Purpose To evaluate femtosecond laser lens fragmentation and anterior capsulotomy in cataract surgery. Methods Anterior capsulotomy and phacofragmentation procedures performed with an intraocular femtosecond laser (LenSx Lasers Inc) were initially evaluated in ex vivo porcine eyes. These procedures were then performed in an initial series of nine patients undergoing cataract surgery. In addition to standard intraoperative assessments (including capsulotomy diameter accuracy and reproducibility), optical coherence tomography was used to evaluate human procedures. Results For an intended 5-mm capsulorrhexis in porcine eyes, average achieved diameters were 5.88+/-0.73 mm using a standard manual technique and 5.02+/-0.04 mm using the femtosecond laser. Scanning electron microscopy revealed equally smooth cut edges of the capsulotomy with the femtosecond laser and manual technique. Compared to control porcine eyes, femtosecond laser phacofragmentation resulted in a 43% reduction in phacoemulsification power and a 51% decrease in phacoemulsification time. In a small series of human clinical procedures, femtosecond laser capsulotomies and phacofragmentation demonstrated similarly high levels of accuracy and effectiveness, with no operative complications. Conclusions Initial results with an intraocular femtosecond laser demonstrate higher precision of capsulorrhexis and reduced phacoemulsification power in porcine and human eyes.

Initial clinical evaluation of an intraocular femtosecond laser in cataract surgery.

OBJECTIVES To estimate the incidence of retinopathy of prematurity (ROP) in the Early Treatment for Retinopathy of Prematurity (ETROP) Study and compare these results with those reported in the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) Study. METHODS The ETROP Study, as part of its protocol, screened 6998 infants at 26 centers throughout the United States. Serial eye examinations were conducted for infants born weighing <1251 g, making it possible to estimate the frequency of ROP in different birth weight and gestational age categories. ROP was categorized according to the International Classification for ROP. RESULTS The incidence of any ROP was 68% among infants of <1251 g. The findings were compared with those for infants born in 1986 and 1987 in the CRYO-ROP Study. The overall incidences of ROP were similar in the 2 studies, but there was more zone I ROP in the ETROP Study. Among infants with ROP, more-severe ROP (prethreshold) occurred for 36.9% of infants in the ETROP Study and 27.1% of infants in the CRYO-ROP Study. The gestational age of onset of ROP of different severities has changed very little since the CRYO-ROP Study was conducted. CONCLUSIONS ROP remains a common important problem among infants with birth weights of <1251 g. The incidence of ROP, time of onset, rate of progression, and time of onset of prethreshold disease have changed little since the CRYO-ROP natural-history study.

The incidence and course of retinopathy of prematurity: findings from the early treatment for retinopathy of prematurity study.

Prevention of what

Corneal neovascularization: an anti-VEGF therapy review.

Background/Purpose:Retinal vein occlusion is the second most common retinal vascular disorder after diabetic retinopathy and is considered to be an important cause of visual loss. In this review, the purpose is to make an update of the literature about the classification, epidemiology, pathogenesis,

Branch retinal vein occlusion: epidemiology, pathogenesis, risk factors, clinical features, diagnosis, and complications. An update of the literature.

Correction of postkeratoplasty astigmatism by femtosecond laser compared with mechanized astigmatic keratotomy.

Background: To compare the effects of different doses of bevacizumab with both saline and dexamethasone on inflammatory angiogenesis in the rat cornea induced by small chemical lesions.



Methods:  Corneal chemical cauterization was performed on 24 rats. Animals were divided randomly into six groups and received a daily subconjunctival injection for 7 days of: balanced salt solution 0.1 mL or dexamethasone phosphate 4 mg/day or bevacizumab 2.5 mg/day, 3.75 mg/day, 5.0 mg/day or bevacizumab 5.0 mg/day + dexamethasone phosphate 4 mg/day. Clinical examination under slit lamp was performed daily for 7 days to evaluate corneal opacity and vessel size evolution. Computer-assisted quantitative image analysis was used to measure the total corneal area covered by neovascularization.



Results:  At final examination, the dexamethasone, bevacizumab 5.0 mg/day and dexamethasone + bevacizumab groups showed a significant lowering in corneal opacity score as compared with control (P = 0.024, P = 0.006 and P = 0.013, respectively). Also, a significant reduction on new vessels size score was observed. Surface of corneal neovascularization was significantly reduced in dexamethasone, bevacizumab 5.0 mg/day and dexamethasone + bevacizumab groups compared with control (P = 0.045, P = 0.047 and P = 0.044, respectively).



Conclusion:  Our study demonstrates the ability of a 5.0 mg/day bevacizumab subconjunctival injection, in monotherapy or associated with dexamethasone, to cause a short-term involution of corneal neovascularization after corneal alkali burn. Combination of both of these treatments may have advantages to monotherapy approaches.

Inhibition of corneal neovascularization after alkali burn: comparison of different doses of bevacizumab in monotherapy or associated with dexamethasone

Introduction Les keratoplasties lamellaires anterieures sont de realisation delicate et l’utilisation du laser femtoseconde dans cette indication doit permettre d’en ameliorer les resultats anatomiques et fonctionnels. Nous rapportons le premier cas de keratoplastie lamellaire anterieure assistee par un laser femtoseconde. Observation Il s’agit d’une patiente âgee de 63 ans, presentant une dystrophie corneenne anterieure de Francois, traitee par keratoplastie lamellaire anterieure assistee par laser femtoseconde ( Femtec 20/10 Perfect Vision ® ). Une decoupe corneenne lamellaire par laser femtoseconde a ete realisee a 400 μm de profondeur sur un greffon corneen, positionne sur une chambre anterieure artificielle ( Moria ® , France ), puis sur la cornee receveuse du patient. Resultats Au cours de la periode postoperatoire, le lenticule corneen etait parfaitement adapte au lit receveur avec une interface claire. L’evaluation en OCT III (Carl Zeiss Meditech, Dublin) a permis de constater une pachymetrie centrale de 713 μm avec un lit receveur extremement regulier et une epaisseur centrale de 132 μm. Discussion Les decoupes corneennes assistees par laser femtoseconde doivent en comparaison avec les decoupes mecanisees ameliorer la securite operatoire, la reproductibilite, et la predictibilite des decoupes obtenues. Une meilleure congruence du greffon limite le risque de deplacement secondaire et la meilleure regularite de l’interface doit ameliorer le resultat fonctionnel. Conclusion Les keratoplasties lamellaires anterieures assistees par laser femtoseconde Femtec 20/10 Perfectvision ® presentent de nombreux avantages pour la prise en charge des pathologies corneennes necessitant une keratoplastie lamellaire anterieure. Des etudes comparatives, multicentriques, et randomisees sont necessaires afin d’evaluer les resultats de cette technique.

Kératoplastie lamellaire antérieure assistée par laser femtoseconde

Background: The foveal avascular zone (FAZ) is known to enlarge in diabetic retinopathy. In a preliminary study, the authors applied a region growing algorithm to fluorescein angiograms to detect the FAZ in a semi-automated fashion.



Methods:  The FAZ in 44 fluorescein angiograms of 44 eyes of 41 patients with diabetic retinopathy underwent manual outlining, then analysis with the region growing function of the ENVI image analysis software. The same algorithm was applied after median filtering of the images.



Results:  Correlation coefficient was 0.98 between the first two authors, 0.89 between the first author and semi-automated detection before median filtering and 0.91 after median filtering. Average surface areas however, were smaller with semi-automated detection (1951 pixels before and 2226 pixels after median filtering) than with manual detection (3032 pixels).



Conclusions:  Semi-automated detection of the FAZ is possible, but refinements need to be made in angiogram quality and/or image pretreatment to improve results.

Semi-automated detection of the foveal avascular zone in fluorescein angiograms in diabetes mellitus.

But de l'etude Le syndrome de Brown entre dans le cadre des strabismes anatomiques ou syndromes de restriction. Il est defini par une limitation active et passive de l'elevation en adduction dans le champ d'action du muscle oblique inferieur. L'etiologie du syndrome de Brown congenital reste inconnue mais le deficit se situe au niveau du muscle oblique superieur avec presence d'un obstacle au passage libre du tendon a travers la trochlee. Nous proposons d'etudier la frequence des signes cliniques et les resultats chirurgicaux de patients presentants un syndrome de Brown congenital. Materiel et methodes Notre etude a porte sur 18 enfants, chacun d'eux a beneficie d'un examen ophtalmologique regulier pre et postoperatoire associe a un examen orthoptique complet. Resultats Pas de lateralite ni de predominance de sexe n'a ete notee. La position vicieuse de la tete a ete retrouvee dans 7 cas sur 18. Le signe constant a ete la limitation de l'elevation en adduction avec un test de duction forcee positif. Onze cas ont beneficie d'une chirurgie avec un recul du muscle oblique superieur. Les resultats de la chirurgie ont ete satisfaisant pour le traitement du torticolis puisque celui-ci a ete gueri dans plus de 80 % des cas. Conclusion L'etiologie du syndrome de Brown congenital reste encore discutee. Les differentes techniques chirurgicales donnent des resultats variables, c'est pourquoi il faut poser l'indication operatoire uniquement en presence de signes fonctionnels et cliniques precis c'est-a-dire un torticolis, une deviation des yeux en position primaire et une alteration de la vision binoculaire.

[Brown syndrome: current status].

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