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In recent years, research in artificial intelligence (AI) has experienced an unprecedented surge in the field of ophthalmology, in particular glaucoma. The diagnosis and follow-up of glaucoma is complex and relies on a body of clinical evidence and ancillary tests. This large amount of information from structural and functional testing of the optic nerve and macula makes glaucoma a particularly appropriate field for the application of AI. In this paper, we will review work using AI in the field of glaucoma, whether for screening, diagnosis or detection of progression. Many AI strategies have shown promising results for glaucoma detection using fundus photography, optical coherence tomography, or automated perimetry. The combination of these imaging modalities increases the performance of AI algorithms, with results comparable to those of humans. We will discuss potential applications as well as obstacles and limitations to the deployment and validation of such models. While there is no doubt that AI has the potential to revolutionize glaucoma management and screening, research in the coming years will need to address unavoidable questions regarding the clinical significance of such results and the explicability of the predictions., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Choosing a first-line treatment to optimize long-term outcomes is a major challenge for treating patients with neovascular age-related macular degeneration (AMD). The development of several new molecules makes it critical to identify the relevant factors to consider so as to provide an optimal risk-benefit ratio when initiating a treatment in naïve patients with neovascular AMD. This paper proposes a consensus established with the Delphi method (which includes a gradation in a consensus based on an analysis of the convergence rate of answers) to provide criteria that guide the ophthalmologist's decision for treatment initiation and follow-up in neovascular AMD patients. Fourteen questions were submitted to 93 French retina experts. Thirteen (93%) of the questions reached a consensus (≥50% of answers consensual). The criteria recommended to take into account were both efficacy and onset of action of the molecules, their safety, and the ability to decrease injection frequency. The primary criterion of expected efficacy of a molecule is a combination of the gain in visual acuity and resorption of retinal fluid. With regard to safety, experts recommend tighter follow-up for molecules currently in development, and at every scheduled visit, patients should be screened to identify early any potential adverse effects such as intraocular inflammation, retinal vasculitis or vascular occlusion. Experts also emphasize the importance of the packaging of the biological, with a preference toward prefilled syringes. Injection frequency is a key factor, and the authors recommended aiming for a maximal injection interval of 12 to 16 weeks. The stability of that maximum interval is also an important factor to consider in treatment selection., (Copyright © 2021. Published by Elsevier Masson SAS.)

Phacoemulsification is the most frequently performed surgery in the world. Over the past few years, this surgery seems to have reached a plateau with no further innovative breakthroughs. In this paper, we focus on alternatives techniques, the latest innovations, and the research and development pipeline in this field., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Infectious keratitis are a frequent cause of ocular morbidity. Today, new treatments are necessary to combat the emergence of antibiotic resistant germs. Corneal collagen cross-linking has been suggested to treat corneal infectious (PACK-CXL). Its action would be both antimicrobial and protective for the cornea, increasing its biochemical resistence to proteolytic enzymes. In vivo, PACK-CXL might demonstrate good efficacy against bacterial keratitis, contrary to herpetic keratitis for which it is contraindicated. For fungal or amoebic keratitis, results are uncertain regarding its safety and efficacy. The purpose of this paper is to clarify the use of corneal collagen cross-linking to treat infectious keratitis., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Keratoconus (KC) is a complex disease whose pathophysiology is only partially understood. The priority in management is to halt the progression of corneal deformation as soon as possible in the course of KC disease. Corneal cross-linking (CXL) is at present the only dedicated treatment for this purpose. Its biochemical mechanism of action leads to changes in the viscoelastic properties of the cornea induced by matrix bonding and renewal of keratocytes. The effect of CXL is difficult to quantify when measured in in-vivo conditions because of a lack of consistent tools adapted for clinical practice. Nevertheless, a large amount of evidence has been collected so far confirming the positive action of CXL on corneal structural reinforcement, and numerous studies have demonstrated significant efficacy in halting progression of KC with long-term follow-up. Published studies, however, are of relatively low scientific power given the great heterogeneity of the disease and the numerous associated biases in evaluation. The purpose of this paper is to summarize the consistent evidence of efficacy of CXL and to justify its role in our therapeutic armamentarium for management of progressive KC., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Introduction: The purpose of this study is to describe a technique for thin endothelial lamellar keratoplasty and to present the results for endothelial transplant performed at the University Hospital of Nantes., Materials and Methods: This paper is a retrospective, single-center descriptive study conducted at the University Hospital of Nantes from September 2010 to May 2014, at first for anatomical or analgesic indications (group 1) and then extended to visual indications (group 2). Patients were followed for 12 months. The preparation of the endothelial graft includes an excimer-laser ablation of the residual stromal bed after lamellar keratectomy by manual deep anterior approach., Results: Seventy surgeries were analyzed. The etiologies were mainly Fuchs Dystrophy, secondary endothelial dystrophy and post-penetrating keratoplasty endothelial failure. Fifty-three patients were integrated in group 1 and seventeen patients in group 2. In group 1, the mean VA at 12 months was 0.70 ± 0.30 Log MAR (0.2 decimal equivalent). In group 2, the mean VA at 12 months was 0.28 ± 0.12 Log MAR (0.5 decimal equivalent). Pachymetry decreased from 740 ± 125.1 μm preoperatively to 613.4 ± 73.4 μm at 12 months. The average central thickness of the graft was 84.1 ± 28.9 μm at 1 month and 80.2 ± 29.4 μm at 12 months., Conclusion: The advantage of this new surgical technique is that it is a rapid and repeatable method allowing thin grafts with satisfactory functionality and easy handling. Its performance independent of the scheduled surgery, allows for predictable organization in the operating room., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: Cross-linking (CXL) increases corneal biomechanical strength in progressive keratoconus. Since riboflavin cannot penetrate intact corneal epithelium, removal of epithelium is necessary for the classic CXL procedure (epi-off), but can cause severe postoperative pain. To avoid this problem, a method preserving the epithelium (epi-on) is used. In this study, we aimed to evaluate and compare postoperative pain after epi-off CXL and epi-on CXL., Materials and Methods: We present a retrospective study assessing the level of pain postoperatively in 38 patients between the age of 12 and 53 years who underwent CXL procedures at the University Hospital of Clermont-Ferrand from July 2013 to May 2014. Epi-off consisted of manual corneal de-epithelialization and riboflavin instillation for 20minutes, followed by UVA exposure for 9minutes. The epi-on technique used an applicator on the eye, filled with riboflavin, and a generator delivered a continuous low-level current for 5minutes. The duration of light exposure was similar in both groups. Postoperative medications were the same for both techniques. Assessment of pain and analgesic intake were reported by the patient on paper questionnaires. Pain was evaluated from preoperatively up until the end of the month. Statistical analyses were performed in bilateral formulation to an alpha type I and error risk of 5%., Results: Twenty-three epi-off patients and 15 epi-on patients. Twenty-nine men and 9 women (76.3%/23.7%). Mean age: 28 years. Reference base time was the return from the operating room. In the epi-off group, pain increased significantly until the morning of D2 and did not return to its intraoperative level until noon D2, 1.8±2.0 vs 2.5±2.5 (P=0.12). Pain remained stable until the morning of D4. From noon D4 until D30, it was significantly less than intraoperatively 1.8±2.0 vs 0.7±1.4 (P=0.01). In the epi-on group, pain was significantly higher than intraoperatively until noon of D1 2.5±2.2 vs 3.8±2.5 (P=0.01). From the evening of D1, it returned to its intraoperative level until the evening of D2 2.5±2.2 vs 2±1.7 (P=0.34). From the morning of D3 it was significantly less than intraoperatively 2.5±2.2 vs 0.8±0.9 (P=0.001). Considering all measurement times, there was no significant difference between the two groups (P=0.75), except from evening of D2 until evening of D3 in favor of iontophoresis: 1.9±2.3 vs 1.0±1.3 (P=0.038)., Discussion: Epi-on seems less painful in the short term (up to noon of D1 for epi-on vs morning of D2 for epi-off) and with a shorter duration than epi-off. This can be explained by the absence of corneal de-epithelialization. However, the reduction in pain is not significant at all postoperative times, and a risk of epithelial abrasion during placement and removal of the corneal applicator may exist., Conclusion: Iontophoresis maintains the corneal epithelium, decreases pain and improves patient comfort. A new study involving more patients and strict monitoring of medication intake would strengthen the validity of these results., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Purpose: To study the impact of certain allergens on the manifestations of tropical endemic limbo-conjunctivitis (TELC) in Togolese children., Methods: This is a 3-year prospective study of 36 Togolese children with acute recurrences of TELC after 1 to 5 months of remission. Skin prick tests were conducted with five perennial respiratory allergens (dust mites, paper mites, roaches, dog and cat, grass pollen) and three food allergens (egg, peanut, shrimp). The reactions were compared to a negative control (saline solution) and a positive control (histamine or codeine sulfate). Length of remissions between acute exacerbations before and after allergy testing were noted., Results: Thirty-five children were polysensitive. Individual allergens were: dust mites (83.3%), followed by cockroach (72.2%), shrimp (61.1%), peanuts (55.6%), eggs (44.4%), the cat and/or dog dander (38.9%), and grass pollen (22.2%). The rate of remission prior to allergy testing was 77.8% within 2 months after treatment of an exacerbation; with allergy management, 55.5% of patients experienced remission beyond 1 year., Discussion: The literature reports that TELC is caused by multiple antigens. The clear predominance of respiratory and food allergens may lead to a new pathway for managing TELC in Togolese children., Conclusion: Allergy testing is of great importance for patients with frequent acute exacerbations of TELC., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Introduction: In 2009, we developed a non-prismatic cone in accordance with Goldmann tonometer standards. We undertook a prospective comparative clinical study of the non-prismatic cone versus the traditional biprismatic cone., Materials and Methods: The disposable non-prismatic Plexiglas cone contains, on the inner side of its applanating end, a raised circular pattern 3.06 mm in diameter. Patient recruitment was performed in the setting of diurnal intraocular pressure (IOP) measurement for all comers including medically treated glaucoma patients. Two operators clinically tested the non-prismatic cone, with each operator measuring his or her own series of 50 eyes, for a total of 100 IOP measurements., Results: For the first operator, the mean IOP measurement with the non-prismatic cone was 17.92 mmHg, range 13 to 26 mmHg; the mean IOP measurement with the biprismatic cone was 17.40 mmHg; the difference between mean IOP measurements was 0.52 mmHg, with a correlation coefficient of 0.98. For the second operator, with a series ranging from 10 to 19 mmHg, similar results were observed., Discussion: Disposable cones, including the non-prismatic cone, adapted for the Goldmann tonometer are superior to other strategies for infection prophylaxis, such as chemical disinfection or condoms., Conclusion: This study demonstrates the reliability of the disposable non-prismatic cone adapted for the Goldmann tonometer. Other features unique to the non-prismatic cone are evoked at the end of this paper., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Necrotizing periorbital or palpebro-orbital fasciitis represents a unique anatomical site for necrotizing fasciitis, which is an extremely rare and very severe, potentially devastating bacterial infection, rapidly leading to facial necrosis with loss of vision and even death of the patient from toxic shock. In this paper, we report a case of necrotizing periorbital fasciitis as a complication of cosmetic lower eyelid blepharoplasty. Necrotizing fasciitis most often affects the upper and lower limbs, the trunk and the perineal area. It is rarely observed in the facial region due to the rich blood supply in this area. The most commonly implicated pathogen is group A, β-hemolytic "pyogenic"Streptococcus, either alone or in combination with other bacteria, such as staphylococcus or pseudomonas. Mortality varies according to the series and anatomical site. The mortality rate for necrotizing fasciitis is approximately 28 %. It is slightly lower in the periorbital area (15 %). Risk factors for death include alcoholism, diabetes mellitus, immunocompromise, hematologic or pulmonary diseases, and the identity of the causative agent (group A Streptococcus), although approximately 50 % of patients have no predisposing conditions. Management of periorbital necrotizing fasciitis is based on early detection of initial symptoms and on aggressive multidisciplinary treatment including surgical debridement of necrotic areas and antibiotic coverage. The timeliness of treatment and the multidisciplinary approach are considered to be the two essential factors in influencing the mortality and morbidity of this condition., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Introduction: Lyme borreliosis (LB) is the most common human tick-borne disease in the Northern hemisphere. The various ophthalmologic manifestations of Lyme borreliosis (LB) during childhood are discussed in this paper., Patients and Methods: Six children with LB-associated ocular manifestations were treated between 2000 and 2010 in the ophthalmology department of Strasbourg University Hospital (an endemic area). Medical history, ocular and systemic clinical findings, determinations of antibodies related to Borrelia, as well as exclusion of other causes were the diagnosis criteria., Results: Two cases of uveitis, two cases of abducens palsies, one case of optical neuropathy, and one case of orbital myositis associated with LB were diagnosed. Systemic findings, such as arthritis, rash, or erythema migrans were mentioned in all cases. Two children also complained of severe knee arthritis. Determination of antibodies was positive in all patients. They were all treated with antibiotics adjusted to individual circumstances and some of them (two cases of uveitis and one of optic neuropathy) also had anti-inflammatory treatment. Resolution of ocular signs, with no relapse, was observed in all patients within two to 12 weeks., Conclusion: For any unexplained ocular symptom, even in children, LB should be taken into account, especially in endemic areas. Such patients should undergo serological testing. If the clinical presentation is suggestive of LB, a course of oral antibiotics should be used. All in all, permanent defects are extremely rare during the childhood period, even following long-term manifestation at an early age., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Burns are devastating injuries scarring patients, both physically and psychologically, for life. This remains particularly true for facial burns. Eyelid burns occur in about 10% of thermal injuries and is a considerable challenge for the reconstructive surgeon given the particular anatomy of the eyelids. Reconstruction of the eyelids following burn injuries has been performed by plastic surgeons since the earliest days of reconstructive surgery, yet a consensus on a treatment regime has not been reached and plastic surgeons are divided on the subject. Controversies exist regarding the excision and debridement of eschar, temporary suture and surgical tarsorrhaphy, timing of surgery for eyelid contraction, and the role of full and split-thickness skin grafts in eyelid reconstruction. This paper describes the particularities of the treatment of burned eyelids in our Burn Center., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

We report the case of an 86-year-old man with unilateral panuveitis concurrent with an infectious retinal focus. The diagnosis of endogenous endophthalmitis with subretinal abscess was suggested. The biology workup and CT scan showed a renal abscess. This was caused by Klebsiella pneumoniae, which was confirmed by analysis of abscess aspiration and vitrectomy samples. This paper underscores the importance of etiological assessment in infectious panuveitis and the consequences on visual outcome.

The technique of intravitreous injections has been well documented for several years. Recently, a descriptive article on the intravitreous injections procedure was published in the Journal Français d'Ophtalmologie, and the AFSSAPS (French agency for drug safety) released recommendations concerning this matter on the occasion of commercial launch of pegaptanib. Since that time, the number of intravitreal injections has considerably increased, because anti-VEGF drugs had been made available to ophthalmologists, and several teams have performed a large number of procedures, allowing them to better comprehend intravitreous injections. The present paper describes our current practice of intravitreous injections. Several specialists have exchanged their experiences and issued a common synthesis. Detailed modifications of the initial recommendations have been suggested, with such basic changes such as abandoning preoperative pupil dilatation and easing postsurgical monitoring. Follow-up examinations should be adapted to each patient rather than being systematic. The suggested modifications do not change the procedure of intravitreous injections substantially, but they simplify many steps and detail the various procedures when consensus is lacking.

The optic nerve glioma is a relatively rare pathology in children and only a few cases have been described in infants. This paper reports the symptoms of this exceptional case in a 4-month-old child and reviews the differential diagnoses at this age. Finally, we discuss the diagnosis and therapeutic possibilities.

Ocular neovascularizations are responsible for irreversible loss of vision in various diseases, including age-related macular degeneration. Treatments have changed greatly, and photodynamic therapy with verteporfin has come into common use. However, the visual prognosis remains poor. The recent approval of new antiangiogenic molecules such as ranibizumab and pegaptanib should allow for new therapeutical possibilities. The unapproved ophthalmological use of bevacizumab requires further studies. This paper updates what is known about old and new neovascularization treatments: their mechanism of action, their efficacy, and their toxicity. It reviews the principal clinical studies, and concludes with the recognized recommendations. For the first time, ophthalmologists can hope not only to stabilize loss of vision, but also to improve visual acuity. Complementary treatments can now be tested in associations, concomitantly or not, with the hope of improving visual results.

The prognosis of fungal and acanthamoeba keratitis depends on early diagnosis and treatment. Keratomycosis treatment requires antifungal eye drops such as polyene, triazoles, or echinocandins, whereas acanthamoeba keratitis therapy is based on biguanide and diamidine agents. The aim of this paper is to review the antifungal and antiamoebicide eye drops that are currently available in ophthalmology.

Aim: Anti-VEGF drugs are the most recent treatments for choroidal neovascularization, the most severe complication of the age-related macular degeneration (AMD). These drugs are administered by intravitreal injections. Several clinical studies have demonstrated their advantages. However, these same studies have not established the modalities for monitoring their efficacy. The aim of this paper is to provide an in-depth look at the existing practices in monitoring anti-VEGF therapy among different French specialists., Methods: Several meetings were held with specialists coming from both the hospital setting and private practice to share their practices in monitoring anti-VEGF therapy and to propose more rational monitoring to standardize practices., Results: The physicians attached an increasing importance to optical coherence tomography (OCT) in monitoring anti-VEGF drugs after intravitreal injection. They acknowledged the value of fluorescein angiography when initiating the treatment and 3 months after beginning anti-VEGF therapy. They advise using fluorescein angiography every time that functional results are not at the level expected by the physician or the patient. The authors provide a flow chart that should help in deciding on retreatment., Conclusion: The authors suggest the use of a flow chart aimed to define indications of retreatment according to clinical response and OCT results.

Nanophthalmos is a rare clinical condition that may lead to serious sight-threatening complications. Knowledge of the physiopathology of nanophthalmos is very useful to understanding the relationships between the different pressures within the eye. With aging, nanophthalmos leads to chronic angle-closure glaucoma that is very difficult to manage, since very severe complications may occur. In this paper, we review the clinical signs, physiopathology, and treatment of nanophthalmos.

In the field of ophthalmology, indications for high-dose corticotherapy are various. This paper reports the case of a Caledonian man who presented with intestinal strongyloidiasis, discovered 25 years after he had left the endemic area. A checkup before corticotherapy for traumatic retina edema provided the diagnosis of the infection. The authors emphasize the importance of searching for Strongyloidiasis stercoralis larva before initiating corticotherapy, as it is the main treatment responsible for parasitic dissemination. The most severe form of strongyloidiasis, the disseminated form, has a high mortality rate: 70%-90%. The definitive diagnostic test is enhanced larva recovery, which should be proposed to every patient returning from endemic area, people with precarious hygiene or with high eosinophilia or intestinal symptoms of chronic infection. Delay in diagnosing strongyloidiasis frequently results in death, despite vigorous treatment.

Background: Lesions of the supranuclear pathways for convergence control can lead to convergence deficit or convergence excess. Whereas pathophysiology of acquired convergence excess is now fully covered in the literature, no specific paper on its surgical treatment could be found., Patients: Cases 1 and 2: Parinaud's syndrome with convergence excess in attempted upgaze (+ convergence retraction nystagmus and VIth nerve palsy in case 2). Case 3: opsoclonus and convergence excess due to hysterical conversion after head trauma. Case 4: acquired nystagmus, accommodative spasm due to hyperopia. Case 5: functional spasm of the near reflex (dubious medical history of multiple sclerosis). Case 6: medial recti palsy after artificial divergence surgery for congenital nystagmus, substitutive convergence. Cases 3 and 5 were not operated on, recession of the four horizontal recti in case 4, recession of the lateral recti in case 6, complex surgical procedure in cases 1 and 2., Discussion: The following guidelines are suggested: Functional spasm of the near reflex: medical therapy. Organic spasm of the near reflex: retroequatorial myopexia on the medial recti. Parinaud's syndrome with convergence excess (spastic) or convergence retraction nystagmus (rhythmic): restoration of upgaze motility with a vertical Kestenbaum-type procedure, retroequatorial myopexia if insufficient. Thalamic esotropia (tonic): botulinum toxin injection, recession of the medial recti if insufficient., Conclusion: Convergence excess associated with neurological diseases should be looked for since it can be improved by effective surgical procedures.

Vision screening of school children at 5-6 years of age must include color vision screening. X-linked dyschromatopsia is the most frequent disorder affecting 8% of boys and 0.4% of girls. This paper presents the physiology of these deficiencies caused by an alteration of the spectral absorption properties of one of the cone pigments (protanomalous or deuteranomalous trichromats) or the absence of one of the pigments (protanopia or deuteranopia), the most frequent. Absence of two of the pigments (blue cone monochromacy) is very rare and differs from achromatopsia. The physiological basis of the main tests for easy clinical screening are presented. Testing methods designed for children are reviewed. The Ishihara test is the most widely used screening test specific for congenital color defects. If the plates are correctly read, the child has normal color vision. If not, arrangement tests such as Panel D 15 and desaturated Panel D 15 tests can be used to diagnose the type of the defect (protan or deutan) and grade the degree of color deficiency according to a strategy adapted to children. Examples of results are presented for each axis along which caps are confused, providing a quick and easy preliminary diagnosis. Early detection of color vision malfunction in children allows parents and teachers to make necessary adjustments to the teaching methods for appropriate learning.

Systemic diseases are unknown diffuse inflammatory disorders. They include systemic and metabolic diseases and connective tissue diseases. Among them, lupus erythematosus, scleroderma, polymyositis and dermatomyositis, Sjögren syndrome, Wegener's granulomatosis, sarcoidosis, Vogt-Koyanagi-Harada's syndrome, and amyloidosis are the diseases encountered most frequently that can manifest cutaneous abnormalities of the eyelids. The main eyelid disorders involved in these diseases are described in this paper.

Transpupillary thermotherapy (TTT) has been proposed over the last a few years for the treatment of subfoveal occult choroidal neovessels resulting from age-related degeneration (AMD) when they are symptomatic and associated with exudation. Several pilot studies have shown how this technique can decrease or slow down the progression of exudation related to choroidal neovessels. Based on these pilot studies, a randomized study (TTT4CNV) is in progress to evaluate the efficacy of TTT. While the inclusion of the patients in this study has come to an end, the therapeutic context of AMD has recently been changed with a permit to market Visudyn for photodynamic therapy (PDT) for some types of subfoveal occult choroidal neovessels. Moreover, the clinical studies in progress on photodynamic therapy and antiangiogenic drugs now make it possible to consider combined treatments possibly including TTT. This paper aims to provide a report on the current place and potential of TTT within the therapeutics available or soon available for subfoveal occult choroidal neovessels of AMD.

Purpose: The purpose of this paper is to collect data describing the implication of intraocular pressure (IOP) and arterial blood pressure in the progression of glaucoma., Method: The literature selection for this Article was based on MEDLINE searches covering the last 20 Years and relevant Articles. Topics covered were ambulatory blood pressure monitoring, IOP fluctuations, arterial hypotension, and glaucoma., Results: Hypoperfusion of the optic nerve head is among the significant factors relating to glaucoma damage. The physiological decrease in nocturnal blood pressure is more pronounced in some glaucoma patients, particularly in those presenting normal pressure glaucoma or with progressive visual field loss. Normal human subjects have a circadian variation in their IOP and these fluctuations are related to the sleep-wake cycle. In glaucoma patients, unappreciated IOP fluctuations may explain many cases of glaucoma progression., Discussion and Conclusion: Eyes with advanced glaucomatous optic neuropathy were associated with more marked alterations in the optic nerve vascular supply circulation than eyes with less nerve damage. Numerous findings suggest that circadian IOP variations and arterial blood pressure may play a role in the progression of glaucoma., (Copyright 2004 Masson)

Purpose: The technical advancements now provide conservative treatment of choroidal melanoma. The course of the disease remains marked by the metastases that usually set in within 3 years. The aim of this paper is to report two unusual cases of hepatic metastases of choroidal melanoma that set in 11 and 18 Years after curietherapy., Methods: A 40-year-old woman and a 50-year-old man presented with T2 and T3 choroidal melanomas and were treated by cobalt plaque. The tumors decreased within the year and the patients were monitored every 3 months for 5 years., Results: Metastases set in, respectively, 11 and 18 years after treatment., Discussion and Conclusion: These two observations show that the metastases had already spread at the moment of diagnosis and that the cell doubling time of the melanoma was very long. These findings indicate the difficulties in monitoring patients with choroidal melanoma.

Congenital eyelid malpositions can be isolated or associated with other structures such as the eyeball, ocular muscles, and lacrimal pathways. It is important to separate eyelid malpositions, which are topographical disorders, from eyelid malformations, which are constitutional morphological disorders. Only eyelid malpositions will be described in this paper, with a distinction made between static and dynamic disorders. Static disorders include epiblepharon, congenital ectropion and entropion, epicanthus, telecanthus, and centurion syndrome. Dynamic disorders group ptosis and congenital eyelid retractions. Epiblepharon is characterized by the absence of adhesion between the lower eyelid retractors and the orbicularis-skin layer, which allows the anterior lamella to roll over. Congenital entropion and ectropion are very rare. They most often require surgical treatment. Epicanthus involves a semi-lunar fold of skin extending from the upper eyelid across the medial canthal area to the margin of the lower eyelid. Four types (supra-ciliaris, palpebralis, tarsalis and inversus) of epicanthus are described. Treatment requires surgery. Telecanthus is defined as an increased distance between canthi. Primary telecanthus results from attenuation of the medial canthal tendons and is usually associated with other soft tIssue abnormalities such as epicanthus or blepharophimosis, or is seen after trauma. Secondary telecanthus is caused by underlying bony malpositions with an abnormal separation between the orbits because of an increased thickness of the interorbital bones such as that seen in hypertelorism or in other complex craniofacial syndromes. Euryblepharon is distinguished by an enlargement of the horizontal palpebral fissure associated with enlarged eyelids. The etiology is unknown and patients may benefit from surgery. Congenital ptosis is characterized by a deficiency of the levator muscle. They are most often unilateral and isolated. When associated with other abnormalities such as squint, synkinesis, blepharophimosis, or craniofacial syndromes, surgical treatment may require several-stage procedures. On the other hand, isolated congenital ptosis is usually treated in childhood (3-6 years) in a single stage. Congenital eyelid retractions may affect either the lower or the upper eyelid. They make up a rare condition and most cases are associated with craniofacial syndromes such as Crouzon or Apert syndromes. Upper eyelid retractions may spontaneously improve in some cases, but lower eyelid retractions do not. Treatment requires surgery, depending on the corneal consequences.

Refractory types of glaucoma continue to present a therapeutic challenge to ophthalmologists. Approaches toward the management of these difficult glaucomas are addressed in this paper. The first part devotes special attention to understand the cause(s) of the failure of previous filtering surgery(ies). The next part emphasizes filtration surgery with intraoperative application of antimetabolites: 5-fluorouracil or mitomycin C and the surgical and pharmacological management of failing filtration. In case of failure of multiple filtering surgery with application of antimetabolites, surgeons have to consider cyclodestructive procedures (transscleral diode laser or endoscopic cyclophotocoagulation) to reduce aqueous production, or fistulizing procedures with tube implants or other drainage devices (valves).

Purpose: The appearance of a secondary cataract constitutes the most common complication of cataract surgery since the advent of phacoemulsification. Prevention is today one of the crucial challenges of research in ophthalmology. We have developed a drug-sustained capsular ring releasing 5-fluorouracil (5-FU). This system targets the goal of combining advantageous mechanical and pharmacological properties with the ability to interfere on the epithelial cellular processes of secondary cataract. This paper presents the results of animal evaluation., Material and Methods: The study first developed the in vitro delivery system as a preliminary step to the animal in vivo approach. After a pilot study conducted on micro pigs, lens extraction was performed on the right eye of 22 female albino rabbits. The four study groups included: group 1 (6 animals) as a control group receiving only phacoemulsification; group 2 (6 animals) receiving phacoemulsification and the implantation of a nonsustained capsular tension ring; and group 3 (6 animals) receiving a drug-sustained ring. Group 4 (4 animals), implanted with a 5-FU-sustained ring, was reserved for staged samples of aqueous humor for kinetic determination of active agent release., Results: Clinical evaluation based on biomicroscopy and histology showed a lesser reaction of secondary cataract in eyes with the ring. Compared to group 1, central posterior capsular opacification appeared significantly lower in density and surface in groups 2 and 3. No intraocular toxicity was observed. The poor sensitivity of the 5-FU detection method (high-performance chromatography) impaired pharmacokinetic evaluation., Conclusions: The decrease in secondary cataract reaction in cases of implanted capsular ring demonstrated the advantages of its mechanical effect. However, the benefit of an additive pharmacological action related to the release of 5-FU could not be proved. Nevertheless, the theoretical concept of a drug-sustained delivery system seems attractive and thus calls for evaluation of other potential modulators of cell behavior.

Introduction: The use of transpupillary thermotherapy alone or associated with systemic chemotherapy is a therapeutic modality of ocular retinoblastoma that allows ocular preservation without external beam irradiation of the eye. We present our experience with thermotherapy in the treatment of selected cases of retinoblastoma., Material and Methods: This paper reports a retrospective case series of patients treated for retinoblastoma by thermotherapy or chemothermotherapy (carboplatin IV followed by thermotherapy) in a single institution from October 1994 to December 2000. Data collected include general characteristics of the treated children, tumor characteristics, and the results of the treatments on local tumor control. Transpupillar thermotherapy was delivered with a diode laser through an operating microscope. Each tumor was treated separately and laser intensity, spot size, and duration were adapted to the size of the tumor and the clinical response. Chemothermotherapy consisted in thermotherapy delivered shortly after an intravenous injection of carboplatin (560 mg/m(2)) at day 1, followed by thermotherapy alone at day 8 if the lesion was 6mm or more in diameter. This cycle was administered every 28 days. The choice between thermotherapy and chemothermotherapy depended on the initial size of the lesions. Thermotherapy was used when the lesion measured 3mm or less. Lesions measuring more than 15 mm, or associated with substantial vitreous seeding, retinal detachment, or optic nerve head involvement are not suitable for these techniques., Results: During the study period, 239 children were treated in our institution and 109 of them (147 eyes, 372 tumors) could be treated conservatively without external beam radiation. The median tumor diameter at the moment of thermotherapy or chemothermotherapy was 2mm (range, 0.2-15.0mm). One hundred and ninety-four tumors were treated by chemothermotherapy and 18 by thermotherapy alone. In 75% of the cases, the treatment was administered after two courses of chemotherapy (etoposide and carboplatin). After a mean follow-up of 55 months (range, 16-89 months), tumor control was obtained in 87.1% of lesions after chemothermotherapy and 77.8% after thermotherapy. Salvage enucleation was necessary for seven lesions (seven eyes) but none in the cases where thermotherapy was used alone. No severe systemic side effects were noted., Discussion: Diode laser delivers hyperthermia on the tumor bed and its use alone or in association with systemic administration of carboplatin makes it possible to preserve the eye without external beam irradiation, with few side effects and less cumulative doses of chemotherapy., Conclusion: Thermotherapy and chemothermotherapy provide excellent local tumor control and eye preservation in selected cases of retinoblastoma.

Eyelid surgery is not always uneventful. Complications (punctal ectropion, retractile scars) can sometimes occur. Argon laser treatment is an interesting alternative technique, particularly in cases with cosmetic indications. The advantages of the procedure, compared to surgery are numerous: magnified view of tissue removal, enhancing complete excision; good hemostasis, avoiding wound sutures and bandage; fast and painless technique; outpatient office procedure with little post-operative care; good acceptance of the technique by most of the patients. The technique and the main indications are described in this paper.

Introduction: Nontraumatic orbital diseases only exceptionally require emergency treatment. In this paper an emergency is considered when the diagnosis and/or treatment must be done within a maximal period of 1 week., Materials and Methods: All patients with nontraumatic orbital diseases from the Department of Ophthalmology of the University of Lausanne and from the office of one of the authors (N.D.) over the last 35 years were studied, in view of their degree of emergency. Data from 77 patients (28 females and 49 males), aged from birth to 85 years, were collected., Results: Idiopathic inflammations of the orbit (pseudotumors) were the most frequent diagnoses seen as an emergency, followed by rhinological diseases with orbital consequences (exteriorized sinusitis or mucoceles), dysthyroid orbital pathologies, bleeding in lymphangiomas and varices, rhabdomyosarcoma, and acute dacryoadenitis. Fast progressive proptosis, oculomotor disorders, and pain are the most frequent alarm signals. After the diagnostic procedure, a surgical or medical treatment is frequently proposed., Conclusion: Although rare, emergencies in orbital diseases are a challenge for the general ophthalmologist. The morbidity and sometimes the mortality due to these diseases are often reduced by proper management. Patients generally have to be referred to a specialized unit.

With laser iridotomy, argon laser trabeculoplasties, cyclophotocoagulations with diode laser and Nd: YAG goniopunctures after deep sclerectomy, among other procedures, the laser has offered a very wide range of treatments for managing glaucomatous patients for roughly twenty years. In this paper we provide a general review of the present applications of lasers in the treatment of glaucoma, focusing on the indications, results and complications of the most frequently used procedures in daily clinical practice.

Introduction: Rhabdomyosarcoma is the most frequent primitive orbital malignant tumor in children. If the treatment is started as soon as possible after discovery of the disease, the vital prognosis is considerably better than otherwise. The goal of this paper is to present the new therapeutic protocol and to report our experience in this field., Material and Method: During the past 35 years, 102 cases of orbital tumors were collected in children under 15 years of age: 5 cases of rhabdomyosarcoma were cared for in our department. At the time of tumor diagnosis, the age of our patients ranged from 3 weeks to 13 years. After a biopsy or excision biopsy, all our cases were treated by chemotherapy with or without radiotherapy. Medication was mostly vincristine, ifosfamide and actinomycine D. When the result of the treatment was not satisfactory, carboplatine and epirubicine, vincristine as well as ifosfamide were given. Radiotherapy was performed only in particular cases or in recurrences., Conclusion: Rhabdomyosarcoma is a highly malignant tumor. Although rare, it is the most frequent of malignant tumors in children. It is important to keep it in mind in order to perform a biopsy enabling quick diagnosis and treatment following the modern protocol giving the highest chances of survival to these patients: about 98% in 3 years.

Purpose: Persistent hyperplastic primary vitreous (PHPV) is a rare developmental malformation of the eye. This anomaly is usually unilateral and unassociated with other disease. PHPV may have clinical variations: an anterior and/or a posterior one. Diagnosis and treatment are exposed in our paper., Methods: We study 38 eyes in 34 patients. All patients had an anterior form of PHPV. Nine of them associated a posterior form. Eighteen eyes underwent surgery, the mean postoperative follow-up is 4.7 years. Treatment is discussed, depending on the initial form of PHPV. We report the evolution of the surgical eyes and the untreated eyes., Results: Slit lamp examination and echographic findings (A-scan and B-scan) support the diagnosis. In some cases computed tomography or RMN can be useful. If the cataract is mild in the anterior form of PHPV, treatment of amblyopia and frequent clinical examination can be sufficient. If the cataract is dense, a lensectomy must to be performed. The surgical technique can be difficult. For the eyes with posterior PHPV, the surgical treatment is to be avoided, because of high risk of retinal detachment., Conclusion: PHPV may have clinical variations, mostly with cataract as major sign. In purely anterior presentation, in absence of marked microphthalmos, lensectomy can be useful.

Purpose: The aim of this paper is to compare our results with the literature and to discuss some therapeutical aspects of the disease., Methods: This retrospective study concerned 520 cases of Behçet's disease followed by internal diseases department and ophthalmology service of U.H.C. Averroes (Casablanca, Morocco) during 10 years., Results: There were 432 men (83%) and 88 women (17%). The mean age of the patients was 20 years. Ophthalmological involvements are found in 80%, bilateral in 60%. The disease occurred at the rate of 2 or 3 episodes a year in 5% of cases. Irreversible blindness was noted in 24.4% of cases, predominately panuveitis in 37% of cases, followed by anterior uveitis in 36.3% and retinal vasculitis in 37% of cases. Good results were obtained by a medical care with corticoids and chloraminophen in case of threatening blindness., Conclusion: Behçet's disease remains frequent in our country. It requires early diagnosis and steady ophthalmological surveillance in order to delay onset of blindness.

We report a case of retinal vein occlusion after breath-holding diving. After one hour of diving at a maximal depth of eight meters, each apnea no longer than one minute, the patient complained of a diminution of the visual acuity in the left eye. Ophthalmological examination revealed an occlusion of the superior branch of the central vein of the retina in the left eye. This could be considered as a decompression sickness even if the occlusion could happen fortuitously in water. Secondary to the multiple descents, a bubble would have appeared in the vein leading to an obstruction. The purpose of this paper is to discuss a possible link between the breath-holding diving and this kind of accident. We also report the different ophthalmological features that may occur while diving.

We report three cases of isolated medial orbital wall blow out fracture with medial rectus entrapment. Few cases have been reported in the literature, predominantly in black people as in this paper. Predominance of this rare fracture in black population could be explained by an anatomic hypothesis based on racial origin. The diagnosis is often suggested by the medial rectus entrapment. Depending on the position of the incarceration in front of or behind the equator of the eyeball, the eye presents pseudo-Duane syndrome or exotropia with decreased adduction. The diagnosis is established by orbital computed tomography visualizing the lamina papyracea of the ethmoid bone fracture and the medial rectus incarceration. This exceptional fracture must be detected to avoid complications: enophthalmos and motility disturbances.

Description of cyclic strabismus has been restricted for a long time to circadian esotropia. In this mysterious phenomenon, the eyes are crossed every other day with no binocular vision, but remain perfectly normal during the straight days. The usual characteristics are those of a non-accommodative and non-paretic strabismus, with onset in early childhood. There is no response to conservative treatment, and the cycles become irregular with time until the deviation becomes constant, with an excellent functional result after surgery in every case. Recently, other papers comprising data irrelevant to the classic picture suggest that cyclic strabismus includes, in fact, several different entities. The only common point is the existence of ocular motility disorders that recur more or less regularly, and whose pathologic substrate is primarily heterogeneous, whether it is thought as a mere hypothesis or a likely mechanism. Two new cases of circadian esotropia are presented together with a review of the literature relating to the criteria of the syndrome.

The paper presents the observation of a 47 year-old patient with pigmentary retinopathy, hypoacousy, and vitiligo. The retinopathy and hypoacousy were associated in 10% of the cases. There is a certain parallelism between the degeneration of the retineal epithelium and the Corti neurosensorial epithelium. The association with vitiligo is only rarely mentioned in the literature. The extension of the abiotrophic process at the level of the cutaneous melanocytes may be explained by the variable expressivity of the pathological gene with the affection of different diencefalic nervous centers.

Cataract is a frequent complication of vitreous surgery after some months or years. In these cases cataract extraction is somewhat difficult. We performed cataract surgery with implantation in 38 eyes from 37 patients between 1986 and 1991. Twenty patients underwent vitreous or vitreoretinal surgery with or without internal tamponade by gas, 17 underwent silicone oil tamponade and silicone oil removal, prior to cataract surgery. Timing of surgery, number of surgical procedures and complications previous to cataract surgery are detailed in the paper. Cataract extraction was extracapsular in 7 cases, intracapsular in 6 cases; phako was performed in 24 cases and phacophagy in one case. A posterior IOL was inserted in 31 cases, an anterior chamber IOL in 7 cases. Anatomical and visual results were satisfying. Visual acuity improved postoperatively in 29 cases (up to 20/20 in 4 cases), was unchanged in 6 cases, decreased in 3 cases. Among these, loss of vision occurred in 5 cases due to retinal detachment or redetachment. For anatomical reasons, lack of vitreous support and the frequent zonular weakness of these eyes, account for surgical difficulties. Thus, phakoemulsification appears the best way to manage cataract in vitrectomized eyes.

The influence of color vision defects on pictorial art was studied using three methods. 1) From a theoretical standpoint, the possibilities of choice of the color-blind painter are determined by the nature of his color perception. Characteristic errors result from the fact that he has to choose between many hues which are different to a normal individual but which all look the same to him. 2) Evaluation of the clinical cases of painters with dyschromatopsias has shown evidence of the following: a) the color-blind painter makes mistakes according to the type of color defect; b) if the color-blind painter makes several copies of the same model, he makes different mistakes at each attempt; c) when several color-blind painters make copies of the same model, they also make different mistakes, even when they suffer from the same type of color vision defect. Preferences for some colored patterns were studied by means of a forced choice procedure and choices of color-blind individuals were often characteristic of their dyschromatopsia. Recent clinical case of acquired dyschromatopsia reported in the literature are discussed, as is a personal case of a painter suffering from tapeto-retinal degeneration. This was a severe dyschromatopsia with a neutral zone in purple (so-called scotpic axis, by Verriest's terminology). The painting of this artist tended to be monochromatic, mainly in green and green-blue colors. 3) Recent studies in art history have shown that only the romantic etcher Meryon was definitively color deficient. The more dubious cases of the Polish painter Grottger and of Eugène Carrière are discussed and conclusions are negative. Among acquired dyschromatopsias, there have been many recent papers devoted to cataract dyschromatopsias, concerning the cases of Rouault, Monet and Mary Cassatt. The hypothesis of a degree of chromatopsia or dyschromatopsia of toxic origin in the case of Van Gogh is also assessed. In conclusion, the problem of the relations between congenital or acquired dyschromatopsias and pictorial art seems very complex and great care is required when making deductions and advancing hypotheses.

The oral fluorophotometric exploration is able to simultaneously quantify the permeability of the blood aqueous (KIN, KOUT) and blood-retinal (PVPR) barriers. It is possible to detect the breakdown of the blood aqueous barrier 3 days after cataract surgery with this fluorophotometric method. Ocular inflammation is responsible for this leakage and non steroidal anti-inflammatory drugs prevent this breakdown. In this paper, we studied the effect of 0.1% indomethacin treatment to patients before and after cataract surgery. This double-blind study was performed in 34 patients: 18 patients in the indomethacin group and 16 patients in the placebo group. We showed that the apparent transfer coefficient of fluorescein in the anterior chamber (KIN) was statistically lower in the indomethacin group (0.0220 +/- 0.0179 hr-1) than in the placebo group (0.0371 +/- 0.0187 hr-1) on the 3rd postoperative day (p = 0.027).

The present paper reports on the case of a 44 year-old woman with progressive facial hemiatrophy associated with bilateral papillitis who developed an acquired complete third nerve palsy on the unaffected side six months later. This Romberg's disease occurred in the context of an immunologic disturbance which was barely improved by steroids and Disulone. Ophthalmic involvement, particularly neurologic involvement, pathogenic hypothesis are reviewed. The responsibility of sympathetic disorder in Parry-Romberg disease is based on frequent association of progressive facial hemiatrophy and Fuch's and Horner's syndromes.

This paper reports the case of a chronic endophthalmitis with hypopion produced by propionibacterium acnes (p. a.) in a patient operated on for cataract and implanted with a posterior chamber intraocular lens. This granulomatous uveitis appeared 8 days after surgery and did not heal with a systemic corticoid-antibiotics treatment. The diagnosis was obtained by vitreous analysis. The responsibility of p. a. must be always searched in case of chronic endophthalmitis in pseudophakic patients: a specific treatment has to be used.

Unlabelled: Some ophthalmic solutions activity is localized at the eye's surface: they are used to manage conjunctivitis and keratitis. Some others must penetrate the eye. They are carried through the cornea. There are many factors allowing the penetration into the cornea. These factors will be studied in this paper. Bio-physical and bio-chemical actions are both numerous and complex., In Conclusion: the different corneal tissues have a selective solubility to ophthalmic solution components.

The tilted disc syndrome is an ocular anomaly characterized by dysversion of the optic nerve head, congenital crescent, vessel anomalies, ectasia and depigmentation of the infero-nasal fundus. Its pathogenesis is not known, but there are many theories as to its origin. The most convincing one links the tilted disc syndrome to an anomalous closing of the embryonic fissure. However this hypothesis does not adequately explains the origin of all the anomalies found in the syndrome. In this paper a new theory is suggested. The ganglion cell fibres of the infero-nasal retina could be misdirected toward the orbit through an anomalous embryonic fissure. In this way the fibres could not reach their central connections and degenerate. The hypoplasia of the infero-nasal quadrant of the eye could originate from the anomalous closing of the embryonic fissure and from the atrophy of the ganglion fibres; the crescent from the lack of fibres in the inferior optic disc; the anomalous appearance of the optic nerve head and the retinal vessels from a shifting of the disc upward due to the imbalance between the ganglion cell fibres coming from the superior and inferior retina.

This paper deals with a family affected by cystinuria associated with eye signs of juvenilis macular degeneration.

Since Goodman and coll. introduced the concept of cone dysfunction syndromes, many papers have been published. Some authors based their diagnosis on functional data while others referred to the classic denominations. As a consequence there is no uniformity with regard to terminology of the cone dystrophies. In an effort to avoir the introduction of new terms the author presents a classification of cone dysfunctions based on the results of electroretinography and color vision examination. This classification is dynamic since it allows the follow-up of a cone dystrophy into its late stages.