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Paracentral acute middle maculopathy is a lesion of the inner nuclear layer and outer plexiform layer of the macula associated with local or systemic vascular diseases that can induce retinal hypoxia. The etiologic mechanism may be related to the increase in intraocular pressure which creates conditions of hypoperfusion in the retinal vasculature. We present a case that shows a possible association between paracentral acute middle maculopathy and glaucoma with the trauma of elevated intraocular pressure as a triggering event., (Copyright © 2024. Published by Elsevier Masson SAS.)

PAX6-related congenital aniridia is a genetic pan-ocular disease characterized by a partial or total absence of the iris and foveal hypoplasia. The mechanisms involved in the development of ocular hypertension and glaucoma in patients with congenital aniridia are still unknown. Many hypotheses have been proposed and the advent of new anterior segment imaging techniques has allowed the identification of various potential mechanisms: congenital trabecular dysfunction, progressive closure of the iridocorneal angle, postoperative ocular hypertension. The diagnosis must take into account the various obstacles to clinical examination (corneal opacity, obturating cataract, foveolar aplasia, significant nystagmus) and is often considered only upon detection of ocular hypertension. Glaucoma remains, along with limbal insufficiency, one of the major causes of blindness in congenital aniridia. The treatment of glaucoma in congenital aniridia is primarily medical. The benefit/risk ratio of a surgical intervention should always be thoroughly evaluated in order to not underestimate the postoperative complications associated with congenital aniridia., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Purpose: Acute postoperative endophthalmitis (APE) is a rare but severe complication of cataract surgery. During the most recent decades, the use of povidone-iodine (PVI) before surgery combined with intracameral cefuroxime has drastically reduced the incidence of endophthalmitis. The goal of this study is to describe the changes in endophthalmitis rates after cataract surgery over the past two decades in a large tertiary ophthalmology center., Methods: A single-center retrospective descriptive study was conducted in the Quinze-Vingts National Ophthalmology Hospital (Paris, France). We included all eyes that underwent cataract surgery between 2000 and 2022. Cases of APE following cataract surgery were reported. The main outcome was the change in yearly incidence of APE. Rates were compared before and after the following events: application of a prophylactic protocol for local anesthesia, use of intracameral cefuroxime, and use of 2% lidocaine gel., Results: We included 178,752 cataract procedures in the study. A total of 49 cases of APE were reported between 2000 and 2022 (0.027%). Endophthalmitis rates progressively decreased, particularly after the introduction of intracameral cefuroxime in surgical practice in 2011. Since an adequate protocol for topical anesthesia was adopted, and intracameral cefuroxime was used systematically, rates of APE decreased and remained as low as 0.007% for the past decade, even though the number of yearly cataract procedures almost doubled., Conclusion: The incidence of endophthalmitis after cataract surgery has significantly decreased over the past twenty-three years in our tertiary care center. The use of PVI before surgery along with systematic intracameral cefuroxime has allowed us to achieve very low rates of endophthalmitis., Competing Interests: Disclosure of interest Marwan Sahyoun declares working at Horus Pharma as a medical advisor at the time of publication. Alexandre Hage declares that he has no competing interest., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

The anatomy and vasculature of the optic nerve head are complex and subject to numerous variations. The main risk factor for glaucomatous optic neuropathy is elevated intraocular pressure, but many other factors have been identified. A vascular component seems to play an important role in the pathogenesis and/or progression of glaucomatous optic neuropathy, either under the influence of ocular hypertension or as an independent risk factor, particularly as in normal tension glaucoma (NTG). Reduced ocular blood flow has been identified as a risk factor for glaucoma. Numerous instruments have therefore been developed to explore the vasculature of the optic nerve head and to try to better understand the changes in blood flow in the optic nerve in glaucomatous optic neuropathy. In this review, we provide an update on the various means of imaging the vasculature of the optic nerve head, from angiography to the most modern techniques with angiographic OCT and laser Doppler holography. Using the results found in glaucomatous optic neuropathies, we will explore the close link between reduced ocular blood flow and the development or progression of glaucoma. A better understanding of this pathophysiology opens the door to improved management of our glaucoma patients., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

The surgical treatment of glaucoma has been and is still based on filtering surgeries, commonly used for about half a century. The safety and efficacy of these techniques have been well described, as it has also been done for cyclophotocoagulation and valves or tubes, indicated in France mostly for refractory glaucoma. Minimally invasive glaucoma surgeries have emerged in recent decades, increasing the number of therapeutic options, and allowing treatment decisions to be as patient-centered as possible. Most of these techniques have now been studied for more than five years. Since glaucoma is a chronic, progressive optic neuropathy, the sustainability of each surgery's results is essential. The amount of available data concerning long-term efficacy and safety of glaucoma surgeries is increasing, so we have decided to describe it through this review of the literature., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Purpose: This study examines the impact of dry eye on screen reading, with an emphasis on glare and visual comfort for patients., Population and Methods: We recruited ten patients with dry eye and nine healthy controls. Clinical signs of dry eye were quantified to determine the quality of the tear film and corneal aberrations. Questionnaires related to quality of life and light sensitivity were administered. All participants underwent a screen reading test under five different levels of brightness., Results: Patients with dry eye presented with more significant ocular inflammation (Oxford score) and reduced tear breakup time (BUT; DED: 4.1s, CO: 11.8s; W=90, P<0.001) compared to the control population. Patients also exhibited impaired quality of life (OSDI score: CO: 15.044±9.16, DED: 38.150±18.66, P=0.004) and increased light sensitivity (Glare test: CO: 96.56±65.5 arc.min, DED: 204.1±82.5 arc.min, W=15, P=0.013; VLSQ score: CO: 16.44±4.85, DED: 22.0±6.34, P=0.049). Reading tests did not show a significant difference between the groups (CO: 155±23.3 words/min and DED: 149±28.0, F=1.935, P=0.169). Brightness did not influence reading speed (F=1.308, P-value=0.275). A correlation was observed between reading speed and the OSDI quality of life questionnaire (R=-0.7, P=0.043)., Conclusion: Although screen brightness did not have a significant impact on reading speed, glare proved to be a major issue for patients with dry eye. The associations between clinical manifestations of dry eye and reading performance emphasize the importance of comprehensive management of this condition. The results suggest that dry eye can influence both quality of life and screen reading, highlighting the need for dedicated approaches to improve the visual comfort of patients., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Purpose: The goal of this study was to assess the efficacy and safety of inferior implantation of the Xen Gel 45® Stent in a cohort of refractory glaucoma patients who had undergone multiple failed procedures and lacked healthy superior conjunctiva., Patients and Methods: We retrospectively included individuals with refractory glaucoma who underwent implantation of a Xen 45® in the inferior quadrants of the conjunctiva. At the 12-month mark, two success criteria were assessed: "Complete" success, defined as an intraocular pressure (IOP)≤21mmHg with a≥20% reduction in IOP without additional IOP-lowering medications, the absence of a requirement for additional filtering surgery, and the absence of chronic hypotony; and "Qualified" success, which consisted of patients meeting the same criteria but requiring glaucoma medications postoperatively. Safety was also monitored throughout the 12-month follow-up., Results: A total of 35 patients who underwent inferior Xen implantation were assessed. After 12months, 20 patients (57.1%) achieved qualified success, with twelve patients (34.3%) attaining complete success. Excluding five patients who underwent additional filtering surgery during follow-up, the mean IOP decreased significantly from 30.73±9.7mmHg to 16.49±7.9mmHg, representing a mean decrease of 14.24±12.13mmHg (46.5%; P<0.0001). The mean number of medications at 12months decreased from 3.43±1.6 to 1.53±1.52 (-55.4%; P<0.0001). The mean number of needlings was 1.29±1.2. Implant exposure was observed in two patients during the first postoperative month., Conclusions: Inferior placement of Xen appears to be a viable treatment option for patients with refractory glaucoma and a history of multiple failed glaucoma procedures. It demonstrates both significant efficacy and acceptable safety., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Hyperbaric oxygen therapy consists of breathing 100% oxygen continuously or intermittently in a chamber at a pressure equal to or greater than 1.4 absolute atmospheres. Indicated for the emergency treatment of carbon monoxide poisoning and other medical-surgical pathologies such as gas embolism or necrotizing soft-tissue infections, various studies have shown a beneficial effect of hyperbaric oxygen therapy in certain ocular pathologies, notably of microcirculatory origin, such as central retinal artery occlusion or macular edema linked to retinal vein occlusions. In addition, hyperbaric oxygen might represent an alternative treatment for ocular quinine toxicity and might also be useful as an adjuvant to surgery and antibiotics in cases of periorbital necrotizing fasciitis. On the other hand, oxygen in high concentrations has toxic ocular effects due to the production of reactive oxygen derivatives., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

The relationship between glaucoma and Obstructive Sleep Apnea Syndrome (OSAS) has long been discussed, with conflicting study findings. OSAS appears in the most recent studies to be more of an aggravating factor than an independent risk factor for glaucoma. Patients with OSAS may develop a more rapid progression of primary open-angle glaucoma (POAG). OSAS may damage the optic nerve not only by increasing the intraocular pressure (IOP) but also by altering the blood supply to the optic nerve as shown by more recent work with OCT-Angiography. Although the systemic benefits of Continuous Positive Airway Pressure (CPAP) have been demonstrated, few studies have evaluated its effect on the optic nerve. CPAP might act on glaucomatous neuropathy by improving the blood supply to the optic nerve. The study of this mechanism of action might provide new insights into the relationship between OSAS and glaucoma., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The surgical management of glaucoma has been enriched in recent years by the arrival of new surgical techniques as a group known as MIGS (minimally invasive glaucoma surgery). The objective of these new techniques is to reduce intraocular pressure (IOP) while limiting the risk of complications of conventional filtering surgery and allowing faster visual recovery. MIGS can be classified into three main categories depending on the route used to promote the outflow of aqueous humor: the trabecular route, the suprachoroidal route and the subconjunctival route. MIGS using the subconjunctival route are also called minimally invasive bleb surgery (MIBS). These new techniques do not replace conventional filtering surgery, which remains the gold standard technique, but now offer new alternatives for the surgical management of glaucoma patients in combination with cataract surgery or as stand-alone procedures., (Copyright © 2023. Published by Elsevier Masson SAS.)

Glaucoma is a chronic optic neuropathy characterized by progressive sclero-laminar remodeling. The main factor at the origin of these deformations is the intraocular pressure (IOP), the effect of which varies according to the biomechanical properties of the individual lamina cribrosa (LC). In this environment, the LC represents a malleable zone of weakness within a rigid corneoscleral shell. It is a dynamic structure whose movements play a key role in the pathogenesis of glaucoma: displacing it posteriorly, in addition to contributing to the characteristic appearance of glaucomatous cupping, would increase constriction on the nerve fibers and the laminar capillaries. Often incorrectly considered permanent in adults, these deformations have a certain degree of reversibility, which is currently better characterized thanks to progress in imaging techniques. The occurrence of anterior displacement and laminar thickening following a reduction in IOP could thus constitute a good prognostic factor by reducing mechanical stress on this region. These changes would tend to reduce laminar pore tortuosity and shear forces, which are probably key mechanisms of axonal loss in glaucoma., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

There is growing interest nowadays for artificial intelligence (AI) in all medical fields. Beyond the direct medical application of AI to medical data, generative AI such as "pre-trained transformer" (GPT) could significantly change the ophthalmology landscape, opening up new avenues for enhancing precision, productivity, and patient outcomes. At present, ChatGPT-4 has been investigated in various ways in ophthalmology for research, medical education, and support for clinical decisions purposes. This article intends to demonstrate the application of ChatGPT-4 within the field of ophthalmology by employing a 'mise en abime' approach. While we explore its potential to enhance the future of ophthalmology care, we will also carefully outline its current limitations and potential risks., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The corneal epithelium is one of the first tissue barriers of the eye against the environment. In recent years, many studies provided better knowledge of its healing, its behavior and its essential role in the optical system of the eye. At the crossroads of basic science and clinical medicine, the study of the mechanical stresses applied to the cornea makes it possible to learn the behavior of epithelial cells and better understand ocular surface disease. We describe herein the current knowledge about the adhesion systems of the corneal epithelium and their resistance to mechanical stress. We will also describe the involvement of these mechanisms in corneal healing and their role in epithelial dynamics. Adhesion molecules of the epithelial cells, especially hemidesmosomes, allow the tissue cohesion required to maintain the integrity of the corneal epithelium against the shearing forces of the eyelids as well as external forces. Their regeneration after a corneal injury is mandatory for the restoration of a healthy epithelium. Mechanotransduction plays a significant role in regulating epithelial cell behavior, and the study of the epithelium's response to mechanical forces helps to better understand the evolution of epithelial profiles after refractive surgery. A better understanding of corneal epithelial biomechanics could also help improve future therapies, particularly in the field of tissue engineering., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Ocular itching and eye rubbing are frequent complaints in an ophthalmology practice. Numerous studies address the consequences of eye rubbing, such as keratoconus. However, there are few studies concerning the pathophysiology of itching, its transmission pathways, or its interactions with eye rubbing. Through this literature review, we will address the various clinical, physiological and therapeutic aspects of this pair of symptoms with a variety of ocular consequences. We will then describe the state of the art in itching and scratching in dermatology, in order to draw a parallel between these two vicious cycles. A better understanding of the pathophysiology of ocular itching and eye rubbing, as well as new studies based on dermatological data, might allow more appropriate clinical management of our patients and their symptoms., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background: The goal of this study was to assess the efficacy and safety of phacoemulsification combined with iStent Inject® implantation for the treatment of chronic open-angle glaucoma controlled on topical anti-glaucoma medications and associated with cataract., Methods: This study was a retrospective analysis of patients who underwent phacoemulsification and implantation of an iStent Inject® for chronic open-angle glaucoma associated with cataract. For all patients, pre- and postoperative characteristics, including number of glaucoma medications and intraocular pressure (IOP), were compared using Paired-sample t-tests and Wilcoxon signed-rank tests, respectively. Postoperative visits were scheduled at 7 days and 1, 3, 6, and 12 months after surgery., Results: Forty-nine eyes of 39 patients were included in the study. Mean preoperative IOP at baseline was 16.3±4.3mmHg (range, 10-29mmHg) with a mean of 2.2±1.0mmHg antiglaucoma medications. At 1 month, the mean IOP reduction was 16% (P<0.05) along with an 18.7% reduction in the mean number of medications. At 6 months, the mean IOP was 12.8±2.6, with a mean of 1.1±0.9 antiglaucoma medications. The mean IOP reduction at 6 months was 22% (P<0.05) along with a 49% reduction in the mean number of medications. At 12 months, the mean IOP was 13.8±2.5 with a mean of 1.1±1.2 medications. The mean IOP reduction at 12 months was 15% (P<0.05) along with a 47% reduction in the mean number of medications. No severe device-related side effects were observed., Conclusions: iStent Inject® implantation combined with phacoemulsification resulted in effective IOP reduction and medication burden in patients with mild to advanced chronic open-angle glaucoma and preoperative IOP well controlled with topical hypotensive medications., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Located within the scleral canal, the lamina cribrosa is a sieve-like structure separating the intraocular and retrobulbar portions of the optic nerve. Identified as the main site of axonal damage in glaucomatous optic neuropathy, the study of the lamina cribrosa has been of great interest for many years. Numerous studies have explored the histological and morphological characteristics of the laminar region in healthy subjects as well as glaucoma patients. More recently, the development of adaptive optics systems and new generations of OCT has allowed great progress in the understanding of the pathogenesis of glaucoma and has opened new perspectives for the improvement of diagnostic procedures., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Glaucoma is an optic neuropathy in which the primary risk factor is increased intraocular pressure (IOP), attributed to increased resistance to trabecular outflow of aqueous humor (AH). This resistance is believed to result from trabecular degeneration secondary to chronic oxidative stress and cellular senescence but may also involve inflammatory mechanisms whose roles are little known. In fact, inflammatory processes play a major role in the pathophysiology of glaucoma to varying degrees, affecting all structures of the eye, including the ocular surface, the anterior and posterior segments, and even the visual pathways of the brain. These processes are thought to result from dysfunction of a regulatory, protective para-inflammation, becoming chronic and harmful in glaucoma. While the mechanisms of the retinal inflammation which accelerates the degeneration of retinal ganglion cells (RGC) as well as the inflammation of the ocular surface aggravated by long-term use of preserved glaucoma eye drops have been described for several years, very little is known about the pathophysiology of trabecular inflammation in glaucoma. The objective of this literature review is to provide a synthesis of knowledge on the roles and mechanisms of inflammation in both the healthy and glaucomatous trabecular meshwork, as well as its role in the pathophysiology of glaucoma. Therefore, after a review of the mechanisms of cellular senescence and oxidative stress - sources of trabecular inflammation, we will approach the study of the expression and roles of the main inflammatory mediators within the trabecular meshwork. Finally, we will discuss current knowledge on the toxicity of glaucoma eye drops and their preservatives on the ocular surface and trabecular meshwork as well as their role in trabecular inflammation., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Dupilumab is a recombinant monoclonal IgG4 type antibody which inhibits IL4 and IL13 signaling. It is indicated in moderate to severe atopic dermatitis (AD) in adults and adolescents over 12 years of age. Its side effects include conjunctivitis and blepharoconjunctivitis, affecting between 4.7% and 28% of patients depending on the study. The incidence of conjunctivitis in patients treated with dupilumab for AD appears to be higher than placebo in clinical studies. This increase was not observed in patients treated with dupilumab for asthma or sinonasal polyposis. The risk factors for conjunctivitis in patients with AD are disease severity, pre-existence of conjunctivitis and low concentrations of dupilumab, but the pathophysiology of this disease is poorly understood. A literature search carried out in April and May 2020 showed an increase in the number of publications on the subject, but there are currently no official joint dermatologist-ophthalmologist recommendations for prevention and management. The objective of this article is to provide an overview of the status of this subject, to address the main questions raised by this type of conjunctivitis and to suggest a course of action for starting and continuing treatment with dupilumab in patients with AD, according to the recommendations of the French Ophthalmologist/Dermatologist group CEDRE., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

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.)

Purpose: To evaluate a customized silicone flexible artificial iris in cases of aniridia or iris deficiencies., Setting: Centre Hospitalier National d'Ophtalmologie, Hôpital des Quinze-Vingts, Paris, France., Design: Retrospective case series investigating cosmetic result, photophobia, endothelial cell density and intraocular pressure., Methods: Patients with iris deficiencies requiring cataract surgery or correction of aphakia, or pseudophakic patients, complaining of photophobia or cosmetic disturbances were implanted with the new flexible artificial iris., Results: Fifteen eyes of 14 patients were evaluated. Mean age was: 49.5 (±18.5). A total of 50% were aphakic, 22.4% pseudophakic and 28.6% phakic. Etiology was trauma (57.1%), previous surgical trauma (28.6%) and congenital aniridia (14.3%). Three months postoperatively, the mean subjective photophobia score improved by 5.2 points (P=.002) and the mean cosmesis score by 4.7 points (P=.001) on a 0 to 10 scale. Mean endothelial cell loss was 16% (P=.001). There was no further statistically significant endothelial cell loss between the 3-month follow-up and the 1-year follow-up visit (P=.320). Elevated intraocular pressure was the main complication (35.7%). Two patients with pre-existing glaucoma required cyclodestructive procedures. The artificial iris was removed in one eye because of chronic pain, elevated intraocular pressure and inflammation that resolved rapidly after removal., Conclusion: Implantation of the customized artificial iris is a very good option because of its outstanding cosmetic result. However, patients with pre-existing glaucoma are not good candidates. Patients should also be warned of possible chronic inflammation necessitating explantation., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Glaucoma is an optic neuropathy in which the primary risk factor is increased intraocular pressure (IOP), attributed to increased resistance to trabecular outflow of aqueous humor (AH). This resistance is believed to result from trabecular degeneration secondary to chronic oxidative stress and cellular senescence but may also involve inflammatory mechanisms whose roles are little known. In fact, inflammatory processes play a major role in the pathophysiology of glaucoma to varying degrees, affecting all structures of the eye, including the ocular surface, the anterior and posterior segments, and even the visual pathways of the brain. These processes are thought to result from dysfunction of a regulatory, protective para-inflammation, becoming chronic and harmful in glaucoma. While the mechanisms of the retinal inflammation which accelerates the degeneration of retinal ganglion cells (RGCs) as well as the inflammation of the ocular surface aggravated by long-term use of preserved glaucoma eye drops have been described for several years, very little is known about the pathophysiology of trabecular inflammation in glaucoma. The objective of this literature review is to provide a synthesis of knowledge on the roles and mechanisms of inflammation in both the healthy and glaucomatous trabecular meshwork, as well as its role in the pathophysiology of glaucoma. Therefore, after a review of the mechanisms of cellular senescence and oxidative stress - sources of trabecular inflammation, we will approach the study of the expression and roles of the main inflammatory mediators within the trabecular meshwork. Finally, we will discuss current knowledge on the toxicity of glaucoma eye drops and their preservatives on the ocular surface and trabecular meshwork as well as their role in trabecular inflammation., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose: To describe en face anterior segment optical coherence tomography (EF-OCT) characteristics of pterygia and their correlation with in vivo confocal microscopy (IVCM)., Patients and Methods: In this observational case series, we prospectively included 21 eyes of 17 subjects with pterygium. All subjects underwent detailed ophthalmic examination, anterior segment photography, an ocular surface disease index (OSDI) questionnaire, IVCM, and EF-OCT. Eyes were divided into two groups according to pterygium severity (Modified Pterygium Classification System) and OSDI score. EF-OCT images for both groups were analyzed for surface area of Fuchs Patches (FP). The IVCM activity score was based on the number of inflammatory cells, blood vessels, activated keratocytes and the appearance of the cornea/pterygium at the head of the pterygium. The correlations between EF-OCT and IVCM images were then analyzed and compared in both groups., Results: EF-OCT permits clear visualization and evaluation of FPs and the border between the pterygium and the adjacent cornea. The severe pterygium group was characterized by irregular borders and larger FPs (0.13±0.06 mm 2 versus 0.06±0.02 mm 2 respectively) (P=0.003). The mean IVCM activity score was 2.36±0.81 in the severe pterygium group and 1.2±0.42 in the mild pterygium group (P=0.0013). There was a positive correlation between FP surface area and IVCM activity score. A larger FP surface area was associated with a higher activity score on IVCM., Conclusion: EF-OCT allows good evaluation of pterygium extension, borders and FP surface area. EF-OCT analysis of pterygium could represent a simple, non-invasive and reproducible method to evaluate pterygium severity and activity., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose: The study aimed to detect and describe glaucoma-related pseudocystic abnormalities at the internal nuclear layer (INL) of the macula using OCT, in relation with visual field defects and other clinical data., Patients and Methods: Primary open-angle glaucoma patients presenting for a follow-up visit were consecutively included over 5 months and underwent clinical examination, OCT imaging, and central 10-2 visual field testing. OCT measures included the thickness of the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC), together with an analysis of B-Scans and en-face images. All data provided by OCT were analyzed and compared with the visual field testing., Results: Fourteen patients out of 216 showed pseudocysts in the INL of the macula. These cysts were hyporeflective, fusiform, and of variable size (15 to 25μm) and were always associated with a thinning of both the RNFL and GCC. En-face OCT showed evidence of a distribution of cysts in the macular region, based on the appearance of numerous, dense hyporeflective pits whose localization matched precisely with the vision loss as assessed by central 10-2 visual field testing. No other correlations were found., Discussion: Pseudocysts of the internal nuclear layer of the macular region are found in some cases of chronic glaucoma. Their presence is always associated with a scotoma in the visual field and appear to constitute a marker for glaucoma progression. Glaucoma-related central pseudocysts could result from Müller cell changes, excitotoxicity, and/or trans-synaptic retrograde degeneration. The presence of pseudocysts could be a marker of a particular subpopulation whose features remain to be determined., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose: This study aimed to evaluate the ability of a freely accessible internet algorithm to correctly identify the need for emergency ophthalmologic consultation for correct diagnosis and management., Method: This retrospective observational cohort study was based on the first 100 patients who requested recommendations on the necessity of breaking the lockdown for emergency ophthalmology consultation during the period from March to May 2020., Results: Ninety-one patients completed questionnaires. Forty-nine were directed to emergency consultation and 42 to differed scheduled visits or telemedicine visits. One patient sent for emergency consultation had an overestimated severity and could have been seen later, while two patients initially recommended for a scheduled visit were considered appropriate for emergency consultation. However, these patients' management did not suffer as a consequence of the delay. The sensitivity of the algorithm, defined as the number of emergency consultations suggested by the algorithm divided by the total number of emergency consultations deemed appropriate by the practitioner's final evaluation, was 96.0%. The specificity of the algorithm, defined as the number of patients recommended for delayed consultation by the algorithm divided by the number of patients deemed clinically appropriate for this approach, was 97.5%. The positive predictive value, defined as the number of appropriate emergency consultations divided by the total number of emergency consultations suggested by the algorithm, was 97.9%. Finally, the negative predictive value, defined as the number of appropriately deferred patients divided by the number of deferred patients recommended by the algorithm, was 95.2%., Conclusion: This study demonstrates the reliability of an algorithm based on patients' past medical history and symptoms to classify patients and direct them to either emergency consultation or to a more appropriate deferred, scheduled appointment. This algorithm might allow reduction of walk-in visits by half and thus help control patient flow into ophthalmologic emergency departments., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose: To assess the prevalence of visual disturbances among school-aged children in prioritized education zones in France., Methods: The PlanVue® pilot project was designed to detect and manage visual disturbances in school-aged children in the prioritized education areas of the city of Nanterre, France. During this pilot study, a cohort of 515 children aged 4 to 13 years underwent a school vision screening between January and March 2019, consisting of an overall evaluation of the child's visual behavior, measurement of uncorrected visual acuity in each eye, objective refraction with a photoscreener and strabismus screening. If the examination was abnormal as determined by impaired vision or an algorithm based on the abnormalities found, the children were referred to an ophthalmologist., Results: Decreased visual acuity was found in 20% of school-aged children. Out of the 515 children screened, 22% were referred to an ophthalmologist. Among these children, 13% were diagnosed with amblyopia, 73% with spherical ametropia, 57% with astigmatism and 2% with strabismus. Of the entire population screened, 12% of the children needed optical correction but had not received glasses., Conclusion: This study confirms the high prevalence of uncorrected refractive errors among school-age children. A screening program carried out in a school environment by paramedical professionals might make it possible to considerably reduce the rate of uncorrected visual disorders and their consequences., (Copyright © 2021. Published by Elsevier Masson SAS.)

Purpose: To determine whether manifest refractive astigmatism (RA) or anterior corneal astigmatism (CA) is the best value for excimer laser programming in cases of ocular residual astigmatism (ORA)., Patients and Methods: Patients who had undergone LASIK surgery with a disagreement between manifest refractive and corneal cylinder (ocular residual astigmatism ORA)>0.75 D were included retrospectively in this study. We calculated target induced astigmatism vector (TIA), surgically induced astigmatism vector (SIA), difference vector between the astigmatism correction programmed in the excimer laser and refractive astigmatism (DVRA), difference vector between the astigmatism correction programmed in the excimer laser and corneal astigmatism (DVCA) and difference vector between TIA and SIA (DV), by the Alpins method. Vectorial differences between DV and DVRA, and between DV and DVCA, were then calculated to determine whether RA or CA was closest to the ideal cylinder for laser programming., Results: Of a total of 104 eyes undergoing LASIK, 22 eyes of 12 patients (21.1%) had an ORA>0.75 D and were included. Mean ORA was 0.9±0.2 D and mean postoperative subjective cylinder was 0.45 D. The DV-DVRA difference vector was 0.57±0.2 D, and the DV-DVCA difference vector was 0.86±0.4 D (P=0.02). RA was closer than CA to the ideal astigmatism correction., Conclusion: In cases of discrepancy between manifest astigmatism and corneal astigmatism, correction of manifest refractive astigmatism seems to give a better refractive result., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Demodex is a saprophytic mite of the ocular adnexa, which can in certain circumstances proliferate on the skin of the face and on the eyelid margins. It is involved in facial rosacea (especially in the papulopustular form) and in the development or aggravation of anterior and/or posterior blepharitis or even keratoconjunctivitis, often in association with cutaneous lesions ; the pathophysiology is often multifactorial. Symptoms are non-specific, but the presence of cylindrical sleeves on the eyelashes is very suggestive of infestation, and certain techniques of biomicroscopic examination or imaging, such as confocal microscopy in vivo, allow direct visualization of the parasite. Parasitological examination of the eyelashes can confirm the diagnosis and can be improved by good sampling technique. Eyelid hygiene and oil-based ointments are the cornerstone of treatment. New specific treatments, in particular topical treatments based on tea tree oil, ivermectin, as well as pulsed light therapy and micro-exfoliation of the eyelid margin, can help to reduce the parasitic load and improve symptoms., (Copyright © 2020. 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.)

Radius-Maumenee syndrome is a rare cause of severe secondary open-angle glaucoma. The ocular hypertension is due to episcleral venous hypertension. This syndrome consists of open angle glaucoma and episcleral venous dilatation without orbital or systemic abnormalities. It is diagnosis of exclusion after ruling out carotid-cavernous fistula, thyroid orbitopathy and an invasive orbital process that might explain the elevated episcleral venous pressure. Treatment begins with glaucoma eyedrops and, in case of failure, filtering surgery. Uveal effusion syndrome and postoperative choroidal detachment are frequent complications of filtering surgery in patients with this syndrome. We present the case report of a 59-year-old woman with Radius-Maumenee syndrome., (Copyright © 2020. Published by Elsevier Masson SAS.)

Glaucoma is a blinding optic neuropathy, the main risk factor for which is increased intraocular pressure (IOP). The trabecular meshwork, located within the iridocorneal angle, is the main pathway for drainage of aqueous humor (AH) out of the eye, and its dysfunction is responsible for the IOP elevation. The trabecular meshwork is a complex, fenestrated, three-dimensional structure composed of trabecular meshwork cells (TMC) interdigitated into a multilayered organization within the extracellular matrix (ECM). The purpose of this literature review is to provide an overview of current understanding of the trabecular meshwork and its pathophysiology in glaucoma. Thus, we will present the main anatomical and cellular bases for the regulation of aqueous humor outflow resistance, the pathophysiological mechanisms involved in trabecular dysfunction in the various types of glaucoma, as well as current and future therapeutic strategies targeting the trabecular meshwork., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Glaucoma is a blinding optic neuropathy, the main risk factor for which is increased intraocular pressure (IOP). The trabecular meshwork, located within the iridocorneal angle, is the main pathway for drainage of aqueous humor (AH) out of the eye, and its dysfunction is responsible for the IOP elevation. The trabecular meshwork is a complex, fenestrated, three-dimensional structure composed of trabecular meshwork cells (TMC) interdigitated into a multilayered organization within the extracellular matrix (ECM). The purpose of this literature review is to provide an overview of current understanding of the trabecular meshwork and its pathophysiology in glaucoma. Thus, we will present the main anatomical and cellular bases for the regulation of aqueous humor outflow resistance, the pathophysiological mechanisms involved in trabecular dysfunction in the various types of glaucoma, as well as current and future therapeutic strategies targeting the trabecular meshwork., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Meibomian gland dysfunction (MGD) encompasses a group of complex pathologies of the ocular surface. They represent one of the main etiologies of dry eye but also one of the leading causes of consultation in ophthalmology. Conventional clinical tests (dry eye symptoms, tear film rupture time, glandular expressiveness assessment, or Schirmer's test) allow only an indirect assessment of Meibomian gland function and physiology. Various in vivo investigation methods have therefore been developed to image the meibomian glands such as meibography, optical coherence tomography, ultrasound or in vivo confocal microscopy. Some are accessible in clinical practice, while others remain in the field of clinical research. All these techniques aim to develop a direct structural analysis of the Meibomian glands to help in the diagnosis of DGM but also to better understand the pathophysiology of Meibomian glands. This review of the literature aims to provide an overview of existing imaging modalities and their interest in the evaluation of Meibomian glands and MGD., (Copyright © 2020 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Meibomian gland dysfunction (MGD) includes a group of complex disorders of the ocular surface. It represents one of the main etiologies of dry eye as well as one of the main reasons for patient visits to the ophthalmologist. Classic clinical tests (dry eye symptoms, tear film break-up time, evaluation of gland expressibility or Schirmer's testing) only provide an indirect assessment of the function of the Meibomian glands and the meibum. Various in vivo testing methods have therefore been developed to image the Meibomian glands, such as Meibography, optical coherence tomography, ultrasound, or even in vivo confocal microscopy. Some are accessible in clinical practice, while others are limited to the realm of clinical research. All of these techniques aim to develop a direct structural analysis of the Meibomian glands so as to assist in the diagnosis of MGD as well as to better understand the pathophysiology of the Meibomian glands. This review of the literature hopes to provide an overview of the current imaging modalities and their role in the evaluation of the Meibomian glands and MGD., (Copyright © 2019. Published by Elsevier Masson SAS.)

Ischemic optic neuropathies are among the leading causes of severe visual acuity loss in people over 50 years of age. They constitute a set of various entities that are clinically, etiologically and therapeutically different. Anatomically, it is necessary to distinguish anterior and posterior forms. From an etiological point of view, the diagnosis of the arteritic form due to giant cell arteritis requires emergent management to prevent blindness and even death in the absence of prompt corticosteroid treatment. When this diagnosis has been ruled out with certainty, non-arteritic ischemic optic neuropathies represent a vast etiological context that in the majority of cases involves a local predisposing factor (small optic nerves, disc drusen) with a precipitating factor (severe hypotension, general anesthesia or dialysis) in a context of vascular disease (sleep apnea syndrome, hypertension, diabetes, etc.). In the absence of specific available treatment, it is the responsibility of the clinician to identify the risk factors involved, in order to reduce the risk of contralateral recurrence that may occur even several years later. Due to their complexity, these pathologies are the subject of debates regarding both the pathophysiological and therapeutic perspectives; this review aims to provide a synthesis of validated knowledge while discussing controversial data., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Ischemic optic neuropathies are among the leading causes of severe visual acuity loss in people over 50 years of age. They constitute a set of various entities that are clinically, etiologically and therapeutically different. Anatomically, it is necessary to distinguish anterior and posterior forms. From an etiological point of view, the diagnosis of the arteritic form due to giant cell arteritis requires emergent management to prevent blindness and even death in the absence of prompt corticosteroid treatment. When this diagnosis has been ruled out with certainty, non-arteritic ischemic optic neuropathies represent a vast etiological context that in the majority of cases involves a local predisposing factor (small optic nerves, disc drusen) with a precipitating factor (severe hypotension, general anesthesia or dialysis) in a context of vascular disease (sleep apnea syndrome, hypertension, diabetes, etc.). In the absence of specific available treatment, it is the responsibility of the clinician to identify the risk factors involved, in order to reduce the risk of contralateral recurrence that may occur even several years later. Due to their complexity, these pathologies are the subject of debates regarding both the pathophysiological and therapeutic perspectives; this review aims to provide a synthesis of validated knowledge while discussing controversial data., (Copyright © 2019. Published by Elsevier Masson SAS.)

The increase in life expectancy has resulted in a greater number of patients presenting for cataract surgery as well as an increasing prevalence of dry eye disease (DED) symptoms or signs noted in these patients. Low grade and/or non-symptomatic DED is common and can be exacerbated after surgery. DED can induce errors in IOL power calculation. DED can impair the visual prognosis and patient comfort after cataract surgery, leading to dissatisfaction of both the patient and the surgeon. Hence, preoperative evaluation for DED for all cataract candidates is crucial to mitigate these risks. To optimize clinical efficiency during the screening examination, we propose a strategy of three levels of DED screening, according to a patient's risk of DED given his or her history. We also propose a summary of the main clinical points before, during and after cataract surgery in eyes with DED., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Lacrycon ® is a preservative-free hypotonic artificial tear for the treatment of dry eye syndrome containing hyaluronic acid, carbomer, and glycerol. Lacrycon has been used for many years; this is the first comprehensive review of clinical efficacy and tolerability. Eight clinical studies (1992-2013) were reviewed. Comparators included phosphate-buffered saline (Phase I) and active controls (Phase II: Lacrisol™; Phase III: Gel-larmes™, Lacrisol, Hyalistil ® , Vismed ® , or the currently prescribed tear substitute). Administration schedules varied from 3 to 8 instillations per day for 7 to 84 days, and evaluation timepoints varied between studies. Pre-corneal retention of Lacrycon was 22% better than phosphate-buffered saline in terms of AUC (P=0.048). Patients' evaluation of efficacy was better for Lacrycon than Gel-larmes on Day 15 and 45 (P<0.05) and similar on Day 90 (P>0.05); there was no difference (P>0.05) versus Hyalistil (Day 30) or Vismed (Day 35 and 85). Functional tests were either in favor of Lacrycon (P<0.05) (fluorescein test [versus Gel-larmes/Lacrisol/Hyalistil], tear break-up time [TBUT] and rose Bengal test, Schirmer I test, and tear meniscus [versus Lacrisol]), or there was no difference between treatments (P>0.05) (fluorescein test [versus Vismed], TBUT and rose Bengal test [versus Gel-larmes], Schirmer I test [versus Gel-larmes/Lacrisol/Hyalistil/VisMed], tear meniscus [versus Lacrisol/Hyalistil], Oxford Grading Score, OSDI, van Bijsterveld score, and conjunctival hyperemia [versus Vismed]). Lacrycon was better tolerated than most comparators and had a similar safety profile to Vismed. No comparison showed favored the comparator over Lacrycon. These good efficacy, tolerability and safety data support the use of Lacrycon in dry eye syndrome., (Copyright © 2019. Published by Elsevier Masson SAS.)