case report]. / Pseudo-tumeurs orbitaires et thyroïdite de Riedel: à propos d'un cas.

INTRODUCTION: We report a case of a patient with orbital pseudotumors associated with Riedel's thyroiditis. This association of unknown etiology may be related to idiopathic multifocal fibrosclerosis that includes retroperitoneal fibrosis, mediastinal fibrosis, sclerosing cholangitis, Riedel's thyroiditis, and orbital pseudotumors. CASE REPORT: A 44-year-old woman was referred for a bilateral inflammatory malignant exophthalmos with progressive optical neuropathy (bilateral visual acuity<1/20). Imaging studies demonstrated bilateral exophthalmos (grade III) with compression of the both optic nerves by extensive tumoral infiltration. The general work-up showed a compressive goiter, with the histopathologic examination establishing the diagnosis of Riedel's thyroiditis. Orbital biopsy and antithyroid antibody testing were not contributive. Systemic corticosteroid associated with total thyroidectomy resulted in regression of the symptoms within 3 months. DISCUSSION: The coexistence of bilateral orbital pseudotumor and Riedel's thyroiditis is the most common situation found for idiopathic multifocal fibrosclerosis. We discuss the differential diagnosis with thyroid-associated orbitopathy and orbital lymphoma. This observation is original because the diagnosis was reached by ophthalmic manifestation. The ophthalmologist should be able to identify this pathology to optimize the diagnostic and the therapeutic strategy. CONCLUSION: In case of exophthalmos, a complete assessment should be made, including radiological and histopathological orbital and thyroid work-up.

[Central corneal thickness and endothelial cell density in congenital glaucoma]. / Pachymétrie centrale et comptage cellulaire endothélial dans le glaucome congénital.

PURPOSE: The aim of this study was to compare endothelial cell density and central corneal thickness between eyes with congenital glaucoma and normal eyes. MATERIALS AND METHODS: We conducted a prospective study of pediatric patients between 3 and 18 years of age. Group A comprised 401 normal eyes and group B 69 glaucoma eyes, categorized into three subgroups: 3-4, 5-9, and 10 or more years of age. Measurements were taken using the Topcon SP 2000 specular microscope. RESULTS: The mean pachymetry in group B (519+/-34 microm) was significantly thinner than in group A (529+/-32 microm) (p<0.05). There was a significant positive correlation with age in the two groups (p<0.05 ANOVA) until the 5- to 9-year-old subgroup. The mean endothelial cell density in group B (2,922+/-553 cells/mm2) was lower than in group A (3,470+/-357 cells/mm2) (p<0.01). There was a significant negative correlation with age in group A (p<0.01 ANOVA). DISCUSSION: Corneal distension attributable to intraocular hypertony may explain the thinner pachymetry. In congenital glaucoma, a thinner cornea may tend to lower tonometrically recorded intraocular pressure. Glaucoma seems to be the main factor of the endothelial cell loss. CONCLUSION: Central corneal thickness and endothelial cell density should be taken into account when managing congenital glaucoma to avoid undertreatment and to measure endothelial damage.

[Bilateral papilledema as the manifestation of Schwannoma of the cauda equina]. / Oedème papillaire bilatéral révélant un schwannome de la queue-de-cheval. A propos d'un cas.

PURPOSE: A case of schwannoma of the cauda equina in which the initial manifestation was visual loss, due to papilledema, is described. OBSERVATION: A 56-year-old man presented a history of 1 month of progressively blurred vision. On examination, visual acuity was 20/1,000 due to bilateral papilledema without spinal symptoms or neurological signs. Brain computed tomography demonstrated a nonobstructive hydrocephalus. He underwent a ventriculoperitoneal shunt without improvement. One month later, he complained of disturbance while walking associated with lower back pain. A lumbar puncture revealed an increased opening pressure. Analysis of the cerebrospinal fluid demonstrated an elevated protein level (6.8 g/l). Spinal magnetic resonance imaging showed a neurinoma of the cauda equina. We performed complete surgical resection and the histopathology diagnosis was schwannoma. Neurological dysfunctions resolved except visual acuity due to bilateral optic atrophy. DISCUSSION: The association of papilledema and spinal tumor is an unusual but well-known phenomenon. Several theories have been proposed to explain the development of increased intracranial pressure in such cases but the exact physiopathology remains unknown. CONCLUSION: Spinal cord tumor should be considered when acute papilledema associated with normal brain computed tomography and high cerebrospinal fluid protein levels are encountered. Spinal magnetic resonance imaging should then be performed.