Novel deep learning approach to estimate rigid gas permeable contact lens base curve for keratoconus fitting.

INTRODUCTION: Rigid gas permeable contact lenses (RGP) are the most efficient means of providing optimal vision in keratoconus. RGP fitting can be challenging and time-consuming for ophthalmologists and patients. Deep learning predictive models could simplify this process. OBJECTIVE: To develop a deep learning model to predict the base curve (R0) of rigid gas permeable contact lenses for keratoconus patients. METHODS: We conducted a retrospective study at the Rothschild Foundation Hospital between June 2012 and April 2021. We included all keratoconus patients fitted with Menicon Rose K2® lenses. The data was divided into a training set to develop the model and a test set to evaluate the model's performance. We used a U-net architecture. The raw matrix of anterior axial curvature in millimeters was extracted from Scheimpflug examinations for each patient and used as input for the model. The mean absolute error (MAE) between the prediction and the prescribed R0 was calculated. Univariate and multivariate analyses were conducted to assess the model's errors. RESULTS: Three hundred fifty-eight eyes from 202 patients were included: 287 eyes were included in the training dataset, and 71 were included in the testing dataset. Our model's Pearson coefficient of determination (R2) was calculated at 0.83, compared to 0.75 for the manufacturer's recommendation (mean keratometry, Km). The mean square error of our model was calculated at 0.04, compared to 0.11 for Km. The predicted R0 MAE (0.16 ± 0.13) was statistically significantly different from the Km MAE (0.23 ± 0.23) (p = 0.02). In multivariate analysis, an apex center outside the central 5 mm region was the only factor significantly increasing the prediction absolute error. CONCLUSION: Our deep learning approach demonstrated superior precision in predicting rigid gas permeable contact lens base curves for keratoconus patients compared to the manufacturer's recommendation. This approach has the potential to be particularly beneficial in complex fitting cases and can help reduce the time spent by ophthalmologists and patients during the process.

Anatomical and functional macular changes after rhegmatogenous retinal detachment with macula off.

PURPOSE: To evaluate the correlation between morphologic changes in the outer retina and visual function after successful repair of rhegmatogenous retinal detachment with macula off. DESIGN: Observational case series. SETTINGS: Dijon University Hospital. PATIENTS: Thirty patients (30 eyes) with successful repair of rhegmatogenous retinal detachment after macula off and a minimum 6-month follow-up after surgery. MAIN OUTCOME MEASURES: Spectral-domain optical coherence tomography (SD-OCT) of the outer retina, fundus autofluorescence (FAF), and microperimetry. RESULTS: Twenty of 30 eyes presented microstructural changes within the photoreceptor layer (66.7%). Of these, half of the patients (50%) had more than 1 lesion. Disrupted inner segment/outer segment (IS/OS) junction was noted in 16 out of 30 eyes (53.3%), irregular hyporeflectivity in the photoreceptor outer segments (PROS) was observed in 17 eyes (56.7%), external limiting membrane was discontinued in 10 eyes (33.3%), and hyperreflective spots in the outer nuclear layer were observed in 5 eyes (16.7%). FAF changes were detected in only 5 eyes (16.7%). Abnormalities in the IS/OS junction were significantly associated with lower foveal and macular sensitivity, thinner PROS, and global photoreceptor changes (P = .014, P = .003, P = .006, P < .0001, respectively). Patients with a normal foveal profile showed similar findings. CONCLUSIONS: SD-OCT and microperimetry seem to be appropriate tools to determine the visual and the anatomic recovery of the macula after surgery.

Efficacy of tocilizumab in two patients with anti-TNF-alpha refractory uveitis.

PURPOSE: To report on two patients with refractory uveitis treated with tocilizumab; a new humanized monoclonal antibody against the interleukin-6 receptor (IL-6R). DESIGN: Retrospective interventional case series. METHODS: Both patients received a monthly infusion of tocilizumab 8 mg/kg; associated with corticosteroids. Outcome measures were visual acuity and central retinal thickness evaluated with optical coherence tomography. RESULTS: An improvement in visual acuity and a decrease in macular edema were observed in these two patients. CONCLUSIONS: Tocilizumab seems to be a promising treatment in refractory uveitis. A prospective study is needed to evaluate the role of this new agent in the management of refractory uveitis.

Long-term outcome of idiopathic macular hole surgery.

PURPOSE: To evaluate the role of preoperative macular hole (MH) diameter, cataract surgery, and cystoid macular edema (CME) in the reopening of idiopathic macular hole (IMH) after initially successful surgery. DESIGN: Multicenter, retrospective, comparative case series. METHODS: One hundred and thirty patients (135 eyes) with stage 2, 3, or 4 IMH were included after successful IMH repair at Dijon University Hospital or Nancy University Hospital. The eyes were separated into 4 groups according to the lens status: group 1, vitrectomy in pseudophakic eyes; group 2, vitrectomy and cataract extraction as a combined procedure; group 3, vitrectomy followed by cataract extraction; group 4, vitrectomy on eyes that remained phakic. All patients underwent a complete vitrectomy with retinal inner limiting membrane peeling and intraocular gas tamponade. The main outcome measures were IMH closure rate and best-corrected visual acuity. RESULTS: Mean duration of symptoms was 8.6 +/- 7.6 months. The follow-up was 37 +/- 8.6 months (range, 30 to 67 months). The mean preoperative IMH diameter was 454 +/- 191 mum. No MH reopened during the follow-up after the initial vitreous surgery. Seven cases of CME were observed (1 in groups 1 and 2; 5 in group 3), and cataract surgery was performed in the 53 patients in group 3 with a mean delay of 11.6 months. CONCLUSIONS: Cataract extraction, CME, or preoperative MH diameter measured by optical coherence tomography were not identified as risk factors for IMH reopening.

Macular hole surgery and cataract extraction: combined vs consecutive surgery.

PURPOSE: To compare the functional and the anatomic outcomes of a combined surgery and consecutive surgery for macular hole and cataract extraction. DESIGN: Multicenter, retrospective, comparative case series. PATIENTS: One hundred twenty patients (120 eyes) with an idiopathic macular hole and cataract were operated on in 1 or 2 sessions in 2 academic centers, Dijon University Hospital and Nancy University Hospital. Combined surgery (n = 64) and consecutive surgery (n = 56) were performed between 2006 and 2007. All patients underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade. Cataract extraction was performed with phacoemulsification followed by a posterior chamber intraocular lens implantation. The main outcome measures were near and far visual acuity at 6 and 12 months, and the rate of closure of macular hole evaluated with optical coherence tomography. RESULTS: After a 12-month follow-up, the postoperative best-corrected visual acuities significantly improved in both the combined and the consecutive surgery groups (near and far vision in both groups, P < .0001). However the improvement of far visual acuity was not significant in the consecutive surgery group at 6 months (P = .06) while such an improvement was observed in the combined surgery group (P < .0001). The rates of closure, 100% and 96% in the combined and the consecutive groups respectively, and the complications did not differ significantly between groups. CONCLUSION: Both combined and consecutive surgeries are safe and effective methods to treat macular hole and cataract with equivalent functional and anatomic results in both procedures. However, combined surgery shortened the delay for visual recovery.