Purpose. - To compare the refractive outcomes of sutureless scleral-fixated Carlevale (R) intraocular lenses versus Artisan (R) iris-claw-fixated tenses in terms of surgically induced astigmatism. Setting. - We included patients from the Quinze-Vingts National Ophthalmology Hospital, Paris, from August 2020 to December 2020. Design. - This was a single-center retrospective study. Methods. - Each patient included had undergone surgery with a sutureless scleral-fixated Carlevale (R) foldable intraocular lens or an Artisan (R) iris-claw lens in the context of secondary implantation. Exclusion criteria included a history of retinal detachment or any other retinal disease. We analyzed postoperative refractive data three months after surgery for the Carlevale group and three months after removal of all sutures for the Artisan group. Results. - A total of 25 eyes of 25 patients were included in the Carlevale group and 37 eyes of 36 patients in the Artisan group. At three months, the best-corrected visual acuity was not statistically different, at 0.33(+/- 0.35) and 0.32(+/- 0.33) LogMAR, respectively (P= 0.99), and surgically induced astigmatism was significantly lower in the Carlevale group, at 0.538 (+/- 0.560) and 2.30 (+/- 3.97) Diopters, respectively (P<0.001). Conclusions. - In this first comparative study, Carlevale (R) intraocular lenses appear to offer better refractive accuracy and less induced astigmatism than Artisan (R) iris-claw lenses, without increasing mean surgical time. (C) 2022 Published by Elsevier Masson SAS.

Purpose. - This study aimed to evaluate the ability of a freely accessible internet algorithm to correctly identify the need for emergency ophthalmologic consultation for correct diagnosis and management. Method. - This retrospective observational cohort study was based on the first 100 patients who requested recommendations on the necessity of breaking the lockdown for emergency ophthalmology consultation during the period from March to May 2020. Results. - Ninety-one patients completed questionnaires. Forty-nine were directed to emergency consultation and 42 to differed scheduled visits or telemedicine visits. One patient sent for emergency consultation had an overestimated severity and could have been seen later, while two patients initially recommended for a scheduled visit were considered appropriate for emergency consultation. However, these patients' management did not suffer as a consequence of the delay. The sensitivity of the algorithm, defined as the number of emergency consultations suggested by the algorithm divided by the total number of emergency consultations deemed appropriate by the practitioner's final evaluation, was 96.0%. The specificity of the algorithm, defined as the number of patients recommended for delayed consultation by the algorithm divided by the number of patients deemed clinically appropriate for this approach, was 97.5%. The positive predictive value, defined as the number of appropriate emergency consultations divided by the total number of emergency consultations suggested by the algorithm, was 97.9%. Finally, the negative predictive value, defined as the number of appropriately deferred patients divided by the number of deferred patients recommended by the algorithm, was 95.2%. Conclusion. - This study demonstrates the reliability of an algorithm based on patients' past medical history and symptoms to classify patients and direct them to either emergency consultation or to a more appropriate deferred, scheduled appointment. This algorithm might allow reduction of walk-in visits by half and thus help control patient flow into ophthalmologic emergency departments. (C) 2021 Elsevier Masson SAS. All rights reserved.

ObjectiveTo assess linear correlation between swept-source optical coherence tomography (SS-OCT) lens density variation and patients’ best-corrected visual acuity (BCVA).Methods and analysisLinear densitometry was performed on horizontal lens images from 518 eyes, obtained using SS-OCT. All densities from the anterior to the posterior side of the cataract were exported for detailed analysis. The algorithm used a classical random forest regression machine learning approach with fourfold cross-validation, meaning four batches of data from 75% of the eyes with known preoperative best-corrected visual acuity (poBCVA) were used for training a model to predict the data from the remaining 25% of the eyes. The main judgement criterion was the ability of the algorithm to identify linear correlation between measured and predicted BCVA.ResultsA significant linear correlation between poBCVA and the algorithm’s prediction was found, with Pearson correlation coefficient (R)=0.558 (95% CI: 0.496 to 0.615, p<0.001). Mean BCVA prediction error was 0.0965±0.059 logarithm of the minimal angle of resolution (logMAR), with 312 eyes (58%) having a BCVA prediction correct to ±0.1 logMAR. The best algorithm performances were achieved for 0.20 logMAR, with 79%±0.1 logMAR correct prediction. Mean, anterior cortex, nucleus and posterior cortex pixel density were all not correlated with patient BCVA.ConclusionPixel density variations based on axial lens images provided by SS-OCT biometer provide reasonably accurate information for machine learning analysis to estimate patient BCVA in all types of cataracts. This study demonstrates significant linear correlation between patients’ poBCVA and the algorithmic prediction, with acceptable mean prediction error.

This prospective observational cohort study is based on the first 500 patients who requested emergency teleconsultation during the initial days of the COVID-19 lockdown in Paris, France between 20 March and 10 April 2020. It is the first study to assess the utility of emergency teleophthalmology with a simple smartphone application or web browser and a webcam to manage emergency eye care in a population with sudden restricted access to ophthalmologists. In this study, every patient who asked for an ophthalmic emergency consultation in a single specialized center in Paris (‘SOS Œil’) first had to undergo a teleconsultation appointment to evaluate the indication for a physical consultation to preserve lockdown. Under medical advice only, a physical appointment was given within a day (if necessary). The aim of the study was to describe the population and diagnoses and evaluate the main judgment criteria, defined as the ‘ability of teleconsultation to properly indicate a physical consultation for fair diagnosis and treatment in eye emergencies’. This organization has permitted physicians and patients to preserve social distancing while avoiding 3 or 4 physical consultations per person. Notably, 27% of teleconsultations were followed by a physical appointment. There was a mean 4.12-day delay between symptom apparition and consultation, and less than 1 day for traumas, superficial corneal foreign body and neuro-ophthalmological emergencies. There was a 96% sensitivity and 95% specificity to properly evaluate the indication of a physical consultation and only 1.0% misdiagnoses that lead to delayed care. Hence, teleconsultation maintained satisfactory healthcare access to patients with severe ophthalmological disorders while preserving social distancing and sanitary precautions. Therefore, teleconsultation may be seriously considered as a way to efficiently regulate ophthalmic emergencies, especially for patients with limited access to a specialist.

Localiser les structures cérébrales atteintes dans le blépharospasme.Étude rétrospective, consécutive, des IRM craniocérébrales portant sur les patients atteints de blépharospasme secondaire et ayant dans leurs antécédents immédiats un accident vasculaire cérébral ou un traumatisme crânien.Six patients répartis en 4 patients atteints d’AVC avec des lésions ischémiques ou hémorragiques des thalamus et des noyaux caudés et 2 victimes de TC ayant des lésions contusives séquellaires de la lame quadrigéminée et atrophie du cortex frontal et cérébelleux.En reprenant la littérature, les lésions cérébrales corrélées au blépharospasme atteignent principalement le thalamus, la tête du noyau caudé, le striatum, le pallidum, la capsule interne, le cortex cérébral et cérébelleux. Cette étude démontre que le blépharospasme est corrélé à une lésion sur le trajet d’un réseau nerveux complexe, cortico-thalamo-pallido-cortical et ne correspond pas à une lésion neurologique unique. Ce réseau est en connexion avec les voies ascendantes et descendantes, sensitivo-motrices et les noyaux de la coordination des mouvements.To localize the brain structures involved in blepharospasm.This is a retrospective consecutive series of brain MRI's of patients with secondary blepharospasm whose immediate past medical history included cerebrovascular accident or head trauma.Six patients, including 4 with CVA with ischemic or hemorrhagic lesions of the thalamus and caudate nuclei and 2 with head trauma with contusive sequellae to the tectal plate and frontal cortical and cerebellar atrophy.According to the literature, brain lesions associated with blepharospasm involve mainly the thalamus, head of the caudate nucleus, corpus striatum, globus pallidus, internal capsule, cerebral cortex and cerebellum. This study demonstrates that blepharospasm is associated with a lesion of a complex neural network – cortex-thalamus-globus pallidus-cortex – and does not correspond to a single, unique lesion. This network is connected with ascending and descending sensory-motor pathways and motor nuclei.

Plateau iris syndrome (PIS) is a frequent cause of angle closure. Argon laser peripheral iridoplasty (ALPI) has been proposed in PIS to widen the iridocorneal angle. The objective of the present study was to perform a systematic review of the available studies evaluating the efficacy of ALPI on intraocular pressure (IOP), iridocorneal angle opening and the number of medications in patients with chronic angle-closure associated with PIS. One prospective and seven retrospective studies with a minimum 1 month of follow-up were included. Although ALPI seemed to lower IOP, to decrease the number of topical antiglaucoma medications and widen the iridocorneal angle shortly after the procedure, there is no current evidence of long-term efficacy. To date, there is no robust scientific evidence to advocate ALPI as a treatment for chronic angle-closure caused by PIS.

Purpose: Hypertension is the most common operative medical complication in patients undergoing cataract surgery under topical anaesthesia. Our objective was to identify risk factors for high blood pressure requiring anaesthetic interventions.Methods: All patients undergoing elective cataract operations were included in an observational prospective study preceded by a medical history description and physical examination. Intraoperative adverse medical events and type of management were recorded.Results: We studied 514 elective cataract operations. The overall rate of hypertension during surgery was 10.4% (n = 54). Independent risk factors for developing intraoperative hypertension were female sex (OR = 3.8 [1.4-10.3]; P = 0.01), age > 80 years (OR = 4.5 [1.5-13.8]; P = 0.01) and anxiety (OR = 10.5 [4.1-27.0]; P < 0.001). The incidence of hypertension was not significantly reduced by premedication (OR = 0.5 [0.04-6.0]; P = 0.6). There was no significant difference between patients with or without hypertension history in the rates of hypertensive events (OR = 3.2 [0.6-15.5]; P = 0.15). Management of hypertension or anxiety was similar in patients regardless of their past medical history or ASA risk class.Conclusions: A specific at-risk population may benefit from targeted preoperative interventions for reducing intraoperative anxiety and hypertension. (C) 2016 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.