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Resume Introduction La retinochoroidite toxoplasmique (RCT) est la premiere cause d’inflammation oculaire et d’uveite posterieure chez le patient immunocompetent. Plusieurs etudes ont montre l’efficacite et la surete d’un traitement des RCT par injection intravitreenne de clindamycine chez des patients presentant des contre-indications, des effets secondaires ou une mauvaise reponse au traitement oral. Le but de cette etude est de decrire les resultats anatomiques et fonctionnels d’un traitement local de RCT par IVT de clindamycine. Materiel et methode Nous avons mene une etude observationnelle, retrospective, unicentrique au CHU de Bordeaux, dans le service d’ophtalmologie entre decembre 2017 et janvier 2020 afin d’examiner la prise en charge de retinochoroidites toxoplasmiques par injection intravitreenne de clindamycine. Nous analysions l’efficacite du traitement sur l’amelioration de l’acuite visuelle, la diminution de la taille du foyer et la diminution de l’epaisseur maculaire. Resultats Un total de 10 yeux de 9 patients ont ete injectes. Une seule IVT a ete necessaire dans 9 cas sur 10. Les injections ont montre une amelioration des 3 criteres de jugement ; l’acuite visuelle est passee en moyenne de 1 LogMAR (1,07 ± 0,77) pre-injection a 0,4 LogMAR (0,43 ± 0,53)a 6 mois, la taille du foyer a diminuee de 51 % et l’epaisseur maculaire a diminuee de 78 μm en moyenne au cours du suivi. Conclusion Les IVT de clindamycine se sont montrees sures et efficaces dans le traitement des RCT. Elles presentent une alternative chez des patients allergiques, intolerants ou presentant une resistance au traitement oral.

To report a case series of 3 patients with choroidal granulomas due toA retrospective case series of patients with choroidal granulomas due toPatients were a 48-year old man, a 14-year old girl and a 31-year old man. They all had a choroidal granuloma seen on optical coherence tomography (OCT) and angiography. The laboratory work-up revealed a positive serology forOn multimodal imaging choroidal granulomas in B Henselae appeared as single or multiple, uni or bilateral round yellowish lesions. Fluorescein and indocyanine green angiography of the granuloma showed respectively a late staining and a hypofluorescence. On EDI-OCT choroidal granuloma appeared as a round hyporeflective lesion in the choroid with a retinal elevation. The exclusion of other diagnosis, the natural course and the serology must lead the ophthalmologist to evoke the diagnosis.

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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.

Purpose. - To evaluate long terms outcomes of botulinum toxin in infantile esotropia by measuring the amount of microtropia 24 months after injection. Secondary purpose was to identify predictive factors of microtropia. Methods. - A retrospective, single-center study was performed at the university medical centerin Bordeaux between 2001 and 2018, including all patients with infantile esotropia greater than 20 D. All patients received 5 or 7,5 IU of botulinum toxin A in each medial rectus, once or twice depending on the angle of deviation after the first injection and after wearing full optical correction at least two months. We noted the angle at 1, 6, 12 and 24 months, the occurrence of any complications and the need for later strabismus surgery. The primary endpoint was the achievement of a microtropia less than 8 diopters (D) at 24 months post-injection. We evaluated the predictive factors for microtropia with a Fischer's test. Results. - We included 30 patients with esotropia greater than 20 D. The mean follow-up after injection was 48 months +/- 30. The mean age was 16.24 months (7-29 months) with a female predominance in the population (SR = 0.43). The mean pre-injection deviation was 41.25 +/- 12.17 D. The majority of patients were mildly (40%) or moderately (40%) hyperopic. At 24 months, 46.7% microtropias were obtained (95% CI: 28.9%-64.5%). The change in mean angle at 1, 6,12 and 24 months post-injection was -8.57 +/- 25.21 D; 14.48 +/- 13.40 D; 18.38 +/- 12.07 D and 21.23 +/- 14.97 D, respectively. No factors were predictive of microtropia. Of the 30 children, 3 had transient ptosis requiring strips and 12 showed an exotropia at 1 month. All complications were self-limited and without consequences. 3 children had a second injection of botulinum toxin, which in 2/3 of the cases resulted in a long-lasting microtropia. 26.7% (n = 8) of the children underwent secondary surgery. Obtaining a microtropia 24 months after injection statistically significantly reduced the need for secondary strabismus surgery: 92.9% P = 0.039% CI 95% (0.002; 1.0606). Conclusion. - Botulinum toxin appears to be a less invasive and more conservative alternative to surgery in children with infantile esotropia. In 46.7% of cases, microtropia is achieved. An improvement was noted in 90% (n = 27) of the children with a reduction of half (21.23 D) of the mean post-injection angle at 24 months. When effective, it significantly reduces the need for secondary surgery. (c) 2021 Elsevier Masson SAS. All rights reserved.; Objectif: Évaluer l’efficacité à long terme de la toxine botulique dans le traitement de l’ésotropie précoce grâce au pourcentage de microtropie à 24 mois post-injection. L’objectif secondaire était de rechercher les facteurs prédictifs à l’obtention de cette microtropie. Méthodes: Nous avons réalisé une étude rétrospective, monocentrique au Centre Hospitalier universitaire (CHU) de Bordeaux entre 2001 et 2018 en incluant tous les patients ayant une ésotropie précoce. Ces patients ont reçu une injection bilatérale de 5 ou 7,5 unités de toxine botulique à une ou deux reprises en fonction de l’angle après la première injection et port de la correction optique totale. L’ensemble des caractéristiques sociodémographiques et ophtalmologiques ont été recueillis en préopératoire. Nous avons noté l’angle à 1,6,12 et 24 mois ; l’apparition de complications ainsi que la nécessité d’une chirurgie de strabisme à distance. Le critère de jugement principal était l’obtention d’une microtropie inférieure à 8 dioptries (D) à 24 mois post-injection. Nous avons évalué les facteurs prédictifs de la microtropie par un test de Fischer. Résultats: Nous avons inclus 30 patients ayant une ésotropie supérieure à 20 D avec un délai moyen de suivi post-injection de 48 mois ± 30. L’âge moyen était de 16,24 mois (7–29 mois) avec une prédominance féminine dans la population (sex ratio SR = 0,43). L’angle moyen pré-injection était de 41,25 ± 12,17 D. Il y avait une majorité d’hypermétropes légers (40 %) et modérés (40 %). À 24 mois, on obtenait 46,7 % de microtropies (intervalle de confiance : IC 95 % : 28,9 %–64,5 %). L’évolution de l’angle moyen à 1,6,12 et 24 mois post-injection était respectivement de −8,57 ± 25,21 D ; 14,48 ± 13,40 D ; 18,38 ± 12,07 D et 21,23 ± 14,97 D. Aucun facteur n’était prédictif de l’obtention d’une microtropie. Parmi les 30 enfants, 3 ont eu des ptôsis transitoires nécessitant la pose de strips et 12 ont présenté une exotropie à 1 mois. Toutes les complications étaient spontanément résolutives et sans conséquences. 3 enfants ont eu une seconde injection de toxine botulique permettant dans 2/3 des cas l’obtention d’une microtropie durable. 26,7 % (n = 8) des enfants ont été opérés secondairement ; l’obtention d’une microtropie à 24 mois diminuait de façon statistiquement significative les chirurgies secondaires du strabisme : p = 0,039 % IC 95 % (0,002 ; 1,0606). Conclusion: La toxine botulique semble être une alternative moins invasive et plus conservatrice que la chirurgie chez les enfants présentant une ésotropie précoce. Elle permet l’obtention d’une microtropie dans 46,7 % des cas. On notait une amélioration chez 90 % (n = 27) des enfants avec une réduction de la moitié (21,23 D) de l’angle moyen post-injection à 24 mois. Lorsqu’elle est efficace elle réduit significativement les chirurgies secondaires.

To evaluate long terms outcomes of botulinum toxin in infantile esotropia by measuring the amount of microtropia 24 months after injection. Secondary purpose was to identify predictive factors of microtropia.A retrospective, single-center study was performed at the university medical center in Bordeaux between 2001 and 2018, including all patients with infantile esotropia greater than 20 D. All patients received 5 or 7,5 IU of botulinum toxin A in each medial rectus, once or twice depending on the angle of deviation after the first injection and after wearing full optical correction at least two months. We noted the angle at 1, 6, 12 and 24 months, the occurrence of any complications and the need for later strabismus surgery. The primary endpoint was the achievement of a microtropia less than 8 diopters (D) at 24 months post-injection. We evaluated the predictive factors for microtropia with a Fischer's test.We included 30 patients with esotropia greater than 20 D. The mean follow-up after injection was 48 months ±30. The mean age was 16.24 months (7-29 months) with a female predominance in the population (SR=0.43). The mean pre-injection deviation was 41.25±12.17 D. The majority of patients were mildly (40%) or moderately (40%) hyperopic. At 24 months, 46.7% microtropias were obtained (95% CI: 28.9%-64.5%). The change in mean angle at 1, 6, 12 and 24 months post-injection was -8.57±25.21 D; 14.48±13.40 D; 18.38±12.07 D and 21.23±14.97 D, respectively. No factors were predictive of microtropia. Of the 30 children, 3 had transient ptosis requiring strips and 12 showed an exotropia at 1 month. All complications were self-limited and without consequences. 3 children had a second injection of botulinum toxin, which in 2/3 of the cases resulted in a long-lasting microtropia. 26.7% (n=8) of the children underwent secondary surgery. Obtaining a microtropia 24 months after injection statistically significantly reduced the need for secondary strabismus surgery: 92.9% P=0.039% CI 95% (0.002; 1.0606).Botulinum toxin appears to be a less invasive and more conservative alternative to surgery in children with infantile esotropia. In 46.7% of cases, microtropia is achieved. An improvement was noted in 90% (n=27) of the children with a reduction of half (21.23 D) of the mean post-injection angle at 24 months. When effective, it significantly reduces the need for secondary surgery.

La degenerescence maculaire liee a l’âge (DMLA) est la premiere cause de cecite legale chez les personnes âgees de plus de 65 ans dans les pays developpes. Le traitement de la forme exsudative a ete revolutionne par l’apparition des therapies anti-VEGF. L’aflibercept est le dernier anti-VEGF a avoir obtenu l’autorisation de mise sur le marche. Objectif : L’objectif de cette etude etait d’evaluer la reponse visuelle et anatomique en condition de vraie vie du traitement par aflibercept chez les patients naifs atteints de DMLA exsudative. Patients et methodes : Il s’agit d’une etude retrospective sur une serie de patients diagnostiques pour la DMLA exsudative et traite par aflibercept dans le service d’ophtalmologie du CHU de Bordeaux entre novembre 2013 a juillet 2015. Les patients ont beneficie d’une phase d’induction de 3 injections puis d’un suivi personnalise laisse a l’appreciation de quatre retinologues. Une mesure de l’acuite visuelle en score EDTRS, un fond d’œil et un examen OCT etaient realises a chaque visite de controle et les donnees ont ete recueillies a J0, 3 mois, 6 mois, 9 mois, 12 mois, 18 mois et 24 mois. Le nombre d’injections et de visites sur l’ensemble du suivi a ete evalue. Le critere de jugement principal etait l’evolution de l’acuite visuelle sur la periode de suivi. Resultats : 43 yeux de 40 patients, âges de 77,7 ans en moyenne, ont ete traites par aflibercept avec un suivi de minimum 3 mois. 25 yeux etaient suivis 1 an et 5 yeux deux ans. A l’inclusion la meilleure acuite visuelle avec correction moyenne etait de 55,7 lettres. Les patients ont recu une moyenne de 7,5 injections la premiere annee et 2,6 la 2ieme annee. Le gain moyen d’acuite visuelle etait de 7,3 lettres a 3 mois, de 6,2 lettres a 12 mois, et 6,8 lettres a 2 ans. Sur le plan anatomique, l’epaisseur maculaire centrale a diminue de 118,3μm a 3 mois, 136,4μm a 12 mois et 65,5μm a 2 ans. Conclusion : Le gain d’acuite visuelle a 3 mois etait maintenu a 12 mois et a 2 ans. Les parametres anatomiques montraient une evolution similaire. Nous pouvons obtenir pour nos patients des resultats se rapprochant des etudes pivotales malgre des protocoles differents, personnalises et l’allongement des intervalles de surveillance. Des etudes sur de plus gros echantillons, a plus long terme et evaluant les differents schemas therapeutiques seraient interessantes.

Summary Purpose To describe changes of the retinal peripapillary microvasculature on optical coherence tomography angiography (OCT-A) in non-arteritic anterior ischemic optic (NAION) neuropathy. Methods Observational study of 10 patients at the acute phase of NAION. OCT-A was performed using a 3 mm × 3 mm square centered on the optic disc (Cirrus HD-OCT with Angioplex, Carl Zeiss Meditec, Dublin, CA). A qualitative comparison was made with the healthy fellow eye of each patient. All patients had a fluorescein angiography (HRA2, Heidelberg, Germany) and a visual field examination (Octopus 101®, Haag-Streit, USA). Results In the affected eyes, OCT-A showed clear modifications in the radial peripapillary network. In all these eyes, a focal disappearance of the superficial capillary radial pattern was present, twisted and irregular. In 8 eyes, there was also a lack of vascularization in some focal areas, appearing as dark areas. No correlation was found between the topography of the vascular alteration shown on OCT-A and visual field pattern defects. Conclusions OCT-A is a new imaging technology able to demonstrate easily and safely the changes in the peripapillary capillary network during the acute phase of NAION. These changes are likely related to a decrease of the prelaminar optic nerve blood flow during the acute phase of NAION. Visual field defects are not correlated with OCT-A images, suggesting that they may be due mainly to disturbances in posterior ciliary artery blood flow.

To evaluate the medical-surgical management of cataract surgery in children with chronic uveitis in various French pediatric ophthalmology centers.Two-part study: first, a descriptive observational segment on the evaluation of French practices. A questionnaire was sent to the various pediatric ophthalmologists in France. A second retrospective chart review, including children with non-infectious chronic uveitis who had cataract surgery in the pediatric ophthalmology department of Bordeaux University Hospital from 2008 to 2017.Twenty-one ophthalmologists responded to the questionnaire. Only 23.8% systematically initiated immunosuppressive drugs (aside from corticosteroids) before surgery. A total of 88.2% prescribed oral corticosteroid treatment preoperatively. Eleven surgeons administered intravenous corticosteroid boluses during the surgery, and primary lens implantation is the most common method used in 95.2%. A total of 76.2% initiated oral steroid therapy after surgery. Postoperatively, all surgeons started local therapy with high-dose corticosteroids. At one year, 100% achieved improvement of visual acuity greater than or equal to 2 lines. On our service, 10 eyes (7 children) underwent cataract surgery. Seven were treated with systemic immunosuppressive drugs (aside from corticosteroids) and 80% of cases received oral corticosteroid therapy a few days before surgery. An intravenous corticosteroid bolus was administered preoperatively in 8 cases, and primary lens implantation was performed in 100% of cases. Postoperatively, 5 children received oral corticosteroid treatment. All were treated with local high dose steroids. At one year, the mean best-corrected visual acuity was 0.18 LogMar (0-0.7, SD: 0.25).When performed with an aggressive anti-inflammatory protocol, cataract surgery leads to a good visual outcome in selected children with chronic uveitis.

This is a retrospective case series of three patients presenting with syphilitic chorioretinitis. The diagnosis of syphilis rests on the ophthalmologic clinical exam as well as serologic confirmation. We studied the en face and SD-OCT images upon first consultation and after one month of antibiotic treatment with penicillin G.Four eyes of three male patients between 40 and 60 years of age all diagnosed with syphilitic placoid chorioretinitis were studied by en face OCT. Visual acuities upon initial presentation were unrecordable. On all the en face OCT examinations of the three patients, numerous small hyperreflective oval lesions were observed within the ellipsoid line and the retinal pigment epithelium around the macula. These lesions corresponded to small elevated nodules in the retinal pigment epithelium and interruptions in the ellipsoid line observed on SD-OCT. One month after treatment for neurosyphilis, the visual acuity had improved, and the outer retinal lesions had partially reversed in these eyes.We documented the characteristic lesions of syphilitic placoid chorioretinitis by en face OCT. En face OCT allows a more precise approach to the outer retina for diagnosis and follow-up as well as in understanding the pathophysiology of the disease.

To compare precision in toric intraocular lens (TIOL) alignment and refractive outcomes between an intraoperative automated digital marker system and the conventional manual-ink marking.Prospective single center study including consecutive patients undergoing uneventful cataract surgery with corneal astigmatism greater than 1 diopter. Total corneal astigmatism was measured using a placido-dual Scheimpflug system (GalileiG4In total, 45 eyes of 30 patients were included (n=25 digital group, n=20 ink-marking group). The mean preoperative total corneal astigmatism was 1.71±0.53 diopters. At one month, there was a significantly lower mean average error in TIOL axis in the digital group compared to the ink-marking group (2.6±2.3° and 6.4±2.8° respectively, P=0.009). At 6months, these results remained statistically significant. Mean residual astigmatism was 0.7±0.4 diopters at one month, without significant difference between the two groups (P=0.9). The rate of misalignment less than or equal to 5° was 86 % (n=25) in the digital group and 63 % (n=20) in the ink-marking group (P=0.05).Intraoperative digital marker system is associated with better TIOL alignment accuracy and better reproducibility than the manual ink-marking method.

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

Resume Introduction La maladie d’Erdheim-Chester est une pathologie systemique rare, de diagnostic difficile du fait d’un polymorphisme clinique et morphologique important. L’atteinte orbitaire est rare, mais constitue un mode de decouverte classique de cette maladie. Observation Un patient âge de 60 ans est adresse en medecine interne pour exploration de tumeurs retro-orbitaires bilaterales. Ces tumeurs ont ete decouvertes deux ans plutot sur un scanner cerebral pour exploration d’une exophtalmie. Deux biopsies de ces lesions ont ete realisees. Le premier prelevement montrait un tissu inflammatoire polymorphe. Le second notait une forte reaction granulomateuse riche en histiocytes spumeux non specifique. Le scanner thoraco-abdominopelvien mettait en evidence une infiltration peri-aortique et retro-peritoneale. Cette association, evocatrice, a conduit a la relecture des prelevements, confirmant le diagnostic de maladie d’Erdheim-Chester. Discussion La maladie d’Erdheim-Chester est une hystiocytose non langherhansienne presentant un tropisme particulier pour les tissus conjonctivo-adipeux et peri-vasculaires. Le diagnostic est histologique. Conclusion Dans le cadre de tumeurs intra-orbitaires bilaterales, le diagnostic classique mais rare de maladie d’Erdheim-Chester doit etre evoque.

Nous presentons le cas d’une femme de 52 ans adressee en mars 2013 aux urgences ophtalmologiques pour baisse d’acuite visuelle bilaterale. L’acuite visuelle est de 1/10e aux deux yeux. L’examen du fond d’œil montre un aspect de liquide sous retinien organise en strates successives au niveau du pole posterieur sur les deux yeux (Fig. 1). La tomographie par coherence optique en haute definition (5 lignes verticales) confirme la presence de liquide sous retinien avec des decollements sereux retiniens superposes d’âges differents (Fig. 2). L’angiographie a la fluoresceine nous montre aux temps tardifs une diffusion de fluoresceine au niveau du nerf optique qui confirme l’œdeme papillaire, une plage hypofluorescente qui correspond a un effet masque du liquide sous retinien, et en extreme peripherie un arret brusque

Resume Introduction Le syndrome des taches blanches evanescentes multiples (MEWDS) est une pathologie retinienne rare, responsable d’une baisse d’acuite visuelle brutale, le plus souvent unilaterale et dont la physiopathologie reste encore meconnue. L’objectif de ce travail a ete de mieux localiser les couches retiniennes lesees grâce a une nouvelle technologie : la tomographie par coherence optique avec reconstruction « en face » (OCT « en face »). Methodes Une patiente de 21 ans, presentant un MEWDS bilateral, a beneficie de la realisation d’un OCT Cirrus ® avec reconstructions « en face » des differentes couches retiniennes et de la choroide interne, d’une angiographie a la fluoresceine et d’une angiographie au vert d’infracyanine (ICG). Resultats L’OCT « en face » permet de localiser les lesions au niveau de la ligne de jonction segments internes/segments externes des photorecepteurs et de la choroide interne. Les images obtenues montrent des taches sombres aux contours identiques a ceux des lesions visualisees en angiographie ICG. Conclusion L’OCT « en face » est une technologie nouvelle, non invasive, capable de mettre en evidence dans le MEWDS des lesions de la ligne de jonction segments internes/segments externes des photorecepteurs, organisees en taches d’un motif identique a celui visualise en angiographie ICG.

Anti-VEGF therapies have revolutionized the treatment of neovascular age-related macular degeneration (AMD).The goal of this study was to evaluate the "real life" visual and anatomical outcomes of aflibercept treatment for treatment-naive patients with exudative AMD.This was a retrospective study of patients treated with aflibercept in the department of Ophthalmology at the University Hospital of Bordeaux between November 2013 and July 2015. The follow-up period varied from 3months to 2years. All patients received an induction phase with 3monthly intravitreal injections (IVT) followed by personalized monitoring. ETDRS best-corrected visual acuity (BCVA), fundus examination and OCT were performed at each visit. Data were collected at day 0, 3 months, 6, 9, 12months, 18 and 24months.Forty-three eyes of forty patients, mean age 77.7years, were included, with a minimum of 3months follow-up. Twenty-five eyes were followed for 1year; 5 eyes for two years. At baseline, the mean BCVA was 55.7 letters. Patients received 7.5 injections on average the first year and 2.6 the 2nd year. The mean gain of visual acuity was +7.3 letters at 3 months, +6.2 letters at 12 months, and +6.8 letters at 2years. Anatomically, the OCT data showed a decline of all parameters. The central macular thickness decreased by 118.3μm at 3months, 136.4μm at 12months and 65.5μm at 2years.Aflibercept can achieve effective visual and anatomical outcomes with results, which approach the pivotal studies, despite the use of personalized protocols and longer monitoring intervals.

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