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PURPOSE To assess a new polynomial regression formula integrating the refractive prediction error of the first operated eye in order to improve the intraocular lens (IOL) power calculation of the second eye in cataract surgery. SETTING Centre Hospitalier Universitaire, Toulouse, France. DESIGN Retrospective multicentric dataset study. METHODS A polynomial regression formula called WeOptimeye2nd (WO2nd) was developed using a machine-learning algorithm trained on a dataset of 534 patients who underwent sequential bilateral cataract surgery. A separate multicentric dataset was used to retrospectively calculate predicted refraction with WO2nd, SRK/T, Barrett Universal II, and 3 other methods of constant factors (CF) second eye refinement (CF0.38, CF0.35 and CF0.5). Mean absolute errors (MAE) and percentage of eyes within ±0.25, 0.5, and 1.0 diopters (D) from predicted spherical equivalent were compared between formulas. RESULTS The study comprised data on 722 patients. In the overall population, WO2nd had the lowest MAE: 0.339 versus 0.347 (p=0.137), 0.340 (p=0.956), 0.350 (p=0.066), 0.399 (p

Introduction: We performed a prospective, single-center, cohort study in order to evaluate the effects of vitrectomy with epiretinal membrane (ERM) peel on optical quality in patients with primary ERM. Methods: Thirty patients treated for primary ERM by vitrectomy with ERM peel were included from our tertiary university hospital ophthalmology department. The main study outcome was a variation in optical quality parameters measured using the HD Analyzer™ between preoperative and 2-month postoperative evaluations in operated eyes. Optical quality parameters comprised point spread function (PSF) width at 10% and 50%, objective scatter index (OSI), and modulation transfer function (MTF) cutoff. Contralateral non-operated eyes were used as an internal control for measurement reproducibility. Results: Mean PSF width at 10% (42.22 vs. 27.37 arc/min; p = 0.0002) and mean OSI (3.32 vs. 2.32; p = 0.0003) were significantly improved between pre- versus postoperative evaluations. Mean PSF width at 50% and mean MTF cutoff showed no changes. Subgroup analysis according to crystalline lens status gave similar results, demonstrating that improvements in mean PSF width at 10% and OSI were not lens-related. Non-operated eyes showed no changes in any of the parameters analyzed. Conclusion: Reduced light scattering measured by OSI indicates improved optical quality following vitrectomy with ERM peel among patients with primary ERM. OSI measurement could thus be a new parameter of interest in the preoperative assessment of primary ERM and other pre-vitrectomy assessments.

PURPOSE: To evaluate the efficacy and safety of transepithelial corneal cross-linking (CXL) with supplemental oxygen. METHODS: This was a prospective, non-comparative, pilot cohort study conducted at the National Reference Center for Keratoconus (Toulouse, France) on patients with progressive keratoconus. Transepithelial, pulsed, accelerated CXL was performed in an oxygen-rich atmosphere. Oxygen goggles were applied to the eyes to maintain a high level of oxygen during treatment. The main efficacy outcome was the mean change from baseline in maximum keratometry (Kmax) and the secondary outcomes were the mean changes in flat keratometry (K1), steep keratometry (K2), mean keratometry (Km), corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), and demarcation line depth. The safety outcomes were the incidence of adverse events, the mean change in pachymetry, and endothelial cell count. RESULTS: Thirty-four eyes of 34 patients were included. At 12 months postoperatively, the Kmax decreased by 1.56 ± 1.71 diopters (D) ( P < .0001) and CDVA improved by 0.093 ± 0.193 logMAR ( P < .02). The K2 and Km decreased by 0.51 ± 1.03 D ( P < .02) and 0.40 ± 0.78 D ( P < .01), respectively. There was no change in K1 and UDVA. The most frequent adverse event was corneal haze (64.78%). There were neither cases of infectious keratitis or loss of more than two lines in CDVA nor changes in pachymetry or endothelial cell count. CONCLUSIONS: Transepithelial CXL performed in an oxygen-rich atmosphere results in improved Kmax and CDVA with good safety. These promising findings suggest that this procedure could be safe and capable of halting the progression of keratoconus. [ J Refract Surg . 2021;37(1):42–48.]

Background. Because of the implications of Receptor for Advanced Glycation End Products (RAGE) in keratoconus (KC), we describe a differential expression of RAGE transcripts and proteins in corneal tissues and tears of KC and healthy patients. Methods. Using a case-controlled study, corneal epitheliums and tears of KC and healthy subjects were obtained during corneal collagen cross-linking and photorefractive keratectomy (PKR) and during usual consultations. Quantitative reverse transcription (RT-qPCR) and Western-Blot were performed to analyze RAGE transcripts and proteins’ expression in corneal tissues and tears. Results. One hundred and six patients were included in this study. The characteristics of the patients were as follows: 56 KC (25 corneal epithelium and 31 tears) and 50 control subjects (25 corneal epithelium and 25 tears). Transcripts of RAGE, HMGB1, and S100 family ligands were quantified by RT-qPCR, identifying a significantly higher expression of RAGE and HMGB1 in the healthy group than in the KC group ( p = 0.03 and 0.04, respectively). Western Blot showed a significantly higher fl-RAGE expression in KC corneal epithelium than control ( p < 0.001 ) and lower s-RAGE expression in KC tears than control ( p = 0.04 ). Conclusions. Linked with the inflammatory process occurring in KC pathophysiology, we propose for the first time that the RAGE expression (total and truncated forms of receptor and ligands) in KC corneal tissues and tear samples provides viable biomarkers.

International audience; PurposeTo conduct a systematic review and meta-analysis on the levels of oxidative stress markers and antioxidants in keratoconus compared to healthy subject.MethodThe PubMed, Cochrane Library, Embase, Science Direct and Google Scholar databases were searched on 1st June 2020 for studies reporting oxidative and antioxidative stress markers in keratoconus and healthy controls. Main meta-analysis was stratified by type of biomarkers, type of samples (tears, cornea, aqueous humour and blood) and type of corneal samples (stromal cells, epithelium and endothelium).ResultsWe included 36 articles, for a total of 1328 keratoconus patients and 1208 healthy controls. There is an overall increase in oxidative stress markers in keratoconus compared with healthy controls (standard mean deviation (SMD) = 0.94, 95% confidence interval (95% CI) 0.55–1.33), with a significant increase in reactive oxygen and nitrogen species (1.09, 0.41–1.78) and malondialdehyde (1.78, 0.83–2.73). There is an overall decrease in antioxidants in keratoconus compared with healthy controls (−0.63, −0.89 to −0.36), with a significant decrease in total antioxidant capacity/status (−1.65, −2.88 to −0.43), aldehyde/NADPH dehydrogenase (−0.77, −1.38 to −0.17), lactoferrin/transferrin/albumin (−1.92, −2.96 to −0.89) and selenium/zinc (−1.42, −2.23 to −0.61). Oxidative stress markers were higher in tears and in cornea of keratoconus than in aqueous humour, and antioxidants were decreased in tears, aqueous humour and blood without difference between sample type. Oxidative stress markers increased in stromal cells and antioxidants decreased in endothelium.ConclusionOxidative stress markers and antioxidants were dysregulated in keratoconus, involving an imbalance of redox homeostasis in tears, cornea, aqueous humour and blood.

Item does not contain fulltext The involvement of genetic factors in the pathogenesis of KC has long been recognized but the identification of variants affecting the underlying protein functions has been challenging. In this study, we selected 34 candidate genes for KC based on previous whole-exome sequencing (WES) and the literature, and resequenced them in 745 KC patients and 810 ethnically matched controls from Belgium, France and Italy. Data analysis was performed using the single variant association test as well as gene-based mutation burden and variance components tests. In our study, we detected enrichment of genetic variation across multiple gene-based tests for the genes COL2A1, COL5A1, TNXB, and ZNF469. The top hit in the single variant association test was obtained for a common variant in the COL12A1 gene. These associations were consistently found across independent subpopulations. Interestingly, COL5A1, TNXB, ZNF469 and COL12A1 are all known Ehlers-Danlos Syndrome (EDS) genes. Though the co-occurrence of KC and EDS has been reported previously, this study is the first to demonstrate a consistent role of genetic variants in EDS genes in the etiology of KC. In conclusion, our data show a shared genetic etiology between KC and EDS, and clearly confirm the currently disputed role of ZNF469 in disease susceptibility for KC.

Purpose To assess the keratoconus (KC) prevalence among first-degree relatives of affected subjects. Methods We performed large epidemiological, prospective, and observational cohort, which took place in the French KC National Reference Centre, in Bordeaux. We studied data from 94 unrelated patients with KC and at least 2 first-degree relatives assessable. Each subject had a thorough ocular examination including visual acuity, refraction, slitlamp biomicroscopy, indirect ophthalmoscopy, keratometry, corneal topography and tomographer (Topographic Modeling System; Tomey Corporation, Japan; and Galilei G4, Ziemer, Switzerland, respectively), pachymetry, and biomechanical properties of cornea (Ocular Response Analyzer; Reichert, Depew, NY). Additional data were collected about atopy, smoking, and eye-rubbing habits. KC prevalence, multivariate analysis, and familial correlation analysis have been studied. Results Of the 221 relatives, 9.05% (n = 20) had clinically manifest KC, and 15.4% (n = 31) had subclinical KC. The prevalence of KC was estimated equal to 0.14 [95% confidence interval (CI), 0.07-0.22] among parents, 0.03 (95% CI, 0-0.10) among offspring, and 0.10 (95% CI, 0.04-0.20) among siblings. In multivariable analysis, age and eye-rubbing were associated with an increased risk of KC. The familial correlation of KC among probands' first-degree relatives was estimated at 0.55 among parents, 0.29 among offspring, and 0.49 among siblings. Conclusions Being a first-degree relative of a subject with KC remains a risk factor for developing KC. This should be taken into account especially when screening for KC in pediatric patients, for refractive surgery candidates, and for patients being evaluated for cataract surgery.

Indexation en cours.; International audience; PURPOSE: Contact lens (CL)-related microbial keratitis (MK) has major public health implications, with about 300 million wearers worldwide, and certain potentially modifiable risk factors. This study aimed to identify the risk factors of CL-related MK. METHODS: A multicenter case-control study was conducted between 2014 and 2017. Cases presenting with CL-related MK were submitted to an anonymous 52-item questionnaire, which was also completed by healthy controls. Univariate followed by multivariate logistic regression analysis was performed. Risk factors for CL-related MK were given as odds ratio (OR) with 95% confidence interval and P-value. RESULTS: The study included a total of 2267 patients (1198 cases and 1069 controls). The MK risk factors for the daily disposable lenses group were exceeding the lens renewal period (OR = 9.16, P = 0.008) and occasionally wearing CL when sleeping (OR = 15.83, P = 0.035). The most important risk factors in the nondaily disposable lenses group were lens cleaning solution distributed by eye care brands (OR = 3.50, P < 0.001) and failure to renew lens cases (OR = 3.39, P = 0.001). Statistically and clinically significant variables were used to establish the MK risk equation for CL wearers, allowing an individual calculation of the risk of MK under lenses. CONCLUSIONS: The MK risk equation is a valuable tool for educating patients about the risks associated with wearing CL. It allows the patient to be informed about their overall risk of infection while detailing the precipitating elements of the infectious risk with the aim of modifying risk behavior.

Resume Objectif L’objectif de notre etude retrospective et monocentrique d’une serie de cas etait de comparer l’astigmatisme total, interne et corneen, ainsi que l’acuite visuelle a un an d’une chirurgie combinee ou non, ayant consiste en la mise en place d’un iris-claw (ARTISAN Aphakia chez des patients aphaques) selon que la fixation ait ete faite a la face anterieure de l’iris (n = 21) ou a la face posterieure de ce dernier (n = 51). Resultats Nous n’avons pas retrouve de difference significative entre ces deux types de fixation pour aucune des variables etudiees. L’astigmatisme chirurgical induit etait de 1,67 D a 176 dans le groupe A versus 1,19 D a 11° dans le groupe P. Conclusion Bien que cette chirurgie engendre un astigmatisme corneen supplementaire, il n’a pas ete prouve que ce dernier differe en fonction du type de fixation de l’iris-claw. Si nous conservons l’idee que l’iris-claw fixe en retro-pupillaire diminue le risque de decompensation endotheliale en cas de decrochage de l’implant, alors la fixation retro-irienne de ce dernier prend ici tout son sens.

Purpose To describe the surgical technique and report the outcomes of 2 patients treated with femtosecond laser-assisted ipsilateral rotational lamellar autokeratoplasty in central corneal scars. Methods The corneal scar depth was mapped using preoperative optical coherence tomography. An eccentric lamellar lenticule was cut with a femtosecond laser and rotated to decenter corneal opacity and free the pupil area in 2 patients with nonprogressive central corneal scars. The surgical plan was set after simulating lenticule rotation with a digital corneal image and computer software. Results In both cases, the corneal scar was decentered inferiorly, out of the pupillary area, with increased postoperative visual acuity but visual outcome limitations secondary to corneal irregularities and residual deep opacity. Conclusions Femtosecond laser-assisted ipsilateral rotational lamellar autokeratoplasty is effective for shifting central corneal opacities and can be considered in appropriate cases.

OBJECTIVES To evaluate the success rate, efficacy, and safety of the ICD 16.5 mini-scleral gas permeable (GP) contact lens. METHODS This prospective study included referred consecutive patients with irregular corneas and severe ocular surface disease (OSD) in treatment failure. All patients were fitted with the ICD 16.5 mini-scleral GP lens. Even though we had some limited experience with scleral lenses, it was our first experience with the ICD 16.5 mini-scleral GP lens. Efficacy was assessed by comparing best-corrected visual acuity (BCVA) with the mini-scleral lens to baseline BCVA. A subjective visual functioning questionnaire (comfort score, visual quality score, handling rating, and wearing time) was administered in a face-to-face structured interview. RESULTS Thirty-nine eyes of 23 patients with a mean age of 43±16 years were included. Fitting indications were keratoconus (46%), post-penetrating keratoplasty (21%), other irregular astigmatism (15%), and severe OSD (18%). Twenty-five eyes (64%) were successfully fitted with an 18-month follow-up. The mini-scleral GP lens BCVA was 0.16 logarithm of the minimum angle of resolution (logMAR; 20/25) versus a baseline BCVA of 0.44 logMAR (20/63; P

Purpose To compare the outcomes of transepithelial photorefractive intrastromal corneal crosslinking (CXL) and photorefractive keratectomy (PRK) in eyes with low myopia. Setting Purpan Hospital, Toulouse, France. Design Prospective case series. Methods Myopic patients with a manifest refraction spherical equivalent (MRSE) of −1.00 to −2.50 diopters (D) and a cylindrical component of plano to −0.75 D were included. The dominant eye had PRK (PRK eyes). The nondominant eye had transepithelial photorefractive intrastromal CXL with riboflavin (ParaCel Part 1 and 2), 30 mW/cm2 pulsed ultraviolet-A irradiation centered on the pupil (Mosaic System) for 16 minutes and 40 seconds, and a supplemental oxygen delivery mask (CXL eyes). The primary outcome measure was the change in the MRSE. Other outcome measures were the uncorrected (UDVA) and corrected (CDVA) distance visual acuities, mean keratometry, and endothelial cell count (ECC) over a 6-month follow-up. Adverse events were assessed. Results Nineteen patients were included. By 6 months, the mean MRSE had decreased by 0.72 D ± 0.42 (SD) in CXL eyes and by 1.35 ± 0.46 D in PRK eyes (P Conclusions Photorefractive keratectomy provided better visual and refractive outcomes than transepithelial photorefractive intrastromal CXL. Transepithelial photorefractive intrastromal CXL, however, showed the potential refractive effect of CXL but with a limited magnitude of myopic correction.

Keratoconus (KC) is a complex disease whose pathophysiology is only partially understood. The priority in management is to halt the progression of corneal deformation as soon as possible in the course of KC disease. Corneal cross-linking (CXL) is at present the only dedicated treatment for this purpose. Its biochemical mechanism of action leads to changes in the viscoelastic properties of the cornea induced by matrix bonding and renewal of keratocytes. The effect of CXL is difficult to quantify when measured in in-vivo conditions because of a lack of consistent tools adapted for clinical practice. Nevertheless, a large amount of evidence has been collected so far confirming the positive action of CXL on corneal structural reinforcement, and numerous studies have demonstrated significant efficacy in halting progression of KC with long-term follow-up. Published studies, however, are of relatively low scientific power given the great heterogeneity of the disease and the numerous associated biases in evaluation. The purpose of this paper is to summarize the consistent evidence of efficacy of CXL and to justify its role in our therapeutic armamentarium for management of progressive KC.

Resume Contexte et objectifs La myopie forte (MF), qui affecte de 0,9 a 3,1 % de la population, est une cause importante de perte de la vision. L’objectif de cette enquete etait d’etudier et d’evaluer l’impact de leur forte myopie sur la vie quotidienne des patients et de mieux cerner leurs attentes en vue de mieux repondre a leurs besoins. Materiels et methodes L’enquete a ete realisee entre le 19 fevrier et le 21 mars 2014. Pour etre eligibles, les patients devaient avoir une myopie d’au moins −8 dioptries, etre âges de plus de 40 ans, avec ou sans complications myopiques. Le degre de myopie des patients a ete retrouve grâce aux prescriptions optiques de l’œil le plus atteint des patients. Les 123 patients inclus ont ete interroges par telephone a l’aide d’un questionnaire elabore et valide par un comite scientifique compose d’experts et de patients membres de l’Association de lutte contre la maculopathie myopique (AMAM). L’entretien telephonique, semi-structure, avait une duree de 20 minutes. Resultats En moyenne, la myopie etait de −11,7 dioptries. Les femmes representaient 71 % de l’effectif, 89 % des patients avaient moins de 65 ans et avaient le plus souvent une activite professionnelle (65 %). Plus de la moitie des sujets de l’enquete souffraient de complications myopiques, 5 % des patients presentaient des neovaisseaux choroidiens (NVC). Seulement 29 % avaient ete informes du risque de NVC ou de maculopathie. La MF constituait un handicap dans les activites sportives pour 64 % des patients, dans les activites de loisir pour 51 % et dans les activites professionnelles pour plus d’un quart (28 %). Seulement 56 % des patients MF disaient vivre parfaitement bien leur etat. Conclusions Cette enquete est la premiere etude sur la vie quotidienne des personnes souffrant de MF visant a analyser leur environnement social et affectif. Elle montre que la MF a un impact profond sur la vie quotidienne des patients et peut avoir altere la vie sociale comme l’activite professionnelle. La plupart des patients myopes ont une information incomplete ou confuse sur la nature et le risque de complications myopiques. Ils ont exprime le desir d’etre mieux informes et plus precocement sur leur condition, avant la survenue des complications.

PURPOSE: To evaluate the safety and efficacy of topical recombinant human nerve growth factor (rhNGF) for treating moderate-to-severe neurotrophic keratitis (NK), a rare degenerative corneal disease resulting from loss of corneal innervation. DESIGN: Phase II multicenter, randomized, double-masked, vehicle-controlled trial. PARTICIPANTS: Patients with stage II (moderate) or stage III (severe) NK in one eye. METHODS: The REPARO Phase II study assessed safety and efficacy in 156 patients randomized 1:1:1 to rhNGF 10μg/ml, 20 μg/ml, or vehicle. Treatment was administered 6 drops per day for 8 weeks. Patients then entered a 48- or 56-week follow-up period. Safety was assessed in all patients who received study drug, while efficacy was by intention to treat. MAIN OUTCOME MEASURES: Corneal healing (defined as

Neurotrophic keratitis/keratopathy (NK), a rare degenerative corneal disease, lacks effective pharmacologic therapies.1 Because NK pathology involves trigeminal nerve damage and loss of corneal innervation, nerve growth factor (NGF) is surmised to promote healing of NK.2 Preliminary studies with murine NGF demonstrated efficacy for treating corneal neurotrophic ulcers;3 however, the complex tertiary structure of NGF has complicated the production of recombinant human NGF (rhNGF) suitable for clinical development. To this end, we developed an Escherichia coli–derived rhNGF formulation that demonstrated to be well tolerated and safe for topical ophthalmic use in a phase I study in healthy volunteers.4 We report phase I results of topical rhNGF for patients with moderate-to-severe NK.

International audience; Iron is essential for retinal function but contributes to oxidative stress-mediated degeneration. Iron retinal homeostasis is highly regulated and transferrin (Tf), a potent iron chelator, is endogenously secreted by retinal cells. In this study, therapeutic potential of a local Tf delivery was evaluated in animal models of retinal degeneration. After intravitreal injection, Tf spread rapidly within the retina and accumulated in photoreceptors and retinal pigment epithelium, before reaching the blood circulation. Tf injected in the vitreous prior and, to a lesser extent, after light-induced retinal degeneration, efficiently protected the retina histology and function. We found an association between Tf treatment and the modulation of iron homeostasis resulting in a decrease of iron content and oxidative stress marker. The immunomodulation function of Tf could be seen through a reduction in macrophage/microglial activation as well as modulated inflammation responses. In a mouse model of hemochromatosis, Tf had the capacity to clear abnormal iron accumulation from retinas. And in the slow P23H rat model of retinal degeneration, a sustained release of Tf in the vitreous via non-viral gene therapy efficently slowed-down the photoreceptors death and preserved their function. These results clearly demonstrate the synergistic neuroprotective roles of Tf against retinal degeneration and allow identify Tf as an innovative and not toxic therapy for retinal diseases associated with oxidative stress.

Resume Introduction La chirurgie de la cataracte est une candidate ideale a une prise en charge ambulatoire. En 2013, au CHU de Toulouse, le taux de chirurgie ambulatoire concernant la phacoemulsification etait de 75,8 %. Cette etude a ete menee afin d’identifier les obstacles qui limitent le developpement de la pratique ambulatoire de la chirurgie de la cataracte dans notre etablissement. Materiel et methodes Pour cette etude retrospective, tous les sejours incluant un acte de phacoemulsification (code CCAM : BFGA004) realise au CHU de Toulouse en hospitalisation traditionnelle en 2013 ont ete inclus. Nous avons exclu les sejours pour lesquels les dossiers medicaux, infirmiers et anesthesiques, ainsi que les fiches correspondantes de programmation operatoire, etaient incomplets. Les sejours ont ete classes selon le motif d’hospitalisation et selon le type de chirurgie, cataracte geste principal ou cataracte geste combine. Resultats Notre etude a porte sur 298 sejours avec un âge moyen des patients de 66,8 ± 16,8 ans et un sex-ratio homme/femme de 0,76. L’indication d’hospitalisation traditionnelle relevait de motifs sociaux, chirurgicaux et anesthesiques dans les proportions respectives suivantes : 41, 34 et 8 % des cas. Les echecs de la prise en charge en ambulatoire representaient 7 % des cas. L’isolement social representait 89 % des motifs sociaux. Lors d’une chirurgie combinee, le motif etait chirurgical dans 89 % des cas. Conclusion Le developpement de la chirurgie ambulatoire implique tous les acteurs de la filiere. En particulier, la prise en compte du facteur social est un element essentiel impliquant une prise en charge adaptee. Au niveau chirurgical, le changement des pratiques pour developper la chirurgie ambulatoire de la cataracte doit cibler en priorite les chirurgies combinees.

International audience; The cornea represents the external part of the eye and consists of an epithelium, a stroma and an endothelium. Due to its curvature and transparency this structure makes up approximately 70% of the total refractive power of the eye. This function is partly made possible by the particular organization of the collagen extracellular matrix contained in the corneal stroma that allows a constant refractive power. The maintenance of such an organization involves other molecules such as type V collagen, FACITs (fibril-associated collagens with interrupted triple helices) and SLRPs (small leucine-rich proteoglycans). These components play crucial roles in the preservation of the correct organization and function of the cornea since their absence or modification leads to abnormalities such as corneal opacities. Thus, the aim of this review is to describe the different corneal collagens and proteoglycans by highlighting their importance in corneal transparency as well as their implication in corneal visual disorders.

To evaluate to what extent the modification of corneal asphericity to induce spherical aberration (SA) can improve the depth of focus and to determine whether preoperative adaptive optics assessment (Voptica SL) can predict an optimal SA value for each patient.Comparative, prospective clinical trial with paired eye control.Patients ≥45 years old who are hyperopic from +1.00 to +2.50 diopters (D), with eyes suitable for LASIK surgery.Bilateral hyperopic LASIK surgery using a 200-Hz Allegretto excimer laser. The dominant eye was operated using a conventional profile. The nondominant eye was programmed with an aspheric ablation profile and -0.75 D monovision.Primary outcome was the correlation between postoperative SA and depth of focus, defined as the pseudo-accommodation value (PAV = [1/reading distance {m}] - minimum addition [D]). Main secondary outcome was the comparison of depth of focus between patients with an induced SA close to the optimal one (group 1), patients with an induced SA far from the optimal one (group 2), and patients for whom SA induction did not increase the depth of focus (control group).We included 76 patients. Between preoperative and postoperative assessment, the mean increase of distance-corrected PAV for near vision was +0.25±0.64 D (P0.001) for dominant eyes and +0.63±0.55 D (P 0.001) for nondominant eyes. As the level of negative or positive postoperative SA increased, PAV for intermediate and near vision increased. Among the 37 eyes that followed the preoperative adaptive optics assessment, the mean PAV increase at near was significantly higher (P0.05) in group 1 (0.93±0.50 D) than in group 2 (0.46±0.42 D) and than in the control group (0.35±0.32 D). The mean optimal SA value determined by the dynamic simulation procedure to optimize the depth of focus was -0.18±0.13 μm at 4.5 mm.Aspheric hyperopic LASIK can increase the depth of focus without impairing far vision, but this benefit would be maximal and reproducible if we could define and achieve an optimal SA value determined by preoperative assessment using an adaptive optics instrument.

Purpose To evaluate the efficacy and safety of the combined implantation of a monofocal intraocular lens (IOL) in the capsular bag with a diffractive multifocal IOL designed for sulcus placement (Reverso). Setting Purpan Hospital, Toulouse, and Helios Clinic, Saint-Jean-de-Luz, France. Design Prospective case series. Methods The multifocal IOL piggyback IOL was implanted in the sulcus during cataract surgery. Visual acuity, defocus curve, contrast sensitivity, IOL positioning, and patient satisfaction were assessed with 1-year follow-ups. Results Fifty-four eyes of 27 patients were included. At 1-month, monocular uncorrected distance (UDVA) and near (UNVA) visual acuities were 0.13 logarithm of the minimum angle of resolution (logMAR) ± 0.18 (SD) and 0.20 ± 0.16 logMAR, respectively. Binocular UDVA and UNVA were 0.03 ± 0.06 and 0.12 ± 0.08 logMAR, respectively. At 1 year, the mean monocular logMAR UDVA, corrected distance visual acuity, UNVA, and corrected near visual acuity were 0.10 ± 0.11, 0.02 ± 0.06, 0.18 ± 0.12, and 0.13 ± 0.08, respectively. The defocus curve and contrast sensitivity values were comparable to those obtained with other multifocal IOLs. On Scheimpflug imaging, the mean distance between the sulcus multifocal IOL and the monofocal IOL was 517 ± 141 μm. At 1 year, ultrasound biomicroscopy showed an annular fibrosis of the anterior capsule in 94.4% of the eyes. Complications included 1 posttraumatic IOL decentration and 1 slight corectopia. Eighty-nine percent of patients reported satisfaction. Conclusions The piggyback implantation of this multifocal IOL seemed to be safe and effective. It might provide similar results as a primary in-the-bag multifocal IOL, with the advantage of reversibility that might extend primary or secondary implantation.

Purpose To assess the quality of life in French keratoconus patients. Setting Fifty-seven Keratoconus National Reference Centers across France. Design Prospective case series. Methods Patients completed the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) and a French validated questionnaire on disability and dependency from February to June 2012 when they came for an ophthalmic examination at 57 participating centers across France. An ocular examination including refraction, corneal topography, pachymetry, and slitlamp biomicroscopy was performed. The composite or global NEI VFQ-25 score and the proportion of patients who were dependent (defined by the difficulties with activities of daily living) because of keratoconus were the main evaluation criteria in this study. Results The study comprised 550 keratoconus patients. Women, corrected distance visual acuity worse than 20/40, steep keratometry higher than 52.0 diopters, history of surgery (corneal transplant, intrastromal corneal ring segments, or corneal crosslinking), and more severe keratoconus according to the Amsler-Krumeich classification were associated with an increasingly negative impact on quality of life (overall scores are significantly lower). Moreover, 4.9% of participants reported having changed their jobs because of keratoconus and 7.8% received keratoconus-related disability. Sixty-nine (12.5%) patients reported having difficulties with activities of daily living and are considered dependent. Conclusion Keratoconus was associated with a significant reduction in quality of life but it did not result in social exclusion.

Purpose To report adverse device effects and annualized endothelial cell loss rate for up to 10 years after implantation of the Acrysof L-series Cachet phakic intraocular lens (pIOL). Setting Clinical centers in the United States, European Union, and Canada. Design Nonrandomized clinical trial. Methods After implantation of the pIOL, the endothelial cell density (ECD) at follow-up evaluations was compared with the 6-month postoperative baseline. Adverse device effects were assessed. Results This study assessed 638 patients (1087 eyes) from previous clinical trials. The mean central ECD change from baseline was −9.6% ± 8.3% (SD) (−1.7% annualized; 623 eyes) and −11.0% ± 9.9% (−1.7% annualized; 703 eyes) at 6 years and 7 years, respectively. The mean peripheral ECD change from baseline was −10.8% ± 8.7% (−2.0% annualized; 615 eyes) and −11.9% ± 10.0% (−1.8% annualized; 680 eyes), respectively. Endothelial cell loss greater than 30% from the preoperative baseline at any time after implantation affected 8.0% of all eyes. An ECD of 1500 cells/mm2 or less at any time after implantation affected 2.7% of all eyes. The most common adverse device effects were peripheral iris adhesions (57 eyes [5.2%]), corneal endothelial cell loss (42 eyes [3.9%]), and pIOL explantation (37 eyes [3.4%]). Conclusions Long-term evaluation of the pIOL showed a persistent ECD decrease in some eyes that was numerically larger than the annual rate expected with aging. Endothelial cell loss resulted in explantation in 3.1% of all eyes with the pIOL. Patients had no permanent vision loss. The manufacturer recommends that patients continue to be monitored and their corneal endothelium evaluated semiannually.

Resume Introduction La neuroretinopathie maculaire aigue fait partie des pathologies dites « a fond d’œil normal » : la discretion des signes cliniques et leur paucite peuvent faire parfois prendre cette pathologie pour une neuropathie optique. Nous presentons ici cinq cas cliniques de neuroretinopathie maculaire aigue, dont un retrospectif. Dans les cinq cas, le diagnostic a pu etre pose grâce a l’apport de l’imagerie multimodale combinant cliche infrarouge et OCT maculaire. Materiel et methodes Etude retrospective de cinq cas cliniques. Les meilleures acuites visuelles corrigees, initiale et finale, ainsi que les imageries infrarouge et OCT ont ete collectees pour tous les patients. Resultats Dans les cinq cas, il existait initialement une gene visuelle associee a une baisse plus ou moins severe de l’acuite visuelle. L’imagerie infrarouge montrait un aspect sombre et peri-foveolaires des lesions. Les cliches OCT montraient une atteinte systematique de la couche plexiforme externe sous la forme d’un epaississement et d’une hyperreflectivite qui s’etendait vers les couches les plus externes. Conclusion La neuroretinopathie maculaire aigue est une entite clinique de description ancienne pour laquelle l’apport des nouvelles technologies d’imagerie est immense, permettant un diagnostic plus precoce et plus precis, remettant en question le nom meme de la pathologie. La physiopathologie exacte de la maladie reste en revanche incompletement elucidee.

We report the case of a 56-year-old patient, presenting with bilateral hypertensive anterior uveitis due to Leishmania infantum, in the setting of immune deficiency related to HIV infection. The etiology of the uveitis was diagnosed following detection of L. infantum DNA on anterior chamber paracentesis. Initially, the patient received an intravitreal injection of liposomal amphotericin B, systemic antiparasitic treatment, topical steroid and ocular hypotensive treatment. Due to unfavourable disease progression in the right eye, we re-evaluated the anti-inflammatory, antiretroviral and antiparasitic medications (beginning meglumine antimoniate): the uveitis in the left eye was thus able to be controlled. We followed the efficacy of treatment with weekly quantification of Leishmania DNA in the aqueous humor. Uveitis secondary to leishmaniasis is rare and serious. Physicians must be aware of this cause of uveitis, particularly in immunodeficient patients. The quantitation of Leishmania DNA in the aqueous humor is an indispensible tool for monitoring the disease.

Myopia is the most frequent refractive disorder in the world. It has become a real Public Health problem, due to its frequency and to high myopia-related blinding complications. Myopic progression depends on genetic and environmental factors. Genetic studies have identified more than forty candidate genes that take part in pathophysiological pathways, from retinal phototransduction to axial lengthening via scleral remodelling. Environmental factors also influence scleral remodelling by way of visual perception. In the case of predominant attention to near tasks, a physiological feedback loop leads to axial growth. This phenomenon, called active emmetropization, is particularly obvious in animal models and in some human populations. To date, research has failed to identify a molecule common to all the implicated metabolic pathways which could be a target for an effective preventive treatment against myopic progression.

Purpose To evaluate safety of medium-chain triglycerides used as a possible intraocular tamponading agent. Methods A 20-gauge pars plana vitrectomy was performed in the right eye of 28 rabbits. An ophthalmologic examination was performed every week until rabbits were killed. At days 7, 30, 60, and 90, rabbits were killed and the treated eyes were examined macroscopically and prepared for histologic examination. Principal outcome was retinal toxicity evaluated by light and electron microscopy, and secondary outcomes were the presence of medium-chain triglyceride emulsification, inflammatory reactions, and the development of cataract. Results Histologic examination did not reveal any retinal toxicity. Two cases of moderate emulsification were observed, but in these cases, emulsification was caused by the perioperative injection of the agent and did not increase during the postoperative period. We noted 13 cases of inflammatory reaction in vitreous cavity and no case of inflammatory reaction in anterior chamber. Two eyes developed cataract as a result of perioperative trauma to the lens with the vitreous cutter and not secondary to the presence of medium-chain triglycerides in the vitreous cavity. Conclusion Medium-chain triglycerides did not induce morphologic evidence of retinal toxicity. The results suggest that medium-chain triglycerides could be a promising alternative intraocular tamponading agent for the treatment of retinal detachments.

The pathogenesis of keratoconus remains unknown. This review focuses on recent advances in the knowledge of keratoconus biology from a gene and protein expression. Biological hypotheses were investigated either on a candidate approach or on global approaches. Candidate approach relies on the knowledge of the disease pathology and biochemistry, or on association of keratoconus with other genetic or ophthalmologic diseases. Global approach aims to identify the origin of keratoconus without taking into account any preconceived ideas of the pathophysiology of the disease. Despite a great deal of research, the pathogenesis of keratoconus is still poorly understood. If genetic susceptibility is probably a key factor in the occurrence of keratoconus, as with many complex diseases, distinguishing between primary disease mechanisms from secondary effects is extremely challenging.

To evaluate visual performance and factors associated with abnormal vision in patients screened for frailty at the Geriatric Frailty Clinic (GFC) for Assessment of Frailty and Prevention of Disability at Toulouse University Hospital. Retrospective, observational cross-sectional, single-centre study. Institutional practice. Patients were screened for frailty during a single-day hospital stay between October 2011 and October 2014 (n = 1648). Collected medical records included sociodemographic data (including living environment and educational level), anthropometric data, and clinical data. The general evaluation included the patient’s functional status using the Activities of Daily Living (ADL) scale and the Instrumental Activity of Daily Living (IADL) scale, the Mini-Mental State Examination (MMSE) for cognition testing, and the Short Physical Performance Battery (SPPB) for physical performance. We also examined Body Mass Index (BMI), the Mini-Nutritional Assessment (MNA), and the Hearing Handicap Inventory for the Elderly Screening (HHIE-S) tool. The ophthalmologic evaluation included assessing visual acuity using the Snellen decimal chart for distant vision, and the Parinaud chart for near vision. Patients were divided into groups based on normal distant/near vision (NDV and NNV groups) and abnormal distant/near vision (ADV and ANV groups). Abnormal distant or near vision was defined as visual acuity inferior to 20/40 or superior to a Parinaud score of 2, in at least one eye. Associations with frailty-associated factors were evaluated in both groups. The mean age of the population was 82.6 ± 6.2 years. The gender distribution was 1,061 females (64.4%) and 587 males (35.6%). According to the Fried criteria, 619 patients (41.1%) were pre-frail and 771 (51.1%) were frail. Distant and near vision data were available for 1425 and 1426 patients, respectively. Distant vision was abnormal for 437 patients (30.7%). Near vision was abnormal for 199 patients (14%). Multiple regression analysis showed that abnormal distant vision as well as abnormal near vision were independently associated with greater age (P < 0.01), lower educational level (P < 0.05), lower performance on the MMSE (P < 0.001), and lower autonomy (P < 0.02), after controlling for age, gender, educational level, Fried criteria, and MMSE score. The high prevalence of visual disorders observed in the study population and their association with lower autonomy and cognitive impairment emphasises the need for systematic screening of visual impairments in the elderly. Frailty was not found to be independently associated with abnormal vision.

International audience; Inflammasome complexes function as key innate immune effectors that trigger inflammation in response to pathogen- and danger-associated signals. Here, we report that germline mutations in the inflammasome sensor NLRP1 cause two overlapping skin disorders: multiple self-healing palmoplantar carcinoma (MSPC) and familial keratosis lichenoides chronica (FKLC). We find that NLRP1 is the most prominent inflammasome sensor in human skin, and all pathogenic NLRP1 mutations are gain-of-function alleles that predispose to inflammasome activation. Mechanistically, NLRP1 mutations lead to increased self-oligomerization by disrupting the PYD and LRR domains, which are essential in maintaining NLRP1 as an inactive monomer. Primary keratinocytes from patients experience spontaneous inflammasome activation and paracrine IL-1 signaling, which is sufficient to cause skin inflammation and epidermal hyperplasia. Our findings establish a group of non-fever inflammasome disorders, uncover an unexpected auto-inhibitory function for the pyrin domain, and provide the first genetic evidence linking NLRP1 to skin inflammatory syndromes and skin cancer predisposition.

PURPOSE: To compare the efficacy and safety of topography-guided corneal collagen cross-linking (TG-CXL) to conventional corneal CXL (C-CXL) in progressive keratoconus. METHODS: In this prospective, nonrandomized clinical trial, 60 eyes of 60 patients were scheduled to receive either TG-CXL (30 eyes with deepithelialization focused on the cone, riboflavin application for 10 minutes, and 30 mW/cm 2 pulsed ultraviolet-A irradiance pattern according to topography) or C-CXL (30 eyes treated in accordance with the Dresden protocol). Patients were observed for 1 year postoperatively. Maximum keratometry (Kmax), mean keratometry in the inferior part of the cornea (I index), corrected distance visual acuity (CDVA), demarcation line observed in optical coherence tomography, and nerves and cell densities analyzed by confocal microscopy were compared preoperatively and at 1 year postoperatively. Results: The difference was significant for both Kmax ( P < .01) and I index ( P < .01) between the two groups. CDVA improved significantly in the TG-CXL (0.2162 ± 0.2495 logMAR, P < .05) versus the C-CXL (0.2648 ± 0.2574 logMAR, P = .104) group. A stromal demarcation line was observed in both treatment groups, with similar depth at the top of the cone ( P = .391), but it was shallower at the surrounding area in the TG-CXL group ( P < .0001). Stromal evaluation by confocal microscopy showed less damage and faster healing in the surrounding area than on the cone area in the TG-CXL group. CONCLUSIONS: At 1 year postoperatively, TG-CXL seems to be as safe as C-CXL with stronger flattening in Kmax and I index and better improvement in CDVA. TG-CXL induces a biological gradient between the cone and the surrounding area that facilitates nerve and cell recovery. [ J Refract Surg. 2017;33(5):290–297.]

International audience; Purpose: We compared an iontophoresis riboflavin delivery technique for transepithelial corneal collagen crosslinking (I-CXL) with a conventional CXL (C-CXL).Methods: We designed three experimental sets using 152 New Zealand rabbits to study riboflavin application by iontophoresis using charged riboflavin solution (Ricrolin+) with a 1-mA current for 5 minutes. The first set was to compare riboflavin concentration measured by HPLC in corneas after iontophoresis or conventional riboflavin application. The second set was to analyze autofluorescence and stromal collagen modification immediately and 14 days after I-CXL or C-CXL, by using nonlinear two-photon microscopy (TP) and second harmonic generation (SHG). In the third set, physical modifications after I-CXL and C-CXL were evaluated by stress-strain measurements and by studying corneal resistance against collagenase digestion. Results: Based on HPLC analysis, we found that iontophoresis allowed riboflavin diffusion with 2-fold less riboflavin concentration than conventional application (936.2 ± 312.5 and 1708 ± 908.3 ng/mL, respectively, P < 0.05). Corneal TP and SHG imaging revealed that I-CXL and C-CXL resulted in a comparable increased anterior and median stromal autofluorescence and collagen packing. The stress at 10% strain showed a similar stiffness of corneas treated by I-CXL or C-CXL (631.9 ± 241.5 and 680.3 ± 216.4 kPa, respectively, P = 0.908). Moreover, we observed an increased resistance against corneal collagenase digestion after I-CXL and C-CXL (61.90% ± 5.28% and 72.21% ± 4.32% of remaining surface, respectively, P = 0.154).Conclusions: This experimental study suggests that I-CXL is a promising alternative methodology for riboflavin delivery in crosslinking treatments, preserving the epithelium.

Background: Apoptosis is a programmed cell death in multicellular organisms, found in a wide variety of conditions, including inflammatory process, everywhere in the body, including the cornea and conjunctiva. Aim: To evaluate the effect of a new topical formulation of sphingosine-1 phosphate on preventing apoptosis of the corneal epithelium. Setting: Medical University. Materials and Methods: We tested several formulations suitable for topical application. Twenty-five rabbits were distributed among five groups. Group 1 comprised the controls. In Group 2, 20% ethanol was applied topically for 20 seconds; in Group 3, 50 μM topical sphingosine-1 phosphate was applied 2 hours prior to 20% ethanol application. In Group 4, 200 μM topical sphingosine-1 phosphate was applied 2 hours before the 20% ethanol application. In Group 5, only 200 μM topical sphingosine-1 phosphate was applied. Apoptosis was evaluated using the terminal deoxynucleotidyl transferase biotin-dUTP Nick End Labeling (TUNEL) assay. Pairwise comparisons were performed using t-tests with Scheffe's correction. Data were analyzed using STATA 9.0 statistical software. Results: A suspension of sphingosine-1 phosphate in the presence of Montanox 80 was stable and could be formulated without sonication. Epithelial apoptosis was detected only in Groups 2 and 3. Conclusion: Sphingosine-1 phosphate can prevent ethanol-induced apoptosis in the corneal epithelium of rabbits.

The cornea is a transparent, avascular, and highly specialized connective tissue that provides the majority of light refraction in the optical system of the eye. The human cornea is composed of several layers interacting in a complex manner and possessing specific functions, like eye protection and optical clearness. Only few proteomic studies of mammalian cornea have been performed leading to the identification of less than 200 proteins in human corneas. The present study explores the proteome of the intact normal human cornea using a shot-gun nanoLC-MS/MS strategy and an LTQ Orbitrap mass spectrometer. A total of 2070 distinct corneal proteins were identified from five human cornea samples, which represents a 14-fold improvement in the number of proteins identified so far for human cornea. This enlarged dataset of human corneal proteins represents a valuable reference library for further studies on cornea homeostasis and pathophysiology. Network and gene ontology analyses were used to determine biological pathways specific of the human cornea. They allowed the identification of subnetworks of putative importance for corneal diseases, like a redox regulation and oxidative stress network constituted of aldehyde and alcohol dehydrogenases, most of them being described for the first time in human cornea.

Resume Objectif Definir des facteurs predictifs de succes apres implantation de segments d’anneaux intracorneens de type Ferrara dans le keratocone. Patients et methodes Vingt-cinq yeux de 25 patients atteints de keratocone ont beneficie d’une implantation manuelle d’anneaux intracorneens de Ferrara. Nous avons mesure la profondeur d’implantation des anneaux, la meilleure acuite visuelle corrigee (MAVC), les donnees refractives et keratometriques. Pour etudier les facteurs predictifs de succes, les patients ont ete repartis en deux groupes selon le gain de deux lignes ou plus de MAVC (« bons repondeurs ») ou la perte de lignes de MAVC, la stabilite, ou le gain d’une seule ligne de MAVC (« mauvais repondeurs »). Resultats A la fin du suivi postoperatoire de six mois, 41 % des patients presentaient un gain d’au moins deux lignes de MAVC, 31,8 % un gain d’une ligne, 13,6 % une stabilite et 13,6 % une perte de lignes de MAVC. Nous avons observe une diminution de la sphere moyenne de 4,39 a 2,34 dioptries (D) ( p p p p p Conclusion Si le traitement du keratocone par implantation d’anneaux intracorneens de Ferrara est une technique efficace, la definition de criteres predictifs de succes est primordiale pour poser l’indication operatoire.

Resume Introduction Notre etude a pour but de mieux caracteriser le phenotype de la myopie forte en analysant le profil biometrique oculaire d’une population myope forte et ainsi de verifier l’existence d’un reel phenotype homogene pouvant caracteriser la myopie forte. Patients et methodes Nous avons analyse les caracteristiques biometriques de 718 yeux de myopes ayant une erreur refractive superieure a5 dioptries. Les parametres biometriques (keratometrie, longueur axiale et pression intraoculaire) ont ete compares en fonction du sexe et du degre du trouble refractif. Resultats Il existe une heterogeneite des profils biometriques entre hommes et femmes. Le phenotype myopique des hommes est domine par une elongation isolee du globe oculaire alors que celui des femmes est la resultante d’une elongation de l’œil et d’une augmentation de la puissance corneenne. Cette difference de phenotype est d’autant plus vraie que l’on se situe a des niveaux intermediaires de myopie (entre −5 et −10 dioptrie). Au-dela de 15 dioptries, ces phenotypes semblent se rejoindre en un modele determine essentiellement par la longueur du globe oculaire. Conclusion Les myopes forts, tels qu’on les definit actuellement, ne presentent pas un phenotype homogene du fait, essentiellement, de differences entre les deux sexes ; cette homogeneite n’est en fait retrouvee qu’a partir de 15 dioptries d’erreur refractive.

Resume Objectif Rapporter les complications per- et postoperatoires de la technique de greffe lamellaire endotheliale par Descemet stripping automated endothelial keratopkasty (DSAEK) rencontrees au cours de l’apprentissage de la technique operatoire avec deux methodes differentes de transplantation du greffon. Materiel et methodes Nous avons realise une etude prospective monocentrique portant sur 32 yeux atteints de dystrophie endothelio-descemetique ou de decompensation endotheliale secondaire. La DSAEK a ete combinee a une chirurgie de la cataracte dans 15 cas. Les 23 premiers greffons ont ete introduits dans la chambre anterieure du receveur par la technique du « taco » et les 9 derniers greffons par la technique de la « spatule glissiere ». Nous avons releve les complications per- et postoperatoires ainsi que leur prise en charge. Resultats Les principales complications postoperatoires ont ete le decollement du greffon (22 %), la decompensation endotheliale primaire du greffon (9,5 %) et le rejet endothelial du greffon (9,5 %). La principale reintervention a ete l’injection postoperatoire d’air en chambre anterieure (22 %) en cas de decollement precoce du greffon. Nous avons du realiser une deuxieme DSAEK dans 6,2 % des cas et convertir secondairement en keratoplastie transfixiante dans 9,5 % des cas. Conclusion La DSAEK tend a remplacer la keratoplastie transfixiante dans le traitement des pathologies endotheliales en raison notamment du moindre risque de complications liees a l’ouverture du globe et a la presence de sutures. Cependant, elle expose a des complications specifiques comme le decollement postoperatoire du greffon et la decompensation endotheliale primaire du greffon.

Purpose To report the use of Descemet stripping automated endothelial keratoplasty (DSAEK) and to treat visual loss in Descemet membrane (DM) breaks after forceps delivery. Methods An 8-year-old boy presented with unilateral DM ruptures secondary to forceps delivery. Central, vertically oriented DM breaks significantly decreased visual acuity. Preoperative visual acuity was 20/80. A DSAEK was performed, the DM and endothelium were stripped from the recipient, and an 8.5-mm-diameter donor button consisting of posterior stroma and healthy endothelium was folded and implanted through a 5-mm incision. An air bubble was used to press the donor tissue against the recipient cornea, allowing it to attach without sutures. Results Graft dislocation in the early postoperative period required surgical repositioning of the donor lenticule, which led to excellent anatomic and functional outcomes. There was a significant and rapid improvement of the best-corrected visual acuity, which was 20/50 at the first month and 20/32 at the seventh month postoperatively. Conclusions To our knowledge, this is the first report of a DSAEK in a child with DM tears after forceps delivery. Selective replacement of posterior corneal layers with DSAEK might be a promising alternative to penetrating keratoplasty to successfully treat endothelial or DM lesions during childhood.

Objective To evaluate the safety, efficacy, predictability, stability, and complications of the foldable Artiflex iris-fixated intraocular lens (Ophtec BV, Groningen, The Netherlands) for the correction of myopia in phakic eyes. Design Prospective, nonrandomized, open-label, multicenter trial. Participants Two hundred ninety eyes of 191 patients aged 18 to 60 years with average spherical equivalent of –7.33±2.60 diopters (D; range, –12.63 to –1.5 D) were analyzed. Methods All eyes underwent implantation of the foldable iris-fixated Artiflex phakic intraocular lens (PIOL) with an optic zone of 6 mm. The follow-up was 2 years. Phakic intraocular lenses were implanted in powers ranging from –2.0 to –12.0 D. Main Outcome Measures The main parameters assessed were best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), refraction, and endothelial cell count. Results After 2 years, a UCVA of 20/40 or better was observed in 97.2% of eyes. The BSCVA was 20/40 or better in all eyes. A gain of 1 line or more of BSCVA was found in 49.9% of eyes, and 0.8% lost 2 or more lines. The mean endothelial cell change was –0.05%, 1.79%, and –1.07% at 6 months, 1 year, and 2 years, respectively. Complications were comparable with complications that have been reported previously of the Artisan PIOL, the only exception being a higher incidence of iris pigment precipitates (4.8% at 2 years after surgery). Conclusions After 2 years of follow-up, the implantation of the foldable iris-fixated Artiflex intraocular lens proved to be effective and predictable for the correction of myopia in phakic eyes. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Resume Introduction La greffe endotheliale par Descemet stripping automated endothelial keratoplasty (DSAEK) est une technique recente qui permet de ne greffer que la cornee posterieure du donneur. Le risque de rejet de greffe n’est cependant pas nul. Observations Nous rapportons trois cas de rejet endothelial apres DSAEK. Les rejets sont survenus 3, 4 et 18 mois apres la greffe alors que la corticotherapie locale avait ete interrompue. Dans les trois cas, le rejet etait endothelial, subaigu, paucisymptomatique. Conclusion Le risque de rejet endothelial apres DSAEK existe ; mais, le recul est encore trop court pour determiner son incidence. La survenue de rejets endotheliaux apres un arret precoce de la corticotherapie locale nous incite a conseiller une corticotherapie postoperatoire prolongee apres la greffe. Une evolution torpide est possible et le patient doit etre prevenu afin de consulter rapidement devant la moindre symptomatologie.

INTRODUCTION The aim of the present study was to evaluate the clinical usefulness of riboflavin- and ultraviolet-A (UV-A)-induced collagen cross-linking (CXL) on progressive keratoconus. PATIENTS AND METHODS Twenty eyes of 20 patients with progressive keratoconus were included in a prospective, nonrandomized pilot study. The preoperative progression of keratoconus was documented by an increase in maximum keratometry (Kmax) on serial corneal topographies. Preoperative corneal thickness was at least 400 microm. The postoperative progression of keratoconus was evaluated from corneal topography, best-corrected visual acuity (BCVA) testing, and corneal biomechanical properties assessed with the Ocular Response Analyzer (ORA). The follow-up time was between 3 and 18 months. RESULTS The steepening decreased significantly by 1.68+/-2.18 diopters (D) in the first year (p

Microphthalmia and anophthalmia are at the severe end of the spectrum of abnormalities in ocular development. Mutations in several genes have been involved in syndromic and non-syndromic anophthalmia. Previously, RAX recessive mutations were implicated in a single patient with right anophthalmia, left microphthalmia and sclerocornea. In this study, we report the findings of novel compound heterozygous RAX mutations in a child with bilateral anophthalmia. Both mutations are located in exon 3. c.664delT is a frameshifting deletion predicted to introduce a premature stop codon (p.Ser222ArgfsX62), and c.909C>G is a nonsense mutation with similar consequences (p.Tyr303X). This is the second report of a patient with anophthalmia caused by RAX mutations. These findings confirm that RAX plays a major role in the early stages of eye development and is involved in human anophthalmia.

International audience; The aim of this work was to analyse genetic influences on ocular refractive value and axial length using the hypothesis of a polygenic control. The genealogical records of 55 families were used in the analyses. The cohort included 723 individuals and clinical data were collected for 445 individuals with a mean age of 37.86 years. Ocular refraction was determined by standard autorefractometry. Axial length was evaluated by scan ultrasonography. Gender, age and ethnic origin were included as covariates in the statistical analyses. Using variance component analysis via a Markov Chain Monte Carlo (MCMC) method, we estimated the heritability of refractive value and axial length in the pedigree. We then performed a segregation analysis, using Loki, a (MCMC) linkage analysis program for multilocus inheritance models, examining different inheritance models with polygenic components. Polygenic control was modelled under an additive infinitesimal model (which assumes infinite loci with small effects, with additive actions) and under a finite locus model (i.e. several causal loci). The estimates of heritability were 0.20 (95% confidence interval (CI) 0.04e0.36) for refractive value and 0.20 (95% CI 0.03e0.43) for axial length. Segregation analyses suggested that ocular refraction and axial length are under a polygenic control. A finite number of genes were identified with or without a polygenic, infinitesimal component. Ocular refraction is mildly-moderately heritable in the studied population.