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Neurotrophic keratopathy (NK) is a rare degenerative disease in which damage to the corneal nerves leads to corneal hypoesthesia or anesthesia. Neurotrophic corneal ulcers are notoriously difficult to treat and can lead to blindness. Corneal neurotization (CN) is a recent surgical technique aimed at restoring corneal sensation and may offer a definitive treatment in the wake of NK. Herein, we review the surgical techniques utilized in direct and indirect CN. Technical considerations, outcomes, current limitations and future perspectives are also discussed. This article highlights the key points of this promising procedure and biological aspects that will help provide the best treatment options for patients with severe NK.

A 48-year-old woman with no significant past history underwent bilateral simultaneous laser in situ keratomileusis for correction of her myopia. On the tenth postoperative day, the patient complained of visual decrease and photophobia. Slit lamp exam showed corneal epithelial irregularities. Confocal microscopy was performed and revealed a characteristic appearance of epithelial basement membrane dystrophy (EBMD). The patient was successfully treated with artificial tears and autologous serum eyedrops. EBMD may be missed before LASIK surgery, even after a careful pre-operative examination. Exacerbation of EBMD after LASIK surgery is rare. It should be considered when unexplained corneal epithelial defects or irregularities occur following LASIK. Confocal microscopy is very useful to confirm the diagnosis.

Resume Introduction La pathogenie des fossettes colobomateuses compliquees de decollement sereux retinien (DSR) de la macula reste controversee. Son traitement l’est aussi. A travers cette etude, qui a la particularite de comprendre la plupart des techniques proposees, nous rapportons notre experience dans le traitement de cette pathologie. Patients et methodes C’est une etude monocentrique retrospective a propos de vingt patients presentant un DSR maculaire secondaire a une fossette colobomateuse entre 1983 et 2009. Differents traitements ont ete realises : les patients au tout debut de l’etude ont eu un traitement simple par laser peripapillaire. Puis, un traitement associant le laser peripapillaire et une injection intravitreenne de gaz (C3F8) avec positionnement tete vers le bas pendant deux semaines a ete realise apres echec du laser, puis d’emblee. Au cours des dernieres annees, les patients ont ete traites en premiere intention par une vitrectomie avec ou sans pelage de la membrane limitante interne (MLI), laser peripapillaire peroperatoire et tamponnement par gaz (C2F6). Resultats Notre serie est composee de vingt patients : Neuf hommes et 11 femmes. L’âge moyen des patients au moment du diagnostic etait de 29 ans (neuf a 60 ans). La duree moyenne entre le debut des symptomes et la prise en charge therapeutique etait de 6,1 mois. Aucun patient n’avait eu de decollement posterieur du vitre lors du diagnostic. Six patients ont ete traites par du laser peripapillaire avec succes dans deux cas. Onze patients (dont trois avaient eu un echec au laser seul) ont eu un traitement par laser associe a l’injection intravitreenne de gaz avec 72 % de succes. Huit patients (dont deux avaient eu un echec au laser gaz) ont eu une vitrectomie avec dissection de la hyaloide posterieure associee au laser gaz avec succes dans 87 % des cas sans recidive. Parmi eux, cinq ont eu un pelage de la MLI au cours de la vitrectomie. La duree de suivi moyenne globale de tous les patients etait de 60 mois allant de deux mois a dix-sept ans. Conclusion Notre etude montre qu’en cas de DSR maculaire compliquant une fossettte colobomateuse, un traitement precoce par vitrectomie, pelage de la MLI, laser peripapillaire et tamponnement par gaz s’accompagne d’un bon resultat anatomique et fonctionnel. Ce traitement est superieur aux autres traitements moins invasifs. La tomographie en coherence optique (OCT) constitue un outil important permettant le diagnostic et le suivi postoperatoire des patients.

Resume Introduction Etudier les caracteristiques des keratites bacteriennes afin d’identifier des facteurs de risque et des facteurs pronostics. Patients et methodes Etude retrospective sur 111 yeux de 105 patients hospitalises entre 2005 et 2006 pour une keratite bacterienne confirmee (identification d’un germe au laboratoire) ou fortement suspectee (evolution favorable sous traitement antibiotique sans germe identifie sur les prelevements). Resultats Les principaux facteurs de risque retrouves etaient le port de lentilles de contact (39,6 %), une pathologie de la surface oculaire (36,9 %), une chirurgie oculaire (27,9 %) et un traumatisme oculaire (11,7 %). Les cocci Gram+ representaient 46,8 % des cas ( Staphylococcus ), les bacilles Gram− 19,8 % ( Pseudomonas ), les bacilles Gram+ 7,2 % ( Proprionibacterium et Corynebacterium ), les cocci Gram− 2,7 % ( Branhamella ) et les coccobacille Gram− 0,9 % ( Moraxella ). Dans 22,5 % des cas aucun germe n’a ete retrouve. Dans 25,6 % des cas, deux germes ou plus ont ete retrouves. Le suivi moyen etait de 6,5 mois. Le taux de guerison de l’infection etait de 77,5 % avec un traitement purement medical et 99,1 % avec un traitement medicochirurgical. Une greffe de membrane amniotique a ete realise dans 16,2 % des cas et une keratoplastie a chaud dans 8,1 %. L’acuite visuelle moyenne initiale etait a 0,04 et l’acuite visuelle finale a 0,14. L’acuite visuelle finale moyenne est 0,09 pour les Gram+ et 0,44 pour les Gram− ( p = 0,03). Conclusion Les keratites bacteriennes sont des infections graves engageant le pronostic visuel. Les keratites a germe Gram+ sont les plus frequentes, sauf chez les porteurs de lentilles, et plus severes.

Purpose To analyze the influence of various factors on the post-operative refractive power after anterior lamellar keratoplasty (ALK) and penetrating keratoplasty (PK) in eyes with corneal diseases not involving the corneal endothelium. Methods Retrospective comparative case series. Two hundred and thirty-eight consecutive eyes of 238 patients with clear graft and at least one post-operative Orbscan examination performed after suture removal were retrospectively analyzed. Multivariate analysis of recipient and surgical parameters was performed by multivariate regression. Results The average Orbscan 3-mm corneal power was 47.1 D with a wide 95%-confidence interval [40.3 D; 53.9 D]. It was 47.9 D for ALKs and 46.2 D for PKs (p 0.5). Conclusion The post-operative, suture-out, corneal refractive power is higher after ALK compared with PK and it features important variability. In ALK eyes, non-oversized grafts result in post-operative corneal power close to normal values and corneal diseases associated with stromal thinning result in higher post-operative corneal power. Taking into account these parameters at the time of surgery may help decreasing the post-operative spherical refractive error.

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 correlation between the eye axial length and the corneal biometric parameters in a normal population. Methods We prospectively recorded axial length, ultrasonic pachymetry and corneal topography (Orbscan) of 250 healthy eyes (excluding high myopia) of 125 patients aged from 10 to 80 years. Three refractive subgroups (hyperopia, emmetropia, myopia) were defined according to the subjective spherical equivalent (emmetropia -1D to +1D). Corneal biometric parameters were compared in these 3 groups and were correlated with the axial length. Results No significant correlation was found between axial length and the corneal biometric parameters (i.e., pachymetry, anterior corneal curvature, corneal cylinder, corneal diameter, asphericity, irregularity, irregular astigmatism, location of thinnest point…)(r≤0.09 p≥0.07). The three subgroups were not significantly different for the corneal biometric parameters (p>0.13) except for the corneal curvature (hyperopia, 42.89D; emmetropia, 43.69D, myopia, 44.37D; p 0.14). Conclusion Although corneal curvature is relevant to spherical refraction, axial length does not seem to have a significant influence on the biometric parameters of the cornea.

Purpose To evaluate with in vivo confocal microscopy (IVCM) the corneal microstructure changes due to Intrastromal Corneal Ring Segments (ICRS; KERARING Mediphacos Inc., Belo Horizonte, Brazil) implantation. Methods Nine eyes of keratoconic patients were prospectively examined with the HRT 3 confocal microscope with the Rostock cornea module before and 1 month after ICRS implantation. Epithelial basal cell density, endothelial cell density and keratocyte density in the anterior, mid and posterior stroma were measured in the center of the cornea and around ICRS (approximately 3.5 mm off the center of the cornea). Results In the central cornea, we found normal morphologic features at all layers. In peripheral section (near the ICRS) epithelial basal cell density and endothelial cell density were unchanged. However, around the ICRS, keratocyte density increased in the mid stroma (6% increase) and in the posterior stroma (9% increase)(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

Purpose To assess the refractive and topographic outcome after Intracorneal ring segment (ICRS) implantation in the management of keratoconus. Methods Prospective case series of 10 keratoconic eyes (10 patients) with ICRS implantation (KERARING Mediphacos Inc., Belo Horizonte, Brazil). All patients were contact-lens intolerant. The main outcome measure were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, keratometry, SAI and SRI. Patients were examined before ICRS implantation and 3 months afterward. Results Mean preoperative keratometry was 50.94 ± 5.56 Diopters (D) (range 45.81 – 59.32). KERARING implantation decreased the spherical equivalent by 1.60 ± 3.31 D and the average keratometric values by 2.05 ± 1.49 D. UCVA significantly increased from 0.16 ± 0.16 to 0.26 ± 0.25 (P 0.05) and SRI increased from 1.30 ± 0.38 to 1.56 ±0.52 (P>0.05). Conclusion ICRS implantation improved UCVA and BCVA in the majority of the keratoconus patients. The treatment was more efficient for patient with low preoperative keratometry values.

Purpose To study the kinetics of growth and the phenotype of cells cultured from human limbal explants in a cholera toxin-free medium with no feeder cell layer. Methods Human organ-cultured corneas were used to prepare limbal explants (full-thickness and superficial limbal explants) and corneal stromal explants. Cell growth kinetics and phenotypes were assessed by cultivating explants in cholera toxin-free Green medium. Epithelial and progenitor cell markers were assessed by immunocytochemistry, flow cytometry, and Reverse Transcription and Polymerase Chain Reaction (RT-PCR). Results The successful epithelial cell growth rates from full thickness limbal explant and superficial limbal explant tissues were 41 and 86%, respectively (p=0.0001). The mean cell area and the percentage of small cells in superficial and full-thickness explant cultures were, respectively, 317 µm2 and 429 µm2, and 8.9% and 1.7% (p

Purpose To analyze graft survival and the outcome of the corneal endothelium after corneal transplantation in a single model to predict the long-term prognosis of these grafts. Methods Cohort study. Data were prospectively recorded and then analyzed retrospectively. Participants: One thousand one hundred and forty-four consecutive eyes of 1,144 patients who underwent corneal transplantation between 1992 and 2006. Interventions: Penetrating keratoplasties and deep anterior lamellar keratoplasties. Main Outcome Measures: Slit lamp examination and wide-field specular microscopy. A joint analysis of endothelial cell loss and time to graft failure was undertaken. From mid-term simultaneous analysis of graft survival and endothelial cell loss, long-term graft survival was predicted. Results The observed 5- and 10-year graft survival estimates were, respectively, 74% and 64%. The average endothelial cell density (cell loss) was 2,270 cells/mm2 preoperatively, 1,058 cells/mm2 (-53%) during the 6th post-operative year, and 865 (-61%) cells/mm2 during the 10th post-operative year. Overall, the predicted graft survival estimate was 27% at 20 years and 2% at 30 years. Both observed and predicted graft survival were higher in patients with lamellar keratoplasty than in patients with penetrating keratoplasty and normal recipient endothelium and higher in patients with penetrating keratoplasty and normal recipient endothelium than in patients with penetrating keratoplasty and impaired recipient endothelium. Conclusion For corneal diseases involving the endothelium, penetrating keratoplasty appears to be a good therapeutic approach in elderly patients as the graft lifespan may be similar to the patient life expectancy. Conversely, for younger patients, penetrating keratoplasty is only a mid-term therapeutic approach. For corneal diseases not involving the endothelium, deep anterior lamellar keratoplasty appears to be a promising therapeutic approach with higher long-term expected survival.

Purpose To compare various indices calculated using refractive data to quantify defocus. Methods Subjective refraction, pupil diameter (Colvard) and asphericity (Orbscan) were prospectively recorded in 200 healthy eyes (including ametropia) of 121 patients. Refractive data were expressed by a sinusoidal curve in one plane (power / meridian) and by a vector in a 3D dioptric power space. The three Cartesian coordinates of the vector respectively represented the spherical equivalent, WTR/ATR component (0°/90° Jackson), and oblique component (45°/135° Jackson). The defocus was quantified by the root-mean-square (RMS) value of the power curve and the length of the vector. Correlations between uncorrected visual acuity (UCVA) in LogMAR units and principal parameters including defocus indices and refractive parameters were analyzed. Results The length of the power vector and the RMS index provided the highest correlation with UCVA (rs=0.90 p 0.20) with UCVA. Conclusion The length of the sphero-cylindrical vector is clinically relevant to quantify the defocus with the aid of a single index using both spherical and astigmatic components of refraction. The UCVA is mainly explained by the ametropia.

Purpose the purpose of this study was to analyze morphometry of corneal epithelial cells in normal eyes and after anterior lamellar keratoplasty using confocal microscopy. Methods The combination of the Heidelberg Retina Tomograph II and the Rostock Cornea Module (HRT II/RCM) was used to evaluate the corneal epithelium of 10 eyes of patients who had undergone anterior lamellar keratoplasty (ALK group) and 10 normal eyes (control group). Three epithelial layers per cornea were examined: superficial cell layer, wing cell layer, and basal cell layer. A morphometric analysis software was used to determine area, perimeter, circularity, and Feret diameter of the corneal epithelial cells. Results The mean basal cell area in the central zone was significantly higher (p< 0.001) after ALK than in the control group. After ALK, the mean basal cell area decreased with post-operative time (rS = - 0.42; p = 0.039) but it did not return to normal 24 months after transplantation. Comparison of both groups showed significant differences in cell perimeter, circularity, and Feret diameter of basal cells (p< 0.001). Similar differences were found in wing cell layer. Only few superficial cells could be analyzed on corneal graft (no statistical analysis could be done). Conclusion This study imaged the living human basal epithelium of lamellar grafts, analyzed its structure and highlighted changes in epithelial cells density and morphology. We found an increase in basal cell density between 12 and 30 months. This could be explained by reinnervation of the cornea. Indeed, corneal nerves provide important protective and trophic functions. The basal cell area seems to be a relevant morphometric parameter to assess the corneal epithelium.

This study demonstrates the adhesion and growth of bovine corneal epithelial cells on the surface of a new hydrogel. The hydrogel, containing 78% of water and 22% of AN-69 polymer (poly(acrylonitrile-sodium methallyle sulfonate)), was obtained by phase inversion of polymer-dimethylformamide solution in physiological saline (0.9% NaCl). Experiments were also carried out using hydrogel treated with arginine, human albumin and collagen IV. Covering of hydrogel samples by epithelial cells was completed within ten days, with good cell viability. The epithelial cells spread out and formed a consistent cell layer, confirmed by immunocytochemistry experiments against cytokeratins. Transmission electron micrographs showed numerous desmosomes between cells and the presence of some membrane differentiations at the cell/hydrogel interface. This study suggests therefore that the hydrogel might be suitable for the development of artificial epikeratoplasty grafts.

To try to facilitate evaluation of corneal stroma during organ culture by means of light microscopy.Corneal stroma of 53 consecutive organ-cultured corneas was studied by means of light microscopy during endothelial quality control. Out of 9 corneas with bad stromal evaluation, 2 were studied by means of transmission electron microscopy, and 7 were grafted. From the remaining 44 corneas with a normal light microscopic appearance, 35 were grafted.Stromal abnormalities consisted of bright visible structures with a cell-like shape corresponding to keratocyte injuries (i.e. cellular edema, light and dark vacuoles, cell membrane disruption and, finally, internal cytolysis) as observed by TEM. At 3 months postoperatively no clinical differences between the two groups of transplants were observed.Corneal stroma can be evaluated qualitatively and easily by means of light microscopy during organ culture. Further studies are needed to investigate whether the presence of lysed keratocytes in the graft's stroma actually influences the outcome of transplantation.

Resume Introduction La microscopie confocale in vivo (IVCM) est un outil d’utilisation croissante dans les pathologies complexes de la cornee et du segment anterieur. Nous illustrons l’interet de cette technique d’imagerie dans les syndromes irido-corneo-endotheliaux (ICE) a l’aide d’un cas clinique. Observation Une femme de 47 ans presentait une baisse d’acuite visuelle unilaterale associee a une hypertonie oculaire et a des synechies irido-corneennes peripheriques. L’examen biomicroscopique de la cornee ne retrouvait pas d’anomalie mais l’examen en IVCM a mis en evidence un pleomorphisme et un polymegatisme des cellules endotheliales, contenant un noyau hyper-reflectif et leur donnant un aspect epithelioide. Ces aspects confirmerent le diagnostic de syndrome ICE. Discussion L’aspect de l’endothelium corneen des syndromes ICE en IVCM est comparable a son aspect histopathologique. L’analyse de l’endothelium corneen avec cette technique d’imagerie apporte une aide au diagnostic, en mettant en evidence ses caracteristiques particulieres, surtout dans des situations de diagnostic difficile (œdeme corneen genant l’analyse en microscopie speculaire, absence d’anomalie irienne evocatrice).

Resume Nous rapportons le cas d’une femme de 67 ans sans antecedent ophtalmologique, adressee pour la prise en charge d’une keratite infectieuse post-traumatique avec un tissu de vetement un mois auparavant au Portugal, et s’aggravant malgre un traitement antibiotique topique fortifie. A l’entree, l’acuite visuelle etait limitee a « perception lumineuse ». Un abces corneen de 11 mm de diametre infiltrait toute l’epaisseur de la cornee. Le diagnostic microbiologique et la microscopie confocale ont revele la presence d’un champignon filamenteux saprophyte de l’environnement : Cylindrocarpon lichenicola qui est responsable de keratites de maniere exceptionnelle. Devant le risque de perforation corneenne, une keratoplastie transfixiante a ete realisee malgre un traitement par voriconazole et amphotericine B. Les suites ont ete simples avec une absence de recidive a un an. Une etiologie fongique doit etre suspectee devant toute keratite d’origine traumatique. Des examens microbiologiques specifiques et une microscopie confocale doivent etre realises precocement afin de ne pas retarder la prise en charge adaptee.

Resume Les membranes epiretiniennes (MER) dites « vasocentriques » sont des MER centrees sur des vaisseaux retiniens. Elles ont ete decrites essentiellement chez le sujet jeune. Nous rapportons le cas d’un patient de 70 ans qui a consulte pour une baisse d’acuite visuelle (BAV) en rapport avec une membrane epiretinienne « vasocentrique » idiopathique. Apres vitrectomie et ablation de la MER, il a presente, quatre ans apres la chirurgie, une recidive de MER contractile centree sur le vaisseau temporal superieur associee a des distorsions retiniennes importantes au niveau du pole posterieur. La reprise chirurgicale a associe une dissection elargie de la MER au niveau du vaisseau temporal, et un pelage de la membrane limitante interne (MLI) maculaire. Malgre l’amelioration de son acuite visuelle, le patient garde toujours des metamorphopsies deux ans apres la chirurgie. Les MER « vasocentriques » ont un pronostic visuel plus reserve ainsi qu’un risque plus eleve de recidive par rapport aux autres MER. Nous discuterons a travers ce cas clinique les principales particularites cliniques et chirurgicales de ce type de membrane.

Introduction Analyser tous les cas de keratomycoses suivis et traites dans un meme centre pour etablir le type des agents pathogenes, les facteurs de risques ainsi que l’evolution clinique sous traitement. Materiels et Methodes Etude retrospective incluant les patients ayant consulte ou ayant ete hospitalises dans un meme centre d’ophtalmologie pour keratite fongique. La periode evaluee s’etendait de janvier 2001 a octobre 2008. Le diagnostic de keratomycose a ete retenu sur des arguments cliniques (presence d’un abces corneen d’allure fongique) et microbiologiques (isolement d’un champignon par les examens de laboratoire). Resultats Nous avons observe 29 cas de keratites fongiques. Vingt-quatre patients ont ete hospitalises pour une duree moyenne de 18,2 jours. Tous les patients hospitalises ont recu une bitherapie antifongique locale. Les traitements collyres comportaient le plus souvent de l’amphotericine B, de la natamycine, de la caspofongine ou du voriconazole. Une monotherapie par voie generale etait associee (vfend, itraconazole, ou triflucan). Les champignons filamenteux sont majoritairement retrouves (69 %) : Fusarium (62 %) suivis par les levures (31 %) telles que les Candida albicans. Treize patients ont conserve une cicatrice stromale, le recours a la chirurgie a ete necessaire dans 34,5 % des cas (1 evisceration, 1 enucleation, 8 greffes transfixiantes, 1 greffe lamellaire anterieure profonde, 3 greffes bouchon, 4 greffes de membranes amniotiques et une tarsorraphie). Les facteurs de risque identifies etaient le port de lentilles de contact (51,7 %) avec l’utilisation de solution d’entretien multifonction Renu Moisture LOC (20,5 %), un traumatisme ou un corps etranger corneen (10,3 %), une keratoplastie transfixiante (3,4 %), une autre pathologie corneenne (20,6 %), aucune cause retrouvee (13,8 %). Discussion Les champignons infectent le plus souvent les porteurs de lentilles de contact puis des cornees traumatisees ou pathologiques. L’utilisation de Renu Moisture LOC augmenterait le risque de keratites a Fusarium. Conclusion Les keratomycoses ont un diagnostic souvent tardif et un pronostic sombre.

Objectif Analyser la variation de la refraction objective induite par la dilatationpupillaire pharmacologique dans une population « normale ». Materiels et Methodes Analyse prospective de la refraction objective obtenue a l’aide d’un auto-kerato-refractometre avant et apres dilatation pupillaire maximale obtenue par instillation de tropicamide et de neosynephrine. Les donnees refractives ont ete exprimees dans un espace dioptrique par 3 coordonnees cartesiennes (x, y, z) representant l’equivalent spherique et 2 cylindres croises de Jackson d’axes 0°/90° et 45°/135°. Resultats 44 yeux de 22 patients phaques âges en moyenne de 53 ans (de 18 a 80) ont ete inclus. L’astigmatisme moyen est de + 0,37D × 175,9° avant dilatation et de + 0,18D × 3,0° apres dilatation soit une variation vectorielle de +0,21D × 79,9°. Apres dilatation pupillaire, l’equivalent spherique se modifie significativement (hypermetropisation de 1,08D : − 0,22D vs + 0,86D p S > = 0,41 p = 0,003) contrairement aux variations du cylindre et de l’axe. Discussion Contrairement a la dilatation en ambiance scotopique qui entraine une myopisation (« myopie nocturne »), la dilatation pupillaire pharmacologique entraine essentiellement une hypermetropisation d’origine cristallinienne. Cette hypermetropisation semble liee a l’action cycloplegique du tropicamide. La dilatation pupillaire pharmacologique n’entraine pas de variation de l’astigmatisme total et de l’astigmatisme corneen anterieur. Conclusion La dilatation pupillaire pharmacologique modifie essentiellement l’equivalent spherique dans le sens d’une hypermetropisation sans modification de l’astigmatisme.

Objectif Decrire l’evolution clinique de 10 patients ayant beneficie d’une keratoplastie lamellaire profonde (KPLP), et qui ont presente un rejet epithelial et/ou stromal du greffon corneen. Materiels et Methodes Cette etude retrospective a analyse les dossiers cliniques de 10 patients atteints de rejet de greffe sur KPLP, afin de determiner les indications chirurgicales, les delais entre la KPLP et le rejet, l’evolution de la meilleure acuite visuelle corrigee et de la pachymetrie US apres traitement ainsi que l’existence eventuelle de facteurs de risque de rejet. Discussion Apres comparaison des resultats de cette etude avec les donnees de la litterature, et notamment celles portant sur le pronostic visuel apres rejets sur keratoplasties transfixiantes, il apparait que le pronostic des rejets survenant sur KPLP est meilleur. La KPLP merite donc d’etre proposee en premiere intention lorsque l’etat endothelial le permet. Conclusion La KPLP permet d’eviter le redoutable rejet endothelial, de pronostic souvent mediocre ; cependant, les rejets epitheliaux et stromaux sont toujours possibles. Une surveillance reguliere des patients, un diagnostic et une prise en charge precoces des rejets restent donc necessaires pour prevenir un echec de la greffe.