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Choosing a first-line treatment to optimize long-term outcomes is a major challenge for treating patients with neovascular age-related macular degeneration (AMD). The development of several new molecules makes it critical to identify the relevant factors to consider so as to provide an optimal risk-benefit ratio when initiating a treatment in naïve patients with neovascular AMD. This paper proposes a consensus established with the Delphi method (which includes a gradation in a consensus based on an analysis of the convergence rate of answers) to provide criteria that guide the ophthalmologist's decision for treatment initiation and follow-up in neovascular AMD patients. Fourteen questions were submitted to 93 French retina experts. Thirteen (93%) of the questions reached a consensus (≥50% of answers consensual). The criteria recommended to take into account were both efficacy and onset of action of the molecules, their safety, and the ability to decrease injection frequency. The primary criterion of expected efficacy of a molecule is a combination of the gain in visual acuity and resorption of retinal fluid. With regard to safety, experts recommend tighter follow-up for molecules currently in development, and at every scheduled visit, patients should be screened to identify early any potential adverse effects such as intraocular inflammation, retinal vasculitis or vascular occlusion. Experts also emphasize the importance of the packaging of the biological, with a preference toward prefilled syringes. Injection frequency is a key factor, and the authors recommended aiming for a maximal injection interval of 12 to 16 weeks. The stability of that maximum interval is also an important factor to consider in treatment selection.; Le choix d’un traitement de 1re intention pour optimiser les résultats à long terme est un enjeu majeur de la prise en charge des patients atteints de DMLA néovasculaire. Dans un contexte actuel de molécules en développement est apparue la nécessité d’identifier les critères indispensables à prendre en compte lors de la mise en place d’un traitement chez un patient naïf atteint de DMLA néovasculaire afin de garantir un rapport bénéfice/risque optimal à long terme. Cet article propose un consensus établi selon la méthodologie de type Delphi (en intégrant une gradation dans les consensus en fonction de l’analyse du taux de convergence des réponses) qui pourrait constituer une aide pour les ophtalmologistes pour l’initiation et le suivi du traitement des patients atteints de DMLA néovasculaire. Quatorze questions ont été soumises à un panel de 93 experts rétinologues français. Treize questions (93 %) ont obtenu un consensus (≥ 50 % de réponses consensuelles). Les experts recommandent ainsi de prendre en compte en priorité l’efficacité et la rapidité d’action respectives des molécules, leur sécurité d’utilisation ainsi que leur capacité d’espacement des injections. Le critère d’efficacité attendu en priorité d’une molécule est la combinaison de l’amélioration de l’acuité visuelle et de l’assèchement des fluides. En matière de sécurité d’utilisation, les experts recommandent une surveillance supplémentaire pour les molécules actuellement en développement, et ce à toutes les visites programmées, visant à détecter précocement d’éventuels effets indésirables tels que l’inflammation intraoculaire et accordent une place importante au conditionnement de la molécule. La capacité d’espacement des injections est importante à prendre en compte et il est recommandé d’atteindre un intervalle maximal compris entre 12 et 16 semaines. La stabilité de l’intervalle maximal atteinte par les patients est également un critère de choix important.

We report a rare case of quinine toxicity causing acute bilateral blindness, followed by documented partial recovery within 24 hours. The patient was treated with hyperbaric oxygenotherapy and intravenous nitrates. Visual defects persist after 6 months.

Resume Objectif Decrire les caracteristiques sociodemographiques, cliniques et paracliniques des patients ayant un œdeme papillaire unilateral consultant aux urgences ophtalmologiques. Patients et methodes Il s’agit d’une etude retrospective observationnelle des patients avec un œdeme papillaire unilateral, consultant aux urgences ophtalmologiques du centre hospitalo-universitaire de Bordeaux, entre le 1er octobre 2008 et le 31 octobre 2009. Resultats Nous avons inclus 52 patients avec un œdeme papillaire unilateral. On comptait 61,5 % de femmes (n = 32) et 38,5 % d’hommes (n = 20). La moyenne d’âge etait de 53,5 ans (σ = 22,9 ans), avec un âge plus eleve pour les hommes que pour les femmes (61,1 ans vs 48,7 ans avec p = 0,05). Le diagnostic retenu etait une neuropathie optique ischemique anterieure aigue pour 27 patients, une neuropathie optique inflammatoire pour 17 patients, une hypertension intracrânienne pour trois patients et un « pseudo-œdeme papillaire » pour deux patients. Quant aux trois patients restants, le diagnostic etiologique precis de l’œdeme papillaire n’a pas ete fait. Conclusion Cette etude a evalue la prise en charge des patients atteints d’un œdeme papillaire unilateral consultant aux urgences ophtalmologiques. Elle aurait ainsi aide a l’amelioration de nos pratiques.

International audience; Background: Worldwide, degenerative eye diseases (age-related maculopathy (ARM), cataract, glaucoma) are the main causes of visual impairment and blindness, which contribute to disability in the elderly. Mainly three types of nutritional factors are investigated for their potential protection against eye ageing: antioxidants; lutein and zeaxanthin (carotenoids which accumulate specifically in the eye); omega 3 polyunsaturated fatty acids. Few epidemiological studies have been conducted in this field, particularly in Europe. Objective: The Alienor (Antioxydants, Lipides Essentiels, Nutrition et maladies OculaiRes) Study aims at assessing the associations of eye diseases with nutritional factors, determined from plasma measurements and estimation of dietary intakes. Design, setting and participants: Subjects were recruited in Bordeaux (France) from the ongoing population-based 3C study. In 2006-2008, 963 subjects from the 3C Study, aged 73 years or more, had an eye examination and will have follow-up eye examinations every 2 years. Measurements: Vascular, genetic and nutritional factors were assessed at baseline (1999-2001) and follow-up examinations of the 3C Study. Eye diseases were classified according to international classifications. Results: Nutritional status and vascular disease and risk factors were similar between participants and non participants, except for a slight difference in plasma triglycerides and HDL-cholesterol. As expected, the prevalence of eye diseases was high: early and late ARM (28.4 % and 5.6 %, respectively), open-angle glaucoma and treated ocular hypertension (4.8 % and 10.0 %, respectively), cataract extraction (45.2 %), retinopathy (8.4 %), retinal vein occlusion (1.1 %), epiretinal membrane (3.9 %), current use of artificial tears (17.3 %). Conclusions: This study confirms the high prevalence of eye diseases in the elderly. Its main strength is the combination of nutritional, vascular and genetic information, collected over a 7 year period of time before the first eye examination. It may help design future interventional studies, which might be common with other age-related disorders, because of common nutritional factors.

Tuberculosis (infection by Mycobacterium tuberculosis) remains a public health problem with increasing incidence. The diagnosis of primary ocular tuberculosis is troublesome because of the low sensitivity and poor specifity of routine diagnostic methods and the problems obtaining reliable samples. We report the cases of two patients, one immunocompromised male and one immunocompetent male, presenting chorioretinitis with high clinical suspicion of ocular tuberculosis. We performed serologies, polymerase chain reaction tests in aqueous humor, a purified protein derivative skin test, and measurement of interferon-gamma in whole blood using the QuantiFERON-TB Gold assay. The QuantiFERON-TB Gold assay was positive in both cases, in agreement with the diagnosis of ocular tuberculosis. The purified protein derivative skin test was positive in one case. The whole blood interferon-gamma assay is a precious tool for detecting extrapulmonary tuberculosis, especially in cases of primary ocular disease.

To evaluate results of 23-gauge transconjunctival sutureless vitrectomy in various indications of vitreoretinal diseases.Prospective, non-comparative study.Fifty-seven consecutive eyes of 57 patients underwent vitreoretinal surgery by one surgeon using the 23-gauge, two-step instrumentation developed by Dutch Ophthalmic Research Center Inc., for epiretinal membranes (n=24), macular holes (n=10), diabetic retinopathy (n=4), rhegmatogenous retinal detachment (n=3), silicone oil removal (n=10), and other procedures (n=4). Mean operative time and intraoperative and postoperative complications were recorded. At 1 month, postoperative visual acuity, anatomical results, and induced astigmatism measured by Orbscan (BAUSCH and LOMB laboratories Inc., Rochester, NY, USA) were analysed.Mean operative time was 32.6+/-21.5 min. At 1 month, mean visual acuity improved from 1.09+/-0.82 to 0.80+/-0.79 logMar. Transient postoperative hypotony was the most common complication (21.1%), resolving without treatment. There was no choroidal effusion; and no postoperative endophthalmitis was observed. There were no significant changes in mean keratometry (P=0.957), mean axis (P=0.818), and power of astigmatism (P=0.860) at 1 month.A 23-gauge vitrectomy seems to be safe and effective for a wide range of indications for vitreoretinal surgery. Further studies are needed to compare it with 25-gauge and 20-gauge vitrectomy in larger series.

Purpose To compare macular pigment optical density (MPOD) measured by two techniques (autofluorescence, reflectometry) in healthy subjects at high risk for age-related macular degeneration (AMD). Methods The Limpia Study is a double-blind, placebo controlled, prospective randomized clinical trial performed in 120 subjects with at least one parent affected by neovascular AMD. Subjects having used supplements containing lutein and/or zeaxanthin in the preceding year were not included. MPOD was measured using two methods: the two-wavelength autofluorescence method with a modified scanning laser ophthalmoscope (Heidelberg Retinal Analyzer Results At baseline, mean MPOD within 0.51°, measured with the modified HRA method, was 0.5 (standard deviation 0.2). Maximal MPOD, measured with Visucam, was 0.4 (standard deviation 0.1). Parameters from the modified HRA (optical density within 0.5°, 1°, 2° and 6°) and from the Visucam method (volume, area, mean and maximum optical density) were weakly correlated. The best correlations were observed for MPOD within 2° and 6° with volume from Visucam(r=0.21 and r=0.22, respectively), and mean MPOD from Visucam (r=0.21 and r=0.18). Conclusion The two methods propose different parameters to evaluate macular pigment, which overall correlated weakly in this population of middle-aged healthy subjects at high risk for AMD. Further research is needed to characterize the differences between the methods and identify the best parameters and techniques to measure macular pigment. Commercial interest

Summary Purpose To investigate macular pigment optical density (MPOD) and distribution in patients with Stargardt disease. Methods Prospective observational case series. The study included 13 eyes of 13 consecutive patients. A modified confocal scanning laser ophthalmoscope (SLO, Heidelberg, Germany) was used for MPOD measurement. It calculated the MPOD at 0.5° of the center of the fovea, and MPOD in the 0.5° and 2° areas. Results Two different MPOD profile patterns were observed: group 1 was composed of patients with a flat profile, i.e., with very low MPOD in all locations, and group 2 presented a normal profile. In group 2, all eyes but one had good visual acuity (VA); in group 1, some displayed poor VA, but others had good VA. All patients in group 1 displayed a thinning of the macular area on OCT. Conclusions These results suggest that the flat MPOD profile, even if the visual acuity is good, could be associated with poor prognosis. The two different patterns of MPOD distribution described could reflect two different stages in the course of Stargardt disease. No strong correlations were found between MPOD profiles and visual acuity or macular thickness, but a straight trend was brought out that may indicate that the flat MPOD profile has a poor functional prognosis. Long follow-up is required to confirm this hypothesis.

Summary Introduction Case report of a traumatic optic nerve avulsion. Observation We report the case of a traumatic right optic nerve avulsion in an 11-year-old boy as a result of a contusion with a surfboard. On initial examination, the patient exhibited bilateral mydriasis with a right afferent pupillary defect. Visual acuity was no light perception. A moderate microhyphema was noted along with intraocular pressure of 12 mmHg and no open globe. Fundus examination revealed retinal ischemia with white retinal edema, attenuated arteries and segmentally occluded vasculature. In place of the optic nerve, there was a hole with associated vitreous hemorrhage. Non-contrast CT and MRI demonstrated vitreous prolapse into the optic nerve sheath, which still appeared securely attached to the globe. Spectral domain OCT and visual evoked potentials confirmed disruption of the ganglion cell layer. Discussion While obvious in the presence of clear media, an avulsion may remain undetected in the case of associated vitreous hemorrhage. Orbital imaging may clarify the diagnosis. Conclusion Although rare, optic nerve avulsions exhibit the same risk profile as open globe injuries and arterial occlusions.