Comparison of corneal topography maps obtained using the IOLMaster 700® and the Anterion® in candidates for toric IOL implantation

OBJECTIVES

To compare central corneal topography (CT) obtained using the IOLMaster 700® biometer to corneal topography obtained using a Swept-Source OCT-based predicated topographer (PT), in candidates for toric intraocular lens (IOL) implantation.

METHODS

A retrospective comparative study was conducted in consecutive patients undergoing a routine cataract surgery assessment with significant astigmatism on keratometry. Each patient was examined using both the IOLMaster 700® (Carl Zeiss Meditec, Jena, Germany) and the Anterion® (Heidelberg Engineering, Heidelberg, Germany) for routine preoperative measurements. The corneal axial anterior power map obtained with each device was then anonymized and analysed independently by two ophthalmologists using a reading grid. The reading grid assessed the usual parameters describing astigmatism and evaluated if a toric IOL was indicated or a second topography examination was needed to confirm the indication.

RESULTS

In total, 169 eyes of 120 patients were included. The inter-examination agreement for the astigmatism description ranged from 56 to 85% depending on the reader and parameter. The decision to implant a toric IOL based on the axial map was the same in 59-60% of cases depending on the examiner. A second examination was needed in 18-25% and 8-14% of cases after CT and PT, respectively. The IOLMaster 700® central anterior axial map allowed toric IOL implantation in 58-70% of cases with no need for second corneal examination.

CONCLUSION

The agreement between the anterior axial maps obtained using both devices was good. However, in about a quarter of the cases, dedicated topography had to be performed to confirm the surgical indication.

Long-term real-life outcomes of the Clareon® hydrophobic intraocular lens: the Clarte study in 191 eyes : 3-years real-life outcomes of the Clareon® intraocular lens

BACKGROUND

To describe and analyze the real-life refractive, functional and safety outcomes of the Clareon® intraocular lens (IOL) after 3 years.

METHODS

Data was collected retrospectively for observational purposes between July 2017 and December 2019 in the ophthalmology department of Desgenettes military hospital in Lyon, France. Eyes that underwent cataract surgery with Claeron® implantation were consecutively included. Patients with a systemic or ocular condition that could affect the visual outcome were excluded. Postoperative corrected (CDVA) and uncorrected (UDVA) distance visual acuities as well as capsule and IOL transparency were assessed at 1 month and 3 years.

RESULTS

A total of 326 eyes were analyzed at one month and 191 eyes were reassessed at the 3-year follow-up visit. At 3 years, the mean CDVA was 0.003 LogMAR (95% confidence interval [CI]: -0.003 to -0.01) and the mean UDVA was 0.075 (95% CI: 0.054 to 0.095). Three quarters of the patients had an UDVA ≥ 0.097 logMAR (20/25 Snellen equivalent) and 50% had an UDVA ≥ 0 (20/20). The absence of glistening was reported in 95.3% of cases and 4.7% [9] of patients experienced a clinically significant posterior capsular opacification (PCO) for which Nd:YAG treatment was required.

CONCLUSIONS

This real-life study reports high-performance and stable long-term refractive outcomes of the Clareon® IOL with good safety in terms of PCO and glistening.

[Intraoperative opacification of a scleral-fixated Carlevale (Soleko®) intraocular lens]

Thermal shock can cause intraoperative opacification of a Carlevale (Soleko®) implant. This is a rare phenomenon which resolves spontaneously. It is crucial to recognise this phenomenon in order to avoid unnecessary and potentially harmful explantation decisions for the patient.

Long Intervals between Intravitreal Injections Using a Treat-and-Extend Protocol in a Real-Life Context in AMD: The LIRE Study

INTRODUCTION

The aim of the study was to assess the outcome of long treat-and-extend (TE) anti-VEGF intravitreal injection (IVI) intervals (≥every 12 weeks [Q12W]) in neovascular age-related macular degeneration (nAMD). The aims of this retrospective study were to determine the proportion of nAMD eyes treated ≥ Q12W, to analyze their longitudinal, functional, and anatomical outcomes, and to compare functional and anatomical outcomes between eyes that rapidly versus slowly reached a Q12W regimen and between eyes directly treated with versus initiating lately the TE regimen.

METHODS

All patients receiving IVIs for nAMD were screened. The longitudinal, functional, and anatomical characteristics of Q12W-treated eyes were reported at different timepoints.

RESULTS

Ninety-one eyes were included (38% of our total nAMD cohort). The mean TE regimen time to reach a Q12W interval was 20.1 ± 16.2 months. During this time, a mean number of 12.1 ± 9.3 IVIs were needed. The mean best-corrected visual acuity was 68 letters at the time of diagnosis and was maintained (p > 0.05). Eyes that rapidly reached a Q12W interval had a shorter follow-up before TE regimen initiation (p = 0.04) and received fewer IVIs (p = 0.02) than eyes that slowly reached a Q12W interval. Eyes directly treated with the TE regimen reached a Q12W interval more rapidly than eyes with late TE initiation. The neovascularization subtype was not a predictor of outcome in TE-treated eyes.

CONCLUSION

≥Q12W eyes represent an important part of the nAMD population in our real-life study. No baseline anatomical characteristics were associated with the outcome under a TE regimen, although early TE regimen initiation allowed extending more rapidly the IVI interval.

[Late steroid-induced ocular hypertension after intravitreal dexamethasone implants: A series of 20 cases]

INTRODUCTION

Steroid-induced ocular hypertension (OHT) occurs in approximately one third of cases after dexamethasone implant (DEXi) injection. Among these, more than one fifth occur after the third DEXi intravitreal injection (IVI). Our goal was to analyze the clinical profiles of these late responders.

MATERIAL AND METHODS

A real-life, retrospective, observational study was conducted to assess demographic characteristics and intraocular pressure (IOP) responses in late responders (IOP ≥ 21mmHg, n DEXi ≥ 4). The following parameters were analyzed: IOP 2 months after IVI and number of glaucoma medications needed. The IOP response compared to baseline was defined as low (< +6mmHg), moderate (≤ +15mmHg) or high (> 15mmHg).

RESULTS

Late steroid-induced OHT occurred in 20.8% of cases. Twenty eyes (18 patients) were included. The mean duration of follow-up was 3.8±1.9 years. They received a mean number of 9.5±4.2 IVI. The first OHT peak, measured at 25.3±3.2mmHg (21-31), occurred after 6.8±2.3 IVI. Approximately 65% of OHT spikes occurred between the fourth and sixth IVI; 35% occurred later. At maximum, 1.7±1.0 glaucoma medications and 0.75±0.79 SLT procedures were required to control the OHT, with no filtering surgery required. The ratio of "low," "moderate," and "high" responders was 5%, 85% and 10% respectively.

CONCLUSION

Late steroid-induced OHT occurs after at least 3 DEXi in one fifth of multi-injected patients, requiring long-term IOP monitoring. This case series identifies mostly moderate responder profiles, whose IOP rise often remains well-controlled with medical management or laser treatment (SLT).

Management of diabetic macular oedema in France from 2012 to 2018: The nationwide LANDSCAPE study

OBJECTIVE

To describe the management of diabetic macular oedema (DME) patients from the entire French population between 2012 and 2018.

METHODS

In this retrospective longitudinal study, we identified adults treated for DME from the French population using the exhaustive French National Health Information database (SNDS), and an algorithm based on diagnosis and procedure codes, and reimbursed treatments.

RESULTS

Between 2012 and 2018, we identified 53 584 treated DME patients, who were followed for up to 7 years from DME treatment initiation. Optical coherence tomography (OCT) became the predominant imaging tool to diagnose DME. Only 14% of patients consulted a diabetologist or endocrinologist in the 3 months prior to initiating DME treatment, whereas 84% consulted a general practitioner. The percentage of patients consulting an ophthalmologist declined over time, from 97% of patients in Year 1 (median of 9 consultations), to 46% in Year 7 (median of 7 consultations). The median DME treatment duration with an anti-VEGF and/or dexamethasone implant treatment was 9 months; 54% of patients had a treatment duration less than 1 year. First-line treatment was more common with ranibizumab (55% of patients) than with aflibercept (30%), or dexamethasone implant (15%). About 25% of patients who initiated anti-VEGF treatment switched treatment at least once, while 30% of patients who initiated dexamethasone implant switched to anti-VEGF treatment at least once.

CONCLUSIONS

French DME patients seem well-monitored by their ophthalmologist, but median DME treatment duration was just 9 months. These results emphasise the challenge to manage and treat patients with DME over the long term.

Incidence of Nd:YAG laser capsulotomy following cataract surgery: a population-based nation-wide study - FreYAG1 study

RATIONALE

Nd:YAG (neodymium:yttrium-aluminum-garnet) capsulotomy (Nd:YAG-caps) is the gold standard for the treatment of PCO (Posterior Capsule Opacification). There is a lack of real-world data about Nd:YAG-caps use.

PURPOSE

This study's objectives were to estimate Nd:YAG-caps incidence in France, to describe the patient characteristics, and to analyze the time between surgeries and capsulotomies.

SETTING

The study was based on data extracted from the EGB database, a 1/97th sample representative of the French population.

DESIGN

observational, retrospective, cohort study using national claims data.

METHODS

French adult patients who underwent Nd:YAG-caps between 2014 and 2017 were selected. Main outcomes were the number of patients and procedures performed and the risk factors associated with early Nd:YAG-caps.

RESULTS

During the study period, Nd:YAG-caps were performed in 8,425 patients accounting for 10,774 procedures. The extrapolation to the French population led to estimate that 253.103 patients had Nd:YAG-caps, representing 312.103 procedures in 2017. The mean age at Nd:YAG-caps was 75.1 (± 10.2) years. About 36% of patients presented at least one ocular comorbidity. Nd:YAG-caps was performed within 2 years after surgery in 33.0% of patients and within one year in 9.8% of patients. Patients with Nd:YAG-caps within the first year (OR CI95 0.721 [0.673-0.772]) or in the first two years (OR CI95 0.721 [0.673-0.772]) were younger than patients with later Nd:YAG-caps and had a more frequent history of treated ocular diseases (OR 1.516 and 1.178, respectively).

CONCLUSIONS

This study brought new real-world and large-scale data regarding Nd:YAG-caps use and gave an updated insight into the patients' characteristics.

Management of Neovascular Age-Related Macular Degeneration Treatment in France from 2008-2018: The Nationwide LANDSCAPE Study

INTRODUCTION

The aim of this study was to describe the management of neovascular age-related macular degeneration (nAMD) in French patients between 2008 and 2018.

METHODS

This was a retrospective longitudinal cohort study using exhaustive nationwide health records from the French National Health Information database. Enrollment criteria were adults aged ≥ 50 years, nAMD diagnosis, or reimbursement for nAMD treatments (anti-vascular epithelial growth factor [VEGF] injection or dynamic phototherapy with verteporfin). Exclusion criteria were high myopia, diagnosis of other retinal diseases, and treatments for other macular diseases (dexamethasone implant, laser). Main outcome measures were consumption of medical care and nAMD treatments per calendar year and number of years of follow-up.

RESULTS

Between 2008 and 2018, we identified 342,961 patients who have been treated for nAMD. Median duration of ophthalmological follow-up exceeded 7 years (90 months). The median annual number of ophthalmology consultations decreased from nine visits in year 1 after treatment initiation to four visits from year 7 onwards. The median duration of nAMD treatment was 10.1 months for all patients, with 48.5% of patients undergoing treatment for < 1 year. Only 24.4% of patients had maintained treatment at year 11. Patients remaining under treatment had a median of four anti-VEGF treatments per year throughout the 10-year study period. Ranibizumab was the more common first-line treatment (67.5% of patients) compared to aflibercept (32.4%). About 20% of patients who initiated treatment switched treatment at least once.

CONCLUSIONS

LANDSCAPE provides exhaustive nationwide data on the real-world management of nAMD in France over a 10-year period. Further investigation into short treatment duration is required, especially in terms of understanding its relation to visual outcomes.

Ocular hypertension and intravitreal steroids injections, update in 2023. French guidelines of the French glaucoma society and the French ophthalmology society

These guidelines are a consensus of French glaucoma and retina experts on the management of ocular hypertension (OHT) observed in a third of the cases after corticosteroid implant intravitreal injections. They update the first guidelines published in 2017. Two implants are marketed in France: the dexamethasone implant (DEXi) and the fluocinolone acetonide implant (FAci). It is essential to assess the pressure status before injecting a patient with a corticosteroid implant. A molecule-specific monitoring of the intraocular pressure is needed throughout the follow-up and at the time of reinjections. Real-life studies have allowed optimizing the management algorithm by significantly increasing the safety of these implants. Corticosteroid testing with DEXi should be performed before switching to FAci to optimize pressure tolerance of FAci. Beyond topical hypotensive treatments, selective laser trabeculoplasty may be considered in the therapeutic arsenal for the management of steroid-induced OHT and subsequent injections.

[Intraocular pressure elevation and intravitreal steroid implant injection: State of the art in 2023. Recommendations of the French Glaucoma Society and French Ophthalmology Society [French version]]

These are the recommendations of French glaucoma and retina experts on the management of ocular hypertension (OHT) observed in 1/3 of cases after intravitreal steroid implant injections. They are an update to the recommendations first published in 2017. There are two implants on the French market: the dexamethasone (DEXi) and fluocinolone acetonide (FAci) implants. It is important to know the pressure status before injecting a patient with a steroid implant. Monitoring of the IOP adapted to the specific drug is necessary throughout follow-up and reinjections. Real-life studies have made it possible to optimize the management algorithm by significantly increasing the safety of use of these implants. A corticosteroid test with DEXi is necessary before switching to FAci to optimize the pressure tolerance of the latter. In addition to topical glaucoma medications, SLT laser can be considered in the therapeutic arsenal for the management of steroid-induced OHT and future injections.

Impact of Total Corneal Astigmatism Estimated With the Abulafia-Koch Formula Versus Measured With a SS-OCT Biometer on the Refractive Outcomes of a Toric Intraocular Lens in Cataract Surgery

PURPOSE

To compare the impact of total corneal astigmatism (TCA) estimated with the Abulafia-Koch formula (TCA^ABU) versus measured by Total Keratometry (TK), swept-source optical coherence tomography (OCT) coupled with telecentric keratometry (TCA^TK) on the refractive outcomes after cataract surgery with toric intraocular lens (IOL) implantation.

METHODS

Two hundred one eyes of 146 patients who underwent cataract surgery with toric IOL implantation (XY1AT; HOYA Corporation) were included in this single-center, retrospective study. For each eye, TCA^ABU (estimated from the anterior keratometry values measured with the IOLMaster 700 [Carl Zeiss Meditec AG]) and TCA^TK (measured using TK IOLMaster 700) were entered into the HOYA Toric Calculator. Patients were operated on based on TCA^ABU. For each eye, centroid and mean absolute error in predicted residual astigmatism (EPA) were calculated according to TCA used (TCA^ABU or TCA^TK). The cylinder power and the axis of the posterior chamber IOL were compared.

RESULTS

The mean uncorrected distance visual acuity was 0.07 ± 0.12 logMAR, the mean spherical equivalent was 0.11 ± 0.40 D, and mean residual astigmatism was 0.35 ± 0.36 D. Mean centroid EPA was 0.28 D at 132° with TCA^ABU and 0.35 D at 148° with TCA^TK (P(x) < .001; P(y) < .01). Mean absolute EPA was 0.46 ± 0.32 D with TCA^ABU and 0.50 ± 0.37 D with TCA^TK (P < .01). In the with-the-rule astigmatism subgroup, a deviation from the target of less than 0.50 D was achieved in 68% of eyes with TCA^ABU versus 50% of eyes with TCA^TK. The proposed posterior chamber IOL was different depending on the calculation methods used in 86% of cases.

CONCLUSIONS

Both calculation methods showed excellent results. However, the predictability error was significantly reduced when TCA^ABU was used compared to TCA^TK measured with the IOLMaster 700 in the whole cohort. Finally, TCA was overestimated by TK in the with-the-rule astigmatism subgroup. [J Refract Surg. 2023;39(3):171-179.].

Incidence of Retinal Detachment, Macular Edema, and Ocular Hypertension after Neodymium:Yttrium-Aluminum-Garnet Capsulotomy: A Population-Based Nationwide Study-The French YAG 2 Study

PURPOSE

To estimate the incidence and assess the risk factors associated with 3 adverse events (AEs) after neodymium:yttrium-aluminum-garnet posterior capsulotomy (Nd:YAG-caps): ocular hypertension (OHT), macular edema (ME), and retinal detachment (RD).

DESIGN

Observational cohort study using a nationwide claims database.

PARTICIPANTS

Adults who underwent Nd:YAG-caps between 2014 and 2017, with no ocular disease history in the year before.

METHODS

Patients who underwent Nd:YAG-caps were identified using data from the French national representative sample and followed up for 12 months postprocedure. The time to AE was assessed using the Kaplan-Meier method. Factors associated with AE were assessed using Cox models.

MAIN OUTCOME MEASURES

Neodymium:YAG-caps epidemiology, patients' characteristics, proportion of patients with AE, and hazard ratios (HRs) associated with variables identified as factors associated with AEs.

RESULTS

During the study period, 6210 patients received Nd:YAG-caps (7958 procedures). The mean age (± standard deviation) at Nd:YAG-caps was 75.0 (± 10.3) years. The 3-month and 12-month overall AE rates (≥ 1 AE of interest) were 8.6% and 13.3%, respectively. Among patients with ≥ 1 AE of interest, 68.4% of AEs occurred within 3 months post-Nd:YAG-caps. Three-month rates were ≈5% for OHT and ME. Retinal detachment remained ≤ 0.5% over follow-up. Cox models showed that patients with Nd:YAG-caps performed within 1 year after cataract surgery had a higher risk of AEs than those with later Nd:YAG-caps (hazard ratio [HR], 1.314 [1.034-1.669], P = 0.0256), notably ME (HR, 1.500 [1.087-2.070], P = 0.0137). Diabetic patients were more at risk of OHT (HR, 1.233 [1.005-1.513], P = 0.0448) and ME (HR, 1.810 [1.446-2.266], P < 0.0001) than nondiabetic patients. Patients with Nd:YAG-caps performed between 1 and 2 years after cataract surgery were more at risk of OHT than patients with later Nd:YAG-caps (HR, 1.429 [1.185-1.723], P = 0.0002).

CONCLUSIONS

According to a national claims database, OHT and ME were the most frequent AEs of interest post-Nd:YAG-caps, mainly observed within 3 months postprocedure, highlighting the need for a close follow-up during this period or a delayed capsulotomy. Diabetes and an early Nd:YAG-caps after cataract surgery were among the main drivers for AE occurrence.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Two-year outcomes of the APOLLON observational study of intravitreal aflibercept monotherapy in France in patients with diabetic macular edema

APOLLON (NCT02924311) was a prospective observational study to evaluate the effectiveness of intravitreal aflibercept (IVT-AFL) treatment of diabetic macular edema (DME) over 24 months in routine clinical practice in France. The primary endpoint was mean change from baseline in best-corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study letters) by 12 months, and safety was monitored throughout the study. Of 402 patients enrolled across 61 participating clinics and hospitals in France, 168 patients were followed for at least 24 months and included in the effectiveness analyses (79 treatment-naïve and 89 previously treated). After 24 months of IVT-AFL treatment, the mean (± standard deviation [SD]) change in BCVA from baseline was + 6.5 (± 10.7) letters in treatment-naïve patients (p < 0.001) and + 1.6 (± 17.0) letters in previously treated patients (p = 0.415) from a baseline of 63.8 (± 13.6) and 60.5 (± 16.5) letters. The mean number of IVT-AFL treatments over 24 months was 11.3 (± 4.9) and 11.9 (± 4.7) for treatment-naïve and previously treated patients. This final analysis of the APOLLON study indicated that following 24 months of IVT-AFL treatment in routine clinical practice in France, treatment-naïve patients with DME achieved significant gains in visual acuity and previously treated patients maintained prior visual acuity gains.Trial registration number: NCT02924311.

Epidemiology of Treated Diabetes Ocular Complications in France 2008-2018-The LANDSCAPE French Nationwide Study

AIM

LANDSCAPE aimed to estimate the annual incidence and prevalence of treated diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) between 2008 and 2018.

METHODS

This French nationwide observational study used data from the French National Health Insurance Databases covering 99% of the French population. Data about healthcare consumption were used to identify adults treated with anti-VEGFs or dexamethasone implants (for DME) and with pan-retinal photocoagulation (for PDR). All French patients newly treated between 2008 and 2018 were included. Incidence and prevalence of treated DME and PDR were estimated for the age-matched general population and the population with diabetes in France. Sociodemographic characteristics and medical history were described in both populations.

RESULTS

We identified 53,584 treated DME patients and 127,273 treated PDR patients between 2008 and 2018, and 11,901 DME and 11,996 PDR new incident patients in 2018. The treated DME incidence in 2018 was 2.5 per 10,000 in the general population and 37.3 per 10,000 in the population with diabetes. Prevalence in 2018 was 9.5 and 143.7 per 10,000 in the respective populations. Treated PDR incidence in 2018 was 2.3 per 10,000 in the general population and 31.2 per 10,000 in the population with diabetes. Prevalence in 2018 was 19.9 and 270.3 per 10,000 in the respective populations. Incidence and prevalence were not age-dependent. Incidence of treated PDR incidence was relatively stable from 2008-2018. Incidence of treated DME incidence rose from 2012-2018, probably due to widening access to newly available treatments, such as anti-VEGFs.

CONCLUSIONS

We provide exhaustive nationwide data on the incidence and prevalence of treated diabetic ocular complications in France over a 10-year period.

Real-Life Value of the Odysight® Application in At-Home Screening for Exudative Recurrence of Macular Edema

Background: The aim of this study was to describe the value of the Odysight® application in addition to a classical follow-up regimen in the detection of exudative recurrences in patients with macular edema. Methods: We conducted an observational, multicenter, retrospective study. The Odysight® application includes a visual acuity (VA) test that can lead to alerts in case of a drop of >5 VA letters on two successive tests. The efficacy of the alerts in detecting exudative recurrence was studied. Results: A total of 149 eyes of 123 patients were included. The sensitivity of alerts for the detection of recurrence was 30.8% (95% CI [17.6; 44.0]) and its specificity was 83.7% (95% CI [73.2; 94.3]. A better baseline VA was found to be significantly associated with a better retention of the application (OR = 0.05, 95% CI [0.002; 0.62]; p = 0.045). Of the 12/39 alerts that detected a recurrence, eight (20.5% of all alerts) resulted in the scheduling or advancement of an intravitreal injection. Conclusions: In the present study, the sensitivity and positive predictive value of the Odysight® application seems low but its use in addition to the usual follow-up of the patient can detect, in certain cases, an early recurrence and thus allow an anticipated readjustment of the treatment.

Efficacy and Safety of Intravitreal Fluocinolone Acetonide Implant for Chronic Diabetic Macular Edema Previously Treated in Real-Life Practice: The REALFAc Study

Diabetic macular edema (DME) is the main cause of visual impairment in diabetic patients and a chronic disease requiring long-term treatments. The fluocinolone acetonide (FAc) implant has recently been approved to treat DME in patients considered insufficiently responsive to available therapies. This study evaluates the functional and anatomical efficacy of the FAc implant in real-life practice. A total of 62 eyes with chronic DME were included and followed for a mean of 13.9 (+7.5) months. Previous treatment included at least anti-vascular endothelial growth factor (VEGF) in 83.9% of eyes, dexamethasone implant (DEX-I) in 100% of eyes, vitrectomy in 29.0% of eyes, and laser photocoagulation (either panretinal or focal photocoagulation) in 75.8% of eyes. The mean baseline best corrected visual acuity (BCVA) was 64.0 (+/−17.2) letters (median: 67.5 letters) with a mean DME duration of 60.3 (+/−30.6) months. The maximum BCVA gain occurred at 21 months with a mean gain of 5.0 (+/−12.7) letters. A total of 50.0% of eyes gained ≥5 letters during follow-up. Patients with lower BCVA at baseline had the lowest final BCVA (p < 0.001) but the highest BCVA gain (p = 0.02). The best overall improvement in mean central macular thickness (CMT) occurred at 18 months (p < 0.0001). The improvement in BCVA was inversely associated with the decrease in CMT and showed a decrease when CMT increased (DME recurrence). According to the history of vitrectomy, we did not find any significant difference in mean final BCVA (p = 0.1) and mean BCVA gain (p = 0.2) between eyes previously vitrectomized or not. A total of 23 eyes (37.1%) required additional treatment for DME, and 17.7% required an IOP-lowering procedure during follow-up. In conclusion, this real-life observational study demonstrated the efficacy and safety of the FAc implant in patients with chronic DME already treated with other available therapies.

Comparative Effectiveness of Intravitreal Anti-Vascular Endothelial Growth Factor Therapies for Managing Neovascular Age-Related Macular Degeneration: A Meta-Analysis

Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) have become the standard of care for age-related macular degeneration (AMD). Although most pivotal trials have used monthly injections, alternative strategies that enable the injections to be administered on a more flexible schedule, including pro re nata (PRN) and treat-and-extend (T&E) regimens, are being applied more frequently. This review sought to provide further scientific evidence about the visual outcomes and treatment burden among the currently available anti-VEGF agents and regimens, including aflibercept, ranibizumab, abicipar and brolucizumab. To this end, a systematic review of published randomized studies was conducted from the MEDLINE and EMBASE databases and the Cochrane library, and a meta-analysis was applied to the obtained data using single-means modeling to compare the efficacy and maintenance among the different available treatments and regimens at Years 1 and 2. Quality analysis identified the best-informed data for modeling purposes. Overall, 47 relevant publications were retrieved for the analysis. Superior efficacy, meaning that there were observed improvements in visual acuity (VA) and central retinal thickness (CRT), occurred with monthly versus PRN regimens, yet a higher IVI number was also observed. Conversely, the T&E regimens displayed similar efficacy to the monthly regimens, but with a reduced IVI number. Aflibercept T&E exhibited similar efficacy to ranibizumab T&E, but with significantly lower IVI numbers at both Year 1 (p < 0.0001) and Year 2 (p = 0.0011). Though all of the regimens resulted in maintained efficacy between Years 1 and 2, the required IVI number varied. The retrieved data did not enable other regimens or newer anti-VEGF agents such as brolucizumab to be compared. In conclusion, the T&E regimens were shown to be the most efficient, optimizing durable effectiveness whilst minimizing the IVI number in newly diagnosed exudative AMD, with aflibercept requiring the lowest IVI number.

Macular edema in Cogan-Reese syndrome

PURPOSE

Iridocorneo-endothelial (ICE) syndrome is known as a rare spectrum causing glaucoma, corneal and iris damages. Retinal complications are uncommon.

OBSERVATIONS

We report the case of a middle-aged woman suffering from a Cogan-Reese Syndrome (CRS) with refractory ocular hypertension (OHT) who presented a cystoid macular edema (CME) during follow up.

CONCLUSIONS AND IMPORTANCE

We suspect the CME to be inflammatory linked to the pathophysiological hypotheses of the CRS. The CME was successfully treated with topical nonsteroidal anti-inflammatory drugs (NSAID). No consensus is available on its duration. A recurrence happened when treatment was stopped, its reintroduction was successful.

A prospective multicentre study of intravitreal injections and ocular surface in 219 patients: IVIS study

PURPOSE

To assess the impact of intravitreal injections (IVTI) on ocular surface of patients treated with multiple injections.

METHODS

Prospective, tricentric study conducted in patients treated with unilateral IVTI. An asepsis protocol with povidone-iodine was used for all patients during IVTI. The primary endpoint was the difference between the pre-IVTI Ocular Surface Disease Index (OSDI 1) score and that measured on day one (D1) post-IVTI (OSDI 2). Secondary endpoints were the evaluation of predictive factors for OSDI scores, pain assessment on D1, and the Lacrydiag® analysis of tears from the injected eye versus contralateral eye before IVTI.

RESULTS

Two hundred and nineteen patients with a mean age of 75.9 ± 10 years were included. The mean OSDI2-OSDI1 difference was 19.2 ± 20.6 (p < 0.001). The mean noninvasive tear break-up time was 6.41 ± 4.59 seconds in the injected eye versus 7.36 ± 4.36 seconds in the contralateral eye (p < 0.001). In the multivariate analysis, the factors significantly associated with the OSDI 2 score were the OSDI 1 score (p < 0.001), the pain score on D1 (p < 0.001) the number of instilled glaucoma eye drop (p = 0.01) and a centre effect (centres 2 and 3 versus centre 1, p < 0.001).

CONCLUSION

Our results confirm the impairment of the ocular surface and quality of life immediately after an IVTI. These results suggest 3 levels of action to improve the immediate tolerance: improving the basal status of the ocular surface, reducing the contact time with povidone-iodine that might be toxic to the surface, and improving immediate post-IVTI treatment.

Should Artificial Tears Be Used During the Preoperative Assessment of Toric IOLs Before Age-Related Cataract Surgery? The TORIDE Study

PURPOSE

To assess the impact of the use of artificial tears during the preoperative work-up performed before age-related cataract surgery, when a toric intraocular lens (IOL) was indicated.

METHODS

This was a monocentric prospective study assessing 73 eyes of 51 patients, included consecutively after a preoperative work-up performed without artificial tears (no artificial tears group), when a toric IOL was indicated. Each included patient underwent a second series of examinations: biometry using the IOLMaster 700 (Carl Zeiss Meditec AG) and topography using the OPD-Scan II (Nidek), 1 minute after artificial tears instillation (artificial tears group; hyaluronate de sodium 0.15%, threalose 3% [Théalose; Théa]). Changes in anterior corneal astigmatism and subsequent changes in toric IOL calculation were analyzed. The error in predicted residual astigmatism was calculated.

RESULTS

Anterior corneal astigmatism and total corneal astigmatism measured with the IOLMaster 700 were significantly modified when artificial tears were instilled before the examinations (1.51 ± 0.57 diopters [D], range: 0.75 to -3.55 vs 1.42 ± 0.63 D, range: 0.42 to 3.35 D; P = .043 and 1.59 ± 0.54 D, range: 0.87 to 3.48 vs 1.51 ± 0.59 D, range: 0.56 to 3.27 D, P = .038, respectively). This modification led to a change in IOL cylinder calculation in 43.8% of cases and to a change in implantation axis greater than 10° in 17.7% of cases. These changes were significantly greater in patients with a breakup time (BUT) less than 5 seconds (57.5% and 27.8%, with P = .009 and .029, respectively). In the subgroup of patients with a BUT of less than 5 seconds, the mean absolute error in predicted astigmatism was significantly lower after artificial tears instillation (0.48 ± 0.50 D, range: 0.00 to 2.79 vs 0.37 ± 0.25 D, range: 0.00 to 1.10 D, P = .048).

CONCLUSIONS

Dry eye significantly impacted toric IOL calculations and should be taken into account during the preoperative assessments. Using artificial tears reduced the number of refractive errors. [J Refract Surg. 2021;37(11):759-766.].

LONG-TERM INCIDENCE AND RISK FACTORS OF OCULAR HYPERTENSION FOLLOWING DEXAMETHASONE-IMPLANT INJECTIONS: THE SAFODEX-2 STUDY

PURPOSE

To analyze the incidence, risk factors, and time to onset of ocular hypertension (OHT) after intravitreal injections (IVI) of dexamethasone implant and to evaluate the long-term cumulative probability of intraocular pressure elevation.

METHODS

Eyes of patients having received at least one dexamethasone implant IVI between October 2010 and February 2015 were included in the present study. Ocular hypertension was defined as intraocular pressure > 25 mmHg and/or an increase of 10 mmHg over the follow-up period compared with baseline intraocular pressure.

RESULTS

Four hundred ninety-four eyes were studied in 410 patients. For a total of 1,371 IVI, the incidence of OHT was 32.6% in the study eyes with a mean follow-up period of 30 months (3-62.5) and a median follow-up of 29 months. Pressure-lowering treatment was introduced for 36.9% of eyes. Topical treatment alone was sufficient to manage OHT in 97%. Young age, male sex, uveitis and retinal vein occlusion, and glaucoma treated with a double- or triple-combination topical pressure-lowering medication were found to be risk factors for OHT. The incidence of OHT did not change with an increase in the number of IVI, and there was no cumulative effect, defining by an increase of the incidence of OHT in patients after repeated IVI (P = 0.248).

CONCLUSION

This study confirmed that OHT is of moderate incidence, transient, controlled by topical treatment and provides data on the long-term cumulative probability of intraocular pressure elevation in a large cohort of eyes treated with dexamethasone implant IVI. Repeat injections of dexamethasone implant neither increase nor decrease the risk of OHT.

[Treatment of exudative age-related macular degeneration: Consensus of French experts for first-line treatment selection and the importance of long-term risk/benefit ratio]

Choosing a first-line treatment to optimize long-term outcomes is a major challenge for treating patients with neovascular age-related macular degeneration (AMD). The development of several new molecules makes it critical to identify the relevant factors to consider so as to provide an optimal risk-benefit ratio when initiating a treatment in naïve patients with neovascular AMD. This paper proposes a consensus established with the Delphi method (which includes a gradation in a consensus based on an analysis of the convergence rate of answers) to provide criteria that guide the ophthalmologist's decision for treatment initiation and follow-up in neovascular AMD patients. Fourteen questions were submitted to 93 French retina experts. Thirteen (93%) of the questions reached a consensus (≥50% of answers consensual). The criteria recommended to take into account were both efficacy and onset of action of the molecules, their safety, and the ability to decrease injection frequency. The primary criterion of expected efficacy of a molecule is a combination of the gain in visual acuity and resorption of retinal fluid. With regard to safety, experts recommend tighter follow-up for molecules currently in development, and at every scheduled visit, patients should be screened to identify early any potential adverse effects such as intraocular inflammation, retinal vasculitis or vascular occlusion. Experts also emphasize the importance of the packaging of the biological, with a preference toward prefilled syringes. Injection frequency is a key factor, and the authors recommended aiming for a maximal injection interval of 12 to 16 weeks. The stability of that maximum interval is also an important factor to consider in treatment selection.

ETOILE: Real-World Evidence of 24 Months of Ranibizumab 0.5 mg in Patients with Visual Impairment Due to Diabetic Macular Edema

Purpose

To evaluate the real-world effectiveness of intravitreal ranibizumab 0.5 mg (Lucentis) in improving visual acuity (VA) in adults with decreased VA due to diabetic macular edema (DME).

Patients and Methods

Real-world prospective observational 24-month study. Ranibizumab-naïve patients (n=116) were enrolled, treated and followed up according to investigators’ usual procedures. Outcomes included change from baseline to month 24 in best-corrected VA (BCVA; primary outcome), central retinal thickness (CRT), treatment exposure and safety.

Results

Overall, 62.9% of patients completed the study per protocol, 68.6% completed the induction phase (first three injections one month apart). On average, patients had 12.5 ophthalmologist visits and 5.74 injections in year 1, decreasing to 4.6 visits and 1.94 injections in year 2. Mean baseline BCVA was 58.4 letters, mean gain at M24 was +6.08 letters (95% CI: 2.95, 9.21). Gains were higher for patients who completed induction, and for patients who did not switch treatment. Mean CRT improved by 149.17 μm at M24. There were no new safety signals. BCVA variation of ≥6 letters by M3 was predictive of BCVA gains at M24 (p=0.007), as was hypertension medication at baseline (p=0.022).

Conclusion

Real-world ranibizumab treatment improved VA in DME patients, despite fewer injections than recommended.

Impact of measured total keratometry versus anterior keratometry on the refractive outcomes of the AT TORBI 709-MP toric intraocular lens

PURPOSE

The aim of this study was to compare the visual and refractive outcomes of total keratometry (TK) versus anterior keratometry (AK) measurements of the IOLMaster 700® (Carl Zeiss Meditec AG, Jena, Germany) in surgery for age-related cataract with preexisting corneal astigmatism.

METHODS

Monocentric retrospective comparative study. The IOLMaster 700® biometer was used in the 2 groups: in AK mode (AK group) and in TK mode (TK group), for toric IOL (AT TORBI 709 MP) calculation with ZCALC®, Zeiss toric IOL calculator. A 2:1 matching was made between the AK and TK groups. Uncorrected distance visual acuity (UDVA), the correction index and the error in predicted residual astigmatism were analyzed 1 month postoperatively using the vector analysis by the Alpins method.

RESULTS

The whole cohort included 405 eyes distributed as follows after 2:1 matching: 158 eyes in the AK group and 79 eyes in the TK group. The mean UDVA was similar in both groups (0.07 ± 0.10 LogMAR; p = 0.587). No significant difference in mean absolute error in predicted residual astigmatism (0.37 ± 0.33 D versus 0.35 ± 0.26 D; p = 0.545) and in mean centroid error in predicted residual astigmatism (0.19 ± 0.49 at 3° and 0.06 ± 0.46 at 0°; p = 0.008 and 0.161 respectively for the x- and y-components) was found between the AK and TK groups.

CONCLUSION

TK of the IOLMaster 700® gives excellent refractive and visual outcomes, comparable to those obtained in AK mode, without showing its superiority for corneas with regular astigmatism.

Long-term follow-up of diabetic macular edema treated with dexamethasone implant: a real-life study

AIMS

To evaluate the efficacy and safety of intravitreal dexamethasone implant (DEX-implant) for diabetic macular edema (DME) in real-life practice with an extended follow-up for up to 5 year.

METHODS

This multicentric retrospective study reviewed 227 eyes of 152 patients with DME treated by DEX-implant. Main outcome measures included changes in best corrected visual acuity (BCVA), central macular thickness (CMT), time to retreatment and incidence of adverse effects.

RESULTS

The mean number of DEX-implant received by patients was 2.6 (± 2.2) with a mean (SD) follow-up of 20.1 (± 15.8) months, median [IQR] 15.8 [7.4-30.1]. The mean time of retreatment was 6.9 months. The mean maximal BCVA gain during follow-up was 12.3 (± 12.7) letters. A gain of ≥ 5, ≥ 10 and ≥ 15 letters from baseline BCVA was obtained for 71.8%, 48.9% and 34.8% of eyes, respectively. A total of 62.6% of eyes presented a significant anatomical response (decrease of CMT ≥ 20%), and DME was resolved (absence of cystoid macular spaces on OCT) in 37% of cases at the end of the follow-up. A transient increase in intraocular pressure ≥ 25 mmHg occurred in 14.1% of eyes, and cataract surgery was performed for 49.1% of the phakic eyes during the follow-up. Four eyes developed a proliferative diabetic retinopathy.

CONCLUSION

This large cohort study showed favorable long-term outcomes when using DEX-implant, which provides substantial long-term benefits in the treatment of DME in real life.

Increased choroidal thickness: a new indicator for monitoring diabetic macular oedema recurrence

PURPOSE

The aim of this study was to determine whether choroidal thickness (CT) increases at the time of exudative recurrence in diabetic patients with unilateral diabetic macular oedema (DME) treated with intravitreal injections of anti-VEGF or dexamethasone.

METHODS

A real-life, prospective, two-centre study was conducted over a 9-month period investigating diabetic patients presenting with unilateral DME treated with anti-VEGF or dexamethasone intravitreal injections, and CT was measured manually, using the enhanced depth imaging module of the spectral domain optical coherence tomography. Choroidal thickness (CT) was measured in the morning, in both the affected and healthy eye of each patient at two timepoints: when the macula was 'dry' (T0) and at the time of exudative recurrence (T1).

RESULTS

A total of 51 patients with unilateral DME were included. Mean CT in the affected eye was significantly thicker at the time of exudative recurrence (210.8 ± 44.1 μm at T0 versus 238.0 ± 49.0 μm at T1, p < 0.001). There was no significant variation in CT in the fellow eye (214.4 ± 52.3 µm at T0 versus 218.9 ± 53.4 µm at T1, p = 0.53). The type of intravitreal injection, the number of injections and the CT at T0 had no influence on the change in CT.

CONCLUSION

This study found that CT increased significantly in the affected eye at the time of recurrence of DME treated with anti-VEGF or dexamethasone injections. Choroidal thickness (CT) could constitute an interesting new indicator for monitoring patients with DME.

[Treat-and-extend anti-angiogenic protocol in clinical practice for patients with exudative age-related macular degeneration: Consensus of French experts]

Optimizing treatment regimens for anti-angiogenic drugs is now a major issue in the management of patients with exudative AMD. The evolution of these approaches has led retinologists to favor so-called proactive administration regimens, such as Treat-and-Extend (T&E), which make it possible to anticipate recurrence and to plan intravitreal injections of anti-angiogenic drugs in advance. Nevertheless, a real need to standardize the application of this regimen has been identified. This article proposes a consensus based on the Delphi methodology, which might provide a guide for ophthalmologists to manage patients with exudative AMD using the T&E protocol. While some aspects remain debated to date, this article provides elements to guide the implementation of T&E. The experts recommend that a loading dose of 3 monthly injections should be administered before starting T&E. They also recommend adjusting the reinjection intervals by±2 weeks in a standardized fashion. The intervals are then decreased in the presence of anatomical and/or functional deterioration, maintained when the interval of recurrence is identified, and increased when anatomical and/or functional improvement is observed. A maximum interval between 3 and 4 months is recommended by the experts, with maintenance of the maximum interval for 1 year before considering a possible exit from the T&E protocol. In the event of a significant decrease in visual acuity related to the disease along with significant anatomical degradation, it is recommended to restart monthly injections. In the case of bilateral disease, when synchronized timing of injections for both eyes is desired, the experts recommend using the shorter of the two intervals.

[Descemet's membrane detachment after phacoemulsification: Series of 9 cases]

PURPOSE

Descemet's membrane detachment (DMD) is a rare but potentially serious complication of cataract surgery. Although there are no consensual guidelines regarding the diagnosis or treatment of DMD, incorrect treatment may result in irreversible corneal changes with visual sequellae. The purpose of our study is to describe the diagnosis and treatment of DMD.

METHODS

We report a series of 9 cases of DMD, their diagnosis, treatment and outcomes. We tested the HELP protocol retrospectively against our 9 real-life cases.

RESULTS

Two cases recovered with simple medical management, 4 required air-bubble descemetopexy, and three required keratoplasty. Our study revealed that the main factor associated with poor outcomes is late diagnosis and management.

CONCLUSION

Our series illustrates the importance of proactive management and timely diagnosis by performing anterior segment OCT in the setting of persistent postoperative corneal edema.

Contribution of swept-source OCT-angiography in analysis of choroidal osteoma and its quiescent neovascular complications: A case study

Purpose

Choroidal osteoma (CO) is a rare benign tumor of the choroid. Improvements in Optical Coherence Tomography (OCT) technologies, notably swept-source (SS), enables a better visualization of the choroid with deeper signal penetration in the tissues.

Observation

We describe SS-OCT and OCT-angiography findings in a 30-year-old patient with CO. The best visualization of the choroid allows even more precise analysis beyond the identification of classical structures of trabecular bone and denser cortical bone. OCT-Angiography show in this case a quiescent choroidal neovascularization without exudation on B-scan OCT.

Conclusions and importance

SS-OCT and OCT-angiography allow a nearly histological description of choroidal osteoma.

Patient consent

Written consent to publish this case has not been obtained. This report does not contain any personal identifying information.

Real-world outcomes following 12 months of intravitreal aflibercept monotherapy in patients with diabetic macular edema in France: results from the APOLLON study

Purpose

To report the effectiveness of intravitreal aflibercept (IVT-AFL) treatment for diabetic macular edema (DME) in French clinical practice.

Methods

APOLLON (NCT02924311) was a prospective, observational cohort study of patients with DME. Effectiveness was evaluated by change from baseline in best-corrected visual acuity (BCVA) at 12 months in treatment-naïve patients (i.e., had not received any anti-vascular endothelial growth factor [anti-VEGF] agent, laser, or steroid at IVT-AFL treatment start) and previously treated patients (i.e., previously treated with anti-VEGF agents other than IVT-AFL, laser, or steroids at IVT-AFL treatment start). Secondary endpoints included change in central retinal thickness (CRT) over 12 months, frequency of injections, and proportion of patients with safety events.

Results

Of the 147 patients followed for at least 12 months and included in the effectiveness analysis, 52.4% (n = 77) were treatment-naïve and 47.6% (n = 70) were previously treated. Mean (standard deviation [SD]) BCVA score at baseline was 62.7 (14.3) Early Treatment Diabetic Retinopathy Study (ETDRS) letters in treatment-naïve patients and 60.0 (13.7) ETDRS letters in previously treated patients. At month 12, mean (SD) change in BCVA was + 7.8 (12.3) letters in treatment-naïve patients and + 5.0 (11.3) letters in previously treated patients. Mean CRT decreased in both patient cohorts. The mean (SD) number of IVT-AFL injections at month 12 was 7.6 (2.5) for treatment-naïve patients and 7.6 (2.3) for previously treated patients. Of 388 patients included in the safety analysis, ocular treatment-emergent adverse events occurred in 54.1% (n = 210) of patients.

Conclusion

IVT-AFL treatment was associated with improvements in functional and anatomic outcomes in both treatment-naïve and previously treated patients with DME in France.

Diagnosis and treatment of peripheral exudative haemorrhagic chorioretinopathy

PURPOSE

Peripheral exudative haemorrhagic chorioretinopathy (PEHCR) is a rare disorder that is often misdiagnosed. The aim of this study was to better characterise PEHCR and to assess treatment options.

MATERIAL AND METHODS

Retrospective multicentric chart review.

RESULTS

Of 84 eyes (69 patients) with PEHCR referred between 2005 and 2017, the most common referral diagnosis was choroidal melanoma (41.3%). Bilateral involvement was found in 21.7% of cases. Haemorrhagic retinal pigment epithelium detachment was the most common peripheral lesion (53.6%). Maculopathy was associated with peripheral lesions in 65.8% of cases. PEHCR lesions were mostly heterogeneous (58.8%) on B-scan ultrasonography. Choroidal neovascularisation was found in 10 eyes (26.3%) out of 38 eyes that underwent fluorescein angiography. Polyps were observed in 14 eyes (58.3%) out of 24 eyes that underwent indocyanine green angiography. Fifty-one eyes were treated (62.2%). Intravitreal injections (IVTI) of antivascular endothelial growth factor (VEGF) were the most used treatment (36.6%) before laser photocoagulation, photodynamic therapy, vitrectomy and cryotherapy. Only vitrectomy improved visual acuity. Most lesions (65.6%) regressed at the last follow-up visit.

CONCLUSION

In case of PEHCR, multimodal imaging is useful to avoid misdiagnosis, to characterise PEHCR lesions and to guide treatment strategies. Regression of PEHCR lesions was observed in two-thirds of the patients. Vitrectomy improved visual acuity. More than a third of patients underwent anti-VEGF IVTI. Further studies are needed to assess IVTI's efficacy.

Idiopathic polypoidal choroidal vasculopathy in Caucasians: The POLYON real-life study in 50 naive patients

Objectives:

Polypoidal choroidal vasculopathy is a common disease in Asia, but it has been less described in the Caucasian population. The aim of this real-life observational study was to describe the diagnostic and therapeutic practices as well as the prognosis in this population.

Method:

Fifty Caucasian patients with polypoidal choroidal vasculopathy were included in this study. All patients underwent angiography to confirm the diagnosis. Patients were divided into two treatment groups: patients of group 1 only received anti–vascular endothelial growth factor injections and those of group 2 required photodynamic therapy rescue in addition to intravitreal injections in case of suboptimal (anatomically or functionally) response. Clinical (visual acuity, fundus examination), paraclinical (retinal pigment epithelium detachment height and central retinal thickness on optical coherence tomography), and therapeutic (number of intravitreal injections) criteria were analyzed after 24 months.

Results:

Patient mean age was 73.9 ± 9.1 years, and half of the patients had age-related macular degeneration. In the whole cohort, the initial visual acuity was equivalent to the final visual acuity (59.9 ± 24.0 letters vs 62.5 ± 21.1 letters, p = 0.259). In group 1, the final visual acuity was significantly increased (from 56.9 ± 24.7 letters to 63.4 ± 21.6 letters, p = 0.016), while in group 2, it remained stable (from 61.7 ± 23.4 letters to 61.0 ± 21.4 letters, p = 0.249). The number of intravitreal injections was similar between both groups.

Conclusion:

In a Caucasian population, polypoidal choroidal vasculopathy seems to have a later onset. A non-standardized management allows stabilizing the functional prognosis. Patients requiring photodynamic therapy rescue have a poorer prognosis.

Increased choroidal thickness: a new feature to monitor age-related macular degeneration recurrence

PURPOSE

The main objective of this study was to assess choroidal thickness (CT) changes during an exudative recurrence of age-related macular degeneration (AMD).

METHODS

A real-life prospective non-interventional 9-month study was conducted in two centers in consecutive patients with exudative AMD between November 2016 and July 2017. CT was measured manually in both eyes based on enhanced-depth imaging spectral-domain optical coherence tomography at different follow-up visits scheduled in the morning.

RESULTS

A total of 134 patients were included. Ninety-five patients presented at least one episode, defined by a follow-up visit under controlled condition (dry retina) followed by a visit for exudative recurrence. A total of 119 episodes were analyzed. The mean CT change in the treated eye was + 8.45 ± 13.52 μm (p < 0.001) and + 5.62 ± 14.77 μm (p = 0.009) respectively in the subfoveal area and nasal area. No significant change in CT was observed in the fellow eye. No significant association between CT changes and treatment, number of intravitreal injections, and blood pressure was observed.

CONCLUSION

CT increased in case of exudative recurrence of neovascular AMD. The increase was mild but significant. Thus, CT could be used as a monitoring criterion, like the central retinal thickness, in AMD management.

Retinal vein occlusion and obstructive sleep apnea: a series of 114 patients

PURPOSE

Evaluate the prevalence of obstructive sleep apnea (OSA) in patients with retinal vein occlusion (RVO).

METHODS

A prospective and controlled study including 114 patients from January to September 2016, who were divided into two groups: 69 patients with RVO (RVO+) and 45 controls (RVO-), matched for age, sex and disease. All the patients completed a simple questionnaire and the Epworth Sleepiness Scale and underwent a RUSleeping^® (portable monitoring device and then continuously monitored the subject's respiration to detect respiratory events). In addition, all patients with RVO were administered OSA screening with a polysomnography (PSG) during an overnight stay in the hospital, which was analysed by a single sleep apnea specialist.

RESULTS

Sleep apnea was suspected in 73.9% in the RVO group and 63% in the control group based on the simple questionnaire; 22% in the RVO group and 4.3% in the control group according to the Epworth Sleepiness Scale; 82.6% in the RVO group and 55.6% in the control group (p = 0.005) according to RUSleeping^® . Multivariate logistic regression analysis (based on RUsleeping^® ) confirmed that RVO was associated with OSA (adjusted odds ratio, 5.65, [1.60-19.92], p = 0.007). All patients in the RVO group were confirmed by PSG, and finally, 91.5% were diagnosed with moderate-to-severe OSA. Among the RVO+ patients, the mean apnea-hypopnoea index (AHI) was 42.2 events per hour (7.7-96.5). OSA was moderate in 22% patients and severe in 69.5% patients. There was no significant relationship between RVO severity and the PSG data variables.

CONCLUSION

The systematic screening of OSA with the gold standard PSG found a high prevalence of OSA in patients with RVO. The OSA is probably a risk factor associated with RVO. Polysomnography remains the gold standard method; nevertheless, the RUsleeping^® RTS portable monitoring device can assess the presence and severity of sleep apnea with a low failure rate and a single use, prior to PSG, which is less available in clinical practice. Further studies with larger samples are needed to clarify the association.

Comparison of two biometers: A swept-source optical coherence tomography and an optical low-coherence reflectometry biometer

PURPOSE

The technological improvements in optical biometers have made cataract surgery evolve to the level of refractive surgery. This study assessed the correlation and agreement between a biometer using swept-source optical coherence tomography technology (IOLMaster 700; Carl Zeiss Meditec, Jena, Germany) and a biometer using optical low-coherence reflectometry (Lenstar; Haag Streit, Koeniz, Switzerland).

PROCEDURES

Optical biometric measurements were taken with the IOLMaster 700 and the Lenstar on 129 eyes of 129 patients referred for cataract surgery. We compared biometric data (axial length, mean keratometry, central pachymetry, anterior chamber depth, lens thickness, and horizontal white-to-white measurement) and the emmetropic intraocular lens power calculated with SRK/T and Haigis formulas. Correlation and agreement for these parameters were evaluated.

RESULTS

Only anterior chamber depth measurements (3.05 ± 0.07 vs 3.07 ± 0.07, p < 0.001) and the white-to-white measurement (11.97 ± 0.07 vs 12.06 ± 0.07, p < 0.001) differed significantly between the machines. Correlations and agreements were excellent, with perfect agreement for axial length measurement (r = 1, intraclass correlation coefficient = 1). Emmetropic intraocular lens power did not differ between devices with SRK/T formula (20.94 ± 0.51 vs 20.92 ± 0.50, p = 0.51). With Haigis formula, there was a statistically significant difference (21.04 ± 0.52 vs 20.84 ± 0.52, p < 0.001).

CONCLUSION

This study suggests that there is a very high correlation and agreement for the biometric measurements and calculation of intraocular lens implant power with the SRK/T formula.

Cephalic region war injuries in children: Experience in French NATO hospital in Kabul Afghanistan

BACKGROUNDS

The NATO KAIA Hospital (Kabul International Airport), under French command, provided medical support for NATO forces in the Kabul region from 2009 to 2014. Medical assistance to civilians was an additional mission which included support for children who were war injured. The objective of this study was to analyze characteristics of cephalic injuries in children victims of war trauma.

METHODS

A retrospective study was conducted and commenced with the hospital opening (July 2009) to March 2012 on all children (<15years) with war trauma. We distinguished cephalic lesions in cranial (neuro-surgical), ophthalmological and neck regions. We analyzed mechanism, region, severity score, surgeries and resuscitation efforts.

RESULTS

217 children were operated on with 81 war traumas (mean age 10.2years). 36 children (44.4%) had a cephalic injury. 52.9% of the injured had an ophthalmological injury, 38.2% a cranial region injury and 29.4% a neck lesion. Mortality rate was 5.6% (1 hemorrhagic shock and 1 cerebral wound) in this cephalic lesion group. Ophthalmic injuries were the most common of cephalic injuries; 19 children of which 7 had a bilateral injury (26 eyes). In this group, fragmentary injuries were the most frequent (64% of eyes). In cerebral lesion group, the lesions were linked to a bullet or a shrapnel in 9 of 13 children. This mechanism systematically caused a crania-cerebral wound. Explosion (fragmentary and shrapnel) was the most important in the neck lesions (7 children of 10).

CONCLUSIONS

The cephalic lesions were the second most common region in children during our experience in Afghanistan. Lack of protection (helmet) in children may explain the frequency of cephalic wounds.

Macular toxicity and blind spot enlargement during a treatment by voriconazole: A case report

Purpose:

To report a case of macular toxicity and blind spot enlargement during voriconazole treatment.

Methods:

This is a case report.

Results:

We describe a 77-year-old man treated by voriconazole for pulmonary aspergillosis, who complained of visual disorders such as dyschromatopsia and visual hallucinations 3 days after voriconazole initiation. Initial ophthalmological examination found no loss of visual acuity. The anterior and posterior segments presented no anomalies. The chromatic vision evaluated with the Lanthony 15-Hue Desaturated Test demonstrated dyschromatopsia in the left eye along the tritan axis, and the Goldmann visual field examination found a blind spot enlargement in both eyes. The multifocal electroretinogram found a global decrease in the foveal peak in both eyes. Visual evoked potential showed asymmetric data and lower amplitudes of the P(100) wave on the left eye. No anomalies were observed on spectral domain macular optical coherence tomography. As a first step, based on presumed dose-dependent toxicity, voriconazole dose was reduced. No improvements were noted. The voriconazole treatment was then discontinued and replaced with itraconazole. After 1 month, visual field and multifocal electroretinogram had improved and visual hallucinations had disappeared.

Conclusion:

Voriconazole can cause potentially serious visual side effects. Adapting treatment based on plasma concentrations of voriconazole did not prevent the appearance of visual side effects in this case. Therapeutic drug switching within the same drug family seems to be an effective alternative to preserve ocular function.

[Prospective, monocentric, uncontrolled study of efficacy, tolerance and adherence of cyclosporin 0.1 % for severe dry eye syndrome]

PURPOSE

To evaluate the efficacy, tolerability and treatment adherence of Ikervis^® (Santen, SAS) (ciclosporine 0.1 %) for first line therapy or following treatment with Restasis^® (Allergan, Inc.) (ciclosporine 0.05 %) for severe dry eye syndrome.

MATERIAL AND METHODS

A prospective, monocentric, uncontrolled study was conducted between January 2012 and March 2015 on 110 eyes of 55 patients with severe dry eye on first line therapy or previously treated with Restasis^® who required the introduction of Ikervis^®. Patients' quality of life was assessed before and after treatment was started using a standardized questionnaire (Ocular Surface Disease Index^© [OSDI]), clinical efficacy was quantified at the slit lamp, by measurement of the Break Up time Test (BUT) and the Oxford classification. Tolerability and adherence to treatment were measured using a simple questionnaire.

RESULTS

A total of 72 eyes of 37 patients were included. Etiologies of dry eye syndrome were dominated by Sjögren syndrome (32 %) and severe ocular surface conditions (48 %). The mean age was 57.7 years (±17.45) and mean follow-up was 458 days (±292). The mean BUT increased by 2.043seconds [1.522-2.563] (P<0.0001). Corneal/conjunctival involvement evaluated by the Oxford classification was also improved with a difference in level of 1.68 [1.290-2.071] (P<0.0001). Ocular Surface Disease Index^© (OSDI) decreased by 21.7 [16.372-27.024] (P<0.0001). Treatment tolerability was moderate, with more than 50 % of patients experiencing pain on instillation. Overall satisfaction with treatment was good, with more than 60 % of patients feeling better after initiation of treatment.

CONCLUSION

Ikervis^® is an effective treatment of severe dry eye. Its indications tend to evolve towards less severe dry eye. However, the tolerability profile remains poor, and an improvement in this would be desirable.

[Toric lens implantation in cataract surgery: Automatic versus manual horizontal axis marking, analysis of 50 cases]

SUBJECT

The main objective of our study is to evaluate the contribution of automated conjunctival recognition in the alignment of toric implants by comparing the automatic alignment optimized with Callisto™ to the manual marking of the horizontal axis.

MATERIALS AND METHODS

We performed a prospective, descriptive, and monocentric study on patients undergoing cataract surgery with toric implantation (Asphina 709 Zeiss), operated by a surgeon with good experience in toricity, between September 2016 and March 2017. We analyzed the agreement between the manual marking of the 0°-180° axis versus the one automatically generated by the Callisto™, as well as the alignment of the IOL and the refractive results at 1 month.

RESULTS

We included 50 eyes of 26 patients. The corrected mean astigmatism was 1.9 D. The mean difference between the 2 axes was 4.7° [0°-12.3°]. Only 50 % of the preoperative manual markings were consistent with the automatic measurement (<5°). At one month, the average rotation recorded was 4.3° [0°-29°]. The alignment was identical for 70 % (n=35) of the IOL (≤5°). As for residual subjective astigmatism, it was on average 0.58 D. The mean visual acuity without correction was 8/10 and 55 % had 10/10 without correction.

DISCUSSION

The refractive performance depends on the preoperative measurement, the correct alignment of the IOL and its stability in the bag. Our study shows the value of automatic conjunctival recognition in the determination of the axis of peroperative alignment, even in an experienced operator. This precision is essential for a good refractive result, especially since the residual astigmatism in case of misalignment will increase with the power of the implant.

CONCLUSION

Our study shows excellent refractive results, whatever the initial astigmatism, using the automatic alignment. The precision of the toric implantation opens the way to the toric multifocal implantation under the best conditions.

Toric lens implantation in cataract surgery: Automated versus manual horizontal axis marking, analysis of 50 cases

SUBJECT

The main objective of our study was to evaluate the contribution of automated conjunctival registration in the alignment of toric intraocular lenses by comparing automated registration optimized with Callisto^® to manual marking of the horizontal axis.

MATERIALS AND METHODS

We performed a prospective, descriptive, monocentric study on patients undergoing cataract surgery with a toric intraocular lens (Asphina 709 Zeiss), performed by a surgeon with good experience in toric implants, between September 2016 and March 2017. We analyzed the agreement between the manual marking of the 0-180° axis versus the one automatically generated by the Callisto™, as well as the alignment of the IOL and the refractive results at 1 month.

RESULTS

We included 50 eyes of 38 patients. The mean corrected astigmatism was 1,9 D. The mean difference between the 2 axes was 4,7° [0-12.3°]. Only 50 % of the preoperative manual markings were consistent with the automated measurement (<5°). At one month, the mean rotation recorded was 4,3° [0-29°]. The alignment was identical for 70 % (n=35) of the IOLs (≤5°). As for residual subjective astigmatism, the mean was 0.58 D. The mean visual acuity without correction was 8/10 and 55 % saw 10/10 without correction.

DISCUSSION

Refractive performance depends on preoperative measurement, correct alignment of the IOL and its stability in the bag. Our study shows the value of automated conjunctival registration in the determination of the intraoperative axis of alignment, even with an experienced surgeon. This precision is essential for a good refractive result, especially since residual astigmatism in the case of misalignment will increase with the power of the implant.

CONCLUSION

Our study shows excellent refractive results, regardless of the initial astigmatism, using automated alignment. Precision of toric implantation opens the way to toric multifocal implantation under the best conditions.