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Resume La reforme du 3e cycle des etudes medicales, en vigueur depuis la rentree 2017 au terme de 8 annees de gestation, a pour principaux objectifs de rendre coherente et equitable la formation des futurs specialistes et de substituer a une qualification basee sur une duree, une formation basee sur l’acquisition progressive de competences. Pour les 13 colleges de specialites chirurgicales, cette reforme a ete l’occasion, pour la premiere fois peut-etre, de partager une reflexion sur ce qu’etait un chirurgien et ce que devait etre la formation aux specialites chirurgicales. Celle-ci leur a permis de s’adapter aux contraintes du cahier des charges et de construire des maquettes de formation coherentes entre elles. Cet article aborde l’historique de cette reforme, ce qui change dans la formation des futurs chirurgiens, ainsi que quelques points de vigilance. Cette reforme du 3e cycle a enclenche la reforme du second cycle, qui devrait entrer en vigueur pour la rentree universitaire 2020. Son objectif sera en particulier de supprimer le couperet que constituent les epreuves de l’ECN et de permettre aux etudiants de mieux apprehender et tester leurs appetences et leurs competences pour une specialite donnee. Il appartiendra a ces memes colleges de specialites chirurgicales de definir comment y parvenir pour les specialites de la discipline « chirurgie ».

International audience

To evaluate diagnostic and therapeutic practices and then establish a consensus on the management of ocular toxoplasmosis in France through a Delphi study.Twenty-three French experts in ocular toxoplasmosis were invited to respond to a modified Delphi study conducted online, in the form of two questionnaires, in an attempt to establish a consensus on the diagnosis and management of this pathology. The threshold for identical responses to reach consensus was set at 70 %.The responses of 19 experts out of the 23 selected were obtained on the first questionnaire and 16 experts on the second. The main elements agreed upon by the experts were to treat patients with a decrease in visual acuity or an infectious focus within the posterior pole, to treat peripheral lesions only in the presence of significant inflammation, the prescription of first-line treatment with pyrimethamine-azithromycin, the use of corticosteroid therapy after a period of 24 to 48hours, the prophylaxis of frequent recurrences (more than 2 episodes per year) with trimethoprim-sulfamethoxazole as well as the implementation of prophylactic treatment of recurrences in immunocompromised patients. On the other hand, no consensus emerged with regard to the examinations to be carried out for the etiological diagnosis (anterior chamber paracentesis, fluorescein angiography, serology, etc.), second-line treatment (in the case of failure of first-line treatment), or treatment of peripheral foci.This study lays the foundations for possible randomized scientific studies to be conducted to clarify the management of ocular toxoplasmosis, on the one hand to confirm consensual clinical practices and on the other hand to guide practices for which no formal consensus has been demonstrated.

For over 10 years, the description of the retinal microvascular network has benefited from the development of new imaging techniques. Automated retinal image analysis software, as well as OCT angiography (OCT-A), are able to highlight subtle, early changes in the retinal vascular network thanks to a large amount of microvascular quantitative data. The challenge of current research is to demonstrate the association between these microvascular changes, the systemic vascular aging process, and cerebrovascular and cardiovascular disease. Indeed, a pathophysiological continuum exists between retinal microvascular changes and systemic vascular diseases. In the Montrachet study, we found that a suboptimal retinal vascular network, as identified by the Singapore I Vessel Assessment (SIVA) software, was significantly associated with treated diabetes and an increased risk of cardiovascular mortality. In addition, we supplemented our research on the retinal vascular network with the use of OCT-A. In the EYE-MI study, we showed the potential role of quantitative characterization of the retinal microvascular network by OCT-A in order to assess the cardiovascular risk profile of patients with a history of myocardial infarction. A high AHA (American Heart Association) risk score was associated with low retinal vascular density independently of hemodynamic changes. Thus, a better understanding of the association between the retinal microvasculature and macrovascular disease might make its use conceivable for early identification of at-risk patients and to suggest a personalized program of preventative care. The retinal vascular network could therefore represent an indicator of systemic vascular disease as well as an interesting predictive biomarker for vascular events.

Resume La description du reseau microvasculaire retinien beneficie, depuis plus de 10 ans, du developpement de nouvelles techniques d’imagerie. Les logiciels automatiques d’analyse d’images, ainsi que l’OCT-angiographie (OCT-A) permettent de mettre en evidence des modifications subtiles et precoces de l’arbre vasculaire retinien grâce a de nombreuses donnees quantitatives microvasculaires. L’enjeu des recherches actuelles est de demontrer l’association entre ces modifications microvasculaires, le vieillissement vasculaire systemique et les pathologies cerebro et cardiovasculaires. En effet, un continuum physiopathologique existe entre alterations microvasculaires retiniennes et pathologies vasculaires systemiques. Dans l’etude de population Montrachet, nous avons montre qu’un reseau vasculaire suboptimal, evalue sur fond d’œil avec le logiciel Singapore I Vessel Assessment (SIVA), etait significativement associe a l’existence d’un diabete traite et d’un sur risque de mortalite cardiovasculaire. Par ailleurs, nous avons complete nos recherches sur le reseau vasculaire retinien avec l’utilisation de l’OCT-A. Dans l’etude EYE-MI, nous avons demontre le potentiel interet de caracteriser, de maniere quantitative, le reseau microvasculaire retinien en OCT-A afin d’evaluer le profil de risque cardiovasculaire des patients atteints de cardiopathies ischemiques. Un score de risque AHA (American Heart Association) eleve etait associe a une faible densite vasculaire retinienne independamment des modifications hemodynamiques systemiques. Ainsi, une meilleure comprehension du lien entre microvascularisation retinienne et pathologie macrovasculaire permettrait d’envisager son utilisation pour une identification precoce des patients a risque et de leur proposer un programme de prevention primaire personnalise. Le reseau vasculaire retinien pourrait donc etre un temoin de l’histoire vasculaire systemique mais aussi un biomarqueur predictif interessant d’evenements vasculaires systemiques.

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.

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.

Conventional immunosuppressive drugs, anti-TNF alpha and other biotherapies used in clinical practice are capable of controlling non-infectious anterior uveitis, posterior uveitis and panuveitis. The present work has been led by a multidisciplinary panel of experts, internists, rheumatologists and ophthalmologists and is based on a review of the literature. In case of corticodependency or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or anti-TNF alpha (adalimumab, infliximab) are used to achieve and maintain remission. Interferon is an efficient immunomodulatory treatment, as a second-line therapy, for some therapeutic indications (refractory macular edema, Behçet's vascularitis). Other biologics, especially tocilizumab, are showing promising results. Local treatments (corticosteroids, sirolimus etc.) are adjuvant therapies in case of unilateral inflammatory relapse. Therapeutic response must be evaluated precisely by clinical examination and repeated complementary investigations (laser flare photometry, multimodal imaging, perimetry, electroretinography measures).

Diagnostic work-up of uveitis involves many uncertainties. Search for an etiology should take into account the epidemiology of uveitis and focus on the most severe diseases or those, which can be treated. This work was undertaken to establish recommendations for the diagnosis work-up of uveitis.Recommendations were developed by a multidisciplinary panel of 15 experts, including internists, ophthalmologists and a rheumatologist and are based on a review of the literature with regard to effectiveness of investigations and the results of the ULISSE study, which is the first prospective study assessing the efficiency of a standardized strategy for the etiological diagnosis of uveitis. Children, immunocompromised patients, severe retinal vasculitis and specific ophthalmological entities are excluded from these recommendations.Investigations should be first guided by the history and physical examination. Serological screening for syphilis is the only test appropriate in all forms of uveitis. If no diagnosis is made after this stage, we propose investigations guided by the anatomic characteristics of uveitis. It includes HLA B27 testing (in unilateral acute anterior non-granulomatous uveitis), serum angiotensin converting enzyme, interferon-gamma release assay and chest CT (chronic uveitis), cerebral MRI and anterior chamber tap with IL10 analysis (intermediate or posterior uveitis in patients over 40 years). Investigations ordered in the absence of orientation are almost always unhelpful.We propose a strategy for the etiologic diagnosis of uveitis. The recommendations should be updated regularly. The efficiency of more invasive investigations has yet to be evaluated.

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.

Resume La syphilis est une maladie sexuellement transmissible liee a une infection par Treponema pallidum. Cette maladie, connue pour etre une grande imitatrice, peut se reveler par des manifestations cliniques variees. L’ophtalmologiste doit evoquer le diagnostic chez un patient presentant une uveite ou une neuropathie optique et une conduite sexuelle a risque et/ou une autre maladie sexuellement transmissible (comme le VIH). Par ailleurs, une chorioretinite posterieure en plaque ou une retinite necrosante doit faire rapidement rechercher cette etiologie. L’atteinte oculaire survient essentiellement pendant les phases secondaires et tertiaires de la maladie. La syphilis peut atteindre tous les tissus oculaires. L’uveite est l’atteinte la plus frequente (1 a 5 % des uveites en centre tertiaire) sous la forme d’uveite anterieure granulomateuse ou non, uveite posterieure, panuveite ou kerato-uveite. L’atteinte du systeme nerveux central peut etre asymptomatique mais est frequente, ce qui justifie la realisation systematique d’une ponction lombaire en cas d’uveite et/ou de neuropathie optique. La confirmation diagnostique est essentiellement serologique. Le traitement parenteral par penicilline G est le traitement de premiere intention en cas de syphilis oculaire. Un traitement adjuvant par corticotherapie generale sera discute en cas d’uveite, de neuropathie optique ou de sclerite. Un suivi prolonge est necessaire etant donne les possibilites de reinfections. Le pronostic anatomique et fonctionnel oculaire est souvent favorable apres traitement antibiotique approprie.

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.

Resume Introduction Les keratites infectieuses constituent une preoccupation majeure de sante pour les millions de porteurs de lentilles de contact, ainsi que pour leurs ophtalmologistes. Certains facteurs de risque infectieux sont bien connus (defaut d’hygiene, port permanent des lentilles…), d’autres sont seulement evoques, voire meconnus et gagneraient ainsi a etre demontres. Patients et methodes Une etude multicentrique prospective regroupant 12 centres hospitaliers universitaires francais (Besancon, Bordeaux, Dijon, Fort-de-France, Grenoble, Limoges, Lyon, Nancy, Nantes, Paris, Marseille et Strasbourg) comparant des patients souffrant d’une keratite infectieuse sous lentilles de contact (cas) a des porteurs sains de lentilles de contact (temoins) a l’aide d’un questionnaire standardise anonyme regroupant 51 items donnant des informations sur des facteurs de risques potentiels et developpe pour l’etude a ete debutee en juillet 2007. Resultats Deux cent cinquante-six cas et 113 temoins ont participe a cette etude. Une part importante des abces sous lentilles de contact est survenue sous lentilles cosmetiques (risque relatif [RR] : 16,5). Un delai de consultation chez l’ophtalmologiste superieur a un an (RR : 3,4) ou l’adaptation des lentilles par un non-ophtalmologiste (RR : 7,6) a entraine une augmentation du risque de survenue d’abces sous lentilles. Le non-respect des regles d’hygiene (lavage des mains : RR : 2,2 ; ou absence de rub and rinse : RR : 2,7) a aussi augmente le risque d’infection sous lentilles. Discussion Un questionnaire standardise, remis a tout patient presentant un abces de cornee sous lentilles de contact, semble etre un outil pertinent pour l’etude des facteurs de risque de keratite infectieuse sous lentilles de contact et l’education au bon maniement des lentilles de contact des porteurs.

Resume Introduction Les fistules carotido-caverneuse indirectes sont une pathologie rare, dont la prise en charge therapeutique est multidisciplinaire. A ce jour, il n’existe pas de consensus quant au traitement, meme si l’embolisation constitue actuellement le traitement de premiere intention. Nous presentons dix cas de fistule carotido-caverneuse indirecte, en axant l’etude sur l’evolution de la strategie therapeutique developpee entre 1989 et 2004 et associant traitements non invasifs et/ou traitement endovasculaire neuroradiologique interventionnel. Patients et methodes Tous les patients, 7 femmes et 3 hommes (65,9 ans en moyenne), ont eu un examen ophtalmologique et une arteriographie cerebrale. Le traitement a consiste soit en des traitements non invasifs seuls (decoagulation, compressions manuelles jugulo-carotidiennes ou oculaires), soit en une embolisation. Une association de ces traitements a ete realisee chez certains patients. Resultats L’examen ophtalmologique montrait une dilatation des vaisseaux episcleraux, une exophtalmie, une baisse d’acuite visuelle, un chemosis, une hypertonie ou une diplopie. Sur les sept patients ayant eu des traitements non invasifs seuls, ont ete notees une stabilisation chez trois patients, une amelioration partielle chez trois patientes et une guerison clinique chez une patiente. Les trois autres patients ont ete traites par embolisation (en premiere ou seconde intention) avec une amelioration partielle pour le premier patient, une guerison clinique pour le deuxieme patient et une disparition de la fistule pour le dernier patient. Conclusion Nos resultats concernant l’embolisation comme traitement de premiere intention des fistules carotido-caverneuses indirectes sont encourageants et rejoignent ceux de la litterature. Cependant, meme si l’embolisation represente actuellement le traitement de premiere intention des fistules durales carotido-caverneuses, les traitements non invasifs demeurent des alternatives therapeutiques efficaces.

The arrival of fluoroquinolones in the 1980s aroused enormous enthusiasm in the medical community, justified by the spectrum of antibacterial activity, good tolerance, and wide distribution in tissues, even after oral administration. However, the extensive use of these new antibiotiques finally ended in emerging resistance, which limits the efficiency of all the molecules in the class, including those that have appeared in the last few years. Ocular diseases also benefited from the emergence of fluoroquinolones, notably for topical treatments. It is now mandatory to adapt the prescriptions to the best indications, in order to protect the vast therapeutic potential of these molecules.

Les fluoroquinolones en ophtalmologie : indications et modalites d’utilisation Les fluoroquinolones sont des antibiotiques d’utilisation courante en ophtalmologie, tant pour les infections de surface que pour les infections endoculaires (endophtalmies). Leur utilisation necessite une bonne connaissance de leur pharmacocinetique, de leurs contre-indications et effets secondaires. L’apport des fluoroquinolones en infectiologie repose actuellement sur le spectre antibacterien et la bonne diffusion oculaire des fluoroquinolones de troisieme generation et sur la possibilite de les injecter dans la cavite vitreenne.

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.

L’etude bacteriologique des endophtalmies permet de caracteriser le spectre bacterien apres un acte chirurgical (chirurgie de la cataracte, chirurgie filtrante…), de survenue aigue, retardee ou d’evolution chronique. Le diagnostic etiologique microbiologique a recemment beneficie des techniques de biologie moleculaire (PCR) afin d’identifier le genome bacterien et/ou fongique dans des echantillons oculaires. Afin d’optimiser la detection des micro-organismes responsables d’endophtalmies, il est preferable de prelever du vitre initialement et d’appliquer sur ce prelevement une culture conventionnelle et une technique de biologie moleculaire (PCR pan-bacterienne par exemple), les deux approches etant complementaires. L’efficacite et la rapidite des nouvelles techniques de diagnostic microbiologique devraient modifier dans l’avenir nos indications therapeutiques.

National audience; Purpose To describe the course of functional and anatomical damage after successful repair of macula‐off rhegmatogenous retinal detachment (RRD). Methods This was a prospective multicenter study including patients with successful surgery for macula‐off RRD between October 2011 and April 2014. Patients with pre‐existing macular diseases or with surgery failures were excluded. Each patient underwent a complete ophthalmologic exam at baseline and at one, three and six months after the surgery (M1, M3, M6), with an assessment of the best‐corrected visual acuity (BCVA) at 4 m using the standard Early Treatment Diabetic Retinopathy Study chart, and with Spectral‐Domain Optical Coherence Tomography (SD‐OCT) macular imaging. Results One hundred and three eyes of 103 patients from ten French centers, with a 63‐years median age (IQR: [58; 69]), were included. The median BCVA increased significantly from 63 [46; 73] letters at M1 to 73 [62; 80]) at M6, p < 0.01). SD‐OCT morphologic lesions in the outer retina significantly improved between M1 and M6: irregular hyporeflectivity of the photoreceptor outer segments (76.7% vs 61.5%, p < 0.01) and disruption of the inner/outer segment junction line (51.5% vs 26.2%, p < 0.01). The rate of epiretinal membrane did not significantly increase between M1 and M6 (9.7% vs 20.4%, p < 0.67). Conclusions These preliminary results of the study “DécOllement de REtine: Fonction et Anatomie (DOREFA)” show a slow recovery of the external retinal layers after a successful RRD surgery. These observations seem to be parallel to the progressive recovery of the visual function after the intervention. A better knowledge of functional and anatomical kinetics after macula‐off RRD constitutes a preliminary step to the study of factors influencing the visual prognosis.

The exact pathophysiology of glaucoma is not fully understood. Understanding of the vascular pathophysiology of glaucoma requires: knowing the techniques for measuring ocular blood flow and characterizing the topography of vascular disease and the mechanisms involved in this neuropathy. A decreased mean ocular perfusion pressure and a loss of vascular autoregulation are implicated in glaucomatous disease. Early decrease in ocular blood flow has been identified in primary open-angle glaucoma and normal pressure glaucoma, contributing to the progression of optic neuropathy. The vascular damage associated with glaucoma is present in various vascular territories within the eye (from the ophthalmic artery to the retina) and is characterized by a decrease in basal blood flow associated with a dysfunction of vasoregulation.

Objectifs Decrire les caracteristiques cliniques et histologiques des lesions conjonctivales de l’enfant a partir d’une etude retrospective de 42 lesions operees sur une periode de 11 ans. Patients et methodes Entre janvier 1990 et decembre 2001, 40 enfants ont ete operes d’une tumeur de la conjonctive dans le service d’ophtalmologie de l’hopital Edouard Herriot a Lyon. La technique operatoire consistait en la realisation d’une exerese en vase clos de la lesion. Apres inclusion en paraffine, l’examen histopathologique de la piece d’exerese etait effectue en microscopie optique apres coloration a l’hematoxyline-phloxine-safran (HPS). L’etude decrit les presentations cliniques et les caracteristiques evolutives des lesions operees. Resultats Au total, 42 lesions de la conjonctive ont ete retirees chez 40 enfants dont 22 filles et 18 garcons. L’âge moyen des enfants operes etait de 10 ans (10,0 ± 4,7 ans). La tumeur etait le plus souvent de siege temporal et occupait la portion limbique dans 57,1 % des cas. L’exerese chirurgicale a ete le plus souvent motivee la croissance de la lesion ou a l’augmentation de sa vascularisation. Le diagnostic evoque lors de l’examen clinique etait exact dans 91 % des cas. La plupart des lesions rencontrees (83 %) correspondaient a des naevi de la conjonctive. L’analyse histologique a denombre au total 35 naevi, 2 angiomes, 2 dermolipomes, 1 carcinome epidermoide, 1 papillome et 1 kyste dermoide. La seule tumeur maligne observee, un carcinome epidermoide, etait presente chez un enfant atteint de xeroderma pigmentosum. Conclusion Malgre des accroissements lesionnels frequents et malgre l’apparition ou l’accentuation de la vascularisation tumorale, aucune des lesions pigmentees n’a presente de caractere de malignite a l’histologie. Cette etude souligne d’une part l’importance de l’expertise histologique si la lesion conjonctivale survient sur un terrain predisposant, et d’autre part, elle confirme le caractere exceptionnel de la malignite d’une lesion pigmentee de la conjonctive chez l’enfant.

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.

Given the growing number of patients on antithrombotic therapy we are increasingly confronted with the management of this therapy before, during and after vitreoretinal surgery. In the absence of a consensus, the decision to withdraw antithrombotic therapy is based on the cardiovascular thromboembolism risk versus the theoretical risk of bleeding if the antithrombotic treatment is continued. As suggested by the literature, antiplatelet therapy (acetylsalicylic acid or clopidogrel) may be safely continued for vitreoretinal surgery, including retinal detachment repair. However, the risk/benefit ratio for patients being treated with two antiplatelet therapies is unknown. It appears that an International Normalized Ratio (INR) less than 3 for patients treated with anticoagulant therapy does not increase the perioperative risk of ocular bleeding. This risk has not been evaluated in patients treated by new antithrombotic therapies (prasugrel, ticagrelor as antiplatelet medication, or dabigatran, rivaroxaban, apixaban as anticoagulant therapy), and there is a need to study it further.

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 (

Resume But de l'etude Evaluer l'effet de la radiotherapie d'apres les signes fonctionnels et l'evolution des lesions vasculaires choroidiennes de la degenerescence vasculaire liee a l'âge (DMLA) non accessibles a un traitement par laser. Materiel et methodes Depuis 1994, 250 patients ont ete inclus de facon consecutive dans l'etude. Ils ont ete traites par irradiation pour des neovaisseaux choroidiens par deux equipes lyonnaises. Fin septembre 1996, les dossiers de 52 patients etaient evaluables avec un recul d'un an. Le groupe 1 (departement de radiotherapie oncologie du centre hospitalo-universitaire Lyon Sud) comprenait 26 patients traites avec un champ lateral de photons de 6 MV. La dose delivree etait de 20 Gy en cinq fractions pour les petites lesions, et de 28,8 Gy en huit fractions pour les lesions plus evoluees. Le groupe 2 (centre oncologie radiotherapie Saint-Jean) etait constitue de 26 patients traites par un mini-faisceau de 25 MV et une arctherapie laterale. Le diametre du faisceau (14 et 18 mm) etait adapte a la taille des lesions. La dose etait de 16 Gy en quatre fractions, ou 20 Gy en cinq fractions. Resultats Les resultats fonctionnels et angiographiques ont ete evalues a 3, 6, 9 mois et un an apres la radiotherapie. L'acuite visuelle a ete stabilisee chez 44 % des patients (23/52), et amelioree chez 35 % des patients (18/52) a 6 mois. Il y a donc eu un bon resultat fonctionnel chez 79 %des patients (41/52) a 6 mois et chez 74% des patients (17/23) a 12 mois. La diminution des surfaces des plaques de neovaisseaux (> 10 %) a ete constatee dans 46 % des cas (16/52) a 6 mois et dans 65 % des cas (1 5/23) a 12 mois. Il n'y avait pas de difference significative entre les deux groupes, ni en fonction de la dose. Les complications severes (une cataracte, trois dilatations de vaisseaux choroidiens, deux papillites) sont toutes apparues dans le groupe 1 (avec les doses les plus elevees, a l'exception de la cataracte). Conclusion La radiotherapie donne des resultats encourageants pour controler les neovaisseaux des DMLA non accessibles a un traitement par laser. Il est trop tot pour indiquer le meilleur niveau de dose. La technique de radiotherapie doit etre tres precise afin d'irradier au mieux la region foveolaire et d'epargner les structures sensibles avoisinantes. Des etudes complementaires et des essais randomises sont indispensables pour confirmer les resultats preliminaires.

Syphilis is a sexually transmitted disease caused by Treponema pallidum. Previously known as the "great imitator", this disease can have numerous and complex manifestations. The ophthalmologist should suspect the diagnosis in patients with uveitis or optic neuropathy and high-risk sexual behavior and/or another sexually transmitted disease (such as HIV) or those presenting with posterior placoid chorioretinitis or necrotising retinitis. Ocular involvement in acquired syphilis is rare, tending to occur during the secondary and tertiary stages of the disease. Syphilis may affect all the structures of the eye, but uveitis (accounting for 1-5% of the uveitis in a tertiary referral center) is the most common ocular finding. Granulomatous or non-granulomatous iridocyclitis (71%), panuveitis, posterior uveitis (8%) and keratouveitis (8%) are often described. In the secondary stage, the meninges and the central nervous system can be affected, sometimes with no symptoms, which justifies performing lumbar puncture in patients with uveitis and/or optic neuropathy. The diagnosis of ocular syphilis requires screening with a non-treponemal serology and confirmation with a treponemal-specific test. Parenterally administered penicillin G is considered first-line therapy for all stages of ocular syphilis. Systemic corticosteroids are an appropriate adjunct treatment for posterior uveitis, scleritis and optic neuritis if ocular inflammation is severe. Prolonged follow-up is necessary because of the possibility of relapse of the disease. With proper diagnosis and prompt antibiotic treatment, the majority of cases of ocular syphilis can be cured.

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.

Proliferative vitreoretinopathy (PVR), which causes contractile fibrocellular membranes that may prevent retinal reattachment, remains one of the most severe complications of rhegmatogenous retinal detachment (RD), with an incidence of 5-11%, and one of the most frequent causes of surgical failure (50-75%). Its severity is due to the complexity of the surgery required to treat patients, and to its uncertain anatomic and functional prognosis. Curative treatment of PVR includes vitrectomy, sometimes associated with phacoemulsification or scleral buckling; systematic peeling of epiretinal membranes, occasionally retinectomy; and systematic retinopexy by endolaser photocoagulation. The current preferred internal tamponade is silicone oil. Silicone oils of various densities are undergoing comparative studies.

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.

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 24-h intraocular pressure (IOP) rhythm reproducibility during repeated continuous 24-h IOP monitoring with non-contact tonometry (NCT) and a contact lens sensor (CLS) in healthy subjects. Methods Twelve young healthy subjects were housed in a sleep laboratory and underwent four 24-h sessions of IOP measurements over a 6-month period. After randomized attribution, the IOP of the first eye was continuously monitored using the CLS Sensimed TriggerFish® and the IOP of the fellow eye was measured hourly using the Pulsair Intellipuff® non-contact tonometer. A nonlinear least-squares dual harmonic regression analysis was used to model the 24-h IOP rhythm. Comparison of acrophase, bathyphase, amplitude, the midline estimating statistic of rhythm (MESOR), IOP values, IOP changes and agreement were evaluated in the two tonometry methods. Results A significant nyctohemeral IOP rhythm was found in 31 out of 36 sessions (86%) using NCT and in all sessions (100%) using CLS. Hourly awakening during NCT IOP measurements did not significantly change the mean phases of the 24-h IOP pattern evaluated using CLS in the contralateral eye. Throughout the sessions, intraclass correlation coefficients (ICCs) of the CLS acrophase (0.6 [0–0.9]; p=0.03), CLS bathyphase (0.7 [0.1–0.9]; p=0.01), NCT amplitude (0.7 [0.1–0.9]; p=0.01) and NCT MESOR (0.9 [0.9–1]; p

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 compare the anterior chamber (AC) and AC angle measurements obtained with a spectral-domain and a time-domain anterior segment optical coherence tomography (AS-OCT), and to evaluate their repeatability Methods Prospective cross-sectional study conducted on healthy subjects. The AC was imaged with a spectral-domain (Casia SS-100, Tomey) and a time-domain AS-OCT (Visante, Zeiss) in one eye of each patient in a random order. The central corneal thickness (CCT), anterior chamber depth (ACD), angle opening distance at 500 and 700 µm (AOD 500 and AOD 750), trabecular iris space area at 500 and 700 µm (TISA 500 and TISA 750) and scleral spur angle (SSA) were measured. The repeatability measurements were evaluated by the intraclass correlation coefficients (ICCs) Results 101 eyes of healthy subjects were analyzed. The repeatability was excellent with the Casia and the Visante for CCT (ICC 0.90-0.94 and 0.95-0.97), ACD (ICC 0.95-0.98 and 0.93-0.96), AOD 500 (ICC 0.92-0.96 and 0.90-0.94) and 750 (ICC 0.93-0.96 and 0.91-0.94), TISA 750 (ICC 0.81-0.97 and 0.9-0.94) and SSA (ICC 0.9-0.94 and 0.89-0.94), and moderate for TISA 500 (ICC 0.68-0.97 and 0.7-0.93). For all parameters, Casia and Visante measurements were significantly correlated (r 0.76-0.98; p

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

Palatogenesis is a complex process implying growth, elevation and fusion of the two lateral palatal shelves during embryogenesis. This process is tightly controlled by genetic and mechanistic cues that also coordinate the growth of other orofacial structures. Failure at any of these steps can result in cleft palate, which is a frequent craniofacial malformation in humans. To understand the etiology of cleft palate linked to the BMP signaling pathway, we studied palatogenesis in Bmp7-deficient mouse embryos. Bmp7 expression was found in several orofacial structures including the edges of the palatal shelves prior and during their fusion. Bmp7 deletion resulted in a general alteration of oral cavity morphology, unpaired palatal shelf elevation, delayed shelf approximation, and subsequent lack of fusion. Cell proliferation and expression of specific genes involved in palatogenesis were not altered in Bmp7-deficient embryos. Conditional ablation of Bmp7 with Keratin14-Cre or Wnt1-Cre revealed that neither epithelial nor neural crest-specific loss of Bmp7 alone could recapitulate the cleft palate phenotype. Palatal shelves from mutant embryos were able to fuse when cultured in vitro as isolated shelves in proximity, but not when cultured as whole upper jaw explants. Thus, deformations in the oral cavity of Bmp7-deficient embryos such as the shorter and wider mandible were not solely responsible for cleft palate formation. These findings indicate a requirement for Bmp7 for the coordination of both developmental and mechanistic aspects of palatogenesis. © 2013 Kouskoura et al.

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.