Homonymous visual field defects in patients with multiple sclerosis: results of computerised perimetry and optical coherence tomography.

AIMS OF THE STUDY: Visual dysfunction is frequent in multiple sclerosis, usually resulting from retrobulbar optic neuritis or papillitis. Less frequently, demyelinating lesions can affect the retrochiasmal pathways. There are few reports of homonymous visual field defects (HVFD) in multiple sclerosis and little is known about their evolution. The purpose of this study was to better define both the clinical profile and the evolution of HVFD in patients with multiple sclerosis. METHODS: We performed a retrospective study of all multiple sclerosis patients who presented HVFD and were examined by automated static perimetry. A subset of patients benefited from macular assessment with optical coherence tomography (OCT). We also reviewed the worldwide literature on the subject. RESULTS: Twenty patients were retrieved from the neuro-ophthalmology database of the Hôpital Ophtalmique Jules-Gonin. There were 11 women and 9 men, and their average age was 35 ± 11 years. The relapsing-remitting form of multiple sclerosis was most common (18/20; 90%), the primary progressive form (1/20; 5%) and the secondary progressive form (1/20; 5%) were rare. HVFD were the presenting symptom of multiple sclerosis in seven patients (35%). The recovery was complete in 12/20 patients (60%), and the median time to recovery was 10 weeks (2-13 weeks). An incomplete recovery was found in 5/20 subjects (25%) and no recovery occurred in 3/20 subjects (15%). Magnetic resonance imaging disclosed a definite lesion explaining the HVFD in 7/11 patients: five within the optic radiations (71.4%), one within the optic tract (14.3%) and one within the lateral geniculate nucleus (14.3%). Our results were comparable to those compiled from our literature search (29 publications, totalling 70 cases). A recurrent episode of HVFD occurred in three patients (15%). OCT was performed in 10/20 patients. Retinal ganglion cell layer thickness was assessed and revealed a homonymous thinning in three patients, diffuse unilateral or bilateral thinning (resulting from previous episodes of optic neuritis) in six patients, and normal retinal ganglion cell layer thickness in one patient. CONCLUSION: HVFD in multiple sclerosis are found mostly in young patients with relapsing-remitting multiple sclerosis, which is consistent with the epidemiology of multiple sclerosis. HVFD can be the first manifestation of multiple sclerosis and have a relatively good prognosis. Like optic neuritis, HVFD can recur. The incidence of HVFD in multiple sclerosis is unknown, as it is probably underdiagnosed. Systematic automated static perimetry and OCT could help to determine the true incidence of HVFD in multiple sclerosis.  .

New Sutureless, Scleral-Fixated Intraocular Lens (Carlevale, Soleko) Implantation Combined With Descemet Stripping Automated Endothelial Keratoplasty: An Innovative Surgical Approach.

PURPOSE: To describe a novel technique of combined Descemet stripping automated endothelial keratoplasty (DSAEK) with implantation of a new scleral fixated, sutureless, posterior chamber intraocular lens (IOL) (Carlevale, Soleko). METHODS: A new surgical technique description. RESULTS: We describe a novel surgical approach, namely combining implantation of a new scleral-fixated sutureless posterior chamber IOL with DSAEK for the management of IOL dislocation and corneal endothelial decompensation. The existing, dislocated IOL was removed, and 2 scleral radial incisions were performed 180 degrees apart. Two partial thickness scleral pockets were created along each scleral radial incision, followed by a 23 G sclerotomy. The IOL was placed in the posterior chamber by using 23 G vitreoretinal forceps, and each plug was secured under the 2 pockets. A standard DSAEK procedure was then performed. Four months postoperatively, the corneal graft was attached and clear. The Carlevale IOL was well positioned, and an improvement in the patient's vision was observed. CONCLUSIONS: Combining implantation of a new scleral fixated foldable sutureless IOL (Carlevale, Soleko) with DSAEK could represent a viable and effective option for patients with IOL dislocation or aphakia, accompanied by corneal endothelial dysfunction.

Resolution of Corneal Fibrosis After Descemet's Stripping Automated Endothelial Keratoplasty: A Case Report.

PURPOSE: To report the resolution of anterior corneal fibrosis after Descemet's stripping automated endothelial keratoplasty (DSAEK), in a patient with chronic corneal edema and anterior stromal scarring. METHODS: A 63-year-old woman, with a history of Fuchs endothelial dystrophy, presented with increasing discomfort and gradual visual loss in her right eye. Clinical examination revealed long-standing bullous keratopathy accompanied by marked subepithelial fibrosis (SEF). Based on the low postoperative visual potential due to glaucomatous optic neuropathy, we decided to proceed with DSAEK. RESULTS: During the follow-up period, SEF was found to gradually resolve. Corneal clarity was restored and an improvement in visual acuity was observed up to 12 months after surgery. CONCLUSION: DSAEK alone may represent an effective therapeutic option for the restoration of impaired corneal clarity in patients with long-standing corneal edema and concomitant anterior subepithelial scarring.

Simultaneous Penetrating Keratoplasty and Implantation of a New Scleral-Fixated, Sutureless, Posterior Chamber Intraocular Lens (Soleko, Carlevale): A Novel Technique.

PURPOSE: To describe a novel technique of combined penetrating keratoplasty (PKP) with implantation of a new scleral-fixated, sutureless, posterior chamber intraocular lens (PC-IOL) (Soleko, Carlevale). METHODS: New surgical approach description. RESULTS: We describe a novel technique for the management of PKP graft failure and posttraumatic aphakia with repeat-PKP and simultaneous implantation of a new scleral-fixated, sutureless PC-IOL. The postoperative course was uneventful, and the patient reported marked improvement in his vision. Up to 6 months postoperatively, the graft showed no signs of failure or rejection, the intraocular lens remained well-positioned, and no complications were observed. CONCLUSIONS: The favorable final outcome of our patient suggests that simultaneous PKP and implantation of this new scleral-fixated, sutureless PC-IOL may represent an efficient and effective method for the management of aphakia combined with corneal scarring.