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Summary Purpose To assess the ability of patients with exudative AMD to detect exudative recurrence. Another objective was to assess if self-monitoring, as currently taught, improves this ability. Materials and methods An observational cross-sectional study was carried out in the ophthalmology center of BeauSoleil clinic in Montpellier between March 1 and April 1 2016. Inclusion criteria were presence of neovascular age related macular degeneration treated with the loading dose of three monthly intravitreal anti-VEGF injections, with at least one injection in the past 12 months and at least one exudative recurrence. All patients underwent a visual acuity measurement with ETDRS charts at 4 meters. A questionnaire assessed familiarity with the Amsler grid and its proper use, performance of and type of self-monitoring at home and the subjective feeling of an exudative recurrence at the visit with a 5-level Likert scale. Results A total of 94 eyes of 70 patients were included in this study with 69.0 % women and a median (interquartile range) age of 83 (77–96) years. Among them, 81 % performed regular self-monitoring, mostly with environmental Amsler tests (70 %). Only 63 % of the patients knew of the Amsler grid, among which 52 % used it correctly. Sensitivity (95 % confidence interval, 95 % CI) and specificity (95 % CI) of the subjective sensation of exudative recurrence were 0.32 (0.14-0.55) and 0.85 (0.74-0.92), respectively, for the entire population. Sensitivity (95 % CI) and specificity (95 % CI) were 0.33 (0.13-0.59) and 0.85 (0.74-0.93); 0.25 (0.0063-0.81) and 0.82 (0.48-0.98), respectively, in patients performing and not performing self-monitoring. Conclusion Patients’ prediction in wet AMD is insufficient in detecting exudative recurrences, even if regular self-monitoring with Amsler grid or environmental Amsler is performed.

Resume Introduction L’opacification capsulaire complique la chirurgie de la cataracte par extraction extracapsulaire. Le traitement de cette complication est la capsulotomie posterieure au laser YAG. L’œdeme maculaire cystoide est une complication rare, mais preoccupante de ce traitement. L’objectif de cette etude est de mesurer et comparer l’epaisseur foveolaire avant et apres capsulotomie dans le but de clarifier sa physiopathologie. Methode Etude prospective monocentrique chez des patients traites par capsulotomie au laser YAG entre mai 2008 et novembre 2009. Le protocole therapeutique apres laser etait le meme dans tous les cas (acetazolamide, apraclonidine et rimexolone). Pour chaque patient, l’acuite visuelle, le tonus oculaire et la mesure par OCT (OCT 3 de Zeiss) de l’epaisseur foveolaire etaient notes avant YAG (j0), a j7, a j30 et a j90 apres YAG, ainsi que le nombre d’impacts realises pour la capsulotomie et la puissance delivree. Un test de Student a ete utilise pour l’etude statistique. Un « p » inferieur a 0,05 etait considere comme significatif. Resultats Trente yeux de 26 patients sont inclus dans l’etude. Les patients sont âges en moyenne de 73,3 ± 10,4 ans. L’epaisseur maculaire centrale moyenne est de 209 ± 26 μm avant capsulotomie, de 213 ± 23 μm a j7, 204 ± 19 μm a j30, 213 ± 23 μm a j90, apres capsulotomie. Les differences observees ne sont pas statistiquement significatives ( p > 0,05). Nous ne retrouvons aucune complication sur ce petit echantillon. Conclusion Dans notre etude, nous n’avons pas mis en evidence d’epaississement maculaire significatif apres capsulotomie posterieure au laser Nd:YAG.

Resume But de l’etude Etudier les resultats de la chirurgie de la cataracte par phacoemulsification chez les patients presentant un syndrome pseudoexfoliatif (complications per- et postoperatoires) ainsi que les caracteristiques cliniques de ces patients. Patients et methodes Nous avons mene une etude retrospective, monocentrique et comparative de deux groupes de patients. Les patients inclus dans l’etude ont eu une chirurgie de cataracte par phacoemulsification a l’hopital Avicenne entre janvier 2006 et decembre 2008, par un chirurgien senior. Deux groupes ont ete constitues : un premier groupe regroupant les patients avec un syndrome pseudoexfoliatif (groupe PEC) et un second groupe de patients ne presentant pas de pseudoexfoliation (groupe temoin), ni autre pathologie favorisant les complications operatoires (pas de glaucome par fermeture de l’angle, ni de traumatisme). Les deux groupes etaient comparables en termes demographique (âge et sexe), et d’intensite de la cataracte (acuite visuelle preoperatoire comparable). Les caracteristiques cliniques de chaque patient (acuite visuelle pre- et postoperatoire, PEC uni- ou bilaterale, hypertension oculaire, glaucome, diametre pupillaire dilate), ainsi que les complications per- et postoperatoires de la chirurgie de cataracte ont ete relevees. Resultats Cent quatre yeux de 81 patients ont ete inclus dans l’etude : 52 yeux dans le groupe PEC et 52 yeux dans le groupe temoin. Une phacoemulsification a ete realisee dans 100 % des cas avec un cas d’implant de chambre anterieure pour le groupe PEC. L’acuite visuelle postoperatoire moyenne etait de LogMAR 0,06 ± 0,2 dans le groupe PEC et de LogMAR 0,03 ± 0,06 dans le groupe temoin. Il n’y avait pas de difference significative de rupture capsulaire entre les deux groupes (p = 0,32). La survenue d’un œdeme corneen en postoperatoire etait plus frequente dans le groupe PEC (p Discussion Le syndrome pseudoexfoliatif est associe a une mauvaise dilatation pupillaire et une fragilite zonulaire. Plusieurs techniques alternatives peuvent aider a la gestion peroperatoire d’un syndrome pseudoexfoliatif pour en limiter les complications (dilatation medicamenteuse intensifiee, ou mecanique par crochets a iris, geste doux et non traumatique lors de la phacoemulsification, anneau de tension zonulaire). Apres phacoemulsification, le syndrome pseudoexfoliatif est associe a une plus grande incidence d’œdeme coreen postoperatoire et une recuperation fonctionnelle plus lente. Les caracteristiques des patients presentant un syndrome pseudoexfoliatif sont une atteinte bilaterale, une mauvaise dilatation, une hypertonie oculaire, voire un glaucome plus frequent et plus severe que le reste de la population. Cette population serait egalement a risque cardiovasculaire eleve. Conclusion Un syndrome pseudoexfoliatif diagnostique en preoperatoire et bien gere en peroperatoire ne presente pas un taux de complications accru lors de la chirurgie de la cataracte par phacoemulsification.

Resume Introduction En 2009, en France, les patients operes de chirurgie de la cataracte sont revus par leur chirurgien le lendemain. L’interet d’une visite a J1 apres chirurgie de la cataracte est clairement remis en question depuis quelques annees mais cette visite reste largement pratiquee. Le but de cette etude est d’evaluer si cette visite modifie la prise en charge therapeutique. Patients et methodes Cent trois patients (106 yeux) consecutifs operes de chirurgie de la cataracte par phacoemulsification ont ete inclus de maniere prospective dans notre service (82 % etaient pris en charge en ambulatoire). Les complications per-operatoires ont ete notees. Ont ete analyses a J1 : tonus oculaire, examen du segment anterieur et du pole posterieur. Tout changement de prescription par rapport a une ordonnance « standard » a ete note. Resultats Des complications per-operatoires sont survenues dans 8 cas. A l’examen du J1, six patients ont eu une hypertonie oculaire superieure a 24 mmHg, 14 un œdeme corneen, 6 une erosion corneenne, 2 un seidel, 1 une subluxation anterieure d’une haptique, 1 seul un decollement de retine. Dans 26 cas (24,5 %), il y a eu un changement de prescription par rapport a l’ordonnance standard. Discussion Un grand nombre d’etudes ont montre que la visite du J1 apres phacoemulsification n’etait pas obligatoire. Le principal objectif de cette visite est de detecter une hypertonie oculaire. Plus rarement, elle permet de detecter un seidel, une malposition de l’implant, un decollement de retine, complications pouvant necessiter une reprise chirurgicale. Conclusion La visite a J1 apres phacoemulsification reste necessaire, car des complications parfois imprevisibles peuvent survenir et potentiellement compromettre le resultat de la chirurgie. Elle a egalement un interet d’education therapeutique des patients (reexplication des symptomes devant faire consulter en urgence).

La disminucion de la agudeza visual constituye un signo de alerta principal en oftalmologia. El contexto clinico de este sintoma permite a menudo su orientacion etiologica; la uni o bilateralidad, la rapidez de su instauracion, su asociacion a dolor o a enrojecimiento ocular constituyen caracteristicas esenciales. Las disminuciones de la agudeza visual acompanadas de enrojecimiento y dolor oculares hacen pensar en una enfermedad del compartimiento anterior (queratitis, uveitis o glaucoma agudo); la disminucion unilateral de la agudeza visual de instauracion brusca hace pensar en una enfermedad vascular (oclusion venosa o arterial retiniana, neuropatia isquemica); la disminucion bilateral progresiva en el paciente de edad avanzada hace pensar en cataratas. Las neuropatias opticas inflamatorias y las coriorretinitis serosas centrales se presentan en pacientes jovenes y son unilaterales. En los pacientes de edad avanzada una disminucion de la agudeza visual acompanada de deformacion de las imagenes (metamorfopsia) debe llevar a buscar una posible degeneracion macular.

Granulomatosis lesions occurring after diagnosis of primary or secondary immunodeficiency are not accidental and have been described in a small number of patients suffering from various diseases: common variable immunodeficiency (CVID), malignancy (lymphoma and solid tumors), and acquired immunodeficiency syndrome (AIDS). Two types of granulomatosis can appear: true sarcoidosis and sarcoid-like reaction. We report four patients, two with CVID and two with malignancy, in whom clinical granulomatosis appeared a few months to a few years after diagnosis of immunodeficiency. They developed noncaseating granulomas of the lung, spleen and liver associated with conjunctival granulomas and bilateral panuveitis. The granulomatous disorder was diagnosed after immunodeficiency on histopathological studies revealing noncaseating granulomas. Causation agents such as infectious organisms and environmental compounds were excluded. The relationship between sarcoid-like reaction, true sarcoidosis and immunodeficiency is discussed. The underlying pathophysiology responsible for the association between granuloma formation and immunodeficiency in the same patient remains obscure. It may be quite difficult to distinguish true sarcoidosis and sarcoid-like reaction. It is possible that these two entities are the clinical extremes of a common pathological process.

Cataract surgery and age-related maculopathy: benefits in terms of visualacuity and quality of life – a prospective study C. Rohart, F. Fajnkuchen, S. Nghiem-Buffet, O. Abitbol, I. Badelon, G. Chaine Purpose: To assess the benefits of cataract surgery in patients with age-related macular degeneration (AMD) in terms of visual acuity and quality of life. Patients and methods: Forty-two eyes of 30 patients were included in this prospective study between October 2003 and January 2005. The eyes were divided into two groups: the first group ( n =12) with geographic atrophy and neovascularization (late-stage AMD) and the second group ( n =30) with drusen and retinal pigment epithelium abnormalities (early-stage AMD). Assessment included best corrected visual acuity (BCVA) and quality-of-life measures (VF-14 questionnaire) before surgery and BCVA and the VF-14 score after surgery. Results: In the first group, there was no statistical difference but a trend toward improvement in BCVA ( p >0.05). In terms of quality of life, there was a statistical difference between pre- and postoperative VF-14 ( p =0.0078). In the second group, there was a statistical difference between pre- and postoperative BVCA ( p p Conclusion: This study shows a benefit in terms of visual acuity and quality of life in the majority of patients with age-related maculopathy after cataract surgery, even in late-stage AMD. Indeed, we noted a marked improvement in visual acuity in cases of early-stage AMD and a slight improvement of visual acuity in late-stage AMD. Quality of life was improved at both stages. In conclusion, cataract surgery is justified in patients with AMD.

Pseudoexfoliation syndrome in cataract surgery. Retrospective study of 37 cases M. Streho, C. Rohart, B. Guigui, F. Fajnkuchen, G. Chaine Purpose: To analyze the clinical features of pseudoexfoliation syndrome and to determine complications in cataract surgery in eyes with pseudoexfoliation syndrome compared with eyes without this syndrome. Methods: A retrospective, single-center comparative study was conducted on patients who underwent cataract surgery between 2004 and 2006. Demographic parameters (age, sex, ethnicity, medical and ophthalmologic history), clinical features (visual acuity, pupil dilatation, intraocular pressure) before and after surgery, and surgical complications were analyzed and compared to a control group without pseudoexfoliation. Results: Seventy-four eyes of 71 patients were included in the study. The sex ratio of the pseudoexfoliation group was 1.26 with 19 males (56%) and 15 females (44%). Pseudoexfoliation was unilateral in 21 cases (61%). Open-angle glaucoma was associated in 11 cases (32%) in the pseudoexfoliation group versus two cases in the control group (5.4%). Poor pupil dilatation was observed in eight cases (24%) in the pseudoexfoliation group and in one case (2.7%) in the control group. Phacoemulsification with IOL was the surgical technique in all the cases with only one case (2.7%) of anterior chamber IOL in the pseudoexfoliation group. There was no significant difference in the surgical complications between the pseudoexfoliation and control group (5.4%). The mean preoperative intraocular pressure was 16±5 mmHg in the pseudoexfoliation group and 14±3 mmHg in the control group. The mean postoperative intraocular pressure at 1 month was 14±4 mmHg in the pseudoexfoliation group and 14±3 in the control group. The mean preoperative visual acuity was 1.0±0.7 LogMar in the pseudoexfoliation group and 0.7±0.5 LogMar in the control group. The mean postoperative visual acuity was 0.4±0.6 LogMar in the pseudoexfoliation group and 0.2±0.1 LogMar in the control group. The mean follow-up was 70 days in the pseudoexfoliation group and 30 days in the control group. Conclusion: Pseudoexfoliation syndrome is the most common in its unilateral presentation. It is frequently associated with chronic secondary open-angle glaucoma. Poor pupil dilatation is one of the most common problems faced by cataract surgeons. Nevertheless, pseudoexfoliation syndrome did not confer a statistically higher risk for surgical complication in eyes without marked phacodonesis or lens subluxation.

Characteristics of patients undergoing cataract surgery in a poor northern suburb of Paris R. Gineys, C. Rohart, G. Chaine Objective: To determine the characteristics of patients undergoing cataract surgery in a poor northern suburb of Paris in terms of socioeconomic factors as well as systemic and ocular characteristics. Materials and methods: This retrospective study investigated 250 consecutive patients who underwent cataract surgery in the Bobigny University Hospital between May and November 2005. Information on age, sex, place of birth, residence, medical insurance, and fluency in French were gathered from medical charts; clinical records were used to collect information on associated general disease, number of medications, ASA (American Society of Anesthesiology) score, lack of autonomy, associated ocular disorders, best corrected visual acuity before surgery, and surgical and anesthetic procedures. Results: The mean age was 72 years, the sex ratio was 1, 54.8% of the patients were born out of France, more than 90% lived in Seine-Saint-Denis department, 57.2% were referred by local ophthalmologists, and 24% did not speak French. More than 60% of the patients benefited from free medical care related to a critical general chronic disease, 25% had an ASA score of at least 3, and 65% took a minimum of three medications per day. Legal blindness was present in 20% of the cases and 45% had associated ocular disorders. One-third of the patients were out-patients. Discussion and conclusion: General chronic disease was present in more than half of the patients studied and associated ocular disorders were present in approximately half of the patients. The best corrected visual acuity before surgery was 1/10.

Purpose To compare visual acuity and complications in phacoemulsification in eyes with white cataract and in eyes with immature senile cataract. Patients and methods This was a prospective study on 36 eyes in 34 patients with white cataract (group 1) and 36 eyes in 36 patients with immature senile cataract (group 2). Results In group 1, mean preoperative visual acuity was 1/100 and mean postoperative visual acuity was 5/10 at 1 month. Posterior capsule tears occurred in four eyes (11%). In group 2, mean preoperative visual acuity was 2/10 and mean postoperative visual acuity was 7/10 at 1 month. No posterior capsule tear was observed. The preoperative visual acuity was significantly lower in group 1 (p=1.8x10(-14)). Postoperative visual acuities were not significantly different between the two groups (p=0.07). The increase in visual acuity was significantly higher in group 1 (p=2.2x10(-11)). Discussion Our study shows that white cataract is not a risk factor of poor postoperative visual acuity and the increase in visual acuity is greater in the white cataract group than in the immature cataract group. Conclusion The results of phacoemulsification in white cataracts are satisfactory in spite of a high rate of posterior capsule rupture in our study.

Age macular degeneration (AMD) is a degenerative disease, the early stages are characterized by the development of drusen and/or areas of hyperpigmentation and hypopigmentation. In the later stages atrophy or growth of new vessels can occur. The early stages of the disease are, in general, asymptomatic. Later there may be considerable distortion of vision and complete loss of visual function in the cental area of vision. Several prevalence studies have been conducted, prevalence is around 7% in the age group 75+. The genetic predisposition is one of the risk factors for AMD. Amost avoidable or modifiable risk factors, smoking, lack of nutrients and antioxidants, cardiovascular disease and possibly cataract extraction, are important.

But Le but de cette etude est d’evaluer les modifications a long terme du diametre pupillaire apres insertion d’un implant phaque Artisan® pour la correction d’une forte ametropie myopique. Patients et methodes Nous avons inclus 14 yeux de 7 patients dans cette etude. Nous avons determine le diametre pupillaire en ambiance photopique, en ambiance scotopique apres 10 minutes d’adaptation dans l’obscurite, puis apres dilatation pharmacologique. Les mesures du diametre pupillaire dans ces trois conditions ont ete realisees en utilisant l’image du segment anterieur capturee par le topographe-aberrometre OPD-scan® (Nidek). Resultats Le suivi moyen etait de 46 mois apres la chirurgie. Le diametre pupillaire moyen mesure en ambiance photopique etait de 2,94 ± 0,33 mm (extremes de 2,54 a 3,6 mm). Le diametre pupillaire moyen mesure en ambiance scotopique etait inferieur a 6 mm chez tous les patients (4,68 ± 0,59 mm, avec un diametre pupillaire scotopique maximal de 5,67 mm). Le diametre pupillaire moyen apres dilatation pharmacologique etait egalement diminue (5,39 ± 1,08 mm), avec une dilatation pupillaire superieure a 7 mm chez un seul patient. Conclusion La diminution du diametre pupillaire a long terme apres insertion d’un implant Artisan® pourrait contribuer a preserver la qualite de vision en condition scotopique chez ces patients. Le mecanisme le plus probable serait une restriction mecanique de la dilatation pupillaire par l’implant.

Posterior capsular opacification is the commonest complication of cataract surgery. It is treated with Nd:YAG laser capsulotomy. However, after treatment, cases of cystoid macular edema have been reported. The purpose of this study was to measure the foveal thickness change after Nd:YAG capsulotomy using optical coherence tomography (OCT) in order to clarify the physiopathology of this edema.A prospective, single-center study was conducted on patients who underwent Nd:YAG laser capsulotomy between May 2008 and November 2009. All patients received the same drug protocol after Nd:YAG capsulotomy (acetazolamide, apraclonidine, and rimexolone). Demographic parameters (age, sex, and medical history), clinical features (visual acuity, intraocular pressure) before and after Nd:YAG laser, and laser complications were analyzed. Central foveal thickness was measured by OCT (Stratus OCT 3, Zeiss). Data were collected before Nd:YAG laser capsulotomy and 1 week, 1 month, and 3 months after capsulotomy. The preoperative and postoperative thicknesses were compared. We used a Student t-test for statistical analysis.Thirty eyes of 26 patients were analyzed. The mean foveal thickness was 209 ± 26 μm before capsulotomy, 213 ± 23 μm, 204 ± 19 μm, 213 ± 23 μm 1 week, 1 month, and 3 months, respectively, after capsulotomy. The foveal thickness did not significantly change during the first 3 months following laser treatment. No complications occurred.Macular cystoid edema was a classical complication after Nd:YAG capsulotomy. However, there was no significant increase of macular thickness shortly after Nd:YAG capsulotomy in our study.

To determine the outcomes in cataract surgery by phacoemulsification in eyes with pseudoexfoliation syndrome (PEX) compared with eyes without this syndrome and to analyze the clinical features of pseudoexfoliation syndrome.A retrospective, single-center comparative study was conducted on patients who underwent cataract surgery between January 2006 and December 2008. Demographic parameters (age, sex, ethnicity, medical and ophthalmologic history), clinical features (visual acuity, pupil dilatation, intraocular pressure) before and after surgery, and surgery complications were analyzed and compared to a control group without PEX.One hundred and four eyes of 81 patients were included in the study. The eyes were divided into two groups: 52 eyes with pseudoexfoliation syndrome (PEX) and 52 eyes without pseudoexfoliation (control group). The rate of surgical complications was not statistically different between the pseudoexfoliation and control groups. The mean preoperative and postoperative visual acuity were not statistically different between the two groups. The mean postoperative visual acuity was LogMAR 0,06 + or - 0,2 in the pseudoexfoliation group and LogMAR 0,03 + or - 0,06 in the control group. The mean follow-up was 1,4 + or - 1,3 months in the pseudoexfoliation group and 1 month in the control group. Pseudoexfoliation was bilateral in 72 % of cases. Open-angle glaucoma or ocular hypertension was associated in 21 cases (40 %) in the pseudoexfoliation group versus no open-angle glaucoma and five cases of ocular hypertension in the control group (10 %). Poor pupil dilatation was observed in 25 cases (48 %) in the pseudoexfoliation group and in two cases (4 %) in the control group. Phacoemulsification with IOL was the surgical technique in all the cases, with only one case of anterior chamber IOL in the pseudoexfoliation group.Cataract surgery in PEX is known to be associated with more complications during surgery. Poor pupil dilatation is one of the most common problems in cataract surgery in eyes with PEX. Nevertheless, the cataract surgery in eyes with PEX syndrome is not associated with a higher rate of surgical complications in our study. However, PEX required optimized surgery. Pseudoexfoliation syndrome is most common in its bilateral presentation. It is associated with chronic secondary open-angle glaucoma. The best visual acuity after surgery was similar in the two groups, but PEX required more time to attain this maximal visual acuity. Coronary heart disease could occur more frequently in patients with PEX compared with subjects without PEX.Pseudoexfoliation syndrome did not confer a statistically higher risk for surgical complications in eyes without marked phacodonesis or lens subluxation. Pseudoexfoliation syndrome did confer a higher risk for glaucoma and coronary ischemia.

In France in 2009, newly operated patients after cataract surgery are usually seen by their surgeon the day after surgery (D1). The value of this day-after visit has been undergoing reassessment for some years, but this visit remains in widespread use in France. The aim of this study was to assess whether this visit changes patient management.One hundred three consecutive patients (106 eyes) undergoing cataract surgery by phacoemulsification were prospectively treated in our department (82% were outpatients). All intraoperative events were noted. The day after surgery, we monitored ocular tension, the anterior segment, and the fundus. Every change in the postoperative prescription compared with a standard prescription was noted.Intraoperative complications occurred in eight cases. On D1, six patients had ocular hypertension that exceeded 24 mmHg, 14 had a corneal edema, six had corneal erosion, two had a Seidel, one had an anterior subluxation of the IOL, and one had retinal detachment. In 26 cases (24.5%), the prescription was changed compared to our standard prescription.Several studies have shown that the day-after-surgery visit was not mandatory. The main objective of this visit is to check for ocular hypertension. More rarely, it can detect a Seidel in front of the wound, incorrect position of the IOL, retinal detachment, or other complications that may require surgery.The day-after-surgery visit remains necessary after phacoemulsification because complications, sometimes unpredictable, can occur and compromise the result of surgery. This visit also has an educational value (to reiterate to the patients the symptoms that would require an emergency visit).

Granulomatosis lesions occurring after diagnosis of primary or secondary immunodeficiency are not accidental and have been described in a small number of patients suffering from various diseases: common variable immunodeficiency (CVID), malignancy (lymphoma and solid tumors), and acquired immunodeficiency syndrome (AIDS). Two types of granulomatosis can appear: true sarcoidosis and sarcoid-like reaction. We report four patients, two with CVID and two with malignancy, in whom clinical granulomatosis appeared a few months to a few years after diagnosis of immunodeficiency. They developed noncaseating granulomas of the lung, spleen and liver associated with conjunctival granulomas and bilateral panuveitis. The granulomatous disorder was diagnosed after immunodeficiency on histopathological studies revealing noncaseating granulomas. Causation agents such as infectious organisms and environmental compounds were excluded. The relationship between sarcoid-like reaction, true sarcoidosis and immunodeficiency is discussed. The underlying pathophysiology responsible for the association between granuloma formation and immunodeficiency in the same patient remains obscure. It may be quite difficult to distinguish true sarcoidosis and sarcoid-like reaction. It is possible that these two entities are the clinical extremes of a common pathological process.

To determine the characteristics of patients undergoing cataract surgery in a poor northern suburb of Paris in terms of socioeconomic factors as well as systemic and ocular characteristics.This retrospective study investigated 250 consecutive patients who underwent cataract surgery in the Bobigny University Hospital between May and November 2005. Information on age, sex, place of birth, residence, medical insurance, and fluency in French were gathered from medical charts; clinical records were used to collect information on associated general disease, number of medications, ASA (American Society of Anesthesiology) score, lack of autonomy, associated ocular disorders, best corrected visual acuity before surgery, and surgical and anesthetic procedures.The mean age was 72 years, the sex ratio was 1, 54.8% of the patients were born out of France, more than 90% lived in Seine-Saint-Denis department, 57.2% were referred by local ophthalmologists, and 24% did not speak French. More than 60% of the patients benefited from free medical care related to a critical general chronic disease, 25% had an ASA score of at least 3, and 65% took a minimum of three medications per day. Legal blindness was present in 20% of the cases and 45% had associated ocular disorders. One-third of the patients were out-patients.and conclusion: General chronic disease was present in more than half of the patients studied and associated ocular disorders were present in approximately half of the patients. The best corrected visual acuity before surgery was 1/10.

To analyze the clinical features of pseudoexfoliation syndrome and to determine complications in cataract surgery in eyes with pseudoexfoliation syndrome compared with eyes without this syndrome.A retrospective, single-center comparative study was conducted on patients who underwent cataract surgery between 2004 and 2006. Demographic parameters (age, sex, ethnicity, medical and ophthalmologic history), clinical features (visual acuity, pupil dilatation, intraocular pressure) before and after surgery, and surgical complications were analyzed and compared to a control group without pseudoexfoliation.Seventy-four eyes of 71 patients were included in the study. The sex ratio of the pseudoexfoliation group was 1.26 with 19 males (56%) and 15 females (44%). Pseudoexfoliation was unilateral in 21 cases (61%). Open-angle glaucoma was associated in 11 cases (32%) in the pseudoexfoliation group versus two cases in the control group (5.4%). Poor pupil dilatation was observed in eight cases (24%) in the pseudoexfoliation group and in one case (2.7%) in the control group. Phacoemulsification with IOL was the surgical technique in all the cases with only one case (2.7%) of anterior chamber IOL in the pseudoexfoliation group. There was no significant difference in the surgical complications between the pseudoexfoliation and control group (5.4%). The mean preoperative intraocular pressure was 16+/-5 mmHg in the pseudoexfoliation group and 14+/-3 mmHg in the control group. The mean postoperative intraocular pressure at 1 month was 14+/-4 mmHg in the pseudoexfoliation group and 14+/-3 in the control group. The mean preoperative visual acuity was 1.0+/-0.7 LogMar in the pseudoexfoliation group and 0.7+/-0.5 LogMar in the control group. The mean postoperative visual acuity was 0.4+/-0.6 LogMar in the pseudoexfoliation group and 0.2+/-0.1 LogMar in the control group. The mean follow-up was 70 days in the pseudoexfoliation group and 30 days in the control group.Pseudoexfoliation syndrome is the most common in its unilateral presentation. It is frequently associated with chronic secondary open-angle glaucoma. Poor pupil dilatation is one of the most common problems faced by cataract surgeons. Nevertheless, pseudoexfoliation syndrome did not confer a statistically higher risk for surgical complication in eyes without marked phacodonesis or lens subluxation.

To compare visual acuity and complications in phacoemulsification in eyes with white cataract and in eyes with immature senile cataract.This was a prospective study on 36 eyes in 34 patients with white cataract (group 1) and 36 eyes in 36 patients with immature senile cataract (group 2).In group 1, mean preoperative visual acuity was 1/100 and mean postoperative visual acuity was 5/10 at 1 month. Posterior capsule tears occurred in four eyes (11%). In group 2, mean preoperative visual acuity was 2/10 and mean postoperative visual acuity was 7/10 at 1 month. No posterior capsule tear was observed. The preoperative visual acuity was significantly lower in group 1 (p=1.8x10(-14)). Postoperative visual acuities were not significantly different between the two groups (p=0.07). The increase in visual acuity was significantly higher in group 1 (p=2.2x10(-11)).Our study shows that white cataract is not a risk factor of poor postoperative visual acuity and the increase in visual acuity is greater in the white cataract group than in the immature cataract group.The results of phacoemulsification in white cataracts are satisfactory in spite of a high rate of posterior capsule rupture in our study.

To evaluate the long-term changes in pupil size after implantation of an Artisan phakic intraocular lens for correction of high myopia.Fourteen myopic eyes of seven patients were included in the study. Pupil size was measured under photopic conditions, under scotopic conditions after 10 min of dark adaptation, and after topical medical mydriasis. The pupil size was measured using the eye image of the OPD scan (Nidek).The mean follow-up was 46 months after surgery. The mean photopic pupil diameter was 2.94+/-0.33 mm (range, 2.54-3.6 mm). The diameter of the scotopic pupil remained less than 6.0 mm in all patients (4.68+/-0.59 mm, with maximal pupil diameter of 5.67 mm). The mean pupil diameter after pharmacological dilation was also reduced (5.39+/-1.08 mm; range, 4.19-7.59 mm), with pupil dilation more than 7 mm in only one patient.The iris-fixated intraocular lens mechanically limited pupil dilation in our patients. The long-term reduction in pupil size after Artisan phakic intraocular lens implantation may contribute to the maintenance of the quality of vision in scotopic conditions.

Giant cell arteritis is the most common vasculitis in the elderly. Visual loss is established as the most dreaded and irreversible complication of the disease, which makes giant cell arteritis an ophthalmic emergency. It is important to recognize its various ocular manifestations; isolated cotton wool spots are one of them.We describe a patient with constitutional symptoms and mild visual loss who was found to have giant cell arteritis. The ophthalmic examination was significant for only isolated cotton-wool spots. A delay in arm-to-retina circulation time was demonstrated by fluorescein angiography. Prompt treatment with corticosteroids led to preservation of vision and uneventful resolution of the cotton-wool spots.Common ophthalmologic presentations include anterior ischemic optic neuropathy or choroidal ischemia when short posterior ciliary arteries are involved, and central retinal artery occlusion. Retinal ischemia has also been recognized as a possible manifestation. Because the disease concerns medium-size and larger arteries, it cannot involve terminal retinal arterioles to produce cotton-wool spots. These are probably caused by platelet microembolization from the partially thrombosed regional arteries.Isolated cotton-wool spots can be an early ophthalmoscopic finding in giant cell arteritis and precede severe irreversible visual loss. Their detection is essential because it allows the ophthalmologist to establish a prompt treatment and preserve vision.

Introduction La chirurgie de la cataracte est l’intervention la plus pratiquee en France avec plus de 450 000 interventions realisees par an. Le but de cette chirurgie etant l’amelioration visuelle, il est important de connaitre les pathologies les plus frequemment associees a la cataracte pouvant, a court ou moyen terme, limiter cette recuperation visuelle. Materiels et methodes Il s’agit d’une etude retrospective portant sur 1 062 patients ayant eu une chirurgie de la cataracte entre Janvier 2007 et Novembre 2008. Les donnees recueillies concernent les pathologies ophtalmologiques associees deja connues ou mises en evidence. Resultats Mille soixante deux patients ont etes operes de la cataracte entre Janvier 2007 et Novembre 2008. L’âge moyen etait de 68 ans avec 53 % de femmes et 47 % d’hommes. Il y a 51 % de cataractes simples. 25 % des patients sont diabetiques, avec sur ces 25 % pres de 38 % ne presentant pas de retinopathie diabetique et 62 % presentant une retinopathie diabetique. 3 % de patients avec au fond d’œil des alterations de l’epithelium pigmentaire et des drusens et 2 % presentant une DMLA atrophique. Aucun patient ayant une DMLA exsudative n’a ete opere. Enfin 6 % des patients presentaient une hypertonie oculaire ou un glaucome, 3 % une cataracte blanche, 3 % une pseudo exfoliation capsulaire et 3 % une myopie superieure a 4D. Discussion Faut-il modifier notre attitude face a ces cataractes dites « non » simples ? Conclusion Un peu plus de la moitie des cataractes de cette serie sont considerees comme simples. L’autre moitie concerne des cataractes associees a des pathologies ophtalmologiques ou generales pouvant modifier le pronostic visuel. Il est donc important de ne pas negliger ces pathologies afin de prevenir les eventuelles complications et ainsi ameliorer le pronostic visuel.

But Etudier les risques de la chirurgie de la cataracte par phacoemulsification chez les patients presentant un syndrome pseudo-exfoliatif ainsi que les caracteristiques cliniques de ces patients. Materiels et Methodes Les patients inclus dans l’etude ont tous beneficies d’une chirurgie de cataracte par phacoemulsification entre 2006 et 2008. Il s’agit d’une etude retrospective, comparative de 2 groupes de patients. Un premier groupe de 50 patients presente une pseudoexfoliation capsulaire (groupe PEC) et un deuxieme groupe de 50 patients (groupe temoin) ne presente pas de pseudoexfoliation, ni autre pathologie favorisant les complications operatoires. Les caracteristiques cliniques de chaque patient sont egalement etudiees. Les complications per et post-operatoires de la chirurgie de cataracte sont notees dans les 2 groupes. Resultats L’etude regroupe 100 patients repartis dans deux groupes distincts et comparatifs (groupe PEC et groupe temoin sans PEC). Une phacoemulsification a ete realisee dans 100 % des cas avec 1 seul cas d’implant de chambre anterieure pour le groupe PEC. Dans le groupe PEC, il existe une predominance de forme unilaterale (61 %) et un glaucome chronique a angle ouvert est associe dans 11 cas (22 %) versus 2 cas (4 %) dans le groupe temoin. Une mauvaise dilatation est observee dans 8 cas (16 %) dans le groupe PEC versus 1 cas (2 %). Il y a eu 2 complications operatoires dans les 2 groupes (4 %). Aucune complication post-operatoire n’est retrouvee a 1 mois. En termes d’acuite visuelle, la recuperation est identique dans les deux groupes. Discussion Le syndrome de pseudoexfoliation capsulaire est associe a des risques accrus lors de la phacoemulsification lies a une mauvaise dilatation et une fragilite zonulaire. Cependant dans notre etude, le taux de complications est identique. Les caracteristiques des patients presentant une PEC sont une atteinte plutot unilaterale, une mauvaise dilatation, une hypertonie oculaire voir un glaucome plus frequent et plus severe que pour le reste de la population. Cette population aurait egalement un risque cardiovasculaire plus eleve. Conclusion La chirurgie de cataracte avec PEC ne presente pas un taux de complication accrue.

Introduction Quelques etudes retrouvent parmi les complications d’une capsulotomie au laser YAG la formation d’un oedeme maculaire cystoide apparaissant dans les semaines qui suivent le geste. Toutefois, on ne retrouve pas dans la litterature de mesures OCT de l’epaisseur centrale maculaire apres capsulotomie. Objectifs et Methodes L’objectif de l’etude est de mesurer l’epaisseur maculaire apres capsulotomie YAG chez 30 patients ne presentant par ailleurs aucune pathologie retinienne connue. Il s’agit d’une etude prospective unicentrique chez des patients adresses dans le service pour capsulotomie au laser YAG. Les capsulotomies ont ete realisees par 5 ophtalmologistes differents. Les differents parametres ont ete etudies a J0 (avant le laser), J7, J30 et J90. Ces parametres etaient : l’acuite visuelle, le tonus oculaire et la mesure par OCT (OCT 3 de Zeiss) de l’epaisseur maculaire centrale. De plus, le nombre d’impact et la puissance du laser ont ete notes pour chaque patient. Un test de Student a ete utilise pour l’etude statistique. Un « p » Resultats On ne constate pas d’epaississement significatif de l’epaisseur maculaire apres capsulotomie au laser YAG (p > 0.05). Discussion Les complications connues apres capsulotomie YAG sont l’oedeme maculaire cystoide, le decollement de retine, et l’hypertonie. Dans notre serie, nous n’avons pas retrouve de telles complications, notamment pas d’oedeme maculaire cystoide. Nous avons note une legere augmentation de l’epaisseur maculaire apres laser a J7 mais non significative (p > 0.05). Conclusion La capsulotomie au laser YAG n’apparait pas, sur ce petit echantillon, comme un facteur favorisant l’epaississement maculaire.

Objectif Le but de l’etude est d’evaluer le pronostic en termes visuel et les complications post-operatoires des ruptures capsulaires, chez des patients ayant ete operes de cataracte par phacoemulsification. Materiels et Methodes Il s’agit d’une etude retrospective realisee sur des patients operes de cataracte compliquee de rupture capsulaire posterieure sur une periode de 2 ans. Nous avons etudie pour tous les patients : la duree du suivi, la presence de facteurs de risques, le temps operatoire, le site d’implantation, la necessite d’une vitrectomie anterieure lors du geste initial, la participation de l’interne a la chirurgie, l’acuite visuelle finale, la presence d’une hypertonie post-operatoire necessitant un traitement, le taux de reprise chirurgicale, la prescription supplementaire de medicaments (antibiotiques), la presence d’un œdeme maculaire post-operatoire, le nombre de visites post-operatoires durant la duree du suivi et le nombre de consultations en urgence post-operatoires. Resultats Vingt-neuf (2.5 %) patients ont ete inclus dans cette etude sur 1 148 operes durant cette periode. La duree moyenne du suivi est de 4.3 mois. L’acuite visuelle post-operatoire finale est superieure a l’acuite visuelle pre-operatoire dans 75.8 % des yeux (22/29 yeux). Dans 72.4 % (21/29 des yeux), l’acuite visuelle finale est superieure ou egale a 5/10. Dans 69 % des yeux (20/29) une vitrectomie anterieure a ete pratiquee. 6 yeux ont necessite une reprise chirurgicale (20.7 %). La complication post-operatoire la plus frequente etait l’hypertonie oculaire (34.5 %). Le nombre de visites post-operatoires etait en moyenne de 5.2. Nous n’avons pas observe d’œdeme maculaire ni d’endophtalmie ni de decollement de retine. Discussion La rupture capsulaire posterieure reste la complication la plus frequente pouvant affecter le pronostic visuel lors de la phacoemulsification. Ses complications classiques sont : l’hypertonie oculaire et l’œdeme maculaire. Conclusion Malgre une prise en charge post-operatoire plus complexe, la recuperation fonctionnelle est satisfaisante dans les ruptures capsulaires posterieures.

Introduction En 2007 en France, les patients operes de chirurgie de la cataracte sont traditionnellement revus par leur chirurgien le lendemain. L’interet d’une visite a J1 est remis en question depuis quelques annees mais elle reste largement pratiquee en France. Materiels et Methodes Cent patients consecutifs operes de chirurgie de la cataracte ont ete inclus de maniere prospective. Ont ete analyses a J1 : tonus oculaire, examen du segment anterieur (presence d’un seidel, degre d’inflammation, œdeme corneen, position de l’implant), et prescription post-operatoire supplementaire par rapport a la prescription « standard ». Resultats Six pour cent des patients ont presente une hypertonie oculaire superieure a 25 mmHg, 20 % ont eu un tyndall superieur ou egal a 2 + et 13 % ont eu une modification de leur ordonnance de sortie par rapport a une prescription « standard », essentiellement en raison d’une hypertonie oculaire. Discussion De nombreuses etudes ont montre que la visite du J1 post-chirurgie de la cataracte n’etait pas indispensable. L’interet essentiel est de rechercher une hypertonie, une inflammation intra-oculaire, necessitant une modification de l’ordonnance post-operatoire (plus particulierement chez les patients ayant un antecedent de glaucome ou d’uveite). Plus rarement, elle permet de mettre en evidence un phenomene de Seidel en regard de l’incision, une malposition de l’implant, complications necessitant une reprise chirurgicale. Conclusion La visite a J1 apres chirurgie de la cataracte n’est probablement pas indispensable chez tous les patients mais devrait etre ciblee aux patients susceptibles de presenter des complications post-operatoires necessitant une prescription individualisee. Elle permet egalement de reexpliquer aux patients les signes devant faire consulter en urgence (douleur, rougeur, baisse de l’acuite visuelle).

But Determiner l’efficacite de l’autogreffe conjonctivale dans le traitement du pterygion. Materiels et Methodes Il s’agit d’une etude retrospective non comparative d’une serie de patients operes de pterygions entre 2004 et 2006. L’etude regroupe 30 yeux de 25 patients. 27 patients ont beneficie d’une premiere chirurgie et 3 d’une seconde chirurgie pour recidive du pterygion. L’acte chirurgical a consiste en l’exerese complete du pterygion. Une autogreffe conjonctivale est ensuite realisee afin de recouvrir la sclere mise a nue. Les parametres etudies sont le taux de recidives et de complications post-operatoires. Resultats La moyenne du suivi des patients est de 23 mois (12 a 36 mois). Le taux de recidive est de 10 % (3 patients sur 30). Les recidives sont plus frequentes dans les 6 premiers mois, et chez des patients a risque. Le taux de complications postoperatoires est de 10 % (3 patients sur 30). Les complications retrouvees sont des œdemes du greffon, des kystes et granulomes. Discussion La difficulte de la chirurgie du pterygion est le risque de recidives. La greffe de conjonctive a ete proposee pour diminuer le taux de recidives eleve des resections simples. Conclusion L’autogreffe conjonctivale diminue le risque de recidives des pterygions. Des combinaisons therapeutiques pourraient reduire les recidives et ameliorer les resultats notamment chez les patients a risques.

Introduction Etude prospective comparant cent patients operes de cataracte par phacoemulsification, par un medecin en formation ou un senior. Objectifs et Methodes L’etude vise a comparer cinq criteres de la chirurgie de la cataracte qui sont : le temps chirurgical, le temps de phacoemulsification, la survenue de complications, la pression intra-oculaire (PIO) post-operatoire, et la meilleure acuite visuelle corrigee a sept jours et a un mois, chez des patients operes soit par un senior, soit par un medecin en formation. La difficulte de realisation, par les medecins en formation, de chaque temps operatoire est evaluee par un questionnaire. Cent cataractes sont incluses dans l’etude avec une equipe de cinq operateurs : trois seniors et deux medecins en formation. Cinquante cataractes ont ete operees par un des trois seniors et cinquante par un des deux medecins en formation. Resultats Malgre un temps chirurgical et de phacoemulsification significativement plus eleve chez les medecins en formation, le taux de complication et la PIO post-operatoire sont identiques. La meilleure acuite visuelle corrigee reste plus faible a sept jours dans le groupe des medecins en formation ; cette difference entre les deux groupes disparait a un mois post-operatoire. Discussion La chirurgie de la cataracte par phacoemulsification, pratiquee dans de bonnes conditions par un medecin en formation, semblerait retarder legerement la recuperation visuelle, sans incidence sur l’acuite visuelle finale du patient. Ceci pourrait s’expliquer par un temps de chirurgie et de phacoemulsification plus long. Conclusion Une selection pre-operatoire soigneuse des patients permet a la fois un apprentissage des gestes chirurgicaux, et un taux de complications avec un resultat visuel acceptable.

Objectif Comparer en terme d’acuite visuelle et de complications per- et post-operatoires un groupe de patients operes de cataracte blanche par rapport a un groupe temoin opere de cataracte senile « non blanche ». Materiels et Methodes Nous avons analyse de facon prospective 36 yeux de 34 patients operes de cataracte blanche (groupe 1) et 36 yeux de 36 patients operas de cataracte senile « non blanche » (groupe 2). Resultats Dans le groupe 1, l’acuite visuelle pre-operatoire moyenne etait de 1/100 et de 5/10 en post-operatoire a un mois. Quatre interventions (11 %) ont ete compliquees de rupture capsulaire posterieure. Dans le groupe 2, l’acuite visuelle pre-operatoire moyenne etait de 2/10 et de 7/10 en post-operatoire a un mois. Aucune rupture capsulaire n’a ete observee. L’acuite pre-operatoire du groupe 1 etait inferieure de facon significative par rapport au groupe 2 (p 0,05). Le gain d’acuite visuelle etait significativement plus important dans le groupe 1 (p Discussion Notre etude montre que la cataracte blanche n’est pas un facteur de risque de mauvaise recuperation visuelle et que le benefice en termes d’acuite visuelle est plus important en cas de cataracte blanche qu’en cas de cataracte « non blanche ». Conclusion Les resultats des patients operes de cataracte blanche sont satisfaisants malgre un taux de ruptures capsulaires plus important dans notre etude.

Introduction Le but de l’etude est de comparer le gain en termes de qualite de vie de deux groupes de patients operes de la cataracte (un groupe numero 1 atteint de cataracte bilaterale et un groupe numero 2 atteint de cataracte unilaterale avec une bonne acuite visuelle de l’œil adelphe). Materiels et Methodes Nous avons realise une etude prospective. Deux groupes de patients atteints de cataracte (unilaterale ou bilaterale) sont distingues en fonction de leur acuite visuelle pre-operatoire. Un groupe numero 1 comprend des patients ayant une acuite visuelle pre-operatoire aux 2 yeux ou = a 8/10 de l’autre. Pour chaque patient des deux groupes nous realisons un questionnaire de qualite de vie (VF 14) en pre-operatoire et en postoperatoire a 1 mois. Resultats Il existe une difference significative entre le VF 14 pre-operatoire et post-operatoire dans les deux groupes. Dans le groupe numero 2, le VF 14 pre-operatoire est superieur au groupe numero 1. Discussion Le benefice en termes de qualite de vie est important meme chez les sujets dont l’œil adelphe a une bonne acuite visuelle. Conclusion Notre etude confirme l’interet d’operer de la cataracte les patients ayant une atteinte unilaterale avec une bonne acuite visuelle (> 8/10) de l’œil adelphe.

Introduction L’arterite a cellules geantes est la plus frequente des vascularites du sujet âge. Les complications oculaires ischemiques de la maladie, frequemment responsables de baisse severe et irreversible d’acuite visuelle, en font une urgence therapeutique. Des nodules cotonneux peuvent etre revelateurs de la maladie. Observation Nous rapportons le cas d’une arterite a cellules geantes diagnostiquee chez un patient presentant une baisse d’acuite visuelle d’un œil associee a des signes generaux. Des nodules cotonneux isoles etaient visibles au fond d’œil. L’angiographie a la fluoresceine montrait uniquement un retard circulatoire retinien. Une corticotherapie instauree rapidement permit de preserver la vision et de normaliser le fond d’œil. Discussion La neuropathie optique ischemique anterieure aigue ou l’ischemie choroidienne, en cas d’atteinte des arteres ciliaires courtes posterieures, ainsi que l’occlusion de l’artere centrale de la retine, sont les presentations habituelles de la maladie. L’ischemie retinienne a egalement ete decrite. Parce que l’arterite geante atteint les arteres de gros et moyen calibres, la survenue de nodules cotonneux signant une ischemie focale du reseau arteriolaire terminal ne peut resulter que d’un mecanisme embolique. Il s’agit peut-etre de microemboles plaquettaires. Conclusion Les nodules cotonneux peuvent etre dans de rares cas un signe ophtalmoscopique precoce et isole de la maladie. La precocite du diagnostic d’arterite a cellules geantes est essentielle car elle permet a l’ophtalmologiste d’instaurer en urgence une corticotherapie generale qui previent d’eventuelles complications cecitantes.