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Jurkiewicz T, Marty AS, Febvay C, Burillon C. [Effect of keratoplasty on the quality of life of keratoconus patients]. J Fr Ophtalmol 2024; 47:104185. [PMID: 38608625 DOI: 10.1016/j.jfo.2024.104185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/10/2023] [Accepted: 11/21/2023] [Indexed: 04/14/2024]
Abstract
Corneal deformations caused by keratoconus produce high levels of optical aberration (OA). Despite appropriate optical correction, these alter the quality of vision and diminish the patient's quality of life, especially since the affected population is predominantly young and of working age. When thinning is too severe or corneal transparency too impaired, a corneal transplant may be considered. In this study, we compare the quality of life of patients with keratoconus in the early (stages 1 and 2) or advanced (stages 3 and 4) stages of the Krumeich classification, as well as patients who have had keratoconus treated by keratoplasty. Quality of life was assessed using the NEI-VFQ 25 questionnaire, the most widely used for keratoconus. An aberrometric examination (OQAS®; HD Analyser, Visiometrics, Terrassa, Spain) was also performed to assess patients' quality of vision. Our results show that keratoplasty provides an improvement in quality of life compared with advanced-stage keratoconus in the areas of distance (p=0.0083) and near vision (p=0.029) activities. This improvement also applies to Best-Corrected Visual Acuity (BCVA) (p=0.032) and transparency (OSI) (p=0.049). Our study shows that keratoplasty improves corneal transparency, and it is interesting to note that it improves patients' quality of life over the long term.
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Affiliation(s)
- T Jurkiewicz
- Centre d'exploration de la rétine Kléber (CERK), 50, cours Franklin-Roosevelt, 69006 Lyon, France; Centre de recherche en neurosciences de Lyon (CRNL), université de Lyon, 69500 Bron, France.
| | - A-S Marty
- Clinique ophtalmologique Thiers, 144, avenue Thiers, 33100 Bordeaux, France
| | - C Febvay
- Cabinet d'ophtalmologie De La Vallée, 8, route de Besançon, 25290 Ornans, France
| | - C Burillon
- Service d'ophtalmologie, Pavillon C, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France; Faculté de médecine Lyon Sud, Charles-Mérieux, rue du Grand-Revoyet, 69006 Oullins, France
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Aoun T, Harissi-Dagher M. [Long-term visual outcomes of Boston type I keratoprosthesis in Canada]. J Fr Ophtalmol 2023; 46:1212-1221. [PMID: 37867123 DOI: 10.1016/j.jfo.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/11/2023] [Accepted: 07/17/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND/PURPOSE To evaluate long-term visual outcomes of Boston type I keratoprosthesis (KPro) surgery and identify risk factors for visual failure. METHODS Single surgeon retrospective cohort study including 85 eyes of 74 patients who underwent KPro implantation to treat severe ocular surface disease, including limbal stem cell deficiency, postinfectious keratitis, aniridia and chemical burns. Procedures were performed at the Centre hospitalier de l'Université de Montréal from October 2008 to May 2012. All patients with at least 5 years of follow-up were included in the analysis, including eyes with repeated KPro. Main outcome measures were visual acuity (VA), visual failure, defined as a sustained VA worse than the preoperative VA, postoperative complications, and device retention. RESULTS Mean follow-up was 7.2±1.3 years (±SD). Mean VA was 2.1±0.7 (logarithm of minimal angle resolution) preoperatively and 1.9±1.2 at last follow-up. In total, 2.4% of patients had VA better than 20/200 preoperatively vs. 36.5% at last follow-up. Maintenance of improved postoperative VA was seen in 61.8% of eyes at 7 years. Preoperative factors associated with visual failure were known history of glaucoma (HR=2.7 [1.2 to 5.9], P=0.02) and Stevens-Johnson syndrome (HR=7.3 [2.5 to 21.4], P<0.01). Cumulative 8-year complication rates were 38.8% retroprosthetic membrane formation, 25.9% hypotony, 23.5% new onset glaucoma, 17.6% retinal detachment, 8.2% device extrusion and 5.9% endophthalmitis. The majority (91.8%) of eyes retained the device 8 years after implantation. CONCLUSION Nearly two-thirds of patients exhibited improved VA 7 years after KPro implantation. Preoperative risk factors for visual failure were known glaucoma and Stevens-Johnson syndrome.
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Affiliation(s)
- T Aoun
- Faculté de médecine, université de Montréal, Montréal, Canada
| | - M Harissi-Dagher
- Centre hospitalier de l'université de Montréal (CHUM), Montréal, Canada.
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Shin JD, Mahesh S. Deep anterior lamellar keratoplasty (DALK) interface neovascularization: An unusual complication. J Fr Ophtalmol 2023:S0181-5512(23)00117-1. [PMID: 37076390 DOI: 10.1016/j.jfo.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/16/2022] [Accepted: 11/11/2022] [Indexed: 04/21/2023]
Abstract
We present a case of a 31-year-old male with a past ocular history significant for keratoconus in both eyes, who underwent Deep Anterior Lamellar Keratoplasty (DALK) for his left eye and experienced graft-host interface neovascularization and interface hemorrhage as a complication. He was treated initially with removal of sutures and optimization of the ocular surface followed by subconjunctival bevacizumab, which subsequently improved his hemorrhage and neovascularization.
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Affiliation(s)
- J D Shin
- School of Medicine, New York Medical College, 40, Sunshine Cottage road, Valhalla, NY 10595, United States
| | - S Mahesh
- School of Medicine, New York Medical College, 40, Sunshine Cottage road, Valhalla, NY 10595, United States; Department of Ophthalmology, Westchester Medical Center, 100, Woods road, Valhalla, NY 10595, United States.
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Lanfant L, Trone MC, Garcin T, Gauthier AS, Thuret G, Gain P. [Corneal perforation with tyrosine kinase inhibitor chemotherapy: REGORAFENIB]. J Fr Ophtalmol 2021; 44:544-548. [PMID: 33612324 DOI: 10.1016/j.jfo.2020.06.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Tyrosine kinase inhibitors (TKIs) are active in a variety of metastatic cancers. They have a good general tolerance with mainly hepatic and dermatological side effects. Rarely, ophthalmologic side effects may occur: eyelash abnormalities, eyelids abnormalities, disorders of the ocular surface with ocular dryness or even corneal erosions that can even lead to perforation. Regorafenib is a new oral multi-targeted tyrosine kinase inhibitor that inhibits multiple protein kinases, including those involved in tumor angiogenesis, oncogenesis and tumor microenvironment. CASE DESCRIPTION We describe, to the best of our knowledge, the first case of complicated bilateral ulcers of corneal perforation in a patient under REGORAFENIB. OBSERVATION 20-year-old patient with metastatic chondrosarcomas of the pelvis, mandible and thorax received chemotherapy with REGORAFENIB. A few weeks after initiation of treatment, he experienced an increased dry eye syndrome associated with bilateral corneal ulcers complicated by perforation. Despite discontinuation of chemotherapy and maximal medical and surgical treatment (iterative amniotic membrane grafts and corneal transplantation), the progression was unfavorable. DISCUSSION This is the first known case of corneal perforation under REGORAFENIB. The pathophysiology is multifactorial. On the one hand, this chemotherapy targets angiogenesis (VEGFR), oncogenesis (KIT, RET, RAF1, BRAF) and the tumor microenvironment (PDGFR, FGFR). On the other hand, other triggers are added, namely mixed dry eye syndrome, hypovitaminosis A (anorexia), the neurotrophic component, as well as the toxicity of chemotherapy via tears. CONCLUSION First described case of corneal perforation under REGORAFENIB, non-regressive at the end of chemotherapy, and despite medical and surgical treatments. Ophthalmologic surveillance is therefore necessary for patients under chemotherapy with tyrosine kinase inhibitors, as serious ocular complications, especially corneal ones, may occur.
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Affiliation(s)
- L Lanfant
- Avenue Albert Raimond, 42055 Saint-Étienne cedex 1, France.
| | - M C Trone
- Avenue Albert Raimond, 42055 Saint-Étienne cedex 1, France
| | - T Garcin
- Avenue Albert Raimond, 42055 Saint-Étienne cedex 1, France
| | | | - G Thuret
- Avenue Albert Raimond, 42055 Saint-Étienne cedex 1, France
| | - P Gain
- Avenue Albert Raimond, 42055 Saint-Étienne cedex 1, France
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Chudzinski R, El Chehab H, Mouchel R, Agard E, Levron A, Chaperon M, Rochepeau C, Rodier-Bonifas C, Burillon C, Dot C. [Descemet's membrane detachment after phacoemulsification: Series of 9 cases]. J Fr Ophtalmol 2020; 43:1002-1008. [PMID: 33036803 DOI: 10.1016/j.jfo.2020.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/12/2020] [Accepted: 02/25/2020] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- R Chudzinski
- Hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69003 Lyon, France.
| | - H El Chehab
- Hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - R Mouchel
- Hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - E Agard
- Hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - A Levron
- Hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - M Chaperon
- Hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - C Rochepeau
- Hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - C Rodier-Bonifas
- Hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - C Burillon
- Hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - C Dot
- Hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
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Borderie VM, Levy O, Georgeon C, Bouheraoua N. Simultaneous penetrating keratoplasty and amniotic membrane transplantation in eyes with a history of limbal stem cell deficiency. J Fr Ophtalmol 2018; 41:583-591. [PMID: 30166235 DOI: 10.1016/j.jfo.2018.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/28/2017] [Accepted: 01/09/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE To describe the outcomes of simultaneous penetrating keratoplasty (PK) and amniotic membrane transplantation (AMT) performed both as a ring-shaped graft and as a temporary patch in eyes with a history of limbal stem cell deficiency (LSCD). METHODS Prospective observational case series including 48 simultaneous PK/AMT procedures (48 patients) in eyes with a history of partial or total LSCD. Patients with total LSCD were first treated with limbal stem cell transplantation. The preoperative indication was graft failure in 58.3% of cases. Most recipients (89.6%) were at high-risk for rejection. RESULTS The mean graft reepithelialization time was 29.2±30.8 days. Graft reepithelialization was achieved in 30 days in 70.8% of cases. No AMT-related adverse events were observed. The mean time from keratoplasty-to-last visit was 84.5±54.5 months. The 3-year graft survival rate was 62.5%. Recurrence of corneal epithelial defects after graft reepithelialization (47.9%) was associated with lower graft survival (P=0.004). In eyes with successful grafts at the last visit, the mean LogMAR visual acuity was 1.90 (20/1575)±5 lines before keratoplasty and 0.89 (20/155)±10 lines at 5 years. A ring of amniotic membrane was visible between the graft stroma and the corneal epithelium on slit-lamp examination and optical coherence tomography in all successful cases. CONCLUSIONS In this series of eyes with a history of LSCD and at high-risk of rejection, simultaneous PK and AMT were associated with satisfactory graft survival and no additional adverse events.
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Affiliation(s)
- V M Borderie
- CIC 1423, Pierre et Marie Curie University Paris 06, Centre Hospitalier National d'Ophtalmologie des XV-XX, Institut de la Vision, 28, rue de Charenton, 75571 Paris, France.
| | - O Levy
- CIC 1423, Pierre et Marie Curie University Paris 06, Centre Hospitalier National d'Ophtalmologie des XV-XX, Institut de la Vision, 28, rue de Charenton, 75571 Paris, France
| | - C Georgeon
- CIC 1423, Pierre et Marie Curie University Paris 06, Centre Hospitalier National d'Ophtalmologie des XV-XX, Institut de la Vision, 28, rue de Charenton, 75571 Paris, France
| | - N Bouheraoua
- CIC 1423, Pierre et Marie Curie University Paris 06, Centre Hospitalier National d'Ophtalmologie des XV-XX, Institut de la Vision, 28, rue de Charenton, 75571 Paris, France
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Baali M, Belghmaidi S, Ahammou H, Belgadi S, Hajji I, Moutaouakil A. [Evaluation of the quality of life of patients fitted with scleral lenses using a Moroccan version of NEI-VFQ 25]. J Fr Ophtalmol 2018; 41:201-205. [PMID: 29573858 DOI: 10.1016/j.jfo.2017.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/08/2017] [Accepted: 09/16/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the contribution of scleral lenses in terms of improving quality of life and vision. METHODS We conducted a retrospective study of the quality of life (QOL) of patients fitted with scleral lenses, between November 2015 and November 2016 in the Marrakech university hospital department of ophthalmology. QOL was assessed before and after scleral lens (ICD) adaptation using a version of the National Eye Institute Visual Function Questionnaire 25 translated into the Moroccan dialect of Arabic. RESULTS We included 48 patients (68 eyes). The main indications included severe corneal ectasia followed by post-keratoplasty eyes, post-traumatic corneas and patients with ocular surface disease. The average duration of scleral lens wear was 6 months, and the average wearing time was 12hours per day. BCVA increased from 0.8 to 0.2±0.5 LOGMAR. The average scores on the NEI-VFQ 25 of patients after scleral lens fitting were significantly higher, 80.5 versus 42.6 before wearing scleral lenses, thus an increase of 38.1. DISCUSSION Quality of life has become a major issue in the healthcare field, which has seen a renewed interest in ophthalmology lately. The results of our study support the data from previous studies regarding the impact of scleral lenses on the quality of life of patients. CONCLUSION High oxygen permeability scleral lenses are a satisfying therapeutic alternative, allowing a significant improvement in the quality of life of patients for whom the usual therapeutic means are limited.
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Affiliation(s)
- M Baali
- IBN Khaldoune, lot n(o) 9, Marrakech, Maroc.
| | | | - H Ahammou
- IBN Khaldoune, lot n(o) 9, Marrakech, Maroc.
| | - S Belgadi
- IBN Khaldoune, lot n(o) 9, Marrakech, Maroc.
| | - I Hajji
- IBN Khaldoune, lot n(o) 9, Marrakech, Maroc.
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Hugo J, Granget E, Ho Wang Yin G, Sampo M, Hoffart L. Intraocular pressure measurements and corneal biomechanical properties using a dynamic Scheimpflug analyzer, after several keratoplasty techniques, versus normal eyes. J Fr Ophtalmol 2017; 41:30-38. [PMID: 29191679 DOI: 10.1016/j.jfo.2017.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/08/2017] [Accepted: 06/16/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the biomechanical properties of the cornea and their impact on intraocular pressure (IOP) measurement after lamellar keratoplasty, compared to healthy eyes, using a non-contact tonometer with a Scheimpflug camera. METHODS This study, from 2014 to 2015, included 22 primary DSAEK, 5 DALK, 6 DSAEK after PK, and 50 control eyes. Using a non-contact tonometer with a high-speed Scheimpflug camera (CORVIS ST, Oculus Optikgeräte GmbH, Wetzlar, Germany), several biomechanical parameters were recorded, including radius at highest concavity (Rhc) and defomation amplitude (DA). Central corneal thickness (CCT) and uncorrected IOP, were also recorded. For the control eyes only, a corrected IOP was calculated, based on age, central corneal thickness, and biomechanical parameters. RESULTS Rhc was significantly lower after DALK (Rhc=5.54±0.71, P=0.007) and DSAEK (Rhc=6.26±0.77, P=0.042) compared to control eyes (Rhc=6.82±0.76). DA was higher after DALK and DSAEK, but not significantly (respectively 1.24±0.09 P=0.41 and 1.22±0.15, P=0.923) compared to normal eyes (1.18±0.15). Uncorrected IOP was not significantly different between post-keratoplasty and control eyes. In control eyes, the corrected IOP (15.23±1.88) was lower than the uncorrected IOP (16.10±2.34); a statistically significant positive correlation between Rhc and CCT (R2=0.6020, P<0001), and a significant negative correlation between DA and CCT (R2=-0.641, P<0.0001) were found. CONCLUSION Our study showed that, after lamellar keratoplasty, corneal biomechanics are altered. Corneas with higher ocular rigidity will show a lower DA and a higher Rhc.
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Affiliation(s)
- J Hugo
- Service d'ophtalmologie, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - E Granget
- Service d'ophtalmologie, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - G Ho Wang Yin
- Service d'ophtalmologie, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - M Sampo
- Service d'ophtalmologie, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - L Hoffart
- Service d'ophtalmologie, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
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Abstract
Degenerative or hereditary corneal diseases are sometimes difficult to discriminate. Corneal dystrophies affect approximately 0.09 % of the population. They are identified by the IC3D classification based on their phenotype, genotype and evidence gathered for their diagnosis. Practically, the ophthalmologist manages functional symptoms, such as recurrent erosions, visual loss and amblyopia, photophobia, foreign body sensation, and sometimes pain and aesthetic concerns. Medical treatments consist of drops to promote healing, ointments, hyperosmotic agents and bandage contact lenses. Less invasive surgical treatments are used as second line therapy (phototherapeutic keratectomy, lamellar keratectomy). More invasive procedures may eventually be utilized (lamellar or penetrating keratoplasty). Anterior lamellar or endothelial keratoplasty are now preferred to penetrating keratoplasty, although the latter still remains the only possible option in some cases. Some rare dystrophies require coordinated and comprehensive medical care.
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Affiliation(s)
- J-L Bourges
- Université Paris Descartes, Sorbonne Paris Cité, 15, rue École-de-Médecine, 75006 Paris, France; Unité d'ophtalmologie de l'Hôtel-Dieu, service d'ophtalmologie, hôpitaux universitaires Paris Centre, Assistance publique-Hôpitaux de Paris, 1, place du Parvis-Notre-Dame, 75004 Paris, France; Équipe 17, Inserm UMRS 1138, centre de recherche des Cordeliers, 15, rue de l'École-de-Médecine, 75006 Paris, France.
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Ho Wang Yin G, Sampo M, Soare S, Hoffart L. [Effect of donor graft characteristics on clinical outcomes in Descemet stripping automated endothelial keratoplasty (DSAEK)]. J Fr Ophtalmol 2017; 40:36-43. [PMID: 28069281 DOI: 10.1016/j.jfo.2016.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/02/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The purpose of our study was to evaluate the progression of lamellar corneal grafts after endothelial keratoplasty by Descemet stripping automated endothelial keratoplasty (DSAEK) and the effect of their characteristics on the clinical and functional results. MATERIALS AND METHODS This was a prospective study in which 74 patients who had undergone endothelial keratoplasty by DSAEK were included. The corneal grafts were obtained from a French tissue bank and were delivered in a preservation medium containing a deturgescent agent (Corneajet® or Stemalpha 3®). Pachymetry of the corneal graft was measured ex vivo by ultrasonic pachymetry prior to dissection, then after the 1st or 2nd cut as necessary. Corrected visual acuity in logMAR, total graft pachymetry, measured by anterior segment OCT (Spectralis® HRA+SDOCT, Heidelberg engineering, Inc., Heidelberg, Germany) and corneal density (Pentacam®, Oculus, Inc., Wetzlar, Germany) were obtained for each patient preoperatively, at D5, M1, M3, M6, M9 and M12. RESULTS Overall, 74 corneal grafts, from donors of mean age 69.7±13.3 years (37 to 92 years) were transplanted into 67 patients aged 70.3±12.1 years. Predissection pachymetry was statistically significantly thicker in the case of short deturgescence time (r=-0.383, P=0.001). For the same deturgescence time, predissection pachymetry was statistically significantly thicker in the Stemalpha 3® medium (691±89μm for Corneajet® vs. 760±100μm for Stemalpha 3®, P=0.01), with the same final pachymetry (168±31μm vs. 166±25μm, P=0.833). Graft pachymetry and total corneal pachymetry decreased significantly between the preoperative measurement and M12 (168±29μm vs. 92±57μm, P=0.0008 et 665±124μm vs. 566±73μm, P=0.027 respectively). Preoperative endothelial cell density (2938±418 cells/mm2) did not correlate with postoperative visual acuity. There was a positive correlation between visual acuity at D5 and donor age (r=0.3, P=0.04). Postoperative visual acuity correlated positively with preoperative visual acuity (P<0.05). Corneal densitometry was statically higher than normal postoperative densitometry. Corneal density at M1 correlated positively with time since obtaining the donor tissue (r=0.373, P=0.043). There was no significant difference between the sub-groups of over or under 130μm. Seven patients experienced graft failure with no statistically significant graft risk factor. DISCUSSION The preservation medium affects predissection pachymetry with no consequence on clinical results. In our study, preoperative visual acuity and donor age were correlated with visual acuity after DSAEK. CONCLUSION Although donor age was associated with better visual acuity at D5, the other donor characteristics had no effect on clinical results.
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Affiliation(s)
- G Ho Wang Yin
- Service d'ophtalmologie, université d'Aix-Marseille, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France; Équipe DiMABio, université d'Aix-Marseille, institut Fresnel, faculté des sciences de Saint-Jérôme, avenue Escadrille-Normandie-Niemen, 13397 Marseille cedex, France.
| | - M Sampo
- Service d'ophtalmologie, université d'Aix-Marseille, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - S Soare
- Service d'ophtalmologie, université d'Aix-Marseille, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - L Hoffart
- Service d'ophtalmologie, université d'Aix-Marseille, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
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Belghmaidi S, Adarmouch L, Baali M, Sebbani M, Hajji I, Amine M, Moutaouakil A. Measurement of visual function among patients undergoing corneal transplantation using the VF-14 index in Morocco. J Fr Ophtalmol 2016; 39:866-871. [PMID: 27843086 DOI: 10.1016/j.jfo.2016.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/27/2016] [Accepted: 07/31/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To validate the Moroccan version of the VF-14 in candidates for keratoplasty and to assess their quality of life using this tool before and after transplantation. METHODS This is a longitudinal prospective study that assessed 57 patients who underwent penetrating keratoplasty, recruited in the ophthalmology service in Marrakech over 5 years. The original VF-14 questionnaire was adapted into Moroccan dialect. The questionnaire was administered before and 2 years after transplantation. The VF-12 questionnaire was also used, deleting the last two items. Data analysis was performed using SPSS 16.0 software. Comparisons of VF-14 scores before and after transplantation used the Wilcoxon test for paired samples. RESULTS In total, 57 patients participated in the study. The most frequent indication for surgery was keratoconus (44%). All patients underwent penetrating keratoplasty. Chronbach's alpha value was 0.989 for VF-14 and 0.990 for VF-12. The two scores were negatively correlated with logMAR visual acuity. The strongest correlation was found with VA in the fellow eye. The average best-corrected visual acuity of the eye scheduled for keratoplasty was 1.1±0.16 logMAR. The average of VF-14 was 53±3. After keratoplasty, the average best-corrected visual acuity of operated eye was 0.34±0.31. The average postoperative astigmatism was 3 D. After keratoplasty, an increase in VF-14 score was observed from 53.5 to 81.92 (P<0.001). In postoperative follow-up, graft rejection was noted in two patients and maculopathy in a single patient. DISCUSSION Graft transparency, absence of complications, minimal astigmatism, and good visual acuity have long been indicators of a successful corneal transplant. However, this does not provide information on visual quality and its impact on everyday life. It is in this sense that the VF-14 was adapted into several languages, as reliable, valid and sensitive as the original Anglo-American version, to assess objectively and subjectively the quality of life of patients after keratoplasty. CONCLUSION With advances in techniques and availability of better materials, surgical success in performing keratoplasty is increasing. At the same time, vision-related quality of life of corneal graft recipients deserves more attention from ophthalmologists.
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Affiliation(s)
- S Belghmaidi
- Ophthalmology department, Mohammed VI university hospital, BP 1456 hay mohammadi, 40000 Marrakesh, Morocco.
| | - L Adarmouch
- Community medicine, epidemiology and public health department, Mohammed VI university hospital, research laboratory, school of medicine, Caddi Ayyad university, Marrakesh, Morocco
| | - M Baali
- Ophthalmology department, Mohammed VI university hospital, BP 1456 hay mohammadi, 40000 Marrakesh, Morocco
| | - M Sebbani
- Community medicine, epidemiology and public health department, Mohammed VI university hospital, research laboratory, school of medicine, Caddi Ayyad university, Marrakesh, Morocco
| | - I Hajji
- Ophthalmology department, Mohammed VI university hospital, BP 1456 hay mohammadi, 40000 Marrakesh, Morocco
| | - M Amine
- Community medicine, epidemiology and public health department, Mohammed VI university hospital, research laboratory, school of medicine, Caddi Ayyad university, Marrakesh, Morocco
| | - A Moutaouakil
- Ophthalmology department, Mohammed VI university hospital, BP 1456 hay mohammadi, 40000 Marrakesh, Morocco
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Belghmaidi S, Hajji I, Ennassiri W, Benhaddou R, Baha Ali T, Moutaouakil A. [Management of corneal neovascularization prior to corneal transplantation: Report of 112 cases]. J Fr Ophtalmol 2016; 39:515-20. [PMID: 27324233 DOI: 10.1016/j.jfo.2016.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/15/2015] [Accepted: 01/28/2016] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The avascular nature of the cornea results from a balance between angiogenic factors and anti-angiogenic factors. Under pathological conditions, this homeostasis can be disturbed, resulting in the onset of corneal neovascularization. The purpose of our study was to report our experience in the management of corneal neovascularization prior to keratoplasty. MATERIALS AND METHODS This is a prospective study of 112 patients with corneal neovascularization and candidates for possible corneal transplant. RESULTS The average age of patients was 38 years, ranging from 15 to 72 years. The etiologies of neovascularization were dominated by ocular trauma (26.8 %). In total, 48.33 % of patients had superficial neovascularization, 18.52 % moderately deep and 33.2 % deep neovascularization. All patients received topical corticosteroids, 29.4 % received subconjunctival injections of bevacizumab, and 22.32 % intrastromal bevacizumab injections. Clinical course was marked by a decrease in the percentage of corneal neovascularization compared to the total corneal surface area, from 45 % (between 16 and 82 %) to 28 % (between 0 and 69 %) at Day 120. There was no statistically significant improvement in visual acuity. DISCUSSION Corneal neovascularization is a major risk factor for graft rejection; its management is crucial prior to every keratoplasty. CONCLUSION Corneal neovascularization can lead to increased risk of graft rejection. Proper management increases the success rate of penetrating keratoplasty.
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Affiliation(s)
- S Belghmaidi
- Service d'ophtalmologie, CHU Mohammed VI, 40000 Marrakech, Maroc.
| | - I Hajji
- Service d'ophtalmologie, CHU Mohammed VI, 40000 Marrakech, Maroc
| | - W Ennassiri
- Service d'ophtalmologie, CHU Mohammed VI, 40000 Marrakech, Maroc
| | - R Benhaddou
- Service d'ophtalmologie, CHU Mohammed VI, 40000 Marrakech, Maroc
| | - T Baha Ali
- Service d'ophtalmologie, CHU Mohammed VI, 40000 Marrakech, Maroc
| | - A Moutaouakil
- Service d'ophtalmologie, CHU Mohammed VI, 40000 Marrakech, Maroc
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Bouheraoua N, Labbé A, Chaumeil C, Liang Q, Laroche L, Borderie V. [Acanthamoeba keratitis]. J Fr Ophtalmol 2014; 37:640-52. [PMID: 25169145 DOI: 10.1016/j.jfo.2014.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/25/2014] [Accepted: 05/26/2014] [Indexed: 11/24/2022]
Abstract
Early diagnosis and appropriate therapy are key elements for a good prognosis in Acanthamoeba keratitis (AK). AK should be considered in any case of corneal trauma complicated by exposure to soil or contaminated water, and in all contact lens (CL) wearers. A presumptive diagnosis of AK can be made clinically and with in vivo confocal microscopy, although a definitive diagnosis requires identification of Acanthamoeba on direct scraping, histology, or identification of Acanthamoeba DNA by polymerase chain reaction (PCR). We use cysticidal drugs for treating AK because encysted forms are more resistant than trophozoites to treatment. The treatment protocol used a biguanide (PHMB 0.02% or chlorhexidine 0.02%) and a diamidine (propamidine 0.1% or hexamidine 0.1%). New diagnostic modalities and more specific topical anti-amoebic treatments would substantially benefit patients with AK.
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Affiliation(s)
- N Bouheraoua
- Service d'ophtalmologie 5, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Inserm, U968, UPMC Paris VI, UMR S 968, CNRS, UMR 7210, institut de la vision, 17, rue Moreau, 75012 Paris, France.
| | - A Labbé
- Inserm, U968, UPMC Paris VI, UMR S 968, CNRS, UMR 7210, institut de la vision, 17, rue Moreau, 75012 Paris, France; Service d'ophtalmologie 3, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, DHU View maintain, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - C Chaumeil
- Service de biologie médicale, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - Q Liang
- Beijing Institute of Ophthalmology, Beijing TongRen Eye Center, Beijing TongRen Hospital, Capital Medical University, Beijing, Chine
| | - L Laroche
- Service d'ophtalmologie 5, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Inserm, U968, UPMC Paris VI, UMR S 968, CNRS, UMR 7210, institut de la vision, 17, rue Moreau, 75012 Paris, France
| | - V Borderie
- Service d'ophtalmologie 5, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Inserm, U968, UPMC Paris VI, UMR S 968, CNRS, UMR 7210, institut de la vision, 17, rue Moreau, 75012 Paris, France
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