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Neovascular glaucoma is a serious pathology with a variety of causes. It results from the secretion by hypoxic retinal tissue of growth factors, including vascular endothelial growth factor (VEGF). Anterior segment involvement begins in the iris, followed by the development of a fibrovascular membrane in the angle, with resultant goniosynechiae. Treatment of the underlying disease consists most often of panretinal photocoagulation. As for the secondary sequelae, current treatment consists of intravitreal injection of anti-VEGF agents. The most utilized agent is bevacizumab or Avastin, off-label. Avastin is effective against neovascularization and ocular hypertension, especially in the early stages. It also represents an adjunct to filtering surgery. It appears to be very well tolerated.

Purpose Acute panuveitis with retinitis diagnosis may sometimes be difficult. Contribution of microbiological analyzes of intraocular samples currently allows a rapid diagnosis to guide therapeutic management when visual function is severely threatened. Methods We report three original cases of panuveitis with retinitis for which analyzes showed concomitant infection with Toxoplasma and Herpes viruses. Results PCR techniques have increased the sensitivity and specificity of diagnostic tests for ocular pathogens, including Toxoplasmosis and Herpes viruses. For Toxoplasmosis, Western blot and Desmonts coefficient remain standards tests in immunocompetent adults. As for central nervous system infections, Herpes viruses PCR is the gold standard test for intraocular samples. The clinical cases described here are atypical and the clinical examination failed to set the diagnosis. The detection of two infectious agents has led to the establishment of a double etiologic treatment, due to the severity of the ocular involvement. However, we may suppose that certain viruses in dormant states can be liberated in an inflammed eye, causing DNA to be detected on PCR testing, making more than one true positive result both possible and clinically relevant. Conclusion In actual clinical use, false-positive results are possible from contamination, and false-negative results are possible from polymorphism, specimen degradation, or failure to sample in the acute stages of disease. It remains difficult to determine the responsibility of both infectious agents revealed. Is it a real co-infection, or false positive?

Purpose To assess the usefulness of a labial salivary gland biopsy (LSGB) in subsets of patients with uveitis. Methods A retrospective study of 116 consecutive patients with uveitis for whom a LSGB had been done because of suspected ocular sarcoidosis (n=87) or unexplained uveitis (n=29). Eighty six patients had a suspicion of ocular sarcoidosis because of ocular features (n=67), an elevated angiotensin converting enzyme (ACE) (n=30) or because of CT findings (n=33) suggestive of sarcoidosis. The biopsy results were analyzed together with their ophthalmological features and the results of other relevant examinations, such as the serum levels of ACE and a chest radiography or a CT scan. Results Six of the 116 patients (5.2%) with uveitis had sarcoid granulomas on the LSGB. At the end of the study, 32 patients had proven sarcoidois while 23 patients were considered as having either indeterminate or presumed sarcoidosis, according to the criteria of Abad et al. A raised ACE (p=0.033) and a compatible radiology (p=0.019) were related to a positive LSGB test but not to the features of uveitis. Granulomas were only found in the LSGB of the patients with an elevated ACE or compatible CT scans. Conclusion In this study, the LSGB sensitivity (18.75%) in the patients with proven sarcoidosis appears to be lower than in other reports. Our results suggest that this investigation should be limited to the patients with a raised ACE and/or CT scans pattern compatible with sarcoidosis and should not be performed in patients with unexplained uveitis or because of ophthalmological features.

Purpose To evaluate the bacterial anti-adhesive effect of cefuroxime and moxifloxacin on the primary-attachment phase of S.epidermidis to acrylic intraocular lenses IOLs Methods 40 single-piece SA30AT IOLs were used throughout the study. IOLs were divided into 5 groups. 2 groups were soaked in antibiotic solution,(moxifloxacin 0.5mg/0.1ml or cefuroxime 1mg/0.1ml),15 min before incubation in a S.epidermidis suspension 108 CFU/ml,t1.2 groups were incubated in the bacterial suspension for 15 min before being added with antibiotics,t2.The last group consisted in a control group. After 1 hour incubation at 37°C, for all groups, IOLs were removed from the test vial and rinsed before being sonicated and vortexed to remove the adhering bacteria. The resultant suspension was diluted and spread over a nutritive agar plate. Colonies were counted after 24-hour incubation. Comparison among groups was performed using the Wald parametric statistical test. A p-value

Purpose Surgical treatment of epiretinal membrane (ERM) have been facilitated by use of dyes such as brilliant blue G (BBG) whose harmlessness by intravitrael injection have been fully reported. Methods We describe the case of a seventy-two year old female patient addressed for surgical treatment of left idiopathic ERM that caused metamorphopsia and a decrease of visual acuity. Pars plana vitrectomy and ERM peeling staining with BBG was performed. Results During the procedure, an unusual complication occurs: intraretinal BBG infiltration. The area was limited (under a disc diameter) located in macular area, in temporal and superior to the fovea; the infiltration reached all retinal layers according to our OCT images. A defect in retina nerve fiber layer seems to be the origin of that staining. No damage in the field or in fluorescein and indocyanine angiography were observed. A progressive resorption of the staining appeared with atrophy of the inners retinal layers as aftereffect. Visual acuity reached 9/10 Pa2 a month and a half after the surgery. Conclusion In spite of the benefits of vital dyes in vitreoretinal surgery which are widely used, this case remains us the damage that can occur.

Purpose To evaluate the various clinical presentations, etiological diagnosis and prognosis of patients with scleritis at a tertiary care eye center. Methods Retrospective, monocentric and analytical study on a series of 32 patients with scleritis seen in the departments of Ophthalmology and Internal Medicine at Croix-Rousse University Hospital, Lyon, France from 2004 through 2011. Results The mean age of patients with scleritis was 46.8 years (range 22-77years). Nineteen of the patients were women and 13 were men. Twenty-six patients (81%) had anterior scleritis (15 nodular, 8 diffuse and 3 necrotizing), six (19%) had posterior scleritis. Unilateral inflammation was present in 24 patients (75%). Twelve of the 32 patients (37.5%) had a systemic disease : Wegener's granulomatosis (n = 3),Behcet's disease (n = 2), unspecified inflammatory arthritis (n = 2), psoriatic arthritis (n = 1),ankylosing spondylitis (n = 1), sarcoidosis (n = 1), Cogan's syndrome (n = 1), ulcerative colitis (n = 1). Six patients (18.8%) were suspected of having infectious disease with herpes : clinical context and positive treatment response with oral valacyclovir. Systemic agents and topical agents were required in 28 patients (87.5%). The first line therapy was mainly oral non steroidal anti-inflammatory drugs in 15 patients (47%) and oral corticosteroids in 8 (25%). Immunosuppressive drugs were required in 6 patients, 4 with systemic disease. The mean follow-up was 16.3 months. Conclusion The number of systemic disease in our series is similar to the main series in the literature. Treatment with valacyclovir might be effective in patients with suspected herpes simplex scleritis.

Summary Aim To compare the efficacy and safety of bevacizumab versus ranibizumab in the treatment of patients with neovascular age-related macular degeneration (AMD). Patients and methods Retrospective case-controlled series of 30 patients treated with intravitreal bevacizumab and 28 patients treated with intravitreal ranibizumab for exudative AMD. Main outcomes measured included best-corrected visual acuity (BCVA), central macular thickness (CMT) and foveal thickness, quantity of subretinal fluid, neovessel size and total number of injections over the first year treatment period. A secondary outcome was the report of any adverse events in both groups. Results BCVA stabilized and increased from LogMAR 0.70 to 0.47 in the bevacizumab group and from 0.55 to 0.54 in the ranibizumab group ( P > 0.05). CMT decreased in the bevacizumab group from 369 to 284 μm and in the ranibizumab group from 340 to 271 μm ( P > 0.05). The number of injection was significantly lower (4.8) in the bevacizumab group than in the ranibizumab group (5.8) ( P Conclusion This retrospective study failed to show a difference in visual and anatomic outcomes between bevacizumab and ranibizumab. The number of re-treatment was lower in the bevacizumab group ( P = 0.03).

Genome study and expression profiling of the tumor seem to be the most significant biologic prognostic factor in uveal melanoma. Many cytogenetic and molecular tests are reported; our aim was to assess their ability to detect high metastatic risk patients through a literature review. Standard karyotyping, fluorescence in situ hybridization and microsatellite analysis are not adequate. DNA-based genome techniques must analyse the entire genome (comparative genomic hybridization [CGH]) and, optimally, detect chromosome 3 isodisomy ("single-nucleotid polymorphism" SNP-array). Multiplex ligation-dependent probe amplification (MLPA) is less expensive than array-CGH, but its interpretation may be delicate. Gene expression profiling is the most accurate molecular test for predicting metastatic death in patient with uveal melanoma even if it remains a costly technique. These prognostic tests could be useful to identify high-risk patients in future adjuvant therapy protocols.

Uveitis is a common (20-50%) and early manifestation of sarcoidosis. Typical sarcoid uveitis presents with bilateral mutton fat keratic precipitates, iris nodules, and anterior and posterior synechia. Posterior involvement includes vitreitis, vasculitis and choroidal lesions. Long-term complications are common, and cystoid macular edema is the most important and sight-threatening consequence. Diagnostic work-up of sarcoidosis usually includes chest radiography or computed tomography scan, bronchoscopy with bronchoalveolar lavage, angiotensin converting enzyme, lysozyme, gallium scintigraphy and biopsy. The gold standard for the diagnosis of sarcoidosis should be obtained with histologic examination. However, an international workshop has recently established diagnostic criteria of "intraocular sarcoidosis" (sarcoidosis uveitis) on the basis of a combination of suggestive ophthalmological findings and laboratory tests, when biopsy is not performed or is negative. More recent techniques such as PET-scan and endoscopic ultrasound-guided fine-needle biopsy of intrathoracic nodes should be assessed in future prospective studies. Corticosteroids are the mainstay of treatment. Anterior and unilateral intermediate or posterior uveitis are usually treated with topical corticosteroids. Systemic corticosteroids are indicated in uveitis not responding to topical corticosteroids or in the presence of bilateral posterior involvement, especially with macular edema and occlusive vasculitis. In 5 to 20% of the patients who are corticosteroids resistant or require an unacceptable dose to maintain remission, additional immunosuppression is used, including methotrexate, leflunomide and mycophenolate mofetil. As in systemic sarcoidosis, infliximab has been recently suggested for refractory or sight threatening disease.

microbial keratitis is a significant health concern for the one million wearers of contact lenses and their ophthalmologists, with some potentially modifiable risk factors. The number of risk factors for contact lens-related microbial keratitis has been described, but many of them still remain assumed or unknown. a multicenter prospective case-control study was conducted in 12 French university hospitals (Besançon, Bordeaux, Dijon, Fort-de-France, Grenoble, Limoges, Lyon, Nancy, Nantes, Paris, Marseille and Strasbourg) beginning in July 2007 on contact lens wearers presenting with microbial keratitis and on healthy contact lens wearers. Patients and healthy wearers were interviewed using a 51-item anonymous standardized questionnaire to determine subject demographics and contact lens wear history. two hundred and fifty-six patients with microbial keratitis were included. One hundred and thirteen healthy contact lenses wearers were surveyed. Cosmetic contact lens wear highly increased the relative risk (RR) of microbial keratitis (RR, 16.5). Time since the last visit to an ophthalmologist longer than 1 year (RR, 3.4) or prescription by someone other than an ophthalmologist (RR, 7.6) also increased the risk of microbial keratitis. Education on lens care and handling was deficient (hand washing: RR, 2.2; rub and rinse: RR, 2.7). a standardized questionnaire is a powerful tool to determine risk factors for contact lens-related microbial keratitis, but also to analyze individual mistakes in contact lenses use and care.

Circumscribed choroidal hemangioma (CCH) is an uncommon benign vascular tumor of the choroid that is usually diagnosed when it causes a decrease in vision due to exudative retinal detachment. The classical treatments of CCH were photocoagulation and radiotherapy, which induced additional chorioretinal damage, explaining the poor visual prognosis even in adequately treated patients. It is difficult to compare these two therapeutic options, laser photocoagulation having been abandoned for many years due to the retractile retinal scars that it induced. Conventional radiotherapy and proton therapy with a total dose of 20 Gy gave and give good results but can be performed only by teams used to these types of treatment. Recently, photodynamic therapy (PDT), which allows a selective occlusion of vascular lesions without damaging overlying retinal structures, has emerged as a sound alternative for the treatment of CCH. Most of the clinicians used the standard treatment of age related macular degeneration by photodynamic therapy (TAP) study protocol with or without variations. The main variations brought to the TAP study protocol were the duration of the verteporfin infusion, and/or the increase of the laser power settings, and/or the increase of the duration of exposure, and/or the number of PDT spots (single spot or multiple spots, overlapping or not). Mid-term PDT results are very encouraging. PDT has been reported to bring about resolution of subretinal fluid and to reduce tumor thickness in almost all cases. Visual acuity was improved or stabilized in at least 80% of the cases. Several studies reported on minor local side effects following PDT, consisting of atrophy and proliferation of the retinal pigment epithelium, atrophy of the choroid, transient choroidal effusion, and mild subretinal fibrosis. Published data demonstrated that PDT is a safe and effective alternative to radiotherapy or photocoagulation as first-line therapy for CCH.

To report the efficacy of external local radiotherapy in the treatment of choroidal metastases.The study reports four cases of patients with choroidal metastases of lung neoplasm confirmed by the bronchial biopsy. Polychemotherapy was associated with external radiotherapy of the ocular metastases.The external radiotherapy dose of 30 Gy to the posterior segment of the eye in 10 fractions was effective and seemed to be the most appropriate management of choroidal metastasis despite the use of the newest molecules in chemotherapy.

Uveitis consists of a large group of diseases characterized by intraocular inflammation involving the uveal tract. This heterogeneity makes the diagnosis and the treatment of uveitis frequently challenging. The purpose of this study was to describe the various clinical and etiologic aspects of uveitis, through the new standardized uveitis classification and the use of modern investigations for its diagnostic work-up.The medical records of 121 new patients with uveitis referred to our tertiary ophthalmologic centre between January 2002 and December 2006 were retrospectively reviewed. Uveitis associated to human immunodeficiency virus and secondary to exogenous endophthalmitis were excluded. All patients had a complete ophthalmological examination and appropriate clinical and paraclinical examination. The diagnosis was established according to the recent international criteria.One hundred and twenty-one patients were included. The four main etiologies were: toxoplasmosis (14%), sarcoidosis (11.6%), spondylarthritis or HLA B27-associated uveitis (13.2%) and Herpes virus infections (9.1%) that represented almost half of the uveitis causes (47.9%). Various diseases constituted the remaining causes of the uveitis (20.9%). Uveitis remained unexplained in the remaining 36 patients (29.7%). Overall, associated systemic diseases were diagnosed in 35.5% of our uveitis patients (34 patients), associated infectious conditions in 26.4% (32 patients) and specific ocular diseases in 8.3% (12 patients).Despite a limited number of patients, our study showed an etiologic distribution similar to that of the main series reported in the literature. Nevertheless, we observed an elevated frequency of sarcoidosis and systemic diseases, which emphasizes a management that takes into account standardized clinical and paraclinical criteria and the usefulness of a collaboration with the internist.

Adhesion of bacteria to intraocular lenses is an important step in the pathogenesis of postoperative endophthalmitis. It can be described as a two-phase process including an initial, instantaneous, and reversible phase followed by a time-dependant and irreversible molecular and cellular phase. The binding of bacteria is affected by many factors including environmental factors such as medium composition, presence of proteins and flow conditions, the bacterial cell surface characteristics, and the material's surface properties. This article reviews all these factors affecting the adhesion of bacteria to intraocular lenses. A better understanding of these mechanisms would make it possible to reduce the bacterial adhesion process and thus could help decrease the incidence of postoperative endophthalmitis.

Toxoplasmosis is the most common etiology of posterior uveitis. Toxoplasma gondii infection during pregnancy means either primary infection and risk of congenital toxoplasmosis or acute retinochoroiditis in a pregnant woman (risk of transmission, severity of injuries, therapeutics). Ingestion or manipulation of raw or undercooked meat is responsible for most contaminations (one- to two-thirds) in pregnant women. Toxoplasmosis seroprevalence is high in Europe, up to 54 % in southern European countries. Primary prevention advice is proposed to immunocompetent pregnant women who are seronegative for toxoplasmosis. The risk of transplacental transmission congenital toxoplasmosis during pregnancy is analyzed. The ocular lesions include retinochoroiditis and a number of other lesions. The departments of ophthalmology and of parasitology of Croix-Rousse University Hospital (Hospices Civils de Lyon) is currently following one of the largest cohorts of children infected with T. gondii (430 children alive in 2005). Our overall transmission rate during primary infection was 30 %. Retinochoroiditis incidence was 24 % in our prospective cohort. During follow-up, recurrences appeared in 29 % of cases. Acute toxoplasmic retinochoroiditis in pregnancy could be a risk of transplacental transmission due to potential parasitemia. Practices in cases of suspected or proved congenital infection are discussed. The antiparasitic drugs authorized during pregnancy are azithromycin and pyrimethamine. Azithromycin can be used alone but an association with pyrimethamine during the second trimester is useful in case of macular threat.

To estimate the effectiveness of moxifloxacin instillation in the treatment of bacterial conjunctivitis.Five randomized clinical trials on moxifloxacin were identified, three versus placebo, one versus ofloxacin, and another versus levofloxacin. The effectiveness parameters included clinical efficacy and drop-out rates for all reasons including lack of efficacy. The fixed and random effects were estimated on intent-to-treat populations. Models for risk ratios and risk differences as well as tests for study homogeneity were computed.Patients treated with moxifloxacin dropped out less frequently (OR=2.22 [1.62-3.03]; p0.001), had less treatment failure (OR=3.61 [2.30-5.65]; p0.001), and experienced clinical cure more often (OR=1.59 [1.21-2.04]; p=0.001) than placebo-treated patients. In comparison to ofloxacin, patients treated with moxifloxacin had fewer drop-outs for reasons other than treatment failure (OR=1.92 [1.28-2.89]; p=0.02) and fewer drop-outs for treatment failure (OR=2.53 [1.41-4.56]; p=0.002).This meta-analysis demonstrated the clinical efficacy of moxifloxacin compared to placebo. Fewer patients dropped out from moxifloxacin treatment compared to ofloxacin.

Cataract surgery is a usually successful procedure that restores vision by replacing the natural lens with an intraocular lens (IOL). Acute postoperative endophthalmitis is still one of the most serious complications of cataract surgery. Its incidence has been reported to be between 0.04% and 0.32%. Precisely why bacteria induce endophthalmitis is not entirely understood. Indeed the risk of its development may be influenced by several factors. Among them, bacterial adhesion to the IOL has been recently emphasized in the ophthalmology literature. Indeed, the ability of an organism to adhere to the IOL surface is believed to be associated with a risk of infection at the implantation site. Several studies have demonstrated that bacterial adhesion is influenced by IOL materials. Ever since, numerous studies have investigated the interactions between bacteria and different types of IOLs to determine which biomaterial would be most permissive to bacterial adherence. This article reviews all the epidemiological and experimental data relating to the study of the relationship between bacterial adhesion, IOL material, and risk of developing postoperative endophthalmitis. Even if discrepancies between these studies exist, mainly stemming from the use of different experimental conditions and protocols, it seems that bacterial adhesion is strongly influenced by IOL material. Epidemiological studies suggest that the implantation of silicone IOLs might be associated with increased rates of endophthalmitis. Experimental studies reach similar conclusions showing that hydrophobic IOLs such as silicone or acrylic hydrophobic IOLs are more permissive to bacterial adhesion and growth than hydrophilic IOLs such as acrylic hydrophilic IOLs. Among the interactions that govern bacterial attachment to the IOLs, it seems that hydrophilic-hydrophobic interactions have the greatest influence. Nevertheless, since bacterial adhesion is a complicated process affected by many factors, the conclusions drawn by these results have to be interpreted with care. Further investigations are still needed to understand the connections between IOL material and endophthalmitis.

We report the case of a single-eyed patient with a small (2.2 mm thick with largest tumor diameter 7.6 mm) choroidal melanoma involving the entire macular surface with few functional signs. Visual acuity was 20/63. The patient was informed of the side effects and so was followed regularly at the oncology unit over 4 years. During this period, the tumor volume increased fourfold (the thickness reached 4.3 mm and the LTD 10.4 mm), with visual acuity decreasing to 20/250: proton beam therapy was therefore performed. The patient showed no metastasis more than 2 years after the treatment. This unusual case raises the question of small choroidal melanoma management, especially if the patient is single-eyed, in good general health, middle-aged and if the tumor is retrofoveal with just a few functional signs: when, why and who should be treated?

We present a case of bilateral purulent conjunctivitis complicated by ocular perforation of the right eye secondary to fulminant corneal melt in a 29-year-old man. He developed urethritis after a sexual contact with a prostitute 3 weeks previously. Microbiological analyses of conjunctival and urinary cultures were positive for Neisseria gonorrhoeae resistant to penicillins, tetracyclines, and fluoroquinolones. Progression was favorable with a 15-day course of high doses of parenterally administered antibiotics associating imipenem and fosfomycin. Keratoplasty was done after 3 months. This observation is a good example of the problems raised by gonococcal conjunctivitis in adults. Extremely rare in developed countries, it remains widely unrecognized by ophthalmologists. It is a sexually transmitted disease usually resulting from autoinoculation from an infected genital site. The risk of marginal purulent corneal melt, which can lead to fulminant perforation, warrants prompt microbiological analysis and early parenteral antibiotic treatment.

Ring melanoma is a rare form of uveal melanoma characterized by the circumferential involvement of the ciliary body. Unilateral chronic and refractory glaucoma is a classic circumstance of diagnosis.We report a case of ring melanoma revealed by acute intraocular hypertonia secondary to spontaneous hyphema. Iris and iridocorneal angle were diffusely invaded by the tumor. The fundus was masked but B-scan ultrasonography revealed a voluminous ciliochoroidal tumor. The patient had been enucleated. Pathological examination confirmed the diagnosis of ring melanoma. The tumor involved angle structures. The patient died 1 year later because of metastasis.Acute or chronic ocular hypertonia is a classic but rare circumstance of uveal melanoma diagnosis. Many mechanisms exist: neovascular glaucoma, secondary angle closure, involvement of angle structures, and trabecular obstruction by tumor cells or pigment. Acute intraocular hypertonia secondary to hyphema is more exceptional. Our observation highlights that apart from the classic situation of acute angle closure glaucoma, intraocular hypertonia requires meticulous fundus examination, if necessary using B-scan ultrasonography.

Local anesthesia for eye surgery was first described in 1884; later Knapp popularized retrobulbar anesthesia. To reduce risks, peribulbar anesthesia appeared in the 1970s. Still used today, periocular anesthesia is not without complications, in particular the risk of ocular perforation.Three patients were referred to our department for diagnosis and treatment of an intravitreous hemorrhage following cataract surgery. We report the clinical features, treatment, and visual outcome for these three patients.The most common presentation was vitreous hemorrhage: the three eyes were found to have associated retinal detachment on initial assessment. One patient presented severe vitreoretinal proliferation with two postoperative recurrences; the globe was finally enucleated. The two other patients presented attached retina after surgery but had achieved very poor visual recovery.Inadvertent globe perforation during local ocular anesthesia is rare. Careful attention to risk factors, early recognition, and prompt referral for management are recommended to improve the visual prognosis. Surgical management must be adapted to the severity of the perforation (vitreous hemorrhage, retinal detachment, vitreoretinal proliferation). The problems treating these patients with severe, often recurrent, retinal detachment, with poor visual prognosis, in a tricky forensic context should be emphasized.

The aim of this retrospective study was to analyze incidence, microorganisms, and final visual acuity after pars plana vitrectomy.Data on all patients with endophthalmitis after pars plana vitrectomy performed at Croix-Rousse Hospital, Lyon, France, between 1994 and 2004 were analyzed.Among 1632 posterior vitrectomies done over an 11-year period, 14 cases of endophthalmitis occurred (0.86%). Half of the patients were diabetic with poor glycemic control. The most frequent microorganism was negative coagulase Staphylococcus. One case of Bacillus cereus was noted. On the whole, visual prognosis was poor: final visual acuity never exceeded 20/200 in the best cases. The final visual acuity depended on the initial pathology requiring vitrectomy. One eye was enucleated because of phthisis.Historically, the incidence of endophthalmitis after vitrectomy is approximately 0.05%. It was higher in our series probably because of the high number of diabetic patients with poor glycemic control. Final visual acuity after pars plana vitrectomy in current series is low. Nevertheless it must be compared with the visual acuity before the vitrectomy because it depends greatly on the causal pathology which is very disabling.Endophthalmitis after pars plana vitrectomy is a serious complication. Prophylaxis is still the best treatment.

Introduction L’uveite est la manifestation oculaire la plus frequente de la sarcoidose (jusqu’a 30 % des patients). Peu d’etudes se sont focalisees specifiquement sur les uveites sarcoidosiques. L’objectif de cette etude etait de determiner les caracteristiques epidemiologiques et cliniques des uveites sarcoidosiques ainsi que la valeur diagnostique des examens biologiques et de l’imagerie. Patients et methodes Etude retrospective des donnees cliniques et paracliniques des patients presentant une uveite sarcoidosique (confirmee histologiquement), pris en charge dans 2 services de medecine interne des Hospices Civils de Lyon, entre avril 2004 et mars 2014. Resultats Les donnees de 83 patients (sexe feminin : 75 % ; caucasiens : 75 % ; âge > 50 ans : 45 %) ont ete analysees. La duree moyenne d’evolution de la sarcoidose etait de 4,8 ans (1–300 mois). L’uveite revelait la maladie dans 86 % des cas. Les caracteristiques des uveites etaient les suivantes : uveite anterieure et/ou intermediaire (37 %), posterieure (11 %), panuveite (52 %) ; uveite granulomateuse (57 %) ; uveite bilaterale (75 %) ; uveite chronique (65 %), aigue (27 %). L’etude des sous-groupes revelait que : – les caucasiens presentaient une uveite plus tardive (âge moyen : 58 vs. 41 ans ; p = 0,001) et d’evolution plus souvent chronique (78,3 vs. 43,8 % ; p = 0,01) ; – l’œdeme maculaire chronique etait plus frequent chez la femme (48,3 % vs. 14,3 % ; p = 0,01) ; – il n’existait aucune difference statistique entre les sujets âges de plus ou moins de 50 ans. Concernant les outils diagnostiques : les taux d’enzyme de conversion de l’angiotensine (ECA) et de lysozyme etaient superieurs a la normale dans 62 % et 84 % des cas testes, respectivement. La radiographie et le scanner thoracique etaient evocateurs d’une sarcoidose dans 63 % et 91 % des cas, respectivement. L’association d’au moins un test biologique a au moins un test d’imagerie permettait de porter le diagnostic de sarcoidose dans 100 % des cas. La cytoponction des adenopathies mediastinales, guidee par echographie, contribuait au diagnostic chez 7 patients dont les biopsies de glandes salivaires et transbronchique etaient negatives. Conclusion Nous rapportons ici une large serie d’uveites dans un contexte de sarcoidose histologiquement prouvee. Nos resultats confirment les differences precedemment rapportees dans les etudes americaines : les uveites sarcoidosiques etant plus volontiers granulomateuses et localisees au segment anterieur chez les sujets jeunes non-caucasiens alors que les formes chroniques posterieures sont plus frequentes chez les femmes caucasiennes, plus âgees. Les patients atteints d’uveite sarcoidosique ont au moins un test biologique (ECA ou lysozyme) ou un examen d’imagerie compatible avec le diagnostic de sarcoidose. L’indication des explorations invasives pourrait donc etre limitee aux patients qui presentent ces anomalies.

We report the case of a persistent unsealed sclerotomy following intravitreous injection of triamcinolone through the pars plana using a 30-gauge needle. The injection was made for the treatment of diabetic macular edema. The eye had been treated 9 months before by pars plana vitrectomy and pan retinal photocoagulation for vitreous hemorrhage complicating diabetic proliferative retinopathy. Five days after injection, the patient presented with severe hypotony and chemosis. A conjunctival Seidel was noted at the site of injection. Surgical exploration revealed a punctiform scleral wound without vitreous incarceration, which was closed with a 10-0 nylon suture. No other complication occurred. Our observation highlights that in spite of its simplicity, intravitreous injection of triamcinolone is an invasive procedure that requires rigorous follow-up. In vitrectomized eyes, the higher risk of unsealed scleral wound after intravitreous injection should encourage this injection to be made in a site where no sclerotomy usually occurs. The 6'o-clock meridian could be a good location.

Uveitis occurring after bacille Calmette-Guerin (BCG) intravesical therapy for bladder carcinoma is rare: only nine cases have been described. In two previous reports, vitreous cultures proved Mycobacterium bovis presence. We describe the case of an 85-year-old woman who presented with bilateral panuveitis 2 months after the last BCG intravesical instillation, with no other systemic symptom. There was no evidence for any other etiology for this uveitis. She was given oral antibiotics that were effective against Mycobacterium species, oral steroids, and anti-inflammatory drops. Her ophthalmologic status dramatically improved. This case highlights that these patients may have a good visual outcome, as long as diagnosis and treatment are not delayed.

To highlight the advantages of conjunctival biopsy in order to confirm the diagnosis of sarcoidosis.A 78-year-old woman presented with unilateral vitreitis. The examination of the conjunctive of right and left eyes revealed multiple, translucent, pale yellow nodules the size of millet grains located in the lower fornix. The diagnosis of sarcoidosis was suspected by an increased level of angiotensin-converting enzyme and bilateral hilar lymphadenopathies. A biopsy from conjunctival nodules showed noncaseating epithelioid and gigantocellular granulomas, confirming the diagnosis of sarcoidosis.Although underused, conjunctival biopsy seems to be both a safe and effective tool in the diagnosis of sarcoidosis.

Thomsen myotonia is an autosomal dominant, but not dystrophic myotonia. We report a family case associating congenital Thomsen's myotonia, strabismus, and ocular myopathy. We successively studied seven isolated patients presenting a myotonic disease and two controls and recorded the ocular saccades of these patients (amplitude, velocity) as a comparison for our family case.Four women from the same family presented Thomsen myotonia associated with strabismus. In addition to the clinical manifestations, the electro-oculographic analysis showed saccade alterations. The saccades of the seven other isolated patients, recruited in a neurology department, were evaluated by electro-oculographic recordings according to four different paradigms.The patients within our family case all presented esotropia, with or without a vertical oculomotor disorder. Clinical examination reported alterations in ocular motility--impairment and slowness of ocular movements--suggesting a myopathic disorder. The electro-oculographic recordings reported a slowing of saccades with increasing duration. For the isolated cases, the slowing of saccades observed was only reported for the patients with myotonic dystrophy (Steinert disease); nevertheless, we failed to show any myotonic phenomena.No cases associating Thomsen myotonia, strabismus, and electro-oculographic disorders have been reported in the literature to date. The electro-oculographic slowing of saccades is not rare in myotonic dystrophy (Steinert disease), but in Thomsen myotonia this has never been reported.This is the first report concerning Thomsen myotonia associated with strabismus and alterations of saccades. The mechanism of this disorder has yet to be discovered, as for Steinert disease.

A 38-year-old woman presented with a swollen left optic disc while being treated for miliary tuberculosis. The diagnosis of optic perineuritis was made, antibiotics were adapted, and the patient slowly recovered. We discuss the elements required to confirm optic perineuritis and the differential diagnosis in cases of papilledema with no visual impairment, as well as the hypotheses on the possible etiologies: dysimmune neuropathy as opposed to infection or toxicity.

After exclusion of a masquerade syndrome, uveitis may be associated with infection, systemic diseases, specific ocular diseases, or may be drug-induced. In order to improve diagnostic strategy in uveitis, we performed a comparative study to assess the importance of internist and ophtalmologist's collaboration and we proposed a well-adapted diagnostic procedure.A comparative study was performed in a tertiary centre. The population was divided in two groups. The first one was retrospective and consisted of patients treated at the Ophthalmology department of Croix Rousse Hospital from 1991 to 2002 without internist's collaboration. The second one was prospective and consisted of patients referred in the same centre in 2003 and 2004 with intervention of an internist. Patients of less than 18 years of age with pre-existent diagnosis, specific ocular diseases, toxoplasmosis infection, or with human immunodeficiency virus infection were excluded.Sixty-six patients were included. Anterior uveitis was the most frequent form (25 cases), followed by panuveitis (20 cases), posterior uveitis (14) and intermediate uveitis (7). The most frequent cause of uveitis was systemic disease (19 cases) followed by infection (7 cases) and neurological entities (4 cases). The rate of diagnosis was 30.3% without internist's intervention and 60.6% when patients were referred to an internist (P=0,01). The internist intervention was contributive in 75% of diagnoses.The internist intervention significantly enhances the rate of etiological diagnoses in uveitis. These results should further strengthen the internist/ophthalmologist collaboration for patients with uveitis.

The purpose of this study was to investigate the current causes and outcomes of open eye injuries in children.We reviewed the hospital records of 57 patients under 14 years of age who were treated for open globe injuries at Edouard Herriot Hospital, Lyon, France, between January 1999 and December 2003.This review includes 57 patients: 41 males and 16 females. The mean age at admission was 6.8 +/- 3.5 years. The injury involved the right eye in 27 cases and the left eye in 30 cases. Sharp or pointed objects accounted for the majority of injuries. The most common location for a perforating ocular injury to occur was at home. Wounds involved the cornea in 41 cases. There was iris hernia in 21 cases, hyphema in 15 cases, vitreous prolapse in 14 cases, lens damage in 12 cases, and shallow anterior chamber in 11 cases. The most frequent complication was traumatic cataract. Secondary lens removal was performed in 15 cases. Visual acuity was 0.5 or better in 27 of the 57 eyes, with a mean follow-up period of 12 months.Perforating ocular injuries are a frequent cause of unilateral visual loss. The highest proportion of injuries occurred at home and sharp objects were the most frequent causative agents. More adequate adult supervision and educational measures are necessary in order to reduce the prevalence of these accidents.

Bacterial adhesion to intraocular lenses (IOLs) during their implantation is a major etiological factor of postoperative endophthalmitis. Polypropylene was the first biomaterial that allowed this relation of cause and effect between bacterial adhesion and endophthalmitis to be proven. Adhesion to IOLs has been investigated in several in vitro studies, with contradictory results reported, due to variations in experimental conditions: the incubation times and the methods all varied. Adhesion is affected by the type of IOL, the bacterial strains, and the surrounding medium. Since this medium is very difficult to model because of its complexity, in vivo studies seemed essential. We have recently determined in vivo progression in the amount of adhering Staphylococcus epidermidis to five types of IOLs. There have been few epidemiological studies published to determine the relationship between endophthalmitis and the IOL type. However, the perfect biomaterial that could prevent postoperative endophthalmitis does not yet exist. Globally, hydrophilic materials and hydrophobic acrylic seem to be less sticky than silicone or PMMA, but this remains to be proven clinically.

Keratoglobus is a rare bilateral condition characterized by a globular protrusion of the cornea. The cornea remains transparent and shows a generalized thinning, most pronounced in the periphery. Most often keratoglobus is a congenital disease, but it may be secondarily acquired. This corneal pathology causes severe visual impairment: it induces extreme myopia, irregular astigmatism, and corneal scarring due to previous hydrops. Spectacle corrections are utilized as long as they provide adequate visual function. Surgery is performed when visual needs are no longer satisfied. However, surgical management of this disease is difficult because of the extreme thinness of the entire cornea. Penetrating keratoplasty is one of the first surgical approaches to have been tested, but it has been partly renounced in favor of more complex procedures. Optimal surgical treatment for keratoglobus remains unknown because of the scarcity of reported surgical results.

Postoperative endophthalmitis is still one of the most fearsome complications of cataract surgery. The present review's aims are to study the etiology and pathogenesis of endophthalmitis and the criteria for antibiotic prophylaxis. Endophthalmitis prevalence is 0.07%-0.32% in cataract surgery. The clinical presentation needs to be perfectly known, even if none of the signs is pathognomonic. Bacteria predominantly cultured in postoperative endophthalmitis are gram-positive, especially Staphylococcus epidermidis. Most of the bacteria come from the patient. Bacterial adhesion to intraocular lenses (IOLs) takes place during their implantation, a prominent etiological factor. Polypropylene was the first biomaterial that proved this relation of cause and effect between bacterial adhesion and endophthalmitis. The benefit of antibiotic prophylaxis during cataract surgery has yet not been proven, since the low prevalence of endophthalmitis makes controlled studies with a large cohort difficult. The criteria and the four possible administration approaches (topical, subconjunctival, irrigation liquid, systemic) are analyzed.

The aim of this study was to describe the clinicopathological characteristics of 42 conjunctival tumors surgically removed in children.Records of all conjunctival tumors surgically removed in children during the 11-year period 1990-2001 were collected from the records of the Department of Ophthalmology, Edouard Herriot Hospital, Lyon. In all cases, the tumor was resected with no additional treatment. Sections of all cases were reviewed by the same pathologist.A total of 42 cases (40 patients) were included in the study. The mean age of the subjects at the time of surgical excision was 10 years, with a range of 1-17 years; 45% were male. The most frequent indication for tumor removal was suspected growth. The clinical diagnosis was accurate in 91% of cases. The tumor was localized at the limbus in 57% of cases. Most tumors were pigmented nevi, accounting for 83% of the lesions. The histopathological diagnoses in decreasing order of frequency were: nevi (35), angioma (2), dermolipoma (2), dermoid (1), papilloma (1), and squamous cell carcinoma (1). In one case, the histological study revealed squamous cell carcinoma in a child suffering from xeroderma pigmentosum.This retrospective study suggests that malignancy of pigmented conjunctival lesions is extremely rare in children. Although squamous cell carcinoma is rare in children, surgical excision and histological study are necessary when a conjunctival lesion is associated with xeroderma pigmentosum or immunodeficiency.

Congenital toxoplasmosis (CT) is the most frequently encountered congenital infection. The aim of the present review is to report about the long-term outcome of functional and morphological manifestations after an early confirmation of the diagnosis.We report on a cohort of patients with serologically confirmed CT, born between 1988 and 2001, who were followed up prospectively at a single centre (Institute of Parasitology, Hôpital de la Croix Rousse, University of Lyon). All patients underwent regular ophthalmological, parasitological and paediatric controls on a half-yearly or annual basis. Ocular manifestations were documented and visual acuity was assessed as far as was possible.1,506 seroconversions were diagnosed during pregnancy, and 327 of the live-born offspring were seropositive for CT. At the end of the study period, ocular manifestations occurred in 79 of the children (24 %), and in 7 cases (9 %) they were discovered during the first month of life. In 72 of the patients (91 %), the ocular manifestations developed between 1 and 151 months (median follow-up time: 6.3 +/- 3.7 years; range: 0.5 - 14 years) under medical treatment for the first year of life. At the end of the study period, information regarding visual acuity was available for 66 patients. In 55 of these (83 %), visual acuity was normal in both eyes, and in 11 (17 %), it was reduced below 0.5. In 1 child, both eyes were functionally affected, one severely.CT may not become manifest ocularly until after a decade, which underlines the necessity for long-term ophthalmological monitoring of the infected individuals. In our patients, the prognostic outcome after therapy for the first year of life was better than that reported in the literature. This favourable outcome may serve as a basis for patient counselling.

A prospective study was performed in seven eyes of seven consecutive patients who had vitrectomy for diffuse diabetic macular edema (DME) with ILM premacular delamination as part of this treatment.All patients had retinopathy and DME. Only one patient had previous grid photocoagulation. In all eyes, there was no ophthalmoscopic evidence of traction from the posterior hyaloid membrane or proliferative tissue, but all patients had no posterior vitreous separation. A clinical examination and optical coherence tomography (OCT) were performed in preoperative and postoperative surgery (1 and 6 months). Pars plana vitrectomy with separation of the posterior hyaloid was performed in seven cases.Only three patients had vitreomacular traction observed on OCT. Statistical analysis revealed a significant decrease in retinal thickness 6 months after surgery. Best corrected visual acuity improved in four patients.Vitreous surgery can improve the visual prognosis of some eyes with DME with or without posterior vitreous separation, whether combined or not with vitreomacular traction observed on OCT.