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Introduction Notre objectif est d’évaluer l’efficacité à long terme de l’interféron alpha pour le traitement de l’uvéite sévère associée à la maladie de Behçet. Patients et méthodes Dans cette étude rétrospective, ont été inclus tous les patients souffrant d’une uvéite sévère associée à la maladie de Behçet résistante aux immunosuppresseurs conventionnels et/ou à des doses de corticoïdes > 10 mg/j et traités par interféron alpha à la Pitié-Salpêtrière entre mai 1995 et juin 2013. Tous les patients ont été initialement traités par interféron alpha à la dose de 3 millions d’unités internationales (MUI) 3 fois par semaine, augmentée à 6 MUI 2 fois par semaine en cas de rechute ou arrêté en cas d’examen clinique stable. Avant, pendant et après traitement, pour chaque patient, ont été systématiquement effectués la mesure de la meilleure acuité visuelle corrigée, un examen ophtalmologique complet, une OCT et une angiographie à la fluorescéine à intervalles réguliers afin de caractériser et de quantifier le nombre d’épisodes inflammatoires. Résultats Trente-six patients, d’âge moyen égal à 30,5 ans, 13 femmes et 23 hommes, principalement atteints de panuvéite (75 %) ont été inclus. La période moyenne d’observation a été de 8,2 ans. Parmis ces 36 patients, 33, 25 et 18 patients ont été suivis respectivement pendant 2, 4 et 9 ans. Sur 36 patients (67 yeux), 31 (86,1 %) ont été répondeurs à l’interféron. Vingt et un des 36 patients ont pu l’arrêter et 76 % d’entre eux n’ont jamais rechuté en moyenne 5 ans après. L’incidence des rechutes a significativement diminué de 1,39 à 0,0496 ( p = 1,82*10^-10) et a faiblement ré-augmenté à 0,057 rechutes/personne/an respectivement avant, pendant et après la période de traitement par interféron alpha. La durée moyenne entre l’arrêt de l’interféron et la première rechute a été de 24,2 mois. Sur la période de suivi, l’acuité visuelle est restée stable ou s’est améliorée pour 90,3 % des patients. Durant les 4 ans suivant l’initiation de l’interféron, nous avons observé une diminution rapide de l’inflammation oculaire et en particulier de la prévalence des vascularites, des œdèmes maculaires et des papillites. Conclusions L’interféron alpha semble efficace pour traiter les uvéites sévères associées à la maladie de Behçet. La possibilité d’une rémission à long terme près arrêt de l’interféron alpha pour les patients répondeurs semblent être confirmée par notre étude. [ABSTRACT FROM AUTHOR]

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.)

Purpose: While endothelial keratoplasty has become the standard treatment for Fuchs dystrophy, the strategy for first-line surgery in patients with associated cataract is still debated. The purpose of this study was to evaluate the surgical outcomes of eyes with Fuchs endothelial corneal dystrophy (FECD) undergoing phacoemulsification alone, to ascertain preoperative factors that predict the need for endothelial keratoplasty (EK)., Methods: Single-center retrospective study. Cataract surgery alone was performed in 64 eyes of 50 patients with FECD. This decision was made if the patient did not have morning blur, the central corneal thickness (CCT) was below 630 microns, and endothelial cells were visible in the periphery., Results: Mean follow-up was 21 months (range 5-55 months). The mean preoperative CCT was 571±43μm. 6 months after surgery, it was 584±52μm (P=0.12). During follow-up, 14 eyes (22%) required an EK because of poor visual outcome after cataract surgery alone. Mean pre-operative CCT of these eyes (595±23μm) was significantly higher than eyes that did not require EK during follow-up (564±45μm, P=0.022). Over 570 microns, 34% of eyes required an endothelial keratoplasty after the cataract surgery alone., Conclusions: CCT below 630μm associated with the absence of morning blur are preoperative criteria allowing 78.1% eyes with FECD to obtain good visual outcomes after cataract surgery alone. In these eyes, EK can therefore be avoided while ensuring good results., (Copyright © 2021. Published by Elsevier Masson SAS.)

Introduction: A fire at the Lubrizol chemical factory in Rouen on September 26, 2019 generated a huge column of smoke directed northeast toward the city. As the eye might be particularly affected by the smoke and other toxic emissions from the fire, we assessed the impact of this industrial and ecological disaster on irritative eye surface disease in the week following the accident., Materials and Methods: We retrospectively collected the medical data of the patients who presented to the Ophthalmology Emergency Department (OED) of Rouen University Hospital (the only OED open during the days following the accident) during the week following the fire (W1). We compared these data with those of patients who presented during the week before the fire (W-1). We also collected data on patients presenting to the ED in general during W-1 and W1, including the number of visits directly related to the fire., Results: 361 patients presented to the OED during W1 following the fire, compared with 384 in W-1. Of these patients, 83 (23%) had ocular surface disease in W1, versus 76 (20%) in W-1. Conjunctivitis was found in 54 patients in W1 (39 viral, 9 allergic, 6 undetermined) versus 44 in W-1 (27 viral, 12 allergic, 5 undetermined). A dry irritative syndrome was present in 29 patients in W1 versus 32 in W-1. Only 4 patients directly attributed their symptoms to the fire: 2 viral conjunctivitis, 1 allergic conjunctivitis and 1 worried patient (at D2, D5, D7 and D7 following the fire respectively)., Discussion: The number of emergency eye consultations did not change in the week following the Lubrizol factory fire (except for a decrease the day of the accident, related to the lock-down). There was a higher number of consultations in W1 for conjunctivitis, mostly viral in appearance and probably not directly related to the fire. The number of consultations for dry irritative syndrome was comparable between the two periods. Despite major media coverage of the event at the national level and a very high level of concern among the population, the fire does not seem to have had an effect on OED activity at Rouen University Hospital, nor on general ED visits. The stay-at-home order on the first day may have had a protective effect, avoiding direct exposure to smoke. The long-term consequences of the soot deposits on the ground as the smoke cloud passed over remain undetermined and are under surveillance. A review of the literature on the ocular consequences of industrial accidents is presented., Conclusion: The Ophthalmology Emergency Department did not record increased activity in the week following the Lubrizol Rouen fire, and ocular surface disease did not give rise to more consultations than the week before the fire. This suggests that there was no or minimal immediate ocular toxicity of the smoke from the fire., (Copyright © 2021. Published by Elsevier Masson SAS.)

Introduction: Meibomian gland dysfunction (MGD) is the most common cause of dry eye syndrome. The goal of this study was to evaluate the efficacy of combined intense pulsed light (IPL) and low-level light therapy (LLLT) in symptomatic MGD., Materials and Methods: This retrospective study analyzed data from 30 patients with MGD causing dry eye symptoms not relieved by medical therapy and managed with combined IPL and LLLT. The primary endpoint was the Ocular Score Disease Index (OSDI) score at 1 month and 1 year. Secondary endpoints were visual acuity, intraocular pressure, tear film break-up time, Schirmer's test, Oxford score, and infrared meibographic score at 1 month after the conclusion of treatment., Results: The mean OSDI score decreased from 43±19 to 17±12 (1 month; p<0.0001) and then to 29±11 (12 months; p=0.013); 63% of patients were meibographic grade 2 before versus 7% after treatment (range, 1-4) (p=0.009); 75% of patients were Oxford grade 1 before versus 41% after treatment (p=0.004) (range, 1-3). No significant difference in the other secondary endpoints was noted., Conclusion: Over time, IPL therapy in combination with LLLT appears to improve patients with symptomatic MGD resistant to medical therapy., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Introduction: Corneal tattooing is a noninvasive technique which appears relatively well-tolerated in the medium term. We report the cases of 3 patients with a significant change in the color of their tattoos performed over 5 years previously., Patients and Methods: Three patients with a history of intracorneal tattooing several years previously were studied because of a significant change from their initial color. Each patient's file was reviewed with analysis of slit lamp photographs, OCT and specular microscopy., Results: All three patients experienced a significant color change in their tattoos between 5 and 6 years after surgery. The color had changed to golden-brown., Discussion: Retrospective analysis of the components of the tattoo ink found the presence of iron in the black pigment. We believe that pigments composed of iron oxide are transformed into golden-brown ferric iron oxide in the presence of oxygen in the aqueous environment. The presence of moderate corneal edema in these three cases of multioperated patients could explain, in these specific cases, the occurrence of oxidation typically not described., Conclusion: Corneal tattooing remains a simple and very interesting technique when partial or total absence of iris causes significant photophobia. However, the significant changes in color that we report more than 5 years later suggest omitting iron from the dyes used for the cornea and limiting its use in cases of limited endothelial prognosis. A long-term evaluation of corneal tattoos appears necessary., (Copyright © 2019. Published by Elsevier Masson SAS.)

Anterior uveitis is the most common form of uveitis. There are several known and many possible etiologies for anterior uveitis. After examining the posterior segment and ruling out masquerade syndromes, the main step of etiologic diagnosis is clinical characterization. It is essential to establish unilateral versus bilateral involvement and presence or absence of granulomatous features. Subsequently, a work-up may be obtained which then helps to confirm diagnostic hypotheses based on the detailed history and clinical examination. The priority is to rule out an infection, although less frequent, before starting steroid therapy, adapted to the severity of the clinical picture. Finally, biologics have greatly changed the management and prevention of some forms of anterior uveitis, in particular uveitis associated with HLA-B27 and juvenile idiopathic arthritis-associated anterior uveitis., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Introduction: Graft-versus-host disease is a major complication of allogeneic hematopoietic stem cell transplantation. Severe keratoconjunctivitis sicca is common in patients with chronic GVH disease. The goal of this study was to evaluate the safety and efficacy of a gas-permeable scleral lens in the management of severe dry eye disease associated with chronic GVH., Patients and Methods: This is a retrospective study from June 2009 to November 2013. Patients fitted with scleral lenses for severe keratoconjunctivitis sicca associated with chronic GVH were included. The main outcomes measured were best-corrected visual acuity and quality of life (OSDI and NEI-VFQ25) composite scores before and six months after scleral lens fitting., Results: Sixteen patients were included. The mean age was 52 years (19-69 years). Mean follow-up was 20 months (3-48 months). All patients reported improvement of their ocular symptoms. Best corrected visual acuity improved from 0.21 ± 0.26 to 0.1 ± 0.14 logMAR (P = 0.002), OSDI score improved from 92.1 ± 11.3 to 23.5 ± 11.2 (P = 0.002) and NEI-VFQ25 improved from 41.3 ± 7 to 83.1 ± 15.9 (P = 0.003), 6 months after scleral lens fitting. No serious adverse events, infectious, hypoxemic or allergic complications attributable to the scleral lens occurred., Conclusion: Gas-permeable scleral lens use appears to be safe and effective in patients with severe dry eye related to chronic GVH., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: Moxifloxacin is an antibiotic of the fluoroquinolone class, marketed in France since 2002. It is used primarily in the treatment of bacterial sinusitis and acute exacerbations of chronic bronchitis. The purpose of this study is to report a possible severe ocular side effect following the systemic use of moxifloxacin., Patient and Methods: Case report of a patient who presented with the appearance of a severe acute uveitis after being treated with systemic moxifloxacin. Eleven days after initiation of moxifloxacin treatment, the patient developed simultaneous bilateral eye pain, pigment dispersion and diffuse iris transillumination. This case was further complicated by ocular hypertension. Etiologic investigations for other causes of the uveitis were negative. In particular, an anterior chamber tap was performed and PCR for herpes viruses (HSV, VZV, EBV, CMV) was negative., Discussion: Drug-induced uveitis is relatively rare. The relationship between systemic fluoroquinolone treatment and the occurrence of uveitis has been considered "possible", according to World Health Organization criteria, in a recent retrospective analysis of 40 case reports. Moxifloxacin was suspected in 25 of these cases. The presence of both iris transillumination and pigment dispersion appears specific to the uveitis in question., Conclusion: It appears that practitioners prescribing moxifloxacin and ophthalmologists should be informed of this possible adverse effect, so that it may be quickly recognized, managed and reported., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

We report the case of an eight-year-old patient referred by his primary care physician for chronic headache. Bilateral papilledema was observed along with right sixth cranial nerve palsy, leading to the diagnosis of intracranial hypertension. Head CT showed no mass lesion. Lyme serology was positive by both Elisa and Western blot. Anti-Borrelia antibodies were positive in the cerebrospinal fluid, with intrathecal synthesis confirming neuroborreliosis. Clinical response to ceftriaxone and acetazolamide was favorable. Intracranial hypertension is rarely caused by Lyme disease. Ophthalmologists should be aware of this clinical presentation, since the presenting clinical signs may be purely ophthalmologic. In addition, early diagnosis may avoid optic nerve atrophy or disease spread., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Corneal pathologies leading to keratoplasty are often associated with cataract and combined surgery is therefore mandatory. Triple procedure with penetrating keratoplasty and concurrent cataract extraction followed by intra ocular lens (IOL) implantation is usually the preferential choice because visual rehabilitation is theoretically more rapid. Surgeons have to be aware of surgical conditions during open-sky surgery because vitreous pressure is not counterbalanced by anterior chamber pressure. Today, many surgeons prefer non-simultaneous procedures with cataract surgery performed months after grafting because of the improvement in spherical refractive error. More recently, new triple procedures, Descemet's stripping automated keratoplasty and concurrent cataract surgery have gained popularity, especially in patients with Fuchs dystrophy associated with cataract. Surgery starts with phacoemulsification, followed by endothelium exchange through a 3 to 5 mm incision. Advantages against classic triple procedure are quick visual rehabilitation, fewer induced refractive errors, minimal postoperative discomfort and corneal integrity. Surgeons have to consider an eventual postoperative hyperopic shift secondary to corneal lenticule shape when choosing adequate intraocular lens., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate the technique of conjunctival flap for the treatment of ocular surface disorders., Patients and Methods: This is a retrospective study. Forty-three eyes of 43 patients had undergone conjunctival flap surgery performed during a 5-year period at the Rouen University Hospital. Thirty-one patients were followed regularly and could thus be included in this study. The indications and complications experienced by patients undergoing partial or total conjunctival flap surgery were reviewed., Results: The surgical indication was tectonic for 15 out of 31 patients (48.4%) including six corneal perforations, analgesic for nine out of 31 patients (29.0%) and aesthetic for 7 out of 31 patients (22.6%). All the operated patients experienced clinical improvement with a decrease in their pain or inflammation of the ocular surface, or an excellent cosmetic result. Complications were encountered in 6 eyes among the 31 patients (19.4%), and four required surgical revision., Conclusion: Conjunctival flap is an underutilized technique. Its primary indication is ocular surface disease in eyes with poor visual potential. It represents an interesting alternative to more mutilating surgeries., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)