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Resume Introduction Determiner des facteurs predictifs de bonne reponse au crosslinking (CXL) dans la prise en charge du keratocone evolutif. Patients et methodes Cinquante-quatre yeux de 41 patients ont beneficie d’un CXL entre juin 2011 et decembre 2012 pour keratocone evolutif. Un examen clinique ophtalmologique avec une topographie corneenne (Orbscan ® ) est realise a 1, 3, 6 mois, 1 an en postoperatoire et compare a l’examen preoperatoire. Resultats A un an, le CXL permet une amelioration significative de la meilleure acuite visuelle corrigee (MAVC) (0,16 ± 0,21 LogMar en preoperatoire versus 0,09 ± 0,16 LogMar a 1 an, p = 0,007), une stabilite de l’astigmatisme refractif (AR) ( p = 0,69), une amelioration significative de l’astigmatisme irregulier topographique des 3 mm centraux ( p = 0,04), et une stabilite du Kmax (48,4 D ± 4,1 en preoperatoire versus 48,5 D ± 4,1 a 1 an, p = 0,46). Les facteurs predictifs d’amelioration postoperatoire de MAVC sont, en preoperatoire, une MAVC faible, un AR eleve et un keratocone evolue. Les facteurs predictifs de stabilite du Kmax postoperatoire sont un keratocone preoperatoire peu evolue, et principalement localise dans les 3 mm centraux. Conclusion Cette etude retrospective confirme l’interet et l’efficacite du CXL dans la prise en charge therapeutique d’un keratocone evolutif, tant sur le plan refractif que topographique. La localisation du cone ou son excentricite semble etre un facteur expliquant la variabilite des resultats bibliographiques d’efficacite du CXL. La severite du cone apparait dans cette etude comme etant un facteur predictif de mauvaise reponse topographique au CXL, mais devant etre pondere par la localisation preferentielle du cone (3 ou 5 mm centraux).

Resume But Evaluer le retentissement fonctionnel de la secheresse oculaire, en fonction de sa severite, sur la qualite de vision en utilisant un index objectif de diffusion lumineuse (OSI) mesure par aberrometrie double passage. Patients et methodes Vingt-huit patients (56 yeux), presentant des syndromes secs de differentes severites, ont participe a cette etude. Un aberrometre double passage a ete utilise pour mesurer les variations dynamiques de l’OSI pendant 20 secondes. La moyenne et la variance de l’OSI ainsi que le nombre de clignements survenus au cours de l’examen ont ete compares en fonction de la severite clinique du syndrome sec. Resultats La moyenne de l’OSI augmentait avec la severite du syndrome sec avec une difference significative pour les stades 3 ( p p p > 0,8) ou d’acuite visuelle ( p > 0,2). La variance de l’OSI augmentait egalement avec la severite clinique du syndrome sec avec une difference significative pour les stades 3 ( p p p > 0,2). La variance de l’OSI refletait le caractere dynamique des modifications aberrometriques en lien avec l’instabilite du film lacrymal. Conclusion Les patients presentaient une qualite de vision qui se degradait avec la severite de leur secheresse oculaire. L’etude de la variance de l’OSI apparait comme un moyen objectif d’evaluer l’intensite des troubles visuels subjectifs rapportes par les patients presentant un syndrome sec. Elle constitue egalement un nouvel outil pour evaluer la severite de l’atteinte de la surface oculaire.

Introduction L’imperforation lacrymo-nasale congenitale concerne plus de 6 % des nourrissons. Alors que certains preconisent un sondage lacrymo-nasal sous anesthesie generale a partir de l’âge d’un an en l’absence de resolution spontanee, d’autres optent pour un sondage precoce des l’âge 4 a 6 mois sous anesthesie topique. Nous presentons le sondage lacrymo-nasal sous inhalation de MEOPA, melange equimolaire de protoxyde d’azote et d’oxygene, comme une alternative therapeutique. Patients et methodes Nous avons realise une etude descriptive prospective incluant 63 patients (75 yeux) ayant eu un sondage lacrymo-nasal sous inhalation de MEOPA entre mars 2005 et mars 2006, en consultation. L’efficacite a pu etre evaluee par l’observation du personnel medical, des parents et la faisabilite du geste. Resultats Les enfants etaient âges de 4 a 28 mois (âge moyen de 11 mois 1/2). Une resolution des symptomes a ete effective dans 79 % des cas apres un sondage unique. Aucun incident n’a ete observe. En cas d’echec, un sondage avec intubation lacrymo-nasale sous controle endoscopique et sous anesthesie generale a ete effectue (21 % des cas a un âge moyen de 17 mois 1/2). Discussion L’administration au masque facial de MEOPA repandue en pediatrie est d’utilisation simple, rapide, peu risquee, peu couteuse et efficace. Conclusion L’utilisation du melange protoxyde d’azote-oxygene lors du sondage des voies lacrymales chez l’enfant pourrait etre une bonne alternative therapeutique permettant d’epargner la douleur aux plus petits et l’anesthesie generale aux plus grands.

Introduction L’objectif etait d’analyser les donnees de notre experience de depistage de la retinopathie du premature, de les comparer a celles de la litterature et de rechercher des facteurs de risque de developper une retinopathie du premature. Materiel et methode Entre mars 2002 et avril 2004, 161 prematures, ayant un terme inferieur ou egal a 32 semaines d’amenorrhee et/ou un poids de naissance inferieur a 1 500 g, ont eu un depistage de la retinopathie du premature par ophtalmoscopie directe avec un verre de Layden, selon les recommandations de la CRYO-ROP. Les facteurs de risque de developper une retinopathie du premature ont ete analyses avec les tests de Student et de Fischer. Resultats Une retinopathie du premature a ete diagnostiquee dans 15 % des cas, dont 20 % a des stades pre-seuils ou seuils. Le terme ( p p p p p p p = 0,0257), et la bronchodysplasie ( p = 0,0012) etaient des facteurs de risque significatifs de developper une retinopathie du premature. Conclusion Malgre les progres de reanimation neonatale, la persistance de la retinopathie du premature s’explique par une prematurite de plus en plus importante, et un diagnostic de plus en plus precoce. Un depistage efficace, realise entre 4 et 6 semaines de vie, tenant compte des facteurs de risque de l’enfant peut en ameliorer le pronostic.

Introduction Les mucopolysaccharidoses (MPS) forment un groupe de maladies de surcharge lysosomales hereditaires heterogenes, caracterisees par un facies en « gargouille ». Le deficit enzymatique concerne le catabolisme des glycosaminoglycanes, dont l’accumulation entraine des troubles generaux et ophtalmologiques graves. Cas cliniques Nous rapportons les cas de 2 fillettes âgees de 18 mois, consultant pour cornees troubles et photophobie. Le diagnostic a ete evoque devant leur dysmorphie faciale puis confirme biologiquement. Il s’agissait d’une maladie de Scheie (MPS type I-S) et d’une maladie de Hurler (MPS type I-H). Les opacites corneennes etaient isolees ou associees a un œdeme papillaire bilateral. Une enzymotherapie a ete instauree dans les 2 cas dans l’attente d’une allogreffe de moelle, avec un meilleur pronostic dans le premier cas compte tenu du type de MPS et de l’atteinte neurologique moins avancee. Discussion L’accumulation des glycosaminoglycanes, presents sous diverses formes dans les tissus oculaires, peut entrainer des opacites stromales, un glaucome secondaire, une retinopathie de type pigmentaire, et/ou un œdeme papillaire. Alors que l’atteinte ophtalmologique est souvent au second plan, elle peut cependant amener l’ophtalmologiste au diagnostic de MPS. Conclusion La precocite du diagnostic des MPS, avant la constitution des deficits neurologiques, est devenue primordiale, puisque le traitement peut en stopper l’evolution. Ainsi, une meilleure connaissance du tableau clinique par les ophtalmologistes pourrait en ameliorer le pronostic.

Purpose Childhood noninfectious uveitis is a relatively uncommon but severe disease. All cases seen at the Tours's Hospital were included in this study and were equally followed by the multidisciplinary consultation to evaluate our practice over time. Methods 44 children followed from 2003 to 2013 were included. Demographic criteria (gender, age, type of uveitis, initial and final clinical description) and therapeutic outlines were recorded. A vision quality questionnaire Eye–Q associated with a tolerance questionnaire were sent to all patients. Results 66% were girls, the average age of diagnosis is 6.5 years and 48% of cases were JIA. Average final visual acuity was approximately 20/20. The initial treatment was topical corticotherapy alone in 47% of cases, and 42% associated with oral corticosteroids. Since the introduction of our multidisciplinary consultation, the delay in determining the change in treatment has been decreased (p = 0.001) without modifying neither the duration nor the dose of corticosteroid therapy. 16% developed new ocular complication during average follow-up of 39 months. 60% of the ocular complications de novo could be topical corticosteroid related. The response rate was 62% and 66% with preserved quality of vision. The Eye – Q score was correlated with the visual acuity but not with the duration or the doses of any treatments. Conclusions Our population showed similarity to that of the literature, except for the early support. Our Visual and inflammatory results were satisfactory, which could be explained by the introduction of our multidisciplinary consultation allowing a faster adaptability of therapeutics.

But Etude prospective cas-temoins visant a evaluer la qualite de vision des patients porteurs d’un implant aspherique prolate comparativement a un implant spherique standard. Patients et methode Vingt patients devant avoir une intervention chirurgicale pour une cataracte ont ete divises aleatoirement en deux groupes : 10 patients (10 yeux) ont recu un implant aspherique prolate (TECNIS Z9000, AMO, Etats-Unis) et 10 patients (10 yeux) ont recu un implant spherique standard (911 CeeOn Edge, AMO, Etats-Unis). L’absence de pathologie oculaire a ete verifiee par un examen clinique complet associe a un electroretinogramme multifocal. Le bilan preoperatoire comportait en outre une evaluation de la sensibilite aux contrastes en ambiance mesopique, photopique et a l’eblouissement. Le bilan post-operatoire effectue deux mois apres la chirurgie associait une etude de refraction avant et apres mydriase induite, une pupillometrie, une sensibilite aux contrastes ainsi qu’une aberrometrie. Resultats La meilleure acuite visuelle postoperatoire ne differait pas dans les deux groupes (0,95 ± 0,13 pour le groupe « TECNIS » et 0,98 ± 0,11 pour le groupe « 911 », p = 0,32). L’evaluation refractive a revele une myopisation en mydriase des patients porteurs de l’implant 911 (-0,10 ± 0,30 D pour le groupe « TECNIS » versus - 0,68 ± 0,21 D pour le groupe « 911 », p = 0,002). Les patients porteurs de l’implant TECNIS ont montre une sensibilite accrue aux contrastes en ambiance mesopique (p = 0,003 aux frequences intermediaires et p = 0,002 aux frequences elevees), alors que les sensibilites photopique et a l’eblouissement n’etaient pas differentes. La moyenne des aberrations optiques d’ordre eleve etait similaire (RMS = 0,36 ± 0,07 mm versus 0,33 ± 0,19 μm, respectivement pour les groupes « TECNIS » et « 911 », p = 0,21), mais le groupe TECNIS presentait une aberration spherique significativement inferieure a celle du groupe controle (Z40 = 0,03 ± 0,06 μm versus 0,20 ± 0,14 μm, respectivement pour les groupes « TECNIS » et « 911 », p = 0,029). Conclusion L’etude combinee des aberrations du front d’onde et de la sensibilite aux contrastes a permis une evaluation objective de la qualite de vision apres chirurgie de la cataracte. Comparativement a un implant spherique standard, l’utilisation d’un implant aspherique prolate pourrait reduire les aberrations spheriques et ameliorer la vision mesopique du patient pseudophake.

But Evaluation de l’apport de l’echographie tres haute frequence (ETHF) dans le suivi comparatif in vivo des modifications corneennes epitheliales induites par une toxicite medicamenteuse locale. Materiel et methode Une solution de timolol contenant 0,01 % de chlorure de benzalkonium (BAC) (Timoptol ® ) a ete instillee deux fois par jour dans l’œil test de 10 lapins pendant deux mois, tandis que l’œil temoin recevait la meme solution sans BAC (Timabak ® ). Nous avons utilise une ETHF a 60 MHz afin d’evaluer in vivo la toxicite corneenne du BAC. Cette etude prospective et comparative comportait une evaluation clinique et echographique hebdomadaire ainsi qu’une analyse histologique finale. Resultats Les examens cliniques ont mis en evidence une alteration de la surface oculaire des cornees exposees au BAC : hyperhemie conjonctivale, keratite et alteration du film lacrymal. L’ETHF a revele une decroissance dans le temps de l’epaisseur epitheliale des cornees exposees au BAC (de 40,9 ± 1,6 μm a J0, a 31,8 ± 3,4 μm a J56 ; p = 0,0006), alors que les cornees non-exposees presentaient une stabilite de l’epaisseur epitheliale. Les mesures quantitatives de l’epaisseur epitheliale corneenne par ETHF etaient correlees a l’atteinte corneenne clinique (a J34 et J56 ; p = 0,0025 et p = 0,0377 respectivement) ainsi qu’aux mesures morphometriques histologiques (p = 0,0176). De plus, l’ETHF a permis la visualisation echographique precoce et in vivo des alterations morphologiques epitheliales induites par le BAC. Conclusion L’ETHF a permis un suivi in vivo des modifications epitheliales induites par une exposition chronique a un conservateur. Cette technique d’imagerie in vivo pourrait permettre une evaluation objective, reproductible et precoce de la pathologie toxique de la surface oculaire.

Vogt-Koyanagi-Harada disease is an autoimmune bilateral uveitis that occurs in people with genetic sensitivity. Diagnosis was based on the association of ocular inflammatory manifestations such as diffuse choroiditis, with or without anterior uveitis, and extraocular manifestations such as meningismus, tegumentary or auditory findings. Intravenous pulses of corticosteroid followed by oral corticosteroid is the mainstay therapy. We present the case of a woman who showed a first improvement of symptoms with three consecutive daily pulses of corticosteroid, but none during the following oral therapy. A second phase of intravenous pulses of corticosteroid, a Month after the first one, induced great improvement in symptoms and retinal findings, whereas oral therapy seemed not to be effective. This case provides the opportunity for a discussion on the advantages of multiple pulses of corticosteroid at the acute phase of this disease, because of its vascular effects associated with anti-inflammatory effects.

Nous rapportons trois cas d’endophtalmies par Enterococcus faecalis secondaires a une chirurgie de la cataracte. L’acuite visuelle initiale etait limitee a la perception lumineuse dans les trois cas. L’acuite visuelle finale etait la perception lumineuse negative dans 2 cas, et positive dans un cas. Apres une amelioration initiale chez un des patients, une poussee inflammatoire est apparue, necessitant une evisceration. La capsule posterieure a ete analysee en microscopie electronique a balayage. Seule l’analyse bacteriologique de la capsule a permis de mettre en evidence une culture de Enterococcus faecalis. L’analyse en microscopie electronique etait compatible avec cette bacterie, adherente a la capsule. Ce germe peut donc etre responsable a la fois d’endophtalmies aigues, mais aussi d’endophtalmies chroniques. La contamination est probablement post operatoire, car Enterococcus faecalis n’est pas un germe commensal de la flore conjonctivale. Les patients doivent etre informes de ces risques et des mesures d’hygiene necessaires a leur prevention.

Purpose To determine the level of residual spherical aberration that gives the best objective and subjective quality of image after cataract surgery with intraocular lens (IOL) implantation. Methods Six months after microincision (1.8 mm) cataract surgery with aspheric IOL implantation, total aberrations were computed using a Wavescan aberrometer. The modulation transfer function (MTF), Strehl ratio, and objective index of scattering were measured using the Objective Quality Analysis System. Objective depth of focus was computed as the focus range at which the Strehl ratio did not fall below 50% of maximum. Subjective depth of focus was calculated as the difference between the vergence of the punctum remotum and that of the punctum proximum. Results Thirty patients (54 eyes) were evaluated. The MTF cutoff values were higher with decreasing total ocular spherical aberration (r = 0.56; P

Purpose To compare binocular subjective quality of vision with modified monovision (MMV) (ie different combinations of spherical (SA4) and secondary spherical (SA6) aberration on each eye) versus traditional monovision (TMV) with different level of anisometropia Methods A numerical eye model was used to generate images (ie three 0.4 logMAR high contrast letters) viewed through a 4.7mm pupil, degraded by various condition of SA and for proximities from -5D to 5D (Naked eye, SA4-0.4μm, SA4+0.4μm, SA4-0.4 and SA6+0.2μm, SA4+0.4 and SA6-0.2μm). Binocular vision was simulated using a 3D-NVIDIA video device projecting different image on each eye. Binocular through-focus (TF) quality of vision was evaluated using a grading scale (ITU-R 500 recommendation) by four subjects with TMV for different level of anisometropia (ie 0.5 to 3D at 0.5D step) and with various combination of MMV Results Area under TF curve (ie a way to evaluate quality of vision) measured for a fair or higher image quality was increased with TMV and MMV compared to naked eye because of the summation of the two best monocular curves. With TMV, a 2.5D anisometropia was the more effective to increase area under TF curve with however a lack of intermediate vision. With MMV the greatest increase of quality of vision was obtained with reverse profile of SA4 and SA6 on each eye (ie SA4-0.4 and SA6+0.2μm on one eye and SA4+0.4 and SA6-0.2μm on the other eye). Compared to TMV, reverse profiles of MMV showed a significant benefit in improving area under TF curve thanks to a better quality of intermediate vision Conclusion MMV especially with reverse profiles of SA improved overall quality of vision without the lack of intermediate quality of vision intermediate quality of vision induced by TMV

Purpose To evaluate tear break-up time (BUT) with repeated higher order wavefront aberrations (HOA) measurements in adult patients with Meibomian Gland Dysfunction(MGD). Methods Wavefront aberrations up to the sixth order for a 4-mm pupil were measured in 10 normal subjects (Group 1) and 10 patients with severe MGD (Group 2) with corneal involvement, using the IRX3 (Imagine Eyes, Orsay, France) Hartmann-Shack (H-S) aberrometer. The aberrometry was performed once every second for up to 20 seconds. HOA measurements were performed 3 times in a row. HOA variations were compared with the BUT by the conventional fluorescein method(CFM). Results There was an excellent correlation between the HOA variation and the BUT recorded by the CFM in both groups. There was also an excellent reproducibility of the HOA measurements in all patients. BUT was significantly decreased (P

Purpose To evaluate the effect of different combinations of spherical (SA4) and secondary spherical (SA6) aberration on each eye on binocular subjective quality of vision. Methods A numerical eye model was used to generate images (ie three 0.4 logMAR high contrast letters) viewed through a 4.7mm pupil diameter and degraded by various spherical aberrations (SA4-0.4μm, SA4+0.4μm, SA4-0.4μm and SA6+0.2μm, SA4+0.4μm and SA6-0.2μm). Binocular vision was simulated using a 3D-NVIDIA video system projecting different image on each eye. Through-focus quality of vision was evaluated using a grading scale (ITU-R 500 recommendation) by three subjects under monocular and binocular condition for each tested conditions (ie various combination of the five aberration profiles). Results Binocular through-focus curve followed the best monocular curve. Binocular inhibition was obtained if subjective image quality was too different between the two eyes. We rarely measured binocular summation in term of subjective quality of vision. Ocular dominance seemed to affect the level of inhibition: binocular inhibition was limited when the dominant eye saw the best image. Area under the binocular curve (ie a way to evaluate subjective depth-of-focus) measured for a fair or higher image quality was increased with all combinations compared to naked eye because of the summation of the two best monocular curves. The greatest increase was obtained with reverse profile of SA4 and SA6 between each eye (ie SA4-0.4μm and SA6+0.2μm on one eye and SA4+0.4μm and SA6-0.2μm on the other eye). Conclusion The use of different spherical aberration on each eye leads to a better binocular through-focus curve especially with combination of opposite sign of SA4 and SA6. However there is no binocular summation of vision quality.

Purpose To evaluate tear break-up time (BUT) with real-time (RT) higher order wavefront aberrations (HOA) measurements in myopic patients after Laser-Assisted In Situ Keratomileusis (LASIK) surgery. Methods HOA up to the sixth order for a 4-mm pupil were measured in 20 normal subjects (Group 1) and in 20 myopic patients, with no history of dry eye (DE), before and after LASIK surgery (Group 2), using the IRX3 (Imagine Eyes, Orsay, France) Hartmann-Shack (H-S) aberrometer. The HOA measurements were performed (in triplicate) with a new dedicated software, once every second for up to 20 seconds. HOA variations were compared with the BUT by the conventional fluorescein method (CFM). Results Twenty percent of the patients from Group 2 were complaining from DE symptoms. There was an excellent correlation between the HOA variation and the BUT recorded by the CFM in both groups. Reproducibility of the HOA measurements in all subjects and patients was excellent. BUT was significantly decreased (P

Purpose Many genes can be involved in congenital cataracts according to different inheritance pattern. NHS (Nance-Horan Syndrome) gene is involved in a rare X-linked syndromic cataract associating dental anomalies and facial dysmorphia. NHS gene mutations are essentially protein truncating mutations. Studies of gene localization show that non-syndromic form of congenital cataract have a gene located in the same region as the NHS gene. The purpose of this study was to determine if others mutations of the NHS gene might cause non syndromic cataracts and to analyse the expression of NHS in lenses. Methods Genomic DNA was isolated from white blood cells from 30 patients diagnosed with non syndromic congenital cataracts. When a surgery was performed, lenses were collected (n=10). The 11 exons of NHS gene were amplified from genomic DNA by PCR, and the amplicon were directly sequenced. NHS gene copy number anomalies were search by real time PCR. mRNA was extracted from the front capsule of lenses. After reverse transcription mRNA expression was analyzed by real time PCR. Results We identified 6 punctual mutations of NHS gene in different patients : 2 missenses mutations, 3 frameshift mutations and one intronic mutation. The analyze of NHS copy number revealed in one patient a duplication of exons 4 to 8. We manage to extract and amplified NHS mRNA in the front capsule. One patient with a missense mutation has a relative low expression. Conclusion We found 23% mutations of NHS gene in our cohort study. For some patients we can’t yet absolutely eliminate a Nance Horan Syndrom because of their young age. This high rate of mutations mean either the diagnostic of NHS is under evaluate or NHS gene is frequently involved in non syndromic cataracts.

The Optical Quality Analysis System (OQAS) has the advantage over Hartmann-Shack aberrometers of being capable of measuring both wavefront aberrations and scatter. In patients with eyes with mild scatter, both techniques give similar results. However in eyes severe amount of scatter, Hartmann-Shack aberrometry may overestimate the quality of vision. On the other hand, the OQAS suffers from a certain level of background noise, generated by the choroid. During this presentation we will determine the current indications for those two techniques.

Purpose To assess optical quality before and after treatment with Meibopatch© (eyelid-warming device) in patient with mild and severe Meibomian gland dysfunction. Methods The Meibopatch© was applied for 5 minutes twice a day for one month to 20 eyes of 10 patients who exhibited dry-eye symptoms (OSDI), decreased tear film break-up time (TFBUT) due to altered meibomian gland secretions. We examined TFBUT, meibomian gland secretions, dry-eye symptoms, and assessed optical quality with OQAS (MTF and OSI) and Hartmann-Schack (RMS) aberrometry before, 15 days and 1 month after treatment. Results We have observed a significant improvement of the BUT, OSDI, Meibomian gland secretion quality, MTF and OSI after treatment. Conclusion The Meibopatch © eyelids warming device improved dry-eye symptoms, TFBUT and meibomian gland secretion quality. Our study showed also a significant improvement of both MTF and OSI.

Purpose To evaluate tear break-up time (BUT) with repeated higher order wavefront aberrations (HOA) measurements. Methods Wavefront aberrations up to the sixth order for a 4-mm pupil were measured in 10 subjects using the IRX3 (Imagine Eyes, Orsay, France) Hartmann-Shack (H-S) aberrometer. The aberrometry was performed once every second for up to 20 seconds. HOA measurements were performed 3 times in a row. HOAvariations were compared with the BUT by the conventional fluorescein method (CFM). Results In 9 patients out of 10 there was an excellent correlation between the HOA variation and the BUT recorded by the CFM. There was also an excellent reproducibility of the HOA measurements in all patients. Conclusion H-S aberrometry can be used in our daily practice for an objective and reproducible assessment of the BUT.

Purpose To evaluate tear break-up time (BUT) with repeated higher order wavefront aberrations (HOA) measurements in children with Meibomian Gland Dysfunction(MGD). Methods Wavefront aberrations up to the sixth order for a 4-mm pupil were measured in 10 normal children (Group 1) and 10 children with severe MGD (Group 2) with corneal involvement, using the IRX3 (Imagine Eyes, Orsay, France) Hartmann-Shack (H-S) aberrometer. The aberrometry was performed once every second for up to 20 seconds. HOA measurements were performed 3 times in a row. HOA variations were compared with the BUT by the conventional fluorescein method (CFM°. Results There was an excellent correlation between the HOA variation and the BUT recorded by the CFM in both groups. There was also an excellent reproducibility of the HOA measurements in all patients. BUT was significantly decreased (P

Purpose to evaluate the feasibility and to compare the results of different algorithms of tractography by diffusion weighted (DWI) magnetic resonance imaging (MRI) coupled with retinotopy by functional MRI (fMRI) at 1,5 tesla, to study the optic radiations. Methods one healthy subject had: (1) a fMRI with visual stimulations by sectorial contrast alternating checkerboard patterns (2) a DWI MRI and (3) anatomical acquisitions. Optic radiations were tracked by both deterministic and probabilistic algorithms, using anatomical and functional data. Results the optic radiations reconstructions agreed with literature data. The deterministic reconstruction algorithm is conceivable in current practice, and can correctly tracked the optic radiations with a good view of the Meyer loop, unlike the probabilistic reconstruction algorithm, whose post treatment is long and results disappointing. Conclusion tractography coupled with the retinotopy is feasible at 1,5 tesla to study the optic radiations with deterministic reconstruction algorithm but not with probabilistic algorithm.

Purpose Several studies, using limbal stem cells or mesenchymal stem cells (MCSs), have confirmed the usefulness of these cells to repair epithelial and stromal corneal tissue. However the reparation process might be hampered by a strong inflammatory reaction inducing non-physiologic remodelling of healing tissue. The use of genetically modified cells with inducible gene to control the stromal reaction might offer an opportunity to improve new treatments in ophthalmology. Methods We aimed at transducing MSCs with an Ecdysone inducible lentivirus. To the end, we generated a conditional expression vector, expressing the luciferase under an ecdysone expression system. We have transduced MSCs and evaluated their ability to synthetize on « demand » the luciferase. Following validation of the process in cultured cells, the genetically modified cells will be evaluated in vivo, in rat. Results Using an in vitro recombination system, we generated a lentiviral vector containing the luciferase as transgene, placed under an Ecdysone promoter (« E/Luc »). To obtain an effective control of the luciferase, we generated a second vector containing the RXR gene and VgEcR gene under a constitutive promoter (« V/R »). Viral recombinant vectors were produced through 293T cells. MSCs were first transduced by the « V/R » vectors followed by the “E/Luc” lentiviruses. Finally, we have tested the responsiveness of the Ecdysone system in MSCs by adding Ponasterone and enzymatic activity of the Luc gene. Conclusion We predict that it could be applied to follow in vivo MSCs after their corneal engraftment. Upon validation of the system, the use of inducible gene expression could be applied to pathological wound-healing.

Purpose Patient complaints such as blurry vision are a very common symptom of dry eye syndrome. We will summarize technologies to measure the optical effects of tear film instability. Methods There are several noninvasive techniques for assessing the kinetics of tear film : high-speed videokeratoscopy, dynamic wavefront sensing and lateral shearing interferometry. Interferometry or break up time are sensitive techniques for recording tear film surface irregularities in a noninvasive manner. Results However, in order to understand the visual complaints associated with tear film instability, we need some dynamic visualization of the corneal tear film quality. Shack-Hartmann wavefront sensor and wavefront aberration could realize an objective evaluation of optical quality of the eye between blinks. We will discuss the use of higher-order aberrations fluctuations during 10 seconds. At last, we will try to quantify the visual impact of dry eye using objective scattering index. Conclusion Dynamic aberration maps may be used for diagnosis of dry eye and for monitoring drops efficiency.

International audience; PURPOSE: Investigate the genotype-phenotype correlations for five TGFBI (transforming growth factor, beta-induced) mutations including one novel pathogenic variant and one complex allele affecting the fourth FAS1 domain of keratoepithelin, and their potential effects on the protein's structure. METHODS: Three unrelated families were clinically diagnosed with lattice corneal dystrophy (CD) and one with an unclassified CD of Bowman's layer. Mutations in the TGFBI gene were detected by direct sequencing, and the functional impact of each variant was predicted using in silico algorithms. Corneal phenotypes, including histological examinations, were compared with the literature data. Furthermore, molecular modeling studies of these mutations were performed. RESULTS: Two distinct missense mutations affecting the same residue at position 509 of keratoepithelin: p.Leu509Pro (c.1526T>C) and p.Leu509Arg (c.1526T>G) were found to be associated with a lattice-type CD. The novel p.Val613Gly (c.1828T>G) TGFBI mutation was found in a sporadic case of an Algerian individual affected by lattice CD. Finally, the Bowman's layer CD was linked to the association in cis of the p.Met502Val and p.Arg555Gln variants, leading to the reclassification of this CD as atypical Thiel-Behnke CD. Structural modeling of these TGFBI mutations argues in favor of these mutations being responsible for instability and/or incorrect folding of keratoepithelin, predictions that are compatible with the clinical diagnoses. CONCLUSIONS: Description of a novel TGFBI mutation and a complex TGFBI allele further extends the mutational spectrum of TGFBI. Moreover, we show convincing evidence that TGFBI mutations affecting Leu509 are linked to the lattice phenotype in two unrelated French families, contrasting with findings previously reported. The p.Leu509Pro was reported to be associated with both amyloid and non-amyloid aggregates, whereas p.Leu509Arg has been described as being responsible for Epithelial Basement Membrane Dystrophy (EBMD).

To assess the relationship and respective contribution of ocular higher-order aberrations (HOAs) on residual accommodative performance in presbyopic patients.We enrolled 20 patients (40 eyes) without ophthalmological pathology, between 48 and 58 years old, with a best-corrected visual acuity more than 10/10. Total aberrations were computed using the Wavescan Aberrometer (AMO, USA). The defocus curve and near visual acuity (30 and 50 cm) were measured. The relationship between accommodation ability and HOAs was evaluated aiming at a linear relationship with a simple regression analysis and with a multiple linear regression analysis (including manifest refraction, ocular aberrations, and age).Even if age and manifest refraction were correlated with accommodative ability, ocular coma seemed to be correlated with near visual acuity without addition and with minimal addition for reading P1.5 at 30 cm (respectively, r(2)=0.117 with P=0.035 and r(2)=0.163 with P=0.012). Total spherical aberration appeared to be correlated with minimal addition (r(2)=0.12 with P=0.032).Ocular aberrations (coma and spherical aberration) are correlated with accommodative performance in presbyopic patients, independently of age and manifest refraction.Ocular aberrations appeared to be a stimulus for accommodation but may also influence quality of accommodative reply.

Purpose To investigate the influence of the secondary implantation site of the Verisyse® iris-claw intraocular lens (IOL) on high order aberrations (HOAs) using wavefront analysis in aphakic patients. Methods Twenty five aphakic patients (25 eyes) who had been left aphakic after complicated phacoemulsification, leaving no capsular support, but good iris support and clear unwounded cornea implantated with the aphakic Verisyse®(AMO) IOL either implanted retropupilarely or over the iris. Wavefront aberrations and contrast sensitivity were measured using the Imagine Eyes IRX3 SH aberrometer. Results Twelve patients were implanted in the anterior chamber versus thirteen, who had the IOL clipped behind the iris. Surgery was uneventful in all patients. No postoperative complication was observed in the two groups. Best corrected visual acuity was significantly higher and HOAs were significantly lower in the retropupilarely implanted group. Simulated contrast sensitivity results calculated from Point Spread Function measurements were significantly better in the retropupilarly implanted group. There was no significant difference regarding HOAs and vision quality between the retropupillary implanted group and the panel of control âtients implanted with standard monofocal IOL in the capsular bag. Conclusion In addition to being atraumatic, the Verisyse® IOL implanted behind the iris may restore vision in the absence of capsular support in a more physiological way than when fixated over the iris. The overall quality of vision is better when the Verisyse® is implanted behind the iris and comparable to values obtained with standard monofocal IOLs.

Purpose To evaluate in vivo confocal microscopy (IVCM) analysis and high frequency ultrasounds (US) assessment in the follow-up of filtering blebs. Methods We retrospectively evaluated 38 filtering blebs (29 patients) which underwent filtering surgery for glaucoma with a mean follow-up time of 16.4 ± 8.4 months. Examination included IVCM and high frequency US. Filtering blebs were classified in 3 functional clinical groups according to the final intra ocular pressure (IOP): target IOP reached without medication (group 1), target IOP reached with medication (group 2) and target IOP not reached despite medication (group 3). Results Our results showed that failed blebs (group 3) present a low density of microcysts (p=0,0035). Microcysts density was correlated negatively to final IOP (r2=0,23 with p=0,002). We also noticed that eyes with a low microcyst density had been treated with more preserved drops per day prior to the surgery (r²=0,12, p=0,04).This point out the negative influence of preservatives on the conjunctiva creating ocular surface damage and modifying its healing process after filtering surgery. Moreover, IVCM examination did not find any relevant differences between ultrasound groups. In clinically efficient blebs we established a panel of microscopic criteria which could define a higher failure risk group not detected by clinical examination or US imaging. Conclusion IVCM enables a precise imaging of filtering blebs at a microscopic level. It brings a panel of valuable criteria for the detection of microscopic signs associated with failed and fibrosed blebs, or with higher failure risk group.

Purpose To compare visual acuity, total and high order wavefront aberrations (coma, spherical aberration, and other terms of high order aberration), and contrast sensitivity in eyes implanted with the multifocal Restore IOL versus the multifocal Acrylisa IOL. Methods Patients were divided in two groups: group 1 (8 patients, 16 eyes implanted with Restor) and group 2 (15 patients / 30 eyes implanted with Acrylisa). All eyes were targeted for emmetropia. Complete ophthalmological examination, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA) was performed. Contrast sensitivity evaluation,and wavefront analysis, were performed with the Imagine Eyes IRX3 wavefront aberrometer. Measurements with the IRX3 were performed in triplicate in order to verify the robustness of the data. Results All eyes in all groups had BSCVA > or = 20/20 postoperatively. Measurements with the IRX3 were easily obtained. The triplicate measurements confirmed the robustness of the data. Mean total aberration root-mean-square (RMS) values and higher order aberrations (HOA) value were not significantly different between the two groups. Residual spherical aberration values were comparable in both groups and appeared inferior if to the ones previously obtained with non aspheric standard monofocal IOLs. Mean contrast sensitivity values were comparable in both groups. Conclusion The measurement of higher order aberrations in patients implanted with multifocal IOLs is easy and reproducible with the IRX3. There is no statistical difference between the values obtained in the 2 groups regarding RMS and HOA. Contrast sensitivity revealed similar values in both groups.

Purpose Gene therapy might offer an opportunity to improve new treatments in ophthalmology. Several studies, using limbal stem cells or mesenchymal stem cells (MCSs), have confirmed the usefulness of these cells to repair epithelial and stromal corneal tissue. Methods We designed a strategy aimed at expressing Luciferase gene. We have tested the viability of mesenchymal stem cells modified by a lentiviral vector delivery system. To allow an adaptative treatment, the target genes would be transcriptionally controlled by the use of an Ecdysone inductible promoter. Results Construction of a lentiviral plasmid with the transgene (luciferase) and inductible promoter: Ecdysone by recombination. Construction of a lentiviral plasmid with the RXR gene and VgEcR gene and a constitutive enhancer. Transfection of 293 FT cells for lentiviral production. MSCs Transduction by “V/R” lentivirus and by “E/Transgene” lentirus. We have tested induction of Ecdysone system and transcription of the transgene (luciferase) in MSCs adding Ponasterone. Conclusion The expression of luciferase, using conditionnal expression vectors, could be applied after an engraftment of mesenchymal stem cells for pathological wound healing in Sprague-Dawley rat cornea.

Purpose To compare quality of vision in pseudophakic patients with customized-asphericity intraocular lens (IOL) compared to patients with zero-aberration IOL after a Micro-Incision Cataract Surgery (MICS). Methods 26 patients (41 eyes) were divided into two groups: 24 eyes received a customized-aspheric IOL in both eyes and 17 eyes received zero-aberration IOLs. IOL asphericity was customized according to the preoperative corneal spherical aberration (SA) in order to obtain a total ocular SA close to +0 µm. We implanted either aspherical AcriSmart 36A® generating a -0,18 µm SA (for a 6 mm pupil diameter), or zero-aberration AcriSmart 46LC®. Postoperative evaluations were conducted 6 months after MICS: refraction, best-corrected visual acuity (BCVA), contrast sensitivities, point spread function (PSF), Modulation Transfer Function (MTF), objective depth-of-focus and ocular wavefront aberrations were analyzed. Results Postoperative BCVA was similar in both groups (-0,021 ± 0,105 LogMAR for the custom group versus 0 ± 0,11 LogMAR, p=0,58). Mesopic contrast sensitivity was significantly better in the custom group at intermediate and high spatial frequencies (p

Purpose To assess the impact of residual spherical aberration (SA) on objective quality of vision in pseudophakic patients. Methods 15 patients (25 eyes) were divided into 2 groups: 13 eyes received an aspherical AcriSmart36A® generating a negative SA, 12 eyes received a zero-aberration AcriSmart46LC®. Postoperative evaluations were conducted 6 months after a 1.8mm micro incision cataract surgery. Aberrometric measurements were done for a standardized pupil size of 5 mm in mesopic conditions using Wavescan Aberrometer®. Modulation Transfer Function (MTF), Strehl ratio and depth of field were measured with Objective Quality Analysis System®. Results Best corrected 100% LogMar distance visual acuity (BCVA) was similar in both groups (p=0.89). 20% and 9% BCVA was increased in 36A® group (p=0.009 and 0.005). Mesopic contrast sensitivity was better and total spherical aberration were significantly less with 36A® IOL(SA=0.075±0.05 μm with 36A® and 0.20±0.05 μm with 46LC®,p=0,0002). Coma and trefoil were not different between the two groups (p>0,05). 36A® induced better image quality with an average MTF of 32.7±9.6 c/deg with 36A® and 23.8±8.1 c/deg with 46LC®, p=0.0002. The 36A® group had 1D less depth of focus than the 46LC® group at 6 months : respectively 1.3±0.59D and 2.27±0.63D. For the whole population, depth of focus appeared to be correlated with SA (r2=0.28, p=0.02) and with trefoil (r2=0.49, p=0.0009). Conclusion While reducing total ocular SA, aspheric IOLs improved mesopic contrast sensitivity, quality of vision with greater MTF values. Reduction of aberrations may be responsible for reduced depth of focus with 36A® IOLs. However, residual trefoil aberrations may be advantageous for depth of focus and reading ability.

Purpose To evaluate the operative results of spheno-orbital meningiomas regarding resectability, recurrence and ophthalmological outcome. Methods Retrospective study of 40 patients who underwent surgical resection of spheno-orbital meningiomas followed by bony reconstruction between 1992 and 2008. Results Mean age of 50 years and sex ratio of 37 women and 3 men. The most common preoperative sign was proptosis (90%), visual acuity (VA) and visual field deficits (55%). Periorbital tumor infiltration is a predictive factor of decreased VA in case of initial VA deficit. Optic canal invasion and resection don’t influence VA recovery. Postoperatively, 10 patients showed severe permanent visual field deficits, versus 17 patients showed no visual field deficits. After surgery, proptosis improved for all patients with a preoperative mean proptosis of 5,6 +/- 3,6 mm versus 2,2 +/- 2,7 mm postoperatively (p 90%) tumor resection gives a long-term survival free of clinical recurrence for 80 % of our patients.

Treatment of detachment retinal is essentially surgical and making by external (scleral buckling) or internal (endocular chirurgy chirurgy) methid. Authors relate functional and anatomical result of retinal detachment in elderly's population. Retrospective study realized in ophthalmological clinic of University and Hospital Center of Tpirs; is concerning fifty-three patients mean aged of 76 years and treating to Irst January 1998 at 31 December 1999 by sclerall buckling in first intention. The authors have noticed one year after surgical treatment, an anatomical recuperation of 71,15 % (n=37) with 59,45 % of functional success superior to 4/10 degrees Seleral buckling can be also to considere as a valid treatment in case of retinal detachment trentment of clderly population.

Purpose The main aim of the study was to compare sensorial and oculomotor examinations in a sample of strabismic young patients corrected with eyeglasses and secondarily fitted with contact lenses. The second aim was to evaluate the quality of life. Methods Forty-eight patients were included (8 to 19 years-old) in Tours University Hospital from June 1st 2005 to May 31st 2007. Oculomotor and sensorial examinations were performed. Results Thirty-seven patients had a mean follow-up of 17.6 months. Twenty-six patients had strabismus. Contact lens wear was stopped in 22.9% cases. In esotropic patients, the decrease of horizontal deviation angle in distant vision with lens was significantly more important when the initial angle measured with eyeglasses was more than 8 dioptries. The contact lens spherical power was significantly higher than the eyeglasses power. We did not find significant difference of quality of life in strabismic young person and the control group. Those results show that contact lens wear can uncover residual accommodation and can decrease the horizontal deviation angle in distant vision when the initial angle is higher than 8 dioptries. Conclusion Contact lens fitting has to take part in the global medical management of strabismus, especially in young patients willing to give up wearing eyeglasses.

Purpose To compare the outcomes of coaxial microincision cataract surgery (C-MICS) versus standard coaxial cataract surgery. Methods In a prospective study, 60 eyes of 30 patients with corticonuclear cataract were selected to have a crystalline lens extraction through a temporal clear corneal incision using either C-MICS (30 eyes) or standard coaxial cataract surgery (30 eyes). C-MICS was performed through a 1.8 mm incision, and coaxial standard cataract surgery through a 3 mm incision. In all cases, hydrophilic intraocular lens was implanted. Collected parameters during the surgery were total surgical time, ultrasound time, and total balanced salt solution used. Preoperative and postoperative parameters collected were refraction, visual acuity, slit lamp exams and endothelial cell counts with corneal thickness evaluation. Results There was no significant difference in postoperative parameters between the 2 groups. On the other hand, there was a significantly lengthening of surgical total time and ultrasound time in MICS group. Conclusion Although ultrasound and total surgical time were significantly higher in coaxial microincision cataract surgery, this technique appears to be as safe and efficient than standard coaxial cataract surgery.

Purpose We report the first case of acute and late-onset Autosomal Dominant Optic Atrophy with a novel mutation. Autosomal Dominant Optic Atrophy (ADOA) is an inherited primary optic neuropathy that leads to reduced visual acuity. ADOA has often been associated with mutations in OPA1 gene. OPA1 encodes a large dynamin-related GTPase, involved in mitochondrial structure, mitochondrial DNA maintenance and apoptosis regulation. Methods We conducted direct DNA sequencing of the entire coding sequence and the exon/intron junctions of OPA1 gene. Results A 62-year-old woman noticed blurred vision with a central scotoma. Visual loss was sudden, painless and severe in her right eye. Papillary edema was noted. Left visual loss occurred one year after initial presentation. The ophthalmoscopic feature of our patient was diffuse optic disc atrophy. MRI examination confirmed the diagnosis of isolated bilateral optic neuropathy. We did not found any neurological, metabolic, toxic, or ophtalmic causes. One novel heterozygous missense mutation in exon 27 was characterized. This mutation has not been previously reported, was absent in 400 control chromosomes and affected highly conserved amino acids. Conclusion The age of onset, like ADOA penetrance must be accepted to be more variable than initially thought, including late-onset cases. The presence of an OPA1 mutation reveales that this sporadic late-onset and acute case of optic neuropathy is related to ADOA. This result shows that the mutation screening of OPA1 gene could be justified in every case of optic nerve atrophy with no clear cause.

To compare the effect of timolol with or without preservatives on the conjunctival epithelium of glaucoma patients.A retrospective study using impression cytology (IC) was conducted on patients treated with 0.5% timolol with or without 0.01% benzalkonium chloride (BAC). Fifteen eyes from 15 patients treated with timolol, BAC+ and 17 eyes from 17 patients treated with timolol, BAC- were included in two groups comparable for age and duration of treatment lasting at least 1 year. Specimens were analyzed by flow cytometry for inflammatory profile (using antibodies directed against HLA DR and ICAM-1) and mucin detection (anti-M1/MUC5AC antibody).IC analyses showed a significant increase in the expression of the two inflammatory markers, HLA DR and ICAM-1 in the timolol, BAC+ group and also a significant decrease in goblet cell density in the same group as compared to the timolol, BAC- group.The use of long-term preserved beta-blocker in glaucoma patients is associated with a direct subclinical epithelial toxicity in the conjunctiva, as already demonstrated by previous experimental studies.

Background/aim: Retinal vein occlusion (RVO) is one of the most frequent ocular vascular diseases and leads to severe vision impairment. Colour Doppler imaging (CDI) is the first method which allows distinct evaluation of arterial and venous velocities in RVO. CDI is valuable for diagnosis of RVO and shows the effects of isovolaemic haemodilution. Patients with RVO were monitored by CDI for 1 year in order to clarify venous and arterial involvement in the pathogenesis of this disease. Methods: Patients with RVO were monitored prospectively for 1 year with clinical examinations, fluorescein angiography, and CDI every 3 months. 102 adults referred for RVO for less than 2 months were enrolled. Unaffected eyes were used as control. The maximum systolic and diastolic flow velocities and the resistance index (RI) were measured in the central retinal artery (CRA) and the maximum and minimum blood flow velocities in the central retinal vein (CRV). Results: During the year of observation, branch retinal vein occlusion (BRVO), ischaemic central retinal vein occlusion (CRVO), and non-ischaemic CRVO had a distinct pattern of venous velocity changes. BRVO had a similar profile to that observed in controls. Venous velocities were continuously lower in central forms, with the lowest values in ischaemic occlusion. In contrast, a brief decrease in arterial diastolic velocity was observed in ischaemic CRVO at presentation, correlated with arteriovenous passage time on fluorescein angiography, but with rapid normalisation. Conclusions: CDI findings were correlated with the type of RVO at all times during follow up. CDI showed persistent impairment of central venous velocity in CRVO whereas there was a fast initial values recovery of the arterial velocity. These results using CDI show strong evidence of a primary venous mechanism in RVO.

Quaternary ammonium ions have been demonstrated to induce apoptosis correlated with superoxide anion production in vitro. The purpose of this study was to further investigate the mechanisms of benzalkonium chloride (BAC), unpreserved and preserved beta-blocker eye-drops-induced programmed cell death, with special attention to the roles of mitochondrial transmembrane potential and intracellular reduced glutathione.Chang conjunctival cells were incubated with different concentrations of unpreserved or preserved timolol (0.1%, 0.25%, and 0.4%), or carteolol (1% and 2%), or BAC (0.0001% to 0.01%) for 15 minutes, or for 15 minutes with a 24-hour recovery period in normal medium. Cellular viability (neutral red test), mitochondrial activity (rhodamine 123 test), intracellular reduced glutathione (monochlorobimane test), DNA condensation (Hoechst 33342 test), and reactive oxygen species (ROS) production (dichlorofluorescein diacetate and hydroethidine tests) were evaluated using microplate cold-light cytofluorometry.A significant, concentration-dependent decrease in cellular viability was found with preserved beta-blockers and with BAC alone, whereas unpreserved preparations did not show any toxicity. Only preserved beta-blockers induced chromatin condensation associated with an alteration of mitochondrial activity and a decrease of glutathione, suggesting an apoptotic phenomenon. BAC increased glutathione after 15 minutes, whereas a decrease was observed after a recovery period. ROS production was found with preserved formulations at significantly higher levels than those observed with unpreserved drugs.This in vitro study demonstrates that oxidative stress, evidenced by enhanced ROS production and mitochondrial injury rather than by cellular glutathione depletion, is a mechanism involved in apoptosis induced by preservative-containing eye-drops.

The aim of this study was to evaluate in vitro antioxidant effects of two mast cells inhibitors.Cytotoxicity tests were done on a continuous human conjunctival cell line using microplate cold light cytofluorimetry. Membrane integrity (neutral red test), DNA condensation (Hoechst 33342 test), and reactive oxygen species (ROS) production (dichlorofluoresceine diacetate and hydroethidine tests) were evaluated on living cells treated with sodium cromoglycate and N-acetyl-aspartyl glutamic acid (NAAGA) preserved (benzalkonium chloride: BAC at 0.01%) and unpreserved after 60 minutes of treatment or 60 minutes and 24 hours of cell recovery. They were tested pure and at a 1/10 dilution. ROS production was also evaluated after a 60 minute pretreatment with antiallergic drugs and a 15-minute treatment with BAC, according to previous experiments performed on BAC showing its ROS production properties.No cytotoxicity was observed with the unpreserved formulations of antiallergic drugs. An apoptotic phenomenom was suggested with preserved drugs after a 1-hour treatment, whereas a necrotic mechanism appeared after a 24-hour cell recovery period. A ROS production decrease was observed with the two preserved and unpreserved drugs tested (p0.001 compared to BAC) even if it was significantly higher with cromoglycate formulations. A ROS production decrease also was detected after a pretreatment with antiallergic drugs and treatment with BAC (p0.001 compared to BAC alone).In vitro, no cytotoxicity was found with the two unpreserved mast cell inhibitors tested. An antioxidant effect also was observed with these two molecules; sodium cromoglycate appeared to be the best free radical scavenger.

Marfan syndrome is the second most common inherited connective tissue disorder after osteogenesis imperfecta. Musculoskeletal abnormalities are at the forefront of the clinical picture and count among the major diagnostic criteria for Marfan syndrome, together with cardiovascular and ocular system involvement. Early diagnosis is of the utmost importance since preventive measures significantly increase life expectancy and prevent the occurrence of impairments and disabilities. Marfan syndrome is due to mutations within the fibrillin-1 gene, which is the main protein of the microfibril network. Microfibrils play a crucial role in the trophicity and function of elastic tissue. Multidisciplinary management of the patients and their families is vital.

Ophthalmic preparations can induce conjunctival toxicity, often caused by preservatives. The aim of this study was to evaluate in vitro cytotoxicity of quaternary ammonium.Cytotoxicity tests were done on a continuous human conjunctival cell line using microplate cold light cytofluorimetry. Membrane integrity (neutral red test), DNA condensation (Hoechst 33342 test) and reactive oxygen species (ROS) production (dichlorofluorescein diacetate and hydroethidine tests) were evaluated on living cells treated with different concentrations of benzalkonium chloride, benzododecinium bromide and cetrimide (0.00001 to 0.01%) after 15 minutes of treatment or 15 minutes and 24 hours of cell recovery.All the compounds tested showed similar in vitro effects. Using the neutral red test, we observed a decrease in membrane integrity even at 0.005% and 0.01% (p0.001) and after a short time (15 minutes). A stimulation of ROS production (H2O2 and O2) was observed at 0.00001% and above (p0.001), associated with a chromatine condensation due to an apoptotic phenomenon.A necrotic phenomenon is suggested at high concentrations of quaternary ammonium preservatives whereas an apoptotic mechanism exists for lower concentrations. This toxicity observed in vitro can explain some of the ocular surface damage caused by long-term use of preserved eye-drops.