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Purpose The aim of the study is to report and to predict long-term endothelial cell outcomes after iris fixated phakic intraocular lens implantation for the correction of high refractive errors. Methods Retrospective, non randomized study of patient who underwent surgery between January,2000 and December,2009 in the same department in the Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts. To predict long-term endothelial cell density, 2 joint regression models were fitted on ECD to individuals with at least 2 ECD measurement in time. Model-predicted parameters for endothelial cell density and survival were obtained for each patient and were used in a Kaplan-Meier method plot for predicted percentage of eyes . Results This study consisted of 78 phakic eyes including 70 myopic eyes and 8 hyperopic eyes. 73 Verisyse/Artisan and 5 foldable Artiflex were implanted. Three eyes underwent further keratorefractive surgery (Bioptic). Two eyes were lost of follow-up.The mean follow-up was 68 months. Recent studies reported an endothelial cell loss 5 years after surgery ranged from -9 to -14%, but we found a decrease of 25% for 18 eyes. Surgery trauma is partially involved but we also found a higher endothelial cell loss one year after surgery ( range from -3.5 to -9%). Conclusion Potential complications such as progressive endothelial cell loss and risk of dislocation are major concerns in operative decision. Close follow-up with regular monitoring is necessary in patients with phakic intraocular lens.

Purpose To analyze risk factors for endothelial cell loss after corneal transplantation. Methods Cohort study including 1438 consecutive eyes of 1438 patients who underwent Penetrating Keratoplasty, Anterior Lamellar Keratoplasty, or Descemet Stripping with Endothelial Keratoplasty between 1992 and 2010. To describe post-operative endothelial cell loss, the biphasic linear model was fitted to grafts with at least 2 (early phase) or 3 (late phase) endothelial cell density (ECD) measurements in time: ECD = ECD0 – (t * E), for t 1 year (late phase). The least squares estimates were used to calculate the coefficients of the various equations for each eye. Results The average follow-up time was 45.9+39.3 months (mean+SD). The early-phase and late-phase annual endothelial cell loss (ECL) were, respectively, -24.7+18.8% (n=921) and -10.8+10.3% (n=664). Overall, the model-predicted cell loss was lower than the observed cell loss in the early phase and higher in the late phase. In multivariate analysis, 5 variables significantly influenced the early-phase endothelial cell loss: graft storage time, recipient rejection risk, preoperative hypertony, surgical group, and rejection episodes. Three variables significantly influenced the late-phase endothelial cell loss: recipient rejection risk, surgical group, and rejection episodes. Conclusion Extending the graft organ culture time beyond 3 weeks results in higher early cell loss. High-risk recipient and rejection episodes are important risk factors for cell loss. ALK induces minimal cell loss whereas keratoplasty in eyes with impaired recipient endothelium is associated with high cell loss.

Purpose To analyze the variation of the objective refraction induced by pharmacological pupillary dilation in a normal population. Methods The objective refraction obtained by an auto-kerato-refractometer was analyzed before and after maximum pupillary dilation obtained by 0.5% Tropicamide and 10% Phenylephrine. 200 phakic eyes of 100 patients aged from 15 to 76 years were prospectively included. The refractive data were expressed in a dioptric space by 3 Cartesian coordinates (X, Y, Z). Results After pupil dilation, the mean refraction ranges from -0.08(+0.11)×90.2° to +0.41(+0.10)×90.3° this equal to an astigmatic vectorial variation of (+0.03)×89.6°. The spherical equivalent increases significantly (hyperopization of +0.49D: +0.24D vs +0.74D p

Purpose To compare the corneal thickness of eyes with high myopia with that of emmetropic eyes. Methods One hundred corneas of 50 myopic patients (axial length >26 mm) and 100 corneas of 50 emmetropic patients (spherical equivalent between –1D and +1D) were prospectively analysed by means of Orbscan and ultrasonic pachymetry. The location of related points to apex, which were quantified using the rectangular coordinates (x, y) of the thinnest point, were used to determinate the location of the quadrant and the distance between this thinnest point and the centre (Pythagoras theorem). Results In the myopic group, the axial length was 27.2+/-1.6mm (26.1 to 33.1mm) and the subjective spherical equivalent was –8.17+/-1.72D (-19.2 to –5.6D). As compared with emmetropic eyes the corneal thickness was significantly lower (p

Purpose To investigate the relationship between refractive astigmatism and corneal (anterior and posterior) astigmatism in normal eyes. Methods We prospectively recorded refractive astigmatism and corneal astigmatism (Orbscan) of 500 healthy eyes (including ametropia) of 250 patients. Astigmatism data was analyzed using polar values (cylinder, axis) and rectangular coordinates (x,y) which respectively represent WTR/ATR component (Jackson 0°/90°) and oblique component (Jackson 45°/135°). Internal astigmatism and enantiomorphism (mirror-image symmetry between both eyes) were calculated. Results Anterior corneal cylinder showed higher correlation with subjective cylinder (r: 0.84 to 0.89 p 0.05). The relative proportion of the anterior corneal astigmatism in the subjective astigmatism increased with the subjective cylinder (r=0.54 p