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Objectives: Graves' ophthalmopathy occurs in 50% of Graves' disease cases. Treatment is based on smoking cessation, and control of the euthyroidism and ocular repercussions associated with the disease. The active orbital forms are treated with glucocorticoids. Non-validated therapies have also been recently tested. Rituximab has been effectively used several times to treat corticosteroid-resistant Graves' ophthalmopathy associated with an optic neuropathy, but its use could be proposed only in inflammatory ophthalmopathies after failure of the corticosteroids. We present six cases treated since early 2012 at the University Hospital Center of Tours, France., Methods: Six patients were treated at the University Hospital Center of Tours, France, between September 2012 and April 2014. The patients had a Mourits' score greater than three after treatment with corticosteroids and/or a severe NOSPECS score and/or orbital inflammation resistant to maximal treatment with intravenous injections of methylprednisolone and an optic neuropathy. They twice received one gram of rituximab by slow intravenous injection two weeks apart. Efficacy was assessed by a decrease of the orbital inflammatory clinical Mourits' score, and visual acuity and visual field testing., Results: The inflammatory score of patients improved and treatment helped to stop the progression of the sequelae due to neuropathy. The orbital inflammatory clinical score, and the visual acuity and visual field improved but orbital decompression was necessary to complete the treatment., Conclusion: Rituximab has been used for the treatment of active corticosteroid-resistant Graves' ophthalmopathies. We also had positive results on patients with visual threat and optic neuropathy, when combined with surgical decompression., (Copyright © 2016. Published by Elsevier Masson SAS.)

Purpose: To evaluate the efficacy and safety of a preservative-free cationic emulsion (CE) with a 0.18% hyaluronate sodium (HS) solution in patients with moderate to severe dry eye disease (DED) with keratitis or keratoconjunctivitis., Methods: Eighty-five patients were randomized (1:1) in this multicenter, prospective, reference-controlled, parallel-group, investigator-masked study to receive CE (n = 44) or HS (n = 41). Clinical signs and symptoms were assessed over 3 months. The primary efficacy endpoint was noninferiority of CE to HS in change from baseline of ocular surface staining (OSS) score at 1 month., Results: In the per protocol (PP) set and full analysis set (FAS), CE showed a similar and noninferior (p<0.0001) improvement in OSS scores compared with HS at 1 month (PP: -2.5 ± 1.3 vs -1.9 ± 1.6; FAS: -2.2 ± 1.5 vs -2.0 ± 1.8 for CE vs HS). Other clinical signs of DED similarly improved in both groups. In the FAS, global symptoms score of ocular discomfort was significantly better with CE compared with HS at 1 month (-14.8 ± 17.3 vs -7.6 ± 14.2; p = 0.0469), including greater alleviation of itching (-14.8 ± 21.2 vs -1.7 ± 19.7; p = 0.0100) and eye dryness (-21.9 ± 28.3 vs -8.4 ± 21.4; p = 0.0016). Similar trends were observed at 3 months for itching and eye dryness. Investigator global efficacy assessment and quality of life scores for eye pain and driving favored CE at 3 months. Incidence of adverse events was low in both treatment groups., Conclusions: CE was similar to HS with regards to safety and efficacy for objective signs but was superior to HS in improving DED symptoms in patients with moderate to severe DED.

Purpose: Bacterial keratitis is a sight threatening infection of the cornea which remains one of the most important potential complications of contact lens use. If the corneal ulcer is small, peripheral with no impending perforation present, intensive monotherapy with fluoroquinolones could be used. Therefore, a study was conducted with the objective to provide pharmacological data of the intra-ocular diffusion after administration of Ofloxacin using a scleral lens reservoir, as well as an evaluation of surface tolerability in rabbits., Materials and Methods: Samples of corneas, aqueous humor and vitreous were collected to measure the drug levels of Ofloxacin using High Performance Liquid Chromatography. The corneas were examined by electron microscopy scanning and the eyeballs by light polarizing microscopy in order to evaluate surface tolerability., Results: Ofloxacin levels found in the aqueous humor and cornea were higher than those previously reported. The mean Ofloxacin corneal levels exceeded the MIC (Minimum Inhibitory Concentration) for which 90% of isolates are indicated for all bacteria implicated in keratitis., Conclusion: To our knowledge, this is the first preclinical study assessing local tolerance and intra-ocular diffusion of Ofloxacin after administration using a scleral lens reservoir., (Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Introduction: Blepharitis has multiple, poorly defined origins. The goal of this study was to investigate the bacterial flora present in patients affected with blepharitis in comparison with healthy subjects, so as to understand the role of bacterial etiologies in blepharitis., Materials and Methods: Fifty-four patients with blepharitis and 50 healthy controls participated in this study. Swabs were obtained and analyzed qualitatively and quantitatively for bacteria. A subgroup of 16 people (9 with blepharitis and 7 controls) also were investigated for Demodex., Results: The percentages of the positive cultures and the number of colonies/case were clearly higher for patients with blepharitis in comparison with healthy controls. Bacteria were isolated for 81% of cases versus 38% for controls, with a mean of 39 colonies versus 4.4 colonies for controls. Corynebacterium sp. were the most common microorganisms isolated from patients with blepharitis (53.7% for cases versus 18% for controls, P<0.01), and the bacterial load was 15 times higher (37.4 col/case versus 2.6 col/case). C. macginleyi was the most common Corynebacteria (33% versus 6%, P<0.01). S. epidermidis: 35.1% versus 16% (P=0.02) with 11.3 col/case versus 1.6 col/case. S. aureus: 13% versus 0% (P=0.01) with 24.7 col/case versus 0. We did not find a significant difference for Propionibacterium acnes: 14.8% versus 14% with 4.7 col/case versus 5.1 col/case, or for Demodex, with 22.2% versus 28.6%., Conclusion: Corynebacterium sp. and especially C. macginleyi seem to participate actively in the physiopathology of blepharitis. S. epidermidis and S. aureus also remain associated with this pathology., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Purpose: To assess the effects of preoperative patient characteristics on clinical outcomes of corneal collagen crosslinking (CXL) in patients with progressive keratoconus., Patients and Methods: Fifty-four eyes of 41 patients underwent CXL for progressive keratoconus between June 2011 and December 2012. Corneal topography (Orbscan(®)) was assessed at 1, 3, and 6 months and 1 year after CXL treatment and compared with preoperative data., Results: A significant improvement in 1-year postoperative best-corrected visual acuity (BCVA) (0.16±0.21 LogMar preoperatively versus 0.09±0.16 LogMar postoperatively, P=0.007) and in 3mm topographic central irregular astigmatism (P=0.04) was demonstrated with CXL. No significant change was noted for refractive astigmatism (P=0.69), or for 1-year postoperative Kmax (48.4 D±4.1 at baseline versus 48.5 D±4.1 postoperatively, P=0.46). Predictive factors for BVCA improvement were low preoperative BCVA, high refractive astigmatism and advanced keratoconus. Predictive factors for stability of postoperative Kmax values were early keratoconus, and central cone ("nipple" morphology of the cone mainly located in the central 3mm of the cornea)., Conclusion: This retrospective study confirms the efficacy of CXL for progressive keratoconus, from a refractive as well as topographic standpoint. While cone localization or its eccentricity seems to explain the variability of CXL efficacy reported in the literature, cone severity appears to be the main predictive factor for a lack of topographic stability after CXL treatment but must be weighted by the preferential localization of the cone (3 or 5mm central corneal zone)., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Background/aims: To evaluate and compare the effect of various modified monovision on binocular through-focus quality of vision., Methods: Simulated images were computed using a numerical eye model, with a 4.7 mm pupil diameter, for various target vergences and with various combinations of spherical (SA4) and secondary spherical (SA6) aberrations. Binocular vision was provided using a video projector synchronised with active glasses. Three subjects evaluated monocular and binocular through-focus images by scoring the displayed image with a five-item continuous grading scale. Performance was evaluated in terms of depth-of-focus and area under the through-focus subjective quality of vision curves (AUC)., Results: On average, viewing through a combination of 0.4 μm of SA4 and -0.2 μm of SA6 with one eye and through a combination of -0.4 μm of SA4 and 0.2 μm of SA6 with the other eye, improved depth-of-focus and AUC, respectively, by 193% and 71% compared with naked eyes. Binocular summation occurred when both eyes viewed comparable image quality, whereas the level of binocular inhibition increased with the interocular difference of image quality., Conclusions: Binocular performance could be optimised by choosing different multifocal profiles for each eye and by adding a defocus term between eyes., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Importance: Few data exist regarding the systemic safety of intravitreal antivascular endothelial growth factor (anti-VEGF) monoclonal antibody (mAb)., Objective: To conduct a systematic review and meta-analysis to evaluate the risk of major cardiovascular and nonocular hemorrhagic events in patients with neovascular age-related macular degeneration (AMD), diabetes mellitus-associated macular edema (DME), or retinal vein occlusions (RVOs) who receive intravitreal anti-VEGF mAbs., Data Sources: The MEDLINE and Cochrane Central databases were searched for potentially eligible studies., Study Selection: Randomized clinical trials comparing ranibizumab or bevacizumab with no anti-VEGF treatment, as well as those comparing ranibizumab with bevacizumab in patients with AMD, DME, or RVOs., Data Extraction and Synthesis: We used a fixed-effects model and report the results as odds ratios (ORs) and 95% CIs., Main Outcomes and Measures: Primary end points were major cardiovascular and nonocular hemorrhagic events. Secondary end points were all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, venous thromboembolic events (VTEs), and hypertension., Results: Twenty-one trials that evaluated 9557 patients were retrieved. Anti-VEGF mAbs did not significantly increase the risk of major cardiovascular events (OR, 1.18; 95% CI, 0.81-1.71) or nonocular hemorrhagic events (OR, 1.42; 95% CI, 0.95-2.13) in treatment groups compared with control populations. Bevacizumab did not increase the risk of major cardiovascular events (OR, 0.94; 95% CI, 0.59-1.52) or nonocular hemorrhagic events (OR, 2.56; 95% CI, 0.78-8.38) compared with ranibizumab, but significantly increased VTEs (OR, 3.45; 95% CI, 1.25-9.54). Subgroup analysis showed a significant increase of nonocular hemorrhagic events in patients with AMD in ranibizumab vs control trials (OR, 1.57; 95% CI, 1.01-2.44). Anti-VEGF mAbs did not significantly increase overall mortality, cardiovascular mortality, stroke, myocardial infarction, VTEs, or hypertension., Conclusions and Relevance: We showed that intravitreal anti-VEGF-mAbs were not associated with significant increases in major cardiovascular or nonocular hemorrhagic events, but studies and meta-analyses were not powered enough to correctly assess these risks. Increased risks of VTEs with bevacizumab and nonocular hemorrhagic events in older patients with AMD with ranibizumab should be cautiously interpreted because more safety data are needed.

In ophthalmic ultrasonography the crystalline lens is known to be the main source of phase aberration, causing a significant decrease in resolution and distortion effects on axial B-scans. This paper proposes a computationally efficient method to correct the phase aberration arising from the crystalline lens, including refraction effects using a bending ray tracing approach based on Fermat's principle. This method is used as a basis to perform eye-adapted beamforming (BF), with appropriate focusing delays for a 128-element 20-MHz linear array in both emission and reception. Implementation was achieved on an in-house developed experimental ultrasound scanning device, the ECODERM. The proposed BF was tested in vitro by imaging a wire phantom through an eye phantom consisting of a synthetic gelatin lens anatomically set up in an appropriate liquid (turpentine) to approach the in vivo velocity ratio. Both extremes of accommodation shapes of the human crystalline lens were investigated. The performance of the developed BF was evaluated in relation to that in homogeneous medium and compared to a conventional delay-and-sum (DAS) BF and a second adapted BF which was simplified to ignore the lens refraction. Global expectations provided by our method with the transducer array are reviewed by an analysis quantifying both image quality and spatial fidelity, as well as the detrimental effects of a crystalline lens in conventional reconstruction. Compared to conventional array imaging, the results indicated a two-fold improvement in the lateral resolution, greater sensitivity and a considerable reduction of spatial distortions that were sufficient to envisage reliable biometry directly in B-mode, especially phakometry.

Purpose: The purpose of this study was to compare the safety and efficacy of a new cationic emulsion (CE) with a formulation of polyvinyl alcohol and povidone (PVA-P) for the treatment of mild to moderate dry eye disease., Methods: This was a multicenter, open-label, comparative study. Patients were randomised to receive CE (Cationorm) or PVA-P (Refresh) (1:1). The following objective criteria were assessed to compare the two eye drops: tear Break-up Time (TBUT), Schirmer's test, lissamine green staining (Van Bijsterveld score), corneal fluorescein staining (Oxford scale) and oculopalpebral examination, on D7 and D28 (end of study). At these visits, ocular symptoms and safety were also assessed., Results: Seventy-nine patients were randomised: CE: 44 patients; PVA-P: 35 patients. At D28, improvement was significantly better for TBUT [CE: 1.7 ± 2.4 s; PVA-P: 0.6 ± 1.8 s; P=0.015] and for the Van Bijsterveld score [CE: -1.4 ± 1.2; PVA-P: -0.9 ± 1.2; P=0.046] in the CE group. The same applied for the palpebral erythema score (P=0.023), overall efficacy assessed by the investigators (P<0.001), and symptoms not related to eye drop instillation (P=0.021). Improvement was observed from D7. No difference was observed between the two treatments with regard to ocular safety., Conclusion: These results suggest that in patients with mild to moderate dry eye, Cationorm, in addition to its moisturizing and lubricating properties, also helps stabilize the tear film due to its oily component. This study demonstrates the benefit of this new pharmaceutical form for the treatment of mild to moderate dry eye disease., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Purpose: To assess the functional impact of the severity of dry eye on the quality of vision by measuring an Objective Scatter Index (OSI) using double pass aberrometry., Patients and Methods: Twenty-eight patients (56 eyes) with dry eye syndromes of varying severity participated in this study. A double-pass aberrometer was used to measure the dynamic changes in the OSI for 20 seconds. The mean and standard deviations of the OSI and the number of blinks occurring during the examination were compared as a function of the clinical severity of dry eye disease., Results: The mean OSI increased with the severity of dry eye syndrome with a significant difference for stages 3 (P<0.01) and 4 (P<0.001) compared to stages 1 and 2, without a significant difference based on age (P>0.8) or visual acuity (P>0.2). Standard deviation of the OSI also increased with the severity of dry eye disease, with a significant difference for stages 3 (P<0.01) and 4 (P<0.0001) compared to stages 1 and 2, with no significant increase in the number of blinks (P>0.2). The values of the OSI standard deviation represented the dynamic nature of aberrometric changes related to the instability of the tear film., Conclusion: Quality of vision of patients deteriorated in relation to the severity of their dry eye. The analysis of OSI standard deviation appears to be an objective way to assess the intensity of subjective visual disturbances reported by patients with dry eye syndrome. It also provides a new tool to assess the severity of damage to the ocular surface., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Introduction: Retinal artery occlusions (RAO) are severe conditions threatening vision, affecting the subsequent mortality of these patients., Patients and Methods: We retrospectively reviewed the work-up performed in all patients diagnosed with retinal artery occlusions evaluated in two university hospitals in France (Tours and Angers)., Results: A total of 131 patients (131 eyes) with RAO were included, with a mean age of 69.5years and male predominance (64 %). Central retinal artery occlusion (CRAO) resulted in poor initial visual acuity (90 % less than count fingers), whereas those with branch retinal artery occlusion (BRAO) had better visual acuity (63.6 % better than 20/40). Systemic arterial hypertension (HTN) was the most common associated risk factor. Carotid stenosis was found in 50 % of cases, leading to endarterectomy in nine patients (6.9 %), while an underlying cardiac cause was implicated in 14 % of cases. Giant cell arteritis was diagnosed in five patients (3.8 %)., Discussion: Work-up of RAO may detect treatable cardiovascular and systemic conditions, allowing prevention of further ocular recurrence or stroke., Conclusion: Etiologic work-up of retinal arterial occlusion can diagnose potentially treatable underlying systemic conditions, such as giant cell arteritis, cardiac conditions and extracranial cerebrovascular disease. Giant cell arteritis has to be ruled out at the acute phase, while the role and timing of semi-urgent testing (supra-aortic Doppler echography, echocardiography, electrocardiography, lab work-up) or delayed testing (transesophageal echocardiography, brain imaging) have yet to be determined., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Introduction: The purpose of this study was to describe the diagnostic strategy and therapeutic approach when sarcoidosis of the visual pathways is suspected, by way of a descriptive study of sarcoidosis patients in the ophthalmology services in Tours, Rennes and Angers., Patients and Methods: A multicenter, retrospective chart review was performed for 30 patients diagnosed with sarcoidosis and followed at the university hospitals of Tours, Rennes and Angers between January 1997 and August 2011. The diagnosis of sarcoidosis was based on a combination of clinical and ancillary tests, including pathologic confirmation and/or hyperlymphocytosis with a CD4/CD8 ratio greater than 5 on bronchoalveolar lavage., Results: We identified 30 patients with ocular and/or neuro-ophthalmic sarcoidosis (25 female [83%], five male [17%], median age 48 years (36-87). Histologic confirmation of epithelioid granuloma was obtained in 24 (80%) of the 30 included patients. Sarcoid uveitis was present in 83% of patients; neurosarcoidosis was found in 37% of patients. Additional complaints at presentation included dyspnea (31%), arthralgia (41%), myalgia (24%) and paresthesia (27%). Bilateral ocular involvement was found in 89% of cases. In 83% of patients, there was an active anterior uveitis on slit lamp examination at initial presentation. Funduscopic abnormalities included vitritis in 67%, snowbanking in 13%, snowballs in 27% and disc edema in 30%. Eight patients (27%) had retinal vasculitis and nine patients (30%) were diagnosed with multifocal choroiditis on angiography. An elevated angiotensin-converting enzyme was present in 13 (52%) of 25 patients tested, with an average of 71 (range 36-241). Evidence of sarcoidosis was present on chest CT in 22 (79%) of 28 patients. Neuroimaging abnormalities on brain MRI were found in eight of ten tested patients. The 10 IU tuberculin skin test was negative in all tested patients (12). Median lymphocytosis in the bronchoalveolar lavage fluid (BALF) was 0.3 (0.2-0.7) in the 15 tested patients. BALF CD4/CD8 ratio was positive in all tested patients (12). Oral corticosteroids were initiated at 1mg/kg per day and then tapered in 20 (67%) of 30 patients. Median duration of steroid treatment was 12 months (5-127), resulting in rapid improvement in 84% of cases. However, nearly half of patients experienced a recurrence of the disease., Conclusion: Positive diagnosis of sarcoidosis requires a careful history and clinical examination, ancillary testing, and collaboration among several medical specialties. Normal angiotensin-converting enzyme levels do not rule out the diagnosis, since in our series, they were normal in almost half the cases. The tests with highest sensitivity included: a negative tuberculin skin test (100%), an elevated CD4/CD8 ratio in the BALF (100%), radiographic evidence of sarcoidosis on chest CT (79%) and brain MRI (80%). Other factors contributing to the diagnosis were: female gender (83%), age over 40 (67%), arthralgia (41%), asthenia (50%), vitritis (67%) and multifocal choroiditis (30%). In our study, treatment with corticosteroids resulted in significant improvement in over 80% of patients., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Introduction: One of the remaining challenges in cataract surgery is to compensate for lost accommodative function. The purpose of our study is to evaluate reading ability with a combination of two different aspheric intraocular lenses., Patients and Methods: This retrospective study included 40 eyes (20 patients). The control group (28 eyes, 14 patients) received two negative aspheric intraocular lenses (Acrismart 36A(®), Carl Zeiss Meditec), while the aspheric-optimized group (12 eyes, six patients) received an AcriSmart 36A(®) in the dominant eye and a zero-aspheric intraocular lens (Acrismart 46 LC(®), Carl Zeiss Meditec) in the fellow eye. Patients with corneal asphericity between 0.15 and 0.30 μm and a bilateral monocular postoperative visual acuity of at least 20/20 were eligible for inclusion. Uncorrected and best corrected visual acuity was measured for near, intermediate and distance vision. Corneal and total higher-order aberrations, monocular and binocular defocus curve, and stereoscopic performance were assessed., Results: Postoperative spherical equivalent and best corrected distance visual acuity were not significantly different between the two groups (P=0.11 and P=0.82 respectively). However, the aspheric-optimized group (36A(®)/46 LC(®)) exhibited better near and intermediate visual acuity (P<0.05), and better stereoscopic vision (P=0.027)., Discussion: The depth of field results in pseudophakes implanted with "mix-and-match" aspheric lenses demonstrates that the binocular combination of two different aspheric profiles seems to improve near vision without affecting stereoscopic vision., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Purpose: To study efficacy and predictability of toric IOL implantation for correction of preoperative corneal astigmatism by analysing spherocylindrical refractive precision and objective quality of vision., Patients and Methods: Prospective study of 13 eyes undergoing micro-incisional cataract surgery through a 1.8mm corneal incision with toric IOL implantation (Lentis L313T(®), Oculentis) to treat over one D of preoperative corneal astigmatism. Preoperative evaluation included keratometry, subjective refraction, and total and corneal aberrometry (KR-1(®), Topcon). Six months postoperatively, measurements included slit lamp photography, documenting IOL rotation, tilt or decentration, uncorrected visual acuity, best-corrected visual acuity and objective quality of vision measurement (OQAS(®) Visiometrics, Spain)., Results: Postoperatively, mean uncorrected distance visual acuity was 8.33/10 ± 1.91 (0.09 ± 0.11 LogMar). Mean postoperative refractive sphere was 0.13 ± 0.73 diopters. Mean refractive astigmatism was -0.66 ± 0.56 diopters with corneal astigmatism of 2.17 ± 0.68 diopters. Mean IOL rotation was 4.4° ± 3.6° (range 0° to 10°)., Discussion: Mean rotation of this IOL at 6 months was less than 5°, demonstrating stability of the optic within the capsular bag. Objective quality of vision measurements were consistent with subjective uncorrected visual acuity., Conclusion: Implantation of the L313T(®) IOL is safe and effective for correction of corneal astigmatism in 1.8mm micro-incisional cataract surgery., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Purpose: To compare a treatment containing carboxymethylcellulose (CMC) and the osmoprotective (OsPr) compatible osmolytes erythritol, L-carnitine, and glycerin (OsPr-CMC) with a standard sodium hyaluronate (Na-HY) formulation in patients with dry eye disease., Methods: This was a 3-month, phase III, noninferiority study. Patients were randomized 1:1 to receive OsPr-CMC (OPTIVE®) or Na-HY (VISMED®). The primary efficacy outcome was the mean change from baseline in total ocular staining at day 35, scored using the 15-point Oxford scale. Noninferiority was assessed using the adjusted means. The secondary efficacy outcome was change in ocular surface disease index (OSDI) score from baseline to day 35. Other outcomes included tear osmolarity, Schirmer-I test score, OSDI, ease of use, patient acceptability, tolerability, and safety., Results: A total of 82 patients were randomized. The primary efficacy analysis was per protocol (OsPr-CMC, n=37; Na-HY, n=29). OsPr-CMC was noninferior to Na-HY in terms of adjusted mean change (SE) in ocular staining score at day 35: -2.0 (0.33) with OsPr-CMC vs -1.7 (0.37) with Na-HY. Similar improvements were seen in tear osmolarity, Schirmer-I test score, OSDI, and ocular staining for OsPr-CMC and Na-HY. More patients treated with OsPr-CMC vs Na-HY liked using their eyedrops, reported that their eyes felt comfortable, and found the treatment easy to use. Both treatments were well tolerated, with no serious treatment-related adverse events., Conclusions: Compared with Na-HY, OsPr-CMC was noninferior in terms of efficacy and safety, preferred by patients, and easier to use. Osmoprotection using OsPr-CMC therefore represents a viable option for dry eye disease management.

Purpose: To assess the impact of wavefront ocular aberrations on objective vision quality and depth of focus in pseudophakic patients., Setting: University Hospital Bretonneau of Tours, Francois Rabelais Medicine Faculty of Tours, France., Design: Cohort study., Methods: Consecutive eyes having implantation of an aspheric monofocal intraocular lens (IOL) (Acri.Smart) were studied. Aberrometry measurements were performed under mesopic conditions with a 6.0 mm pupil using a Wavescan aberrometer. Objective evaluation of optical vision quality was performed using the Optical Quality Analysis System II. The 3 measurements were the modulation transfer function values (MTF cutoff); objective depth of focus, which was computed as the focus range at which Strehl ratio did not fall below 50% of the maximum; and the objective scatter index., Results: Fifty-four eyes (30 patients) were enrolled. Six months postoperatively, MTF cutoff values were increased with decreasing total ocular spherical aberration, ocular trefoil, and 2nd-order astigmatism (P<.05). Objective depth of focus was positively correlated with 2nd-order astigmatism (r(2) = 0.171, P<.001) and total spherical aberration (r(2) = 0.091, P=.028). Objective scatter was more beneficial for depth of focus, with a significantly positive correlation with this parameter (r(2) = 0.28, P=.002), than compromising of optical quality (no significant correlation with MTF measurements in same multiple regression analysis)., Conclusion: Three ocular aberrations (2nd-order astigmatism, trefoil, spherical aberration) seemed to interact with objective contrast sensitivity and depth of focus, whereas residual spherical aberration exerted opposite effects on image quality in individual patients., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Residual astigmatism after cataract surgery can be corrected by three different techniques: classic limbal relaxing incisions, easy to perform but with limited precision; laser refractive surgery (PRK or Lasik), additionally allowing for correction of spherical equivalent; and more recently the use of a piggyback toric intraocular lens in the ciliary sulcus., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Purpose: To assess the relationship and respective contribution of ocular higher-order aberrations (HOAs) on residual accommodative performance in presbyopic patients., Patients and Methods: We enrolled 20 patients (40 eyes) without ophthalmological pathology, between 48 and 58 years old, with a best-corrected visual acuity more than 10/10. Total aberrations were computed using the Wavescan Aberrometer (AMO, USA). The defocus curve and near visual acuity (30 and 50 cm) were measured. The relationship between accommodation ability and HOAs was evaluated aiming at a linear relationship with a simple regression analysis and with a multiple linear regression analysis (including manifest refraction, ocular aberrations, and age)., Results: Even if age and manifest refraction were correlated with accommodative ability, ocular coma seemed to be correlated with near visual acuity without addition and with minimal addition for reading P1.5 at 30 cm (respectively, r(2)=0.117 with P=0.035 and r(2)=0.163 with P=0.012). Total spherical aberration appeared to be correlated with minimal addition (r(2)=0.12 with P=0.032)., Discussion: Ocular aberrations (coma and spherical aberration) are correlated with accommodative performance in presbyopic patients, independently of age and manifest refraction., Conclusion: Ocular aberrations appeared to be a stimulus for accommodation but may also influence quality of accommodative reply., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Purpose: To determine whether oral supplementation with omega-3 and omega-6 fatty acids can reduce conjunctival epithelium expression of the inflammatory marker human leucocyte antigen-DR (HLA-DR) in patients with dry eye syndrome (DES)., Methods: This 3-month, double-masked, parallel-group, controlled study was conducted in nine centres, in France and Italy. Eligible adult patients with mild to moderate DES were randomized to receive a placebo containing medium-chain triglycerides or treatment supplement containing omega-3 and omega-6 fatty acids, vitamins and zinc. Treatment regimen was three capsules daily. Impression cytology (IC) was performed at baseline and at month 3 to assess the percentage of cells expressing HLA-DR and to evaluate fluorescence intensity, an alternate measure of HLA-DR. Dry eye symptoms and objective signs were also evaluated. Analyses were performed on the full analysis set (FAS) and per-protocol set (PPS)., Results: In total, 138 patients were randomized; 121 patients with available IC were included in the FAS, and of these, 106 patients had no major protocol deviations (PPS). In the PPS, there was a significant reduction in the percentage of HLA-DR-positive cells in the fatty acids group (p = 0.021). Expression of HLA-DR as measured by fluorescence intensity quantification was also significantly reduced in the fatty acids group [FAS (p = 0.041); PPS (p = 0.017)]. No significant difference was found for the signs and symptoms, but there was a tendency for improvement in patients receiving the fatty acids treatment., Conclusion: This study demonstrates that supplementation with omega-3 and omega-6 fatty acids can reduce expression of HLA-DR conjunctival inflammatory marker and may help improve DES symptoms., (© 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.)

Introduction: Inflammation is one of the main mechanisms common to all forms of dry eye. Since polyunsaturated acids are known to show biological anti-inflammatory properties, the aim of this study was to evaluate the efficacy of dietary n-6 and n-3 fatty acids in patients suffering from ocular dryness., Patients and Methods: One hundred and eighty-one patients diagnosed with bilateral moderate dry eye who were already treated with lachrymal substitutes were randomized in a double-blind international study to receive placebo or Nutrilarm(®) capsules (combination of omega-3 and omega-6), twice a day for 6 months. In all subjects, dryness feeling, overall subjective comfort, and ocular symptoms (burning, stinging, sandy and/or gritty sensation, light sensitivity, reflex tearing, and ocular fatigue) were evaluated at each visit. Furthermore, fluorescein tests (break-uptime and Oxford scheme) and lissamine green test were performed at each visit. The Schirmer test was performed at inclusion and after 6 months of treatment., Results: After 6 months of supplementation with Nutrilarm(®), both the BUT scores and ocular fatigue were significantly improved when compared with placebo (P=0.036 and P=0.044, respectively). There was a trend in favor of Nutrilarm(®) in terms of the efficacy evaluated by the investigator (P=0.061). Fewer patients experienced a feeling of severe dryness with Nutrilarm(®) compared with placebo after 6 months of treatment (2.5 and 9.3%, respectively), but the difference was not statistically significant., Conclusion: Oral administration of a double supplementation dietary n-6 and n-3 fatty acids present an additional therapeutic advantage in patients suffering from ocular dryness who were already treated with lachrymal substitutes., (Copyright © 2011. Published by Elsevier Masson SAS.)

Purpose: To determine the level of residual spherical aberration that gives the best objective and subjective quality of image after cataract surgery with intraocular lens (IOL) implantation., Setting: Department of Ophthalmology, CHU Bretonneau, Tours, France., Design: Cohort study., Methods: Six months after microincision (1.8 mm) cataract surgery with aspheric IOL implantation, total aberrations were computed using a Wavescan aberrometer. The modulation transfer function (MTF), Strehl ratio, and objective index of scattering were measured using the Objective Quality Analysis System. Objective depth of focus was computed as the focus range at which the Strehl ratio did not fall below 50% of maximum. Subjective depth of focus was calculated as the difference between the vergence of the punctum remotum and that of the punctum proximum., Results: Thirty patients (54 eyes) were evaluated. The MTF cutoff values were higher with decreasing total ocular spherical aberration (r = 0.56; P < .05). Objective and subjective depth of focus were positively correlated with total spherical aberration (r = 0.26 and r = 0.46, respectively; P < .05)., Conclusions: A final spherical aberration of zero obtained by compensation of IOL asphericity gave the greatest improvement in objective quality of vision and better MTF contrast. However, a final target ocular spherical aberration between 0.07 μm and 0.10 μm should be considered to be the best compromise between subjective depth of focus and objective contrast sensitivity., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Aims: To compare the quality of vision of patients with customised aspheric intraocular lenses (IOL) versus patients implanted with zero-aberration IOL after a 1.8 mm micro-incision cataract surgery (MICS)., Methods: Fourty-three eyes were divided into two groups: 17 eyes (reference group) received zero aberration Acri.Smart 46LC and 26 eyes received a customised-aspheric IOL: either aspherical Acri.Smart 36A, generating a -0.18 microm SA compensation equivalent, or zero-aberration Acri.Smart 46LC. IOL asphericity was individually selected according to the corneal spherical aberration (SA) in order to produce a residual ocular SA close to +0.10 microm. Refraction, best-corrected visual acuity (BCVA), contrast sensitivities, ocular wavefront aberrations and objective quality of vision assessment were analysed 6 months after MICS., Results: Postoperative BCVA was similar in both groups (p=0.58). Mesopic contrast sensitivities were significantly better in the custom group at intermediate and high spatial frequencies (p<0.001), while photopic contrast sensitivities were similar. Total SA was significantly lower in the custom group (Z(4)(0)=0.085+/-0.075 vs 0.261+/-0.091 microm, p<0.001), whereas no difference was found in preoperative corneal SA. Modulation transfer function cut-off frequency was higher in the custom group than in the reference group (34.3+/-8.1 vs 23.57+/-8.6 cycles per degree, respectively; p=0.008)., Conclusion: Individual selection of IOL asphericity with a preoperative corneal SA measurement allowed control of final ocular SA. Such customisation improves mesopic contrast sensitivity, and leads to better objective quality of vision.

Background: Few biological data on human eyelash follicles have been reported in the literature., Objectives: To characterize eyelash follicle growth, cycle and morphology, and further investigate the biological mechanisms that determine eyelash length, curl and pigmentation, compared with scalp hair follicle., Methods: Twenty-nine caucasian female volunteers aged between 26 and 60 years were enrolled in the study to provide eyelashes. Four of these volunteers were followed weekly for 9 months to characterize their eyelash cycle. Eyelash length and time of renewal were measured using a high-resolution camera and image analysis. Immunohistological study of the bulbs were performed on eyelid biopsies from 17 patients requiring block excision for ectropion repair., Results: The calculated durations of anagen phase and complete cycle of the eyelashes were 34 + or - 9 and 90 + or - 5 days, respectively. Eyelash follicle growth rate was quite variable, with an average rate of 0.12 + or - 0.05 mm daily. Eyelash follicle morphology was very close to that of the scalp hair follicle, but some remarkable differences were noticed. For example, the K19-positive epithelial stem cell population was spread all along the follicle and not split into two reservoirs as seen in scalp hair follicles. Some asymmetry was detected in HSPG and CSPG, as well as K38 (formerly Ha8) and K82 (formerly Hb2) distribution, similar to that observed in curly hair. Finally, dopachrome tautomerase was found expressed in eyelash follicle melanocytes, while it was strikingly absent in scalp hair follicle melanocytes., Conclusions: The eyelash is structurally very close to curly hair but some biological processes related to follicle cycle and pigmentation differ markedly.

Purpose: To assess the impact of spherical aberration (SA) on clinical ocular performance and the objective quality of vision in pseudophakic patients., Methods: Twenty-five consecutive eyes were divided into two groups: 13 eyes received an aspherical AcriSmart 36A intraocular lens (IOL) (Carl Zeiss Meditec, USA) generating a negative SA and 12 eyes received a zero-aberration AcriSmart 46 LC IOL (Carl Zeiss Meditec, USA). Postoperative evaluations were conducted 6 months after 1.8-mm microincision cataract surgery and included wavefront aberration analysis (Wavescan, AMO, USA) and objective quality of vision (Objective Quality Analysis System, Visiometrics, Spain)., Results: Best corrected visual acuity (BCVA) was not different in the two groups (p=0.89). Total spherical aberration was significantly less with the 36A IOL (0.075 +/- 0.05 microm versus 0.20 +/- 0.05 microm; p=0.0002). The 36A IOL induced better objective image quality with an average MTF of 32.7+/-9.6 c/deg versus 23.8+/-8.1 c/deg with the 46LC, p=0.0002. The 36A IOL group had 1 D less depth of focus than the 46LC IOL group: 1.3+/-0.59 and 2.27+/-0.63 D, respectively. For the whole population, the depth of focus appeared to be correlated with SA (r(2)=0.40, p=0.002) and with trefoil (r(2)=0.53, p=0.001)., Conclusion: Aspheric IOLs objectively improved the quality of vision with greater MTF values. Reduction of aberrations may be also be responsible for reduced depth of focus with the 36A IOLs. However, residual trefoil aberrations may be advantageous for depth of focus., (Copyright (c) 2009 Elsevier Masson SAS. All rights reserved.)

Purpose: To identify color Doppler imaging (CDI) parameters and other prognostic factors of a conversion from nonischemic to ischemic retinal vein occlusion (RVO) in a large population with a long follow-up., Methods: This was a retrospective observational study. Data were collected for patients who had been admitted to the ophthalmologic department of the Hospital of Tours because of nonischemic central RVO (CRVO) or branch RVO (BRVO). We analyzed the relation between time until conversion into ischemic RVO and several prognostic factors of conversion, mainly vein velocities as measured by CDI., Results: Analyses involved 162 patients. One year after inclusion, conversion into ischemic RVO occurred in 25.0% of the 113 CRVO and in 28.6% of the 49 BRVO cases. For CRVO, an increase of the minimal central retinal venous velocity (CRV), measured by CDI before and after treatment by hemodilution, diminished the risk of conversion into an ischemic form (p=0.048). For BRVO, an elevated maximal CRV on diagnosis was a protector (p=0.004). Age was associated with a high risk of ischemic evolution for CRVO (p=0.023) but not BRVO. Initial visual acuity was not associated with the conversion, for BRVO or CRVO. Increased retinal hemorrhages highly increased the risk of conversion both for CRVO (p<0.0001) and BRVO (p=0.010)., Conclusions: Risk of ischemic evolution for BRVO and CRVO treated by isovolemic hemodilution was associated with central venous velocities. CDI might be useful for identifying risk of ischemic conversion and individualizing the follow-up of patients.

Objective: To evaluate the effects of topical cyclosporin A on severe and corticodependent chronic ocular surface disorders (OSD), in immune inflammatory disease., Design: Experimental study, Centre hospitalier universitaire (CHU) Bretonneau, Tours, France., Participants: Twenty-one patients diagnosed with dry eye syndrome secondary to vernal keratoconjunctivitis (7 cases), atopic keratoconjunctivitis (8 cases), and ocular rosacea (6 cases) were treated twice a day with a 0.05% cyclosporin ophthalmic emulsion., Methods: Corneal and conjunctival staining, Oxford score, and symptoms severity assessment (OSDI score) were conducted from the beginning of the cyclosporin treatment up to the end of study. Other collected data included visual acuity, intraocular pressure measurements, an adverse effects questionnaire, and evaluation of the use of adjunctive corticosteroids therapy., Results: Topical cyclosporin 0.05% gave significant long-term improvement of visual acuity (p = 0.018), symptoms severity (OSDI score, p = 0.001), corneal and conjunctival staining (van Bijesterveld score, p = 0.0003), and Oxford score (p = 0.0002). Topical cyclosporin allowed for less corticosteroid treatment in all cases (p = 0.04), and broke it off with no long-term recurrence in 15 cases (71%). No severe adverse effect occurred, but 3 patients (14%) stopped cyclosporin treatment because of increasing ocular symptoms., Conclusion: Given our results, topical cyclosporin represents a new well-tolerated treatment for severe and corticodependent chronic ocular surface disorders. In monotherapy or in association with a corticotherapy, topical cyclosporin could be efficient in any OSD involving immune-based inflammation.

Purpose: To compare the quality of vision with an aspheric intraocular lens (IOL) with no aberration and an IOL with negative spherical aberration., Setting: Bretonneau University Hospital, Tours, France., Methods: Patients scheduled for cataract surgery were randomly chosen to bilaterally receive a SofPort Advanced Optics IOL with no aberration (no-aberration IOL group) or a Tecnis Z9000 IOL with negative spherical aberration (negative-aberration IOL group). Six-month postoperative outcomes included patient-centered visual disability assessed with the Activities of Daily Vision Scale (ADVS), contrast sensitivity testing, and wavefront aberration analysis., Results: There was no difference in the overall ADVS score between the 2 groups (P = 0.07); however, the negative-aberration IOL group had a better night-driving score (mean 82.7 +/- 15.1 [SD] versus 66.4 +/- 7.6) (P<.001) and the no-aberration IOL group had a better corrected near-vision score (mean 96.5 +/- 6.2 versus 86.2 +/- 13.2) (P<.001). Mesopic contrast sensitivity was significantly better in the negative-aberration IOL group at intermediate and high frequencies; the no-aberration IOL group performed better under photopic conditions at intermediate frequencies. There was significantly higher spherical aberration (mean 0.11 +/- 0.05 microm versus 0.01 +/- 0.06 microm; P = .001) and lower 3rd-order coma (mean 0.09 +/- 0.06 microm versus 0.15 +/- 0.06 microm; P<.001) in the no-aberration IOL group than in the negative-aberration IOL group, which had better MTF., Conclusions: Bilateral implantation of an IOL with no aberration resulted in better quality of near vision. A negative spherical aberration IOL provided better night-driving vision and improvements in mesopic contrast sensitivity and MTF.

Purpose: Autosomal dominant optic atrophy (ADOA, OMIM 165500), an inherited optic neuropathy that leads to retinal ganglion cell degeneration and reduced visual acuity during the early decades of life, is mainly associated with mutations in the OPA1 gene. Here we report a novel ADOA phenotype associated with a new pathogenic OPA1 gene mutation., Methods: The patient, a 62-year-old woman, was referred for acute, painless, and severe visual loss in her right eye. Acute visual loss in her left eye occurred a year after initial presentation. MRI confirmed the diagnosis of isolated atrophic bilateral optic neuropathy. We performed DNA sequencing of the entire coding sequence and the exon/intron junctions of the OPA1 gene, and we searched for the mitochondrial DNA mutations responsible for Leber hereditary optic atrophy by sequencing entirely mitochondrial DNA. Mitochondrial respiratory chain complex activity and mitochondrial morphology were investigated in skin fibroblasts from the patient and controls., Results: We identified a novel heterozygous missense mutation (c.2794C>T) in exon 27 of the OPA1 gene, resulting in an amino acid change (p.R932C) in the protein. This mutation, which affects a highly conserved amino acids, has not been previously reported, and was absent in 400 control chromosomes. Mitochondrial DNA sequence analysis did not reveal any mutation associated with Leber hereditary optic neuropathy or any pathogenic mutations. The investigation of skin fibroblasts from the patient revealed a coupling defect of oxidative phosphorylation and a larger proportion of short mitochondria than in controls., Conclusions: The presence of an OPA1 mutation indicates that this sporadic, late-onset acute case of optic neuropathy is related to ADOA and to a mitochondrial energetic defect. This suggests that the mutational screening of the OPA1 gene would be justified in atypical cases of optic nerve atrophy with no evident cause.

Purpose: To evaluate the safety and explore the efficacy of intravitreal injection of ranibizumab 0.5mg in treatment of large peripapillary choroidal neovascularization., Methods: This single-center, prospective, interventional, noncomparative, nonrandomized clinical case series study included six consecutive patients with large or recurrent peripapillary choroidal neovascularization. Ranibizumab 0.5mg was administered at baseline, and then monthly following the development of hemorrhage or subretinal fluid associated with visual symptoms. The response to treatment was assessed in terms of changes in lesion characteristics as measured by FA and change in visual acuity (VA)., Results: Six patients (seven eyes with peripapillary choroidal neovascularization) were enrolled. three of the seven eyes had choroidal neovascularization associated with angioid streaks, two had idiopathic neovascularization, and the last eye had peripapillary neovascular membrane associated with age-related macular degeneration. The median follow-up was 12 months (+/-3 months). At 1 year, the best-corrected visual acuity improved from +0.74 log Mar to +0.45 log Mar (p=0.0431), with resolution of intraretinal fluid. On average, four intravitreal injections of ranibizumab (0.5mg) were required during this year., Discussion: Laser photocoagulation treatment, photodynamic therapy, or subretinal surgery are limited by the high recurrence rate, the difficulty in assessing the true extent of the lesion, and the difficulty in improving visual function., Conclusion: Intravitreal ranibizumab injections appeared to be a good therapeutic option for patients with peripapillary CNV in the short term. Long-term follow-up of these patients will aid in assessing the sustained effect of the drug.

Aim: To compare the optical outcomes of biaxial microincision cataract surgery (B-MICS) versus coaxial small-incision cataract surgery (C-SICS)., Methods: Thirty patients (sixty eyes) with bilateral age-related cataract underwent B-MICS through a 1.7 mm clear corneal incision (CCI) in one eye and C-SICS through a 2.8-mm CCI in the other eye. Every eye was implanted with a micro-incision aspheric aberration-free intraocular lens (Akreos MI60 AO). Preoperative corneal aberrations, and 3-month postoperative corneal and total ocular aberrations were calculated and compared., Results: The 3-month postoperative corneal root mean square (RMS) of third- to sixth-order aberrations (p<0.001), third-order trefoil (p = 0.001), trefoil-like (p<0.001), and third-order RMS (p<0.001) were lower in the B-MICS group than in the C-SICS group. Surgically induced corneal trefoil was reduced in B-MICS eyes (p = 0.001). The total ocular high-order RMS (p = 0.002), third-trefoil (p<0.001), trefoil-like (p<0.001) and fifth-order RMS (p<0.001) were lower in B-MICS than in C-SICS eyes. Corneal aberrations were positively correlated with ocular aberrations for the RMS of third- to sixth-order aberrations, third-trefoil and spherical-like aberrations. Visual acuity, refraction and corneal astigmatism were not different between both groups., Conclusion: Compared with conventional surgery, B-MICS could improve the optical performances of the pseudophakic eye reducing surgically induced corneal higher-order aberrations.

We report the case of a 9-year-old girl with a long-chain 3-hydroxyacyl CoA dehydrogenase (LCHAD) deficiency. This enzyme participates in mitochondrial fatty acid B-oxidation. Genetic fatty acid oxidation defects induce cellular energetic deficiency, and thus early life-threatening manifestations. An appropriate diet prevents these severe disorders. Nevertheless, LCHAD deficiency is the only B-oxidation enzymatic disorder that induces a chorioretinopathy, predominating at the posterior pole. We describe the first case of bilateral macular choroidal neovascularization. One eye presented a fibrovascular lesion. The other eye presented an active neovascularization stabilized by two dynamic phototherapies. The specificity of choroidal degeneration related to LCHAD deficiency remains unknown. Reviewing of literature and biochemical mechanisms suggests that fatty acid oxidative stress rather than a mitochondrial energetic defect is involved. For practical purposes, this report emphasizes the importance of ophthalmological follow-up of these patients.

Aim: To evaluate very-high-frequency (VHF) ultrasound imaging as a new method to detect and quantify early corneal epithelium changes induced by chronic exposure to a benzalkonium-chloride-containing antiglaucoma drug., Methods: Timolol preserved with 0.01% benzalkonium chloride solution was applied b.i.d. in 1 eye of 10 rabbits for 56 days. Unpreserved timolol solution was used as control. Ocular surface changes were assessed weekly combining clinical examinations, in vivo 60-MHz ultrasound imaging and ex vivo histological analysis., Results: VHF ultrasound imaging allowed quantitative measurement of corneal epithelium thickness and qualitative imaging of toxic epithelial damage. It revealed significantly decreased epithelial thickness in vivo as early as the 21st day of treatment (40.75 +/- 1.72 microm at D0 vs. 39 +/- 2 at D21, vs. 31.9 +/- 2.98 at D56; p = 0.017 and p = 0.005, respectively). The first clinical changes appeared from the 42nd day of treatment (conjunctival redness, conjunctival staining and corneal staining; D56 compared to D0: p = 0.005, 0.01 and 0.004, respectively) and then correlated with VHF ultrasound data. Epithelial thickness measured with VHF ultrasound was correlated with histological epithelial pachymetry (p < 0.001) and with the corneal damage score assessed with scanning electron microscopy (p = 0.038)., Conclusion: VHF ultrasound imaging provided an early in vivo diagnosis of corneal epithelium pathology induced by chronic exposure to a preserved glaucoma drug, before the first clinical evidence of ocular toxicity. It could be a new reproducible method to detect the toxicity of glaucoma medication so that therapy can then be adapted., (Copyright 2008 S. Karger AG, Basel.)

In this paper, we report a case of a post-traumatic Scedosporium endophthalmitis treated with a posterior vitrectomy, followed by intravitreal injections and systemic voriconazole. This is the second documented case of S. apiospermum endophthalmitis treated with voriconazole and the first case with intravitreal injections of voriconazole. A 29-year-old man developed endophthalmitis after being struck in the left eye by a chip from a swimming pool pump. Despite 3 weeks of prophylactic antibiotherapy, his visual acuity remained only for the perception of light and vitreous inflammation increased. A creamy-white fungal mass grew at the inferior peripheral retina and pars plana. The fungus was identified as S. apiospermum. Oral voriconazole, at 200 mg twice-daily, did not bring the infection under control, considering the low plasma and intravitreal concentrations. Before steady-state plasma voriconazole concentrations reached an efficacy level greater than minimum inhibitory concentration of Scedosporium, intravitreal injections of 64 ug/0.1 mL of voriconazole were initiated twice-weekly for 3 weeks. Administration of higher intravenous voriconazole doses (6 mg/kg b.i.d.) for 6 weeks was needed to achieve an antifungal effect without systemic dissemination.

Introduction: Children's refraction can usually be measured using cyclopentolate 0.5%. Instilling three drops is time-consuming and inconvenient to both the clinical staff and the child. To remedy this situation, we investigated the refractive results of instilling two drops of cyclopentolate 0.5% at a 10-min interval compared with three drops at a 5-min interval in a group of a Caucasian nonstrabismic children. The kinetics of refraction in this population was also assessed., Patients and Methods: We conducted a randomized cross-over study on 36 children aged between 4 and 13 years from March 1st to August 1st, 2003 at the University of Tours School of Ophthalmology. In protocol I, two cyclopentolate eyedrops were instilled in both eyes at a 10-min interval. In protocol II, three eyedrops were instilled at a 5-min interval. The refractive results were evaluated in terms of sphere and cylinder strength and axis. We used an auto-kerato-refractometer every 15 min from the first instillation for both protocols until the 90th min., Results: Before the first drop instillation, there was no significant influence on skiascopy results for both eyes (-0.30+/-0.20 D for the right eye; -0.37+/-0.24 D for the left eye). The strength and the axis of the cylinder were comparable and stable (-0.5+/-0.18 D for strength; 5 degrees +/-22 for the axis) for all protocols and subjects tested. Sphere variation reached +1+/-0.6 D between t0 and t30 min for both protocols and remained stable between t30 and t90 min (+0.01+/-0.2 D)., Conclusion: Instilling two eyedrops of cyclopentolate 0.5% at a 10-min interval in Caucasian nonstrabismic children aged 4-13 years is as effective as instilling three eyedrops at a 5-min interval in terms of kinetics and depth of cycloplegia. In addition, skiascopy can be performed as early as 30 min after the first instillation and until the 90th minute with the same effectiveness. The stability of astigmatism should be underlined in this population. Since these refractive results cannot be extrapolated for strabismic and ametropic children, we recommend, especially for the latter, instilling three drops for the first exam and only two thereafter, depending on the results.

The authors analyzed the post operative results of the penetrating keratoplasty after removal suture in Ophthalmology Service of University and Hospital's Center in Tours. The age of patients varied 20 to 90 years with an average of 56,83 years. 41,71% of patients had a pseudophakic or aphakic bullous keratopathy. Ocular hypertony was the most frequently post operative complication (63,67%). Final removal's suture improved the transparency of grafts and so the visual acuity in spite of greater endothelial cell loss (65,65%) and residual corneal oedema.

Background: Congenital nasolacrimal duct obstruction affects more than 6% of newborns. Whereas some recommend nasolacrimal probing under general anesthesia from 1 year of age when the condition does not spontaneously resolve, some decide in favor of early probing from 4 to 6 months of age with topical anesthesia. We present nasolacrimal probing with inhalation of MEOPA, an equimolar mixture of nitrous oxide and oxygen, as a therapeutic alternative., Patients and Methods: We conducted a descriptive, prospective study including 63 children (75 eyes) who had nasolacrimal duct probing with inhalation of MEOPA between March 2005 and March 2006, in consultation. Efficacy was estimated by the observation of medical staff and parents and by the feasibility of the probing procedure., Results: Children were 4-28 months old (mean age, 11.5 months). Symptoms resolved spontaneously in 79% of cases after only one probing. No incident was observed. In case of failure, probing with nasolacrimal intubation with nasal endoscopy and general anesthesia was done (21% of cases, mean age, 17.5 months)., Discussion: Administration of MEOPA, by inhalation with a facial mask, is already used for minor pediatric surgical procedures. It is simple to use, fast, low-risk, inexpensive, and effective., Conclusion: Use of MEOPA in nasolacrimal duct probing in children could be a good alternative, making it possible to alleviate pain in the youngest children and general anesthesia in the oldest.

Purpose: To assess the quality of vision in pseudophakic patients with aspheric intraocular lens (IOL) without spherical aberration compared to patients with spherical IOL., Methods: Twenty-four patients (48 eyes) undergoing cataract surgery were randomly divided into two groups: 12 patients received an aspheric IOL in both eyes and 12 received spherical IOLs. The integrity of ocular functions was assessed with clinical examination and multifocal electroretinogram. Postoperative evaluations were conducted 3 months after surgery. Refraction, best-corrected visual acuity, contrast sensitivities, and wavefront ocular aberrations were analyzed. Patient-centered visual functions were evaluated according to the Activities of Daily Vision Scale., Results: The ADVS score was better in the aspheric IOL group (p=0.01), particularly concerning the best-corrected near vision (p=0.006). Refraction and BCVA were similar. Contrast sensitivities in photopic conditions was better in the aspherical IOL group (p<0.001). Higher-order aberration was not different, except from spherical aberration (p=0.022)., Conclusion: Patients with the aspherical IOLs felt they had better quality of vision, particularly near vision, compared with the spherical IOL group. These patient-centered benefits were associated with better photopic contrast sensitivity and reduced spherical aberration.

Background: A prospective analysis of the incidence of retinopathy of prematurity (ROP) by documenting clinical perinatal characteristics of affected infants, in an attempt to describe risk factors for ROP., Materials and Methods: Between March 2002 and April 2004, 161 infants, with a gestational age under 31 weeks and/or a birth weight under 1500 g, were screened according to CRYO-ROP guidelines, using direct ophthalmoscopy with a Layden contact lens. Risk factors for ROP were analyzed with the Student and Fischer tests., Results: ROP developed in 15% of the cases studied, with one out of five at prethreshold or threshold levels of ROP. Gestational age at birth (p<0.0001), low birth weight (p<0.0001), the length of the infant's stay in the neonatal intensive care unit (p<0.0001), the duration of mechanical ventilation (p<0.0001), the duration of oxygen provided (p<0.0001), blood transfusions (p<0.0001), hyaline membrane disease (p=0.0257), and bronchodysplasia (p=0.0012) were significant risk factors for ROP., Conclusion: Despite progress in neonatal intensive care, ROP persists and can be explained by greater and greater prematurity and earlier screening. Effective screening, done between 4 and 6 weeks of life, taking risk factors into account, can improve prognosis.

Ocular allergy, with a significant increase of prevalence, is one of the most usual disease of the ocular surface. But, in a same entity, it means different kinds of clinical diseases with acute hayfever conjunctivitis, usually easy to diagnose, but also chronic perennial forms without any functional or clinical specificity among others ocular surface diseases. These clinical aspects are underlain by complex cellular mecanisms which are essentially located inside the conjunctiva. Initially, allergen cross the lacrimal tear film, the first natural barrier of the eye, then in the conjunctival epithelium, meet the antigen presenting cells, the Langerhans cells, lymphocytes and all the others components of the inflammatory and allergic reaction, including mast cells and eosinophils. The cornea could also be involved in allergic diseases, mostly in severe ones such as vernal or atopic keratoconjunctivitis, but most often, its pathology is due to direct cytotoxic effect of chemical mediators, such as eosinophil proteins, rarely results from mechanical or immunological pathways.

Purpose: To compare ocular performance and quality of vision in pseudophakic eyes with an aspherical intraocular lens (IOL) or a conventional spherical IOL., Setting: Bretonneau University Hospital, Tours, France., Methods: Twenty patients (40 eyes) were randomly divided in 2 equal groups to bilaterally receive the aspherical Tecnis Z9000 IOL (AMO) or the spherical CeeOn Edge 911 IOL (AMO). Contrast sensitivity was measured and ocular wavefront analysis performed before surgery and 6 months after. Patients completed the Activities of Daily Vision Scale (ADVS) to evaluate patient-centered visual outcomes. Other examinations included refraction before and after mydriasis and pupil diameter., Results: The mean postoperative best corrected visual acuity (logMAR) was 0.03 +/- 0.05 (SD) in the Tecnis group and 0.01 +/- 0.05 in the CeeOn Edge group (P = .41). Refractive evaluation with mydriasis showed a mean myopic shift as low as -0.02 +/- 0.36 diopter (D) in the Tecnis group and -0.51 +/- 0.37 D in the CeeOn Edge group (P = .001). Mesopic contrast sensitivity at high spatial frequencies was significantly better in the Tecnis group (P<.001), while contrast sensitivity under photopic and glare conditions was not different between the 2 groups. Spherical aberration was significantly lower in the Tecnis group, which had a mean Z(4)(0) of 0.01 +/- 0.06 microm, than in the CeeOn Edge group, which had a mean Z(4)(0) of 0.16 +/- 0.12 microm (P<.001). The global score on the ADVS was not statistically different between groups; however, quality of distance vision was better in the Tecnis group than in the CeeOn Edge group (mean 99.0 +/- 2.0 versus 89.2 +/- 3.4) (P<.001)., Conclusion: Implantation of an aspherical IOL with a negative spherical aberration resulted in reduced ocular spherical aberration and improved mesopic contrast sensitivity and led to better subjective quality of vision.

Background: The mucopolysaccharidoses (MPS) form a group of heterogeneous hereditary lysosomal storage diseases, distinguished by facial dysmorphy in gargoyle-like facies. The enzymatic deficiency involves the degradation of glycosaminoglycans, whose accumulation manifests in severe general and ophthalmologic problems., Cases Report: We report the cases of two 18-month-old girls consulting for corneal clouding and photophobia. The diagnosis was made based on the facial dysmorphy, then biologically corroborated: Scheie's syndrome (MPS type I-S) and Hurler's syndrome (MPS type I-H). The corneal clouding was isolated or associated with bilateral disc swelling. Enzyme replacement therapy was instituted in both cases while waiting for bone marrow transplantation, with a better prognosis in the first case because of the type of MPS and the less severe neurological involvement., Discussion: The accumulation of glycosaminoglycans in ocular tissues can involve stromal opacities, glaucoma, retinopathy, and optic nerve swelling. Whereas the ophthalmological involvement is often secondary, it can lead the ophthalmologist to the diagnosis of MPS. The early diagnosis of MPS, before the onset of neurological signs, is vital, since treatment can stop disease progression., Conclusion: Better knowledge of the clinical signs of MPS on the part of the ophthalmologists could improve the prognosis of these patients.