J. Conrath

Aix-Marseille Université, Marsiglia, Provence-Alpes-Côte d'Azur, France

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Publications (115)79.96 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose Clinical evaluation of Alphacor™ keratoprosthesis in patients at high risk of corneal allograft rejection. Design Retrospective case series. Patients and methods Alphacor™ implantation was performed via a two-step procedure with intrastromal insertion followed by secondary exposure of the optic after 6 months. Visual acuity and occurrence of postoperative complications were evaluated. Results Fourteen eyes of 14 patients underwent Alphacor™ keratoprosthesis implantation. Mean follow-up was 15.6 ± 5.6 months (from 2 to 24 months). Postoperative mean visual acuity gain was 2.5 ± 3.1 lines (from 0 to +11 lines). Visual acuity was superior or equal to 20/200 in 21% of cases. Seven cases of stromal melt (50%) occurred, of which one case (7.1%) experienced spontaneous extrusion of the implant, three cases (21.4%) required tectonic penetrating keratoplasty, and three patients underwent lamellar keratoplasty on top of the implant. Three cases (21.4%) of retroprosthetic membrane were observed and successfully managed. One patient (7.1%) developed late endophthalmitis. Conclusion Alphacor™ is an alternative to corneal allograft in cases of corneal blindness at high risk of allograft failure. Throughout the preoperative evaluation, it is imperative to take into account the limitations of this keratoprosthesis in terms of indications, and additional studies are necessary in order to determine and refine the optimal surgical technique for implantation as well as the efficacy of postoperative treatments.
    Journal francais d'ophtalmologie 05/2013; 36(5):393–401. · 0.51 Impact Factor
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    ABSTRACT: We report the cases of two patients presenting with unilateral Kyrieleis arteritis complicating severe posterior uveitis, one secondary to toxoplasmosis and the other in the context of Behçet's disease. The treatment response was favorable with complete visual recovery in both cases. Kyrieleis arteritis has been described since 1933, but its pathogenesis is still unknown. However, it appears to be more of a periarteritis than an actual arteritis. It is classically associated with posterior uveitis without a direct correlation with disease severity.
    Journal francais d'ophtalmologie 03/2013; 36(3):191–196. · 0.51 Impact Factor
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    ABSTRACT: PURPOSE: Clinical evaluation of Alphacor™ keratoprosthesis in patients at high risk of corneal allograft rejection. DESIGN: Retrospective case series. PATIENTS AND METHODS: Alphacor™ implantation was performed via a two-step procedure with intrastromal insertion followed by secondary exposure of the optic after 6months. Visual acuity and occurrence of postoperative complications were evaluated. RESULTS: Fourteen eyes of 14 patients underwent Alphacor™ keratoprosthesis implantation. Mean follow-up was 15.6±5.6months (from 2 to 24 months). Postoperative mean visual acuity gain was 2.5±3.1 lines (from 0 to +11 lines). Visual acuity was superior or equal to 20/200 in 21% of cases. Seven cases of stromal melt (50%) occurred, of which one case (7.1%) experienced spontaneous extrusion of the implant, three cases (21.4%) required tectonic penetrating keratoplasty, and three patients underwent lamellar keratoplasty on top of the implant. Three cases (21.4%) of retroprosthetic membrane were observed and successfully managed. One patient (7.1%) developed late endophthalmitis. CONCLUSION: Alphacor™ is an alternative to corneal allograft in cases of corneal blindness at high risk of allograft failure. Throughout the preoperative evaluation, it is imperative to take into account the limitations of this keratoprosthesis in terms of indications, and additional studies are necessary in order to determine and refine the optimal surgical technique for implantation as well as the efficacy of postoperative treatments.
    Journal francais d'ophtalmologie 02/2013; · 0.51 Impact Factor
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    ABSTRACT: We report the cases of two patients presenting with unilateral Kyrieleis arteritis complicating severe posterior uveitis, one secondary to toxoplasmosis and the other in the context of Behçet's disease. The treatment response was favorable with complete visual recovery in both cases. Kyrieleis arteritis has been described since 1933, but its pathogenesis is still unknown. However, it appears to be more of a periarteritis than an actual arteritis. It is classically associated with posterior uveitis without a direct correlation with disease severity.
    Journal francais d'ophtalmologie 01/2013; · 0.51 Impact Factor
  • F Matonti, J Conrath
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    ABSTRACT: Angioid streaks represent breaks in Bruch's membrane, appearing as dark or reddish radial streaks eminating from the optic disc. Usually asymptomatic, these streaks may develop neovascularisation and lead to a maculopathy with marked loss of vision. Some associations with systemic disease are classically described, especially pseudoxanthoma elasticum. This condition may involve cardiovascular complications. A mutation has been found in the ABCC6 gene, which encodes for a membrane transport protein involved in the synthesis of the extracellular matrix. Imaging allows for visualization of the extent of the streaks, and autofluorescence is particularly informative. Spectral domain OCT may also demonstrate early breaks in Bruch's membrane. Neovascular complications, previously responsible for inevitable visual impairment at some point after their occurrence, are now managed by intravitreal injections of anti-VEGFs with clear efficacity. The ophthalmologist must be aware of this condition, in order to guide the patient towards a systemic work-up if necessary, and also to insure quick and targeted treatment in the case of neovascular complications.
    Journal francais d'ophtalmologie 10/2012; · 0.51 Impact Factor
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    ABSTRACT: Purpose To describe characteristics of a delivery device of endothelial graft using in endothelial keratoplasty procedure (Descemet Stripping Endothelial Keraplasty, DSAEK) and to report clinical results. Methods 20 patients are including in our prospective non-randomised study. Patients were benefited of a DSAEK by an experienced surgeon. The dissection of the endothelial graft were realised after removal epithelium and cutting a cornea anterior hat of 350μm by a microkeratom (Moria France). Grafts are inserted by the Endosaver® (Ocular System Inc USA) by a 4 mm incision and applied by a buffering of a air bubble in the anterior segment after a peripheral iridotomy. Authors reports experiences with this device and the density of endothelial cells after 6 month. Results Any failure of the graft was reported. The diminution of endothelial cells was correlated to the thickness of the graft and situated between 26% and 31% depending on pachymetry (50-120 μm and 120-150μm).49% of patients had more than 20/40 at 6 month. Conclusion our study showed the interest of Endosaver® on endothelial grafts to reduce the incision and the diminution of endothelial cells on DSAEK.
    Acta ophthalmologica 09/2012; 90(s249). · 2.44 Impact Factor
  • J. Conrath
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    ABSTRACT: The vitreous is examined with the slit lamp, either alone for observation of the anterior third of the vitreous body or by placement of a lens between the slit lamp and the patient's eye for observation of the rest. Several types of lens are available, both convex and concave, with or without contact, allowing for observation of the different parts of the vitreous and retina. Rules concerning positioning of the slit lamp, the lens, and the patient must be followed to obtain the maximum amount of information.
    Journal francais d'ophtalmologie 05/2012; 35(5):367–370. · 0.51 Impact Factor
  • Journal francais d'ophtalmologie 03/2011; 34(4):279-80. · 0.51 Impact Factor
  • C Marc, L Hoffart, B Ridings, J Conrath
    Journal francais d'ophtalmologie 02/2011; 34(5):353-4. · 0.51 Impact Factor
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    ABSTRACT: To assess the results of intracorneal ring segment implantation assisted by the Tecnolas Perfect Vision(®) femtosecond laser (Heidelberg, Germany). Retrospective observational study. The patients were operated on with the Tecnolas Perfect Vision(®) femtosecond laser. The following parameters were evaluated before and after surgery: uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal topography, wavefront analysis, and central corneal thickness. The Wilcoxon test was used for statistical analysis. Seventeen eyes of 15 patients were included. The mean follow-up was 6.9±0.71 months. Significant improvement of UCVA and BCVA was observed in 82.35% (P=0.027) and 94.12% (P=0.003) of the eyes, respectively. The subjective refraction showed a significant decrease of the sphere from -10.29±5.54 to -6.5±5.03D (P=0.002). The subjective cylinder significantly decreased from 5.43±3.20 to 3.69±2.30D (P=0.026). The SAI also decreased significantly (P=0.011). Femtosecond-assisted intracorneal ring segment implantation is an effective treatment for corneal ectasia. Further studies are needed to improve surgical parameters and outcomes.
    Journal francais d'ophtalmologie 01/2011; 34(1):2-9. · 0.51 Impact Factor
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    ABSTRACT: To quantify the course of papilledema using the OCT 3 Stratus (Carl Zeiss Meditec, Dublin, CA, USA) after lateral sinus stent placement in patients with idiopathic intracranial hypertension (IIH). Ten consecutive patients with a diagnosis of IIH underwent OCT examination before and after lateral sinus stenting, between March 2006 and April 2008, in Timone Hospital's Ophthalmology Department (Marseille, France). All patients had criteria for IIH (International Headache Society, 2004) and sinus abnormalities were diagnosed using three-dimensional rotational gadolinium-enhanced MR venography. In all cases, a direct retrograde cerebral venography with manometry was performed. We used the Cordis PRECISE® RX Nitinol Stent system (ref. 10136245-3, Johnson & Johnson), 30-40 mm in length and 8 mm in diameter, all placed by a single operator via a femoral venous puncture. For each eye, the mean retinal nerve fiber layer thickness was noted using the RNFL Thickness (3.4) strategy, before stenting, and three times after stent placement. The other parameters considered were age, sex, weight, height and body mass index. A significant decrease in retinal nerve fiber layer thickness was observed after stent placement. This parameter was considered normal 3 months after stent placement for eight of ten patients. Even though this pathology remains misunderstood, we observed a significant decrease in papilledema in IIH after lateral sinus stent placement, suggesting that high intracranial venous pressure could play a role in this pathology.
    Journal francais d'ophtalmologie 11/2010; 33(9):637-48. · 0.51 Impact Factor
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    ABSTRACT: Optimization of femtosecond laser characteristics in corneal surgery is still needed to improve clinical results. In this study, we describe an original characterization technique able to measure laser damage of corneal tissues precisely and to provide complementary physical results on the laser-matter interaction. A femtosecond laser was used to damage corneas not suitable for graft. The epithelium and the Bowman layer are exposed to a set of different single-shot fixed laser fluences. Optical microscopy can determine the probability of laser damage on the corneal surface. The high damage threshold (minimum fluence systematically damaging the cornea) roughly fixes the operating laser fluence conditions, while the low damage threshold sets the maximum laser fluence level preserving tissue integrity (safety level). We precisely evaluate the damage fluence threshold of a tissue, using a statistical approach coupled with optical microscopy analysis. This technique gives essential information on laser-tissue interaction with a high rate of confidence. For corneal epithelium and the Bowman layer, we determine the maximum laser fluence level preserving tissue integrity (safety level) and the minimum fluence level systematically damaging the tissue. High and low threshold fluences of epithelium and the Bowman layers are (5.6 ± 0.4 J/cm(2); 2.7 ± 0.1 J/cm(2)), and (7.1 ± 1.1 J/cm(2); 3.4 ± 0.1 J/cm(2)), respectively. These data constitute determinant parameters for clinical applications, since they determine a working window providing the minimal effective irradiation dose that is mandatory for the development of high-quality laser-cutting surgery processes with minimized side effects.
    Journal francais d'ophtalmologie 11/2010; 33(9):610-6. · 0.51 Impact Factor
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    ABSTRACT: Introduction Low levels of lutein and zeaxanthin in blood or food are associated with an increased risk of age-related macular degeneration (AMD). These molecules, provided by food, form the macular pigment. Patients and methods Patients included in this pilot study where categorized into four groups : (1) < 50 years with drusen, (2) ≥ 50 years without drusen, (3) ≥ 50 years with drusen, and (4) ≥ 50 years with drusen and neovascularization. During consultation, macular pigment optical density was measured and information on pathology and eating habits were collected. Results Assessment of macular pigment optical density considering eating habits and groups showed that it was lower in group 1 patients when they ate less than five portions of fruits and vegetables per day and less than two portions of cabbage, broccoli, pepper, corn, or spinach a week. In groups 3 and 4, food supplement intake was related to an increase in optical density. Food supplements were consumed by 58.5 % of patients in group 4. Conclusion Analysis of mean optical density measured by the MPS 9000 QuantifEYE™ considering eating habits confirmed the impact of food supplement intake on optical density, especially in patients ≥ 50 years with drusen and with or without neovascularization.
    Journal francais d'ophtalmologie 04/2010; 33(4):234–240. · 0.51 Impact Factor
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    ABSTRACT: Low levels of lutein and zeaxanthin in blood or food are associated with an increased risk of age-related macular degeneration (AMD). These molecules, provided by food, form the macular pigment. Patients included in this pilot study where categorized into four groups : (1) < 50 years with drusen, (2) > or = 50 years without drusen, (3) > or = 50 years with drusen, and (4) > or = 50 years with drusen and neovascularization. During consultation, macular pigment optical density was measured and information on pathology and eating habits were collected. Assessment of macular pigment optical density considering eating habits and groups showed that it was lower in group 1 patients when they ate less than five portions of fruits and vegetables per day and less than two portions of cabbage, broccoli, pepper, corn, or spinach a week. In groups 3 and 4, food supplement intake was related to an increase in optical density. Food supplements were consumed by 58.5 % of patients in group 4. Analysis of mean optical density measured by the MPS 9000 QuantifEYE considering eating habits confirmed the impact of food supplement intake on optical density, especially in patients > or = 50 years with drusen and with or without neovascularization.
    Journal francais d'ophtalmologie 03/2010; 33(4):234-40. · 0.51 Impact Factor
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    ABSTRACT: Objective To quantify the course of papilledema using the OCT 3 Stratus (Carl Zeiss Meditec, Dublin, CA, USA) after lateral sinus stent placement in patients with idiopathic intracranial hypertension (IIH). Methods Ten consecutive patients with a diagnosis of IIH underwent OCT examination before and after lateral sinus stenting, between March 2006 and April 2008, in Timone Hospital's Ophthalmology Department (Marseille, France). All patients had criteria for IIH (International Headache Society, 2004) and sinus abnormalities were diagnosed using three-dimensional rotational gadolinium-enhanced MR venography. In all cases, a direct retrograde cerebral venography with manometry was performed. We used the Cordis PRECISE® RX Nitinol Stent system (ref. 10136245-3, Johnson & Johnson), 30–40 mm in length and 8 mm in diameter, all placed by a single operator via a femoral venous puncture. For each eye, the mean retinal nerve fiber layer thickness was noted using the RNFL Thickness (3.4) strategy, before stenting, and three times after stent placement. The other parameters considered were age, sex, weight, height and body mass index. Results A significant decrease in retinal nerve fiber layer thickness was observed after stent placement. This parameter was considered normal 3 months after stent placement for eight of ten patients. Conclusion Even though this pathology remains misunderstood, we observed a significant decrease in papilledema in IIH after lateral sinus stent placement, suggesting that high intracranial venous pressure could play a role in this pathology.
    Journal Francais D Ophtalmologie - J FR OPHTALMOL. 01/2010; 33(9):637-648.
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    ABSTRACT: This paper deals with the segmentation of the Foveal Avascular Zone (FAZ) in digital retinal angiograms. Retinal angiography is used for detection and progression in some eye pathologies. The proposed method consists of two-stages: Singular Value Decomposition (SVD) and FAZ segmentation using Markov Random Fields (MRF). The obtained results demonstrate that the method is encouraging as a first approach for location and evolution of FAZ in retinal images.
    Digital Signal Processing 01/2010; · 1.92 Impact Factor
  • Revue De Medecine Interne - REV MED INTERNE. 01/2010; 31.
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    ABSTRACT: Anterior segment imaging using optical coherence tomography (OCT) time domain technology has been used for many years. When it appeared, it was a promising technique in the analysis of the anterior segment, making it possible to reach a definition of the ocular structures comparable with histology. Now with new-generation OCT, it is possible to perform high-definition and three-dimensional imaging. A 3D OCT-1000 (Topcon, Tokyo, Japan) parameterized to obtain high-definition and 3D imaging of the iridocorneal structures. We present a collection of images obtained using this technique. Based on a very sophisticated tool for retinal and glaucoma imagery, it is now possible to obtain very-high-quality imaging of the anterior segment, which, with its great versatility, increases the value of acquiring this type of device. The potential of 3D OCT-1000, already a very good exam for the posterior segment, and the only one to perform anterior segment three-dimensional imaging in a single acquisition, should not be neglected.
    Journal francais d'ophtalmologie 11/2009; 32(10):727-34. · 0.51 Impact Factor
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    ABSTRACT: Evaluation of the effectiveness of arcuate keratotomy performed with femtosecond laser for correction of postkeratoplasty astigmatism. This retrospective clinical study included 11 eyes. All cases underwent arcuate keratotomy using femtosecond laser. Outcome measures included visual acuity and endothelial cell density as well as refractive, keratometric, and topographic astigmatism. The incision depth was also evaluated by OCT-3. With a mean follow-up of 7.4+/-6.7 months, uncorrected visual acuity was not modified and the mean best corrected visual acuity significantly improved from 1.68+/-1.59 lines (p=0.007). The mean preoperative refractive cylinder was 5.18+/-1.15D, decreasing to 3.41+/-1.93D (p=0.045) after laser-arcuate keratotomy. The reduction of preoperative keratometric (7.79+/-3.69D) and topographic (7.98+/-2.41D) astigmatism was higher, with a decrease to 4.81+/-2.52D (p=0.021) and 4.36+/-2.59D (p=0.005) postoperatively. Endothelial cell density was not modified after surgery. The difference between achieved and planned incision depth was -10.7+/-63.5mum. All cases were uncomplicated. Arcuate keratotomies performed with the femtosecond laser were effective in reducing postkeratoplasty astigmatism and has a number of advantages over conventional techniques. However, efficacy could be improved by a more accurate nomogram. Arcuate keratotomy performed with femtosecond laser is a relatively easy, safe, and effective means of treating postkeratoplasty astigmatism. Given our small sample, much larger series are needed to provide more confident estimates of astigmatism reduction proportions and to adjust correction parameters.
    Journal francais d'ophtalmologie 08/2009; 32(8):544-50. · 0.51 Impact Factor
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    ABSTRACT: In this work, we concentrate on the accurate determination of the damage threshold of the epithelial and Bowman's layers of human corneal tissue. To this aim, we use a statistical approach, well adapted to the measurement of the laser damage threshold of a living tissue and giving further information concerning the deterministic character of femtosecond damage and thus the technical development of the laser process. In addition, the technique provides a quantitative measurement of the fluence range for which the damage occurrence is erratic. Determination of these thresholds is the key issue for the technical development of a laser-cut eye surgery process. Actually, the knowledge of the low threshold is required for fixing the laser fluence level for which the tissue integrity is preserved, and the determination of the high threshold is essential for the development of the cutting surgery process of the tissue. Indeed, we presume that the operating laser condition has to be related to the high fluence damage threshold or somewhat higher, depending on the targeted constraints of quality and efficiency of the surgery process.
    Lasers and Electro-Optics 2009 and the European Quantum Electronics Conference. CLEO Europe - EQEC 2009. European Conference on; 07/2009

Publication Stats

224 Citations
79.96 Total Impact Points

Institutions

  • 2005–2012
    • Aix-Marseille Université
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2005–2010
    • Assistance Publique Hôpitaux de Marseille
      • • Service de neurochirurgie infantile
      • • Service d'ophtalmologie (Hôpital Nord)
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2008
    • Hôpital Ambroise Paré – Hôpitaux universitaires Paris Ile-de-France Ouest
      Billancourt, Île-de-France, France
  • 2005–2008
    • Polytech Marseille
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2007
    • Assistance Publique – Hôpitaux de Paris
      • Department of Ophthalmology
      Paris, Ile-de-France, France
  • 1999
    • Hospital Drome Nord
      Romans, Rhône-Alpes, France