Vol. 31, Hors Série 1, 2008 114e Congrès de la Société Française d'Ophtalmologie

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060SLO et OCT à haute résolution en imagerie simultanée dans la DMLA.Simultaneous SLO and high-resolution OCT imaging in age-related macular degeneration.HOLZ FG* (Bonn, Allemagne)

Purpose: To image alterations associated with various phenotypes of age-relatedmacular degeneration (AMD) by simultaneous confocal scanning laser ophthalmos-copy (cSLO) and high-resolution, spectral-domain optical coherence tomography(OCT).Methods: OCT-images and simultaneous recording of fluorescein angiography,indocyanine green (ICG) angiography, infrared, redfree, or fundus autofluorecence(FAF) images were obtained with a novel imaging device (Spectralis HRA+OCT, Hei-delberg Engineering, Heidelberg, Germany). An optically pumped solid state lasergenerates the excitation wavelength (488 nm) required for redfree, FAF and fluores-cein angiography images. For ICG angiography and infrared imaging diode lasersources at 790 and 815 nm are used. For OCT 40.000 A-scans are acquired persecond with 7 μm depth and 14 μm lateral optical resolution. The B-scans with anangle of 30 degrees have a scan width up to 1.536 A-scans with a digital lateralresolution of 6 μm/pixel, a scan depth of 500 pixels with 4 μm/pixel resolution and ascan rate up to 50 B-scans/sec. An integrated eye tracking allows for live averagingof cSLO-images as well as OCT B- scans.Results: Early, atrophic and neovascular manifestations of age-related maculardegeneration were examined and cSLO and OCT frames correlated. Fluorescein andICG-angiographic phenomena recorded in cSLO images could be analysed in cor-responding OCT-cross sections. Abnormal FAF-signals were correlated to altera-tions at the outer retinal/retinal pigment epithelial cell layer in high resolution OCT-scans. Three-dimensional OCT enabled comprehensive retinal coverage. The ima-ging software accurately tracked eye movements and allowed for precise monitoringat identical retinal sites at different time points following anti-VEGF-therapy. Thisfacilitated evaluation of the drug-repsonse and indication for retreatments.Conclusion: The combined cSLO/OCT system allows for simultaneous recordingsof topographic and tomographic images. Particularly the pixel-to-pixel correlationbetween the confocal angiograms, FAF images and other imaging modes with theOCT scans may contribute to our understanding of the pathogenesis, and improvediagnosis and management of patients with AMD.

061Nouveaux colorants dans la chirurgie intra-oculaire.Novel dyes for intraocular surgery.HARITOGLOU C* (Munich, Allemagne)

The application of vital dyes during vitreoretinal surgery greatly facilitates the visua-lization of different structures including the inner limiting membrane (ILM), epiretinalmembranes or the vitreous. Indocyanine green was the first dye introduced for thestaining of the ILM. Recent data indicate a potential toxic effect of ICG, with theunderlying pathomechanisms not being understood completely. A novel dye for ILMstaining is Brilliant blue G, which seems to have a much better safety profile com-pared to ICG. Another blue dye is Trypan blue to visualize epiretinal membranes.Trypan blue can either be injected into the airfilled globe or, after having been dilutedwith glucose into the fluid-filled globe. The presentation will focus on new safety stu-dies on Brilliant blue obtained in animal studies and will discuss clinical data obtai-ned in humans as well as ultrastructural features of tissue removed during surgery.In addition, other dyes, which are currently under investigation, such as Bromphenolblue, will be discussed and a perspective for future concepts will be given. The stai-ning characteristics of these dyes when applied alone or in combination will be pre-sented.

062Modifications biomécaniques et topographiques de la cornée après « cross-linking » par Riboflavine-UV dans le kératocône.Biomechanical and topographical corneal changes after UV- Riboflavin crosslinking in keratoconic eyes.DERHARTUNIAN V* (Francfort, Allemagne), KOHNEN T (Houston, USA)

Purpose: The aim of this study was to evaluate the biomechanical corneal propertiesafter UV- Riboflavin cross-linking in keratoconic eyes. The Ocular Response Analyzer(ORA) provides a new parameter which is called corneal hysteresis. A rapid air

impulse leeds to inward and outward movement of the cornea. During that move-ment an electro-optical system records two applanation pressures. The difference ofthose two preassures results in corneal hysteresis (CH).Methods: Nine eyes of 9 patients were included in this study. Each patient receiveda UV- Riboflavin cross-linking treatement to stabilize the cornea. CH, corneal resis-tance factor (CRF) and corneal topography were measured prior and post treate-ment. The minimum follow up was set for 3 months.Results: Mean preoperative values as follows: age 33.36±6.93 years, spherical equi-valent -1.68±2,24 diopters (D), topographic astigmatism -4.01±1.60 D, CH 7.72±1.56mmHg, CRF 6.44±1.29 mmHg. Mean follow up was 4.85±1.51 months. Mean pos-toperative values as follows: spherical equivalent -2.40±2.82 D, topographical astig-matism -4.09±1.87 D, CH 7.63±1.14 mmHg, CRF 6.64±1.26 mmHg.Conclusions: Corneal UV-Riboflavin cross-linking didn’t change the biomechanicalcorneal properties. In particular cases we observed a reduction in topographic astig-matism.

063L’interféron α dans le traitement des lésions mélaniques de la conjonctive.Interferon α for the treatment of melanocytic conjunctival lesions.HEROLD TR*, HINTSCHICH C (Munich, Allemagne)

Purpose: Melanocytic conjunctival lesions can be treated by controlled observation,surgery, irradiation, heat application, cryotherapy or topical chemotherapy. This non-comparative prospective case series reports on the first topical Interferon a-2b the-rapy for the treatment of melanocytic conjunctival lesions.Patients and Methods: 9 patients with histologically proven acquired melanosiswith dysplasia and/or conjunctival melanoma have been treated with recombinantIFN a-2b (Intron A®, essex pharma). The agent was diluted under sterile conditionsto 1 Mio IU/ml Intron A® and packed in single dose units (EDO) by the pharmacy. Itwas stored in the refrigerator and applied 5x1 drop/day topically by the patient for 6weeks. The patients were seen after 2 weeks and after the end of the treatment.Results: 9 lesions of 9 patients showed complete or almost complete regression andlost pigmentation. 4 patients were treated twice after the first therapy because ofincomplete regression. Only one of those patients needed a third cycle of therapy toshow stabile regression. The follow-up is 14 months (median). No local or systemicside effects were encountered. The pre- and post-therapy clinical pictures will bepresented.Discussion: Our observations suggest that topically applied Interferon a-2b mightbe an effective agent for the therapy of melanocytic conjunctival tumours with so farno adverse side effects. It might be an alternative to other more toxic chemothera-peutical agents.Conclusion: A prospective multicenter study will help to finally evaluate the potentialof topical Interferon therapy for melanocytic conjunctival tumours, in particular PAMwith atypia and minimal invasive conjunctival melanoma.

064-1Le rôle des cellules présentatrices d’antigènes dans la cornée et sa place dans le diagnostic par microscopie confocale.The role of antigen presenting cells in the cornea and its place in clinical diagnosis by confocal microscopy.ZHIVOV A*, STACHS O, KRAAK R, GUTHOFF RF (Rostock, Allemagne)

Purpose: to evaluate the morphology, distribution and density of Langerhans cells(LC) in human cornea Method: In vivo confocal microscopy of the cornea (RostockCornea Module in combination with commercial available confocal laser scanningsystem (Heidelberg Retina Tomograph II, Heidelberg Engineering GmbH, Germany))was performed in healthy volunteers (225 eyes of 129 healthy volunteers aged 16-81 yrs), contact lens wearers (99 eyes of 59 contact lens wearers; age: 13-76 yrs.),glaucoma patients with preservative holding therapy (25 eyes of 15 patients aged41-77 yrs.) as well as in patients with inflammatory diseases or in grafted cornea.Results: In healthy volunteers, in vivo confocal microscopy revealed LCs in 31% ofall volunteers; 37 out of these 43 volunteers present LCs both in the center and theperiphery of the cornea with densities of 34±3 cells/mm2 and 98±8 cells/mm2. In thegroup of contact lens wearers 55% of all probands presented with LCs and 11 outof these 33 probands revealed LCs at central and peripheral location. LC densitieswere significantly higher in both the central (78±25 cells/mm2) and the peripheral cor-nea (210±24 cells/mm2) of contact lens wearers (p<0.03 and p<0.001 vs. healthyvolunteers), the gradient of LC density from peripheral to central cornea was foundalmost identical in both groups. In the central cornea, LC density significantly

114e Congrès de la Société Française d'Ophtalmologie J. Fr. Ophtalmol.

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decreased with duration of contact lens wear. In glaucoma patients were revealed25 eyes with LCs including 24 eyes presenting with both central and peripheral LClocation. LC densities averaged 196±22 cells/mm2 in the central cornea and 304±27cells/mm2 in the periphery, (p<0,001 in both zones vs. healthy volunteers). Moreover,LC present as either large cells bearing long processes or smaller cells lacking celldendrites, most supposedly indicating mature and immature phenotype, respecti-vely. The identification and distribution of the LCs was performed immunohistoche-mically.Conclusion: Quantitative evidence of LC in cornea could be of clinical relevance inevaluation of wound healing, graft versus host disease, allergic and toxic drug sideeffects, etc. Modern diagnostic possibilities of in vivo confocal microscopy undimmunohistochemistry regarding LC distribution and density enable to compare thein vivo and ex vivo data and open a new horizon for clinical practice as well as expe-rimental studies not only in human but also in veterinary medicine.

064-4Plastie de la paupière inférieure associée à une excision cutanée : la technique du pincement revisitée.Transconjunctival lower eyelid blepharoplasty associated with skin excision: the pinch technique revisited.FRONGIA GB (Ancona, Italie), PUCCION M (Florence, Italie)

Aim: The aim of this study is to evaluate the safety, effectiveness and aestheticresults of transconjunctival lower eyelid blepharoplasty associated with skin excisionusing the Pinch Technique.Materials and Methods: 58 patients (45 female and 13 male) aged between 32 and76 showing the following were selected: prominent eyelid fat pads, anterior lamellalaxity and normal eyelid tone; all expressed a desire not to change the shape of theireyes. In all patients the position of the lower eyelid in respect to the limbus in theprimary position, in up and low gaze, was evaluated. Lower transconjuctival eyelidblepharoplasty associated with skin excision was performed on all patients using thetechnique described by Rosenfeld.Results: In all patients a satisfactory reduction of fat pads and an improvement inskin laxity were achieved; results met patients’ expectations. There were no casesof eyelid retraction either imediately postoperatively or in later follow-ups. Discussion: Transconjunctival lower eyelid blepharoplasty has gained in popularityamong opthalmoplastic surgeons over the past decade principally because it resultsin natural appearance and the absence of eyelid retraction. This technique was ini-tially combined with chemical peeling and later with laser resurfacing techniques toachieve an improvement in the skin. These techniques, however, led to complica-tions such as persistent erithema and hyperpigmentation. In our experience, thetechnique, recently described by Rosenfeld, of associating transconjunctival blepha-roplasty with skin excision, makes it possible to correct eyelid fat pads and reshapeskin effectively and without complications since it leaves the middle lamella untou-ched.