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BACKGROUND AND PURPOSE: A rapid identification of the etiology of anterior ischemic optic neuropathy is crucial because it determines therapeutic management. Our aim was to assess MR imaging to study the optic nerve head in patients referred with anterior ischemic optic neuropathy, due to either giant cell arteritis or the nonarteritic form of the disease, compared with healthy subjects. MATERIALS AND METHODS: Fifteen patients with giant cell arteritis–related anterior ischemic optic neuropathy and 15 patients with nonarteritic anterior ischemic optic neuropathy from 2 medical centers were prospectively included in our study between August 2015 and May 2016. Fifteen healthy subjects and patients had undergone contrast-enhanced, flow-compensated, 3D T1-weighted MR imaging. The bright spot sign was defined as optic nerve head enhancement with a 3-grade ranking system. Two radiologists and 1 ophthalmologist independently performed blinded evaluations of MR imaging sequences with this scale. Statistical analysis included interobserver agreement. RESULTS: MR imaging scores were significantly higher in patients with giant cell arteritis–related anterior ischemic optic neuropathy than in patients with nonarteritic anterior ischemic optic neuropathy ( P ≤ .05). All patients with giant cell arteritis–related anterior ischemic optic neuropathy (15/15) and 7/15 patients with nonarteritic anterior ischemic optic neuropathy presented with the bright spot sign. No healthy subjects exhibited enhancement of the anterior part of the optic nerve. There was a significant relationship between the side of the bright spot and the side of the anterior ischemic optic neuropathy ( P ≤ .001). Interreader agreement was good for observers (κ = 0.815). CONCLUSIONS: Here, we provide evidence of a new MR imaging sign that identifies the acute stage of giant cell arteritis–related anterior ischemic optic neuropathy; patients without this central bright spot sign always had a nonarteritic pathophysiology and therefore did not require emergency corticosteroid therapy.

Controlling long-term inflammation during non-infectious intermediate, posterior or panuveitis while limiting side effects remains challenging. There is no standardized pre-therapeutic evaluation providing diagnostic certainty, but some simple tests allow us to identifiy the main etiologies. The ophthalmologist identifies the type of uveitis, and the internist completes the investigations according to the ophthalmologist's findings. Fundus photographs, optical coherence tomography, and fluorescein and indocyanine green angiography should be considered during diagnosis and follow-up. Ocular complications of uveitis are numerous. They require close monitoring and specific medical and sometimes surgical management. The growing number of available drugs makes it possible to optimize the management of these conditions with varied etiologies and presentations. Currently, systemic corticosteroids remain the mainstay of therapy, and other alternatives are considered in the case of poor tolerance, steroid resistance or dependence. The choice of a systemic, periocular or intravitreal treatment depends on several factors: chronicity or recurrence of uveitis, duration, bilaterality, association with a systemic inflammatory disease, the presence of contraindications to certain treatments, and also socioeconomic constraints. It is of the utmost importance to find the best compromise allowing tight control of ocular inflammation by means of adapted systemic and/or local treatment while avoiding the main complications.; Contrôler l’inflammation à long terme au cours des uvéites intermédiaires, postérieures ou totales, non infectieuses en limitant la iatrogénie est un véritable défi. Il n’existe pas de bilan standardisé qui assure une certitude diagnostique, mais quelques tests simples permettent de ne pas omettre les principales étiologies. L’ophtalmologiste qualifie le type d’atteinte puis le médecin interniste complète les investigations en fonction des constatations de l’ophtalmologiste. Photographies du fond d’œil, tomographies en cohérence optique, angiographies à la fluorescéine et au vert d’indocyanine doivent être envisagées au cours du diagnostic et du suivi. Les complications oculaires de l’inflammation sont nombreuses. Elles nécessitent une surveillance étroite et une prise en charge spécifique, médicale et parfois chirurgicale. Le nombre croissant de molécules disponibles permet d’optimiser la prise en charge de ces pathologies aux étiologies et présentations variées. Actuellement, la corticothérapie systémique reste le traitement de référence et les autres thérapeutiques sont envisagées en cas de mauvaise tolérance, corticorésistance ou corticodépendance. Le choix d’un traitement systémique, régional périoculaire ou intravitréen dépend de plusieurs facteurs : chronicité ou récurrence de l’uvéite, ancienneté, bilatéralité, association à une maladie inflammatoire systémique, présence de contre-indications à certains traitements et contraintes socio-économiques. Il est très important de trouver le meilleur compromis permettant un contrôle strict de l’inflammation oculaire à l’aide d’un traitement systémique et/ou local adapté tout en évitant les principales complications.

Proliferative vitreoretinopathy (PVR) is a complex process. It causes contractile fibrocellular membranes that may prevent retinal reattachment. PVR therefore remains one of the most severe complications of rhegmatogenous retinal detachment (RD), with an incidence of 5-11%, and is among the most frequent causes of surgical failure (50-75%). Its severity derives from the complexity of the surgery required to treat patients and from its uncertain anatomic and functional prognosis. The first step in preventing PVR is to identify patients at risk by means of clinical and/or biological factors such as the characteristics of retinal tears (large size, number) and detachment (preexisting PVR, extent), and the use of cryotherapy. Surgeons must therefore adapt their surgical approach to the risk of PVR. The study of animal models and the natural history of the condition in humans demonstrate the importance of early antiproliferative treatment in the early stage of the disease. Combining 5-fluoro-uracil and heparin in the vitrectomy infusion lowers the rate of postoperative PVR onset in patients with PVR risk factors. The evaluation of new molecules and new dosages will lead to a decisive step in the fight against PVR.

Resume La proliferation vitreo-retinienne (PVR), a l’origine de membranes fibrocellulaires contractiles s’opposant a la reapplication de la retine, reste une des complications les plus graves du decollement de retine (DR) rhegmatogene, avec une frequence de survenue de 5 a 11 % et une des causes les plus frequentes d’echec de la chirurgie (50–75 %). Sa gravite est liee a la complexite de la chirurgie a mettre en œuvre pour traiter les patients, et au pronostic anatomique et fonctionnel reserve. Le traitement curatif d’une PVR inclue la realisation d’une vitrectomie, parfois associee a une phaco-exerese ou une indentation, un pelage systematique des membranes epiretiniennes, parfois une retinectomie, et systematiquement une retinopexie par photocoagulation endolaser. Le tamponnement interne privilegie est actuellement l’huile de silicone. Les huiles de silicone de differentes densites font actuellement l’objet d’etudes comparatives.

Proliferative vitreoretinopathy (PVR) remains one of the most common causes of failed retinal detachment (RD) surgery. Many histological and clinical studies have highlighted the chain of events leading to PVR: cellular migration into the vitreous cavity, cellular differentiation, myofibroblast proliferation and activation, synthesis of extracellular matrix proteins, then contraction of preretinal tissues. The development of PVR can be explained schematically by cellular exposure to growth factors and cytokines (particularly retinal pigment epithelial cells and glial cells), in the context of break-down of the blood-retinal barrier (inflammation, choroidal detachment, iatrogenic effect of cryotherapy and surgery) and of cellular contact with the vitreous. Although the pathophysiology of PVR is now better understood, its severity remains an issue. A systematic search for preoperative PVR risk factors allows the most suitable therapeutic option to be chosen.

To characterize and correlate the different patterns of fundus autofluorescence (FAF) in patients with birdshot chorioretinopathy (BSCR), with functional and anatomical parameters. Twenty-one BSCR patients were prospectively studied in 2013 and 2014. Each patient underwent visual acuity (VA) and visual field (SITA standard 30.2) testing as well as fluorescein and indocyanine green angiography, spectral-domain optical coherence tomography (SD-OCT) B scan, enhanced depth imaging (EDI), and fundus autofluorescence (FAF) imaging. The disease was classified as active, chronic, or quiescent. The patients’ mean age was 60.3 ± 9.2 years and 60% were female. Disease duration was 5.7 ± 3.7 years. Autofluorescence imaging showed punctiform hyper-FAF spots in 23 out of the 29 eyes (79%), which was significantly associated with a greater visual field mean deviation (−7 ± 7 versus −3 ± 2 dB, p = 0.04). Hypo-FAF was defined as peripapillary (n = 25; 86.2%), macular (n = 10; 34.5%), lichenoid (n = 17; 58.6%), and/or diffuse (n = 13; 44.8%). Lichenoid hypo-FAF was significantly associated with worse VA (0.18 ± 0.24 vs. 0.05 ± 0.07 LogMAR, p = 0.04). Macular hypo-FAF was associated with a history of macular edema (62.5%; p = 0.06). Diffuse hypo-FAF was observed more frequently (p = 0.01) in chronic disease (66.7%) than in active (0%) or quiescent disease (27.3%). Autofluorescence analysis in BRSC patients contributes to evaluating disease activity and could be useful to guide follow-up and treatment.

Endophthalmitis is a major complication of surgery or trauma that may need an echographic evaluation by a general ophthalmologist in emergency. Echography is also useful for the therapeutic management of endophthalmitis. This review gives a general view of ocular lesions seen in this context (hyalitis, choroidal or retinal detachment, lens dislocation, intraocular foreign body, cellulitis). We describe a practical chart to standardize the echographic evaluation at the initial examination and during the follow-up.

The clinical presentation of endophthalmitis depends on numerous factors, especially the bacteria involved, which determines the delay of infection, the amount of ocular inflammation, and the final prognosis. Results of epidemiological studies have provided a better understanding of the correlation between bacteria and clinical characteristics. Some clinical signs may help the clinician to suspect a virulent bacterium. Clinical and microbiological factors are essential to guide the therapeutic strategy in patients with acute endophthalmitis.

The objective of his study was to compare the visual and anatomical outcomes in treatment-na < ve patients with macular edema secondary to retinal vein occlusion after intravitreal injections of dexamethasone implants (DEX) and anti-VEGF. One hundred two patients (64 in the anti-VEGF group, 38 in the DEX group) without previous treatment were included in this multi-center retrospective study and evaluated at baseline and 1, 3, 6, and 12 months after the onset of treatment. Patients were defined as "good responders" if central macular thickness (CMT) was less than or equal to 250 mu m in TD-OCT or 300 mu m in SD-OCT after the injections. At month 3 (n = 102), BCVA had increased significantly, by 0.1 +/- 0.3 logMAR in the anti-VEGF group (p = 0.04) and 0.4 +/- 0.4 logMAR in the DEX group (p < 0.001); the difference between the two groups was statistically significant (p = 0.007). CMT decreased significantly, by 138 +/- 201 mu m (-19 %, p < 0.001) in the anti-VEGF group and 163 +/- 243 mu m (-21 %, p < 0.001) in the DEX group. After 3 months, five patients (13 %) in the DEX group and 20 (31 %) in the anti-VEGF group (p < 0.001) changed treatment. Among the 77 patients who did not switch from their initial treatment, no significant functional or anatomical difference between the two groups was observed at months 6 and 12. Elevation of intraocular pressure > 21 mmHg was more frequent in the DEX group (21 %) than in the anti-VEGF group (3 %, p = 0.008). Visual acuity recovery was better in the DEX group than in the anti-VEGF group at month 3, but with no difference in CMT. In patients who did not change treatment, the long-term anatomical and visual outcome was similar between the DEX and anti-VEGF groups.

En face OCT is complementary Imaging procedure useful for the analysis of vitreoretinal disorders, including macular hole, epiretinal membrane, or retinal detachment. This procedure is informative before and after vitreoretinal surgery. Before surgery, characteristics of the retinal surface may be defined. After vitrectomy, en face OCT reveals changes in the retinal nerve fibers layer (dimples), residual epiretinal tissue, cystic changes, disruption of external limiting membrane and/or outer segment layer, or persistent subretinal fluid. This procedure helps us to refine high resolution imaging of each layer of the retina during the healing process of macular hole or retinal detachment.

International audience; PURPOSE: To study the clinical and microbiological characteristics as well as the prognostic factors for post-filtering surgery endophthalmitis. METHODS: Twenty-three eyes were included in the study in four tertiary centres between 2004 and 2010. The clinical and microbiological data were collected prospectively (minimum follow-up, 6 months). Microbiological diagnosis was based on conventional cultures and panbacterial PCR (16SrDNA amplification and sequencing). RESULTS: The onset of endophthalmitis was early (

Purpose To compare the visual field rate (VF) of progression of non evolutive and evolutive patients with treated ocular hypertension (OHT) or primary-open angle glaucoma (POAG). Methods From a multicentric database, 441 eyes of 228 patients with treated OHT or POAG followed up at least 6 years with Humphrey 24.2 Sita-Standard VF exam at least twice a year were identified and classified in 5 groups: 104 OHT, 205 early glaucoma (MD>-6dB), 45 moderate glaucoma (MD-6 to -12dB), 41 advanced glaucoma (MD-12 to -18dB) and 46 severe glaucoma (MD

Purpose To evaluate the visual field rate of progression of patients with treated ocular hypertension (OHT) and primary-open angle glaucoma (POAG). Methods From a multicentric database, 441 eyes of 228 patients with treated ocular hypertension or POAG followed up at least 6 years with Humphrey 24.2 Sita-Standard visual field examination at least twice a year were identified. From initial data, eyes were classified in 5 groups: 104 ocular hypertension, 205 early glaucoma (MD>-6dB), 45 moderate glaucoma (MD -6 to -12dB), 41 advanced glaucoma (MD -12 to -18dB) and 46 severe glaucoma (MD

Purpose To report visual and anatomical outcome of patients vitrectomized for acute post bacterial endophthalmitis Methods 123 patients with acute postcataract endophthalmitis and consecutively treated by pars plana vitrectomy (PPV) were included in four academic hospitals (French Institutional Endophthalmitis Study (FRIENDS) group). Results At 6 month follow-up, 49 patients (40%) had a visual acuity (VA) greater than or equal to 20/40, and 83 patients (68%) had VA greater than or equal to 20/200. Baseline factors associated with final VA ≥20/40 were a younger age (Odds ratio, OR= 1.05 (1.05-1.09), p=0.006), presence of fundus visibility (OR=7 (1,4-34,6),p=0.007), and absence of cataract surgery complications (OR=15.3 (1.9-32), p=0.001), corneal edema (OR= 2.3 (1.1-4.9), p= 0.02), hypopion (OR= 2.6 (1.1-6.6), p=0.04), or of virulent bacteria (OR=3.1 (1.4-6.7), p=0.005). At the time of PPV, absence of vasculitis at the posterior pole at the time of PPV (OR= 7 (1.4-34.6), p=0.02) and a lower duration of PPV (OR=1.02 (1.01-1.04), p=0.02) were significantly associated with final VA ≥20/40. Risk factors of RD were diabetes (OR = 4.7 (1.4-15.4), p=0.01), and visualization of retinal vasculitis on the posterior pole (OR = 3.8 (1.1-13.9), p= 0.03) at the time of PPV. Conclusion PPV allowed to be beneficial in a majority of the patients. Baseline inflammatory signs and bacterial virulence are the main prognostic visual factors. RD remains the major complication but final anatomical and visual outcome is still poor, despite updated vitreoretinal techniques

Purpose This study reports the contribution of specific conventional PCR of the Staphylococcus and Streptococcus genera followed by sequencing for the microbiological diagnosis of endophthalmitis. Methods Specific PCR assays targeting the tuf gene of the Staphylococcus and Streptococcus genera were performed in addition to the reference techniques (conventional culture and panbacterial PCR) on samples of aqueous humor and/or vitreous in patients with acute post operative endophthalmitis when Staphylococcus or Streptococcus had been identified using reference methods or no identification had been possible. Results Out of the 125 samples analyzed (60 aqueous humor and 65 vitreous of 85 patients) , the culture was positive in 61 cases (48.8%) and panbacterial PCR was positive in 78 cases (62.4%). By combining culture and panbacterial PCR bacterial identification was obtained in 94 of the 125 samples (75.2%, 72 Staphylococcus, 22 Streptococcus). Staphylococcus-specific PCR was positive in 72 out of the 103 samples tested and allowed 8 additionnal identifications. The Streptococcus-specific PCR was positive in 13 cases. The Streptococcus-specific PCR provided no additional diagnosis to the pan-bacterial PCR. By adding Staphylococcus and Streptococcus tuf specific PCR to the reference methods, bacterial identification was obtained in 102 of the 125 samples (81.6%, 80 Staphylococcus, 22 Streptococcus). Conclusion The Staphylococcus- and Streptococcus-specific techniques used in this study were complementary to the panbacterial PCR techniques and improved sensitivity in the identification of Staphylococcus and better identification of the species with sequencing.

Purpose To evaluate the kinetics of varicella zoster virus (VZV) load using quantitative PCR (qPCR) in patients treated for acute retinal necrosis (ARN). Design: Cohort study, evaluation of diagnostic test or technology. Methods Six patients (52±13 years) with ARN syndrome were consecutively studied. Aqueous humor (AH) was sampled from all eyes for qPCR evaluation. The patients were treated with intravenous aciclovir and intravitreal injections of antiviral drugs. The mean follow-up was 17.6±16.4 months. Results Two main portions of the viral load curves were observed for each patient: a plateau phase (27.8±24.9 days) followed by a decrease in the number of viral genome copies. The mean baseline viral load was 3.4×107±4.45×107copies/ml (6×106 to 1.2×108). The viral load decreased following a logarithmic model, with a 50% reduction obtained in 3±0.7 days. There was a significant viral load (> 102 copies/ml) at 50 days after the onset of treatment, despite antiviral drugs. Conclusion qPCR use demonstrated reproducible VZV DNA kinetics with a two-phase evolution: plateau followed by logarithmic decrease. These data suggest that high-dosage antiviral therapy during the conventional 10 days duration is insufficient in most patients. This patient's series responded with a similar decrease in viral load once initiated, this may be used to predict the progression of future patients. The correlation of the viral load threshold with clinical improvement needs to be more clearly defined.

National audience; Abstract: Purpose To identify baseline clinical factors of visual prognosis in patients with acute endophthalmitis following cataract surgery. Methods: 99 patients of four academic hospitals (FRIENDS group). Factors were analyzed based on the final visual outcome, defined as poor (

Purpose Toxoplasmosis is the most common cause of posterior uveitis in immunocompetent subjects. Taking into account the opposing needs of limiting parasite multiplication and minimizing tissue destruction, the immune imbalance implies especially Th17 and T regulatory (Treg) cells. Methods In a multicenter prospective clinical study of intraocular inflammation (PHRC 3964), we evaluated the cytokine pattern in aqueous humors of 10 T. gondii infected patients. To determine the immunological mechanisms, we evaluated intraocular inflammation, parasite load, and immunological responses using mRNA and protein levels in a mouse model. Anti-IL-17A monoclonal antibodies (mAbs) were administered with the parasite in order to evaluate the role of IL-17A. Results We observed severe ocular inflammation and cytokine patterns comparable to human cases, including IL-17A production. Neutralizing IL-17A decreased intraocular inflammation and parasite load in mice. Detailed studies revealed upregulation of Treg and Th1 pathways. When IFN-γ was neutralized concomitantly, the initial parasite multiplication rate was partially restored. Conclusion Local IL-17A production by resident cells plays a central role in the pathology of OT. The balance between Th17 and Th1 responses (especially IFN-γ) is crucial for the outcome of infection. This data reveals new in vivo therapeutic approaches by repressing inflammatory pathways using intravitreal injection of IL-17A mAbs.

Purpose The systematic microbiological documentation of endophthalmitis allows the confirmation of the infectious nature of the disease and the possible adaptation of treatment at the individual level and, at the collective level, the epidemiological characterization of the bacterial spectrum of endophthalmitis. Methods different microbiological techniques will be presented: conventional techniques (media), eubacterial PCR, real time PCR Results It is preferable to inoculate intraocular samples into culture media (a paediatric blood culture bottle or in Brain Heart Infusion (BHI) broth) under sterile conditions in the operating room and to transfer the sample intended for PCR into a sterile tube without residual DNA (DNA-free) and with a screw cap. Bacterial identifications and antibiograms are then obtained using phenotypic methods. Real time PCR is more sensitive than culture, allows the detection and identification of specific micro-organisms, DNA quantification, and has a faster turn around time (no post-PCR step). The PCR amplification of 16S rDNA uses consensus primers (panbacterial PCR) and is followed by identification from analysis of 16S rDNA sequence. This technique has the advantages of amplification of DNA from all bacteria, and identification of bacteria difficult to identify phenotypically (e.g. coagulase-negative Staphylococcus species). However drawbacks are the possible contaminations, the duration (2-3 days including sequencing), and the impossibility of differentiating mixed bacterial species in the same clinical sample. Conclusion PCR techniques are complementary tools to culture. New techniques of PCR are needed in order to be faster and more sensitive. Genomic characterization of strain virulence of bacteria involved in endophthalmitis will be further studied.

Purpose this review aims to summarize studies which assessed the use of PCR in post operative endophthalmitis. Endophthalmitis is a rare but devastating complication of ocular surgeries. There is a need for more rapid and more sensitive microbiological techniques since clinicians should rapidly identify bacterial pathogens. Methods different microbiological techniques will be presented, eubacterial PCR, real time PCR Results Column-based nucleic acid purification allows removal of DNA-polymerase inhibitors. Real time PCR is more sensitive than culture, allows the detection and identification of specific micro-organisms, DNA quantification, and has a faster turn around time (no post-PCR step). The PCR amplification of 16S rDNA uses consensus primers (panbacterial PCR) and is followed by identification from analysis of 16S rDNA sequence (BIBI). This technique has the advantages of amplification of DNA from all bacteria, and identification of bacteria difficult to identify phenotypically (e.g. coagulase-negative Staphylococcus species). However drawbacks are the possible contaminations, the duration (2-3 days including sequencing), and the impossibility of differentiating mixed bacterial species in the same clinical sample. A summary of the main published clinicomicrobiological studies will be presented. Conclusion PCR techniques are complementary tools to culture. New techniques of PCR are needed in order to be faster and more sensitive. Genomic characterization of strain virulence of bacteria involved in endophthalmitis could help clinicians to identify patients needing a more aggressive treatment and to develop new drugs.

Purpose To present the different non surgical therapeutical options of diabetic macular edema Methods The pathogenesis of diabetic macular edema is multifactorial. Hyperglycemia and poor systemic factor balance are major risk factors. Laser treatemnts and antiagiogenic treatments represent the main non surgical options to treat macular edema. Results Focal macular edema remains the best indication of laser treatment. Laser remains also the standard of care of diffuse macular edema but some edemas remain resistant. Several therapeutic options have been proposed : Steroid intravitreal injection and antiVEGF therapy (either PKC inhibitors, VEGF aptamers or VEGF antibodies) represent the future alternative treatments as well as their potential combination. Conclusion Laser remains the main treatment of diabetic macular edema. However, steroids and antiangiogenic agents either isolated or combined represent the main alternative treatment for non responding diffuse macular edema.

Purpose this review aims to summarize risk factors, preoperative evaluation and principles of operative methods of retinal detachment of phakic eyes Methods Preoperative evaluation includes detailed examination of the retina, the identification of retinal breaks and classification of proliferative retinopathy. Main operative methods will be presented with ab externo or ab interno techniques. Results after a detailed characterization of the retinal detachment, the more appropriate surgical methods will be explained for the search, the treatment (laser or cryotherapy), closure (scleral buckling materials) of retinal breaks, management of subretinal fluid (drainage) and the choice of the intraocular tamponnade (gas or silicone). Conclusion this review will discuss the main advantages of each surgical technique and examples of management will be presented (simple phakic detachment, associated cataract, giant tears, high myopia).

Purpose To study potential clinical and microbiological predictive factors of visual outcome in patients with acute endophthalmitis following cataract surgery. Methods A prospective study included 100 patients in 4 University hospital.Factors related to the cataract surgery, the initial clinical presentation and the microbiological identification were analyzed according to the final visual outcome using univariate and multivariate (logistic regression) analysis. Results 46% out of the patients had a final visual acuity less than or equal to 0.3 logMar (good visual outcome) at 6 months while 10% had only light perceptions. Patients with good visual outcome differed for the duration of cataract surgery, initial visual acuity, the visibility of fundus and the identification of a coagulase negative staphylococcus. In contrast, patients with a poor visual outcome were older, had more cornea oedema and a more important hypopion at the admission, more complications at the time of cataract surgery. Furthermore a bacterium was more frequently identified in this latter group. Multivariate analysis showed that age, complications at the time of cataract surgery, microbiological identification, pars plana vitrectomy were independent predictive factors. Conclusion Factors of visual outcome in acute postcataract endophthalmitis identified in this prospective study were similar to that reported during the Endophthalmitis Vitrectomy Study 10 years ago. As part of the treatment, pars plana vitrectomy is associated with predictive factors of poor visual outcome. Identification of these predictive factors at presentation should allow a better management of patients needed an aggressive treatment.

Purpose Microincision transconjunctival vitrectomy has gained popularity in the recent years. This surgical innovation needs to be evaluated in prospective and controlled studies. Methods A prospective study concerning 23-Gauge vitrectomy (with cryoapplication and gas tamponade) in 20 patients with retinal detachment and 4 patients with acute endophthalmitis was performed and litterature data (Pubmed database research) was analyzed. Results Performance of microincision transconjunctival vitrectomy may be maximized with use of high duty cycle, largest internal diameter (23G), a sharp guillotine and a high cut rate. Sclerotomy construction is a key point of this technique. In retinal detachment surgery on a selected population, the rate of anatomic reattachment and visual recovery were similar between 23G PPV and 20G PPV. In one patient 23G PPV was complicated by a choroidal detachment secondary to a displacement of the infusion cannula. The redetachment in one 23G case was secondary to a sclerotomy related retinal tear. Microincision transconjunctival vitrectomy for acute endophthalmitis is feasible but has limited capacities as compared with 20G technique. Conclusion The main advantage of sutureless vitrectomy remains the confort of patient after complicated surgeries, but this point should be analyzed with quality of life. This trend toward smaller incisions will lead to improvement of instrumentations, better understanding of the surgical techniques (wound construction, performance of vitreous cutters). 23G PPV is suitable for patients with retinal detachment treated with PPV-cryo-gas technique. Sutureless vitrectomy is usefull only in selected cases of acute endophthalmitis .

Purpose To compare the diagnostic yield of microbiological analysis performed on diluted and undiluted vitreous samples from pars plana vitrectomy in patients with acute postcataract surgery endophthalmitis. Methods Undiluted and diluted vitreous samples were harvested in 34 patients at the beginning of the vitrectomy, among the 57 vitrectomized patients (out of 100 patients presenting with an acute postcataract surgery endophthalmitis) included in the multicenter prospective study FRIENDS (2004-2005). Vitrectomy was performed after one (n=12) or two (n=22) antibiotics intravitreal injections. Each vitreous sample was divided into two parts for conventional culture (Brain Heart Infusion broth) and panbacterial PCR, respectively. Results Microbiological analysis of both undiluted and diluted vitreous allowed a bacterial identification in 28 out of 34 cases (82.3%). Microbiological diagnosis using undiluted vitreous and conventional culture was negative in 32 cases and positive in 2 cases. In one case, there was a discrepancy between undiluted (culture negative) and diluted vitreous (S. epidermidis). Analysis of both undiluted and diluted vitreous using PCR was positive in 28 cases and negative in 6/34 cases. There was a discrepancy between both samples in three cases. Conclusion Microbiological results combining PCR and cultures showed that diluted vitreous analysis may replace analysis of undiluted vitreous. The diluted sampling of vitreous, more easily performed and less iatrogenic, may be recommended when panbacterial PCR is used .

Purpose To evaluate the effect of 14-day intermittent hypoxia on the response of the sub-foveal choroidal blood flow (ChBF) after gas inhalation, in healthy subjects. Recent studies have emphasized the effect of the obstructive sleep apnea (OSA) on CO2 vasodilatation and O2 vasoconstriction. A human model of OSA has been developed in our laboratory with healthy subjects submitting to intermittent hypoxia during 14 consecutive nights. The aim of our study was to determine if these subjects exhibit a dysregulation in ChBF response during and after exposition to intermittent hypoxia. Methods The ChBF was measured before, at the end (D14) and 5 days after the period of exposition to intermittent hypoxia. ChBF was measured using laser Doppler flowmetry (LDF) in 6 healthy young volunteers exposed to night time intermittent hypoxia. We measured the variations in ChBF during 10 minutes of air inhalation (placebo), 100% O2, and carbogen (8% CO2) at each visit Results The ChBF response to carbogen was considered as normal (increase of 11%) before the exposition to intermittent hypoxia, and was reduced at the end (+5%) and after the exposition (+5%). The response to 100% O2 in these subjects was not altered by the exposition to intermittent hypoxia. Using placebo, the ChBF remained unchanged at each visit. The sensitivity of the ChBF measurement was 6 %. Conclusion Healthy subjects exposed to intermittent hypoxia exhibit an altered response of ChBF to carbogen. This CO2 responsiveness could be related to an alteration of the nitric oxide synthase expression.

Purpose: to report ocular inflammation secondary to syphilis infection in a tertiary center. Methods: Within a prospective study (2 years, 2005-2007), we collected data on 7 male patients with ocular syphilis. Diagnosis was based on serology tests on blood sample and/or cerebrospinal fluid. All patients underwent a check up for ocular inflammation to rule out another etiological diagnosis and to detect another sexually transmitted infection. Results: Coinfection with human immunodeficiency virus was reported in 4 patients, with a CD4 T lymphocyte count greater than 300/mm3 in all cases. The ocular lesions were variable ; chorioretinitis (1 eye), retinal necrosis (2), panuveitis with macular edema (1), episcleritis (1), anterior optic neuropathy (1), and retrobulbar optic neuropathy (1). Infection of the cerebrospinal fluid was detected in 4/4 cases. The lumbar puncture was refused in 3 cases. In all cases, the inflammation was unilateral, and the anatomical and functional prognosis was excellent. Only one patient with the anterior optic neuropathy required systemic steroid therapy associated with antibiotics. Sequelae were a sectorial atrophy of the optic nerve (1 eye), and abnormalities of the retinal pigment epithelium (3 eyes). 6/7 patients were treated with ceftriaxone 2g/day during 3 weeks, with a good tolerance. One patient was treated with penicillin G. Conclusions: All patients with ocular syphilis exhibited a functional improvement and resolution of ocular inflammation after a specific antibiotic treatment. In our area, the incidence of syphilis increases in immunocompetent and immunocompromised patients. As a great imitator, syphilis should be considered in all patients with uveitis or optic neuritis, especially in men with unprotected sexual behavior.

Purpose: To isolate bacteria after intravitreal antibiotic injection in acute endophthalmitis after cataract surgery, using cultures and eubacterial PCR. Methods: We prospectively enrolled in a multicenter study 100 eyes of 100 patients (2004-2005) presenting an acute endophthalmitis following cataract surgery. Aqueous humor samples were collected before and after one intravitreal antibiotic injection (vancomycin and ceftazidim) for 53 patients while 19 patients underwent a vitreous tap before and after intravitreal antibiotic injections. Microbiological identification was performed using BHI (Brain Heart Infusion) medium and eubacterial PCR. Results: In aqueous humor, microbiological cultures associated with eubacterial PCR identified a bacterium in 26.4% of cases after intravitreal antibiotherapy. Positive cultures before treatment became negative after antibiotic treatment in 33% whereas initial positive PCR before became negative after antibiotic treatment in 35%. However PCR allowed the recognition of previously unidentified bacteria after antibiotic injections in 8% of patients. In vitreous samples, a bacterium was identified in 70% of cases before and in 81.2% after intravitreal injection. After antibiotic injection, initially positive cultures and PCR became negative in 90% and 7% of cases, respectively. Conclusions: A single intravitreal antibiotic injection is not sufficient to eradicate the pathogens responsible for acute post operative endophthalmitis. Eubacterial PCR is useful for the microbiological identification in vitreous samples after intravitreal injections of antibiotics.

Purpose: To present 2 cases of PCR identification of Rhizobium radiobacter in post-operative endophthalmitis. Methods: Microbiological identification was carried out using samples from aqueous humor and/or vitreous. Conventional cultures were performed using a Brain Heart Infusion broth. We used broad-range eubacterial PCR amplification followed by direct sequencing. Results: In both cases, Rhizobium radiobacter was identified using eubacterial PCR and cultures of vitreous from vitreous tap. An 81-year-old female presented an endophthalmitis 4 weeks after an cataract surgery. Inflammation and infection were controlled after 2 intravitreal antibiotic injections and the final visual acuity was of 20/24 at the one-year follow-up exam. A 75-year-old male who underwent a cataract surgery presented an endophthalmitis 9 days after. This patient was treated by 3 intravitreal antibiotic injections and a vitrectomy. The 6-month follow-up exam showed an optic nerve atrophy with a poor visual outcome (20/120). Both patients had an initial marked anterior chamber inflammation with a hypopyon and a severe retinal vasculitis was observed in the second case. Conclusions: Rhizobium radiobacter is a rare pathogen involved in postoperative endophthalmitis. As it is an environmental soil organism, we may assume that the patient's exposure to outdoor environnement and moist soil remains the source of this organism. This gram negative rod is resistant to vancomycin and have an intermediate resistance to most antibiotics used to treat post-operative endophthalmitis. PCR allows a swifter bacterial identification than do cultures and may help choose the most efficient antibiotics.

Purpose: Intraocular pressure (IOP) varies and depends on many factors. Intraocular pressure variations throughout the nycthemeron (the full 24-period of a night and a day) are the most interesting for studying. Methods: With present techniques, it is impossible to measure continuously without waking the subject up. Thus, IOP must be hourly measured during 24 hours with a portable tonometer which allows short measurements in any posture, without requiring the subjects or patients to rise during the night. Results: Intraocular pressure depends on a nyctohemeral rhythm, being higher at night than during the day in healthy subjects, with a nocturnal peak value (acrophase). In the same normal individual, several 24-hour monitorings are identical. Each individual has his own 24-hour pattern of IOP. In glaucoma patients, however, the 24-hour rhythm of IOP was reversed, with values being higher during the day (a midday peak in IOP) than during the night. Conclusions: The time course of the nyctohemeral curve of intraocular pressure is considered to play a role in the prognosis of glaucoma and allows to classify the type of glaucoma (POAG, NTG). Lowering of IOP is still the only option that is available for treating patients with glaucoma. Variations encountered in the individual’s nyctohemeral IOP pattern must be taken into consideration to manage the most efficient treatment.

AIMS—To evaluate the clinical features as well as the visual and anatomical outcome in eyes with magnetic posterior segment foreign bodies, to identify prognostic factors after removal using an electromagnet. METHODS—The records of 40 patients with posterior segment foreign bodies were retrospectively reviewed for 6 years (1989-94). Post-traumatic cataracts and secondary retinal detachments were treated using conventional surgical techniques. Pars plana vitrectomy was used only for late complications. The mean follow up was 30 months (6-71). Clinical factors were studied using univariate analysis. RESULTS—The most common findings before treatment of these 40 eyes were lens wound, hyphaema, vitreous haemorrhage, and retinal impairment. The foreign body was in the vitreous (85%) or minimally embedded in the retina (15%). Initial visual acuity was worse or equal to 20/40 in 70% of the cases. Subsequent to surgical treatment, a cataract was reported in 60% of the patients. Postoperative complications included retinal detachment (15%) and phthysis (5%). The prognosis was worse in cases with intraocular foreign body of largest diameter ⩾3 mm, an initial visual acuity less than 20/200, or the presence of post-traumatic retinal detachment. Presence of initial intravitreous haemorrhage, hyphaema, or intraocular tissue prolapse did not appear to affect the prognosis. CONCLUSION—The long term visual acuity results indicated that wound repair associated with conventional magnet extraction in an emergency is a viable treatment for posterior segment magnetic foreign bodies in this selected group. At the time of diagnosis, size of foreign body (