To evaluate the refractive outcomes of cataract surgery in patients with nanophthalmos. In this retrospective descriptive case series, the medical records of patients with nanophthalmos (axial length<20mm) who underwent cataract surgery between 2015 and 2024 by the same surgeon (J.-S. R) at the National Vision Hospital of Quinze-Vingts were analyzed. Collected data included clinical and biometric characteristics as well as intraoperative and postoperative complications. The intraocular lens power was used to calculate the predicted postoperative refractive error using seven biometric formulas (Barrett Universal II, SRK/T, Hoffer Q, Holladay I, Haigis, EVO, Hoffer QST). For each formula, both the numerical refractive error and the mean absolute error were calculated. Six eyes of six patients (3 women, 3 men) with a mean age of 63years were included in this study. The mean axial length was 17.2±1.17mm. The Barrett Universal II and Hoffer Q formulas showed better refractive accuracy (mean absolute prediction errors respectively 0.99±0.55 D; 1.38±0.59 D; 1.99±1.13 D). For the Holladay I, Hoffer QST, SRK/T, and Haigis formulas, the mean errors were higher (respectively 3.11±1.11 D; 3.48±1.51 D; 4.19±1.35 D; 6.65±0.95 D) and showed a greater tendency toward myopic shift. One patient experienced a postoperative decrease in visual acuity (from 0.3 to 0.4 logMAR). Despite the development of complex automated models, our study suggests that the Barrett Universal II and Hoffer Q formulas, both validated for short eyes, appear to remain reliable for patients with nanophthalmos.
To study the epidemiological, clinical, and therapeutic aspects of a cohort of French patients with thyroid eye disease (TED). We conducted a retrospective, single-center study over a 4-year period, including all patients referred to our tertiary referral center for TED. Patients without TED or with incomplete data were excluded. A total of 100 patients were included (77% women), with a mean age of 43.5years (range: 25 to 90years). Among them, 47% were smokers, 16% had a personal history of autoimmune diseases, and 24% had a family history of autoimmune conditions. One-third of the patients were euthyroid at the time of consultation, and one-third had undergone radical thyroid treatment. The most common symptoms were upper eyelid retraction (48%) and exophthalmos (42%). In our cohort, 5% of patients had associated myasthenia, most often presenting with ptosis. Among these, 80% had pure ocular myasthenia. An active form (CAS≥3) was found in 15% of the patients, primarily treated with corticosteroid boluses. Six patients had severe forms with optic neuropathy, requiring medical and surgical management in the majority of cases. Approximately half of the patients underwent surgical management (orbital decompression, strabismus surgery, eyelid surgery), either alone or sequentially. TED is a condition predominantly affecting women, typically presenting with upper eyelid retraction and/or exophthalmos. Approximately 5% of patients have associated myasthenia and compressive optic neuropathy. An active/inflammatory form is present in 15% of patients.
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Cataract surgery, one of the most performed procedure in the world reaching over 20 million procedures per year. Climate change is leading more and more healthcare professionals to evaluate their practices from an environmental point of view. With this in mind, and with the view to subsequently proposing measures for the eco-design of care, our objective was to evaluate the carbon footprint in a French University Hospital (Reims, France). We conducted a single-center medico-environmental prospective observational study. Carbon emissions have been divided into two categories: direct and indirect. Among the direct emissions, we collected the mode of transport, and the distance travelled to and from the site by patients and staff; the annual energy consumption was collected and adjusted according to the operating surface area and the energy consumption linked to sterilization. Among the indirect emissions, we carried out a life cycle assessment of single-use instruments and pharmaceutical products using the economic input-output life cycle assessment (EIO-LCA) method; waste was also weighed and its emissions assessed. We excluded from our analysis all causes assumed to account for less than 1% of total carbon emissions (building construction, operating microscope and phacoemulsifier). We converted the raw data into CO2 equivalents using conversion coefficients provided by various environmental databases (base empreinte; DEFRA's emissions factors, greenhouse gases protocol). The carbon footprint for cataract surgery in our University Hospital was 97.28kgCO2eq (min: 85kgCO2eq; max: 127.54kgCO2eq; SD: 12.36). Single-use instruments were responsible for most of these emissions (63%), followed by pharmaceutical products (17.9%), patient and staff transport (13.71%), energy consumption in the operating theatre (2.7%), sterilization (1.76%) and waste (0.88%). As a result, the carbon footprint of one cataract surgery is equivalent to that of a 450-km trip by car. Our study confirms the major impact of disposable instruments on carbon emissions in cataract surgery and, through this analysis, opens new avenues to propose solutions for more sustainable development in surgery.
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To characterize childhood non-infectious uveitis (NIU) patients who developed demyelinating lesions during TNF-α blocker therapy and to investigate potential risk factors associated with this pathology. This retrospective single-center cohort study included pediatric NIU patients treated with TNF-α blockers who had undergone brain magnetic resonance imaging (MRI) at any time during the course of the disease. Demographic and clinical characteristics, the ocular complication score (OCS), and imaging data were reviewed. The study cohort included 45 patients with a mean age of 13.8±4.46 (5-22) years. The mean duration of TNF-α blocker treatment within the study period was 44±27.9 months. The OCS did not significantly change from baseline to final visit (P=0.10). Brain MRI was performed before initiation of TNF-α blocker therapy in 21 (46.6%) patients and during treatment in 24 (53.4%). All demyelinating lesions were detected on MRIs obtained after TNF-α blocker initiation (median: 52 months; range 18-84). Central nervous system (CNS) demyelinating lesions were identified in 4 (8.8%) patients; two were diagnosed with multiple sclerosis, and two with radiologically isolated syndrome. CNS demyelination was uncommon but clinically relevant in pediatric NIU patients receiving TNF-α blockers. Demyelinating lesions may be associated with pars planitis, neurologic symptoms, and/or a family history of demyelinating disease. During treatment, CNS MRI may be considered when new neurologic symptoms accompany an uncontrolled uveitis flare, particularly in the presence of newly developed ocular inflammatory findings.
The goal of this study was to assess the agreement between visual field (VF) and probability maps generated from swept-source optical coherence tomography (SS-OCT) in various stages of glaucoma. This cross-sectional study included patients who underwent VF testing and SS-OCT at the same visit. Patients were classified into early, moderate, and advanced glaucoma according to the Hodapp-Parrish-Anderson criteria. The VF pattern deviation maps were partitioned into 10 defined areas, while the probability maps were divided into 6 defined areas. Areas exhibiting significant defects on the probability map were compared with the corresponding VF defect areas. The agreement between VF and the probability map results was assessed. In early glaucoma, moderate agreement was found between the peripapillary defect on the probability map and the nasal step defect on the VF in both hemifields. As the glaucoma stage progressed, the number of areas showing agreement and the level of agreement between the areas increased. In moderate glaucoma patients, the areas of agreement in both hemifields correspond to the arcuate scotoma pattern. In advanced glaucoma, the probability map and VF showed substantial and almost perfect agreement between many areas corresponding to the ring scotoma pattern. In early, moderate, and advanced glaucoma, a significant agreement was found between the defects on the VF and on the probability map. These findings suggest that probability maps may serve as a promising complementary tool in the assessment of patients with glaucoma and in supporting the evaluation of disease progression, particularly in cases where reliable VFs cannot be obtained.
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Vergence disorders are generally treated by office-based vergence/accommodative therapy. Novel technologies now make it possible to include patients in their own care and increase efficiency. Eye movement ability analysis (EMAA) is a software designed to treat binocular vision disorders, combining the use of virtual reality (VR) and eye tracking. The objective of this study is to evaluate, in routine practice and in real-life settings, the safety and efficacy of EMAA in the rehabilitation of vergence disorders. Retrospectively, the elements of an orthoptic assessment (fusional vergences, near point of convergence [NPC], heterophoria, stereoacuity) performed by French orthoptists in their routine practice, were evaluated before and after rehabilitation by EMAA. Symptoms, adverse effects, compliance and use of telecare were also recorded. After vision therapy, 80% of participants had improved near positive fusional vergence by at least 10 prism diopters. More generally, fusional vergence (near positive: P<0.001; near negative: P=0.014), NPC (P<0.001) and symptoms improved (after rehabilitation, 94% were headache-free, 95% asthenopia-free and 96% eye pain-free). Seventy-two percent of patients completed their follow-up. Seventeen percent of rehabilitation sessions were carried out using telecare. No serious adverse events and very few non-serious adverse events (3%) were reported. This study demonstrates the safety and efficacy of EMAA.
To determine the prevalence of retinal ischemic perivascular lesions (RIPLs) in the unaffected fellow eyes of patients with retinal artery occlusion (RAO) and to evaluate their association with systemic vascular risk factors. A total of 80 eyes were included: 40 unaffected fellow eyes of patients diagnosed with RAO and 40 eyes of age-matched healthy control subjects. All participants underwent optical coherence tomography angiography imaging. RIPLs were identified and quantified in the fellow eyes of RAO patients and in control eyes. Quantitative vascular density analysis of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) was performed in regions where RIPLs were present. Associations between RIPLs and systemic vascular conditions - including hypertension, carotid artery stenosis, hypercoagulable states, smoking history, prior COVID-19 infection, and COVID-19 vaccination status - were analyzed using multivariate logistic regression models. RIPLs were detected significantly more frequently in the fellow eyes of RAO patients than in control eyes (70% vs. 17.5%, P<0.001). The mean number of RIPLs per eye was significantly higher in the RAO group (2.21 vs. 0.29, P<0.001). In the inferior temporal quadrant, vascular density was significantly reduced in RIPL-positive regions of both the SCP (P=0.047) and DCP (P=0.045). The presence of RIPLs was independently associated with hypertension (OR=4.80; 95% CI: 1.04-9.15; P=0.035) and carotid artery stenosis (OR=2.96; 95% CI: 1.01-7.04; P=0.040). Overall, the odds of detecting RIPLs were 8.40 times higher in RAO fellow eyes compared with controls (P=0.010). RIPLs are significantly more prevalent in the unaffected fellow eyes of patients with RAO and are strongly associated with systemic vascular risk factors, suggesting their potential role as a subclinical retinal biomarker of systemic vascular disease.
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Trabecular MIGS (minimally invasive glaucoma surgery) procedures target the trabecular meshwork and Schlemm's canal in order to restore the physiological outflow of aqueous humor. Some approaches use implants, such as the iStent® or Hydrus®, which create a bypass to Schlemm's canal and thus improve drainage. Other techniques rely on incision or ablation of the trabecular meshwork, such as the Trabectome®, Kahook Dual Blade®, or gonioscopy-assisted transluminal trabeculotomy (GATT), to facilitate access to the collector channels. Devices like OMNI® or Visco360® combine canaloplasty and viscodilation to expand Schlemm's canal. Finally, excimer laser trabeculotomy offers a non-implant alternative by selectively perforating the trabecular meshwork. Clinical data show that these procedures, to varying degrees, lower intraocular pressure and reduce the need for topical medications, while presenting a safer profile than traditional filtering surgeries. The iStent® and Hydrus® benefit from the strongest scientific evidence, derived from phase III randomized trials that have confirmed their efficacy and safety. Ablative techniques are also effective but associated with a higher risk of hemorrhage, whereas ELT represents an interesting option free of implants. Overall, trabecular MIGS appears to be a safe and effective alternative for mild to moderate glaucoma, helping to reduce medication dependence and delay the need for more invasive surgeries, although outcomes vary depending on the technique and patient profile.
Repeated eye rubbing and ocular microtrauma (F&MOR) have been identified as the main risk factors for the onset and progression of keratoconus. A questionnaire was developed and scientifically validated to provide a tool for screening and managing the behavioral and environmental components of this condition. A consortium of experts initially met to define a list of relevant questions aimed at profiling traits of patients coming for the first time to a National Reference Center for Keratoconus (CRNK). This questionnaire was administered twice to a prospective cohort of patients across eight centers. Statistical analyses were performed to retain only the fifteen most relevant questions. A final expert consultation using a nominal group method completed the validation process. The finalized questionnaire includes 15 items designed to assess the risk of F&MOR. Its objective is to support clinical management and serve as a therapeutic tool for the prevention and inhibition of F&MOR in patients with keratoconus. This validated questionnaire enables ophthalmologists to standardize and strengthen preventive and therapeutic strategies for keratoconus.
To review the literature on neuro-ophthalmologic complications associated with radiofrequency ablation (RFA) for trigeminal neuralgia (TN) and, in light of current evidence, to present and analyze a case of combined autonomic and cranial neuropathy following the procedure. A narrative literature review was conducted on neuro-ophthalmologic complications associated with RFA for TN. Published reports were analyzed with attention to involved cranial nerves, mechanisms of injury, clinical presentation, management strategies, and visual outcomes. In addition, a single case was retrospectively reviewed based on medical records, including clinical findings, neuro-ophthalmologic examination data, treatment interventions, and follow-up documentation. Data were synthesized in the context of existing literature. Published literature indicates that neuro-ophthalmologic complications after RFA for TN are rare but may occur due to the proximity of the trigeminal ganglion to adjacent cranial and autonomic structures. Most reported cases involve isolated cranial nerve deficits, whereas simultaneous multiple nerves and sympathetic involvement is uncommon. In the present case, a 66-year-old female developed diplopia, corneal anesthesia, and anisocoria following RFA. Neuro-ophthalmologic evaluation demonstrated right trochlear nerve palsy, ophthalmic nerve (V1) dysfunction, and sympathetic involvement. Conservative management was initiated. During follow-up, ophthalmic nerve dysfunction resolved by week five, while full recovery of trochlear and sympathetic dysfunction occurred by month five. Radiofrequency ablation for TN is generally safe but may rarely cause neuro-ophthalmologic complications due to proximity of cranial and autonomic structures. Early recognition and ophthalmologic follow-up are essential. This case highlights rare combined trochlear, ophthalmic, and sympathetic involvement after RFA.
The efficacy and safety evaluation of XEN® gel stent implantation, alone and combined with cataract surgery, in glaucoma's surgical treatment, at short- and long-term. In this single-center retrospective study, all patients who received a XEN® gel stent between September 2018 and October 2023 were included. The primary outcome was complete success rate (≥20% decrease in IOP without medication or complication) and qualified success rate (with antiglaucoma treatment or minimal complication) at 1month, 6months, 1year, 2years, 3years and 5years. Needlings were not considered as failures. Secondary endpoints included number of postoperative medications, failures, complications, needlings, visual acuity, RNFL OCT and visual field. One hundred and one eyes of 83 patients were analyzed (41 XEN® single, 60 combined with cataract surgery). Complete success rate went from 73.3% at 1month to 33.3% at 5years, and mean IOP from 17.98mmHg to 13.68mmHg at 5years, with a reduction of around 22% (±4.98). Antiglaucoma medications decreased significantly at all times, from 3 (±0.989 95% CI [0.870-1.149]) classes before surgery to 1 (±1.328 95% CI [0.997-1.991]) class at 5years. Needling was needed in 38.9% cases. Among the 22 failures, ten eyes required trabeculectomy to control IOP, and one case of endophthalmitis was noted. XEN®, alone or in combination, provides effective, long-lasting IOP and medication reduction up to 5years, with a good safety profile, in glaucoma's treatment. However, needling is often necessary, and efficacy seems to decrease over time, so, a close postoperative follow-up is required.