Search

Resume Introduction Le but de cette serie est d’evaluer le pronostic visuel et general de patients atteints d’endophtalmies endogenes. Materiel et methodes Notre etude a recueilli les donnees de 20 endophtalmies de 2012 a 2015 au CHU de Toulouse. Les criteres d’inclusion etaient la presence d’une inflammation du segment anterieur et du vitre associee a la presence d’une infection prouvee par confirmation microbiologique locale ou systemique ou bien associee a une origine infectieuse fortement suspectee. Etaient releves pour chaque patient : les acuites visuelles initiales et finales, le traitement, les prelevements realises, les portes d’entrees infectieuses et les complications. Resultats L’âge moyen etait de 67 ans (± 43,3 ans) avec une majorite d’homme (n = 11). La porte d’entree infectieuse a ete retrouvee dans 14 cas (87,5 %). Onze endophtalmies bacteriennes et 5 fongiques. L’acuite visuelle finale etait a « l’absence de perception lumineuse » dans 7 cas (35 %), « voit bouger la main » dans 2 cas (10 %), « compte les doigts » dans 3 cas (15 %) et 10/10 dans 2 cas (10 %) et un cas sans donnee finale. Les portes d’entree infectieuses ou localisations septiques associees retrouvees principalement etaient l’endocardite (n = 7) et l’infection sur voie centrale ou porte d’entree veineuse (n = 6), Les complications locales principales etaient les suivantes : decollements de retine (n = 6) cataractes (n = 5) et neovaisseau choroidien sur cicatrice (n = 2). Conclusions Les endophtalmies endogenes sont associees a un pronostic visuel sombre. Elles sont aussi souvent associees a des complications generales engageant le pronostic vital.

Resume Dans les pays developpes, la degenerescence maculaire liee a l’âge (DMLA) est la premiere cause de cecite et de malvoyance des sujets âges, dont elle represente la moitie des cas. Il faut distinguer la maculopathie liee a l’âge (MLA), qui est le stade debutant, des formes averees de DMLA, representees par les formes exsudatives et atrophiques. La MLA (caracterisee par la presence de drusen) et la DMLA atrophique necessitent une surveillance ophtalmologique reguliere. La DMLA exsudative implique une prise en charge ophtalmologique associant suivi rigoureux et injections intravitreennes tres frequentes d’agents anti-VEGF. L’hematome maculaire sous-retinien, pouvant compliquer ces formes exsudatives, est un evenement dont le pronostic est tres pejoratif. Son traitement repose sur la chirurgie dont le but est d’obtenir le deplacement du sang sous-retinien hors de la region maculaire ; la chirurgie doit etre suivie d’une surveillance accrue car les recidives neovasculaires sont frequentes.

Resume Objet Identifier les cas d’obliterations veineuses retiniennes (OVR) bien perfusees revelees par un blanc periveinulaire (BPV) isole et decrire les circonstances diagnostiques et l’evolution a court terme. Materiel et methodes Serie monocentrique, observationnelle, retrospective de cas recueillis entre janvier 2013 et janvier 2015. Parmi les 151 cas d’occlusions veineuses retiniennes suivis dans le service, nous avons recherche la presence de BPV isole ayant amene au diagnostic d’occlusion veineuse retinienne. Resultats Nous avons identifie huit patients pour lesquels un diagnostic de BPV isole avait revele une OVR non ischemique (3,9 %) : 5 presentaient une occlusion de veine centrale de retine, trois une occlusion d’hemi-veine centrale et aucun une occlusion de branche. L’acuite visuelle initiale etait conservee dans cinq cas sur huit. Dans tous les cas, le BPV apparaissait isole, sans hemorragie retinienne initiale. Les cliches monochromatiques bleus visualisaient tous les BPV. Il existait sur les examens tomographiques en coherence optique (OCT) une hyper-reflectivite segmentaire et focale des couches internes retiniennes, particulierement de la nucleaire interne. A un mois du diagnostic, il etait note une atrophie des couches retiniennes initialement interessees par l’hyperreflectivite initiale. Trois cas sur huit ont ete malencontreusement initialement diagnostiques comme une obliteration de l’artere centrale de la retine (OAR). Conclusion La complication principale du BPV est l’atrophie localisee des couches internes retiniennes a l’origine de scotomes paracentraux. Le diagnostic differentiel avec une OAR, parfois difficile initialement, repose sur les caracteristiques angiographiques et tomographiques en coherence optique et leur evolution.

Resume Introduction Le decollement de retine (DR) est une pathologie potentiellement cecitante. La rapidite de prise en charge est un facteur pronostique majeur. Nous avons etudie le delai de prise en charge chirurgicale des decollements de retine et analyse les facteurs pouvant l’influencer. Methode Enquete transversale, multicentrique, realisee sur 6 mois. Critere principal : delai separant diagnostic et chirurgie. Critere secondaire : delai separant premiers signes et chirurgie. Facteurs etudies : les caracteristiques sociodemographiques et cliniques, la distance domicile/centre chirurgical et presence d’un week-end. Resultats Nous avons inclus 159 patients. Le delai moyen diagnostic-chirurgie etait de 4,4 jours ± 12,3 (2,7 ± 4,3 pour les DR Conclusion Le delai de prise en charge des DR est relativement court dans la region Midi-Pyrenees, meme si nous avons pu constater un retard diagnostique relativement frequent, notamment chez les DR Macula-OFF, peut-etre en raison de la meconnaissance des symptomes par le patient et des difficultes d’acces aux consultations specialisees. Aucune relation n’a ete mise en evidence entre ce delai et la distance separant le domicile du patient du lieu de prise en charge.

Resume Introduction La chirurgie de la cataracte est une candidate ideale a une prise en charge ambulatoire. En 2013, au CHU de Toulouse, le taux de chirurgie ambulatoire concernant la phacoemulsification etait de 75,8 %. Cette etude a ete menee afin d’identifier les obstacles qui limitent le developpement de la pratique ambulatoire de la chirurgie de la cataracte dans notre etablissement. Materiel et methodes Pour cette etude retrospective, tous les sejours incluant un acte de phacoemulsification (code CCAM : BFGA004) realise au CHU de Toulouse en hospitalisation traditionnelle en 2013 ont ete inclus. Nous avons exclu les sejours pour lesquels les dossiers medicaux, infirmiers et anesthesiques, ainsi que les fiches correspondantes de programmation operatoire, etaient incomplets. Les sejours ont ete classes selon le motif d’hospitalisation et selon le type de chirurgie, cataracte geste principal ou cataracte geste combine. Resultats Notre etude a porte sur 298 sejours avec un âge moyen des patients de 66,8 ± 16,8 ans et un sex-ratio homme/femme de 0,76. L’indication d’hospitalisation traditionnelle relevait de motifs sociaux, chirurgicaux et anesthesiques dans les proportions respectives suivantes : 41, 34 et 8 % des cas. Les echecs de la prise en charge en ambulatoire representaient 7 % des cas. L’isolement social representait 89 % des motifs sociaux. Lors d’une chirurgie combinee, le motif etait chirurgical dans 89 % des cas. Conclusion Le developpement de la chirurgie ambulatoire implique tous les acteurs de la filiere. En particulier, la prise en compte du facteur social est un element essentiel impliquant une prise en charge adaptee. Au niveau chirurgical, le changement des pratiques pour developper la chirurgie ambulatoire de la cataracte doit cibler en priorite les chirurgies combinees.

The purpose of this case series was to evaluate both the visual and systemic prognosis of patients with endogenous endophthalmitis.We reported a series of 20 cases of endogenous endophthalmitis occurring between 2012 and 2015 at the university medical center in Toulouse.The mean age was 67 (±43.3) years with a male predominance (n=11). The site of entry was found in 14 cases (87.5%). In 11 cases (69%), the causative agent was a bacterium; a fungal infection was found in five cases. Visual acuity after maximal medical and surgical treatment was limited to "no light perception" in 7 cases (35%), "hand motion" in 2 cases (10%), "finger counting" in 3 cases (15%) and 10/10 in 2 cases (10%). One case had no final data. The main site of entry was found to be associated endocarditis (n=7), central venous line or venipuncture (n=6). The main local complications were retinal detachment (n=6), cataract (n=5) and choroidal neovascularization secondary to scarring (n=2).Endogenous endophthalmitis is associated with poor visual prognosis. It is also often associated with systemic complications that may be life-threatening.

Resume Introduction La neuroretinopathie maculaire aigue fait partie des pathologies dites « a fond d’œil normal » : la discretion des signes cliniques et leur paucite peuvent faire parfois prendre cette pathologie pour une neuropathie optique. Nous presentons ici cinq cas cliniques de neuroretinopathie maculaire aigue, dont un retrospectif. Dans les cinq cas, le diagnostic a pu etre pose grâce a l’apport de l’imagerie multimodale combinant cliche infrarouge et OCT maculaire. Materiel et methodes Etude retrospective de cinq cas cliniques. Les meilleures acuites visuelles corrigees, initiale et finale, ainsi que les imageries infrarouge et OCT ont ete collectees pour tous les patients. Resultats Dans les cinq cas, il existait initialement une gene visuelle associee a une baisse plus ou moins severe de l’acuite visuelle. L’imagerie infrarouge montrait un aspect sombre et peri-foveolaires des lesions. Les cliches OCT montraient une atteinte systematique de la couche plexiforme externe sous la forme d’un epaississement et d’une hyperreflectivite qui s’etendait vers les couches les plus externes. Conclusion La neuroretinopathie maculaire aigue est une entite clinique de description ancienne pour laquelle l’apport des nouvelles technologies d’imagerie est immense, permettant un diagnostic plus precoce et plus precis, remettant en question le nom meme de la pathologie. La physiopathologie exacte de la maladie reste en revanche incompletement elucidee.

Summary Introduction Cat-scratch disease (CSD) is a systemic infectious disease. The most well-known posterior segment presentation is neuroretinitis with a macular star. In this study, we present a case series emphasising the heterogeneity of the disease and the various posterior segment manifestations. Materials and methods A retrospective case series of consecutive patients presenting with posterior segment CSD, over a 5-year period (2010 to 2015), at two ophthalmological centres in Midi-Pyrenees. Results Twelve patients (17 eyes) were included, of whom 11 (92%) presented with rapidly decreasing visual acuity, with 6 of these (50%) extremely abrupt. CSD was bilateral in 5 (42% of all patients). Posterior manifestations were: 12 instances of optic nerve edema (100%), 8 of focal chorioretinitis (67%) and only 6 of the classic macular edema with macular star (25% at first examination, but 50% later). Other ophthalmological complications developed in three patients; one developed acute anterior ischemic optic neuropathy, one a retrohyaloid hemorrhage and one a branch retinal artery occlusion, all secondary to occlusive focal vasculitis adjacent to focal chorioretinitis. Conclusion Classical neuroretinitis with macular star is not the only clinical presentation of CSD. Practitioners should screen for Bartonella henselae in all patients with papillitis or focal chorioretinitis.

To identify cases of non-ischemic retinal vein occlusion (RVO) presenting as isolated patchy perivenular retinal whitening and to describe diagnostic considerations and short-term natural history.Retrospective observational monocentric case series. Patients monitored in one center between January 2013 and January 2015. Among the 151 patients monitored in our center for retinal vein occlusion, we identified patients presenting with isolated patchy perivenular whitening revealing retinal venous occlusion.Eight patients presenting with isolated perivenular whitening revealing RVO were identified (3.9 %). There were five central retinal vein occlusions, three hemi-retinal vein occlusions and no branch retinal vein occlusions. Initial visual acuity was preserved in five out of eight cases. In all cases, patchy perivenular whitening was isolated, without retinal hemorrhage. Blue monochromatic photographs allowed visualization of patchy perivenular whitening in all cases. Optical coherence tomography (OCT) showed a focal and segmental hyper-reflective area in the inner retinal layers, especially in the inner nuclear layer. One month after diagnosis, atrophy was noted in the retinal layers showing initial hyper-reflectivity. Three cases of our series of eight were initially mistakenly diagnosed as central retinal arterial occlusion.The main complication of perivenular whitening is the atrophy of inner retinal layers responsible for paracentral scotomas. The differential diagnosis with retinal arterial occlusion, which may be difficult, is based on the angiographic and OCT features, and their progression.

Retinal detachment (RD) is a potentially blinding condition. Delay in management is a major prognostic factor. In our study, we analyzed the treatment delay for retinal detachments in the Midi-Pyrenees area, and factors which may influence it.Observational, cross-sectional, multicentric study, carried out over a 6-month period.time between diagnosis and surgery. Secondary outcome: time between first symptoms and surgery. Non-parametric tests were used to analyze the influence of sociodemographic features, clinical features, distance between home and surgical center, and occurrence over a weekend.One hundred and fiftty-nine patients were included. The mean time between diagnosis and surgery was 4.4 ± 12.3 days (2.7 ± 4.3 for recent RD, less than 1 month), and was increased by the presence of a weekend (P0.001), or of a weekend with public holiday (P=0.023), and by macular detachment (P=0.008). The mean time between first symptoms and surgery was 12.0 days and was increased by the absence of RD history (P=0.023), and by macular detachment (P=0.046). No association was observed between these times to surgery and the distance between the patient's home address and the place of surgery.The time between diagnosis and surgery was relatively short in the Midi-Pyrénées area, but we often noted a delayed diagnosis, which may be due to the patient's lack of awareness of the symptoms and difficult access to specialty consultations. However, no relationship was found between this time-to-surgery and the distance between the patient's home and the surgical center.

Cataract surgery is an ideal candidate for outpatient care. In 2013, in the Toulouse University Hospital, outpatient care rate for phacoemulsification was 75.8%. We conducted this study to identify the barriers that limit the development of outpatient cataract surgery in our establishment.A retrospective observational study was conducted. We included all patients who underwent phacoemulsification (Medical Act Code BFGA004) as a traditional inpatient in 2013. We excluded admissions for which the medical, anesthesia or nursing records, as well as scheduling sheets, were incomplete. Patients were classified according to the reason for inpatient hospitalization and the type of surgery: cataract as primary surgery or cataract as combined procedure.Two hundred and ninety-eight stays were included with a mean age of 66.8 ± 16.8 years, and a male/female ratio of 0.76. The indication for inpatient hospitalization was a social, surgical or anesthetic reason in the following respective proportions: 41, 34 and 8% of cases. Failure of ambulatory care represented 7% of cases. Social isolation represented 89% of social reasons. In a combined gesture, the reason was surgical in 89% of cases.Development of outpatient surgery requires the participation of all involved. Taking into account the social factors is an essential element for developing ambulatory surgery. Social isolation is a frequent situation requiring a societal response. With regard to surgical considerations, practice patterns must target outpatient combined procedures in particular.

Purpose Very low-density lipoprotein receptor mutant mice (Vldlr(-/-)) demonstrate retinal neovascularisation. Monoclonal antibody CL1-R2 recognizes human membrane receptor CD160, which is expressed on activated endothelial cells of neovessels but not in vessels of healthy tissues. In this study, we evaluated the therapeutic potential of CL1R2 antibody in Vldlr(-/-) mice as a model for exudative age-related macular degeneration and macular telangiectasia. Methods Thirty Vldlr(-/-) mice benefitted at postnatal day (P) 42 from retinal angiography. Mice population was then divided in three groups (ten mice per group). According to the groups, mice underwent intravitreal injection of CL1-R2 or Bevacizumab or control antibody. At P56, mice benefitted from angiography and were sacrificed. Results At P42, Vldlr(-/-) retinas presented with neovascular lesions. At P56, we observed decrease of neovascular lesions in eyes treated with CL1R2 antibody and with bevacizumab. This decrease of neovascular lesions was not observed in control mice. Conclusion CL1R2 antibody, as well as Bevacizumab, promotes the regression of pathologic retinal neovascularization in the Vldlr knockout mouse. As CL1R2 is an activator of NK cells, our result suggest that the activation of NK cells inhibits the development of Vldlr(-/-) mice retinal neovascularisation.

Acute macular neuroretinopathy is a retinal disease, usually presenting with a "normal fundus". Thus, this condition can be mistaken for optic neuropathy. Herein we present five clinical cases of patients affected with acute macular neuroretinopathy; one of them is a retrospective diagnosis while the others were diagnosed on initial examination. In the five cases, multimodal imaging with infrared photography and OCT helped to establish the diagnosis.Retrospective study of five clinical cases. Initial and final best visual acuities as well as infrared and OCT imaging were collected for all patients.All patients initially reported a visual disturbance associated with a more or less severe decrease in visual acuity. Infrared imaging showed a dark, perifoveolar appearance of the lesions. In all cases, OCT images showed thickening and hyperreflectivity of the outer plexiform layer, extending towards the outer retinal layers.Acute macular neuroretinopathy is a clinical entity that has been long-described, which now benefits widely from new imaging technologies, allowing an earlier and more accurate diagnosis, but calling into question the actual name of this condition. The exact pathophysiology of the condition remains nonetheless incompletely elucidated.