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National audience; Purpose The aim of this study was to identify retinal vascular network patterns using semi‐automated software in an elderly population over 75 years in a population‐based study, the MONTRACHET (Maculopathy Optic Nerve nuTRition neurovAsCular and HEarT diseases) study. Methods In 2009–2011, participants from the 3 Cities Study living in Dijon, were proposed to take part in the MONTRACHET study with a complete eye examination. During these exams, color retinal photographs were performed (centered on the optic disc). Semi‐automated software (Singapore Institute Vessel Assessment: SIVA) was used in order to describe the retinal vascular network of subjects with a photograph of sufficient quality. All subjects with epiretinal membranes and vascular pathology were excluded. Fifty‐four geometric features such as fractal dimension, diameter, tortuosity and branching angle were systematically collected. A principal component analysis (PCA) was used to identify independent patterns. Results Overall, 1,067 photographs were reviewed with SIVA software among the 1,153 participants of the MONTRACHET study. The mean age was 79.8 ± 3.8 years and 62.7% were female. After PCA processing, we extracted 3 vascular patterns summarizing 41% of the retinal vascular network information. The first pattern corresponded to a lower density in the vascular network as well as a higher variability in the vascular width (29% of the total variability). The second pattern was highly correlated to large vessels diameters and width. The third pattern matched to an increased tortuosity. Conclusions In this preliminary study, three vascular patterns were identified: decreased vascular density and heterogeneous network, increased vessels diameter and tortuosity. The next step of this study is to identify associations between these patterns and cardiovascular diseases in this population‐based study.

International audience; IMPORTANCE:Postoperative endophthalmitis (POE) often results in severe visual impairment. In clinical studies, an intracameral cefuroxime injection at the end of surgery was found to be effective at reducing the incidence of POE. Two important issues are the retinal safety of cefuroxime and its use for patients with perioperative capsular rupture where the risk of POE is dramatically increased.OBJECTIVE:To assess the effectiveness and retinal safety of an intracameral injection of cefuroxime sodium for the prevention of POE and its possible use in cases of a perioperative capsular rupture of the lens.DESIGN, SETTING, AND PARTICIPANTS:Population-based cohort study of patients 40 years of age or older who underwent cataract surgery at 1 of 1546 French health care facilities, public or private, and whose medical records were obtained from the national administrative database. Data analyses were performed between March and November 2015.MAIN OUTCOMES AND MEASURES:The effectiveness and safety of the prophylactic injection of cefuroxime as measured by the incidence of POE and cystoid macular edema.RESULTS:From January 2010 to October 2014, a total of 3 351 401 eyes of 2 434 008 patients 40 years of age or older (58.9% were women, and the mean [SD] age was 73.9 [9.5] years) underwent cataract surgery; 1941 patients (0.08%) developed POE during the 6 weeks after cataract surgery. The incidence of POE after cataract surgery decreased over the course of the study (0.11%, 0.09%, 0.08%, 0.06%, and 0.05% in 2010, 2011, 2012, 2013, and 2014, respectively [P = .001 for trend]) as the use of cefuroxime prophylactic injections increased (11.1%, 14.4%, 32.8%, 64.8%, and 79.1% in 2010, 2011, 2012, 2013, and 2014, respectively [P = .001 for trend]). After multivariate adjustment, the risk of POE was reduced with the use of cefuroxime (odds ratio, 0.61 [95% CI, 0.56-0.68]). The retinal safety of an injection of cefuroxime, which was assessed by multiadjusted odds of retinal cystoid macular edema, was not increased for patients receiving cefuroxime injections (odds ratio, 0.86 [95% CI, 0.71-1.05]). For patients with a perioperative capsular rupture of the lens (the major risk factor for POE), the incidence of POE was lower for those who received an injection of cefuroxime than for those who did not (0.37% vs 0.51%, respectively [P = .001]), whereas an increased risk of cystoid macular edema was not identified for those who received or did not receive an injection of cefuroxime (5.6% vs 7.3%, respectively [P = .12]).CONCLUSIONS AND RELEVANCE:These data suggest that, in routine practice, the intracameral injection of cefuroxime at the conclusion of cataract surgery is associated with a lower risk of POE and is safe for patients with or without a perioperative capsular rupture. While these data might be used to support the consideration of its routine use to prevent POE, in the absence of a randomized clinical trial, they cannot prove a direct cause-and-effect relationship between the injection of cefuroxime and POE.

International audience; Orbital apex syndrome is a rare complication of herpes zoster ophthalmicus. In addition to our case, we review the clinical presentation, imaging findings, treatment options, and prognosis of 14 other reported cases. Magnetic resonance imaging of our patient demonstrated diffuse enhancement of the orbit involving the orbital apex, optic nerve and/or nerve sheath, extraocular muscles, and orbital soft tissues. There was significant clinical improvement with acyclovir and systemic corticosteroids, which seems to be preferred treatment for this disorder.

Contains fulltext : 168005.pdf (Publisher’s version ) (Closed access) The European Eye Epidemiology (E3) consortium is a recently formed consortium of 29 groups from 12 European countries. It already comprises 21 population-based studies and 20 other studies (case-control, cases only, randomized trials), providing ophthalmological data on approximately 170,000 European participants. The aim of the consortium is to promote and sustain collaboration and sharing of data and knowledge in the field of ophthalmic epidemiology in Europe, with particular focus on the harmonization of methods for future research, estimation and projection of frequency and impact of visual outcomes in European populations (including temporal trends and European subregions), identification of risk factors and pathways for eye diseases (lifestyle, vascular and metabolic factors, genetics, epigenetics and biomarkers) and development and validation of prediction models for eye diseases. Coordinating these existing data will allow a detailed study of the risk factors and consequences of eye diseases and visual impairment, including study of international geographical variation which is not possible in individual studies. It is expected that collaborative work on these existing data will provide additional knowledge, despite the fact that the risk factors and the methods for collecting them differ somewhat among the participating studies. Most studies also include biobanks of various biological samples, which will enable identification of biomarkers to detect and predict occurrence and progression of eye diseases. This article outlines the rationale of the consortium, its design and presents a summary of the methodology.

BackgroundCardiovascular mortality is increased in patients with rheumatoid arthritis (RA). RA is associated with an increased left ventricular mass index (LVMI), a strong marker of cardiovascular mortality, and vessel abnormalities. Experimental studies have suggested that tumour necrosis factor α (TNFα) may induce LV hypertrophy.ObjectiveTo study the effect of medium-term (3- and 6-months) treatment with the TNFα inhibitor etanercept (ETN) and synthetic disease-modifying antirheumatic drugs (sDMARDs) on LV morphological features and arterial stiffness in patients with RA.MethodsConsecutive female patients with active RA requiring treatment with ETN (n=28) or sDMARDs (n=20) were included. Clinical and biological monitoring, echocardiography and pulse wave velocity (PWV) assessment were performed at inclusion and at 3 and 6 months after the start of treatment. Paired t tests and multivariate linear regression analysis were used.ResultsMean LVMI tended to be higher at baseline in the ETN group than in the sDMARD group (96.5±19.8 vs 84.3±26.8 g/m2; p=0.11 for the ETN and sDMARD groups, respectively). In patients with ETN treatment, mean LVMI was significantly decreased at 3 and 6 months (−6.3±7.6 and −14.2±9.3 g/m2; p2, respectively). Blood pressure (BP) and aortic PWV were not changed by either treatment.ConclusionsETN induced a significant decrease in LVMI with medium-term treatment with no change in BP or PWV. TNFα may be an important factor of LV hypertrophy, which may explain the benefit of TNF inhibitors on cardiovascular morbidity and mortality in RA. These results need to be confirmed by larger studies and with other TNF inhibitors.

Objective.For patients with rheumatoid arthritis (RA), recommendations are inconclusive about whether tumor necrosis factor-α (TNF-α)-blocker therapy should be evaluated at 3 or 6 months. Biomarkers are needed to predict at 3 months which patients would benefit from further treatment because of nonoptimal response. Our objective was to investigate whether serum etanercept (ETN) concentrations and anti-ETN antibodies at 3 months are predictors of clinical response to ETN at 6 months in patients with RA in terms of European League Against Rheumatism criteria and Disease Activity Score in 28 joints (DAS28).Methods.Between 2009 and 2010, we included 19 women with active RA who were candidates for ETN therapy. Response criteria were evaluated at 3 and 6 months. Serum concentrations of ETN and anti-ETN antibodies were measured by ELISA at baseline and at 3 and 6 months.Results.Eighteen patients completed followup. Three-month ETN concentrations were lower for 6-month nonresponders than responders (p = 0.03). Three-month ETN levels correlated significantly with change in DAS28 between baseline and 6 months (r = −0.62, p = 0.006). The best predictor of response at 6 months was observed with an ETN threshold of 3.1 μg/ml at 3 months. No anti-ETN antibodies were found.Conclusion.ETN concentrations at 3 months predict response to ETN therapy at 6 months. Low ETN concentrations could explain the absence of response to ETN, suggesting that patients with low ETN levels could benefit from increased ETN dose or earlier interruption of treatment.

Purpose. To evaluate the 12-month outcome and predictive factors of visual acuity (VA) changes following bevacizumab therapy for central retinal vein occlusion (CRVO). Methods. A total of 50 eyes from 50 patients with CRVO were consecutively included in this prospective study. Predictive factors were assessed by comparing baseline characteristics of patients classified into 3 groups: those showing a decrease in VA; those displaying a change in Early Treatment Diabetic Retinopathy Study (ETDRS) letter score between 0 and 15; and those in whom an increase in VA ≥15 letters was achieved. Baseline variables considered in the analyses of predictive factors were demographic and clinical characteristics. Results. Mean baseline ETDRS letter score was 20±12 and mean macular thickness was 575.1±152.7 µm. Mean final ETDRS letter score improved significantly, reaching 27±20, p=0.04, while mean macular thickness decreased significantly to 391.1±229.6 µm, pConclusions. Intravitreal bevacizumab seems to be an effective primary treatment option for macular edema due to CRVO. Its main drawback is that multiple injections are often necessary to maintain visual improvement. Early injections of bevacizumab in young patients in whom VA is relatively preserved leads to a significant improvement in VA. Ischaemic CRVO and poor baseline VA are associated with nonresponse to such therapy.

Introduction La chirurgie de la cataracte est l’acte chirurgical le plus pratique en France et dans les pays occidentaux. Nous rapportons les disparites departementales de la chirurgie de cataracte primaire en 2015–2016 et l’evolution du nombre de sejours et des taux d’incidence entre 2008 et 2016. Methodes Les donnees de chirurgie proviennent des bases nationales 2008–2016 du Programme de medicalisation des systemes d’information en court sejour (PMSI MCO) et les populations, de l’Insee. Tous les sejours avec code d’acte de chirurgie de cataracte primaire ont ete inclus. Les evolutions temporelles des nombres et taux standardises sur l’âge (population francaise de 2006) ont ete etudiees pour les sejours et pour les patients operes une premiere fois pendant la periode (cas incidents). Des indices comparatifs ont ete calcules par standardisation indirecte pour etudier les disparites departementales en 2015–2016. Resultats En 2016, il y a eu 825 651 sejours pour chirurgie de cataracte primaire, dont 92,5 % en ambulatoire, et 573 914 patients operes : 37 % pour chirurgie d’un premier œil (du moins depuis 2008), 44 % pour chirurgie bilaterale et 19 % pour chirurgie du deuxieme œil. L’indice comparatif relatif aux sejours est inferieur a 90 % dans 20 departements et particulierement bas a Mayotte. Entre 2008 et 2016, le nombre annuel de sejours pour chirurgie de cataracte primaire a augmente de 39,5 % et celui des patients operes une premiere fois de 8 % ; les taux standardises sur l’âge ont augmente de 23 % pour les sejours (de 9,12 a 11,23 pour 1000 habitants), mais l’incidence a diminue de 2 % (de 6,44 a 6,32 ‰). La part des patients avec chirurgie bilaterale dans l’annee est passee de 32 % a 44 %. Discussion/Conclusion L’evolution 2008–2016 du nombre de sejours avec chirurgie de cataracte est due pour une part a l’augmentation et au vieillissement de la population. Mais l’augmentation des taux standardises de sejour, conjuguee a la quasi-stabilite du taux d’incidence reflete aussi l’augmentation de la chirurgie du deuxieme œil.

Item does not contain fulltext OBJECTIVE: To determine the refractive error in patients with autosomal recessive retinitis pigmentosa (arRP) caused by RP1 mutations and to compare it with that of other genetic subtypes of RP. METHODS: Twenty-six individuals had arRP with RP1 mutations, 25 had autosomal dominant RP (adRP) with RP1 mutation, 8 and 33 had X-linked RP (xlRP) with RP2 and RPGR mutations, respectively, 198 and 93 had Usher syndrome and arRP without RP1 mutations, respectively. The median of the spherical equivalent (SE) and the IQR (Q25-Q75) was determined and multiple comparisons were performed. RESULTS: arRP patients with RP1 mutations had SE median at -4.0 dioptres (D) OD (Ocula Dextra); -3.88 D OS (Ocula Sinistra), whereas arRP patients without RP1 mutations (-0.50 D OD; -0.75 D OS) and Usher syndrome patients (-0.50 D OD; -0.38 D OS) were significantly less myopic (p

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Objective The aim of this study was to assess the relationship between retinal vascular caliber and target organ damage in hypertensive patients (HT). Methods Data were collected on cardiac, renal, vascular and retinal variables in 88 consecutive never-treated HT subjects. Retinal vascular calibers were measured from fundus photographs by using a semi-automated computer-assisted program and summarized as central retinal artery and vein equivalent (CRAE, CRVE). Results Mean CRAE and CRVE were significantly lower in patients with left ventricular hypertrophy (left ventricular mass ≥ 110 g/m² for women, 125 g/m² for men) than those with normal left ventricular (CRAE: 129.4±3.7 vs 138.2±2.3 μm; p= 0.04; CRVE: 195.6±4.4 vs 209.8±2.7μm; p=0.008). CRAE and CRVE were negatively correlated with urinary albumin excretion (β±SE =-15.4±3.2, p

Purpose Prevention of visual impairment due to congenital cataract is an international priority. Estimates of incidence are required for implementation and assessment of preventive strategies, but are lacking, despite routine monitoring of birth defects at a national level in many industrialized countries. The purpose of this study was to determine the incidence of congenital cataract in France between 2010 and 2012. Secondary objective was to assess the proportion of unilateral and bilateral cataract surgeries, age of surgery and implantation of intraocular lens or not. Methods All children who undergo cataract surgery before 1 year of age in France between January 2010 and December 2012 were identified using the french national database of information systems. Incidence rate per year was estimate using the French database from the national institut of statistics. Results In 3 years, 590 eyes in 464 children with 46.6 % of girls had a cataract surgery with 27.0 % of them having a bilateral surgery. In the first year of age, cataract surgery incidence was 1.87 / 10 000 birth in this period. Age (median [interquartile]) of surgery was 3.5 (2.2-4.8) months. Among the 590 operated eyes, 28% (168 eyes) were not implanted with intraoculair lens. Conclusion The incidence of congenital cataract in France is close to what was previously assessed in literature in industrialized world. Median age of surgery corresponds to recommendations. An important proportion of children was not primary implanted with an intraoculair lens.

Purpose Optic neuropathy (ON) is one of the complications of alcohol. The aim of this study was to assess the prevalence of alcoholic ON in a cohort of patients hospitalized for alcohol withdrawal. Secondary objective was to explore the predictive value of optic nerve changes for diagnosis of ON. Methods This was a single-center prospective study. A complete eye examination was performed during the patient's alcohol withdrawal. The definition of alcoholic ON used was an assocation of alterations of visual field with impaired color vision. Optic nerve function and morphology were assessed using visual evoked potentials, optical coherence tomography (OCT), Nerve Fiber Indicator from polarimetry (GDx) and Moorfields Regression Analysis of the Heidelberg Retina Tomograph II (MRA-HRT II). Results Two hundred patients were included prospectively from January 2010 to June 2013 (145 men and 55 women) with a mean age of 47 ± 12 year. The average alcohol consumption was 220 ± 122 g/day. 46 patients (23%) responded to alcoholic ON defintion (13.5 % in both eyes and 9.5% in only one eye). Diagnostic sensitivity and specificity for visual evoked potentials were of 55.5% and 54.5% respectively; for GDx 18% and 97%, respectively; for OCT 38% and 92%, respectively; and for MRA-HRT II 19% and 79%, respectively. Conclusion A high prevalence of alcoholic ON observed in this study should prompt screening and early treatment. From predictive value of objective optic nerve changes, we discuss the best couple of exams to complete the screening of alcoholic ON.

Joint Bone Spine - In Press.Proof corrected by the author Available online since jeudi 23 janvier 2014

PURPOSE The pathway linking late-life malnutrition to greater risk of cardiovascular disease is unclear. Microcirulatory changes assessed by retinal vascular caliber have been linked with increased risk of stroke and coronary heart disease. The purpose of this study was to examine whether retinal vascular calibers are associated with malnutrition in elderly subjects free of cardiovascular diseases. METHODS This was a cross-sectional analysis of a community-dwelling cohort comprising 1145 individuals aged 60 years and older. Retinal vascular caliber was measured from fundus photographs using a semiautomated, standardized imaging software. Malnutrition was assessed using body mass index (BMI) < 18.5 kg/m(2) and biomarkers of protein malnutrition: plasma albumin and transthyretin. RESULTS In a multivariate model controlling for cardiovascular risk factors, retinal venular caliber was related to BMI (P = 0.0002) with an increased mean caliber for individuals with obesity and for those with low BMI. After multivariate adjustment for age, sex, hypertension, smoking, high-density lipoprotein (HDL) cholesterol, glomerular filtration rate and BMI, lower levels of albumin or transthyretin were associated with larger retinal venular caliber (P = 0.026 and P = 0.0018, respectively), that remain significant when adjusting for CRP (P = 0.040 and P = 0.0060, respectively) or orosomucoid (P = 0.034 and P = 0.0020, respectively). The relationships between retinal arteriolar caliber and BMI, albumin and transthyretin did not reach significance (P = 0.14, P = 0.12, and P = 0.15, respectively). CONCLUSIONS Protein malnutrition was identified as an additional factor associated with retinal venular dilatation beyond inflammation. This suggests that early microvascular changes may be one of the underlying mechanisms of increased risk of cardiovascular disease observed in elderly subjects suffering from malnutrition.

Background Alcohol has particularly toxic effects on the central and peripheral nervous systems. Optic neuropathy (ON) is one of these neurological complications. Its diagnosis has not been codified, and its prevalence is poorly known. The aim of this pilot study was to assess the prevalence of ON and identify risk factors in a cohort of patients hospitalized for alcohol withdrawal. Methods This was a single-center prospective study. A complete standardized eye examination was performed during the patient's alcohol withdrawal; The data collected included: sociodemographic status; the number of withdrawals; the type and amount of alcohol drunk, tobacco, and illicit drug consumption; and ophthalmological results. Results One hundred patients were included prospectively from January 2010 to June 2011 (67 men and 33 women) with a mean age of 47 ± 12 and 46 ± 10 years, respectively. The average alcohol consumption was higher for men than women: 207 ± 122 vs. 146 ± 92 g/d, p = 0.013. The most frequent definition of ON in the literature is a decrease in visual acuity associated with impaired color vision. Thirteen percent of men and 3% of women met these criteria. But monocular ON was observed in 22% of men and 18% women, and partial damage was demonstrated in 27% of men and 7% of women. Conclusions ON is a relatively rare complication of chronic alcohol consumption, but the high prevalence of incomplete forms should prompt screening and early treatment.

International audience; BACKGROUND: Increasing visual impairment (VI) with age has been associated with mental health problems but the question of temporal direction and reverse causality has not been addressed previously. Our objective was to prospectively examine the bi-directional association of VI and visual function (VF) loss with depressive symptoms in the elderly. METHODS: The cohort comprised 4216 participants (40.2% men) aged 65 and over with 10 years of follow-up. Near VI was defined using measured usual-corrected binocular acuity while distance VF was self-declared. Participants having a major depressive episode or a Center for Epidemiologic Studies Depression Scale score ≥ 16 were classified as having depressive symptomatology. Longitudinal analyses used mixed logistic models for repeated evaluations. RESULTS: After adjustment for demographic factors, participants with moderate to severe near VI at baseline had increased odds of developing depressive symptomatology (Odds Ratio [OR]=1.60; 95% Confidence Interval [CI]=1.08-2.38), but after multiple adjustments the association fell below the significance level. A 2-year decrease in distance VF was associated with increased odds of depressive symptomatology during follow-up after multiple adjustments (OR=3.03; 95% CI=1.75-5.23). Baseline depressive symptomatology was not associated with incident near VI but was associated with VF loss after multivariate adjustment (OR=1.62; 95% CI=1.15-2.28). LIMITATIONS: The causes of VI have not been recorded. CONCLUSIONS: The relation of vision loss to onset of depressive symptomatology differs according to near VI or distance VF and declines across time. A reverse strong association was found between baseline depression and incident loss of distance VF suggesting a downward spiral of events.

Purpose Activity limitations, which induce loss of autonomy in the elderly, are a major public health problem. We investigated the associations between objectively determined visual impairments and activity limitations, and assessed the visual acuity thresholds associated with these restrictions. Methods The study sample consisted of 1887 people aged 63 years and over from a population-based cohort. Visual impairment was defined according to the WHO definition. Multivariate logistic regressions were used to estimate the associations between vision and Instrumental Activities of Daily Living (IADL) limitations. Using receiver-operating characteristic (ROC) curves, we identified visual acuity thresholds that maximized the Youden index ([Sensitivity+Specificity]-1) for predicting IADL limitations. Results After adjustment for potential confounders, moderate to severe visual impairment and mild visual impairment were strongly associated with IADL limitations(odds ratio [OR]=3.49; 95% confidence interval [CI]=1.93, 6.32 and OR=1.77; 95% CI=1.07, 2.91, respectively). Visual acuity was a strong predictor of IADL limitations, with an area under the ROC curve of 0.72 (95% CI=0.68, 0.76). The best discrimination between subjects with or without IADL limitations (global, physical, cognitive) was obtained for visual acuities around 20/40-20/50. Conclusion This study confirms major increased risk for IADL limitations in subjects with moderate to severe visual impairment. In addition, it suggests that milder visual impairments (in particular below 20/40) may also be related to an increased risk for IADL limitations and should be considered for early medical intervention, before the decline of the subjects’ autonomy.

Purpose Activity limitations, which induce loss of autonomy in the elderly, are a major public health problem. We investigated the associations between objectively determined visual impairments and activity limitations and assessed the visual acuity thresholds associated with these restrictions. Methods The study sample consisted of 1887 people aged 63 years and over from a population-based cohort. Moderate to severe visual impairment was defined as presenting visual acuity lower than 20/70, according to the World Health Organization (WHO) definition. In addition, we studied mild visual impairment, defined as visual acuity [20/70–20/40]. Multivariate logistic regressions were used to estimate the associations between vision and instrumental activities of daily living (IADL) limitations. Using receiver-operating characteristic (ROC) curves, we identified visual acuity thresholds that maximized the Youden index ([sensitivity + specificity]−1) for predicting IADL limitations. Results After adjustment for potential confounders, moderate to severe visual impairment and mild visual impairment were strongly associated with IADL limitations (odds ratio [OR] = 3.49; 95% confidence interval [CI] = 1.93, 6.32 and OR = 1.77; 95% CI = 1.07, 2.91, respectively). Visual acuity was a strong predictor of IADL limitations, with an area under the ROC curve of 0.72 (95% CI = 0.68, 0.76). The best discrimination between subjects with or without IADL limitations (global, physical and cognitive) was obtained for visual acuities around 20/40–20/50. Conclusion This study confirms major increased risk for IADL limitations in subjects with moderate to severe visual impairment. In addition, it suggests that milder visual impairments (in particular below 20/40) may also be related to an increased risk for IADL limitations and should be considered for early medical intervention, before the decline of the subject autonomy.

Purpose The aim of this study was to assess the relation between retinal vascular caliber and renal function in normotensive (systolic/diastolic blood pressure

Objective: To evaluate the association between several candidate single-nucleotide polymorphisms (SNPs) and responsiveness to rituximab in patients with rheumatoid arthritis (RA). Methods: Sixty-three RA patients were included. Nine genes (13 SNPs) were subsequently analyzed, including those coding for cytokines involved in synovitis (IL10, LTA, TGF beta 1, TNF-alpha, TNF receptor II) and genes associated with RA susceptibility (-C5 TRAF1, STAT4, TNFAIP3 and PTPN22). Results: Forty-four patients were defined as responders and 19 as nonresponders. TGF beta 1 Codon 10 and TGF beta 1 Codon 25 SNPs were both associated with clinical response (probability to respond to treatment with the Codon 10 C/T genotype: OR = 1.6; P = 0.002, and with the Codon 25 G/C genotype: OR = 1.6; P = 0.025). The probability to be a responder when the TGF beta Codon10 C/T and TGF beta Codon 25 G/C genotypes were co-inherited, doubled (OR = 2.6; P = 0.008). Conclusion: The TGF beta 1 SNPs are associated with a good response to rituximab therapy and as such could be useful genetic biomarkers in predicting therapy outcome. (C) 2011 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.

Background To determine whether inhibitors of the renin-angiotensin system (RAS) reduce the incidence of renal dysfunction when compared to other antihypertensive treatments in patients with essential hypertension and no pre-existent renal disease. Methods The search strategy used the Cochrane Library, Medline, previous meta-analyses, and journal reviews. The selection criteria included randomized, controlled trials of antihypertensive drugs that compared a RAS inhibitor with another treatment in essential hypertension. Studies that specifically enrolled only patients with diabetes or renal disease were not included. The quality assessment and data extraction of studies were performed by two independent reviewers. Effects on dichotomous renal outcome (serum creatinine (SCreat) higher than a prespecified value, doubling of SCreat or end-stage renal disease) and secondary continuous marker of renal outcome (change in SCreat) were calculated using Peto's method. Results 33,240 patients met the inclusion criteria for studies with a dichotomous outcome and 10,634 patients for studies with a continuous outcome. The mean follow-up was 42 ± 13 months. Patients randomized to RAS inhibitors did not show a significant reduction in the risk of developing renal dysfunction as compared to other antihypertensive strategies (odds ratio = 1.05; 95% confidence interval (CI) 0.89-1.25; P = 0.54). There was no significant difference in change of SCreat between groups (mean difference = 0.0005 mg/dl; 95% CI -0.0068 to 0.0077 mg/dl; P = 0.91). Conclusion In patients with essential hypertension and no pre-existent renal disease, prevention of renal dysfunction is not significantly different with RAS inhibitors when compared to other antihypertensive agents.

A 16-month-old white boy born to a mother who had biopsy-proven cutaneous juvenile xanthogranuloma (JXG) at the age of 9 months came in for a consultation with a history of six cutaneous lesions (figure 1A) on the face and the trunk. This was consistent with JXG and was confirmed by a skin biopsy (figure 1B). Owing to a lack of systemic involvement, we decided to not treat the patient at this time. Routine ophthalmologic screening between 16 and 34 months was normal. At 36 months of age, he was referred to the emergency ophthalmologic department because of a sudden bilateral visual loss of 3-day duration. His initial best-corrected visual acuity was “counts fingers in both eyes.” Slit lamp examination was normal, but fundus examination revealed bilateral optic disc swelling. Physical examination revealed hepatomegaly, splenomegaly and persistence of JXG dermatologic lesions, but neither lymph node nor cafe-au-lait spots were found. Visual evoked potentials to flash stimulation were unrecordable. The photopic flash electroretinograms were normal. A lumbar puncture and magnetic resonance imaging (MRI) were performed (figure 2). Figure 1 (A) Close-up view of a JXG with a yellowish nodular lesion. (B) Biopsy of the lesion showing plump histiocystic cells and numerous multinucleate Touton giant cells characteristic of xanthogranulomatous lesions. Immunostaining for CD68a was positive, whereas that for …

The individual response to biological agents in severe rheumatoid arthritis (RA) is unpredictable in daily clinical practice. Despite improving our knowledge on genetic association using GWS in a large RA cohort, no genetic indicators predictive of clinical response to anti-CD20 treatment (rituximab) have been described. To analyse the association of several candidate gene polymorphisms with responsiveness to rituximab in patients with severe RA. The clinical response of 47 …

PURPOSE: Retinal vascular caliber has been linked with increased cardiovascular risk and is predictive of cardiovascular pathology, including stroke and coronary heart disease. Oxidative stress, as well as inflammatory mechanisms, plays a major role in the pathogenesis and progression of atherosclerosis, plaque rupture and vascular thrombotic propensity. The purpose of this study is to explore the relationship between retinal vascular calibers and biomarkers of oxidative stress and inflammation, in subjects free of cardiovascular pathology. PATIENTS AND METHODS: Cross-sectional analysis from a community-dwelling cohort comprising 1224 individuals aged 60 years and over, without a history of coronary or peripheral artery disease or stroke. Retinal vascular caliber was measured from fundus photographs using semi-automated standardized imaging software. Oxidative stress was evaluated using plasma superoxide dismutase 2 and glutathione peroxidase (GPx-3) activities, and inflammatory state was assessed using plasma high sensitivity C-reactive protein (hsCRP) and orosomucoid. RESULTS: In a multivariate model controlling for cardiovascular risk factors, larger retinal arteriolar caliber was independently related to higher level of GPx-3 activity (p = 0.003) whereas larger venular caliber was associated with higher levels of hsCRP (p = 0.0001) and orosomucoid (p = 0.01). CONCLUSION: In the present study, biomarkers of oxidative stress regulation and inflammation were independently associated with retinal vascular calibers. This suggests that an assessment of retinal vessels may offer early and non-invasive detection of subclinical vascular pathology.

The loss of autonomy among older persons is a major public health issue. In the disablement process model1 chronic and acute conditions lead to psychological and physical deficiencies and ultimately to difficulty performing activities of daily life. In elderly, visual impairment is one of the major deficiencies leading to activity limitations and can be caused by either eye trauma or ocular diseases (affecting the ability to receive or process visual information), or by refractive errors (a failure of the eye to focus images sharply on the retina). Refractive errors affect about a third of the US and Western European populations.2 We estimated the proportion of uncorrected refractive errors and the potential improvement in daily life functioning that could be brought about by optimal visual correction.

International audience; BACKGROUND:The PlusOptix photoscreeners (PlusOptix GmbH, Nuremberg, Germany) is used in many vision screening programs. The purpose of the present study was to further explore the accuracy of the PlusOptix A09 photoscreener in children with ametropia (myopia or hyperopia).METHODS:A total of 70 eyes (35 children) were prospectively included. Before administration with the cycloplegia treatment 1 % cyclopentolate hydrochloride, children underwent refraction measurement with the PlusOptix A09. A refraction was then performed after cycloplegia with either Retinomax hand-held or Nidek autorefractor before and after 3 years old, respectively.RESULTS:The median (interquartile range) age was 58 (18 to 86) months. The mean (SD) spherical equivalent differed between PlusOptix A09 and cycloplegic autorefraction (+0.54 [1.82] D vs +1.06 [2.04] D, p = 0.04). PlusOptix A09 refraction was positively correlated with cycloplegic autorefraction (r = 0.81, p

As the different subtypes of juvenile idiopathic arthritis (JIA) do not have the same severity and prognosis, they do not require the same therapeutic modalities. The goal is to obtain clinical remission with steroid-sparing strategy and identify prognosis …

Purpose: obesity is associated with increased cardiovascular risk and death. Bariatric surgery for weight reduction improves the clinical and metabolic profile. Retinal caliber changes could precede cardiovascular events. Different studies have shown an improvement in retinal caliber after surgery. The aim of this study was to examine retinal caliber before and after bariatric surgery and assess the predictors of this improvement.Methods: patients with World Health Organization grade 2 or 3 obesity undergoing bariatric surgery were included in this monocentric, prospective cohort study. Biologic features, vessel stiffness, echocardiograph variables and retinal caliber were assessed at baseline and 6 and 12 months. A mixed linear model adjusted for age and sex was used to evaluate factors associated with retinal caliber changes.Results: we included 88 patients (75 women). The median (interquartile range) age was 43 years (35-51) and median baseline weight 111 kg (101-127). In the first year after bariatric surgery, patients showed a decrease in central retinal vein equivalent (CRVE) (-5.1 µm/year, p

Objective: to evaluate risk factors associated with keratoconus in a monocentric cross-sectional case–control study.Methods: this observational study occurred from June 2019 to February 2021 in Gui de Chauliac University Hospital Center, Montpellier, France. The case group consisted of 195 patients with keratoconus in at least one eye who were followed by a corneal specialist. The control group consisted of 195 patients without evidence of keratoconus on slit-lamp examination and corneal topography, who were matched 1:1 to controls by age and sex. Data were collected by a self-completed paper questionnaire before the consultation. Results: multivariate analysis revealed significant associations of keratoconus with family history (odds ratio [OR]= 22.2, 95% confidence interval [CI]: 5.88–148; p

There are many clinical and topographic classifications of keratoconus but only one, proposed by Sandali et al., used optical coherence tomography (OCT) to evaluate the corneal structure. The purpose of this study was to evaluate the classification in clinical practice.Methode: we performed a retrospective analysis of all patients with keratoconus who consulted at Montpellier University Hospital between July 2018 and July 2020. The diagnosis of keratoconus was based on a range of clinical and topographic features. Exclusion criteria were a history of ocular surgery. Patients with keratoconus were classified according to 5 stages of increasing severity based on the appearance of corneal OCT. We analyzed the functional, clinical and topographic characteristics according to the stages. We also analyzed the error of corneal thickness measurement by topography and described the proposed treatments by stage.Results: we included 143 eyes in 143 patients with keratoconus and 35 eyes in 35 healthy patients. Of the keratoconus patients, 116, 8, 9, 6, and 4 were at stage 1, 2, 3, 4, and 5 of the classification, respectively. The severity of structural damage on OCT was associated with greater severity of functional, anatomic and topographic damage. The difference in corneal thickness measurement between OCT and topography was higher with more severe stage. The proposed treatments for the more severe stages were more invasive.Conclusion: the structural classification examined seems able to classify keratoconus severity. We found similar results to the study of Sandali et al. The classification is not well known by practitioners but could find increasing interest for keratoconus with improvement and wider use of anterior segment OCT.; Il existe de nombreuses classifications cliniques et topographiques du kératocône mais une seule, proposée par Sandali et al. utilise la tomographie en cohérence optique (OCT) pour évaluer la structure cornéenne. L’objectif de cette étude est d’évaluer cette classification en pratique clinique.Matériel et méthode : nous avons effectué une analyse rétrospective de tous les patients atteints de kératocône ayant consulté au CHU de Montpellier entre juillet 2018 et juillet 2020. Le diagnostic de kératocône était posé sur un faisceau d’arguments cliniques et topographiques. Les critères d’exclusion étaient les antécédents de chirurgie oculaire. Les patients atteints de kératocône ont été classé d’après la classification utilisée en 5 stades de sévérité croissante en fonction de l’aspect de leur OCT cornéen. Nous avons analysé les caractéristiques fonctionnelles, clinique et topographique en fonction des stades. Nous avons analysé l’erreur de mesure d’épaisseur cornéenne par la topographie et décrit les traitements proposés en fonction du stade.Résultats : nous avons inclus 143 yeux de 143 patients atteints de kératocône et 35 yeux de 35 patients sains. Parmi les patients atteints de kératocône, 116, 8, 9, 6, 4 ont été classés respectivement en stade 1, 2, 3, 4, 5 de la classification. La sévérité de l’atteinte structurelle en OCT était associée à une plus grande sévérité de l’atteinte fonctionnelle, anatomique et topographique. La différence de mesure d’épaisseur cornéenne entre l’OCT et la topographie était plus élevée pour les stades plus sévères. Les traitements proposés étaient plus invasifs pour les stades plus sévères.Conclusion : cette classification structurelle semble bien être un marqueur de sévérité du kératocône. Nous avons retrouvé des résultats similaires à l’étude de Sandali et al. Elle est peu connue des praticiens et semble peu adaptée aux kératocônes modérés. Elle pourrait trouver un intérêt croissant avec le perfectionnement et l’usage plus large de l’OCT de segment antérieur dans le kératocône.

We prospectively included all patients with keratoconus including form fruste from november 2018 to may 2020 in the department of Ophthalmology, University Hospital Montpellier (France), compared with a control group made of people consulting for visual screening without keratoconus. Diagnostic was based on Rabinowitz and Tanabe criteria’s using Bausch & Lomb© Orbscan IIz topographer. Axis and magnitude of anterior and posterior corneal astigmatism was measured with Zeiss IOL Master 700 biometer©.Conclusion: the ratio posterior/anterior and axis rotation between anterior and posterior astigmatism was lower in keratoconus compared with control. Further study may assess the usefulness of posterior corneal astigmatism in the diagnosis and follow up of keratoconus disease. Posterior astigmatism was not a discriminatory factor for diagnosis of form fruste keratoconus, but the limited number of patients require further investigation; Une des caractéristiques principales du kératocône est un bombement de la face postérieure de la cornée. L’objectif de notre étude était d’évaluer l’astigmatisme cornéen postérieur dans les différents stades du kératocône et chez des sujets sains.Nous avons inclus prospectivement de novembre 2018 à mai 2020 tous les patients atteints de kératocône (dont kératocônes forme fruste) consultant dans le service d’Ophtalmologie au CHU Gui de Chauliac à Montpellier. En parallèle, un groupe de sujets sains consultant pour dépistage visuel a été constitué. Le diagnostic était fait sur les critères de Rabinowitz et de Tanabe grâce au topographe Bausch & Lomb© Orbscan IIz. L’axe et la magnitude des astigmatismes cornéens antérieur et postérieur étaient mesurés grâce au biomètre Zeiss IOL Master 700©.Nous avons inclus 162 yeux avec kératocône, 15 yeux avec un kératocône forme fruste et 178 yeux sains. La magnitude de l’astigmatisme cornéen antérieur était de -4.73D, -2.07D et -1.24D ; et postérieur de -0.83D , -0.49D et -0.34D, respectivement. Nous avons trouvé une forte corrélation entre le cylindre de l’astigmatisme antérieur et postérieur chez les yeux avec (R²=0.86 ; p

Objectifs : estimer l’évolution de la consommation de collyres hypotonisants après chirurgie de la cataracte.Méthodes : étude longitudinale exposé-non exposé de sujets appariés, basée sur le système national des données de santé en France du 1er janvier 2005 au 1er janvier 2017. Comparaison de la consommation de collyres hypotonisants chez des individus ayant subi une chirurgie de cataracte bilatérale vs n’ayant pas eu de chirurgie de cataracte, appariés sur la consommation de collyres hypotonisants, l’âge et le sexe. La chirurgie de la cataracte était identifiée à l’aide du code CCAM BFGA004 « extraction extracapsulaire du cristallin par phakoémulsification, avec implantation de cristallin artificiel dans la chambre postérieure de l'œil ». La consommation de traitement hypotonisant durant les 12 mois précédant la première chirurgie de cataracte était comparée à celle des 12 mois suivant la deuxième chirurgie de cataracte.Critères de jugement : la consommation de traitement hypotonisant avant et après chirurgie de cataracte bilatérale et les facteurs associés à l’arrêt des traitements en post-opératoire.Résultats : 1194 individus traités par collyres hypotonisants ont été inclus, 597 exposés à une chirurgie de cataracte bilatérale et 597 non exposés à une chirurgie (âge moyen, 74.8±8.3 ans ; 69.0% femmes). La diminution moyenne du nombre de collyres hypotonisants était plus importante dans le groupe exposé à la chirurgie que dans le groupe non exposé (-27.6% vs. -7.0%, respectivement, p

Objectif : les occlusions artérielles rétiniennes (OAR) ont été associés à la présence d’un accident vasculaire cérébral (AVC) concomitant dans 13 à 37% des cas. Des facteurs systémiques prédictifs de l’AVC ont été identifiés, mais il manque des données concernant les facteurs ophtalmologiques associés. Certaines anomalies vasculaires rétiniennes ont été décrites comme marqueurs d’un futur événement cérébrovasculaire. L’objectif de cette étude est d’étudier l’association entre des marqueurs rétiniens et la présence concomitante d’un AVC ischémique silencieux chez les patients OAR.Matériel et méthodes : nous avons conduit une série de cas consécutifs du 1er janvier 2015 au 31 décembre 2018. Tous les patients présentant une OAR aigüe, qu’il s’agisse d’une occlusion de l’artère centrale de la rétine (OACR), d’une occlusion de branche (OBAR) ou d’une occlusion de l’artère ophtalmique (OAO), étaient inclus et ont bénéficié d’une imagerie par résonance magnétique (IRM) cérébrale en séquence de diffusion dans les 24 heures. Un examen ophtalmologique complet était réalisé incluant des rétinographies, un OCT et une angiographie à la fluorescéine, ainsi qu’un bilan vasculaire urgent. Nous avons utilisé la classification ASCOD pour identifier et traiter la cause de l’occlusion.Résultats : 103 patients (58 OACR, 39 OBAR, 6 OAO) ont bénéficié du protocole d’imagerie. 28 patients (27,2%) ont présenté une lésion ischémique à l’IRM. 24/28 patients (85,7%) n’avaient aucune traduction neuroclinique de leur AVC. Une OAO (p=0.04), un fond d’œil controlatéral anormal (p=0.004), l’étendue de la sténose carotidienne (p=0.02) et l’échocardiographie (p = 0.03) étaient associés à une IRM positive. En analyse multivariée, une OAO (odd ratio (OR) = 9.1 [95% intervalle de confiance 1.2-70.2], p = 0.04) et un fond d’œil controlatéral anormal (p total = 0.002; rétinopathie diabétique/hypertensive : OR = 7.0 [95% intervalle de confiance 2.1-23.7]; occlusion artérielle rétinienne ou embole: OR = 16.9 [95% intervalle de confiance 1.7-268.4]) étaient prédictifs d’un AVC.Conclusion : notre étude suggère que les OAO et un fond d’œil controlatéral anormal sont des facteurs ophtalmologiques associés à un AVC concomitant chez les patients OAR. Ces résultats pourraient apporter une aide dans la stratification d’un risque vasculaire aigu pour la prise en charge de ces patients. D’autres modèles prospectifs sont nécessaires pour étudier ces marqueurs.

Objectif : évaluer l’effet de la chirurgie de cataracte sur la consommation en somnifères. Design : étude de cohorte. Participants : patients âgés de 40 ans minimum, qui ont eu une première chirurgie de cataracte dans un des 1546 centres de soins français, public ou privé ; entre janvier 2010 et décembre 2011. Méthodes : les informations médicales sont issues d’une base de données administrative nationale. L’évaluation de la consommation de somnifères entre avant et après chirurgie de cataracte unilatérale ou bilatérale a été étudiée par le test de McNemar. Un test de Poisson a permis d’évaluer la quantité de somnifères consommés, déterminé par le nombre de boites achetées, le nombre de mois avec délivrance et le nombre de délivrances totales par les pharmacies. Critère de jugement principal : la consommation et la quantité de somnifères entre l’année précédant la chirurgie de cataracte et l’année suivant cette chirurgie, unilatérale ou bilatérale. Résultats : un total de 7688 chirurgies de cataracte chez 5137 patients ont été analysées (2551 bilatérales et 2506 unilatérales). L’âge moyen était de 75 ans (écart interquartile 68-81). Après chirurgie de cataracte unilatérale ou bilatérale, le nombre de patients débutant un traitement par somnifère n’était pas significativement différent de ceux arrêtant leur traitement (5.1%; 4.6% p=0.30 and 4.7%; 4.6% p=0.90 respectivement). Le nombre de boites de somnifères délivrées après chirurgie de cataracte unilatérale était augmenté (risque relatif : 1.03 [intervalle de confiance 95% 1.00; 1.06], p=0.05). Après chirurgie bilatérale, les résultats étaient similaires mais non significatifs (risque relatif : 1.04 [intervalle de confiance 95% 1.00; 1.08], p=0.06). Conclusion : nous avons mis en évidence une augmentation du nombre de boîtes de somnifères délivrée après première chirurgie de cataracte. Le nombre de patients utilisant des somnifères était stable, après chirurgie de cataracte unilatérale ou bilatérale. Nous nous attendions à d’autres résultats en regard de précédentes études qui démontraient une amélioration de la qualité de sommeil après chirurgie. D’autres études pourraient étudier ces changements en fonction de l’implant de chambre antérieure utilisé (neutre ou bloquant la lumière bleue).