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To evaluate diagnostic and therapeutic practices and then establish a consensus on the management of ocular toxoplasmosis in France through a Delphi study.Twenty-three French experts in ocular toxoplasmosis were invited to respond to a modified Delphi study conducted online, in the form of two questionnaires, in an attempt to establish a consensus on the diagnosis and management of this pathology. The threshold for identical responses to reach consensus was set at 70 %.The responses of 19 experts out of the 23 selected were obtained on the first questionnaire and 16 experts on the second. The main elements agreed upon by the experts were to treat patients with a decrease in visual acuity or an infectious focus within the posterior pole, to treat peripheral lesions only in the presence of significant inflammation, the prescription of first-line treatment with pyrimethamine-azithromycin, the use of corticosteroid therapy after a period of 24 to 48hours, the prophylaxis of frequent recurrences (more than 2 episodes per year) with trimethoprim-sulfamethoxazole as well as the implementation of prophylactic treatment of recurrences in immunocompromised patients. On the other hand, no consensus emerged with regard to the examinations to be carried out for the etiological diagnosis (anterior chamber paracentesis, fluorescein angiography, serology, etc.), second-line treatment (in the case of failure of first-line treatment), or treatment of peripheral foci.This study lays the foundations for possible randomized scientific studies to be conducted to clarify the management of ocular toxoplasmosis, on the one hand to confirm consensual clinical practices and on the other hand to guide practices for which no formal consensus has been demonstrated.

The digital revolution, which has been underway since the 1980's, is disrupting our daily routines with an exponential increase in the use of screens, which has not been without consequence to our visual system. Digital eye strain (DES), or computer vision syndrome (CVS), includes all the visual symptoms secondary to the use of digital devices. DES is present in at least 50% of regular users of digital media and is defined by blurred vision, difficulty focusing, ocular irritation or burning, dry eye, visual fatigue, headaches and increased sensitivity to light. Exposure time, age, female gender, and work environment are the main factors increasing its prevalence. Its pathophysiology, still poorly understood, is felt to be multifactorial and includes disturbances in the accommodative-convergence balance and changes in the ocular surface. Regarding accommodation and convergence, the studies are mostly old and their results heterogeneous. Conversely, many studies have shown an increase in the prevalence of dry eye in screen users. Although the retinal toxicity of blue light has been proven in in vitro models, the low level of evidence in the available studies does not allow it to be clearly correlated with the symptoms of DES. The objective of this review is to condense the knowledge available in the literature on the symptoms, prevalence, pathophysiology and management of DES.

The association of visual and auditory impairments, simultaneously or consecutively, is a rare condition at the onset of neurological diseases. To determine whether audiovisual impairment can be associated with a specific group of neurological disorders at onset, we performed a prospective study of 307 patients over 6 months in a specialized neurological unit in inflammatory diseases. Six patients (2%) experienced inaugural audiovisual impairments. The mean age of patients at onset was 39.5 ± 14.7 years, with a male:female ratio of 1:2. Both deficiencies were reported in three cases, including loss of visual acuity with tinnitus (two cases) or hearing loss (one case). Initial visual dysfunction, characterised by loss of visual acuity, was noted in one patient. Initial auditory impairment, characterised by dizziness and hearing loss, was noted in two patients. The mean interval between the occurrence of visual and auditory impairments was 3.8 ± 4.3 months. A neurological diagnosis was made in four cases (67%) at a mean time of 4.6 ± 4.6 months after disease onset. Visual impairments were optic neuritis for multiple sclerosis, serous retinal detachment for Vogt-Koyanagi-Harada's disease, a central retinal artery occlusion for Susac's syndrome and a retinal vasculitis for Cogan's syndrome. The systematic investigation of inaugural audiovisual impairment in young patients could help shorten the time to a specific neurological diagnosis.

Purpose Retina surgery is an increasingly performed procedure for the treatment of a wide spectrum of retinal pathologies. Methods Yet, as most micro-surgical techniques, it requires long training periods before being mastered. To properly answer requests from clinicians for highly realistic training on one hand, and new requirements from accreditation or recertification from surgical societies on the other hand, we propose to develop a high-fidelity training system for retinal surgery. Results This simulator will be built upon our strong scientific expertise in the field of real-time simulation, and a success story for technology transfer in the field of cataract surgery simulation. Conclusions Members of the consortium have a long expertise in the development of prototypes, as well as collaboration with clinical partners. The simulation system that we propose to develop will be based on the Open Source simulation platform SOFA, and will rely on expertise from our partners to ensure clinical and industrial relevance.

High myopia (HM), which affects 0.9 to 3.1% of the population, is a major cause of vision loss. The purpose of this investigation was to study and evaluate the impact of their high myopia on the daily lives of patients and to better understand their expectations in order to better meet their needs.The survey was conducted between February 19 and March 21, 2014. To be eligible, patients had to have myopia of at least -8 diopters and be over 40 years of age, with or without myopic complications. Patients' degree of myopia was defined as the optical prescription of their worse eye. The 123 patients included were interviewed by phone using a questionnaire developed and validated by a scientific committee composed of experts and members of the patients' Association against myopic maculopathy (AMAM). The phone interview, semi-structured, lasted 20 minutes.On average, myopia was -11.7 diopters. Women accounted for 71% of the population, 89% of patients were under 65 years and were mostly professionals (65%). Over half of the subjects reported myopic complications; 5% of patients had choroidal neovascularization (CNV). Only 29% had been informed of the risk of CNV or maculopathy. HM was a handicap in sports for 64% of patients, in leisure activities for 51%, and in professional activities for more than a quarter (28%). Only 56% of HM patients reported living perfectly well with their condition.This survey is the first study on the daily life of people with HM aiming to analyze their social and emotional environment. It shows that HM has a profound impact on the daily lives of patients and may affect social life and professional activity. Most myopic patients possess incomplete or unclear information about the nature and risk of myopic complications. They expressed the desire to be better informed about their condition earlier, before the onset of complications.

Objectifs Prise en charge diagnostique et therapeutique des pseudo-uveites associees au lymphome de type MALT. Patients et methodes Nous rapportons les cas de trois patients adresses pour une baisse visuelle profonde evoluant sur un mode aigu ou chronique. Ils presentaient tous une uveite ou une sclerite cortico-resistante. Il s’agissait respectivement d’une uveite posterieure associee a une infiltration retinochoroidienne, d’une sclerite anterieure associee a un syndrome d’effusion uveale et d’une pan-uveite bilaterale associee a des decollements sereux retiniens. Deux des patients avaient un antecedent de pathologie maligne systemique. Les trois patients ont eu un bilan etiologique complet. La recherche des etiologies infectieuses, auto-immunes ou malignes etait infructueuse mais l’imagerie orbitaire mettait en evidence un epaississement scleral posterieur. Resultats Le diagnostic de lymphome oculaire de type MALT a ete pose dans les trois cas apres biopsie des lesions sclerales. Les analyses immunohistochimiques mettaient en evidence un infiltrat lymphocytaire scleral de type CD20+ et CD5-. Les trois patients ont ete traites par cure de chimiotherapie associees a une radiotherapie. Les lesions ont ete stabilisees chez le premier patient alors qu’une amelioration de l’acuite visuelle de six lignes chez le deuxieme et une guerison totale chez le troisieme ont ete notees apres traitement. Discussion Les manifestations cliniques de cette atteinte oculaire semblent etre tres variees, mimant differents types d’uveite posterieure ou de sclerite. Dans ces trois cas, nous n’avons pas retrouve d’atteinte muqueuse associee. Le diagnostic repose entierement sur l’examen anatomopathologique. La recuperation visuelle rapide dans deux cas demontre l’importance d’un diagnostic precoce et d’un traitement specifique. Toute uveite posterieure totale, chronique et cortico-resistante impose une analyse radiologique specialisee suivie, le cas echeant, d’une biopsie orbitaire etagee.

In recent years, intravitreal injections have added to the treatment modalities available for macular edema (ME) secondary to retinal vein occlusion (RVO). This article aims to provide an update regarding the management of ME secondary to RVO.A work group met in order to analyze the literature available on Embase/PubMed, regarding treatments for venous occlusion that have received market approval and are reimbursed in France. In total, 33 articles were selected. Consensus within the group for recommendations was based on this data from the literature review and clinical experience and was reported in this article.The management of ME secondary to branch retinal vein occlusion (BRVO) or central vein occlusion of the retina (CRVO) differs on a number of points. Methods of best practice were discussed separately for BRVO and CRVO, taking into account various ocular and associated parameters.Ranibizumab and dexamethasone implant are the first-line treatments for visual impairment due to ME secondary to RVO. The choice of either of these drugs may take into account various ocular and extraocular parameters. A change of treatment to one or the other or to laser may also be considered during follow-up.

For many years, the intraocular lymphatic system and particularly the drainage of the aqueous humor by this system have been considered non-existant. Our study is the first to demonstrate, in a dynamic in vivo fashion, the existence of lymphatic drainage in the mouse eye. This has become possible with lymphoscintigraphy with nano-molecules of rhenium sulphide, marked by technetium-99m and injected into the anterior chamber of the mouse eye. Readings were taken using an experimental gamma camera specially built for the small animal. The hypothesis of a "uveolymphatic" drainage pathway within the ciliary body, contributing to aqueous outflow, has recently been highlighted by new improvements in microbiology (discovery of lymphatic endothelial-specific markers) and imaging. This new pathway may lead to many prospects: the development of techniques for visualization and quantification of this in vivo lymphatic flow may help to increase our understanding of the physiopathology and perhaps treatment of chronic glaucoma as well as neoplastic conditions.

To report anatomical and functional results of choroidal melanoma treated by protontherapy between 2001 and 2011 and to compare these with data reported in the literature.The present study is a retrospective review of the charts of patients presenting with choroidal melanoma, managed at Strasbourg University Medical Center between 2001 and 2011, and receiving protontherapy. Visual acuity and a complete ophthalmologic examination, including intraocular pressure, dilated fundus exam, and ultrasonography with measurement of the major diameter of the tumor, were performed prior to treatment and at various follow-up visits (every six months for five years, then once a year for ten years). The rates and timing of local complications (cataract, rubeosis, retinal detachment, neovascular glaucoma and secondary enucleation) and systemic complications (metastasis) are also reported.Seventy charts were included. Mean age of the treated population was 61.4 ± 15.2 years. Male/female ratio was 1.06. Mean visual acuity, 0.55 ± 0.6 (20/67) on presentation, decreased progressively from month 42. Mean tumor thickness was 5.8 ± 2.8mm and major diameter 11.2 ± 2.9 mm. Decreased tumor thickness was noted beginning at month 12 of follow-up (Anova, P0.0001), while major diameter remained unchanged over time (P0.05). The risk of complications (retinal detachment, rubeosis, neovascular glaucoma) was greater between the second and third year. Mean 5-year survival was 87.5%. The rate of secondary enucleation was 8.5%.Protontherapy most often allows for preservation of the globe. Visual loss, often significant and permanent, is frequent.

To assess the efficacy of early injection of intravitreal triamcinolone acetonide (IVTA) versus delayed injection for macular edema from retinal vein occlusion.This was a retrospective monocentric study. Forty-four patients received an IVTA (4 mg) for macular edema resulting from central retinal vein or branch retinal vein occlusion. The patients were assigned to two groups: group 1 consisted of patients who received an IVTA less than 6 weeks after the diagnosis of macular edema, while group 2 consisted of patients who received the injection more than 6 weeks after. All patients underwent a comprehensive ophthalmological examination before the injection and 1, 3, and 6 months after. Each visit included best-corrected visual acuity measurement (BCVA), slit lamp examination, intraocular pressure measurement, fundus examination and central macular thickness (CMT) measurement by OCT.The two groups were comparable in terms of age, sex-ratio, and the percentage of branch retinal vein occlusion (54 and 61% in groups 1 and 2, respectively). In group 1, the BCVA (logMAR) was 0.87 before the IVTA and significantly improved at 1 and 3 months (0.46 and 0.48, respectively; P0.05) before worsening at the 6-month visit (0.62; P0.05). The mean CMT was also significantly improved (from 567 μm before the injection to 276, 307, and 386 μm at the 1-, 3-, and 6-month visits, respectively) (P0.05 at 1 and 3 months). In group 2, there were no significant differences in visual acuity at any time point (0.86 before the IVTA, 0.76, 0.76, and 0.78 at the 1-, 3-, and 6-month visits; P0.05). The CMT was reduced after the injection from 552 μm to 294, 446, and 456 μm at the 1-, 3-, and 6-month visits, respectively (P0.05 at 1 month).Patients with macular edema due to retinal vein occlusions, who received a single intravitreal injection of triamcinolone acetate less than 6 months after the diagnosis, displayed both anatomical and functional improvement, whereas patients injected more than 6 weeks after the diagnosis of macular edema showed a CMT reduction but with less improvement in visual acuity. The difference observed at 1 month disappeared after 6 months.

The association of visual and auditory impairments, simultaneously or consecutively, is a rare condition at the onset of neurological diseases. To determine whether audiovisual impairment can be associated with a specific group of neurological disorders at onset, we performed a prospective study of 307 patients over 6 months in a specialized neurological unit in inflammatory diseases. Six patients (2%) experienced inaugural audiovisual impairments. The mean age of patients at onset was 39.5 ± 14.7 years, with a male:female ratio of 1:2. Both deficiencies were reported in three cases, including loss of visual acuity with tinnitus (two cases) or hearing loss (one case). Initial visual dysfunction, characterised by loss of visual acuity, was noted in one patient. Initial auditory impairment, characterised by dizziness and hearing loss, was noted in two patients. The mean interval between the occurrence of visual and auditory impairments was 3.8 ± 4.3 months. A neurological diagnosis was made in four cases (67%) at a mean time of 4.6 ± 4.6 months after disease onset. Visual impairments were optic neuritis for multiple sclerosis, serous retinal detachment for Vogt-Koyanagi-Harada's disease, a central retinal artery occlusion for Susac's syndrome and a retinal vasculitis for Cogan's syndrome. The systematic investigation of inaugural audiovisual impairment in young patients could help shorten the time to a specific neurological diagnosis.

The correlation between intraocular pressure (IOP) and age is poorly studied in children. Thus, the aims of our work are to determine the IOP and central corneal thickness (CCT) standards in children from 0 to 10 years of age and to examine the possible relationship between IOP, CCT and age.Three hundred and twenty eyes of 160 healthy subjects were examined between October 2007 and February 2009 under general anesthesia for eye muscle surgery. Three groups were analyzed: 0 to 2 years (n=30), 2 to 6 years (n=68) and older than 6-year-old (n=62). Measurement procedures included Perkins tonometry and contact pachymetry.The mean IOP increased progressively with age (P0.001). Caucasian children had higher IOP than non-Caucasian children (P0.05). Gender and side were not significantly associated with IOP. There was no significant difference in CCT between the three groups of age. None of the following parameters were significantly associated with CCT: ethnicity, gender and side.Correlation between IOP and CCT remains unclear during childhood. False reassurance might result if high IOP measurements are inappropriately adjusted downward in children with increased CCT.

microbial keratitis is a significant health concern for the one million wearers of contact lenses and their ophthalmologists, with some potentially modifiable risk factors. The number of risk factors for contact lens-related microbial keratitis has been described, but many of them still remain assumed or unknown. a multicenter prospective case-control study was conducted in 12 French university hospitals (Besançon, Bordeaux, Dijon, Fort-de-France, Grenoble, Limoges, Lyon, Nancy, Nantes, Paris, Marseille and Strasbourg) beginning in July 2007 on contact lens wearers presenting with microbial keratitis and on healthy contact lens wearers. Patients and healthy wearers were interviewed using a 51-item anonymous standardized questionnaire to determine subject demographics and contact lens wear history. two hundred and fifty-six patients with microbial keratitis were included. One hundred and thirteen healthy contact lenses wearers were surveyed. Cosmetic contact lens wear highly increased the relative risk (RR) of microbial keratitis (RR, 16.5). Time since the last visit to an ophthalmologist longer than 1 year (RR, 3.4) or prescription by someone other than an ophthalmologist (RR, 7.6) also increased the risk of microbial keratitis. Education on lens care and handling was deficient (hand washing: RR, 2.2; rub and rinse: RR, 2.7). a standardized questionnaire is a powerful tool to determine risk factors for contact lens-related microbial keratitis, but also to analyze individual mistakes in contact lenses use and care.

Diabetic retinopathy should be carefully monitored during certain risk situations. Indeed, diabetic retinopathy in pregnant type 1 diabetic patients can rapidly progress and threaten vision, as in other situations such as puberty, glycemic equilibration, or ocular surgery. During pregnancy, five major risk factors for progression have been identified: pregnancy itself, diabetic retinopathy grade at baseline, duration of diabetes, important glycated hemoglobin reduction, and high blood pressure. These factors must be taken into account when planning pregnancy in diabetic patients and during the follow-up of their diabetic retinopathy. Diabetic women should be counseled about the risks of progression of their disease before planning pregnancy. Careful eye examination before and during the first trimester should be done in these patients, in order to detect severe non-proliferative diabetic retinopathy and/or high-risk diabetic retinopathy and perform rapid laser treatment if needed. Follow-up visit frequency should be adapted to the severity of the diabetic retinopathy. Very few authors have studied diabetic macular edema during pregnancy. This complication can spontaneously regress postpartum and should not be treated too rapidly.

Cases of a spontaneous scleral rupture are very uncommon. Their diagnosis can be challenging because the scleral lesion might be invisible on clinical examination. We describe herein one case revealed by hypotony maculopathy. A 30-year-old woman presented with severe visual loss in one eye caused by sudden hypotony. Funduscopy revealed a chorioretinal coloboma in the periphery of the retina associated with a hypotony maculopathy. Extensive work-up included optical coherence tomography (OCT), fluoroangiography, ultrasonography, and magnetic resonance imaging examinations. A search for infectious and inflammatory diseases was conducted. Inflammatory and infectious work-ups were not contributive. A surgical exploration was performed, which showed a spontaneous scleral perforation within the coloboma. A patch of polytetrafluoroethylene was sutured on the damaged sclera and air was injected into the vitreous cavity. Vision and ocular pressure were rapidly restored. Spontaneous scleral rupture cases associated with hypotony and visual loss are rare, with only a few cases reported in the literature. Hypotony maculopathy with sclerochoroidal lesion may be the cause of such cases. Excellent outcome can be obtained with surgical diagnosis and repair.

To study the OCT (optical coherence tomography) features of cases of unexplained macular edema, which were not combined with fluorescein leakage on angiography.We report a retrospective series of three patients who presented with visual acuity impairment due to unilateral macular thickening visible on OCT examination. All eyes studied underwent OCT and angiography and electrophysiological examinations. None of the patients had a medical record and none of the eyes studied was highly myopic.OCT profiles shared characteristics of myopic foveoschisis or X-linked retinoschisis. No fluorescein leakage was detected on angiography. The electrooculogram was impaired in one eye while other electrophysiological investigations were normal in all eyes.Most frequently, macular edemas are associated with a fluorescein leakage on angiography. Macular edemas without angiographic leakage may correspond to unilateral idiopathic retinoschisis or macular edemas, with an atypical mechanism of intraretinal fluid accumulation.

Diagnostic and therapeutic management of masquerade syndromes associated with MALT-type lymphoma.We report the cases of three patients referred for acute or chronic severe loss of visual acuity. All of them suffered from uveitis or scleritis resistant to corticoid treatment. Each one had posterior uveitis associated with retinochoroidal infiltration, anterior scleritis associated with uveal effusion syndrome, or bilateral pan-uveitis associated with serous retinal detachment. Two patients had medical records of systemic malignancies. They underwent an extensive work-up. Search for an infectious, immune or malignant disease was negative but orbital imaging showed a posterior scleral thickening in all cases.Diagnosis of mucosa-associated lymphoid tissue (MALT) ocular lymphoma was assessed in all cases after scleral biopsy. Immunohistochemical analysis showed CD20(+) and CD5(-) scleral lymphocyte infiltrates. The three patients underwent chemotherapy associated with radiotherapy. Lesions were stabilized in the first case, whereas six lines of visual acuity improvement was noted in the second one, and full recovery was achieved after treatment in the third case.Clinical manifestations of this ocular lesion seem to be multiple, masquerading as different types of posterior uveitis or scleritis. In the three cases, we did found other systemic locations of MALT-type lymphoma. Diagnosis was mainly based on pathological analysis. Fast visual recovery in two cases demonstrated the importance of an early diagnosis and a specific treatment. All cases of chronic and corticoid-resistant posterior uveitis require a specialized radiological evaluation followed, if necessary, by multiple orbital biopsies.

This paper completes the proof of the feasibility of passive ocean acoustic tomography (OAT) by using the Cramer Rao bounds (CRB) tool. CRB are calculated on a shallow environment modeled by a homogeneous layer over a semi infinite sediment layer. The results are that considering relative delays instead of absolute delays degrades the estimation of ocean parameters. Taking into account the spatial structure (angles of arrival) enables one to improve performances of passive OAT and have similar performances as soon as accuracy of physical parameter estimations are conserved than active OAT for absolute delays only.

The aim of this study was to hormonally induce lactation in prepubertal, nulliparous, and male goats both transgenic and non-transgenic. Analysis of milk quality, recombinant protein expression levels, total amount of recombinant protein produced, and the affect on long-term reproductive capability was assessed. Fifty-one goats (Saanen, Alpine, and Toggenburg), male and non-pregnant females, 2-31 months of age, either non-transgenic or transgenic were evaluated with a total of 10 transgenes (constructs) represented. Animals were given estradiol (0.25 mg/kg, i.m.) and progesterone (0.75 mg/kg, i.m.) on days 1, 3, 5, 7, 9, 11 and 13, while prednisilone (0.4 mg/kg, i.m.) was administered on days 14-16 with mammary massage occurring daily from day 5 onward. Forty of 51 animals, (36 of 38 females and 4 of 13 males) produced milk with total volumes in the 30-day experiment, ranging from 20 microl to 530 mls per day, or approximately 500 microl to 6.8 liters total. Milk composition was analyzed for various parameters (total protein, fat content, total solids and somatic cell count) with no significant differences found between induced and natural milk. Expression levels of recombinant proteins from transgenic animals that were analyzed during the induced lactation, and subsequently during normal lactations, were found to have no significant differences. Total amount of recombinant protein produced was evaluated at different expression levels with no statistical significance seen. While over 90% of the females placed in the regimen became pregnant, there was a correlation between increased age at time of induction and an increase in number of breedings, or reproductive cycles needed to establish a pregnancy after induction. For males, 100% placed in the regimen settled females after hormonal induction of lactation. Semen quality was evaluated prior to, during, and after hormonal treatments. Semen volume and sperm number did not differ; however, for a small percentage of males, there was a decrease in sperm and post thaw motility after hormonal treatments. These levels returned to normal within 4-5 weeks. Subsequent natural lactations showed total milk volumes within breed standards. These findings indicate that hormonal induction of lactation in the caprine species is a viable alternative to pregnancy for initiating lactation and milk production, does not adversely impact reproductive performance long-term, and can benefit the early assessment of recombinant proteins produced in a transgenic founder program.

The system of mental health services has reached a turning point Two reforms and numerous developments have left their mark on society as well as on available services. Today, it appears necessary to refocus intervention around an integration of the life of individuals living in society, who suffer from a mental handicap. The author's approach isolates the concept of trajectory, defined as the result of a progressive decline of opportunities to live fully. Consequently, the trajectory leads the individual into unproductive environments from the point of view of both social integration and utilization of services. Examined are the possible causes and the mechanisms of such a diminution in order to fuel the debate on the purpose of intervention and the organization of services.