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Purpose. - To evaluate long terms outcomes of botulinum toxin in infantile esotropia by measuring the amount of microtropia 24 months after injection. Secondary purpose was to identify predictive factors of microtropia. Methods. - A retrospective, single-center study was performed at the university medical centerin Bordeaux between 2001 and 2018, including all patients with infantile esotropia greater than 20 D. All patients received 5 or 7,5 IU of botulinum toxin A in each medial rectus, once or twice depending on the angle of deviation after the first injection and after wearing full optical correction at least two months. We noted the angle at 1, 6, 12 and 24 months, the occurrence of any complications and the need for later strabismus surgery. The primary endpoint was the achievement of a microtropia less than 8 diopters (D) at 24 months post-injection. We evaluated the predictive factors for microtropia with a Fischer's test. Results. - We included 30 patients with esotropia greater than 20 D. The mean follow-up after injection was 48 months +/- 30. The mean age was 16.24 months (7-29 months) with a female predominance in the population (SR = 0.43). The mean pre-injection deviation was 41.25 +/- 12.17 D. The majority of patients were mildly (40%) or moderately (40%) hyperopic. At 24 months, 46.7% microtropias were obtained (95% CI: 28.9%-64.5%). The change in mean angle at 1, 6,12 and 24 months post-injection was -8.57 +/- 25.21 D; 14.48 +/- 13.40 D; 18.38 +/- 12.07 D and 21.23 +/- 14.97 D, respectively. No factors were predictive of microtropia. Of the 30 children, 3 had transient ptosis requiring strips and 12 showed an exotropia at 1 month. All complications were self-limited and without consequences. 3 children had a second injection of botulinum toxin, which in 2/3 of the cases resulted in a long-lasting microtropia. 26.7% (n = 8) of the children underwent secondary surgery. Obtaining a microtropia 24 months after injection statistically significantly reduced the need for secondary strabismus surgery: 92.9% P = 0.039% CI 95% (0.002; 1.0606). Conclusion. - Botulinum toxin appears to be a less invasive and more conservative alternative to surgery in children with infantile esotropia. In 46.7% of cases, microtropia is achieved. An improvement was noted in 90% (n = 27) of the children with a reduction of half (21.23 D) of the mean post-injection angle at 24 months. When effective, it significantly reduces the need for secondary surgery. (c) 2021 Elsevier Masson SAS. All rights reserved.; Objectif: Évaluer l’efficacité à long terme de la toxine botulique dans le traitement de l’ésotropie précoce grâce au pourcentage de microtropie à 24 mois post-injection. L’objectif secondaire était de rechercher les facteurs prédictifs à l’obtention de cette microtropie. Méthodes: Nous avons réalisé une étude rétrospective, monocentrique au Centre Hospitalier universitaire (CHU) de Bordeaux entre 2001 et 2018 en incluant tous les patients ayant une ésotropie précoce. Ces patients ont reçu une injection bilatérale de 5 ou 7,5 unités de toxine botulique à une ou deux reprises en fonction de l’angle après la première injection et port de la correction optique totale. L’ensemble des caractéristiques sociodémographiques et ophtalmologiques ont été recueillis en préopératoire. Nous avons noté l’angle à 1,6,12 et 24 mois ; l’apparition de complications ainsi que la nécessité d’une chirurgie de strabisme à distance. Le critère de jugement principal était l’obtention d’une microtropie inférieure à 8 dioptries (D) à 24 mois post-injection. Nous avons évalué les facteurs prédictifs de la microtropie par un test de Fischer. Résultats: Nous avons inclus 30 patients ayant une ésotropie supérieure à 20 D avec un délai moyen de suivi post-injection de 48 mois ± 30. L’âge moyen était de 16,24 mois (7–29 mois) avec une prédominance féminine dans la population (sex ratio SR = 0,43). L’angle moyen pré-injection était de 41,25 ± 12,17 D. Il y avait une majorité d’hypermétropes légers (40 %) et modérés (40 %). À 24 mois, on obtenait 46,7 % de microtropies (intervalle de confiance : IC 95 % : 28,9 %–64,5 %). L’évolution de l’angle moyen à 1,6,12 et 24 mois post-injection était respectivement de −8,57 ± 25,21 D ; 14,48 ± 13,40 D ; 18,38 ± 12,07 D et 21,23 ± 14,97 D. Aucun facteur n’était prédictif de l’obtention d’une microtropie. Parmi les 30 enfants, 3 ont eu des ptôsis transitoires nécessitant la pose de strips et 12 ont présenté une exotropie à 1 mois. Toutes les complications étaient spontanément résolutives et sans conséquences. 3 enfants ont eu une seconde injection de toxine botulique permettant dans 2/3 des cas l’obtention d’une microtropie durable. 26,7 % (n = 8) des enfants ont été opérés secondairement ; l’obtention d’une microtropie à 24 mois diminuait de façon statistiquement significative les chirurgies secondaires du strabisme : p = 0,039 % IC 95 % (0,002 ; 1,0606). Conclusion: La toxine botulique semble être une alternative moins invasive et plus conservatrice que la chirurgie chez les enfants présentant une ésotropie précoce. Elle permet l’obtention d’une microtropie dans 46,7 % des cas. On notait une amélioration chez 90 % (n = 27) des enfants avec une réduction de la moitié (21,23 D) de l’angle moyen post-injection à 24 mois. Lorsqu’elle est efficace elle réduit significativement les chirurgies secondaires.

International audience; Background: Worldwide, degenerative eye diseases (age-related maculopathy (ARM), cataract, glaucoma) are the main causes of visual impairment and blindness, which contribute to disability in the elderly. Mainly three types of nutritional factors are investigated for their potential protection against eye ageing: antioxidants; lutein and zeaxanthin (carotenoids which accumulate specifically in the eye); omega 3 polyunsaturated fatty acids. Few epidemiological studies have been conducted in this field, particularly in Europe. Objective: The Alienor (Antioxydants, Lipides Essentiels, Nutrition et maladies OculaiRes) Study aims at assessing the associations of eye diseases with nutritional factors, determined from plasma measurements and estimation of dietary intakes. Design, setting and participants: Subjects were recruited in Bordeaux (France) from the ongoing population-based 3C study. In 2006-2008, 963 subjects from the 3C Study, aged 73 years or more, had an eye examination and will have follow-up eye examinations every 2 years. Measurements: Vascular, genetic and nutritional factors were assessed at baseline (1999-2001) and follow-up examinations of the 3C Study. Eye diseases were classified according to international classifications. Results: Nutritional status and vascular disease and risk factors were similar between participants and non participants, except for a slight difference in plasma triglycerides and HDL-cholesterol. As expected, the prevalence of eye diseases was high: early and late ARM (28.4 % and 5.6 %, respectively), open-angle glaucoma and treated ocular hypertension (4.8 % and 10.0 %, respectively), cataract extraction (45.2 %), retinopathy (8.4 %), retinal vein occlusion (1.1 %), epiretinal membrane (3.9 %), current use of artificial tears (17.3 %). Conclusions: This study confirms the high prevalence of eye diseases in the elderly. Its main strength is the combination of nutritional, vascular and genetic information, collected over a 7 year period of time before the first eye examination. It may help design future interventional studies, which might be common with other age-related disorders, because of common nutritional factors.

Purpose To evaluate visual acuity outcomes in patients (pts) with myopic CNV receiving intravitreal aflibercept (IVT-AFL) or sham injection in the international, 48 week, Phase 3 MYRROR trial (NCT01249664). Methods Pts were randomised 3:1 to IVT AFL or sham/IVT-AFL (sham to Week 20; IVT-AFL from Week 24 to Week 48). We report on exploratory post hoc analyses evaluating proportions of pts achieving visual gains (ETDRS letters) and the associated time course. Results 121 pts were analysed (IVT-AFL, n=90/ sham/IVT-AFL, n=31). At Week 24, 63.3% and 38.9% of IVT-AFL pts had gained ≥10 or ≥15 letters from baseline. In the sham/IVT-AFL group, 12.9% and 9.7% had gained ≥10 or ≥15 letters from baseline. By Week 48, the proportion of IVT-AFL pts gaining ≥10 or ≥15 letters was 68.9% and 50.0%, respectively. At Week 48 in the sham/IVT-AFL group (i.e., 24 weeks after IVT-AFL initiation), 41.9% and 29.0% of pts had gained ≥10 or ≥15 letters from baseline, respectively. Ocular AEs were mainly mild and occurred at a similar rate with IVT-AFL and sham/IVT-AFL (37.4% vs 38.7%; most common, respectively: conjunctival haemorrhage [11.0%] and punctate keratitis [12.9%]). 7 (5.7%) pts had a serious AE (all IVT-AFL; only one SAE in study eye [macular hole]). No deaths were reported. Conclusion The proportion of IVT-AFL pts who gained ≥10 or ≥15 letters by Week 24 was well maintained and even slightly increased at Week 48. Clinically meaningful benefits from IVT-AFL were also observed at Week 48 in the sham/IVT-AFL group. However, the proportion of gainers did not reach the extent seen in the initial IVT-AFL group, suggesting that earlier IVT-AFL treatment should be recommended. Commercial interest

Purpose Age-related Macular Degeneration (AMD) is the leading cause of blindness and visual impairment in industrialized countries.STARS questionnaire was developed as a fast and simple tool for detecting individuals at high risk of AMD. A study performed with first version included more than 12,000 people and confirmed the relevance of different items. Some limits were also noticed and corrected in the present questionnaire named STARS 2.0. Methods All patients over 55 years examined by eighty French ophthalmologists were included during one week selected at clinicien disctretion between March 2013 and March 2014. AMD risks factors were collected with a statistical weight assigned to each risk factors. A composite score given by the sum of each risk factors was calculated. Fundus examination to detect macular disease was performed in the same time. Results 6837 Patients with 60% of female were included. 31%, 29.6%, 29.6% and 9.9% of the patients were respectively between [55 and 65] ,[65 and 74], [75 and 85], and over 85. Fundus exam found that 71% of the patient did not suffer from AMD on both sides while 10.3% of the patients presented with an advanced AMD on at least one eye. Conclusion STARS 2.0 questionnaire can help ophthalmologists to identify AMD risk factors to prevent AMD in clinical practice. It should be used also in general population to detect patients at high risk for AMD. Commercial interest

Purpose Papillorenal syndrome is an autosomal dominant entity due to PAX2 gene mutation, involving optic nerve and renal malformations. Methods The authors report a 19-year-old man with bilateral macular detachment associated with optic nerve pit in one eye and morning glory syndrome in the other eye. The patient underwent three-port pars plana vitrectomy, endolaser photocoagulation, and C3F8 gas tamponade in his best eye. A medical history of vesicoureteric reflux and kidney hypoplasia led to genetic analysis. Results Molecular genetic PAX2 analysis revealed a novel nondescribed mutation in exon 3. One year postoperatively, ophthalmologic outcomes were satisfactory with complete flattening of the retina and improvement of the best-corrected visual acuity to 11/10. Conclusions PAX2 is involved in the optic vesicles, genital tracts, kidney, and central nervous system embryogenic development. The association of optic nerve and renal malformations should lead to the suspicion of papillorenal syndrome with PAX2 mutation.

Purpose To compare macular pigment optical density (MPOD) measured by two techniques (autofluorescence, reflectometry) in healthy subjects at high risk for age-related macular degeneration (AMD). Methods The Limpia Study is a double-blind, placebo controlled, prospective randomized clinical trial performed in 120 subjects with at least one parent affected by neovascular AMD. Subjects having used supplements containing lutein and/or zeaxanthin in the preceding year were not included. MPOD was measured using two methods: the two-wavelength autofluorescence method with a modified scanning laser ophthalmoscope (Heidelberg Retinal Analyzer Results At baseline, mean MPOD within 0.51°, measured with the modified HRA method, was 0.5 (standard deviation 0.2). Maximal MPOD, measured with Visucam, was 0.4 (standard deviation 0.1). Parameters from the modified HRA (optical density within 0.5°, 1°, 2° and 6°) and from the Visucam method (volume, area, mean and maximum optical density) were weakly correlated. The best correlations were observed for MPOD within 2° and 6° with volume from Visucam(r=0.21 and r=0.22, respectively), and mean MPOD from Visucam (r=0.21 and r=0.18). Conclusion The two methods propose different parameters to evaluate macular pigment, which overall correlated weakly in this population of middle-aged healthy subjects at high risk for AMD. Further research is needed to characterize the differences between the methods and identify the best parameters and techniques to measure macular pigment. Commercial interest

Phenylketonuria (PKU) leads to severe neurological disorders in childhood, shunned by the diet. The long-term prognosis after diet diversification at adolescence is uncertain. We report a case of cortical blindness in a young patient regressive 1 month after the diet was resumed.Mr M., 25 years old, had PKU detected at birth. He maintained good serum levels of Phenylalanine (Phe) (120-300 μmol/L) during childhood and got a normal intellectual development. During adolescence he diversified his diet but maintained low meat and fish intake; Phe was ~1,200 μmol/L with no symptoms. In 2009, the patient stopped the low-Phe amino acid substitutes due to weariness. On June 27, 2011, he consulted for a decrease of visual acuity progressing for 6 months. Ophthalmologic examination found that visual acuity was 2/10 in two eyes associated to a central visual field defect. The visual evoked potentials were altered. MRI showed bilateral and symmetric occipital FLAIR hyperintensities. On admission in the Nutrional Unit on June 29, 2011, blood pressure was 120/70 mmHg, there was no other neurological abnormality. Phe was at 1,512 μmol/L, and not responsive to BH4. He was then treated with a very low-Phe diet with an amino acid substitute, and he obtained Phe between 120 and 300 μmol/L. Visual acuity was suddenly restored on August 1, 2011, with a dramatic attenuation of the MRI hyperintensities.Our observation shows that the withdrawal of the diet and substitutes exposes to serious neurological complications in adults that may reverse with a fast nutritional support.

International audience; PURPOSE: We investigated the association of single nucleotide polymorphism (SNP) in the cholesterol-24S-hydroxylase (CYP46A1) gene, according to CFH and LOC387715 SNPs, with age-related macular degeneration (AMD). METHODS: We enrolled 1388 AMD patients with neovascular AMD or geographic atrophy and 487 unrelated control subjects. SNPs were genotyped in the CYP46A1 (rs754203), LOC387715 (rs10490924), and CFH (rs1061170) genes. Plasma 24S-hydroxycholesterol, the metabolic product of CYP46A1, was quantified by gas chromatography-mass spectrometry using an authentic deuterated internal standard in subgroups of patients and controls. The χ(2) test was used to compare categoric allelic and genotype distributions between cases and controls. The odds ratio (OR) with a 95% confidence interval (95% CI) was calculated for AMD risk, and adjusted for age and gender. Significance levels were set at P < 0.05. RESULTS: The rs754203 SNP in the CYP46A1 gene was not associated with AMD (crude OR = 1.2, 95% CI = 0.9-1.4, P = 0.2). The crude OR for risk of AMD was 2.9 (95% CI = 2.4-3.4, P < 0.0001) according to the number of rs10490924 T alleles in the LOC387715 gene, and 2.0 (95% CI = 1.7-2.3, P < 0.0001) according to the number of rs1061170 C alleles in the CFH gene. After adjustment for age and gender, an OR of 2.2 (95% CI = 1.1-4.1, P = 0.04) was obtained for AMD cases with the C allele in the CYP46A1 gene, and carrying no risk alleles in the CFH and LOC387715 genes. CONCLUSIONS: The rs754203 C allele in the CYP46A1 gene may confer a higher risk for exudative AMD in patients who carry no risk alleles in the CFH and LOC387715 genes. Additional studies with larger sample sizes are needed in AMD subjects at no risk in CFH and LOC387715.

To investigate scleral and episcleral histological alterations induced by encircling explants used in scleral buckling procedures.We performed a histopathological study of 20 enucleated eyes after failure of retinal detachment surgery including encircling scleral buckle.Nonabsorbable materials were encapsulated and often gave rise to a limited scleral invagination. The inner capsular surface was regular in 10 silicone explants, it was partially covered with hydrogel fragments and a granulomatous foreign body giant cell reaction in 8 hydrogel explants. One Arruga thread was encased in fibrosis and a catgut circle showed no encapsulation. Other changes were mostly related to the long-standing retinal detachment: peripheral anterior synechiae, anterior uveal effusion, persistent retinal detachment, retinal gliosis, retinal atrophy, retinal breaks, and silicone oil droplets.All nonabsorbable explants underwent encapsulation and prompted scleral invagination. A granulomatous reaction accompanied hydrogel fragmentation. The long term fragmentation impact on implanted eyes remains unknown.