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Resume La description du reseau microvasculaire retinien beneficie, depuis plus de 10 ans, du developpement de nouvelles techniques d’imagerie. Les logiciels automatiques d’analyse d’images, ainsi que l’OCT-angiographie (OCT-A) permettent de mettre en evidence des modifications subtiles et precoces de l’arbre vasculaire retinien grâce a de nombreuses donnees quantitatives microvasculaires. L’enjeu des recherches actuelles est de demontrer l’association entre ces modifications microvasculaires, le vieillissement vasculaire systemique et les pathologies cerebro et cardiovasculaires. En effet, un continuum physiopathologique existe entre alterations microvasculaires retiniennes et pathologies vasculaires systemiques. Dans l’etude de population Montrachet, nous avons montre qu’un reseau vasculaire suboptimal, evalue sur fond d’œil avec le logiciel Singapore I Vessel Assessment (SIVA), etait significativement associe a l’existence d’un diabete traite et d’un sur risque de mortalite cardiovasculaire. Par ailleurs, nous avons complete nos recherches sur le reseau vasculaire retinien avec l’utilisation de l’OCT-A. Dans l’etude EYE-MI, nous avons demontre le potentiel interet de caracteriser, de maniere quantitative, le reseau microvasculaire retinien en OCT-A afin d’evaluer le profil de risque cardiovasculaire des patients atteints de cardiopathies ischemiques. Un score de risque AHA (American Heart Association) eleve etait associe a une faible densite vasculaire retinienne independamment des modifications hemodynamiques systemiques. Ainsi, une meilleure comprehension du lien entre microvascularisation retinienne et pathologie macrovasculaire permettrait d’envisager son utilisation pour une identification precoce des patients a risque et de leur proposer un programme de prevention primaire personnalise. Le reseau vasculaire retinien pourrait donc etre un temoin de l’histoire vasculaire systemique mais aussi un biomarqueur predictif interessant d’evenements vasculaires systemiques.

Background and purpose: Retinal complications may be encountered during the development of hypertension as a response to oxidative stress. Statins may reduce the risk of developing hypertension and ocular diseases. We evaluate the effects of rosuvastatin (ROSU) on retinal functionality and oxidative stress levels in normotensive and spontaneously hypertensive rats (SHR). Experimental approach: Wistar Kyoto (WKY) and SHR were treated for 3 weeks with rosuvastatin (10 mg kg−1 day−1). Electroretinograms (ERG) were recorded before and after rosuvastatin treatment. Reactive oxygen species (ROS) were determined in the retina with dihydroethidium staining and NAD(P)H oxidase activity was evaluated. Key results: Retinal ganglion cell ROS and retinal NAD(P)H oxidase activity were higher in SHR than in WKY rats, respectively (17.1±1.1 vs 10.2±1.2 AU, P

But de l’etude L’objectif de ce travail est d’evaluer la presence d’anomalies de la proprioception constituant le syndrome de deficience posturale au sein d’une population d’enfants atteints de dyslexie de developpement. Patients et methodes Soixante patients de sexe masculin, âges en moyenne de 11 ans et 9 mois, ont ete inclus dans l’etude. Le diagnostic de dyslexie de developpement a ete confirme par un examen neuropsychologique a l’aide d’epreuves standardisees. Apres un interrogatoire visant a rechercher les signes fonctionnels evocateurs d’une anomalie proprioceptive, les patients ont fait l’objet d’un examen clinique ophtalmologique et postural en 9 etapes precisement decrites. Resultats La totalite des patients recrutes pour l’etude presentait des signes cliniques permettant de confirmer l’existence d’un trouble de la proprioception entrant dans le cadre du syndrome de deficience posturale. Conclusion Cette etude ouvre une nouvelle voie de recherche concernant l’origine et le traitement de la dyslexie de developpement.

Introduction Le risque de transmission des prions concerne les actes que les ophtalmologistes sont amenes a faire lors des consultations. Le depistage des patients a risque passe par le recueil des antecedents de patients et des donnees cliniques. Patients et methodes Les auteurs presentent une version allegee d’un questionnaire dans lequel seuls les antecedents des consultants sont colliges, par le patient lui-meme, puis valides par l’ophtalmologiste. Resultats La pertinence de ce recueil a ete evaluee a partir de 500 questionnaires comportant 3 questions. Seuls 5 patients ont repondu positivement a une des 3 questions et n’ont donc pas ete examines avec des systemes contacts. Apres enquete, aucun patient ne s’est avere reellement a risque. Conclusion Le questionnaire propose semble donc satisfaire aux contraintes de temps et de personnels rencontrees en ophtalmologie, quel qu’en soit le mode d’exercice.

National audience; Purpose: The aim of our study was to describe the frequency of macular pigment distribution patterns in a french population‐based study over 75 years old. Methods: Three city study (3C) included 9294 subjects aged 65 years or more from three cities (Bordeaux, Dijon and Montpellier) in 1999. After a 10 year follow‐up, Dijon’s cohort had a complete ophthalmic examination in the MONTRACHET study. 1153 patients over 75 years were included. All patients had fundus photographs and macular pigment optical density measured by two‐wavelength autofluorescence. Pseudophakic patients without any retinal pathological conditions were included. In each patient, the eye with the best autofluorescence image quality was included. Results: One hundred fourty three eyes were selected (81 right eyes and 62 left eyes). Mean age was 82.0 ± 3.9 years, 71% (102) were women. Macular pigment optical density was 0.93 ± 0.22 density unit at the foveal center, 0.71 ± 0.20 density unit at 0.5° eccentricity, 0.59 ± 0.17 at 1°, 0.36 ± 0.12 at 2° and 0.09 ± 0.03 at 6°. Nineteen patients (13.3%) had ring‐like structure at mean 0.87 ± 0.19° eccentricity, 21 patients had intermediate distribution in density profile, 103 patients had strictly monotonic decline of macular pigment from the center to the periphery. There was no significant correlation between gender and macular pigment pattern (p = 0.36). Conclusion: This is the first study describing the frequency of the patterns of macular pigment distribution in an elderly pseudo‐phakic population. It would be useful to establish normative values in this age subgroup.

National audience; Purpose: To evaluate the efficacy of the Treat andExtend regimen using intravitreal ranibizumab for neovascular age-related macular degeneration (nAMD) Methods: A retrospective single-center study including naive nAMD patients confirmed with a fluorescein and indocyanine green angiography and a macular SD-OCT. After 3 monthly intravitreal ranibizumab injections, the interval between two injections was sequentially extended or shortened by 2 weeks depending on the presence or the absence of exudative disease with a maximum of 12 weeks. At each visit, an ETDRS VA and a macular SD-OCT were performed. The functional outcomes were the gain in VA and the proportion of patients gaining at least three lines. The anatomical outcome was central retinal thickness (CRT) on OCT. The secondary outcomes were the number of injections. Results: 111 patients were followed for one year, and 66 of them for two years. At baseline, the median VA was 59 [45-70] letters and the median CRT was 326 [271-402] µm. The median VA gain was 9 [2-17] letters after one year and 10 [2-23] letters after two years. Almost 30% gained more than three lines after 1 year and 42% after 2 years. The median decrease in CRT was 80 [29-161] µm and 100 [57-151] µm after 1 and 2 years, respectively. The median number of injections was 9 [8-10] after one year and 10 [2-23] after 2 years. Conclusion: A Tret and Extend regimen with ranibizumab provides good visual outcomes after 1 and 2 years of follow-up and seems to be an efficient strategy for the treatment of nAMD.

National audience; Purpose: To analyse prevalence and distribution of vitreomacular adhesion (VMA) in a french population over 75 years old within MONTRACHET study. Methods: Three city study (3C) included 9294 subjects aged 65 years or more from three cities (Bordeaux, Dijon and Montpellier) in 1999. After a 10 year follow up, Dijon’s cohort had a complete ophthalmic examination in the MONTRACHET study. Vitreomacular interface (VMI) was analysed with a spectral‐domain OCT. VMA of each patient was classified according to the IVTS (International Vitreomacular Traction Study) criteria, defining the presence of vitreomacular adhesion (VMA), vitreomacular traction (VMT) isolated or associated with a foveal distorsion. Results: One thousand one hundred fifty three subjects were included in the study, the median age was 84 [79‐99] years. Prevalence of vitreomacular adhesion (VMA) was 12.2%. VMA affected both eyes in 28.5% of cases (80 patients). The median size of the diameter of vitreous attachment to the macular surface was 1377 [50‐5639] µm. Attachment was focal (≤1500 ųm) for 52.3% of cases (147 eyes) and broad (>1500 ųm) for 47.7% of cases (134 eyes). Prevalence of isolated VMT was 0.9% (22 eyes) and was focal (

Purpose The purpose of this study was to investigate a change in macular thickness 9 months after single versus 4 sessions of panretinal photocoagulation (PRP) performed with Pattern Scanning Laser (PSL) in diabetic patients and to make a medico-economic assessment. Methods This prospective, multicenter, randomized trial enrolled patients in 2 arms: single session PRP (group A) and 4 session PRP (group B) between October 2011 and October 2013. Patients had non proliferative severe diabetic retinopathy or proliferative non complicated diabetic retinopathy. The primary endpoint was the difference in macular central retinal thickness (CRT) using spectral domain optical coherence tomography (SD-OCT) at 9 months. CRT with SD-OCT, ETDRS visual acuity (VA), pain with Visual Analogic Scale (VAS), were recorded at baseline, 7 days, 1, 3, 6, and 9 months. A medico-economic assessment was also performed. Results 26 eyes of 26 patients were included. On inclusion, the median CRT was 258 [240-294] µm in group A and 282 [261-292] µm in group B (p=0.06), the median VA was 84 [76-88] letters in group A and 83 [75-90] letters in group B (p=0.94). At M9, the median CRT was 281 [245-322] µm in group A and 301[278-313] µm in group B (p=0.34). At M9, the median VA was 84 [70-91] letters in group A and 85 [74-85] letters in group B (0.58). The median VAS value was 3.5 [2.0-5.0] in in group A and 3.5 [1.0-7.0] for all sessions in group B. The medico-economic assessment was in favor of the single session protocol. Conclusion Single session PSL-PRP seems to be a possible, well tolerated protocol for the treatment of diabetic retinopathy.

National audience; Animal models of glaucoma are still useful to better understand the pathogenesis of glaucoma, to decipher biochemical pathways and to evaluate drugs at a preclinical development. Many species have been used but due to practical and economical reasons, rodents have been the most studied. We will detail the methods used to mimic glaucoma with the most common techniques with an elevation of IOP or not. Then we will review the in vivo endpoints mostly used to assess IOP elevation and glaucoma damage. Rebound tonometry has been a great improvement in the IOP recording accuracy in rodents. Electrophysiology is a surrogate of retina and optic nerve function in these animals. The structure is mainly evaluated with optic disc photography, fluorescein angiography SLO and more recently with OCT. We will end this presentation with the pros and cones of different in vitro techniques mainly used to characterise glaucoma damage at the level of the retina and the optic nerve head.

National audience; Many studies have been published trying to find out some differences in the phenotype of normal-pressure glaucoma (NPG) and high-pressure glaucoma (HPG). The authors of these studies mainly focused on the “vascular signs”, the visual field and the optic nerve head (ONH) appearance of these 2 clinical presentations. However the debate is very controversial and several papers have reported that after all there is no difference in clinical presentation between NPG and HPG. In this review we will detail the pros and cons of each theory and we will provide the physician with useful practical tips leaving him/her with the following questions: Is the limit between NPG and HPG so tight? Can we find specific clinical characteristics of the ONH according to the clinical presentation? Should not we concentrate on the erroneous NPG diagnoses, i.e. the nonglaucomatous optic neuropathies?

National audience; Purpose: To determine anatomical and functional retinal modifications in patients with idiopathic epiretinal membrane (ERM) without objective symptoms. Methods: This prospective monocentric study included 28 eyes of 28 patients with ERM having a best corrected visual acuity greater than 20/25. All patients underwent a complete ophthalmic examination, including the measurement of the visual acuity on the ETDRS scale, a macular SD‐OCT and a microperimetry at 0, 6 and 12 months. We assessed macular abnormalities on SD‐OCT namely: retinal folds, retrofoveolar deposits, cystoid cavities and external retinal layers alterations. Results: At baseline the mean visual acuity was 85±4 letters, the mean macular sensitivity was 14.3±1.3 decibels, the mean macular thickness was 357±32 micrometers and the score of the SD‐OCT retinal abnormalities per patient was 2.5±0.8. At one year, the score of the SD‐OCT retinal abnormalities per patient was significantly higher: 3.3±1.3 (p=0.007). At one year, the mean visual acuity, the mean macular sensitivity and the mean macular thickness were stable at 84±5 letters (p=0.8), 14.4±1.7 decibels (p=0.8) and 356±43 micrometers (p=0.3), respectively. Conclusion: This study showed an increased number of retinal lesions observed on SD‐OCT with a stable visual acuity and a stable retinal sensitivity measured with the microperimetry after one year of follow‐up.

Purpose To assess what is driving the decision to perform a filtering procedure in a patient suffering from glaucoma. Methods Retrospective study in one single University centre with one glaucoma specialist. All the indications for filtering glaucoma surgeries (alone or combined with cataract extraction) undertaken during 2013 with the same surgeon were reviewed. The indications were as follows: clinical evaluation of the optic disc, visual field progression, progression on imaging (OCT and HRT), poor tolerance to medical treatment, non controlled intraocular pressure (IOP) and cataract. Results Retrospective study in one single University centre with one glaucoma specialist. All the indications for filtering glaucoma surgeries (alone or combined with cataract extraction) undertaken during 2013 with the same surgeon were reviewed. The indications were as follows: clinical evaluation of the optic disc, visual field progression, progression on imaging (OCT and HRT), poor tolerance to medical treatment, non controlled intraocular pressure (IOP) and cataract. Conclusion The indications for glaucoma surgery may be highly variable according to the country, the practice and the surgeon. A multicentre study should be useful to better define what is driving the indications for glaucoma surgery.

Purpose To evaluate the efficacy and safety of the Ultrasonic Circular Cyclo Coagulation (UC3) procedure in patients naive of previous filtering glaucoma surgery. Methods Prospective non comparative interventional clinical study performed in 5 French glaucoma centers. Thirty eyes of 30 patients (24 primary open-angle glaucoma and 6 secondary glaucoma), with intraocular pressure (IOP) > 21 mmHg, naive of previous filtering glaucoma surgeries, were insonified with a therapy probe comprising 6 piezoelectric transducers. The 6 transducers were activated with a 6 seconds exposure time. Complete ophthalmic examinations were performed before the procedure, and at 1 day, 1 week, 1, 2, 3, 6 and 12 months after. Primary outcomes were surgical success (defined as IOP reduction from baseline ≥ 20% and IOP > 5mmHg) at the last follow-up visit, and vision-threatening complications. Secondary outcomes were mean IOP at each follow-up visits compared to baseline, medication use, and complications. Results IOP was significantly reduced (p 20%) was achieved in 63% of eyes at 6 months after one HIFU procedure, with a mean IOP decrease of 39%. No major intra- or post-operative complications occurred. Conclusion Ultrasonic Circular Cyclo Coagulation seems to be an effective and well tolerated method to reduce intraocular pressure in glaucoma patients naive of previous glaucoma surgery. Commercial interest

National audience; Sufficient oxygen and nutrient supplies to the retina are dependent on a correct development of blood vessels. Polyunsaturated fatty acids (PUFAs) were shown to modulate factors involved in tissue vascularization. A congenital deficiency in ether‐linked phospholipids also termed as “plasmalogens” was shown to lead to abnormal ocular vascularization. Because plasmalogens are considered as reservoirs of PUFAs, we investigated whether they may influence retinal vascular development through the release of fatty acids by a specific phospholipase A2 (PLA2). Studies on mouse models of plasmalogen deficiency and of retinal PLA2 inhibition have shown that plasmalogens regulate retinal angiogenesis during early phases of retinal vascular development by influencing glial activity and primary astrocyte template formation. Subsequent modifications in the expression of genes involved in retinal angiogenesis impacted endothelial cell proliferation and retinal vessel outgrowth. These early defects in retinal vascular development led to a disorganized and dysfunctional retinal vascular network at adult age. These data suggest a crucial role of plasmalogens in retinal vascularization processes through a signalization involving PUFAs and PLA2.

International audience; PURPOSE: To study the clinical and microbiological characteristics as well as the prognostic factors for post-filtering surgery endophthalmitis. METHODS: Twenty-three eyes were included in the study in four tertiary centres between 2004 and 2010. The clinical and microbiological data were collected prospectively (minimum follow-up, 6 months). Microbiological diagnosis was based on conventional cultures and panbacterial PCR (16SrDNA amplification and sequencing). RESULTS: The onset of endophthalmitis was early (

The heat shock protein 70 (HSP-70) mRNA level was evaluated in Long Evans rat retinas after ischemia and after reperfusion following ischemia. Retinal ischemia was induced by ligation of the optic nerve and vessels. Rats were sacrificed after 90 min of ischemia or 120 min of reperfusion following ischemia. Retinas were dissected. Total mRNA was extracted and inducible HSP-70 (iHSP-70) gene expression was analyzed by quantification of transcripts using an RT-PCR assay. Results were expressed in arbitrary units as a ratio of the optical density of iHSP-70/β-actin electrophoretic bands. iHSP-70 gene expression was 0.220 ± 0.027 (n = 5), 0.502 ± 0.045 (n = 5) and 0.468 ± 0.032 (n = 5) for the sham-operated, ischemia only and ischemia and reperfusion groups, respectively. There was a statistically significant difference between the control and ischemia groups, and between the control and ischemia and reperfusion groups (p < 0.001), suggesting a rapid HSP-70 mRNA expression of the retina due to an ischemic injury.

Purpose: The aim of our study was to underline the changes in the movement perception for early glaucoma. Our working hypothesis consisted in inquiring if the impairment of the magnocellular pathway may modify the movement perception capabilities in the visual field, more particularly in its peripheral area.Methods: We included 14 healthy subjects and 14 patients with early primary open angle glaucoma. A moving target was presented on a semicircular screen (1.8 m diameter); participants were asked to localize the Ending Point (EP) of each movement. Each stimulus consisted in a white dot (0,72° of diameter) moving horizontally with the imposed velocity profile. Two different laws of motion were displayed: a “biological” motion corresponding to the recording of an arm pointing movement, consisting in a bell-shaped velocity profile, and a “non-biological” motion corresponding to a constant velocity profile. The study field was divided into 4 quadrants and 2 eccentricities: EP may be displayed in the “peri-central” (10° from the foveal axis) or peripheral (20° from the foveal axis) visual field. Two trajectories length were presented (10° and 20°). Each stimulus with same characteristics was displayed two times. Thus the experiment was constituted by 192 trials, presented in a random order. For every participant we calculated the PCE (Position Constant Error) which was defined as the average difference between the estimation of the EP indicated by the participant versus the true location of the same target. The PVE (Position Variable Error) was defined as the standard deviation of the responses of each participant.Results: All the participants overestimated the EP (13.23 ± 8.87 mm for healthy subjects and 17.06 ± 13.07 mm for glaucoma patients, p = 0.2518). The PVE was 28.14 ± 6.86 mm for healthy subjects and 40.95 ± 9.83 mm for glaucoma patients (p = 0.0004). There was a significant difference in the PVE for both groups when stimulus moved accordingly to the “non-biological” velocity profile (p = 0.0001). Glaucoma patients had substantial PVE increase when the target image had a “non-biological” speed profile (p = 0.0388).Conclusions: This study desrcibed disorders in movement perception and localization in patients with early glaucoma.Particularly, the unexpected lack of difference between normal subjects and patients in localizing a moving stimulus strongly suggested that the visual deficiency could be partly compensated by endogenous informations.

Purpose Blood lipids are frequently used as a surrogate of lipid composition of peripheral tissues. Even if it is well accepted such a relationship has never been clearly demonstrated for the eye. The aim of this study was to determine in human samples whether a lipidomic approach based on red blood cells could reveal associations between circulating and ocular lipid profiles. Methods Red blood cells, retinas and optic nerves were collected from 9 human donors. The lipidomic analyses on these tissues consisted in gas chromatography and liquid chromatography coupled to an electrospray ionization source-mass spectrometer (LC-ESI-MS). Results Gas chromatographic approach did not shpw any relevant association between circulating and ocular lipids except for arachidonic acid whose circulating amounts were positively associated with its retinal and optic nerve levels. However, significant associations emerged from LC-ESI-MS analyses. Indeed, phospholipid species in red blood cells were positively or negatively associated with representative pools of retinal DHA (docosahexaenoic acid), retinal VLC-PUFA (very-long chain polyunsaturated fatty acids) or optic nerve plasmalogens. Conclusion First, our results show that LC-ESI-MS methodology is more appropriate than gas chromatography for lipidomics on red blood cells, and further extrapolation to ocular lipids. Second, this study has identified several individual lipid species as good candidates to represent circulating biomarkers of ocular lipids.

Cataract extraction combined with glaucoma surgery remains controversial. Some authors advocate consecutive surgeries arguing that the expected lower inflammation will allow a better outcome of the filtering surgery. However it is well known that cataract extraction after a filter may impair the long term efficacy of glaucoma surgery. Conversely the combined approach is more convenient for the patient with one operation and generally a better visual result. However it is generally considered that the IOP-lowering effect is less effective in combined procedures. Rather than opposing these two approaches, it is probable than according to the characteristics of the patient and the type and the stage of glaucoma, a consecutive or a combined surgery is more appropriate. Therefore the surgeon must be prepared to perform the two types of surgery. Micro incisions for cataract surgery (MICS) offer some substantial advantages vs conventional corneal incisions; a better tightness of the surgical wound allows a better control of IOP during the surgery. Therefore glaucoma surgeries (penetrating or not) are much easier to perform without changing your technique. In this presentation some surgical tips will be given in order to facilitate your combined procedures.

New technologies have provided the ophthalmologists with fascinating techniques to evaluating structure and function in glaucoma. Within a couple of minutes we can now obtain very sophisticated mappings, curves, indices, relations etc. The yield of these techniques in the screening, the diagnosis and the follow-up of ocular hypertensive and glaucoma patients is invaluable. However as doctors we cannot forget the basis of a medical examination. Like the stethoscope for general practitioners and cardiologists, the slit-lamp is a key step of the examination for ocular diseases by ophthalmologists. This course is designed for young ophthalmologists and we will give a check list to help them in the slit-lamp examination from the lids to the optic nerve head. This rapid and systematic approach will help them to improve their daily clinical practice in glaucoma.

International audience; Purpose: To evaluate the reliability of expected peeled surface after internal limiting membrane (ILM) removal by junior and senior surgeons with or without Brilliant Blue G (BBG) dye.Methods: We conducted a prospective study based on videorecordings of epiretinal membrane surgeries. Surgeries were performed by a senior vitreoretinal surgeon (SS) and two junior surgeons (JS). Patients were included into two groups: SS(group 1) and JS(group 2). In each surgery, after the ILM peeling, the surgeon described the expected peeled area (A1). Then, the instillation of brilliant blue G stained the actual peeled area (A2). The third area (A3) corresponded to the additional surface peeled with the help of BBG. Areas were measured in square millimeters using the software ImageJ 1.43 µ.Results: 15 patients were included in each group. In the group 1, A1 was 15.1+/-5.1 mm2, A2 was 13.0+/-8.0 mm2 and A3 was 16.3+/-5.0 mm2. In the group 2, A1 was 6.5+/-4.4 mm2, A2 was 5.9+/-5.3 mm2 and A3 was 11.2+/-5.1 mm2. In both groups, there was no stastical difference between A1 and A2 (P = 0.1875 and P = 0.5186 respectivally in group 1 and 2). A2 in the group 1 was significantly larger than A2 in the group 2 (P = 0.0195)as well as A3 (P = 0.0166).Conclusion: In our study, both senior and junior surgeons were able to determine the surface of ILM peeled without BBG. However, the surface of ILM peeled with the dye was larger with BBG with both junior and senior surgeons.

Purpose The aim of our study was to evaluate and compare choroidal thickness (CT) of healthy subjects and primary open-angle glaucoma patients with spectral domain optical coherence tomography (SD-OCT) and to seek a correlation between CT and glaucoma severity. Methods Sixty-five healthy eyes, 27 eyes with early glaucoma , 21 eyes with moderate glaucoma and 30 eyes with advanced glaucoma were included in this cross-sectional study (one eye per patient). Retro-foveolar CT, foveolar retinal thickness and average retinal nerve fiber layer thickness (RNFL) were measured by SD-OCT. Humphrey 24-2 visual field was also performed and mean defect (MD)recorded. Spherical equivalent (SE) was measured with automatic refractometer. Results Average retro-foveolar CT was statistically lower in glaucoma patients than in healthy subjects p=0.0023. The CT was not different according to glaucoma stage (p=0.078). We found a statistically significant correlation between CT and MD (p = 0.040), but not with CT and age (p=0.053), CT and retinal foveolar thickness (p=0,789), CT and RNFL thickness (p=0.732) and CT and SE (p=0.202). Conclusion This preliminary study showed that retro-foveolar CT measured by SD-OCT was significantly thinner in glaucomatous patients than in healthy subjects.

Purpose Plasmalogens are phospholipids characterized by a vinyl ether bond and the preferential esterification of polyunsaturated fatty acids (PUFA). We have shown that the lack of plasmalogens leads to abnormal retinal vascularisation. Because we hypothesize that plasmalogens are negative regulators of vascular development, we aimed to check their circulating levels in patients having a retinal pathology with vascular proliferation. Methods Blood samples were collected from 4 control subjects and 42 patients having proliferative or non-proliferative diabetic retinopathy (DR). Patients were classified according to the stage of DR. The plasmalogen content and the fatty acid composition of erythrocyte phospholipids were determined using gas chromatography. Individual species of phospholipids, including plasmalogens, were quantified by liquid chromatography coupled with a triple quadrupole mass spectrometer (HPLC-ESI+MS/MS). Results Gas chromatographic analyzes did not reveal any change in plasmalogens. The analysis of individual species of phospholipids by HPLC-ESI+MS/MS showed reduced levels of plasmalogens in patients with DR. Five species of plasmalogens having PUFA were at reduced concentrations in erythrocytes of DR patients. In parallel, the amounts of conventional phospholipids having docosahexaenoic acid (DHA) were altered in DR patients when compared to control subjects. Conclusion Mechanisms responsible for the reduction in blood levels of plasmalogens and DHA in patients with DR are unknown. Since erythrocyte membrane lipid composition is admitted to reflect the lipid composition of nervous tissues, including the retina, one may suggest that DR patients have altered retinal concentrations of plasmalogens and DHA.

International audience; Purpose: To establish the prevalence of anticoagulant, aspirin, and clopidogrel use in patients undergoing vitreoretinal surgery, and to compare the outcome of peribulbar anesthesia between users and non‐users. Methods: We conducted a retrospective case series in one academic center between January and June 2009. We analyzed the chart of 239 eyes who underwent posterior segment surgery with peribulbar anesthesia. No changes in the anticoagulant regimen were made prior to surgery. We divided patients into 7 groups: group 1: patients with no anticoagulants and 6 groups defined according to the type of anticoagulant or antiplatelet medication. Results: 239 eyes (206 patients) were included: 168 eyes without any anticoagulant medication (70.3%) and 71 eyes with anticoagulant and/or antiplatelet agents (29.7%). Only 3 cases of long-term sight‐threatening hemorrhagic complications (4.2%) were noted: 2 from patients with pseudo‐tumoral form of age‐related macular degeneration associated with vitreous hemorrhage, and 1 from patient with tractionnal retinal detachment secondary to complicated diabetic retinopathy. No surgery was post-poned or cancelled due to an anesthetic complication.The incidence of postoperative hemorrhagic complications was increased in patients taking anticoagulant and/or antiplatelet medications (P=0.001) vs non-users. Conclusion: Peribulbar anesthesia for vitreoretinal surgery can be safely performed in patients receiving anticoagulant and/or antiplatelet agents.

International audience; Purpose: Stroke and myocardial infarction are common diseases occurring in patients suffering from Age Macular Degeneration (AMD). We assessed the rate of AMD and AMD risk factors in patients suffering from recent stroke or myocardial infarction. Methods: Patients suffering from a recent stroke or myocardial infarction (less than 1 month) benefited from a thorough ophthalmic examination with the following measurements and evaluations: visual acuity, intraocular pressure, fundus photography, Raman spectroscopy and macular OCT. In the same time a food questionnaire was dispensed. Finally, blood samples to measure fatty acids and lutein were performed. Results: 74 patients were examined, 31 females and 43 males. The age of the patients was 65 ±10 years, [47‐90]. The rates of stage 2 and 3 AMD were 25.7 % and 13.5 % respectively (n=19, n=10). Raman spectroscopy did not differ between groups, p=0.83. Central retina thickness was increased in the AMD group, 250±37 µ versus 222±35 µ, p=0.04. The fatty acid profile and lutein in blood did not differ between patients with or without AMD, p=0.7 and p=0.21, respectively. The overall omega 6/ omega 3 ratio was 4.64 ± 0.97 in our population. Conclusion: The rate of AMD risk factors does not seem to be increased in the patients suffering from AMD in this population of patients suffering from stroke and myocardial infarction. A longitudinal study is needed to confirm these results.

Oxysterols are assumed to play important roles in age-related macular degeneration, a major cause of blindness. So we characterized the cytotoxic, oxidative, inflammatory, and angiogenic activities of oxysterols (7β-hydroxycholesterol (7β-OH), 7-ketocholesterol (7KC), 25-hydroxycholesterol (25-OH)) in human retinal ARPE-19 cells, and evaluated the protective effects of resveratrol (Rsv: 1 μM), a polyphenol from red wine.ARPE-19 cells were treated with 7β-OH, 7KC, or 25-OH (5-40 μg/mL; 24-48 h) without or with Rsv. Cell viability was determined using trypan blue and the MTT assay. Cell death was characterized by electron microscopy and in situ detection of activated caspases with fluorochrome-labeled inhibitors of caspases. Reactive oxygen species (ROS) production was measured with hydroethidine. ELISA methods and a cytometric bead assay were used to quantify cytokines involved in inflammation (IL-8, IL-1β, IL-6, IL-10, IL-12p70, TNF-α, MCP-1) and VEGF.7β-OH and 7KC triggered a caspase-independent cell death process associated with the presence of multilamellar cytoplasmic structures evocating phospholipidosis, increased ROS production, and IL-8 secretion. 7β-OH enhanced VEGF secretion. No cytotoxic effects were identified with 25-OH, which highly stimulated ROS production, MCP-1, and VEGF secretion. With oxysterols, no IL-10, TNF-α, and IL-12p70 secretion were detected. 25-OH induced IL-8 secretion through the MEK/ERK½ signaling pathway, and Rsv showed cytoprotective activities and inhibited VEGF secretion.7β-OH, 7KC, and 25-OH have cytotoxic, oxidative, inflammatory, and/or angiogenic activities on ARPE-19 cells. As Rsv has some protective effects against oxysterol-induced cell death and VEGF secretion it could be valuable in ARMD treatment.

Purpose To assess the changes of the irio corneal angle configuration and anterior chamber depth with anterior segment optical coherence tomography (AS OCT) after phacoemulsification. Methods Prospective study including consecutive patients operated on age related cataract with phacoemulsification and intraocular lens implantation. An AS OCT was performed before and one month after cataract surgery on the horizontal meridian. The primary objective was to assess the changes of AC depth, iridocorneal angle, angle opening distance at 500 and 750 µm and trabeculum iris space area at 500 and 750 µm. The secondary objective was to evaluate intra ocular pressure (IOP) changes. Results Thirty five eyes of 35 patients were included. Mean age was 72 ± 9 years. Anterior chamber depth increased from 2.62 ± 0.39 µm to 3.66 ± 0.21 µm after cataract removal Nasal AOD 500 and 750 increased by 75 and 73%, nasal TISA 500 and 750 by 69 and 65%, and nasal angle by 52%, respectively, pConclusion Cataract extraction leads to important changes of anterior segment configuration evaluated with AS OCT. In our series, all measured parameters showed an opening of the IC angle with wide variation among patients.

Purpose To establish the correlation between central corneal thickness (CCT) and retinal nerve fiber layer (RNFL) thickness in ocular hypertensive patients and healthy subjects. Methods We prospectively collected charts of healthy subjects and ocular hypertensive (OHT) patients in one academic center between 2007 and 2008. OHT patients were defined by two measurements of intraocular pressure superior to 21mmHg without treatment, open angle in gonioscopy, normal appearing optic nerve head and normal visual field test Standard Automated Perimetry (SAP SITA) and Frequency Doubling Technique (FDT). Every patient underwent a standard clinical examination including optic nerve head examination, intraocular pressure, CCT measurement by ultrasonic (US) and anterior segment OCT pachymetry, visual field testing (SAP and FDT), RNFL thickness by scanning laser polarimetry (GDX-VCC) and optical coherence tomography (OCT). Results Eighty healthy subjects and 60 OHT patients were included. A correlation between US CCT and OCT CCT was found in both groups (r2=0.85 and r2= 0.87, p 0.15) in GDX-VCC and OCT RNFL thickness in both groups. In controls there was no correlation of any RNFL thickness measurement with the CCT. In OHT patients, the US CCT was weakly correlated with the average TSNIT evaluated by GDX-VCC (r2= 0.04, p

Purpose To present the main causes of corneal bacterial infections and suggest an appropriate management. Methods Bacterial keratitis is the most common cause of infected corneal ulceration. The epidemiology of corneal bacterial diseases and their risk factors will be studied. The initial presentation is important to determine the potential stain responsible for the infection and to assess the overall severity of the disease. Local and general criteria evaluations are needed to adapt the treatment. Results Specific signs to identify bacteria remain rare but some signs can help to determine the first line treatment. However laboratory methods remain the only way to diagnose a corneal bacterial disease with certainty. However the aspect of the infiltrate, the intraocular involvement and the condition of the patient may influence the outcome. The treatment is based on an initial broad-spectrum antibacterial therapy with secondary adaptation to the identified bacteria. Conclusion Multiple microorganisms are involved in corneal infections. Local and systemic risk factors have to be identified to treat these diseases in emergency still considered as a leading cause of visual loss.

Purpose Many new devices and technologies are available nowadays in the diagnosis and the treatment of glaucomas. However for young practitioners, it is mandatory to concentrate on symptoms and clinical signs. Methods In this presentation I will assess the place of the clinical examination in the overall management of glaucoma.In clinical practice many clues for glaucoma are found with simple instruments; a slit-lamp, a gonio-lens and a fundus lens. I will provide a frame, a sort of check list in order to build a diagnosis with the signs found during the clinical examination. Conclusion A moderate knowledge about ocular anatomy and physiology will lead the young resident through an easier diagnosis of glaucoma.Looking for the relevant symptoms and signs during the clinical examination will lead the young practitioner to a good accuracy in the diagnosis of glaucoma.

Purpose Retinal and vitreoretinal surgeries frequently lead to an elevation of intraocular pressure (IOP) and/or glaucoma. Clinical presentations correspond to secondary glaucomas with an open-angle or with angle-closure. Results Since myopia is a risk factor for retinal detachment and glaucoma as well, it is not surprising that these two disorders are often combined. Cortiscosteroids are widely used in retinal surgeries and the elevation of IOP related to the use of corticosteroids has long been recognized, whatever the route, topical, intravenous or intravitreal. Specific conditions such as Schwartz syndrome or Ghost-cell glaucoma are not very frequent. However scleral buckling procedures, injection of air, expansive gas and silicone oil may lead to severe elevations of IOP. Conclusion The management of these secondary glaucomas can be difficult because of the inflammatory status of the eye and the recurrence of the retinal diseases. Clinical examination and particularly gonioscopy is the key issue to lead the clinician to the appropriate treatment.

Purpose To study potential clinical and microbiological predictive factors of visual outcome in patients with acute endophthalmitis following cataract surgery. Methods A prospective study included 100 patients in 4 University hospital.Factors related to the cataract surgery, the initial clinical presentation and the microbiological identification were analyzed according to the final visual outcome using univariate and multivariate (logistic regression) analysis. Results 46% out of the patients had a final visual acuity less than or equal to 0.3 logMar (good visual outcome) at 6 months while 10% had only light perceptions. Patients with good visual outcome differed for the duration of cataract surgery, initial visual acuity, the visibility of fundus and the identification of a coagulase negative staphylococcus. In contrast, patients with a poor visual outcome were older, had more cornea oedema and a more important hypopion at the admission, more complications at the time of cataract surgery. Furthermore a bacterium was more frequently identified in this latter group. Multivariate analysis showed that age, complications at the time of cataract surgery, microbiological identification, pars plana vitrectomy were independent predictive factors. Conclusion Factors of visual outcome in acute postcataract endophthalmitis identified in this prospective study were similar to that reported during the Endophthalmitis Vitrectomy Study 10 years ago. As part of the treatment, pars plana vitrectomy is associated with predictive factors of poor visual outcome. Identification of these predictive factors at presentation should allow a better management of patients needed an aggressive treatment.

Purpose Trabeculectomy is the most popular surgery for glaucoma, however some complications may impair the success of the procedure. Moreover without impacting the overall efficacy of trabeculectomy, the quality of life of the patients could be affected in a certain number of cases. Methods In this session we will give some tips to prevent and to treat these complications. Results Cataract is frequent after trabeculectomy and is mainly related to postoperative hypotony. In most recent clinical studies cataract has been shown to occur in half of the eyes 3 years after trabeculectomy. This has led H Jampel to write a provocative editorial; Trabeculectomy: more effective at causing cataract surgery than lowering intraocular pressure (Ophthalmology 2009;116:173-174). In advanced cases, severe sight-threatening complications such as the wipe-out syndrome, even uncommon may definitely lead the patient to blindness. The two more frequent presentations of infection after trabeculectomy are blebitis and endophthalmitis. Both can occur several years after trabeculectomy and Streptococci which are frequently found are devastating strains. Antimetabolites greatly increase the prevalence of endophthalmitis after trabeculectomy. Other less severe complications such as bleb dysesthesia may alter the quality of life of the patients. Conclusion The information of the patients and the quality of the follow-up are of paramount importance when a trabeculectomy is considered.

Purpose To evaluate the efficacy of intravitreal injections of bevacizumab in exudative ARMD. Methods Retrospective study including naive patients suffering from exudative ARMD whatever the type of neovascularisation. All the participants were treated with three monthly 1.25 mg intravitreal injections of bevacizumab.The primary objective was far and near visual acuity (VA) 1, 3 and 6 months after the third injection. The secondary objective was the residual activity of neovascularisation assessed with fluorescein and ICG angiography and retinal thickness evaluated with OCT3. Results 71 eyes of 66 patients were included. Neovascularisation was occult, visible or combined in 65%, 20% and 15% of the cases, respectively. A statistically significant improvement between pre and post-injection VA (LogMAR) was observed one month after the third injection, 0.88±0.57 and 0.77±0.60, respectively, p=0.001). An active neovascularisation was still present at that time in 57.7% of the eyes and 34% at 6 months needing further bevacizumab injections (3.85±0.96 per eye). VA was similar at 1, 3 and 6 months (F71,2=1,54 ; p=0,46). A complication occurred in 3 eyes. Conclusion Three bevacizumab intravitreal injections led to a significant VA improvement. However, more than half of the eyes had an active neovascularisation after these 3 injections.

International audience; Purpose: Lipids represent 50% of retinal dry matter. Within structural phospholipids, ether-lipids are a major class but their exact species, concentrations and functions in the retina are still unknown. A defect in their biosynthesis is observed in peroximal disorders like Rhizomelic Chondrodysplasia Punctata type 2 and 3 (RCDP) characterized by retinal pigment epithelium (RPE) degeneration and defects in ocular vasculogenesis. The aim of this work was to perform a detailed study of the retinal composition in ether-lipids. Methods: Total lipids were purified from calf retina and RPE samples. The proportion of major lipid classes was determined by thin-layer chromatography (TLC). Phospholipids were separated from non-phosphorus lipids by liquid chromatography (LC), subclasses (linked with ethanolamine, choline, serine or inositol) were quantified by LC and then purified by TLC. The fatty acid composition of each subclass was evaluated by gas chromatography (GC). The expression of the key enzyme of ether-lipids biosynthesis (DHAP-AT) was evaluated by reverse-transcriptase polymerase chain reaction (RT-PCR) on calf retina and RPE samples and its cellular localization was performed on rat retina semi-thin sections by in situ hybridization. Results: Phospholipids represent 85% of retinal and RPE lipids. Within phospholipids 41% and 36% were linked with ethanolamine in the retina and the RPE, respectively. Ether-lipids accounted for 30% of ethanolamine-linked phospholipids in both the retina and the RPE. In the retina, 67% of ethanolamine ether-lipids contained stearic acid in position 1 of glycerol, and 15% contained palmitic acid. Stearic acid accounted for 38% and palmitic acid for 41% in the RPE. DHAP-AT was expressed in both, retinal and RPE cells and its expression within the retina was mainly localized in the photoreceptor inner segments and in bipolar cells to a lesser extent. Conclusions: Our results illustrate the quantitative importance of ether-lipids and particularly those linked to ethanolamine in retinal and RPE cells. According to these results and considering their putative structural and metabolic roles in other tissues, ether-lipids may play a crucial role in retinal physiology as illustrated by their lack in RCDP patients.

Purpose To compare the diagnostic yield of microbiological analysis performed on diluted and undiluted vitreous samples from pars plana vitrectomy in patients with acute postcataract surgery endophthalmitis. Methods Undiluted and diluted vitreous samples were harvested in 34 patients at the beginning of the vitrectomy, among the 57 vitrectomized patients (out of 100 patients presenting with an acute postcataract surgery endophthalmitis) included in the multicenter prospective study FRIENDS (2004-2005). Vitrectomy was performed after one (n=12) or two (n=22) antibiotics intravitreal injections. Each vitreous sample was divided into two parts for conventional culture (Brain Heart Infusion broth) and panbacterial PCR, respectively. Results Microbiological analysis of both undiluted and diluted vitreous allowed a bacterial identification in 28 out of 34 cases (82.3%). Microbiological diagnosis using undiluted vitreous and conventional culture was negative in 32 cases and positive in 2 cases. In one case, there was a discrepancy between undiluted (culture negative) and diluted vitreous (S. epidermidis). Analysis of both undiluted and diluted vitreous using PCR was positive in 28 cases and negative in 6/34 cases. There was a discrepancy between both samples in three cases. Conclusion Microbiological results combining PCR and cultures showed that diluted vitreous analysis may replace analysis of undiluted vitreous. The diluted sampling of vitreous, more easily performed and less iatrogenic, may be recommended when panbacterial PCR is used .

Purpose Individual compliance of glaucoma and ocular hypertensive patients with Brimonidine was studied with regards to total dose, dosage intervals, coverage, drug waste, attempts per application and risk factors for low compliance. Methods Thirty-eight men and 26women aged 70 ±11 years [42-89] received conventional Brimonidine vials (Alphagan®, Allergan™) equipped with a microprocessor-controlled monitoring device capable to record date and time of each eye drop application with a known detection sensitivity for eye drop applications ~ 99%. 48 glaucoma and 16 ocular hypertensive patients used to eye drop therapy for 11 ±8 years [1-35] were enrolled and randomly assigned to Brimonidine therapy b.i.d or t.i.d daily for 4 weeks. Results Electronic records revealed a mean of 1.4 applications per day (range: 0.7-2.2) for patients assigned to Brimonidine 2x daily with a mean treatment interval of 18.2 hours (range: 11.2-38.4 h). Patients on Brimonidine 3x daily showed a mean rate of 1.8 applications per day (range: 1.0-2.7) and a mean treatment interval of 12.4 h (range: 9.1-39.7 h). 10 patients ceased therapy before completing the 4 weeks period, therein 4 with side effects and 6 patients having emptied the bottle prematurely. Conclusion Almost 10 percent of the patients emptied their vial in less than 4 weeks by using more than one drop per application and thereby do need refills more often than usually calculated. Our data confirm the need for larger studies on individual compliance with topical ocular therapy in glaucoma. Electronic compliance monitoring may be a useful tool in ophthalmic practice to recognize low-compliant patients.

Purpose To present the main causes of corneal bacterial diseases and suggest an appropriate management. Bacterial keratitis is the most common cause of infected corneal ulceration. Methods The epidemiology of corneal bacterial diseases and their link with different risk factors will be studied. The initial presentation is important to determine the potential stain responsible for the infection and to assess the overall severity of the disease. Local and general criteria evaluations lead to a proper management. Bacterial identification plays a key-role in the etiological diagnosis. Results Contact lens wear, trauma, preexisting ocular disease and corneal surgery are the main risk factors for corneal bacterial disease. Specific signs to identify bacteria remain rare but the circumstances (contact lens wear, aspect of the infiltrate) can help to determine the first line treatment. However laboratory methods remain the only way to diagnose a corneal bacterial disease with certainty. The aspect of the infiltrate, the intraocular involvement and an immunosuppressed patient may influence the outcome. The treatment is based on an initial broad-spectrum antibacterial therapy with secondary adaptation to the identified bacteria. Conclusion Multiple microorganisms are involved in corneal diseases. The local and systemic risk factors have to be identified to treat these diseases in emergency still considered as a leading cause of visual loss.

International audience; Purpose:Epidemiological studies suggest that dietary omega-3 polyunsaturated fatty acids (PUFAs) may protect against prevalence of dry eye. This work aimed to evaluate whether a dietary deficiency in omega-3 PUFAs may increase the severity of dry eye in a scopolamine-induced rat model. Methods:Three consecutive generations of Lewis rats were bred under diets deprived of omega-3 PUFAs. Dry eye was experimentally induced by continuous scopolamine delivery in female animals from the third deficient generation and in female Lewis rats fed for three generations with a balanced diet. After 14 days of treatment, the clinical signs of ocular dryness were evaluated in vivo using fluorescein staining. MHCII and the mucin Muc5AC were immunostained on ocular sphere cryosections. Lipids were extracted from the exorbital lacrimal glands and phospholipid fatty acids were analyzed by gas chromatography. Results:The ratio of fluorescein stained area to total area of the cornea was significantly increased in scopolamine-treated animals when compared to not implanted animals (from 2.4 ± 1.0% to 23.5 ± 13.6% for the balanced diet and from 7.8 ± 6.1% to 20.1 ± 6.2% for the deficient diet). Scopolamine treatment decreased Muc5AC immunostaining in the conjunctival epithelium (-34% for the balanced diet and -23% for the deficient diet) and tended to increase MHCII immunostaining in the conjunctival epithelium for both diets. In exorbital lacrimal gland phospholipids, arachidonic acid (AA) and the delta5-desaturase index (ratio of AA to dihomo gamma-linolenic acid) were significantly increased by scopolamine treatment for both diets. There was no significant diet-difference in scores of fluorescein staining, Muc5AC and MHCII immunostaining. The omega-3 PUFA deficiency induced a significant increase in AA in the exorbital lacrimal gland (+38% for the control animals and +15% for the scopolamine-treated animals).

International audience; Purpose: : Neuronal tissues such as the brain and the retina contain elevated amounts of long-chain omega-3 polyunsaturated fatty acids (PUFAs) and particularly docosahexaenoic acid (DHA). DHA concentrations are known to decrease in the aging brain and are associated with cognitive decline. The senescence-accelerated mouse prone 8 (SAM P8) is a mouse model for aging that exhibits deficits in cognitive performances as well as alterations of retinal functionality (ARVO 2004 E-abstract 797). The aim of this study was to evaluate the effects of a dietary supplementation with DHA on mood, cognition and visual functionality of SAM P8 during aging. Methods: : SAM P8 mice were studied in comparison with SAM resistant 1 control animals (SAM R1). Animals were fed from weaning until 12 months of age with either a control diet balanced in omega-3 and omega-6 PUFAs but without DHA, a diet deficient in omega-3 PUFAs or a diet containing 6% of lipids as DHA. After 5 and 12 months of diet, the scotopic ERG was recorded and working memory and despair behavior were evaluated. The fatty acid composition of the retina and the brain was determined using capillary column gas chromatography. Results: : Dietary supplementation with long-chain omega-3 PUFAs led to significantly higher retinal and cerebral levels of DHA. The incorporation rate was significantly higher in SAM P8 when compared to SAM R1. An age-related diminution of the ERG b-wave amplitude was observed from 5 to 12 months of age in control and deficient SAM P8 when compared to SAM R1. These differences were emphasized in deficient animals. No age-related alteration of the ERG b-wave amplitude was observed in SAM P8 Meanwhile dietary supplementation with DHA reduced the duration of immobility in the forced swimming test in SAM R1 but not in SAM P8. Conclusions: : Dietary supplementation with DHA was efficient in increasing its retinal and cerebral incorporation. DHA successfully prevented the age-related loss of visual function in SAM P8 but did not improve the depression-like symptoms.

Purpose: To isolate bacteria after intravitreal antibiotic injection in acute endophthalmitis after cataract surgery, using cultures and eubacterial PCR. Methods: We prospectively enrolled in a multicenter study 100 eyes of 100 patients (2004-2005) presenting an acute endophthalmitis following cataract surgery. Aqueous humor samples were collected before and after one intravitreal antibiotic injection (vancomycin and ceftazidim) for 53 patients while 19 patients underwent a vitreous tap before and after intravitreal antibiotic injections. Microbiological identification was performed using BHI (Brain Heart Infusion) medium and eubacterial PCR. Results: In aqueous humor, microbiological cultures associated with eubacterial PCR identified a bacterium in 26.4% of cases after intravitreal antibiotherapy. Positive cultures before treatment became negative after antibiotic treatment in 33% whereas initial positive PCR before became negative after antibiotic treatment in 35%. However PCR allowed the recognition of previously unidentified bacteria after antibiotic injections in 8% of patients. In vitreous samples, a bacterium was identified in 70% of cases before and in 81.2% after intravitreal injection. After antibiotic injection, initially positive cultures and PCR became negative in 90% and 7% of cases, respectively. Conclusions: A single intravitreal antibiotic injection is not sufficient to eradicate the pathogens responsible for acute post operative endophthalmitis. Eubacterial PCR is useful for the microbiological identification in vitreous samples after intravitreal injections of antibiotics.

Purpose: To characterize a rat model on which glaucoma was induced by laser photocoagulation of episcleral veins, trabeculum and limbal veins. The characterization of the model was based on the evaluation of the intraocular pressure (IOP), the retinal function and the number of functional retinal ganglion cells (RGCs). Methods: Male Sprague Dawley rats were used at 6 weeks of age. Three of the episcleral veins, the trabeculum and the limbal veins were photocoagulated with a laser (532nm) in one eye. IOP (using a Tonolab®) and electroretinogram (ERG) were recorded every 2 weeks during 11 weeks. Three months after photocoagulation, RGCs were retrogradely labelled with a 5% Fluorogold solution applied to both superior colliculi. Seven days after labelling, retinas were flatmounted and were examined under a confocal fluorescence microscope equipped with a motorized stage. Functional RGCs were counted using an image analysis software (Image Pro Plus®). Results: Treated eyes displayed a significant increase in IOP as soon as the first week after the procedure (32 mmHg versus 18 mm Hg in control eyes) and lasting for 7 weeks. The retinal function of treated eyes was altered since the ERG b-wave amplitude was significantly decreased when compared to control eyes (50% after 11 weeks). No differences were observed in the b-wave latencies. A reduction of 50% of the number of RGCs was observed in treated eyes when compared to control eyes Conclusions: These results show that in the rat, eyes treated by laser photocoagulation are a valuable model of glaucoma since they display typical characteristics, namely elevated IOP, followed by an alteration of the inner retinal function and retinal ganglion cell death.

Purpose: The purpose of this study was to evaluate the effects of intravitreal injection of ICG (indocyanine green), TB (trypan blue) and TA (triamcinolone acetonide) on the visual function assessed by electroretinogram (ERG) in the rat. Methods: Three groups of 12-week-old Sprague Dawley rats (n=6) received intravitreal injection in one eye of 0.1mL of either ICG 0.5mg/mL, TB 3mg/mL or TA 40mg/mL followed by a rinse with 1mL of saline solution. The controlateral eye was used as a control and was injected similarly with saline only. The scotopic ERG was recorded at different intensities (10mcds/m², 2500mcds/m² and 25000mcds/m²) before injection and 28 days after treatment. Results: No effect of the treatment was observed on the ERG amplitudes and wave latencies in control eyes and in eyes treated with TB and TA. The ERG b-wave amplitudes and latencies were significantly reduced in eyes treated with ICG at 10mcds/m² and 2500mcds/m² but not at 25000mcds/m² (amplitude means: t0=174.8μV versus t28=55.0μV at 10mcds/m² p

Purpose: To present 2 cases of PCR identification of Rhizobium radiobacter in post-operative endophthalmitis. Methods: Microbiological identification was carried out using samples from aqueous humor and/or vitreous. Conventional cultures were performed using a Brain Heart Infusion broth. We used broad-range eubacterial PCR amplification followed by direct sequencing. Results: In both cases, Rhizobium radiobacter was identified using eubacterial PCR and cultures of vitreous from vitreous tap. An 81-year-old female presented an endophthalmitis 4 weeks after an cataract surgery. Inflammation and infection were controlled after 2 intravitreal antibiotic injections and the final visual acuity was of 20/24 at the one-year follow-up exam. A 75-year-old male who underwent a cataract surgery presented an endophthalmitis 9 days after. This patient was treated by 3 intravitreal antibiotic injections and a vitrectomy. The 6-month follow-up exam showed an optic nerve atrophy with a poor visual outcome (20/120). Both patients had an initial marked anterior chamber inflammation with a hypopyon and a severe retinal vasculitis was observed in the second case. Conclusions: Rhizobium radiobacter is a rare pathogen involved in postoperative endophthalmitis. As it is an environmental soil organism, we may assume that the patient's exposure to outdoor environnement and moist soil remains the source of this organism. This gram negative rod is resistant to vancomycin and have an intermediate resistance to most antibiotics used to treat post-operative endophthalmitis. PCR allows a swifter bacterial identification than do cultures and may help choose the most efficient antibiotics.

Purpose: The aim of this study was to evaluate the yield of diabetic retinopathy (DR) screening in a rural population with an itinerant non-mydriatic camera. Methods: 1974 diabetics were screened between 2005 and 2006: 676 the first year and 1298 the second. The 72 lowest medicalised areas of Burgundy were visited. An orthoptist performed fundus photographies with a Topcon’s TRC-NW200 non-mydriatic camera (4 fields: posterior pole, nasal, temporal and upper). The photographies analysis was performed in the department of Ophthalmology, according to the International Clinical Diabetic Disease Severity Scale. The private ophthalmologists agreed to receive the positive or doubtful patients within one month. Results: On the 1974 screened patients, 103 presented a DR (5.2%), including 70 mild non-proliferative DR (68%), 21 moderate non-proliferative DR (20.4 %), and 12 severe non-proliferative DR (11.6%). The rate of non interpretable photographies was 27.6%. The average age of the patients with a DR was 67.5 (27 to 94). The average onset of the diabetes was 16.5 years. Insulinic treatment was founded in 48 patients (46.6%) and 35 were aware of there HbA(1c) (34%) with an average of 7.8%. Lastly, 19 have had an ophthalmologic visit within one year before screening (18.4%), 38 between 1 and 2 years (36.9%), 28 more than 2 years (27.2%) and 10 more than 5 years (9.7%); 7 had never seen an ophthalmologist (6.8%). Conclusions: This screening improves the quality of the ocular follow-up of the diabetics in rural area. The increase of the number of patients per meeting as well as a better recruitment would improve the medical and economic performances of the future campaigns.

Elevated intraocular pressure (IOP) is a major risk factor for development of primary open-angle glaucoma (POAG) (1). Ocular instillation of a hypotensive agent has been shown to effectively delay or prevent the onset of POAG in patients with ocular hypertension (2), and reductions in IOP have been associated with delayed progression of both optic nerve damage and visual field defects in patients with glaucoma (3-6). Given these findings, current treatment of POAG consists of reducing IOP either through medical therapies or surgery (1). European Journal of Ophthalmology / Vol. 17 no. 4, 2007 / pp. 521-527