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Dans la population de moins de 19 ans, les troubles oculomoteurs (TOM) ont une prevalence d’environ 4 % (majoritairement des strabismes de l’enfance). Chez l’adulte, les TOM acquis ont une incidence cumulee de 4 %, et sont le plus frequemment des paralysies oculomotrices et des strabismes lies a l’âge. L’ophtalmologue peut faire face a de nombreux tableaux cliniques, les plus frequents etant ceux ou le TOM est isole ou au premier plan. Le signe fonctionnel principal, au moins dans un TOM acquis, est la diplopie, dont l’analyse est souvent le premier temps de l’evaluation diagnostique, qui est aussi guidee par le terrain (l’âge, les pathologies associees), l’examen oculomoteur, l’examen ophtalmologique et les signes locoregionaux ou/et generaux. L’examen initial determine s’il existe un trouble des ductions (limitation due a une paralysie d’un muscle oculomoteur ou un phenomene restrictif), s’il repond a une systematisation neurologique ou non, et d’evoquer une cause neurogene, musculaire ou mecanique. Ce premier examen permet de proposer des hypotheses etiologiques, de determiner si des examens complementaires ou une prise en charge specialisee sont necessaires et leur eventuel degre d’urgence. La prise en charge ulterieure est conditionnee par l’etiologie. En cas de diplopie, celle-ci doit etre traitee immediatement si elle est invalidante (occlusion d’un œil le plus souvent pour commencer). Nous passerons en revue les situations les plus frequentes de TOM non paralytiques et de paralysies oculomotrices peripheriques, ainsi que les pieges et les erreurs les plus frequemment rencontrees.

SUMMARY Purpose: We followed the neuropsychological development of five children who underwent unilateral neurosurgery of the occipitoparietal lobes as a treatment for epilepsy caused by a developmental lesion (cortical dysplasia). Methods: The follow-up period ranged from 3–7 years postsurgery. Results: Two participants had a verbal intelligence quotient (IQ) >100 and three had a verbal IQ between 65 and 80. All five children had abnormal nonverbal IQ and exhibited deficits related to visual attention, object recognition, and praxis. Nevertheless, our results suggest that brain plasticity after parietooccipital epilepsy surgery in young children allows for a schooling level of cognitive skills such as reading and arithmetic. Discussion: Although recovery for visual perceptual cognition was more limited than for verbal functions, longterm neuropsychological outcomes showed that early surgery for epilepsy offers the possibility of optimizing cognitive outcomes in children with posterior intractable epilepsies.

We followed the neuropsychological development of five children who underwent unilateral neurosurgery of the occipitoparietal lobes as a treatment for epilepsy caused by a developmental lesion (cortical dysplasia).The follow-up period ranged from 3-7 years postsurgery.Two participants had a verbal intelligence quotient (IQ)100 and three had a verbal IQ between 65 and 80. All five children had abnormal nonverbal IQ and exhibited deficits related to visual attention, object recognition, and praxis. Nevertheless, our results suggest that brain plasticity after parietooccipital epilepsy surgery in young children allows for a schooling level of cognitive skills such as reading and arithmetic.Although recovery for visual perceptual cognition was more limited than for verbal functions, long-term neuropsychological outcomes showed that early surgery for epilepsy offers the possibility of optimizing cognitive outcomes in children with posterior intractable epilepsies.

To evaluate prospectively the efficacy and safety of 1 intravitreal injection of 4 mg of triamcinolone acetonide for refractory diffuse diabetic macular edema.Interventional case series.Fifteen patients with bilateral diabetic macular edema unresponsive to laser photocoagulation. In all patients, one eye received the injection, and the other served as a control.Intravitreal injection of 4 mg of triamcinolone acetonide under subconjunctival anesthesia.The main outcome measure was central macular thickness (CMT) at 1, 3, and 6 months, measured by optical coherence tomography. Secondary outcomes were Early Treatment Diabetic Retinopathy Study (ETDRS) scores, intraocular pressure, and cataract progression.In this preliminary report, we give the results for 12 patients who had a follow-up of at least 3 months. Seven of them were followed up for 6 months. Before injection, CMT was 509.6+/-143.5 microm (mean +/- standard deviation [SD]) in injected eyes, versus 474.4+/-82.6 microm in control eyes. Four weeks after injection, it was 207.3+/-44.2 microm in injected eyes and 506.7+/-122.4 microm in control eyes (P0.001, bilateral Wilcoxon test for paired samples), and after 12 weeks, 207+/-96.7 microm and 469.3+/-117.6 microm, respectively (P = 0.005). The difference between the CMTs of injected and control eyes was no longer significant at 24 weeks because of the recurrence of macular edema in 5 of 12 injected eyes. Before triamcinolone injection, the ETDRS score was 47.8+/-13 (mean +/- SD; range, 28-66) in injected eyes, versus 51.9+/-14.6 (range, 31-71) in control eyes. Twelve weeks thereafter, the corresponding values were 52.7+/-10.8 (range, 34-70) and 50.8+/-14.3 (range, 29-69), respectively, and at 24 weeks, 54.7+/-7.6 (range, 47-68) and 50.6+/-18.4 (range, 28-71). At no time was the difference between the ETDRS scores for injected and control eyes significant. In 6 of the 12 injected eyes, intraocular pressure exceeded 25 mmHg, and was controlled by topical medication.Intravitreal injection of triamcinolone effectively reduces macular thickening due to diffuse diabetic macular edema, at least in the short term. Further studies are required to demonstrate that it provides visual benefit.