Search

To evaluate macular microvascular changes and their correlation with visual outcomes after rhegmatogenous retinal detachment (RRD) surgery.Retrospective case series.The study included 74 eyes successfully operated for RRD.The foveal avascular zone area in the superficial capillary plexus, the vessel density (VD) in the superficial capillary plexus, vessel density deep capillary plexus (VD DCP), and choriocapillary plexus were evaluated using octangiography at 1 and 6 months postoperatively. The fellow eyes were used as controls for comparison.The correlation between octangiography parameters and postoperative best-corrected visual acuity (BCVA) was assessed using a hybrid linear mixed model. We also analyzed the relationship between octangiography parameters and the integrity of the external limiting membrane (ELM) and ellipsoid zone (EZ) of photoreceptors.The median VD DCP was significantly decreased in RRD eyes at 1 month (P = 0.019), but gradually improved over time to reach the value of the fellow eyes at 6 months (P = 1). There was no significant difference between the 2 groups in median foveal avascular zone area, superficial capillary plexus, and choriocapillary plexus (P = 0.579, P = 0.618, P = 0.068 and P = 0.819, P = 1, and P = 1, respectively) at both 1 and 6 months postoperatively. Postoperative BCVA was positively correlated with VD DCP (P = 0.009) in multivariate analysis. Eyes with low 1-month VD DCP tended to have worse final BCVA (P = 0.067). There was no correlation between VD DCP and ELM and/or EZ integrity at both 1 (P = 0.156) and 6 months postoperatively (P = 0.161). Eyes with intact ELM and EZ at 6 months, however, had significantly higher 1-month VD DCP than those with disrupted ELM and/or EZ (P = 0.027).The VD DCP was affected in RRD eyes as well as strongly associated with postoperative BCVA and the restoration of photoreceptor layers. It might thus serve as a predictor for visual recovery following successful RRD surgery.

Retinal dysfunction is widely documented in schizophrenia using flash (fERG) and pattern electroretinograms (PERG), but the role of dopamine transmission has seldom been explored.We explored the role of dopamine transmission by evaluating the spatial location of retinal anomalies using multifocal ERG (mfERG) in photopic condition and the oscillatory potentials (OPs) extracted from fERG measured in scotopic condition in 29 patients with schizophrenia and 29 healthy controls.With the mfERG, our main results revealed reduced amplitudes in the center of the retina: P1 (p .005) and N2 amplitudes (p .01) in the2° region, N1 (p .0005) and P1 amplitudes (p .001) in the 2-5° region and P1 amplitude (p .05) in the 5-10° region. For OPs, our results showed a decrease in the O1 (p .005), O2 (p .005), O3 (p .05) and overall O1, O2, O3 index amplitudes (p .005) in patients with schizophrenia.Both the central location of retinal dysfunctions of the mfERG and OPs results could reflect a hypodopaminergic effect in patients with schizophrenia. In future studies, OPs should be considered as a measure to evaluate the hypodopaminergy in patients.

Resume Introduction Le carcinome basocellulaire (CBC) est le carcinome cutane le plus frequent. Son incidence est en constante augmentation principalement du fait de l’exposition solaire au cours des deux premieres decennies de vie. La paupiere inferieure ainsi que le canthus interne en sont des zones de predilection. Quels que soient son type et son pronostic, le traitement de premiere intention, est l’exerese chirurgicale avec des marges de securite suffisantes. En cas de tumeurs ineligibles a la chirurgie, en cas de mauvais etat general du patient (comorbidites), ou lorsque la chirurgie entrainerait des consequences trop lourdes ou inacceptables par celui-ci, un traitement par chimiotherapie peut etre propose. Nous rapportons, l’evolution de 4 patientes ayant un CBC etendu non metastatique et qui ont beneficie d’un traitement par chimiotherapie orale (sonidegib). Methodologie Celles-ci presentaient des tumeurs ineligibles a la chirurgie. L’âge moyen etait de 80 ans. La premiere patiente presentait un CBC infiltrant de toute la paupiere inferieure droite avec envahissement orbitaire anterieur ; la deuxieme, un CBC nodulaire de toute l’orbite droite avec envahissement cutane de la base du nez et du canthus interne controlateral ; la troisieme, un CBC infiltrant de tout l’etage moyen de la face et des deux orbites et la quatrieme, un CBC nodulaire palpebral inferieur droit avec un envahissement orbitaire et cutane homolateral de la base du nez et de la joue. Toutes les patientes ont beneficie d’une confirmation histologique prealable a l’instauration de la chimiotherapie. Elles ont toutes ete traitees par sonidegib a la dose de 200 mg par jour (1 cp/j) et ont beneficie d’examens ophtalmologiques et dermatologiques de controle tous les 3 mois (realisation d’examens cliniques ophtalmologiques et dermatologiques, surveillance biologique et prise de photographies). Resultats Chez les 4 patientes, l’evolution a ete tres favorable, avec une regression nette de la taille et de l’infiltration tumorale. Les principaux effets indesirables de ce traitement ont ete les troubles digestifs, musculaires et la dysgueusie responsable d’une perte de poids significative et d’une denutrition chez ces patientes âgees. Au bout de 11 mois, le traitement a ete arrete chez une des patientes, car les effets indesirables n’etaient plus supportables. Le traitement est encore poursuivi actuellement chez 3 de nos patientes et le sera aussi longtemps qu’un benefice clinique continuera a etre observe. L’arret pourra etre decide en cas d’apparition d’effets secondaires non tolerables. Conclusion Le sonidegib est un traitement efficace et peut etre propose en cas d’ineligibilite a la chirurgie dans des cas bien definis de CBC etendus non metastatiques.

Resume But Evaluer et comparer les resultats fonctionnels et le taux de complications de la vitrectomie immediate et de la vitrectomie differee pour luxation posterieure de materiel cristallinien apres chirurgie de cataracte. Materiel et methode Etude retrospective comparative portant sur 135 yeux operes d’une luxation posterieure de materiel cristallinien entre aout 2014 et juillet 2019. Soixante-deux yeux ont beneficie d’une vitrectomie le jour meme (groupe 1) et 73 yeux d’une vitrectomie differee (groupe 2). La meilleure acuite visuelle corrigee (MAVC) et le taux de complications a 6 mois ont ete analyses et compares entre les deux groupes. Resultats La vitrectomie a ete realisee dans un delai moyen de 4,3 ± 5,3 jours dans le groupe 2. La longueur axiale, la taille du fragment luxe et la technique chirurgicale utilisee etaient comparables entre les deux groupes. A 6 mois, la MAVC etait de 0,27 ± 0,40 logMAR dans le groupe 1 et de 0,35 ± 0,30 logMAR dans le groupe 2, sans difference significative (p = 0,205). Cinquante et un (82,2 %) yeux du groupe 1 et 53 (72,6 %) du groupe 2 avaient une MAVC inferieure ou egale a +0,30 logMAR (p = 0,183). Les principales complications etaient la survenue d’un œdeme maculaire, d’une hypertonie oculaire superieure a 25 mmHg et d’un decollement de retine retrouves chez respectivement 10 (16,1 %) yeux, 4 (6,4 %) yeux et un œil (1,6 %) dans le groupe 1, et 11 (15,0 %) yeux, 5 (6,8 %) yeux et 2 (2,7 %) yeux dans le groupe 2. Au total, le taux de complications etait identique entre les 2 groupes (p = 1). Conclusion Notre etude montre que le delai de vitrectomie n’influence pas l’acuite visuelle finale ni la survenue de complications chez les patients presentant une luxation posterieure de materiel cristallinien. Le choix du moment pour intervenir reste une decision multifactorielle impliquant les preferences du patient et son emplacement, la disponibilite du chirurgien et la severite du tableau clinique initial.

Background Antiphospholipid syndrome (APS) is characterized by several clinical manifestations such as venous and arterial thrombosis associated with persistent antiphospholipid antibodies (aPL). Several studies confirmed that retinal vein occlusion was the most common APS ocular manifestation. The purpose of this study was to identify ophthalmologic manifestations in a homogeneous cohort of well-defined persistently aPL-positive patients and to determine variables associated with these manifestations. Methods APL-positive patients were selected from two research programs. All ophthalmologic manifestations including those related to APS were recorded. Results A total of 117 patients were included and 10 of them had APS-related ophthalmologic manifestations (glaucoma, hydroxychloroquine-related maculopathy, anterior acute uveitis, anterior ischemic optic neuropathy). Systemic Lupus Erythematosus (SLE) (OR = 3.4[95%CI; 0.9-12.7), corticosteroids (OR = 9.0 [95%CI; 2.2-37.7]) and aPL-related nephropathy (OR = 7.1 [95%CI; 1.7-30.0]) were significatively associated with the risk of APS-related ophthalmologic manifestations. Conclusion Most of ocular manifestations in this study were iatrogenic related to corticosteroids or hydroxychloroquine. Patients with SLE, small vessel thrombosis in general, or with aPL-related nephropathy in particular, seemed at higher risk to develop APS-related ophthalmologic manifestations thus deserving adequate monitoring.

BACKGROUND: To report the prevalence of posterior vitreous attachment (PVA) in patients with idiopathic epiretinal membrane (iERM) and to determine associated preoperative predictive factors. METHODS: Retrospective observational case series of 408 eyes who underwent surgery for iERM without vitreomacular traction. The status of the posterior hyaloid was assessed intraoperatively. Predictive factors were analysed using univariate and multivariate logistic regression. We also evaluated the effect of PVA on the anatomical and functional outcomes of surgery. RESULTS: Eighty-two (20.1%) eyes were found to have an undetached posterior hyaloid during vitrectomy. In multivariate analysis, axial length (AL) and lens status were strongly associated with the posterior vitreous status (p = 0.031 and p = 0.048). The odds of having a PVA decreased by a factor 0.81 per mm of AL (95% CI, 0.66–1.00). Phakic eyes had a 2.88-fold increased risk of exhibiting PVA compared to those with previous cataract extraction (95% CI, 1.10–7.52). The presence of PVA did not have any effect on postoperative anatomical and functional outcomes. In contrast, we found that eyes with shorter axial length, low preoperative visual acuity and disruption of the ellipsoid zone exhibited worse visual recovery (p = 0.006, p

Resume Objectif Evaluer si l’existence d’une uveite au cours de la maladie de Behcet (MB) etait associee a un phenotype clinique particulier, et analyser l’impact pronostique d’une meconnaissance de la maladie de Behcet au moment du diagnostic de l’uveite. Materiel et methode Les caracteristiques cliniques ophtalmologiques et extra-ophtalmologiques de 51 patients atteints de MB ont ete collectees de maniere retrospective. Nous avons compare le phenotype clinique des patients avec atteinte ophtalmologique avec celui des patients sans atteinte ophtalmologique. Les patients ont ete separes en deux groupes en fonction de l’evolution de leur acuite visuelle : « baisse d’acuite visuelle » versus « stabilite ou amelioration de l’acuite visuelle ». Resultats Chez les patients avec atteinte oculaire, il existait en moyenne 2,3 autres atteintes systemiques, contre 3,2 dans le groupe sans atteinte ophtalmologique (p = 0,004). Lorsque l’uveite survenait chez un patient deja suivi pour une MB, on recensait moins de patients dans le groupe « baisse d’acuite visuelle » (44,4 %) en comparaison avec les patients non diagnostiques pour la MB au moment de l’uveite (91,3 % dans le groupe « baisse d’acuite visuelle »), p = 0,04. Le delai avant initiation d’un traitement immunosuppresseur ou d’une biotherapie etait plus court chez ces patients (4,4 mois vs. 39,3 mois, p = 0,007). Conclusion Il semble exister des phenotypes differents selon qu’il y ait ou pas une atteinte ophtalmologique dans la MB. Le pronostic visuel etait meilleur si l’uveite survenait sur un terrain de MB deja connue, par utilisation plus rapide des traitements immunosuppresseurs.

The nicotine contained in tobacco is a neuromodulator which affects neurotransmission within the brain. The retina is an easy way to study central synaptic transmission dysfunctions in neuropsychiatric disorders. The purpose of this study is to assess the impact of regular tobacco use on retinal function using pattern (PERG), flash (fERG) and multifocal (mfERG) electroretinogram (ERG). We recorded PERG, fERG and mfERG for 24 regular tobacco users and 30 healthy non-smoking subjects. The protocol was compliant with International Society for Clinical Electrophysiology of Vision standards. The amplitudes and peak times (PT) of P50, N95 waves (PERG), a-, b- and oscillatory potentials (fERG), and N1, P1, N2 (mfERG) were evaluated. Compared to non-smokers, the results (Mann–Whitney U test, Bonferroni correction) for tobacco users suggested a significant increase of ~ 1 ms in the PT of light-adapted 3.0 fERG b-wave (p = 0.002). Using mfERG, we observed the following increases in tobacco users: in ring 3 for P1 PT of ~1,5 ms and in ring 5 for P1 PT of ~ 1 ms and for N2 PT of ~ 1 ms (p = 0.002, p = 0.002 and p = 0.006). It is our hypothesis that these results reflect the consequences of regular tobacco use on retinal synaptic transmission, and more specifically on dopaminergic and cholinergic transmission. We deduce that the retina may provide a crucial site of investigation for neurotransmission modulation of the reward circuit in regular tobacco users.

The retina is considered a useful area for investigating synaptic transmission abnormalities in neuropsychiatric disorders, including as a result of using cannabis, the most widely consumed illicit substance in the developed world. The impact of regular cannabis use on retinal function has already been evaluated, using pattern and flash electroretinogram (ERG) to demonstrate a delay in ganglion and bipolar cell response. Using multifocal ERG, it was showed that the delay to be preferentially located in the central retina. ERG tests do not separately examine the impact of cannabis on the On and Off pathways. The purpose of this study is to assess On and Off pathway function using On-Off ERG. We conducted an On-Off ERG test in 42 regular cannabis users and 26 healthy controls. The protocol was compliant with the International Society for Clinical Electrophysiology of Vision (ISCEV) standards. Amplitude and peak time were measured for the a-, b- and d-waves. Results in the regular cannabis users showed a significant increase in the latencies of both the b- and the d-wave (p = 0.020, p = 0.022, respectively, Mann-Whitney U test), with no change in the wave amplitudes. A-wave peak time and amplitude were unchanged. These findings are reflective of an effect of regular cannabis use on the On and Off pathways and are consistent with previous findings which also identified increases in retinal neuron response times. We confirm here that regular cannabis use impacts the post-receptoral cones pathway at the level of bipolar cells, affecting the On and Off pathways.

Major depressive disorder (MDD) affects people worldwide. MDD treatments include antidepressants, which involve a delayed onset of action, long-term treatment, side effects and, frequently, only partial efficacy. The lack of access to the living brain, and the complex and still poorly elucidated pathophysiology of MDD, hinders treatment development. There is not only a need for new treatment strategies, but also for new approaches to investigating the pathophysiology of MDD. Light therapy is a well-established treatment acting through the retina. Since the retina is part of the central nervous system, it has been suggested as a useful area for investigating mental illness. In this article, we will first set out the evidence that MDD affects the retina's structure and function. We will then review studies evaluating the efficacy of light therapy in unipolar non-seasonal MDD. Finally, we discuss the disruption of melatoninergic pathways in MDD, its assessment through the retina and the treatment of this disruption with light therapy.

PURPOSE To evaluate and to compare the anatomical and functional results of phacovitrectomy and pars plana vitrectomy (PPV) alone for phakic rhegmatogenous retinal detachment. METHODS Retrospective, comparative case series of 266 phakic eyes that underwent either combined phacovitrectomy or PPV alone for primary retinal detachment. The primary anatomical success rate, the final best-corrected visual acuity, and the refractive outcomes were analyzed. RESULTS One hundred and twenty-seven eyes were included in the combined group and 139 in the PPV group. The primary anatomical success rate was 84.3% in the combined group and 89.2% in the PPV group (P = 0.311). One hundred and nine (78.4%) eyes of the PPV group required cataract removal for visual rehabilitation during the follow-up period. There was no significant difference between the two groups in terms of the mean final best-corrected visual acuity (P = 0.185) and mean visual changes (P = 0.470). Overall, combined cataract extraction resulted in a significant myopic shift compared with delayed cataract surgery (P = 0.047). CONCLUSION Combined phacoemulsification and PPV is a safe and effective procedure to treat retinal detachment. The anatomical and functional results were comparable with those obtained with PPV and delayed cataract surgery. However, the refractive outcomes were less favorable and shifted toward myopia, especially in macula-off cases.

To evaluate the effect of the temporal inverted internal limiting membrane (ILM) flap technique compared with that of conventional ILM peeling on the extent of the dissociated optic nerve fiber layer (DONFL) and retinal sensitivity in patients undergoing macular hole (MH) surgery.Single-center, prospective, open-label, randomized controlled clinical trial.Patients requiring vitrectomy for MHs sized250 μm.Patients were randomly assigned (1:1) to 1 of the following 2 groups: (1) the control group undergoing standard ILM peeling and (2) the experimental group (flap group) undergoing the temporal inverted ILM flap technique.The primary outcome measure was the total DONFL score at 3 months after surgery. Important secondary outcomes were microperimetry results, primary MH closure rate, external limiting membrane (ELM) and ellipsoid zone (EZ) recovery rates, and best-corrected visual acuity (BCVA).Sixty-five patients were recruited between February 2018 and July 2020; primary outcome data were available for 60 patients. The median DONFL score was 7.0 (3.0-12.5) in the control group and 5.0 (1.5-8.5) in the flap group at 3 months after surgery (P = 0.145). The focal depressions characteristic of the DONFL were limited to the temporal side of the fovea in the flap group, whereas they were found all around the fovea in the control group on spectral-domain OCT images. The MH closure rate (P = 1), EZ and ELM recovery rates (P = 0.252), and BCVA (P = 0.450) were similar between the 2 groups. The 3-month overall median retinal sensitivity (MRS) (P = 0.142) and MRS improvement (P = 0.916) in the control group were comparable with those observed in the flap group. In addition, there was no significant difference between the 2 techniques when considering the temporal area (P = 0.105) or the nasal area (P = 0.468).The temporal inverted ILM flap technique reduced the extent of the DONFL by preserving the nasal part of the fovea. However, the overall DONFL score was similar between the 2 techniques. In addition, the MRS and BCVA did not differ from those obtained after complete ILM peeling.

One goal of research into major depressive disorder (MDD) is to develop markers to predict and monitor the response to psychotropic treatments. The retina is endowed with a complex neurotransmission system, composed of the main neurotransmitters involved in the pathophysiology of MDD. The retina is therefore a relevant site of investigation for the identification of reliable and robust markers. However, the effects of antidepressants on the human retina are poorly studied. Here, we seek to study the potential specific effects of various antidepressants on retinal function in MDD patients.We assessed retinal function using flash (fERG), pattern (PERG) and multifocal (mfERG) electroretinogram in 19 MDD patients treated using antidepressants at baseline and at weeks 4, 8 and 12.We observed reduced b-wave amplitude of photopic fERG 3.0 in patients treated with Selective Serotonin Reuptake Inhibitor (SSRI) in comparison with patients treated with Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) or Tricyclic Antidepressant (TCAD). We also showed that SNRIs were associated both with a decrease in PERG P50 implicit time and an increase in fERG 3.0 b-wave amplitude. TCADs were associated with an increase in fERG flicker 3.0 a- and b-wave amplitude.This is the first study in real-life conditions to show a specific effect of various antidepressants on retinal function evaluated by electroretinogram. Further investigations should be led to specify the effects of antidepressants on ERG in order to isolate reliable and reproducible markers for predicting and monitoring the response to antidepressants.

Resume Introduction L’hematome sous-retinien maculaire est une complication de la degenerescence maculaire liee a l’âge (DMLA) responsable d’une alteration massive de la vision. Nous avons evalue les resultats anatomiques et fonctionnels du traitement chirurgical de l’hematome par vitrectomie, injection sous-retinienne de rtPA (recombinant tissue plasminogen activator), injection intravitreenne de bevacizumab et tamponnement par air. Materiel et methodes Etude retrospective de 26 patients vitrectomises pour hematome maculaire sous-retinien de moins de 15 jours. La taille de l’hematome et sa localisation par rapport a l’epithelium pigmentaire (EP) etaient precisees par tomographie a coherence optique (OCT). Le succes anatomique de l’intervention etait defini par le deplacement de l’hematome en dehors de l’aire maculaire au premier controle post-operatoire. Le gain d’acuite visuel etait mesure a 1 mois, 6 mois et au terme de l’etude. Resultats La vitrectomie a permis un deplacement de l’hematome chez 20 patients (81 %). Le gain d’acuite visuel etait de 5,8 (± 7,2) lignes (p = 0.0003) a 1 mois, 7,4 (± 6,7) lignes (p = 0.0004) a 6 mois et 7,4 (± 7,4) lignes (p = 0.0002) en fin de suivi (16,5 ± 19,8 mois). Il existe une correlation inverse entre le diametre initial de l’hematome et le gain d’acuite visuelle a terme (coefficient de correlation de Pearson p = −0.60 (IC 95 % [−0.81 ; −0.26] ; p = 0.002)). Conclusion Cette serie retrouve un taux de succes anatomique de 81 %, et un gain d’acuite visuelle de plus de 7 lignes au terme du suivi, ce qui confirme l’efficacite et le benefice fonctionnel du deplacement chirurgical des hematomes maculaires de la DMLA.

Summary Introduction Macular subretinal hematoma is a complication of age related macular degeneration (AMD) responsible for a severe change in vision. We evaluated anatomic and functional results of surgical treatment of hematoma by vitrectomy , subretinal injection of r-tPA (recombinant tissue plasminogen activator), intravitreal bevacizumab injection and air tamponade . Methods Retrospective case series including 26 patients with submacular hemorrhage who underwent vitrectomy within 15 days after the onset of symptoms. Optical coherence tomography (OCT) was performed to measure the diameter of the hemorrhage and specify the location in relation to the retinal pigment epithelium . Anatomical success was defined as a total displacement of the hemorrhage out of the fovea at the first postoperative visit. Visual acuity improvement was measured at 1 and 6 months and at final postoperative visit. Results The procedure resulted in hemorrhage displacement away from the fovea in 20 eyes (81%). Visual acuity significantly improved by 5.8 (±7.2) lines (P = 0.0003) at 1 month postoperatively, 7.4 (±6.7) lines (P = 0.0004) at 6 months and 7.4 (±7.4) lines (P = 0.0002) at the final postoperative visit (16.5 ± 19.8 months). There was an inverse correlation between hemorrhage diameter and final acuity improvement (Pearson correlation coefficient ρ = −0.60 (IC 95% [−0.81; −0.26]; P = 0.002)). Conclusion Vitrectomy with subretinal r-tPA injection was found to be effective for the displacement of AMD hemorrhage in 81% of the patients. Mean final visual acuity improved by more than 7 lines, confirming the efficacy and functional benefit of surgical displacement.

Bipolar disorder is a lifelong condition. Today, there is a urgent need to find indicators of the disease. Specifically, they could be useful to improve the diagnosis and the early detection, the prognosis, to estimate the treatment response and to create homogeneous subgroups of patients based on similar pathophysiological mechanisms. Here, we assume that visual electrophysiology in combination with a neuropsychological assessment can give additional data to routine practice, especially to precise specific damages and pathophysiological characteristics of these patients. Visual electrophysiology is characterized by an electroretinogram and the delivery of visual evoked potentials, which measure retinal and visual cortical neuronal functioning in response to visual stimulations. This review highlights the interest of visual electrophysiology and neuropsychology performed in isolation and to present the benefits of combining these measures. We will review the results based on these measures in patients with bipolar disorders. Finally, we argue for the use of innovative techniques such as signal processing and artificial intelligence techniques for routine care and precision medicine in bipolar disorders.

Major depressive disorder (MDD) is a major public health problem. The retina is a relevant site to indirectly study brain functioning. Alterations in retinal processing were demonstrated in MDD with the pattern electroretinogram (PERG). Here, the relevance of signal processing and machine learning tools applied on PERG was studied.PERG - whose stimulation is reversible checkerboards - was performed according to the International Society for Clinical Electrophysiology of Vision (ISCEV) standards in 24 MDD patients and 29 controls at the inclusion. PERG was recorded every 4 weeks for 3 months in patients. Amplitude and implicit time of P50 and N95 were evaluated. Then, time/frequency features were extracted from the PERG time series based on wavelet analysis. A statistical model has been learned in this feature space and a metric aiming at quantifying the state of the MDD patient has been derived, based on minimum covariance determinant (MCD) mahalanobis distance.MDD patients showed significant increase in P50 and N95 implicit time (p = 0,006 and p = 0,0004, respectively, Mann-Whitney U test) at the inclusion. The proposed metric extracted from the raw PERG provided discrimination between patients and controls at the inclusion (p = 0,0001). At the end of the follow-up at week 12, the difference between the metrics extracted on controls and patients was not significant (p = 0,07), reflecting the efficacy of the treatment.Signal processing and machine learning tools applied on PERG could help clinical decision in the diagnosis and the follow-up of MDD in measuring treatment response.

IntroductionMajor depressive disorder (MDD) affects more than 264 million people worldwide and is associated with an impaired quality of life as well as a higher risk of mortality. Current routine treatments demonstrate limited effectiveness. Light therapy (LT) on its own or in combination with antidepressant treatments could be an effective treatment, but the use of conventional LT devices use is restrictive. Portable LT devices allow patients to continue with their day-to-day activities and therefore encourage better treatment compliance. They have not been evaluated in MDD.Methods and analysisThe study is a single-centre, double-blind, randomised controlled trial assessing the efficacy of LT delivered via a portable device in addition to usual care (medical care and drug treatment) for inpatients and outpatients with unipolar non-seasonal MDD. Over the course of 8 weeks, patients use the device daily for 30 min at medium intensity as soon as possible after waking up and preferably between 07:00 and 09:00. All patients continue their usual care with their referring physician. N=50 patients with MDD are included. The primary outcome measure is depressive symptom severity assessed using the Montgomery-Åsberg Depression Rating Scale between baseline and the eighth week. Secondary outcome measures are sleep quality assessed using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale and anxiety level assessed on the Hamilton Anxiety Rating Scale, between baseline and week 8. Further parameters relating to cognitive function are measured at baseline and after the intervention. An ancillary study aims to evaluate the impact of MDD on the retina and to follow its progression. Main limitations include risk of discontinuation or non-adherence and bias in patient selection.Ethics and disseminationThe study protocol was approved by Ile de France X’s Ethics Committee (protocol number 34–2018). Findings will be published in peer-reviewed journals.Trial registration numberNCT03685942.

Background Developing easy-to-access biomarkers is crucial in Major Depressive Disorder. The retina has already been suggested as relevant. However, there is a need for a global and local assessment of whole retinal function using a reproducible, standardized protocol allowing for comparison across studies. Our aim is to assess whole retinal function in patients with actual unipolar Major Depressive Episode (MDE) using pattern, flash and multifocal electroretinogram (ERG) according to the International Society for Clinical Electrophysiology of Vision standardized protocols. Methods We assessed retinal function in 14 males and females with MDE, diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, and in age- and sex-matched healthy controls. Results Comparing the patients with the controls, we observed the following using multifocal ERG: a significant increase in N1 peak time in ring 3 and a decrease in P1 amplitude in ring 2; using pattern ERG: a significant increase in P50 peak time; using flash ERG: a decrease in a- and b-wave peak time and an increase in the b-wave amplitude in dark-adapted 3.0, a decrease in a- and b-wave peak time and an increase in both wave amplitudes in light-adapted 3.0, and a decrease in the b-wave peak time in light-adapted flicker. Limitations Sample size. Contribution of pharmacological treatments to the outcomes cannot be formally excluded. Conclusions Patients with MDE exhibit delayed signaling in the central retina and hyperreactivity to light in the periphery. Central retinal function may be a marker of psychomotor retardation and cognitive impairment in MDE.

International audience; The treatment of primary vitreoretinal lymphoma (PVRL) remains controversial regarding the use of local, systemic, or combined treatments. The aim of this study was to analyze the efficacy and toxicity of intravenous high-dose methotrexate (IV HD-MTX) based systemic therapy in a uniformly treated population of PVRL patients. From a nationwide French database, we retrospectively selected 59 patients (median age: 70 years, median Karnofsky Performance Status: 90%) with isolated PVRL at diagnosis who received first-line treatment with HD-MTX between 2011-2018. 8/59 patients also received a local treatment. No deaths or premature discontinuations of MTX due to toxicity were reported. A complete response was obtained in 40/57 patients after chemotherapy. Before treatment, IL-10 was elevated in the aqueous humor (AH) or in the vitreous in 89% of patients. After treatment, AH IL-10 was undetectable in 87% of patients with a CR/uCR/PR and detectable in 92% of patients with PD/SD. After a median follow-up of 61 months, 41/59 (69%) patients had relapsed, including 29 isolated ocular relapses as the first relapse and a total of 22 brain relapses. The median overall survival, progression-free survival, ocular-free survival and brain-free survival were 75, 18, 29 and 73 months, respectively. IV HD-MTX based systemic therapy as a first-line treatment for isolated PVRL is feasible, with acceptable toxicity, even in an elderly population. This strategy seems efficient to prevent brain relapse with prolonged overall survival. However, the ocular relapse rate remains high. New approaches are needed to improve local control of this disease, and ocular assessment could be completed by monitoring AH IL-10.

International audience; Patients with schizophrenia have altered visual cognition and retinal functions. No studies have explored if retinal anomalies are related to visual cognition and the presence of visual hallucinations (VH). We explored functional responses of the retinal ganglion cells in schizophrenia patients with or without VH and conducted a neuropsychological evaluation to explore the links between cognition and retinal function. The VH+ group showed poorer visual cognition and we found correlations between the amplitudes of the P50 and the N95 waves and visual cognition. Our results provide arguments for a link between retinal dysfunction, impaired visual processing and VH in schizophrenia.

Aim Psychosis can be preceded by a clinical high risk for psychosis (CHR) and visual anomalies are predictors of transition to psychosis. Visual retinal processing is altered in psychosis, but no study has explored the links between visual symptoms and retinal functions in CHR patients. We report here the case of NR, an antipsychotic-naive young adult with CHR and severe visual symptoms in whom we explored the retinal function. Methods A flash electroretinogram (fERG) and a pattern electroretinogram (pERG) protocol were conducted and we compared NR results to a group of patients with schizophrenia and a group of healthy controls. Results Despites an overlap between the measures of NR and the two groups, visual analyses revealed that NR showed increased b-wave implicit time (rod response) compared to the control group and NR's response was at an intermediate level between two subgroups of schizophrenia patients regarding presence or absence of visual hallucinations. Discussion The relevance of retinal dysfunctions as a marker of vulnerability for psychosis is discussed.

Major depressive disorder, bipolar disorder and schizophrenia are currently among the most common psychiatric disorders, known to constitute a serious public health issue in terms of morbidity, mortality and functional handicap. Their pathophysiology is still unclear, but there is now increasing evidence supporting the existence of abnormalities of neurotransmission. As the retina is an extension of the central nervous system, it may be an interesting site of study which might provide a better understanding of the pathophysiology of psychiatric disorders. Several studies have demonstrated retinal abnormalities, with abnormal cone and rod responses on electroretinography (ERG), suggesting a process of functional neuronal loss, structurally supported by a decrease in the retinal nerve fiber layer thickness (RNFL) on optical coherence tomography (OCT), which suggests involvement of the molecular signal pathways of neurotransmission. These tests could be useful tools for diagnosing and monitoring psychiatric disorders. This article is an overview of the literature on retinal abnormalities observed in patients with major depressive disorder, bipolar disorder or schizophrenia, and discusses how they could be pathophysiologic markers.

Purpose To develop and investigate an evidence-based performance test for assessment of vitreoretinal surgical skills on the EyeSi Surgical Simulator. Methods Ten junior residents without any surgical experience, eight senior residents with prior experience in cataract surgery and five vitreoretinal surgeons were included in the study. The test consisted of seven modules and was completed twice by all groups during a single session. Validity evidence was evaluated using Messick's validity framework. Senior residents completed four additional test sessions and were retested 3 months after to assess skill acquisition and retention. Results Content was aligned with vitreoretinal surgical skills as evaluated by expert surgeons. Response process was ensured through standardized instruction and data collection. The test showed satisfactory internal consistency with Cronbach's α = 0.76 (internal structure) and significant discriminative ability between the residents and the experienced surgeons (relation to other variables). A pass/fail level was determined at 596 using the contrasting groups' method. Consequences of applying this standard resulted in no false positive and no false negative. Senior residents significantly improved their simulator skills over time, reaching a plateau at the fifth iteration and equalling expert performance (p = 0.420). This level of competency was retained during the post-3-month retention testing (p = 0.062). Conclusion We established a performance test with solid evidence for assessment of vitreoretinal surgical skills on the EyeSi Simulator and determined a benchmark criterion that may be used for future implementation of proficiency-based training for novices.

Psychiatry and neuroscience research need novel approaches to indirectly investigate brain function. As the retina is an anatomical and developmental extension of the central nervous system (CNS), changes in retinal function may reflect neurological dysfunctions in psychiatric disorders. The last and most integrated retinal relay before visual information transfer to the brain is the ganglion cell layer. Here, based on collected arguments, we argue that these cells offer a crucial site for indirectly investigating brain function. We describe the anatomical and physiological properties of these cells together with measurements of their functional properties named pattern electroretinogram (PERG). Based on ganglion cell dysfunctions measured with PERG in neurological disorders, we argue for the relevance of studying ganglion cell function in psychiatric research. We review studies that have evaluated ganglion cell function in psychiatric and addictive disorders and discuss how changes in PERG measurements could be functional markers of pathophysiological mechanisms of psychiatric disorders.

To evaluate if the presence of uveitis in Behçet's disease (BD) is associated with a particular clinical phenotype and to analyze the prognostic impact of a missed diagnosis of BD at the time the uveitis is diagnosed.Ophthalmologic and systemic clinical features of 51 patients with BD were recorded retrospectively. We compared the clinical phenotype of patients with ocular manifestations with those without ocular manifestations. The patients were divided into two groups depending on the progression of their visual acuity: "decreased visual acuity" versus "stable or improved visual acuity."In the group of patients with ocular involvement, there was a mean 2.3 systemic manifestations, vs. 3.2 in the group without ocular manifestations (P=0.004). When BD was diagnosed prior to the onset of uveitis, we counted fewer patients in the "decreased visual acuity" group in comparison with the patients who had no prior diagnosis of BD at the onset of the uveitis (91.3% in the "decreased visual acuity" group, P=0.04). The time before initiation of immunosuppressive treatment or a biological agent was shorter for these patients (4.4 vs. 39.3 months, P=0.007).It appears that different phenotypes exist according to whether or not the BD patient has ocular involvement. Moreover, the visual prognosis is better if the uveitis occurs in patients who have already been diagnosed with BD, due to earlier initiation of immunosuppressive therapy.

Owing to the difficulty of obtaining direct access to the functioning brain, new approaches are needed for the indirect exploration of brain disorders in neuroscience research. Due to its embryonic origin, the retina is part of the central nervous system and is well suited to the investigation of neurological functions in psychiatric and addictive disorders. In this review, we focus on cannabis use, which is a crucial public health challenge, since cannabis is one of the most widely used addictive drugs in industrialized countries. We first explain why studying retinal function is relevant when exploring the effects of cannabis use on brain function. Next, we describe both the retinal electrophysiological measurements and retinal dysfunctions observed after acute and regular cannabis use. We then discuss how these retinal dysfunctions may inform brain synaptic transmission abnormalities. Finally, we present various directions for future research on the neurotoxic effects of cannabis use.

Resume Introduction L’objectif de cette etude etait de decrire les caracteristiques epidemiologiques des uveites de l’adulte pour lesquelles un bilan a ete realise dans le centre de competences regional dedie aux maladies systemiques et auto-immunes du centre hospitalier universitaire (CHRU) de Nancy. Les objectifs secondaires etaient de decrire l’evolution de la repartition etiologique au cours du temps et d’identifier des specificites locales. Patients et methodes Nous avons realise une etude epidemiologique retrospective au CHRU de Nancy sur les patients vus en consultation ophtalmologique pour une uveite et adresses dans le Centre de competences regional dedie aux maladies systemiques et auto-immunes entre le 1er janvier 2005 et le 31 decembre 2016. Les patients de moins de 18 ans, ceux presentant un premier episode d’uveite anterieure aigue, ainsi que ceux pour lesquels le diagnostic etiologique etait fait par l’ophtalmologiste seul, etaient exclus. L’âge, le genre, la lateralite, le siege de l’inflammation, les signes cliniques et l’etiologie (infectieuse, non infectieuse ou idiopathique, et diagnostic) ont ete recueillis. Resultats Nous avons inclus 690 patients dont 59 % de femmes, avec un âge moyen de 49 ans. L’uveite etait unilaterale dans 53 % des cas. La panuveite etait la forme la plus frequente (52 %, n = 358), suivie par l’uveite anterieure recidivante (30 %, n = 205), l’uveite posterieure (16 %, n = 107) et l’uveite intermediaire (3 %, n = 20). Les etiologies non infectieuses representaient 35 % de l’ensemble des uveites, les plus frequentes etant les uveites liees au HLA-B27, la sarcoidose, la spondylarthrite ankylosante et la maladie de Behcet. Treize pourcent de l’ensemble des uveites etaient d’origine infectieuse avec en premier lieu la tuberculose, la toxoplasmose, et la maladie de Lyme. La proportion d’uveites idiopathiques etait de 52 %. Une tendance a l’amelioration du rendement diagnostique a ete observee : 53 % des uveites ont ete considerees comme idiopathiques avant 2011 contre 50 % apres 2011 (p Conclusion Nous avons identifie une majorite de panuveites, ce qui s’explique par notre mode d’inclusion. Notre serie comptait 52 % d’uveites idiopathiques, avec une tendance a l’amelioration du rendement diagnostique au cours du temps. Cette etude nous a permis de mieux connaitre les caracteristiques des uveites dans notre centre.

Background Cannabis is a neuromodulating substance that acts on central synaptic transmission. Regular cannabis use induces a decreased capacity for dopamine synthesis in the brain. The retina is considered an easy means of investigating dysfunctions of synaptic transmission in the brain. We have previously studied the impact of regular cannabis use on retinal function. Using the N95 wave of the pattern electroretinogram, we found a 6 ms-delayed ganglion cells response. Using the b-wave of the photopic flash electroretinogram, we found a 1 ms-delayed bipolar cells response. Here, we investigated amacrine cells function because these cells are located between the bipolar cells and the ganglion cells and contribute to amplifying the signal between these two layers of the retina. We tested the effect of regular cannabis use on these retinal dopaminergic cells. We assessed the role of these cells in amplifying the delay observed previously. Methods We recorded dark-adapted 3.0 flash ERG oscillatory potentials in 56 regular cannabis users and 29 healthy controls. The amplitude and implicit time of OP1, OP2, OP3 and OP4 were evaluated. Results Cannabis users showed a significant decrease in OP2 amplitude (p = 0.029, Mann-Whitney test) and OP3 amplitude (p = 0.024, Mann-Whitney test). No significant difference was found between the groups for OP1 and OP4 amplitude or for the implicit time of oscillatory potentials. Conclusions These results reflect the impact of regular cannabis use on amacrine cells function. They highlight abnormalities in dopaminergic transmission and are similar to those found in Parkinson's disease. Oscillatory potentials could be used as markers of central dopaminergic modulation.

Background Mood disorders are particularly common, disabling conditions. Diagnosis can be difficult as it may involve different pathophysiological assumptions. This could explain why such disorders are resistant to treatment. The retina is part of the central nervous system and shares a common embryonic origin with the brain. Optical coherence tomography (OCT) is an imaging technique for analysing the different layers of the retina. We reviewed studies that examined the retina with OCT in mood disorders. Methods We conducted Pubmed search and additional manual research based on the bibliography in each of selected articles. We found and analysed 11 articles relevant to our subject. Results This literature review confirms that it is possible to use OCT to detect neurodegeneration and neuroinflammation in mood disorders. Their impact is thought to depend on the duration and severity of the disease, and whether it is in acute or chronic stage. The differences seen in studies dealing with depression and those looking at bipolar disorder may reflect the particular characteristics of each disorder. A number of OCT parameters can be proposed as biomarkers of active or chronic inflammation and neurodegeneration. Markers of predisposition to an at-risk mental state are also suggested. Limitations The main limitation is selection bias, studies including more varied population would help to confirm and precise these results. Conclusion OCT is thus a particularly promising tool for evaluating some of the etiopathogenetic mechanisms involved in mood disorders. The combination with other approaches could help to find more specific biomarkers.

Resume Introduction Le but de notre etude est de tester la capacite du simulateur EyeSi a discriminer les chirurgiens novices des chirurgiens experimentes lors de la realisation des exercices de 3 modules de formation a la chirurgie de cataracte, afin de confirmer sa validite de construction pour ceux-ci. Materiels et methode Nous avons inclus 18 chirurgiens repartis en 3 groupes : les « novices » (6 internes n’ayant jamais opere de cataracte), les « intermediaires » (6 internes ayant opere entre 1 et 10 cataractes) et les « experts » (6 chirurgiens ayant opere plus de 500 cataractes). Nous avons selectionne 3 modules d’entrainement du simulateur, le capsulorhexis, la phacoemulsification-cracking et l’aspiration des masses cristalliniennes residuelles. Douze exercices de difficulte croissante ont ete realises 2 fois de suite par chaque participant. Nous avons compare les resultats du 2eme essai en stratifiant sur l’experience du chirurgien. Resultats Pour le module capsulorhexis, dans l’exercice 1, les experts obtiennent des scores plus eleves que les 2 autres groupes (p = 0,0102). Pour le module phacoemulsification-cracking, les experts ont des scores significativement superieurs dans l’exercice 8 (p = 0,0495) et il existe une tendance a la significativite dans les exercices 3 (p = 0,0934) et 5 (p = 0,0938). Le temps de realisation de l’exercice decroit egalement en fonction du niveau d’experience dans les exercices 1 (p = 0,0444), 4 (p = 0,06) et 5 (p = 0,0189). Conclusion Nos resultats mettent en evidence de meilleurs resultats du groupe experts pour 4 exercices des modules capsulorhexis et phacoemulsification-cracking. Ceci confirme la validite de construction du simulateur EyeSi pour la chirurgie de cataracte deja mise en evidence par d’autres travaux. Notre etude permettra de contribuer a la realisation de programmes de formation pertinents sur simulateur pour les internes en ophtalmologie.

Widely used in industrialized countries, cannabis is a neuromodulator substance. The cannabinoid system is present at critical stages of retinal processing. We have recently shown a delay in bipolar and ganglion cell responses in regular cannabis users, as observed using flash (fERG) and pattern (PERG) electroretinogram. Although the results obtained during these tests provide information about global retinal responses, they do not give any indication about the spatial localization of the anomalies that were detected. The latter may be analyzed, however, by means of multifocal electroretinogram (mfERG). We recorded the mfERG responses in 49 regular cannabis users and 21 healthy subjects. The amplitudes and implicit times of the mfERG N1, P1 and N2 waves were recorded. The results showed that in regular cannabis users: in the2° region, a significant increase in the N2 implicit time (p = 0.037); in the 2-5° region, a significant increase in the N2 (p = 0.018) and P1 (p = 0.046) implicit times; in the 5-10° region, a significant increase in the P1 (p = 0.006) and N1 (p = 0.034) implicit times; and in the 10-15° region, a significant increase in the P1 implicit time (p = 0.014). An isolated decrease in the N1 amplitude in the 2-5° region (p = 0.044) was also found. This indicates that there is a delay in the transmission of visual information from the central retina to the near periphery in cannabis users suggesting potential alterations in precise and color vision.

Background Cannabis consumption is widespread across the world, and the co-occurrence of cannabis use and alcohol consumption is common. The study of background noise - resting-state neural activity, in the absence of stimulation - is an approach that could enable the neurotoxicity of these substances to be explored. Preliminary results have shown that delta-9-tetrahydrocannabinol (Δ9-THC) causes an increase in neural noise in the brain. Neurons in the brain and the retina share a neurotransmission system and have similar anatomical and functional properties. Retinal function, evaluated using an electroretinogram (ERG), may therefore reflect central neurochemistry. This study analyses retinal background noise in a population of regular co-occurrent cannabis and alcohol consumers. Methods We recorded the flash ERGs of 26 healthy controls and 45 regular cannabis consumers, separated into two groups based on their alcohol consumption: less than or equal to 4 glasses per week (CU ≤ 4) or strictly >4 glasses per week (CU >4). In order to extract the background noise, the Fourier transform of the pseudo-periodic and sinusoidal signals of the 3.0 flicker-response sequence was calculated. This sequence represents the vertical transmission of the signal from cones to bipolar cells. The magnitude of the background noise is defined as the average of the magnitudes of the two neighbouring harmonics: harmonic −1 (low frequency noise) and harmonic +1 (high frequency noise). Results The magnitude of harmonic −1 was significantly increased between the groups CU > 4 (6.78 (±1.24)) and CU ≤ 4 (5.69 (±1.80)) among regular users of cannabis and alcohol. A significant increase in the average magnitude of the two harmonics was found between the groups CU > 4 (5.12 (±0.92)) and CU ≤ 4 (4.36 (±1.14)). No significant difference was observed with regard to the magnitude of the harmonic +1. Conclusions The increase in background noise may reflect the neurotoxicity of cannabis, potentiated by alcohol consumption, on retinal neurons dynamic. This neural disruption of the response generated by retinal stimulation may be attributable to altered neurotransmitter release.

Although cannabis is very widespread worldwide, the impact of cannabis on visual function remains poorly understood. This is partly due to numerous difficulties met in developing clinical studies in cannabis users. Here, we report the first documented case of neuroretinal dysfunction after acute cannabis smoking. This observation was favored by the need of an annual ophthalmic evaluation in the context of a chloroquine intake for a systemic lupus erythematosus in a 47-year-old heavy cannabis user. A complete ophthalmic evaluation including visual acuity tests, intraocular pressure, fundoscopic examination, automated 10° central visual field, full-field electroretinogram (ERG) and multifocal ERG was performed twice - 30 min and 5 h after cannabis smoking. A strong decrease (up to 48%) in the a-wave amplitude of the full-field ERG was measured 30 min after cannabis smoking for all scotopic responses compared with the responses 5 h after smoking. Other tests showed reproducible results between the 2 series of measurements. This clinical case suggests that acute inhalation of cannabis affects the photoreceptors functioning. This rare situation suggests further investigations are required on the impact of cannabis on retinal processing, especially since cannabis has been incriminated in car injuries.

Cannabis is one of the most prevalent drugs used worldwide. Regular cannabis use is associated with impairments in highly integrative cognitive functions such as memory, attention and executive functions. To date, the cerebral mechanisms of these deficits are still poorly understood. Studying the processing of visual information may offer an innovative and relevant approach to evaluate the cerebral impact of exogenous cannabinoids on the human brain. Furthermore, this knowledge is required to understand the impact of cannabis intake in everyday life, and especially in car drivers. Here we review the role of the endocannabinoids in the functioning of the visual system and the potential involvement of cannabis use in visual dysfunctions. This review describes the presence of the endocannabinoids in the critical stages of visual information processing, and their role in the modulation of visual neurotransmission and visual synaptic plasticity, thereby enabling them to alter the transmission of the visual signal. We also review several induced visual changes, together with experimental dysfunctions reported in cannabis users. In the discussion, we consider these results in relation to the existing literature. We argue for more involvement of public health research in the study of visual function in cannabis users, especially because cannabis use is implicated in driving impairments.

Cannabis use is widespread worldwide, but the impact of smoking cannabis regularly on brain synaptic transmission has only been partially elucidated. The retina is considered as an easy means of determining dysfunction in brain synaptic transmission. The endocannabinoid system is involved in regulating retinal synaptic transmission, which might also be affected by tobacco. Previous preliminary results have shown impairments in retinal ganglion cell response in cannabis users. Here, we test the extent to which earlier retinal levels—bipolar cells and photoreceptors—are affected in cannabis users, i.e. by the association of tobacco and cannabis. We recorded pattern (PERG) and flash (fERG) ERG in 53 regular cannabis users and 29 healthy controls. Amplitude and peak time of P50 and N95 (PERG) and of a- and b-waves (fERG) were evaluated. Cannabis users showed a significant increase in PERG N95 peak time and in fERG light-adapted 3.0 b-wave peak time, compared with controls (p = 0.0001 and p = 0.002, respectively; Mann-Whitney U test). No significant difference was found between the groups in terms of wave amplitude (p = 0.525 and p = 0.767 for the N95 and light-adapted 3.0 b-wave amplitude respectively; Mann-Whitney U test). The results demonstrated delayed ganglion and bipolar cell responses in cannabis users. These results reflect a delay in the transmission of visual information from the retina to the brain. This retinal dysfunction may be explained by an effect of cannabis use on retinal synaptic transmission. Main limitations of these results concern tobacco and alcohol use that differed between groups. The consequences of these anomalies on visual perception along with the molecular mechanisms underlying this retinal dysfunction should be explored in future human and animal studies.

Visual hallucinations are a psychotic symptom present in numerous clinical conditions such as eye disease, Parkinsonian syndromes, neurodegenerative disorders and psychosis. Alteration of low level visual processing is a common feature in these clinical conditions, and various stages of processing from the retina to visual cortices are involved. We undertook a literature review of abnormalities of the retina and their potential link with the occurrence of VHs in these clinical conditions of interest. We found that structural and functional abnormalities of the retina are frequently present. In Parkinson disease and eye disease, VHs have been related to dysfunctions of the retina. By contrast, in neurodegenerative disorders and psychosis, possible links have yet not been explored. We show that structural or functional abnormalities of the retina are given little consideration in cognitive models of VHs, which primarily postulate an alteration of sensory visual processing and a top-down attentional process. We conclude that contrast sensitivity measures and an exhaustive exploration of the retinal functions using the clinical electroretinography standards of the International Society for the Clinical Electrophysiology of Vision (ISCEV) are needed to explore retinal involvement in the occurrence of visual hallucinations.

Because cannabis use is a major public health concern and cannabis is known to act on central neurotransmission, studying the retinal ganglion cells in individuals who regularly use cannabis is of interest.To determine whether the regular use of cannabis could alter the function of retinal ganglion cells in humans.For this case-control study, individuals who regularly use cannabis, as well as healthy controls, were recruited, and data were collected from February 11 to October 28, 2014. Retinal function was used as a direct marker of brain neurotransmission abnormalities in complex mental phenomena.Amplitude and implicit time of the N95 wave on results of pattern electroretinography.Twenty-eight of the 52 participants were regular cannabis users (24 men and 4 women; median age, 22 years [95% CI, 21-24 years]), and the remaining 24 were controls (20 men and 4 women; median age, 24 years [95% CI, 23-27 years]). There was no difference between groups in terms of age (P = .13) or sex (P = .81). After adjustment for the number of years of education and alcohol use, there was a significant increase for cannabis users of the N95 implicit time on results of pattern electroretinography (median, 98.6 milliseconds [95% CI, 93.4-99.5]) compared with controls (median, 88.4 milliseconds [95% CI, 85.0-91.1]), with 8.4 milliseconds as the median of the differences (95% CI, 4.9-11.5; P .001, Wald logistic regression). A receiver operating characteristic curve analysis (area under the curve, 0.84 [95% CI, 0.73-0.95]; P .001) revealed, for a cutoff value of 91.13 milliseconds, a sensitivity of 78.6% (95% CI, 60.5%-89.8%) and a specificity of 75.0% (95% CI, 55.1%-88.0%) for correctly classifying both cannabis users and controls in their corresponding group. The positive predictive value was 78.6% (95% CI, 60.5%-89.8%), and the negative predictive value was 75.0% (95% CI, 55.1%-88.0%).Our results demonstrate a delay in transmission of action potentials by the ganglion cells in regular cannabis users, which could support alterations in vision. Our findings may be important from a public health perspective since they could highlight the neurotoxic effects of cannabis use on the central nervous system as a result of how it affects retinal processing.

Cannabisis one of the most prevalent drugs used in industrialized countries. The main effects ofCannabisare mediated by two major exogenous cannabinoids: ∆9-tetrahydroxycannabinol and cannabidiol. They act on specific endocannabinoid receptors, especially types 1 and 2. Mammals are endowed with a functional cannabinoid system including cannabinoid receptors, ligands, and enzymes. This endocannabinoid signaling pathway is involved in both physiological and pathophysiological conditions with a main role in the biology of the central nervous system. As the retina is a part of the central nervous system due to its embryonic origin, we aim at providing the relevance of studying the endocannabinoid system in the retina. Here, we review the distribution of the cannabinoid receptors, ligands, and enzymes in the retina and focus on the role of the cannabinoid system in retinal neurobiology. This review describes the presence of the cannabinoid system in critical stages of retinal processing and its broad involvement in retinal neurotransmission, neuroplasticity, and neuroprotection. Accordingly, we support the use of synthetic cannabinoids as new neuroprotective drugs to prevent and treat retinal diseases. Finally, we argue for the relevance of functional retinal measures in cannabis users to evaluate the impact of cannabis use on human retinal processing.

But Decrire les malpositions des paupieres superieures liees au syndrome de Brown congenital et en discuter la physiopathologie. Contexte Le defaut d’elevation de l’œil en adduction caracteristique du syndrome de Brown congenital s’accompagne, de facon courante, d’un ecarquillement de la paupiere superieure. Le decalage oculaire etant souvent etendu au regard droit devant, des malpositions palpebrales associees sont plausibles, mais ce probleme est meconnu. Patients et methodes Pour 82 patients porteurs d’un syndrome de Brown congenital unilateral et vus entre 1989 et 2001, nous avons soigneusement mesure la position de la paupiere superieure en position primaire d’un cote par rapport a l’autre. Les patients etaient classes selon l’extension du deficit d’elevation : type I, seulement en adduction (42 cas), type II empietant sur la position primaire (26 cas), et type III, deficit plus global de l’elevation avec predominance en adduction (14 cas). Cinquante patients ont ete operes de strabisme et la position des paupieres a ete reevaluee en postoperatoire. Resultats Vingt-trois patients (28 %) presentaient une anomalie de position palpebrale. La repartition, selon l’extension du deficit d’elevation, etait de 14 % dans le type I, de 30 % dans le type II et de 63 % dans le type III. Nous avons distingue 8 pseudoptosis accompagnant une hypotropie, 6 ptosis vrais, 5 pseudo-retractions accompagnant un decalage oculomoteur vertical et 4 cas de retraction palpebrale, ces anomalies pouvant etre intermittentes. Ptosis et pseudoptosis etaient plutot retrouves lorsque le syndrome de Brown etait present sur l’œil domine, et les exces d’ouverture palpebrale plutot lorsqu’il s’agissait de l’œil dominant. Apres correction du strabisme vertical, les anomalies sont fortement attenuees et seuls 3 ptosis ont du etre operes. Conclusion Nous avons retrouve des malpositions de la paupiere superieure, en position primaire, chez pres d’un tiers des patients presentant un syndrome de Brown. Il s’agit parfois d’un ptosis congenital associe, mais le plus souvent, il s’agit d’une reaction du deficit d’elevation soit en abaissant la paupiere par abandon, soit en la retractant s’il y a un essai de compensation.