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Introduction Papilledema is a common sign in ophthalmology and is typically associated with increased intracranial pressure (ICP) in neurological diseases. Since the beginning of the 20th century, some cases of papilledema have been reported in association with acute or chronic inflammatory neuropathies. Case report We describe a 42-year-old man with acute-onset inflammatory polyradiculoneuropathy and bilateral papilledema. Conclusions Based on a personal case report and from an extensive review of the medical literature, we identify 2 distinct patterns. First, radiculoneuropathy may be a consequence of intracranial pressure (peripheral nerve involvement corresponding to a "false localizing sign"). Second, papilledema may occur after the onset of inflammatory neuropathy. For such cases, the pathophysiological mechanism remains unknown (eg, reactional inflammatory processes or actions of unknown autoantibodies) and requires further elucidation.

A low concentration of macular carotenoid pigment (lutein and zeaxanthin) is a significant risk factor for macular degeneration. The goal of this paper is to investigate the relationship between macular pigment optical density (MPOD) and lacquer cracks (LC) in high myopia.This is a prospective comparative observational study (NCT02205632) including high myopic patients with or without LC. High myopia was defined as a refractive error greater than 6 diopters of myopia or axial length greater than 26mm. All patients underwent best-corrected visual acuity in logMAR, MPOD measurement, multicolor imaging, SD-OCT, autofluorescence and axial length measurement. MPOD was calculated using heterochromatic flicker photometry. Group 1 was defined as eyes without LC and group 2 as eyes with LC.Forty-five eyes of 32 patients with a mean age of 51.3 years were included in group 1, and 15 eyes of 13 patients aged 54.1 in group 2 (P=0.56). Mean spherical equivalent was -10.11 diopters in group 1 and -15.11 in group 2 (P=0.0004). Mean visual acuity was +0.08 logMAR (0.8 in decimal notation) in group 1 and +0.11 logMAR (0.8 in decimal notation) in group 2 (P=0.061). Axial length was 27.8mm in group 1 and 29.2 in group 2 (P=0.0052). Central macular thickness was lower in group 1 (295μm) than in group 2 (305μm) (P0.0001), and macular choroidal thickness did not differ between the two groups (P=0.094). Mean MPOD in group 2 was 0.52 and 0.63 in group 1 (P=0.042). Differences in axial length were not related to MPOD measurements (P=0.74).A lower rate of MPOD was observed in cases of LC in high myopia. Further studies are needed to investigate if dietary carotenoids could have a protective effect in reducing the risk of LC.

International audience; Fluorescein angiography has been so far the gold-standard test to assess diabetic macular ischemia (DMI), a cause of irreversible visual impairment in diabetic patients. The aim of this study was to investigate foveal avascular zone (FAZ) and perifoveal microcirculation changes in eyes with nonproliferative diabetic retinopathy (NPDR) using optical coherence tomography angiography (OCTA), a new and noninvasive vascular imaging technique.Cross-sectional study including eyes of diabetic patients with NPDR.All patients underwent medical history, best-corrected visual acuity (BCVA) measurement, slit-lamp and fundus examination, multicolor imaging, SD-OCT, and swept-source OCT. OCTA was performed in order to assess macular superficial and deep capillary plexus, and swept-source OCT was performed to evaluate the central choroidal thickness.Fifty-eight eyes of 35 patients with a mean age of 61.8 years (±12.1) with mean HbA1C level of 7.6% (±1.5) were included in this study. Among them, 19 eyes had mild NPDR, 24 eyes had moderate NPDR, and 15 eyes had severe NPDR. There was a significant progression between NPDR stages for FAZ grade (P

Resume Introduction La penurie d’anesthesistes en milieu hospitalier a amene a reconsiderer la prise en charge anesthesique des patients d’ophtalmologie. Ainsi un protocole de prise en charge simplifiee a ete elabore en collaboration etroite avec les professionnels concernes pour les patients operes de cataracte en topique (collyres anesthesiants ou injection sous-tenonienne). Patients et methodes A l’issue de la consultation posant l’indication operatoire, le chirurgien remplit un questionnaire qui recherche la presence d’un diabete (type I ou II), des antecedents de greffe d’organe, une insuffisance renale dialysee, des problemes de communication, un psychisme defavorable, une allergie et/ou une cataracte difficile. Si un des items est positif : le patient est dirige en consultation d’anesthesie preoperatoire. Si tous les items sont negatifs : le patient n’est pas examine en consultation preanesthesique. Le chirurgien explique la necessite du jeune et de la prise des medicaments habituels le matin de l’intervention. Le patient n’arrete en aucun cas son traitement, ne beneficie d’aucun examen biologique ni radiologique. Le chirurgien prescrit si necessaire une antibioprophylaxie et la preparation preoperatoire. Au cours de l’intervention, le patient est perfuse, monitore (pression arterielle non invasive, frequence cardiaque, saturation arterielle en oxygene) et surveille par une infirmiere anesthesiste diplomee d’etat. L’anesthesiste present dans le bloc operatoire (un anesthesiste pour quatre salles) s’engage a intervenir sans delai au moindre probleme. Le chirurgien signe la surveillance postoperatoire et l’autorisation de sortie. Resultats Cette procedure a ete evaluee sur un an par un chirurgien et concerne 145 patients soit 60 % des patients recrutes pour cette chirurgie realisee le plus souvent en ambulatoire (77 %) sous topique (Oxybuprocaine® + Visthesia®, Zeiss) ou injection sous-tenonienne (Xylocaine®). Aucune complication majeure n’a ete observee. Sept acces d’hypertension arterielle traites par injection intraveineuse d’inhibiteur calcique (nicardipine) et trois etats d’agitation rapidement resolutifs ont ete observes. Conclusion Ce protocole de prise en charge anesthesique simplifiee s’avere sur et securisant mais necessite une implication rigoureuse du chirurgien qui voit son domaine de competence et de responsabilite accru. Ce n’est qu’a ce prix qu’il est possible de poursuivre une activite soutenue et competitive de chirurgie de la cataracte dans le service.

Summary Purpose To describe the prevalence of macular complications in patients with visual acuity decrease related to high myopia (HM). To establish correlations between these complications and demographic or anatomical characteristics. Materials and methods Cross-sectional observational study including HM patients undergoing best-corrected visual acuity (BCVA), fundus examination, macular SD-OCT, and fluorescein angiography in the case of suspicion of choroidal neovascularization (CNV). The presence of anatomical criteria (staphyloma, subfoveal choroidal thickness [CT]) and macular complications (CNV, lacquer cracks, central chorioretinal atrophy, dome-shaped macula with serous retinal detachment [SRD], retinal foveoschisis, macular hole and epiretinal membrane) was investigated. Results A total of 87 eyes of 47 patients were included (39 eyes without macular complication and 48 eyes with macular complications). In the case of macular complications, decrease in BCVA was related to CNV in 33%, macular hole in 25%, chorioretinal atrophy in 19%, foveoschisis in 11%, lacquer crack in 6%, to a dome-shape macula with serous retinal detachment in 4% and epiretinal membrane in 2%. After adjusting for interocular correlation and degree of myopia, staphyloma ( P = 0.0023), choroidal thinning ( P = 0.0036), and extrafoveal chorioretinal atrophy ( P = 0.042) were significantly associated with macular complications. Conclusions High myopic patients with staphyloma or choroidal thinning should undergo regular comprehensive retinal screening for retinal complications.

Purpose To report the incidence and characteristics of endophthalmitis after intravitreal injections of anti–vascular endothelial growth factor agents or corticosteroids and to describe the clinical and bacteriologic characteristics, management, and outcome of these eyes with acute endophthalmitis in France. Design Retrospective, nationwide multicenter case series. Methods From January 2, 2008 to June 30, 2013, a total of 316 576 intravitreal injections from 25 French ophthalmic centers were included. For each center, the number of intravitreal injections was determined using billing codes and the injection protocol was recorded. A registry and hospital records were reviewed to identify patients treated for endophthalmitis after injection during the same time period. The main outcome measures were the incidence of clinical endophthalmitis and visual acuity of endophthalmitis cases. Results During the study period, 65 cases of presumed endophthalmitis were found, giving an overall incidence of 0.021% (2.1 in 10 000 injections) (95% confidence interval [CI], 0.016%–0.026%). The median number of days from injection to presentation was 4 [1–26] days. The most common symptom was vision loss. Bacterial identification was achieved in 43.4%. The most frequent pathogens were gram-positive bacteria (91.3%), including coagulase-negative Staphylococcus in 78.3%. Neither the interval between injection and presentation for endophthalmitis nor the clinical signs differentiated culture-positive from culture-negative cases. In multivariate analysis, the use of a disposable conjunctival mould assist device and the use of prophylaxis with an antibiotic or antiseptic were significantly associated with an increased incidence of endophthalmitis ( P = .001). The majority of patients had worse visual acuity after 3 months of follow-up when compared with acuity before endophthalmitis. Conclusions The incidence of presumed endophthalmitis after intravitreal injections of anti–vascular endothelial growth factors or corticosteroids was low and the prognosis poor. Prevention and management remain challenging. It remains to be determined whether the findings of this study are relevant for other countries using different techniques for intravitreal injections.

Introduction Les membranes epiretiniennes idiopathiques semblent liees au decollement posterieur du vitre. La vitrectomie posterieure et le pelage en sont le traitement de choix. Le bleu tryptan colore les membranes epiretiniennes et a un moindre degre, la limitante interne, ce qui permet leur ablation selective et complete, facilitant ainsi le geste chirurgical. Une etude prospective est menee evaluant, d’une part l’interet d’une coloration selective associee au geste chirurgical, et d’autre part l’incidence des complications postoperatoires et l’influence sur le pronostic visuel final. Materiel et methodes Quatorze patients presentant une membrane epiretinienne idiopathique unilaterale sont operes par un seul et meme chirurgien. Une vitrectomie complete puis un echange fluide-air permet l’injection de 0,2 ml de bleu Trypan 0,15 % non dilue en regard de la membrane et la realisation de son pelage. L’acuite visuelle pre-operatoire, les complications postoperatoires, ainsi que le statut oculaire a la fin du suivi sont analyses. Toutes les membranes sont etudiees en microscopie electronique. Un examen angiographique systematique est pratique avant et apres chirurgie. Resultats Les resultats preliminaires montrent une ablation complete et facilitee des membranes. La coloration est rapide et facile a executer. Le colorant ne presente pas d’effet toxique a court terme. Les resultats fonctionnels a 3 mois montrent une amelioration de la fonction visuelle et une disparition des metamorphopsies. Conclusion La technique de coloration des membranes epiretiniennes idiopathiques au bleu tryptan est, a l’heure actuelle, une bonne alternative a l’utilisation du vert d’indocyanine.

Introduction Les membranes epiretiniennes idiopathiques semblent liees au decollement posterieur du vitre et a l’involution naturelle de la membrane limitante interne de la retine. La vitrectomie posterieure et le pelage en sont le traitement de choix. Le bleu trypan colore les membranes epiretiniennes et la limitante interne ce qui permet leur ablation selective et complete, facilitant ainsi le geste chirurgical et limitant d’eventuels dommages retiniens. Une etude anatomo-pathologique est menee etudiant d’une part les caracteristiques ultrastructurales des membranes epiretiniennes idiopathiques colorees au bleu trypan, et d’autre part la presence et l’aspect de la limitante interne ainsi que ses rapports avec le plan retinien sous-jacent. Materiel et methodes Quinze patients presentant une membrane epiretinienne idiopathique sont operes avec succes par un seul et meme chirurgien. Une vitrectomie complete est realisee, puis un echange fluide-air permet l’injection de 0,2 ml de bleu Trypan 0,15 % non dilue en regard de la membrane et la realisation de son pelage. Chaque membrane avec sa limitante interne est immediatement recueillie dans une solution de glutaraldehyde 4 % en vue de leur etude en microscopie electronique. Resultats Les resultats montrent que le bleu trypan permettrait une ablation complete et facilitee des membranes epimaculaires et de leur limitante interne. Le colorant ne presente pas d’effet toxique sur les prelevements. Le contingent cellulaire majoritaire est celui des cellules gliales qui participent activement a la synthese de neocollagene. Leur presence renforce l’hypothese de l’existence d’un mouvement migratoire des cellules d’origine retinienne vers l’interface vitreo-retinienne. Conclusion La presence constante d’une limitante interne intacte, l’absence de fibres optiques appartenant a la retine sous-jacente et l’absence de signe d’apoptose inhabituelle, font du bleu trypan, un colorant utile a la chirurgie des membranes epiretiniennes.

Introduction Les membranes epiretiniennes idiopathiques sont considerees comme la consequence d’un processus de gliose, a la surface de la membrane limitante interne, et peuvent provoquer un syndrome fonctionnel maculaire severe associant principalement des metamorphopsies et une baisse d’acuite visuelle. Cette derniere n’est pas liee a l’etendue et au degre de transparence de la membrane, mais a la distorsion des couches externes de la retine. L’electroretinogramme multifocal (ERGm) est un examen qui permet d’evaluer la fonction maculaire dans les 20 degres centraux. Au travers d’un examen electrophysiologique utilisant un electroretinogramme multifocal (ERGm), nous nous proposons d’etudier la fonction maculaire de 7 patients presentant une membrane epiretinienne idiopathique. Patients et methodes Tous les patients ont beneficie d’une vitrectomie complete associee a une injection de 0,2 ml de bleu trypan 0,15 % non dilue en regard de la membrane et la realisation de son pelage. Ce colorant n’est pas toxique pour l’epithelium pigmentaire mais le devient pour les photorecepteurs pour des doses depassant 0,2 %. Nous evaluerons la toxicite du bleu trypan 0,15 % sur les photorecepteurs par l’intermediaire de cet examen. Un ERGm est realise en pre-operatoire et en post-operatoire a 1 mois et 4 mois, sur 14 yeux de 7 patients atteints d’un syndrome de Jaffe unilateral. Resultat En pre-operatoire, une diminution de l’amplitude des reponses electriques retiniennes dans les aires foveolaire, peri et para-foveolaires des yeux atteints etait observee par rapport aux yeux sains. A 1 mois post-operatoire, on ne retrouvait pas de difference significative par rapport aux reponses pre-operatoire. En revanche, une nette augmentation de l’amplitude des reponses retiniennes dans l’aire maculaire etait constatee a 4 mois. L’amplitude des reponses electriques retiniennes dans l’aire maculaire augmentait de facon progressive apres une chirurgie de membrane epiretinienne. La coloration par le bleu trypan 0,15 % facilite le pelage de la membrane et ne semble pas presenter de toxicite retinienne a cette concentration.

Introduction La hyalopathie asteroide du vitre est une degenerescence vitreenne lipidique avec depots de calcium et de phosphore, le plus souvent associee a des maladies cardiovasculaires ou generales comme le diabete chez des patients âges. Le synchisis etincelant survient sur des yeux pathologiques. Ces degenerescences sont habituellement asymptomatiques. Le but de cette etude est de determiner l’interet d’une vitrectomie en cas de baisse d’acuite visuelle associee. Cas cliniques Trois patients ont beneficie d’une vitrectomie par la pars plana en raison d’une acuite visuelle inferieure a 1/10 e . L’examen au biomicroscope retrouve les caracteristiques de la hyalopathie : particules blanchâtres et brillantes, de forme arrondie, de taille variable siegeant dans le vitre anterieur, mobiles aux mouvements du globe. Le fond d’œil est mal ou non visible. L’examen en echographie B objective un vitre tres echogene, dense avec decollement posterieur laissant un espace pre-retinien libre d’echos. La vitrectomie est realisee sans probleme ; elle est completee dans un cas par l’ablation d’une membrane epiretinienne associee. La recuperation visuelle est bonne dans deux cas (6/10 e ou plus), mediocre dans un cas suite a une maculopathie atrophique. Discussion et conclusion Malgre les risques de complications postoperatoires, la vitrectomie peut etre proposee en cas de baisse importante d’acuite visuelle. Le pronostic visuel depend de l’etat maculaire sous-jacent evalue au mieux par une angiographie fluoresceinique pre-operatoire si la densite de la hyalopathie le permet.

Purpose: To describe the anatomical and functional outcomes in patients with exudative age-related macular degeneration (AMD) undergoing ranibizumab therapy in real-life practice. Methods: This is a retrospective analysis of patients with exudative AMD treated with ranibizumab. Visual acuity (VA) and optic coherence tomography characteristics at baseline and at the end of the follow-up, clinical forms of the disease, delay between diagnosis and treatment as well as the number of follow-up visits and of intravitreal injections were collected. Results: One hundred and seventy-nine patients (220 eyes) were followed up during a mean of 24 months. The mean delay between diagnosis and treatment was 20.3 days (SD ±16.8). VA stabilization was observed in 46.4% of eyes, 21.7% of eyes gained ≥15 ETDRS (Early Treatment Diabetic Retinopathy Study) letters and 31.9% lost ≥15 ETDRS letters. The mean central retinal thickness decreased from 380.6 μm at baseline to 295.6 µm at the final examination. A lower baseline VA score was associated with a greater gain of letters (OR 1.04, 95% CI 1.02-1.06; p < 0.001). Conclusion: Shortening the delays in diagnosis appears to be a key point in real-life situations.

Purpose To study and classify retinal lesions in patients with birdshot disease using wide-field autofluorescence imaging and correlate them according to patients' visual status. Methods A multicentre study was carried out on 76 eyes of 39 patients with birdshot disease, analysing colour images and under autofluorescence using the wide-field Optomap® imaging system. This was combined with a complete clinical exam and analysis of the macula with OCT. Results In over 80% of the eyes, a chorioretinal lesion has been observed under autofluorescence with a direct correlation between the extent of the lesion and visual status. The presence of macular hypo-autofluorescence was correlated with a decreased visual acuity, due to the presence of a macular oedema, active clinical inflammation or an epiretinal membrane. The hypo-autofluorescence observed correlated with the duration of the disease and the degree of inflammation in the affected eye, indicating a secondary lesion in the pigment epithelium in relation to the choroid. The pigment epithelium was affected in a diffuse manner, as in almost 50% of the eyes the wider peripheral retina was affected. Conclusion Wide-field autofluorescence imaging could appear to be a useful examination when monitoring patients, to look for areas of macular hypo-autofluorescence responsible for an irreversible loss of vision.

Intracranial silicone oil is a rare complication of intraocular endotamponade with silicone oil. We describe a case of intraventricular silicone oil fortuitously observed 38 months after an intraocular tamponade for a complicated retinal detachment in an 82 year-old woman admitted in the Department of Neurology for a stroke. We confirm the migration of silicone oil along the optic nerve. We discuss this rare entity with a review of the few other cases reported in the medical literature. Intraventricular migration of silicone oil after intraocular endotamponade is usually asymptomatic but have to be known of the neurologists and the radiologists because of its differential diagnosis that are intraventricular hemorrhage and tumor.

Purpose To study the outcome of various filtrating surgery techniques in patients with glaucoma witthe Visante Anterior Segment Optical Coherence Tomograph (AS-OCT) Methods Fourty seven patients (47 eyes) (age 55 to 87) were enrolled after they had undergone filtrating surgery for glaucoma (Sclerectomy, Trabeculectomy, and combined surgery associating phacoemulsification and Sclerectomy or Trabeculectomy). Antimetabolites were used in all patients (mitomycin C or 5-Fluoro Uracile). Intraocular pressure was recorded 6 months, 3 months and 1 month before surgery as well as 3 months, 6 months, 1 year and 2 years postoperatively. Each time the patients underwent full ophtalmological examination with subjective slit lamp evaluation of the bleb. Morphological evaluation of the bleb was performed with the Visante AS-OCT in all patients after a minimum period of one year after surgery. The trabeculectomy / sclerectomy site as well as the morphology of the scleral flap, the conjunctival flap, the iris, and the relationship between these structures were analyzed Results In most cases, a good correlation was observed between the AS-OCT evaluation of the bleb and the measured IOP. AS-OCT was helpful in determining the functional properties of filtration blebs in cases in which the target IOP was no reached. Conclusion AS- OCT is a valuable tool for an accurate functional evaluation of the outcome of filtrating surgery in patients with glaucoma.

The reduced supply of anesthesiologists in the hospital setting calls for a reconsideration of anesthesia management for ophthalmology patients. Therefore, a simplified management protocol has been designed through close collaboration between the involved specialists for cataract surgery under topical anesthesia (anesthetic eye drops or sub-Tenon's injection).At the conclusion of the visit confirming the need for surgery, the surgeon completes a questionnaire designed to elicit a history of the presence of diabetes mellitus (type I or II), prior organ transplantation, chronic renal insufficiency requiring dialysis, communication difficulties, psychiatric disorders, allergy and/or a complex cataract. If one of the items is positive, the patient is scheduled for a preoperative anesthesia consult. If all the items are negative, this anesthesia evaluation is waived. The surgeon explains the fasting requirement and how to take the patient's usual medications on the morning of surgery. The patient continues his/her medications. No lab tests or chest X-ray are performed. If necessary, the surgeon prescribes preoperative antibiotic prophylaxis and any other preparation. During the surgery, the patient receives IV fluids and is monitored via EKG, non-invasive blood pressure and pulse oxymetry by a certified nurse anesthetist. The anesthesiologist on duty (one per every four rooms) is immediately available for the slightest problem. The surgeon signs the postoperative anesthesia note and discharge order.This procedure was assessed by one surgeon over a one year period, including 145 patients (60% of the patients recruited for this surgery), primarily outpatient (77%) under topical anesthesia (Oxybuprocaine(®)+Visthesia(®), Zeiss) or under sub-Tenon's injection (Xylocaïne(®)). No major complications were observed. Seven cases of arterial hypertension, treated with calcium channel blockers (nicardipine), and three episodes of brief anxiety were observed.This simplified anesthesia protocol appears to be safe and effective but requires more demanding involvement of the surgeon, whose scope of competence and responsibility must naturally increase. This is the only way by which cataract surgery can remain competitive.

Purpose To compare the refractive precision and the ease of use of 2 recent optical biometry devices. Methods Fifty patients (50 eyes with grade II and over cataracts according to the Oxford classification) underwent optical biometry measurements with 2 optical biometers, the IOLMaster 500 (partial coherence interferometry [PCI] device) and the Lenstar LS 900 (optical low-coherence reflectometry [OLCR] device. Keratometry was also measured in each patient with the NIDEK ARK 900 keratometer. IOL power calculation was performed using the SRK-T formula. The duration of the actual measurement process was also recorded. Results IOL power calculation could not be achieved in 2 patients with the PCI biometer (1 post traumatic cataract, 1 dense subcapsular cataract) versus 5 patients with the OLCR device (1 post traumatic cataract, 1 dense subcapsular cataract and 3 loss of fixation). There was an excellent correlation between the keratometric measurements obtained with both biometers and the ones obtained with the NIDEK ARK 900 keratometer. Measurements with the new OLCR device took significantly longer than with the PCI biometer. Conclusion The accuracy of the IOL Master 500 and Lenstar 900 make them the 2 new gold standards of optical biometry. Both of them are easy to use and due to their non contact technology they prevent the potential transmission of non conventional infectious agents (theoretically possible with contact biometers).

Preretinal arterial loops are congenital vascular anomalies that originate from a main branch of the central retinal artery on the optic disc. These arterial loops are usually unilateral and asymptomatic, but they can be associated with retinal artery branch occlusion. We report one case of inferior temporal retinal artery occlusion in a patient with preretinal arterial loops. Two different mechanisms are thought to be the cause of occlusion: twisting of the loop or thrombosis.

Oguchi disease, originally described in Japanese people, is a rare form of stationary night blindness in patients with normal acuity.We report the case of an 8-year-old girl who presented with an abnormal terrified behavior in the dark. Thorough questioning revealed hemeralopia. Her clinical examination (visual acuity, Goldmann visual field, and color vision) were normal. The fundus examination showed golden-brown color, grayish, almost greenish yellow discoloration in the peripheral area with no osteoclast. This abnormality disappeared after prolonged dark adaptation. The electroretinogram showed a reduced b wave amplitude under scotopic conditions. Her parents were cousins.This diagnosis should be suggested when hemeralopia is associated with typical fundus aspect resolving after dark adaptation (so called Mizuo-Nakamura phenomenon). The long-term prognosis in these patients is good in the absence of clinical progression. This is a genetic autosomal recessive disease caused by mutations in the gene coding for arrestin located in 2q37.1.

International audience; AIMS: Insulin resistance is a key feature of type 2 diabetes. It is also involved in the development and progression of microvascular complications. We analysed the relationship between parental history of diabetes, insulin resistance and diabetic nephropathy (DN) and assessed the specific maternal and paternal influences of history of type 2 diabetes on DN in type 1 diabetic offspring. METHODS: We recorded information regarding family history of type 2 diabetes and of cardiovascular disease in 160 consecutive, unrelated type 1 diabetic patients. Insulin resistance was assessed using a validated estimation of the glucose disposal rate (eGDR). RESULTS: Type 1 diabetic patients with a maternal history of type 2 diabetes were more likely to be insulin-resistant (P=0.043) and to have renal complications (P=0.0041) than those from the reference group (without parental history of diabetes), while patients with a paternal history were not different from those from the reference group, regarding eGDR and DN. Time to development of abnormal albuminuria was significantly affected by maternal history of type 2 diabetes (log-rank=12.66; P=0.0004) and by familial history of premature cardiovascular disease (log-rank=5.48; P=0.0234). In multivariate analysis, a maternal history of type 2 diabetes was independently associated with nephropathy after adjustment for sex, diabetes duration and familial history of premature cardiovascular disease. CONCLUSION: Maternal history of type 2 diabetes is independently associated with DN in type 1 diabetic patients. This might suggest the transmission of a maternal trait related to microvascular complications, raising the hypothesis of imprinted genes predisposing to diabetic renal disease.

Idiopathic epiretinal membrane (ERM) results from detachment of the posterior hyaloid. Vitrectomy and peeling are the treatment of choice. Trypan blue 0.15% (TB) stains the epiretinal membrane and the internal limiting membrane (ILM), facilitating surgery and thus allowing selective and complete removal with less retinal damage. We conducted a study evaluating the advantages of selective staining associated with surgery, the incidence of postoperative damage, and the influence on final visual acuity.Fourteen patients were operated on by the same surgeon, who carried out a complete vitrectomy, then fluid-air exchange for dye injection of undiluted 0.2 ml of Trypan blue 0.15% in front of the membrane, which was then easily distinguished from the area under the retina. Preoperative visual acuity, postoperative damage, as well as eye status at the end of follow-up are discussed. Transmission electron microscopy was used to determine if epiretinal membrane removal was complete and selective. Angiography was systematically used to study the state of retina before and after surgery.Preliminary results show that trypan blue is useful and facilitates complete removal of ERM and ILM. It may reduce long-term complications and recurrent membrane formation. Trypan blue is a staining agent that is quick and easy to use. It presents no short-term toxic effects. Functional results in 6 months show improvement of visual acuity and disappearance of metamorphopsia.Idiopathic epiretinal membrane surgery with tryptan blue staining is a better alternative than indocyanine green staining.

Idiopathic epiretinal membrane results from detachment of the posterior hyaloid and is believed to be related to naturally occurring defects in the internal limiting membrane (ILM) of the retina. Vitrectomy and peeling are the treatment of choice. Trypan blue 0.15% (TB) stains epiretinal membrane and internal limiting membrane. It allows selective and complete removal, facilitating surgery, with less retinal damage. An ultrastructural study was conducted showing ultrastructural features of idiopathic epiretinal membranes (ERM) and those of the internal limiting membrane and its connections with the retinal side.After pars plana vitrectomy and induction of posterior vitreous detachment, 0.2 ml TB 0.15% was injected over the ERM in an air-filled eye. The stained tissue was peeled with intraocular forceps. Specimens were at once collected in 4% glutaraldehyde for a transmission electron microscopy study.TB may allow complete and easier ERM and ILM peeling. The staining does not present toxic effects. The major cellular contingent is represented by glial cells, participating actively in neocollagen synthesis. Their presence supports the hypothesis of a migratory movement of retinal cells toward the vitreoretinal side.The presence of an intact internal limiting membrane, the absence of optical fibers belonging to the under retina, and the absence of any sign of apoptosis make TB a useful staining agent for ERM and ILM peeling.

Idiopathic epiretinal membranes are considered the consequence of glial proliferation through a defect of the internal limiting membrane and can induce a functional macular syndrome associating mainly metamorphopsia and visual acuteness. Visual disturbance is not bound to the area and the degree of transparency of the membrane, but to distortion of external layers of the retina. Multifocal electroretinography (ERGm) can assess the macular area and retina extending 20 degrees. We used this tool to study macular function pre- and post-operatively with seven patients presenting idiopathic epiretinal membrane.All patients had successful vitrectomy, with 0.2 ml of 0.15% trypan blue (TB) staining to facilitate peeling. This stain is not toxic for the pigment epithelium but it becomes so for photoreceptors at doses exceeding 0.2%. We tried to estimate the echo of TB 0.15% on photoreceptors through this exam. An ERGm was done 1 week before the operation as well as 1 month and 4 months after on 14 eyes of seven patients with ERMs.Results show a pre-operative decrease in the electrical retinal response densities in the foveal, perifoveal and parafoveal areas. One month after operation, no significant difference was found compared to pre-operative results. However, at 4 months, an improvement of the retinal response density was observed. Retinal response densities in the macular area increased progressively after ERM surgery.The 0.15% TB facilitated ERM peeling and does not seem to present any retinal toxicity.

Asteroid hyalosis is a vitreous degeneration with calcium and phosphorus--lipid complexes in elderly patients with vascular risk factors or general disease such as diabetes mellitus. Synchysis scintillans is a complication of pathological eyes. Generally there are no symptoms. This study aims to evaluate the role of vitrectomy in patients with a decrease in visual acuity.Pars plana vitrectomy was performed in three patients with visual acuity less than 1/10. The biomicroscope examination showed white and bright particles with rounded and variable shapes localized in the anterior vitreous, moving with the eye. The visualization of the fundus was difficult or impossible. On echography B, the vitreous was very dense with a complete posterior vitreous detachment. The vitrectomy was completed in one case by peeling an epiretinal membrane. Visual acuity was improved for two patients (6/10 or more) and stable for one patient with an atrophic DMLA.These results were compared with studies in the literature: in spite of complications, vitrectomy can be indicated in patients with a substantial decrease in visual acuity. However, the result is conditioned by the macular status. Fluorescein angiography can, when it is possible, evaluate the fundus before surgery.

Described by Theodore Leber in 1916, this syndrome is characterized by unilateral visual loss, optic disc swelling and a stellate pattern of exudative deposits in the macula.Two young adults were examined for sudden unilateral visual loss preceded by a flu-like syndrome. Fundus examination revealed a swollen optic disc and a macular star, visualized on fluorescein angiography. Visual field, laboratory tests and cranial and orbital tomodensitometry were performed.Visual field examination showed a centrocecal scotoma. Laboratory tests showed inflammatory syndrome in one case. Serology testing (leptospirosis, cat scratch disease, toxoplasmosis and syphilis, etc.) were negative. Tomodensitometry of the brain and orbits gave normal results. One of the patients was treated with intravenous steroid boluses; the other received no treatment. A few weeks after the beginning of symptoms, the swelling of the optic disc seemed to have declined, leaving the macular star unchanged.These two cases typically describe Leber's idiopathic stellate neuroretinitis. The prognosis for visual recovery is usually reported to be excellent, but visual sequelae have been described.

We report two techniques for treatment of dural arteriovenous fistulas using femoral vein catheterism and direct surgery via the superior ophthalmic vein. We will attempt to show the advantages of these new techniques instead of using the arterial pathway, which is currently the reference procedure.Mrs G, 75 years old was sent by her ophthalmologist because of a suspected orbital tumor. Visual acuity: right eye: 3/10, exophthalmia, chemosis, with no thrill or murmur. The fundus examination was normal. The ultrasound exam with color Doppler imaging showed an arterialization of the superior ophthalmic vein compatible with an arteriovenous sinus dural fistula. Angio-MRI revealed a large left cavernous sinus, confirming the diagnosis. Considering the type of the fistula and the weak physical condition of the patient, we decided to attempt an endovascular embolization with coil placement, using femoral vein catheterism. Exophthalmia regressed within days. The fistula remains sealed 1 year after the procedure. Mr D, 40 years old, showed a similar clinical aspect of sinus dural fistula. We attempted an embolization with the femoral vein, which failed. We decided to embolize the cavernous sinus via the direct surgical pathway of the superior ophthalmic vein. Coils were placed and the fistula was sealed.These clinical cases show two less invasive alternatives giving better results than arterial embolization, the reference method (Brooks 1930; Spearmann 1964; Parkinson 1965), endovascular trapping, or surgery.

Introduction Le glaucome neo-vasculaire est secondaire a un feutrage du trabeculum par des neo-vaisseaux apres une production de VEGF par une retine ischemique. On distingue quatre stades : stade 1 : simple hyperhemie irienne ; stade 2 : neo-vaisseaux dans l’angle irido-corneen sans hypertonie oculaire ; stade 3 : stade 2 avec hypertonie ; stade 4 : angle irido-corneen ferme par la contraction des membranes neo-vasculaires. Objectifs et Methodes Au travers de trois exemples, nous illustrerons l’interet du bevacizumab associe aux mesures hypotonisantes dans la prise en charge du patient. Observation Trois patients de plus de 55 ans, hypertendus, presentent un glaucome neo-vasculaire : un de stade 3 et deux de stade 4. Tous ont recu une tritherapie hypotonisante topique, de l’acetazolamide par voie generale et une injection intra-vitreenne de 1,25 mg de bevacizumab. Sept jours apres l’injection et sous traitements hypotonisants topiques, tous les patients presentent une analgesie et une regression de la rubeose irienne, un eclaircissement des milieux transparent de l’œil. La tension oculaire est normale pour le glaucome de stade 3 et baisse pour les deux autres patients. La panphotocoagulation retinienne est debutee. Un mois apres l’injection, la panphotocoagulation est complete chez tous les patients. Le patient ayant un glaucome de stade 3 a une tension normale sans traitement et la rubeose a quasiment disparu. Les deux autres, ayant des glaucomes de stade 4, presentent toujours une hypertonie sous traitement maximal. Sans perception lumineuse et avec une recidive douloureuse, l’un a eu un cyclo-affaiblissement par cryo-application. L’autre ayant toujours une acuite visuelle chiffrable (14/100 parinaud 8), a beneficie d’une chirurgie combinee phacoemulsification-trabeculectomie. Dans les deux cas cette prise en charge complementaire normalise leur tension. Apres trois mois d’evolution, les trois patients sont stables au niveau tensionnel. Discussion Le bevacizumab presente des avantages : analgesie et regression rapide de la rubeose irienne, controle tensionnel. Dans ce contexte particulier, les risques d’un tel traitement semblent faibles. Conclusion Ces constatations devront etre confirmees par des etudes approfondies.

rinized during the procedure, followed by long-term therapy with clopidogrel. Clinical improvement was immediate, marked by alleviation of headaches, regression of the papillary edema, and a return to normal visual acuity (10/10 right, 9/10 left). In this case angioplastic intervention proved efficacious, and no other surgical or medical treatment was performed. Dear Sir, As the pathogenesis of idiopathic intracranial hypertension (IIH) remains elusive, different medical and surgical treatments merit consideration.

We report two cases of toxocariasis peripheral granuloma in adults.Diagnostic difficulties linked to parasite serologies, particular to these two cases, are presented. Serology is often poorly contributive, but PCA and/or vitreous study with the ELISA reaction to Toxocara canis homologous antigens in the endocular fluids are the most reliable means of reaching a diagnosis, as evidence in our two observations. In the same way, the presence of eosinophils and of IgE in the aqueous humor and or vitreous is of great importance for orienting the diagnosis.The treatment consisted in systemic steroids and granuloma cryotherapy associated with vitrectomy and for one case indentation due to a traction. Later, retinal membrane peel was performed for the same patient. No treatment with antihelminthic drugs was proposed. The functional and anatomic results were good in both cases (8/10-P2 and 6/10-P2).Toxocara canis infection is based on clinical aspects. The ELISA technique is useful for biological diagnosis.

Introduction Certains parametres cliniques (HTA, nephropathie) ou biologiques (taux corriges d’hemoglobine glycosylee) sont des facteurs de risque d’oedeme maculaire diabetique (OMD). L’objectif de l’etude etait d’identifier des facteurs cliniques potentiellement associes a la presence d’un OMD. Materiels et methodes Etude monocentrique transversale d’une cohorte de diabetiques de type 2, suivis au sein du centre d’investigation clinique d’un centre hospitalier et universitaire. Le diagnostic d’OMD et de RD ont ete etablis a l’aide de cliches couleur du fond d’oeil expertises par un ophtalmologiste. Les donnees epidemiologiques ainsi que les taux corriges d’hemoglobine glycolyses ont ete recueillis. En outre, les antecedents de maladie cardiovasculaire (angor, infarctus du myocarde, AIT, AVC), la presence d’une nephropathie diabetique, les antecedents d’amputation et la presence d’une RD ont aussi ete analyses. Un groupe de patients diabetiques avec un OMD a ainsi ete compare a un groupe de patients sans OMD. Une comparaison de moyenne pour les variables quantitatives (test Z) et par un test du Chi2 pour les variables qualitatives ont ete realises. Resultats 349 patients avec OMD (H/F = 221/128; âge moyen de 65 ans) ont ete compares a 2739 patients sans OMD (H/F = 1683/1056; âge moyen de 63 ans). Une difference significative a ete retrouvee entre les 2 groupes pour la frequence de l’atteinte cardiovasculaire (42,1 versus 31,5 %), la frequence de la nephropathie diabetique (70,3 versus 48,9 %) et les taux d’amputation (11,5 versus 3,8 %) (p Conclusion Une etude multicentrique recente a mis en evidence une association entre maladie cardiovasculaire et RD (Pugliese et al. 2012). La presente analyse precise les facteurs associes a l’OMD. L’identification de facteurs de risque d’OMD pourrait permettre d’etablir des modeles predictifs afin d’optimiser le depistage de la RD ou de l’OMD en ciblant plus precisement les categories a risque.

Vision prognostic study depending on the germs and the therapic performed in bacterial endophthalmitis.In a retrospective study over a period of 3 years (1991-1993), 32 cases of post surgery bacterian endophthalmitis were detected: 30 cases after cataract surgery (29 cases after extra capsular surgery and one case after intra capsular), one case after trabeculectomy and one case after keratoplasty.A risk factor was evidenced in 15.6% of the cases. Endocular samples were done in 68.75% of the cases. The positive rate was 36.4% showing a Staphylococcus in 5 cases out of 8 (62,5%). In 37.5% of the cases an intraocular antibiotic injection was associated to the anterior chamber punction. 40% of the cases contaminated with Staphylococcus regained a visual acuity of more than 3/10. For the two cases where a Streptococcus was isolated an evisceration was necessary. Our results show that a higher visual acuity was obtained when a posterior vitrectomy was performed. When the posterior vitrectomy was associated with a corticoid therapy, the visual prognostic was better. Thus, 71% of these cases regained a visual acuity of more than 3/10.Our results show that performing a posterior vitrectomy associated to a general corticotherapy within 48 hours from the bacterian endophthalmitis diagnosis would allow best vision improvement.

The purpose of this study was to assess the effects of amount of myopia, axial elongation staphyloma and type of optical correction on contrast sensitivity of high myopic subjects.Fifty-one patients (91 eyes) were selected on the following qualifications: myopiaor = 8 dpt and/or axial lengthor = 26 mm, and visual acuityor = 0.1 recorded through spectacle lenses. Contrast sensitivity was measured using a "Moniteur Ophtalmologique" for all subjects when corrected with spectacle lenses, and thereafter on a lot of patients (50 eyes) wearing a contact lens.Contrast sensitivity obtained with spectacle lenses was significantly decreased over the whole spatial frequency range. The higher the spatial frequency was, the lower contrast sensitivity was. The impairment increased with the amount of myopia and axial length, but without positive correlation. Contrast sensitivity was significantly lower for only the three highest spatial frequencies measured (6.4; 12.8 and 25.6 c/deg), when a staphyloma (n = 52) was present by comparison with results obtained for eyes without staphyloma (n = 39). Differences between the two situations (spectacle lens vs. contact lens) were not significant for eyes wearing daily spectacle lenses; conversely, for myopic subjects generally fitted with contact lenses, contrast sensitivity with contact lenses was significantly better than that measured with spectacles for the three highest spatial frequencies tested.This suggests that the decrease in contrast sensitivity measured in high myopia is related to defects in the optical and neuro-retinal systems.

Bacterial contamination of anterior chamber at the end of cataract surgery, was compared between two techniques: extracapsular extraction and phacoemulsification. The effectiveness of preoperative antibiotic eyedrops using Norfloxacine 0.3% (Chibroxine) was also evaluated.The study focused on 101 patients grouped according to surgical technique and presence of preoperative antibiotic eyedrops. Conjunctival sampling was made the day prior the surgery, as well as in the operating room, after skin and conjunctival desinfection with povidone iodine in all the patients included in the study. Aqueous humour was collected at the end of surgery.Eight samples out of 101 were positive which represents 7.9% of the cases. In 75% of the cases, the anterior chamber aspirate showed a different germ or non-recurrent germ in the second conjunctival sample. None of the included patients developed endophthalmitis. The two most frequent pathogens were Propionibacterium acnes in 62.5% of the cases, and Staphylococcus epidermidis in 50%. Another pathogen was found in a culture environment: Micrococcus roseus. In two samples, two different bacteria grew: Propionibacterium acnes and Staphylococcus epidermidis. Whatever the surgical technique, no statistically significant bacterial contamination was found. There was no significant statistical difference between patients who had local antibiotic eyedrops and those who did not.This study confirms the poor reliability of local antibiotic eyedrops to prevent surgical contamination. Furthermore performing an anterior chamber aspirate at the end of the surgery for risk patients would help the physician identify the pathogens involved in endophthalmitis in order to begin antibiotic treatment as soon as possible.

The progression of field loss was determined by Humphrey Automated threshold perimetry in the short and intermediate term after surgical trabeculectomy for chronic glaucoma: mean indices (MD, PSD et FOV) were studied before and after normalisation of the intraocular pressure. Risk factors such as secondary glaucoma, previous visual field defects and cardiovascular risk factors were significantly correlated to poor or bad progression of field loss: the mean variation of MD = +1.23 dB +/- 2.84 (p1.5%), the mean variation of PSD = 0.50 dB +/- 1.37 (p6%), but the mean variation of FOV was not significant; so 36% of field defects were improved, 42% were stabilized and 22% were aggravated. When the risk factors were absent, 86% of field losses were stabilised but when cardiovascular factors were present, only 64% were stabilised. These risk factors can also be used to ascertain the prognosis of post-surgical progression of visual field, as already shown in previous reports. Automated threshold perimetry was useful to study the visual field progression with standardized and reliable numerical parameters, allowing statistical computerised management of the patients with glaucoma.

Introduction Nous rapportons le cas d’un homme diabetique de 70 ans ayant presente un rejet de greffe de cornee de type endothelial survenu 3 jours apres l’ablation des sutures malgre une prophylaxie par dexamethasone collyre. Materiels et Methodes L’examen d’entree au biomicroscope montre un œdeme corneen sectoriel important epargnant la cornee receveuse. On realise egalement une tomographie en coherence optique (OCT) de type Visante qui permet de quantifier l’œdeme au moyen d’une carte pachymetrique et de rechercher des facteurs favorisant le rejet de greffe. Un traitement topique intensif a la dexamethasone associe a des injections sous-conjonctivales de bethamethasone est instaure. Discussion La repetition de l’OCT de segment anterieur au fil des examens d’objective une diminution de l’œdeme de cornee alors que l’examen biomicroscopique semble stable. Cette donnee permet de ne pas instaurer une corticotherapie intra-veineuse chez ce patient diabetique. Par ailleurs l’OCT de segment anterieur met en evidence un contact entre l’iris et l’anneau limitant, impossible a visualiser au bio-microscope en raison de l’œdeme. Conclusion Il apparait donc que l’OCT Visante est un outil interessant pour juger de l’efficacite du traitement lors d’un rejet endothelial de greffe de cornee. Cet examen s’avere egalement utile dans la recherche des faveurs favorisant le rejet.

Introduction Le DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) est une reaction d’hypersensibilite medicamenteuse retardee rare, mais pouvant engager le pronostic vital, associant une eruption cutanee febrile a des atteintes multiviscerales et a une hyper-eosinophilie sanguine. Objectifs et Methodes Une femme de 49 ans, aux antecedents allergiques multiples, a consulte pour une baisse d’acuite visuelle bilaterale a 2/10 P8, en rapport avec une epitheliopathie en plaques associee a des signes de panuveite, dans un contexte d’eruption cutanee survenant trois semaines apres l’arret de la prise d’ibuprofene. Le bilan biologique retrouvait une hyper-eosinophilie, un syndrome inflammatoire et une cytolyse hepatique avec cholestase anicterique. Sous traitement general par bolus de corticoides intraveineux, l’evolution initiale fut favorable. Cependant, l’etat general s’est degrade a moyen terme, avec la survenue d’une insuffisance renale aigue, de pics febriles, d’atteintes pancreatique et myocardique biologiques. La mise sous traitement immunosuppresseur associe a la corticotherapie et a des seances de dialyse a permis l’amelioration progressive des signes cliniques et biologiques, avec une bonne recuperation de l’acuite visuelle a trois mois (8/10 P2 œil droit, 5/10 P2 œil gauche). Discussion Les mecanismes physiopathologiques du DRESS syndrome sont peu connus : une cascade de reactions dysimmunitaires est suggeree, favorisee par la prise medicamenteuse. Elle entraine une atteinte multi-viscerale, parmi laquelle l’atteinte uveale est tres peu rapportee. L’association a un facteur viral est, de meme, souvent evoquee. Les mecanismes de l’epitheliopathie en plaques demeurent egalement mal connus, mais des reactions inflammatoires avec troubles de la perfusion choroidienne seraient mises en jeu, a la suite d’une agression virale, par hypersensibilite retardee. Conclusion Cette observation d’epitheliopathie en plaques bilaterale associee a un DRESS syndrome severe est un des rares cas d’atteinte ophtalmologique survenant dans ce contexte, et semble corroborer les hypotheses physiopathologiques actuelles de cette atteinte.

Introduction L’interferon alpha est utilise dans le traitement de l’hepatite chronique C chez des adultes ayant un ARN-VHC serique positif, souvent en association avec la ribavirine. Cet immunomodulateur peut entrainer des retinopathies de type ischemique, associant des nodules cotonneux, des hemorragies, des occlusions de veine ou d’artere retinienne, des neovaisseaux choroidiens. Des cas de neuropathie optique ischemique ont egalement ete rapportes. Materiels et Methodes Description d’un cas clinique. Observation Un patient de 45 ans, VIH +, ancien toxicomane a l’heroine et tabagique, traite depuis 6 mois pour une hepatite C chronique par interferon alpha (135 μg/semaine) et ribavirine (800 mg/j) nous consultait pour une baisse recente d’acuite visuelle bilaterale (œil droit = 2/10 et œil gauche = 7/10). Le fond d’œil et l’angiographie a la fluoresceine montraient une ischemie de la macula majeure a droite et moins importante a gauche. On n’observait par ailleurs aucun nodule cotonneux ni de micro-hemorragie. Ce patient n’etait ni hypertendu, ni anemie, ni diabetique. Un arret de son traitement avait alors ete decide en concertation avec les gastro-enterologues qui le suivaient. A trois mois, l’acuite visuelle restait stable. Le controle angiographique revelait alors une atrophie sequellaire faisant place a l’ischemie maculaire, confirmant le caractere irreversible de cette maculopathie secondaire a l’interferon. Discussion La physiopathologie de la retinopathie a l’interferon alpha reste encore mal connue. Elle semble etre liee a une alteration des cellules endotheliales des vaisseaux et elle est favorisee par l’association a la ribavirine, lors d’une hypertension arterielle, d’une anemie ou d’un diabete. Elle demeure le plus souvent asymptomatique et regressive apres arret du traitement ou diminution des posologies. Conclusion Les patients porteurs d’une hepatite C chronique et a risque traites par interferon alpha devraient beneficier d’un suivi ophtalmologique a la recherche de complications ischemiques imposant l’arret de traitement.

The subjective aniseiconia was measured with spatial eiconometer on 51 isometropic and unilateral pseudophakic patients in relation with the post-operative anisometropia. The median value of subjective aniseiconia is 2-3% for anisometropia minus or equal to 5 diopters, without statistic correlation, related to a probably "sensorial brain adaptation". So error of intra-ocular lens power calculation less than 7.5 diopters may be accepted.

Introduction L’hypertension intracrânienne est une affection liee a une augmentation de la pression du liquide cephalorachidien, se manifestant par des cephalees et un œdeme papillaire bilateral. Il est possible grâce a l’apport de la tomographie par coherence optique (OCT) d’effectuer une mesure fiable et reproductible du volume papillaire au cours de cette affection. Materiels et Methodes Madame P., adressee pour une baisse d’acuite visuelle, presentait un œdeme papillaire bilateral majeur evoluant dans le cadre d’une hypertension intracrânienne et documente par un OCT papillaire initial. La radiographie interventionnelle mit en evidence une stenose du sinus longitudinal veineux cerebral qui fut traitee par un stent. En post-operatoire, il existait une decroissance significative du volume papillaire mesurable par OCT, correle a l’amelioration d’acuite visuelle. Discussion L’OCT permet d’effectuer une mesure fiable et reproductible du volume papillaire quelle que soit l’etiologie. L’interet de cette technique est dans le diagnostic des recidives precoces d’un œdeme et ainsi d’adapter la therapeutique en temps reel. La technique presente des limites : il n’existe pas de lien entre le diametre et le volume papillaire, ce qui ne permet pas de differencier une papille physiologiquement charnue d’un œdeme debutant. Conclusion L’OCT est un outil moderne de mesure du volume papillaire, utile dans les suivis d’œdemes papillaires, a correler a la clinique.

Preretinal arterial loops are congenital vascular anomalies that originate from a main branch of the central retinal artery on the optic disc. These arterial loops are usually unilateral and asymptomatic, but they can be associated with retinal artery branch occlusion. We report one case of inferior temporal retinal artery occlusion in a patient with preretinal arterial loops. Two different mechanisms are thought to be the cause of occlusion: twisting of the loop or thrombosis.

Introduction Le syndrome d’Oguchi, primitivement decrit chez les Japonais, est une forme rare d’hemeralopie congenitale non evolutive chez des patients par ailleurs normaux sur le plan visuel. Observation Une enfant âgee de 8 ans fut amenee en consultation pour un comportement anormal de type terreur en ambiance nocturne. Un interrogatoire pousse permit de mettre en evidence une hemeralopie. L’examen clinique, comprenant la mesure de l’acuite visuelle, l’evaluation du champ visuel au Goldmann, et de la vision des couleurs, etait normal. A l’examen du fond d’œil, des reflets blancs-grisâtres presque cuivres, peripheriques sans osteoclaste, etaient notes. Cet aspect disparut apres 3 heures d’adaptation a l’obscurite. L’electroretinogramme montrait une alteration de l’onde b en ambiance scotopique. Il existait un lien de consanguinite chez les parents. Le diagnostic de cecite de nocturne congenitale stationnaire (Syndrome d’Oguchi) fut retenu. Conclusion Le diagnostic de ce syndrome doit etre evoque devant une hemeralopie et l’aspect typique du fond d’œil se modifiant apres adaptation a l’obscurite (phenomene de Mizuo-Nakamura). Le pronostic visuel est bon en l’absence d’evolution clinique. La transmission se fait sur le mode autosomique recessif : le gene en cause est localise en 2q37.1 et code pour l’arrestine.

We measured apparent accommodation in 51 pseudophakic eyes (44 patients, after implantation of anterior (15 eyes) or posterior (36 eyes) intraocular lens. Glasses for distant vision were born during the test. The mean apparent accommodation was 1.89 +/- 0.91 dpt. 25 among these 51 pseudophakic eyes who were tested without their glasses showed a mean apparent accommodation that was not different in statistical and clinical terms. The mean accommodative power of 25 phakic and presbyopic eyes used as controls was 1.31 +/- 1.01 dpt. For these 51 pseudophakic eyes the correlation between apparent accommodation and the reciprocal of the pupillary diameter is the most significant (r = 0.79): the smaller the pupil, the greater the apparent accommodation. There was a negative correlation between apparent accommodation and anterior chamber depth (r = -0.64). No correlation was found between pseudo-accommodation and corrected visual acuity, corneal astigmatism and refractive error.