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Resume Introduction Avec les progres effectues en reanimation pediatrique ces dernieres annees et l’augmentation de la survie des grands prematures, les consequences de la prematurite sont de plus en plus documentees. Au niveau ophtalmologique, la retinopathie du premature est bien connue, mais la papille presente, elle aussi, des particularites. L’objectif de cette etude est de comparer les nerfs optiques des enfants prematures en fonction du terme de naissance avec une population temoin du meme âge. Materiel et methodes Notre etude etait une etude cas-temoins avec l’appariement d’un enfant ne a terme pour chaque enfant ne premature. Les criteres d’inclusions pour les cas etaient : tout enfant premature, âge de 5 a 10 ans, separe en trois sous-groupes en fonction du degre de prematurite. Les criteres de comparaison etaient : le rapport cup/disc, la biometrie oculaire, la pression intraoculaire, l’epaisseur des fibres optiques RNFL. Resultats Trente-sept enfants nes prematures et 37 temoins ont ete inclus dans l’etude. L’âge moyen des enfants nes prematures etait de 7,05 ans, au moment de l’inclusion, et 7,19 pour les temoins. Au niveau de la longueur axiale et de l’equivalent spherique, il n’y avait pas de difference significative avec respectivement p = 0,31, et p = 0,98. Concernant la pachymetrie et la pression intraoculaire, il n’y avait pas non plus de difference significative avec respectivement p = 0,28 et p = 0,22. On retrouve cependant une difference significative concernant le rapport cup/disc avec p Conclusions La reduction du nombre de fibres au RNFL est un phenomene qui depend essentiellement du stade de la prematurite chez les enfants etudies, âges de 5 a 10 ans. Il serait utile de suivre au long cours ces populations d’anciens prematures et de pouvoir les comparer a des temoins dans le temps et ainsi en tirer des resultats fonctionnels.

Resume Introduction L’objectif de cette etude est de rechercher des correlations anatomo-fonctionnelles chez les patients atteints de chorioretinopathie de Birdshot afin de mieux comprendre les mecanismes aboutissant a la perte de fonction visuelle. Materiel et methode Nous avons realise une etude prospective observationnelle monocentrique au CHU de Nantes incluant tous les patients suivis pour une maladie de Birdshot entre janvier 2019 et juillet 2019. Les parametres etudies etaient l’acuite visuelle, la microperimetrie, la perimetrie automatisee standard, l’OCT-SD, l’OCT-EDI, l’OCT-A, l’OCT-RNFL, les retinophotographies grand champ et les angiographies a la fluoresceine et a l’ICG. Resultats Quarante-quatre yeux ont ete etudies. Une correlation significative a ete retrouvee entre l’acuite visuelle et l’epaisseur retinienne (p = 0,002 r = 0,44) mais pas choroidienne (p = 0,16). Une correlation significative a egalement ete constatee entre la sensibilite retinienne et l’epaisseur maculaire de la retine totale (p Discussion Nous retrouvons des correlations significatives entre les parametres fonctionnels tels que l’acuite visuelle et la sensibilite retinienne et les parametres anatomiques retiniens et notamment avec la retine interne tandis qu’il n’y a pas de correlation mise en evidence avec les parametres anatomiques choroidiens. Conclusion Les principaux resultats de notre etude concordent en faveur d’une origine retinienne plutot que choroidienne a l’origine de la degradation de la fonction visuelle dans la maladie de Birdshot.

Resume A l’ere du photo depistage, une actualisation des recommandations sur les methodes de depistage visuel chez l’enfant devenait necessaire. Nous exposons dans cet article les recommandations etablies suite au travail d’un groupe d’experts de l’AFSOP en fevrier 2019. Les enfants a risque de developper une amblyopie organique precoce doivent beneficier d’un examen ophtalmologique au cours du premier mois de vie. Les enfants a risque de developper une amblyopie fonctionnelle doivent beneficier d’un examen ophtalmologique avec mesure de la refraction sous cycloplegie entre l’âge de 12 et 15 mois. A tout âge, un enfant presentant des signes d’appel de pathologie oculaire ou des signes fonctionnels doit beneficier d’un examen ophtalmologique dans un delai rapide. Pour les enfants ne presentant ni facteur de risque ni signe d’appel, un examen de depistage systematique doit etre realise par un orthoptiste entre l’âge de 3 et 4 ans. Cet examen doit comprendre une mesure de l’acuite visuelle, un test a l’ecran et une mesure de la refraction par appareil de photo depistage. L’enfant est adresse a l’ophtalmologiste uniquement en cas d’anomalie a l’examen de depistage, selon les criteres suivants : acuite visuelle +2,5 D pour la sphere, > 1,5 D pour l’astigmatisme et > 1 D d’anisometropie. Enfin, une mise au point sur les normes refractives de l’enfant en fonction de l’âge et les conditions d’utilisation des appareils de photo depistage est egalement realisee.

Background Surgeries for idiopathic uveitis and juvenile idiopathic arthritis-associated uveitis in children are complex because of the high risk of inflammatory postoperative complications. There is no consensus about treatment adaptation during the perioperative period. The objectives of this study are to report the therapeutic changes made in France and to determine whether maintaining or stopping immunosuppressive therapies is associated with an increased risk of surgical site infection or an increased risk of uveitis or arthritis flare-up. Methods We conducted a retrospective cohort study between January 1, 2006 and December 31, 2018 in six large University Hospitals in France. Inclusion criteria were chronic idiopathic uveitis or chronic uveitis associated with juvenile idiopathic arthritis under immunosuppressive therapies at the time of the surgical procedure, operated before the age of 16. Data on perioperative treatments, inflammatory relapses and post-operative infections were collected. Results A total of 76 surgeries (42% cataract surgeries, 30% glaucoma surgeries and 16% posterior capsule opacification surgeries) were performed on 37 children. Adaptation protocols were different in the six hospitals. Immunosuppressive therapies were discontinued in five cases (7%) before surgery. All the children in the discontinuation group had an inflammatory relapse within 3 months after surgery compared to only 25% in the other group. There were no postoperative infections. Conclusions The results of this study show varying practices between centres. The benefit-risk balance seems to favour maintaining immunosuppressive therapies during surgery. Further studies are needed to determine the optimal perioperative treatments required to limit post-operative inflammatory relapses.

A 6-year-old boy was referred for constant right gaze deviation. Rather than a gaze deviation, he constantly seemed to look on the left side of any displayed target. Examination revealed the association of a highly positive angle Kappa and an esotropia of equal values. He also exhibited signs of ocular albinism with no associated infantile nystagmus syndrome. The X-linked ocular albinism was confirmed genetically, explaining the presence of a positive angle Kappa. A highly positive angle Kappa can be associated with a convergent strabismus; in case both values offset each other, this can result in a constant "sidelooking," which should not be confused with a gaze deviation.

Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) can lead to severe ophthalmologic sequelae. The main risk factor is the severity of the initial ocular involvement. There are no recommendations for ocular management during acute phase.We conducted a national audit of current practice in the 11 sites of the French reference center for toxic bullous dermatoses and a review of the literature to establish therapeutic consensus guidelines. We sent a questionnaire on ocular management practices in SJS/ TEN during acute phase to ophthalmologists and dermatologists. The survey focused on ophthalmologist opinion, pseudomembrane removal, topical ocular treatment (i.e. corticosteroids, antibiotics, antiseptics, artificial tear eye drops, vitamin A ointment application), amniotic membrane transplantation, symblepharon ring use, and systemic corticosteroid therapy for ophthalmologic indication. Nine of 11 centers responded. All requested prompt ophthalmologist consultation. The majority performed pseudomembrane removal, used artificial tears, and vitamin A ointment (8/9, 90%). Combined antibiotic-corticosteroid or corticosteroid eye drops were used in 6 centers (67%), antibiotics alone and antiseptics in 3 centers (33%). Symblepharon ring was used in 5 centers (55%) if necessary. Amniotic membrane transplantation was never performed systematically and only according to the clinical course. Systemic corticosteroid therapy was occasionally used (3/9, 33%) and discussed on a case-by-case basis.The literature about ocular management practice in SJS/ TEN during acute phase is relatively poor. The role of specific treatments such as local or systemic corticosteroid therapy is not consensual. The use of preservatives, often present in eye drops and deleterious to the ocular surface, is to be restricted. Early amniotic membrane transplantation seems to be promising.

In light of the international literature, a workgroup of experts from the AFSOP met in February 2019 to formulate updated recommendations for visual screening in children. An ophthalmologic examination during the first month of life is recommended for children at risk of developing infantile organic amblyopia. An ophthalmologic examination including cycloplegic refraction between 12 and 15 months of age is recommended for children at risk of developing functional amblyopia. At any age, a prompt ophthalmologic examination is recommended for a child suspected of functional or organic ocular pathology. In children without risk factors or warning signs, a systematic orthoptic screening examination is recommended during the third year of life, including a monocular visual acuity test, a cover-test and a refraction by photoscreener. The child is referred to the ophthalmologist only in the case of an abnormal screening result, according to the following criteria: visual acuity5/10, or1 difference between eyes, abnormal cover test, photodetection refraction values-3D or+2.5D for the sphere,1.5D for astigmatism and1D for anisometropia. Finally, we review normal childhood refractive errors as a function of age as well as the correct use of photo screening devices.

Thanks to the progress made in the past few years in pediatric intensive care as well as the increased survival of preterm infants, the consequences of premature birth are increasingly well documented. With regard to ophthalmologic complications, retinopathy of prematurity is well described, but the optic nerve may also be affected. The goal of this study is to compare the optic nerves of preterm infants as a function of their gestational period with a control group of the same age.We conducted a case-control study pairing a full-term infant with each preterm infant. Inclusion criteria were: any child from 5- to 10-years-old, separated into three sub-groups according to their degree of prematurity. Variables were: cup/disc ratio, ocular biometry, intraocular pressure and RNFL thickness.Thirty-seven preterm infants and 37 controls were included in the study. The mean age at the time of inclusion was 7.05 years for the preterm group and 7.19 years for the control group. No significant difference was observed in axial length or spherical equivalent (P=0.31 and P=0.98, respectively). No significant difference was observed in pachymetry or intraocular pressure (P=0.28 and P=0.22, respectively). We observed a significant increase of 0.1 in the cup/disc ratio of the preterm group compared to the control group (P0.05). The preterm group cup/disc ratio was 0.36 versus 0.27 for the control group. No significant difference was observed in the 7 quadrants of RNFL between the two groups. However, when comparing infants born before 28 weeks gestation with the control group, we observed a mean decrease of 14.5 microns in the superior temporal sector (P=0.04), a 9 micron decrease in the global thickness G (P=0.03) and a 12.7 micron decrease in the nasal sector (P=0.01).In the case of the studied children (aged 5 to 10), the reduced RNFL fiber thickness is a phenomenon dependent essentially on the stage of prematurity. It would be useful to follow these preterm populations over the long term and to compare them to a matched control group to be able to obtain functional results.

The purpose of this study was to identify anatomic-functional correlations in patients with Birdshot chorioretinopathy in order to better understand the mechanisms of visual loss.We conducted a single-center observational prospective study at the Nantes University Medical Center including all patients followed for Birdshot chorioretinopathy between January 2019 and July 2019. The parameters studied were visual acuity, microperimetry, standard automated perimetry, SD-OCT, EDI-OCT, OCT-A, RNFL-OCT, wide-field fundus photographs, and fluorescein and ICG angiography.Forty-four eyes were studied. A significant correlation was found between visual acuity and retinal thickness (P=0.002, r=0.44), but not choroidal thickness (P=0.16). A significant correlation was also observed between retinal sensitivity and total macular thickness (P0.001, r=0.68) as well as inner retinal thickness (P0.001, r=0.65), while the correlation was weaker with choroidal thickness (P=0.03, r=0.32). There was a weak correlation between retinal sensitivity and superficial capillary density (P=0.02, r=0.42) as well as deep capillary density (P=0.02, r=0.41). The peripheral hypo-autofluorescent zones correspond to the visual field defects, but these defects are larger than the hypo-autofluorescent zones. Patients with paracentral or peripheral field defects had a history of vasculitis more often than hypo-ICG spots.We found significant correlations between functional parameters such as visual acuity and retinal sensitivity and retinal anatomic parameters, particularly the inner retina, while there was no correlation shown with choroidal anatomic parameters.The main results of our study suggest a retinal rather than choroidal origin of the degradation of visual function in birdshot chorioretinopathy.

Background Whether they are injected peri- or intraocularly, corticosteroids are still essential tools in the therapeutic arsenal for treating inflammatory macular oedema. A few years ago, however, only triamcinolone acetonide was available to ophthalmologists. While this compound was initially developed for rheumatological or dermatological use, it has been increasingly deployed in ophthalmology, despite still being off-label. In 2011, the system for delivery of dexamethasone from a biodegradable, injectable implant into the vitreous cavity obtained approval for use in inflammatory macular oedema. While the efficacy and safety of triamcinolone in macular oedema, including inflammatory oedema, have already been studied, there are currently no publications on subconjunctival triamcinolone injections, which are simple, effective and well tolerated. To date, the dexamethasone 700 μg implant has been authorized for the treatment of noninfectious intermediate and posterior uveitis, but there have been no studies to evaluate the efficacy and safety of the different peri- and intraocular strategies, including the treatment of inflammatory macular oedema. Methods This protocol is therefore designed to compare the efficacy and safety of peri- and intraocular corticosteroid injections in the treatment of inflammatory macular oedema. In this ongoing study, 142 patients will be included, and the oedematous eye will be randomised to treatment with either subconjunctival triamcinolone injection or an intravitreal implant containing 700 μg dexamethasone. Follow-up is planned for 6 months with monthly visits. Each visit will include visual acuity measurement, a slit lamp examination, fundoscopy, intraocular pressure measurement, laser flare measurement (if available) and spectral domain optical coherence tomography. Discussion The results of this trial will have a real impact on public health if it is shown that a Kenacort retard® (i.e. triamcinolone) injection costing just €2.84 and performed in the physician’s office (with no additional overhead costs) is at least as effective as the dexamethasone 700 μg implant (Ozurdex®; costing approximately €960 with the injection performed in a dedicated room), with no increased side effects. Trial registration ClinicalTrials.gov, NCT02556424. Registered on 22 September 2015.

Controlling long-term inflammation during non-infectious intermediate, posterior or panuveitis while limiting side effects remains challenging. There is no standardized pre-therapeutic evaluation providing diagnostic certainty, but some simple tests allow us to identifiy the main etiologies. The ophthalmologist identifies the type of uveitis, and the internist completes the investigations according to the ophthalmologist's findings. Fundus photographs, optical coherence tomography, and fluorescein and indocyanine green angiography should be considered during diagnosis and follow-up. Ocular complications of uveitis are numerous. They require close monitoring and specific medical and sometimes surgical management. The growing number of available drugs makes it possible to optimize the management of these conditions with varied etiologies and presentations. Currently, systemic corticosteroids remain the mainstay of therapy, and other alternatives are considered in the case of poor tolerance, steroid resistance or dependence. The choice of a systemic, periocular or intravitreal treatment depends on several factors: chronicity or recurrence of uveitis, duration, bilaterality, association with a systemic inflammatory disease, the presence of contraindications to certain treatments, and also socioeconomic constraints. It is of the utmost importance to find the best compromise allowing tight control of ocular inflammation by means of adapted systemic and/or local treatment while avoiding the main complications.; Contrôler l’inflammation à long terme au cours des uvéites intermédiaires, postérieures ou totales, non infectieuses en limitant la iatrogénie est un véritable défi. Il n’existe pas de bilan standardisé qui assure une certitude diagnostique, mais quelques tests simples permettent de ne pas omettre les principales étiologies. L’ophtalmologiste qualifie le type d’atteinte puis le médecin interniste complète les investigations en fonction des constatations de l’ophtalmologiste. Photographies du fond d’œil, tomographies en cohérence optique, angiographies à la fluorescéine et au vert d’indocyanine doivent être envisagées au cours du diagnostic et du suivi. Les complications oculaires de l’inflammation sont nombreuses. Elles nécessitent une surveillance étroite et une prise en charge spécifique, médicale et parfois chirurgicale. Le nombre croissant de molécules disponibles permet d’optimiser la prise en charge de ces pathologies aux étiologies et présentations variées. Actuellement, la corticothérapie systémique reste le traitement de référence et les autres thérapeutiques sont envisagées en cas de mauvaise tolérance, corticorésistance ou corticodépendance. Le choix d’un traitement systémique, régional périoculaire ou intravitréen dépend de plusieurs facteurs : chronicité ou récurrence de l’uvéite, ancienneté, bilatéralité, association à une maladie inflammatoire systémique, présence de contre-indications à certains traitements et contraintes socio-économiques. Il est très important de trouver le meilleur compromis permettant un contrôle strict de l’inflammation oculaire à l’aide d’un traitement systémique et/ou local adapté tout en évitant les principales complications.

Tropospheric ozone (O3) is a greenhouse gas as well as a harmful air pollutant with adverse effects on human health and vegetation: The observation and attribution of its long-term variability are key activities to monitor the effectiveness of pollution reduction protocols. In this work, we present the analysis of multi-annual near-surface O3 (1996–2016) at the Mt. Cimone (CMN, Italian northern Apennines) WMO/GAW global station and the comparison with two “reference” high-mountain sites in Europe: Jungfraujoch (JFJ, Swiss Alps) and Mt. Zugspitze (ZUG/ZSF, German Alps). Negative O3 trends were observed at CMN over the period 1996–2016 (from –0.19 to –0.22 ppb yr–1), with the strongest tendencies as being observed for the warm months (May–September: –0.32 ppb yr–1 during daytime). The magnitude of the calculated O3 trends at CMN are 2 times higher than those calculated for ZUG/ZSF and 3–4 times higher than for JFJ. With respect to JFJ and ZUG/ZSF, higher O3 values were observed at CMN during 2004–2008, while good agreement is found for the remaining periods. We used Lagrangian simulations by the FLEXPART particle dispersion model and near-surface O3 data over different European regions, for investigating the possibility that the appearance of the O3 anomalies at CMN could be related to variability in the atmospheric transport or in near-surface O3 over specific source regions. Even if it was not possible to achieve a general robust explanation for the occurrence of the high O3 values at CMN during 2004–2008, the variability of (1) regional and long-range atmospheric transport at CMN and (2) European near-surface O3 could motivate the observed anomalies in specific seasons and years. Interestingly, we found a long-term variability in air mass transport at JFJ with enhanced (decreased) contributions from Western European (intercontinental regions).

Resume Objectif Un nombre croissant d’etudes rapporte l’impact negatif du strabisme sur l’image de soi, les relations avec autrui ou la situation professionnelle. L’AS-20 est un questionnaire anglais standardise mesurant precisement le retentissement psychosocial du strabisme chez l’adulte. L’objectif de cette etude etait sa validation en langue francaise. Participants Trois cent quatre vingt onze patients ont participe a l’etude, dont 131 strabismes (groupe 1), 128 autres pathologies oculaires (groupe 2) et 132 sujets normaux (groupe 3). Resultats L’echelle AS-20 presentait de bonnes proprietes psychometriques en 2 dimensions ou en 4 : la consistance interne etait tres bonne (coefficient alpha de Cronbach > 0,9 pour chaque dimension et la dimension globale) et la reproductibilite etait correcte (CCI > 0,7). La comparaison des scores de l’echelle en 2 dimensions a permis de distinguer significativement chacun de nos groupes (p 0,9). Conclusion Nous disposons desormais d’un questionnaire valide en francais pour quantifier le retentissement du strabisme et analyser l’efficacite des traitements proposes.

Resume Introduction Le domaine des uveites est en relation avec de nombreuses entites pathologiques. L’une des principales causes de baisse d’acuite visuelle chez ces patients est l’œdeme maculaire. Un volet de son traitement est represente par les corticoides d’utilisation peri- et intra-oculaire. Materiels et methode Le but de notre travail etait d’evaluer les criteres d’efficacite (sur l’amelioration de l’acuite visuelle et de l’œdeme maculaire ainsi que le delai de recidive) et de securite (sur l’apparition d’une hypertonie oculaire ou d’une cataracte) de ces differentes voies d’administration d’un corticoide apres une seule injection. Nous avons compare des patients traites par intra-vitreenne d’Ozurdex® versus sous-conjonctivale de triamcinolone versus sous-tenonienne de triamcinolone. Il s’agit d’une etude retrospective realisee dans 2 centres tertiaires, le CHU de Nantes et l’hopital de la Pitie-Salpetriere de novembre 2011 a novembre 2013. Resultats Au temps initial, 25 % des patients presentaient une AV superieure a 5/10. Au cours du suivi, cette proportion a augmente a 45 % a M1, 49 % a M6 et 48 % en fin de suivi. Il n’y avait pas de difference significative en termes de gain d’AV entre les 3 groupes. Les reductions d’EMC moyennes par rapport a j0 (soit un gain d’une ligne logarythmique en log-OCT) etaient toutes statistiquement significatives. De facon generale, on a observe une amelioration d’epaisseur maculaire de 88 % a M1, 61 % a M6 et 60 % en fin de suivi, significative a chaque temps (p = 0,001) Il n’a pas ete retrouve de difference significative entre les 3 groupes. Un comparatif des delais de recidive anatomique et visuelle a ete realise sans difference. La plus forte augmentation de TIO a ete observee a M1 statistiquement differente par rapport aux autres temps. Discussion Les injections intra- et peri-oculaires sont a considerer comme un traitement adjuvant, car la majorite des pathologies considerees necessitent un traitement general de fond. Elles permettent d’avoir des concentrations intra-vitreennes plus efficaces avec moins d’effets systemiques. Conclusion A terme, nous n’avons pas demontre de reelle superiorite d’un des 3 traitements. Il n’y a pas eu de difference de tolerance entre les 3 groupes non plus.

PURPOSE: Ranibizumab is used in the treatment of choroidal neovascularization (CNV). Although systemic exposure to ranibizumab is low after ocular administration, its mechanism of action must be regarded as potentially teratogenic and embryo-fetotoxic. Women are advised to wait 3 months after the last dose of treatment with ranibizumab before conceiving. Little is known about the fetal side-effects of this drug. METHODS: Three pregnant women were treated with ranibizumab. One patient had idiopathic CNV. RESULTS: After receiving injections at 10 and 21 weeks after her last menstrual period (LMP), she gave birth to a healthy child. The second patient had myopic choroidal neovascularization (mCNV) and was treated by a single injection at 17 weeks post LMP. She gave birth to a healthy child after an uneventful pregnancy. The third patient had CNV secondary to a punctuate inner choroiditis. The injection was performed at 8 weeks post LMP. This patient presented a cholestasis of pregnancy at 36 weeks post LMP and gave birth at 38 weeks post LMP to a child that did not present any malformations. CONCLUSIONS: This case series describes three women who underwent intravitreal ranibizumab treatment during pregnancy without showing any obstetric, embryofetal or neonatal complications.

Purpose: The aim of this study was to further explore the efficacy and safety of interferon-α in refractory non-infectious inflammatory macular edema and to compare interferon-α2a and pegylated interferon-α2b.Methods: 34 patients with refractory non-infectious uveitic macular edemaunder interferon-α were retrospectively reviewed.Results: Mean baseline best-corrected visual acuityimproved from 0.55 logMar to 0.37 logMAR (P < 0.001) at month (M) 1 and 0.40 logMAR (P < 0.001) at M6. The mean baseline CMT decreased from 554 µm to 367 µm (P < 0.001) at M1 and 394 µm (P < 0.001) at M6. Clinical adverse effects (AEs) were observed in a third of patients, leading to treatment discontinuation because of frequent mild AEs and few severe AE. No statistically significant difference was found between both molecules.Conclusions: Anatomically and functionally, interferon-α was rapidly effective despite a low dosage regimen and no difference in efficacy and tolerance was observed between interferon-α2a and pegylated interferon-α2b.

Purpose Immune checkpoint inhibitors (ICI) targeting the programmed cell death protein 1 (PD-1), or its ligand PD-L1, are the mainstay of metastatic cancer treatment. Patients receiving these treatments may develop immune-related adverse events (irAEs). This study aimed to estimate the prevalence and describe the clinical patterns of moderate-to-severe ocular irAEs-associated with anti-PD-(L)1 treatment. Design Prospective case series. Methods This study included patients recruited via (1) a single-center prospective cohort and (2) a national pharmacovigilance registry between June 2014 and March 2018, and focused on patients with moderate-to-severe ocular irAEs following anti-PD-(L)1. All patients underwent a comprehensive ophthalmologic assessment. The main outcome measure was the prevalence of moderate-to-severe ocular irAEs. Results Of a total of 745 patients included in the prospective cohort, 3 developed moderate-to-severe ocular irAEs, providing a prevalence of 0.4% and an incidence of 0.7 per 1000 patient-months of treatment. An additional 5 cases of moderate-to-severe ocular irAEs were reported through the national registry. From these 8 patients, 5 presented with intraocular inflammation, 2 with ocular surface disease, and 1 with orbital myopathy. Five patients (62.5%) experienced additional extraophthalmologic irAEs. Ocular irAEs led to permanent discontinuation of anti-PD-(L)1 in 4 patients. Treatment by local and/or systemic corticosteroids allowed resolution or control of the ocular symptoms in 7 of 8 patients. Conclusion Although uncommon, anti-PD-(L)1-associated ocular complications may be sight-threatening and lead to discontinuation of anti-PD-(L)1 treatments. Patients complaining of eye problems while receiving ICI treatment should immediately be seen by an ophthalmologist.

Controlling long-term inflammation during non-infectious intermediate, posterior or panuveitis while limiting side effects remains challenging. There is no standardized pre-therapeutic evaluation providing diagnostic certainty, but some simple tests allow us to identifiy the main etiologies. The ophthalmologist identifies the type of uveitis, and the internist completes the investigations according to the ophthalmologist's findings. Fundus photographs, optical coherence tomography, and fluorescein and indocyanine green angiography should be considered during diagnosis and follow-up. Ocular complications of uveitis are numerous. They require close monitoring and specific medical and sometimes surgical management. The growing number of available drugs makes it possible to optimize the management of these conditions with varied etiologies and presentations. Currently, systemic corticosteroids remain the mainstay of therapy, and other alternatives are considered in the case of poor tolerance, steroid resistance or dependence. The choice of a systemic, periocular or intravitreal treatment depends on several factors: chronicity or recurrence of uveitis, duration, bilaterality, association with a systemic inflammatory disease, the presence of contraindications to certain treatments, and also socioeconomic constraints. It is of the utmost importance to find the best compromise allowing tight control of ocular inflammation by means of adapted systemic and/or local treatment while avoiding the main complications.

Purpose: To date, no protocol of anesthesia for pediatric ophthalmic surgery is unanimously recognized. The primary anesthetic risks are associated with strabismus surgery, including oculocardiac reflex, postoperative nausea and vomiting, and postoperative pain. Methods: This was a prospective, monocentric, observational study conducted in a tertiary pediatric ophthalmic unit. Our anesthetic protocol for strabismus surgery included postoperative nausea and vomiting prevention using dexamethasone and ondansetron. No drug-based prevention of oculocardiac reflex or local/locoregional anesthesia was employed. Results: A total of 106 pediatric ophthalmic surgeries completed between November 2015 and May 2016 were analyzed. The mean patient age was 4.4 (range: 0.2–7.3, standard deviation: 2.4) years. Ambulatory rate was 90%. Oculocardiac reflex incidence was 65% during strabismus surgery (34/52), 50% during congenital cataract surgery (4/8), 33% during intramuscular injection of botulinum toxin (1/3), and 0% during other procedures. No asystole occurred. Postoperative nausea and vomiting incidence was 9.6% after strabismus surgery (5/52) and 0% following the other procedures. One child was hospitalized for one night because of persistent postoperative nausea and vomiting. Postoperative pain generally occurred early on in the recovery room and was quickly controlled. Its incidence was higher in patients who underwent strabismus surgery (27%) than in those who underwent other procedures (9%). Conclusion: Morbidity associated with ophthalmic pediatric surgery is low and predominantly associated with strabismus surgery. The benefit–risk ratio and cost-effectiveness of oculocardiac reflex prevention should be questioned. Our postoperative nausea and vomiting rate is low, thanks to the use of a well-managed multimodal strategy. Early postoperative pain is usually well-treated but could probably be more effectively prevented.

Resume Introduction La syphilis peut se presenter sous de nombreuses formes ophtalmologiques. L’objectif principal de notre etude etait de preciser les elements diagnostiques, therapeutiques et pronostiques des cas de syphilis oculaire. Patients et methodes Nous avons analyse retrospectivement les cas d’uveites syphilitiques vues au CHU de Nantes de 2000 a 2013. Resultats Vingt-sept patients ont ete inclus avec une moyenne d’âge de 53,1 ans. L’uveite etait plus frequemment bilaterale (67 %). Le delai moyen du diagnostic apres les premiers symptomes etait de 2,8 mois. Trois patients presentaient une uveite anterieure (11 %) et 24 une atteinte posterieure, panuveite ou papillite (89 %). Les presentations cliniques les plus frequemment observees etaient l’atteinte papillaire (44 %), la choroidite multifocale (33 %) ou un foyer chorio-retinien (37 %). Quatre-vingt-treize pour cent des patients ont beneficie d’un traitement par benzathine penicilline en intraveineux, un patient a ete traite par injections intramusculaires et un autre patient par ceftriaxone intramusculaire. L’atteinte oculaire a permis de faire le diagnostic de syphilis dans 25 cas (93 %) et de seropositivite VIH chez 3 patients (11 %). Quarante et un pour cent des patients ont beneficie d’un traitement adjuvant par corticoides. Le traitement a ainsi permis une amelioration visuelle de –0,48 log MAR ( p p = 0,33). Conclusion Nous n’avons pas objective de difference significative de prise en charge ni de resultats entre le groupe VIH seropositif et seronegatif. Les autres etudes divergent a ce sujet. La frequence de l’atteinte ophtalmologique et l’augmentation de l’incidence de cette pathologie montrent l’interet d’un depistage systematique en cas d’uveite.

A growing number of articles have shown the negative impact of strabismus on self image, relationships with others and professional life. The AS-20 is a standardized questionnaire in English measuring the psychosocial impact of strabismus in adults. The goal of this study is to validate the AS-20 in the French language.Three hundred and ninety one patients took part in the study: 131 had strabismus (group 1), 128 other ocular diseases (group 2) and 132 "normal" patients (group 3).The AS-20 scale showed good psychometrical properties in 2 or 4 dimensions: internal consistency was very good (Cronbach's alpha coefficient0.9 in all dimensions and overall) and the reproducibility was satisfactory (intra class coefficient0.7). The comparison of the scores in the 2 dimension scale showed significant differences between the groups (P0.001): lower score in strabismus (63.9±18.3) than in other ocular diseases (73.5±17.8) and normal group (89.4±12.0) (divergent validity). The 4 dimension psychometric analysis was performed by removing 2 items and grouping the 18 others in 4 groups. It confirmed the divergent and convergent validity, internal consistency and reproducibility of the scale. The results of the confirmatory factor analysis were better with the 4 dimension scale than the 2 dimension scale (adjustment coefficients0.9).We now have access to a health related questionnaire in French to quantify the impact of strabismus on quality of life and measure the results of treatment.

Triamcinolone acetonide (Kenacort) is a corticosteroid that can be administrated by subconjunctival injection, with an extended release for up to three months. Our retrospective study aims to analyze safety and efficacy of subconjunctival triamcinolone injections in the treatment of uveitic macular edema. We included 31 eyes of 30 patients, who had one or several injections. We studied the progression of visual acuity, central macular thickness by optical coherence tomography (OCT), intraocular pressure, and presence or absence of cataract, on the day of injection (T0), and at 1, 3, 6 and 12 months after injection. Twenty-one patients had only one injection; 10 patients had 2. The 12-month follow-up showed an improvement in visual acuity with an initial mean of 0.36 ± 0.27 logMAR to 0.23 ± 0.33 logMAR at 3 months of follow-up (P

The area of uveitis is related to numerous pathological entities. One of the main causes of decreased visual acuity in these patients is macular edema. One aspect of the treatment includes cortosteroids used peri- and intra-ocularly.The goal of our work was to estimate the criteria of efficacy (on improvement in visual acuity and macular edema, as well as time to recurrence) and safety (on intraocular pressure and cataract) of these various routes of administration of corticosteroid after a single injection. We compared patients treated with OzurdexAt presentation, 25 % of the patients displayed VA better than 5/10. During follow-up, this proportion increased to 45 % at M1, 50 % at M3, 49 % at M6 and 48 % at the end of follow-up. There was no significant difference between the groups with respect to VA gain. The reductions in mean CMT compared with D0 were all statistically significant (improvement of one line in log-OCT). We observed an improvement in macular thickness of 88 % at M1, 86 % at M3, 61 % at M6 and 60 % at the end of follow-up, significant at each time, with no significant difference between the three groups. A comparison of time to anatomic vs. functional recurrence was performed, showing no difference. The largest increase in IOP was observed at M1, statistically different from the other time points.Intra- and periocular injections should be considered as an adjuvant therapy, since the majority of the conditions in question require systemic treatment. They allow for increased intravitreal concentrations with fewer systemic effects.We demonstrated neither any true superiority of any of the 3 treatments nor any difference in tolerability between the 3 groups.

Air quality studies need to be based on accurate and reliable data, particularly in the field of the emissions. Biogenic emissions from forests, crops, and grasslands are now considered as major compounds in photochemical processes. Unfortunately, depending on the type of vegetation, these emissions are not so often reliably defined. As an example, although the silver fir ( Abies alba ) is a very widespread conifer tree in the French and European areas, its standard emission rate is not available in the literature. This study investigates the isoprene and monoterpenes emission from A. alba in France measured during the fieldwork organised in the Fosse Rhenan, from May to June 2003. A dynamic cuvette method was used. Limonene was the predominant monoterpene emitted, followed by camphene, α-pinene and eucalyptol. No isoprene emission was detected. The four monoterpenes measured showed different behaviours according to micrometeorological conditions. In fact, emissions of limonene, α-pinene and camphene were temperature-dependant while eucalyptol emissions were temperature and light dependant. Biogenic volatile organic compounds emissions were modeled using information gathered during the field study. Emissions of the three monoterpenes previously quoted were achieved using the monoterpenes algorithm developed by Tingey et al. (1980) [Tingey D, Manning M, Grothaus L, Burns W. Influence of light and temperature on monoterpene emission rates from slash pine. Plant Physiol 1980;65: 797–801.] and the isoprene algorithm [Guenther, A., Monson, R., Fall, R., 1991. Isoprene and monoterpene emission rate variability: observations with eucalyptus and emission rate algorithm development. J Geophys Res 26A: 10799–10808.]; [Guenther, A., Zimmerman, P., Harley, P., Monson, R., Fall, R., 1993. Isoprene and monoterpene emission rate variability: model evaluation and sensitivity analysis. J Geophys Res 98D: 12609–12617.]) was used for the eucalyptol emission. With these methods, simulation results and observations agreed fairly well. The standard emission rate (303 K) and β -coefficient averaged for limonene, camphene and α-pinene were respectively of 0.63 μg g dw −1 h −1 and 0.06 K −1 . For eucalyptol, the standard emission rate ( T =303 K and PAR=1000 μmol m −2 s −1 ) was 0.26 μg g dw −1 h −1 . This classified A. alba as a weak monoterpenes emitter.

Syphilis may manifest as several distinct ophthalmological forms. The main objective of our study was to describe the diagnostic, therapeutic data and prognosis of ocular syphilis.We retrospectively analysed the cases of syphilitic uveitis diagnosed in the University Hospital of Nantes between 2000 and 2013.Twenty-seven patients were included in our study. Their mean age was 53.1 years. Bilateral uveitis was the most frequent clinical presentation (67%). The average diagnostic delay after the first symptoms was 2.8 months. Three patients (11%) presented with an anterior uveitis and 24 (89%) with a posterior uveitis, panuveitis or papillitis. The most frequent clinical signs were papillar lesion (44%), multifocal choroiditis (33%) and chorio-retinitis (37%). Ninety-three percent of the patients were treated with benzathine penicillin intravenously, one patient was treated by intramuscular penicillin injections and another by ceftriaxone intramuscularly. Ocular manifestations alone were sufficient to make the diagnosis of syphilis in 25 patients (93%) and of HIV seroconversion in 3 patients (11%). Forty-one percent of the patients benefited from an adjuvant therapy with corticosteroids. The treatment allowed a visual improvement of -0.48 log MAR (P0.0001) with an average reduction of retinal central thickness of 70.2 μm (P=0.33).We did not find a significant difference neither in management nor in results between the HIV seropositive and HIV seronegative groups. Others studies remains controversial about this aspect. The increased frequency of ocular manifestation as well as the increase of syphilis makes systematic screening in uveitis of a great value.

Introduction La proliferation melanocytaire uveale bilaterale diffuse (PMUBD) est un syndrome paraneoplasique rare et grave, connu des ophtalmologistes, caracterise par une baisse de l’acuite visuelle bilaterale due a une proliferation melanocytaire benigne choroidienne. Une minorite de patients presentent des lesions cutaneo-muqueuses pigmentees mal decrites dans la litterature. Observations Un homme de 74 ans consultait en ophtalmologie pour une baisse d’acuite visuelle bilaterale evoluant depuis 3 semaines et une alteration de l’etat general depuis 3 mois. Il n’avait pas d’antecedent et ne prenait aucun traitement. L’examen au fond d’œil et angiographique montrait plusieurs lesions pigmentees choroidiennes associees a une hyalite et un decollement sereux retinien bilateral. Le reste de l’examen clinique trouvait des lesions pigmentees punctiformes sur l’ensemble des teguments predominant aux levres, aux organes genitaux externes et sur l’anus. Le scanner thoraco-abdomino-pelvien decouvrait une masse renale droite suspecte. L’examen histologique d’une lesion pigmentee du dos montrait une proliferation melanocytaire intra-epidermique jonctionnelle et thecale, discretement atypique. Le diagnostic de syndrome paraneoplasique de type PMUBD etait pose. Discussion La PBMUD est un syndrome paraneoplasique rare (40 cas rapportes dans la litterature exclusivement ophtalmologique) caracterise par une proliferation melanocytaire choroidienne entrainant un epaississement de la choroide et des plages jaunes orangees au niveau de l’epithelium pigmentaire sur l’angiographie a la fluoresceine. Le pronostic ophtalmologique est mauvais : un decollement sereux retinien et une cataracte d’apparition rapide sont les principales complications observees. Le syndrome PMUBD est rapporte le plus souvent chez des patients atteints de stades avances de carcinomes (notamment les cancers ovariens chez la femme et les cancers du poumon chez l’homme). Les signes peuvent preceder de 3 a 12 mois le diagnostic du cancer. Les lesions cutanees associees sont peu decrites dans la litterature et sont probablement sous-diagnostiquees. Comme l’illustre notre observation, il s’agit de naevus eruptifs de localisations particulieres (organes genitaux, levres, anus). Notre observation est originale par le caractere tres profus des lesions cutaneo-muqueuses. Les mecanismes induisant cette proliferation melanocytaire sont encore mal connus mais tres recemment, une proteine serique de type IgG capable de stimuler la proliferation melanocytaire in vitro a ete mise en evidence chez quelques patients atteints de PMUBD. Un traitement par plasmapherese semble ainsi avoir apporte un benefice clinique net chez quelques patients diagnostiques precocement. Conclusion La PBMUD est un syndrome paraneoplasique oculocutane caracterise par une baisse de l’acuite visuelle et des naevus eruptifs cutaneo-muqueux.

Silylphosphanes 3 and 4 gave 1,4-additions with the O=C-C=C moiety of oxazolones 1a-e and 2a-f to afford the adducts 5–8. Oxidation or sulfuration of 5–8 followed by hydrolysis led to oxyphosphorus (or thiophosphorus) amido-acids 9–11 and 15, 19, 20 respectively. A great difference was observed in the behaviour of thiophosphane oxides 16 (R = Me) and 17(R = Ph) toward hydrolysis: 16 led directly to the amido-acid 19 by opening of the lactonic ring whereas, from 17, the heterocyclic intermediate 18 could be isolated.

Triamcinolone acetonide (Kenacort) is a corticosteroid that can be administrated by subconjunctival injection, with an extended release for up to three months. Our retrospective study aims to analyze safety and efficacy of subconjunctival triamcinolone injections in the treatment of uveitic macular edema. We included 31 eyes of 30 patients, who had one or several injections. We studied the progression of visual acuity, central macular thickness by optical coherence tomography (OCT), intraocular pressure, and presence or absence of cataract, on the day of injection (T0), and at 1, 3, 6 and 12 months after injection. Twenty-one patients had only one injection; 10 patients had 2. The 12-month follow-up showed an improvement in visual acuity with an initial mean of 0.36 ± 0.27 logMAR to 0.23 ± 0.33 logMAR at 3 months of follow-up (P0.0004), and to 0.24 ± 0.21 logMAR at 12 months (P=0.0371), for a two-line improvement. A decrease in mean central macular thickness was measured by OCT, from a mean of 444 ± 112 μm (0.24 ± 0.11 logSD-OCT) at T0 to 355 ± 103 μm (0.14 $ ± 0.10 logSD-OCT) at 3 months (P=0.0002). We did not find a significant increase in intraocular pressure, and we diagnosed one cataract during follow-up but this occurred in the uninjected eye as well. Subconjunctival injection of triamcinolone acetonide is a safe and effective treatment of macular edema related to uveitis. Initial clinical monitoring is necessary to detect iatrogenic events.