BACKGROUND:Toxic/nutritional optic neuropathy (TON) is a diagnosis of exclusion after an extensive work-up. In cases of a non-contributory history or atypical presentation, formal diagnosis can sometimes be difficult and delay management. The goal of this study was to evaluate the diagnostic value of checkerboard visual evoked potentials (VEP) for toxic/nutritional optic neuropathy. The working hypothesis was that, in TON, VEPs are more affected than best corrected visual acuity (BCVA). We assumed that, for BCVA ≥ 1/20 and ≥ 2/10, the 60' and 15' checkerboard VEP responses would be respectively affected. METHODS:This was an observational, single-center, retrospective study. We collected demographic data, self-declared data on alcohol and tobacco use, data from the ophthalmologic examination, and notably the BCVA as well as the 60' and 15' VEPs. We divided the subjects into two visual acuity groups, one with BCVA ≥ 1/20, for which we reported the 60' VEP results, and the other with BCVA ≥ 2/10, for which we reported the 15' VEP results. RESULTS:Sixty-five patients were included. For those with BCVA ≥ 1/20, 64.2% of the 60' VEPs were undiscernible from background noise. Similarly, 95.3% of the 15' VEPs were undiscernible for the BCVA ≥ 2/10 group. CONCLUSION:Our study results indicate that, in TON, VEPs are more affected than the visual acuity would suggest. This may be a diagnostic pattern suggestive of TON.
PURPOSE: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. METHODS: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. RESULTS: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. CONCLUSION: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.
INTRODUCTION:The goal of this study is to compare the functional outcomes and impact on quality of life of external and endonasal dacryocystorhinostomies using the Lac-Q questionnaire. MATERIAL AND METHODS:This was an observational, retrospective, and comparative study conducted at Caen University Hospital between January 2019 and December 2022. Patients who underwent external or endonasal DCR were evaluated using the French translation of the Lac-Q questionnaire, completed between February 2024 and February 2025. Collected data included pre- and postoperative scores for functional and social impact, overall satisfaction, and cosmetic discomfort. RESULTS:Thirty-nine patients were included (29 external, 10 endonasal). Postoperatively, a significant improvement in total score, functional score, and social impact score was observed in both groups (P<0.001). Satisfaction rates were high, and cosmetic concerns were minimal. No statistically significant difference was found between the techniques in terms of score improvement (P=0.175). CONCLUSION:Both external and endonasal DCR significantly improve symptoms and quality of life, with no difference between techniques. Assessment using the Lac-Q allows quantification of this functional and social benefit, complementing traditional anatomical criteria. As both approaches yield comparable results, the choice of technique should be guided by the clinical context and the preferences of both surgeon and patient.
PURPOSE:To assess diagnostic and clinical decision concordance between a face-to-face ophthalmological examination using handheld equipment and an asynchronous teleophthalmology assessment in disabled elderly fall-risk patients as well as the feasibility of this approach. PATIENTS AND METHODS:This prospective single-center study evaluated a diagnostic method. Disabled elderly fall-risk patients underwent an in-person ophthalmological examination using a handheld slit-lamp followed by an asynchronous teleophthalmology assessment based on videos acquired by handheld anterior segment and fundus cameras. Diagnostic and management concordance were assessed using Cohen's kappa coefficient. Feasibility was evaluated by the rate of readable examinations. RESULTS:A total of 142 patients (281 eyes) were included. Concordance was very good for phakic/pseudophakic status assessment (kappa=0.87-0.96), moderate for lens assessment (kappa=0.51-0.58) and macular evaluation (kappa=0.48-0.57), and low for other anterior (cornea, iris) and posterior segment (optic nerve head, retinal vessels) assessment as well as for overall clinical decision-making (kappa=0.15-0.35). Feasibility was excellent for anterior segment examination (90-98%) and acceptable for posterior segment assessment (61-81%). A clinical decision could be proposed via teleophthalmology in 50-72% of cases. The main causes of visual impairment were cataract, age-related macular degeneration, and optic neuropathy. CONCLUSION:Asynchronous teleophthalmology using handheld equipment appears feasible in disabled elderly patients, with variable reliability depending on the parameters assessed. Technological, organizational, and methodological improvements are required before broader implementation.
PURPOSE:Benign essential blepharospasm (BEB) is a focal dystonia characterized by involuntary eyelid contractions that can disrupt tear film stability and corneal morphology. Botulinum toxin type A (BTX-A) injection is the standard treatment, yet its impact on ocular surface health and corneal epithelial structure remains unclear. This study aimed to assess the effects of periocular BTX-A on tear film parameters and corneal epithelial remodeling using anterior segment optical coherence tomography (AS-OCT). METHODS:This retrospective, single-center study included 35 eyes of 35 BEB patients treated with standardized periocular BTX-A injection (total dose ∼12.5 units). Ocular surface parameters Ocular Surface Disease Index (OSDI), tear breakup time (TBUT), Schirmer test, tear meniscus height (TMH), and meibomian gland dropout were evaluated at baseline and 3 months post-treatment. Corneal epithelial maps obtained via AS-OCT provided central, superior, and inferior epithelial thicknesses and irregularity indices. Corneal power and astigmatism were analyzed by topography. Pre- and post-treatment values were compared using paired tests. RESULTS:At 3 months, blepharospasm severity and OSDI scores improved significantly (P<0.001). TBUT and TMH increased (P<0.001), while Schirmer test and gland dropout were unchanged. Superior epithelial thickness increased and irregularity indices decreased (P<0.001), indicating smoother remodeling. Corneal power and astigmatism decreased significantly (P<0.001), consistent with corneal flattening. No adverse effects were observed. Improvements correlated with reduced spasm severity. CONCLUSION:BTX-A injection in BEB patients alleviates spasms and enhances tear film stability and epithelial regularity. The treatment is safe and well tolerated, offering additional ocular surface benefits beyond motor symptom control.
Purpose To evaluate the differences and interchangeability of white-to-white (WTW) distance and anterior chamber depth (ACD) measurements among three devices: Anterion (Heidelberg Engineering, Heidelberg, Germany), IOL Master 700 (Carl Zeiss Meditec, Jena, Germany), and Pentacam (Oculus, Wetzlar, Germany). Methods A randomized sample of 275 healthy subjects was selected. Measurements were taken of the right eye of all participants. WTW and ACD were measured using Anterion, Pentacam, and IOL Master 700. Differences between instruments were analyzed using the Friedman test, and device interchangeability was assessed using the Bland-Altman plots. Results A total of 275 eyes of 275 subjects were evaluated. With regard to WTW analysis, statistically significant differences were found when comparing the three instruments (P<0.001). The highest values were obtained with IOL Master 700, followed by Anterion and Pentacam. For ACD, significant differences were also found among the three devices (P<0.001). The highest ACD measurements were obtained with Anterion, followed by Pentacam and IOL Master 700. Conclusion Significant differences in WTW and ACD measurements were found when comparing the three devices. The clinical relevance of these differences and the interchangeability of the instruments should be individually considered.
OBJECTIVE: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. MATERIAL AND METHOD: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. RESULTS: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. CONCLUSION: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.
PURPOSE:To describe the current challenges in the management of bilateral blindness in southern Togo in the population aged 50 years and over. PATIENTS AND METHODS:This was a standardized descriptive cross-sectional survey in clusters based on the size of the population carried out from September 2 to 26, 2024, following the rapid assessment of avoidable blindness (RAAB) version 7, or RAAB7, methodology of the London School of Hygiene and Tropical Medicine (LSHTM) in subjects aged 50 years and over in southern Togo. Each person aged 50 years or over residing in the locality who gave informed consent underwent measurement of distance visual acuity and an interview on the barriers to treating blindness. RESULTS:In total, 3726 people were examined out of 3850 planned, corresponding to a participation rate of 96.8%. Bilateral blindness was observed in 133 people, composed of 95 women and 38 men, representing a prevalence rate of bilateral blindness of 3.6% with a sex-ratio of 0.4. The 2 main causes of bilateral blindness were cataract in 61.7% and glaucoma in 15.8%. The main barriers to cataract surgery were cost in 31.8%, fear in 22.7%, ignorance of the existence of effective treatment in 17.3%, and difficulty in accessing surgery in 10.9%. CONCLUSION:Cataract remains the leading cause of bilateral blindness, which remains a major public health challenge in southern Togo. The challenges are financial, psychological and infrastructural. Increased action is necessary to reduce the extent of avoidable blindness in southern Togo.
PURPOSE:To evaluate the performance of an innovative, noninvasive, rapid chromatic multifocal dynamic pupillometry protocol (mPFTCo) in detecting functional retinal changes in three chronic diseases: age-related maculopathy (ARM), age-related macular degeneration (AMD), and diabetic retinopathy (DR). METHODS:A cohort of 222 participants (68 controls, 18 ARM, 79 AMD, 57 DR) was tested with mPFTCo. This one-minute test per eye used a multifocal stimulus covering 40° of the visual field, divided into nine regions, each periodically modulated in luminance, with chromatic alternation (blue, red, green, gray) every 15s. Regional and spectral pupillary responses were analyzed to characterize functional deficits. Group comparisons were performed using Student's t-tests and ROC curve analyses. RESULTS:Compared with controls, significant regional alterations were observed in all three diseases. In AMD, pupillary responses were reduced in central and paracentral regions, particularly under red stimulation (P<0.001). In ARM, a moderate paracentral deficit was observed with blue and green stimulation (P<0.005). In DR, a diffuse deficit affected the entire visual field across all colors (P<0.001). This brief, objective, well-tolerated test showed excellent diagnostic performance (AUC=1). CONCLUSION:mPFTCo enables rapid, noninvasive topographic assessment of retinal function. It effectively discriminates between pathological profiles and identifies subclinical alterations not detected by conventional visual tests, representing a promising tool for screening, monitoring, and functional evaluation of treatments in routine clinical practice.
PURPOSE:The goal of the present study was to compare the effect of nasal versus temporal placement of the iStent Inject W® during phacoemulsification on intraocular pressure (IOP). DESIGN AND PARTICIPANTS:Over 5 consecutive years, 389 eyes of 244 patients undergoing phacoemulsification with 2 iStent Inject W® injections in a tertiary referral center were included retrospectively. In 50.6% of eyes, 2 iStent Inject W® were injected in the inferior nasal region of right eyes, while 49.4% received injections in the inferior temporal region of left eyes. MAIN OUTCOME MEASURES:The main parameters were IOP and the number glaucoma medications. RESULTS:One month after surgery, there was no significant difference in the mean (SD) change in IOP between right eyes injected nasally [-1.2 (6.7) mmHg] and left eyes injected temporally [-1.2 (6.7) mmHg; P=0.71] and no significant difference in the mean (SD) change in the number of glaucoma medications for the right eyes injected nasally [-0.4 (1.3)] and left eyes injected temporally [-0.5 (1.3); P=0.67]. There was also no significant difference at 6 months or 12 months. Subgroup analysis in patients who underwent surgery in both eyes found no significant difference in IOP or change in glaucoma medications at 1, 6, or 12 months. The complication rate was low. CONCLUSION:The efficacy of the iStent Inject W® is not dependent on its area of implantation. From these results, we propose that iStent Inject W® can be injected either temporally or nasally based on the surgeon's preferences. This has significant implications for simplifying and speeding up the procedure and might result in improved surgical outcomes for the patient.
The goal of this review is to trace the history of refractive correction, from the earliest optical devices to modern refractive surgical techniques. Following the invention of spectacles in the Middle Ages, the first corneal procedures, such as Sato's and Fyodorov's keratotomies and Barraquer's keratomileusis, highlighted the limitations of early mechanical approaches. In the 1980s, the advent of the excimer laser revolutionized refractive surgery with the introduction of PRK (photorefractive keratectomy) and subsequently LASIK (Laser-Assisted In Situ Keratomileusis). The development of the femtosecond laser further enhanced precision and safety, while KLEx (keratorefractive lenticule extraction) provided an alternative minimally invasive procedure. In parallel, personalized treatments guided by corneal topography or wavefront analysis have significantly improved visual outcomes. When corneal surgery is not feasible, phakic intraocular lenses or refractive lens exchange offer effective alternatives. Current research is focused on artificial intelligence, new laser platforms, advanced "intelligent" intraocular implants, and ocular bioengineering. The evolution of refractive surgery thus exemplifies continuous progress toward increasingly safe, precise, and patient-tailored techniques.
INTRODUCTION:The long-term use of pressure-lowering topical medications to treat glaucoma is frequently associated with deleterious effects on the ocular surface. Ocular surface disease (OSD) often remains overlooked and untreated in patients with glaucoma and/or ocular hypertension. This study aims to determine the prevalence of OSD in Algeria and to identify risk factors. METHODS:A cross-sectional, descriptive study was conducted in 9 public and private clinical centers and included 544 patients followed for glaucoma and/or ocular hypertension. Individual historical and demographic data, as well as characteristics and management of the patients' glaucoma were collected between October 2023 and February 2024. OSD was evaluated using standard clinical tests. RESULTS:Objective signs of OSD were found in 387 patients (71.3%), and the most frequent form of OSD was dry eye disease (56.6% of all OSDs). Compared to patients without OSD, patients with OSD were older (P=0.001) and had been diagnosed with glaucoma for a longer period of time (P=0.023). Patients with severe glaucoma, previous glaucoma surgery, auto-immune disease, or diabetes were more likely to have OSD (P<0.05). OSD was also more frequent in patients receiving 3 medications or more (80.6%) compared to patients receiving two (73.9%), or one medication (60.6%, P<0.0001). A total of 75.2% of patients using preserved eye drops had OSD versus 41.3% of patients using preservative-free eye drops (P<0.001). The exposure to preserved eye drops (number of drops per day and number of topical medications) was higher in patients with OSD (P<0.05). Among patients who had interrupted their treatment due to local intolerance (n=87), a large majority (89.7%) had OSD. CONCLUSION:Our results confirm the high prevalence of OSD in Algerian patients with glaucoma and/or ocular hypertension. Several risk factors, such as exposure to preserved eye drops, were associated with a higher prevalence of OSD. Management of glaucoma patients should include regular, systematic examination of the ocular surface and can be optimized by switching to preservative-free eye drops if possible or by reducing the number and concentration of medications.
Purpose To assess the prevalence of light-induced toxic effects on the ocular and palpebral regions in maritime professionals chronically exposed to light radiation in the Provence-Alpes-Côte d’Azur region and to compare the results to a non-overexposed population. The study also investigates risk factors for and protective factors against ocular phototoxicity in exposed individuals. Design Single-center, cross-sectional comparative analysis. Participants The study included 77 maritime professionals (overexposed group) and 70 non-overexposed individuals (control group). Participants were examined between July 2023 and June 2024 at the ophthalmology department of Sainte-Anne Military Hospital. Methods Cross-sectional comparative analysis was performed between the two groups. Participants underwent a clinical examination, including ocular imaging, focused on ocular conditions such as conjunctival lesions, cataracts, and macular changes linked to light overexposure, and completed questionnaires on sun exposure. Results The study found no connection between age-related macular degeneration (AMD) and solar overexposure but highlighted the significant role of light reflection from water in other ocular conditions. Four basal cell carcinomas were found in the exposed group, consistent with the pathogenesis of these skin cancers. A higher risk of conjunctival lesions (pinguecula and/or pterygium) and cortical cataracts was noted. Macular epithelial damage was linked to increased light exposure. Protective solar equipment reduced the risk of ocular damage in certain conditions. Conclusions The PHOTOPPA study is the first to compare ocular pathologies related to light overexposure in maritime professionals. It confirms the increased risk of ocular conditions, emphasizing the importance of comprehensive sun protection to reduce light-induced ocular damage and possibly prevent AMD development.
Purpose To evaluate mid-term safety and efficacy of a new surgical technique using amniotic membrane plugs for the treatment of posterior or retracted retinal breaks or those associated with chorioretinal atrophy in tractional and chronic rhegmatogenous retinal detachment. Methods Patients with rhegmatogenous retinal detachment with at least grade C proliferative vitreoretinopathy or tractional retinal detachment whose retinal breaks were sealed with amniotic membrane plugs were included. With a minimum follow-up of 12 months, parameters measured included visual acuity evaluation, optical coherence tomography, retinal photography, intraocular pressure and re-detachment rate at 1, 3, 6 and 12 months. Results Nine eyes of 9 patients were included. The mean 12-month postoperative best-corrected visual acuity was 1.12 logMAR. Fundus photography and optical coherence tomography showed that the plugs stayed in place at 1, 3, 6 and 12 months without dislocation. Glial tissue regeneration was seen without restoration of the original retinal layers. Only one retinal re-detachment occurred after silicone oil removal. Neither elevation of intraocular pressure nor signs of inflammation were observed. Conclusion Amniotic membrane plugs represent a safe and effective surgical technique to manage posterior or retracted retinal breaks, or those associated with chorioretinal atrophy, without the limitations of laser retinopexy.
PURPOSE:To describe the demographic and clinical characteristics of pediatric patients presenting with papilledema in a tertiary university center. PATIENTS AND METHODS:This study is a single-center retrospective study of papilledema in patients under 18 years of age between January 2013 and January 2023. Visual acuity, visual field defects and retinal nerve fiber layer thickness were recorded at the beginning and conclusion of follow-up. The etiological diagnosis was established based on ocular and physical clinical examination, brain imaging and cerebrospinal fluid analysis. RESULTS:Eighty-five patients (162 eyes) were included. The mean age at diagnosis was 9.0±5.7 years, ranging from 0.1 to 17.9 years, with a mean follow-up of 15.6±19.1 months. The main etiology of papilledema, affecting 63 patients, was secondary intracranial hypertension (74.1%), mostly due to intracranial masses (20%), intracranial hemorrhages/hematomas (16.5%), and cerebral venous thrombosis (9.4%). Twenty-two patients (25.9%) had idiopathic intracranial hypertension. During follow-up, 6 patients (7.1%) died from their condition. CONCLUSION:In our tertiary center, the leading cause of papilledema was secondary intracranial hypertension, which differs from results of primary, secondary, or outpatient settings. Our study highlights the need for multidisciplinary approach in diagnosis and management of children with papilledema. These findings might guide clinicians in their evaluation of the underlying etiology.
PURPOSE:Endophthalmitis is a rare but serious ophthalmologic emergency that can lead to permanent vision loss. Due to limited literature on the subject, many aspects of its management remain controversial. This study aims to provide an overview of current management practices in French university hospitals (CHU). METHODS:A descriptive, observational, cross-sectional survey was conducted among hospital-based ophthalmologists working in CHUs using an online questionnaire. It covered diagnostic and therapeutic modalities (medical and surgical), as well as the presence of institutional protocols. RESULTS:Twenty-eight centers participated. Systemic antibiotic therapy was used in 64.3% of cases; intravenous induction followed by oral continuation was employed in 72.2% of reported cases. Levofloxacin is the most frequently prescribed antibiotic (94.4% of centers reporting use of systemic antibiotic therapy). Intravitreal injections (mainly vancomycin/ceftazidime) were systematically performed, although the number of injections varied between centers. Surgery during the "acute" phase was performed in 75% of CHUs, although the indication criteria were heterogeneous. CONCLUSION:This study highlights significant variability in the management of endophthalmitis in French university hospitals. It underscores the absence of recent national guidelines and the need for multicenter studies to evaluate therapeutic strategies, particularly the role of systemic antibiotic therapy and surgical indications for vitrectomy.
Congenital horizontal tarsal kink syndrome is a rare but well-defined form of congenital upper eyelid entropion, characterized by a horizontal tarsal fold causing inversion of the lid margin and lashes, with absence of a visible upper eyelid crease. Induced trichiasis may lead to corneal complications and a major risk of amblyopia if diagnosis and management are delayed. We report the case of a 4-week-old infant with right unilateral tarsal kink complicated by a central corneal ulcer and associated microphthalmia. This case was managed by an anterior approach with release of orbicularis adhesions, everting sutures, amniotic membrane graft and temporary tarsorrhaphy, achieving rapid corneal healing and sustained normal eyelid position. A systematic review of 38 prior published cases from 1894 to 2025 revealed a male predominance, mostly unilateral, and high frequency of corneal lesions. Surgery was required in 94.9% without reported recurrence, regardless of technique (open or closed, anterior or posterior). In this condition, early recognition and prompt surgical management can prevent corneal damage and amblyopia.
Purpose This study aimed to evaluate retinal structural and microvascular changes in children with atopic dermatitis (AD) using optical coherence tomography (OCT) and OCT angiography (OCTA) and to analyze their associations with disease severity, comorbidities, corticosteroid use, and IgE levels. Methods A prospective, cross-sectional case-control study included 43 children with AD and 32 age- and sex-matched healthy controls. Peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell layer (GCL) thicknesses were measured by spectral-domain OCT. Retinal microvasculature was assessed by OCTA with 6×6mm macular scans. Vascular densities in superficial and deep capillary plexuses and choriocapillaris were calculated using the ETDRS grid. Clinical data included SCORAD scores, serum IgE, skin hydration, eosinophil counts, and duration of corticosteroid use. Results Children with AD showed significantly reduced superior and temporal RNFL thickness compared with controls (P<0.05). Central and superior GCL thicknesses were lower but not significantly so. Foveal vascular density of the superficial plexus was significantly reduced in AD (18.7±3.3% vs. 20.4±3.4%, P=0.039). Correlation analyses showed superior RNFL thickness positively associated with skin hydration, whereas inferior GCL thickness correlated negatively. Longer corticosteroid use correlated with increased foveal superficial and superior deep vascular density, while serum IgE correlated positively with superior deep density and negatively with nasal density. Conclusion Pediatric AD may be linked to selective RNFL thinning and subtle macular vascular alterations, reflecting systemic inflammation. OCT and OCTA may serve as biomarkers for monitoring severity and early ocular involvement, underscoring the importance of interdisciplinary care.
Age-related macular degeneration (AMD) is a chronic disease whose progression toward advanced stages is closely related to the phenotype observed at the early and intermediate stages. The detection and characterization of drusen and pigmentary abnormalities are central to the stratification of progression risk. Retro mode imaging, based on indirect infrared retro-illumination, enhances the visualization of retinal surface elevation, depth-related features, and variations in pigment density. This review examines the contribution of the various retro mode configurations (deviated left [DL]; deviated right [DR]; and ring aperture [RA]) in AMD, based on recent data in the literature as well as our clinical experience. When integrated into a multimodal imaging strategy, the combined use of DL and DR modes improves the detection and morphological assessment of drusen, while the ring aperture mode facilitates the identification of subtle pigment migration at the onset of the disease. A more precise characterization of these lesions allows refinement of AMD staging and provides clinically meaningful prognostic information.
Introduction Corneal perforation is a progressive complication of Mooren's ulcer. Its management in African blacks is difficult and empirical. Materials and methods We performed a prospective study over a 6-year period on black African patients with perforated Mooren's ulcers. They received medical and surgical treatment. Results Eighteen eyes of sixteen patients were included during the study period. The mean age was 29.54years with a sex ratio of 0.6. Six eyes were visually impaired, while ten eyes (55.6%) were blind. Corneal suturing combined with conjunctival advancement was performed in 72.2% of cases, and an amniotic membrane graft was used in 27.8%. Recurrence after treatment was observed in 33.3% of cases. In univariate analysis, predictive factors for recurrence include female gender, age under 30, and a delay until consultation of more than 3 months. Conclusion Perforated Mooren's ulcer is a blinding disease in African blacks. Recurrence is frequent and requires special attention from the patient and the specialist. Amniotic membrane transplantation has proven to be an effective treatment.
