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Conventional immunosuppressive drugs, anti-TNF alpha and other biotherapies used in clinical practice are capable of controlling non-infectious anterior uveitis, posterior uveitis and panuveitis. The present work has been led by a multidisciplinary panel of experts, internists, rheumatologists and ophthalmologists and is based on a review of the literature. In case of corticodependency or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or anti-TNF alpha (adalimumab, infliximab) are used to achieve and maintain remission. Interferon is an efficient immunomodulatory treatment, as a second-line therapy, for some therapeutic indications (refractory macular edema, Behçet's vascularitis). Other biologics, especially tocilizumab, are showing promising results. Local treatments (corticosteroids, sirolimus etc.) are adjuvant therapies in case of unilateral inflammatory relapse. Therapeutic response must be evaluated precisely by clinical examination and repeated complementary investigations (laser flare photometry, multimodal imaging, perimetry, electroretinography measures).

Q-switched lasers operating in the nominally eye-safe 2 μm wavelength region are important for applications such as material processing, medicine, LIDAR systems, and pumping of optical parametric oscillators based on ZnGeP 2 or periodically poled GaAs. Many of these benefit from wavelengths above 2.05 μm, which are not accessible by the actually widely used Tm-lasers. The long upper laser level lifetime and large energy storage capacity makes Ho-doped crystals very attractive for these applications. In band pumping of singly doped Ho-crystals around 1950 nm enables high laser efficiencies and reduced heat generation inside the laser crystal due to the low quantum defect. Optically pumped semiconductor disk lasers (OPSDL) based on GaSb could be an attractive and compact pump source. These OPSDL can be pumped with cheap laser diodes around 976 nm or 1470 nm and built up in simple and robust setups. In the wavelength range around 2 μm cw output powers up to 17 W have been demonstrated at room temperature [1].

The (AlGaIn)(AsSb) material system has been shown to be ideally suited to realize VECSELs for the 2-3 μm wavelength range. In this report we will present results on increasing the output power of the SDL chips with special emphasis on the 2.8 μm emission wavelength by means of low quantum defect pumping. Further on we have investigated concepts for a VECSEL-pumped Q-switched Ho:YAG laser in order to convert the high cw-power of the VECSEL into pulses with a high peak power. Up to 3.3 mJ of pulse energy were achieved with a compact setup (corresponding to a peak power of 30 kW at 110 ns pulse length) combined with stable pulsing behavior.

Resume L’incidence du melanome de l’uvee et en particulier du corps ciliaire est tres faible chez le sujet noir, y compris chez l’Antillais. Lorsqu’il est symptomatique, il se manifeste par une baisse ou des troubles de l’acuite visuelle, tres rarement par la douleur. Nous rapportons un cas de melanome du corps ciliaire interessant a double titre : sa survenue chez une femme antillaise et son mode de revelation : celui d’une uveite recidivante, hypertone puis normotone, sans baisse d’acuite visuelle. Devant toute uveite y compris chez le melanoderme, il faut toujours eliminer une tumeur du corps ciliaire apres dilatation pupillaire.

Primary cutaneous mucinous carcinoma, a tumor of the sweat glands, is a rare tumor localized to the eyelid in 40% of cases. We report a case of a primary cutaneous mucinous carcinoma of the upper eyelid in a 53-year-old Caucasian male who appeared to have a chalazion. Histology showed rows and lobules of epithelial cells with discretely anisonucleotic nuclei and few mitotic figures scattered throughout the tumor cells, surrounded by a mucoid substance. Immunohistochemical analysis was cytokeratin 7 positive and cytokeratin 20 negative, and imaging and endoscopic screening were negative for metastasis, favoring the diagnosis of primary cutaneous mucinous carcinoma. Despite a high recurrence rate of about 35%, this type of tumor displays an indolent course, and metastatic spread is very rare.

Using the (AlGaIn)(AsSb) material system, VECSELs covering the 2 – 3 μm wavelength range can be realized. The best laser performance of GaSb-based VECSELs was achieved so far at emission wavelengths around 2.0 μm with a slope efficiency of more than 30 %, a low threshold pump power density of 1.1 kW/cm2 at 20°C heatsink temperature and concomitant a high output power exceeding 7 W in CW operation (depending on the mounting technology). These parameters were degrading significantly for longer wavelength devices emitting around 2.5 μm and 2.8 μm. But for applications like the generation of MWIR light (3-8 μm) by pumping ZGP-OPOs, high-power VECSELs around 2.5 μm are required to suppress absorption losses, while for medical laser treatment, high-power operation near the water absorption peak at around 2.9 μm is desirable. We will present results of our ongoing research strand for further optimization of the semiconductor heterostructure design of ≥ 2.5 μm emitting GaSb-based VECSELs. By using a low quantum deficit design (i.e. optical pumping at around 1.5 μm) in combination with highly strained QWs (compressive strain 2.1 %) we were able to realize a 2.5 μm emitting VECSEL with a slope efficiency above 30 %, corresponding to an external quantum efficiency exceeding 50 %, and a low threshold pump power density of 0.8 kW/cm2. These values are as good as those for the best performing 2.0 μm VECSELs. With a frontside SiC heatspreader and operated in a standard linear cavity, over 7 W of CW output power were achieved for this 2.5 μm emitting VECSEL structure when operated at 20°C. Furthermore, we will compare laser structures with different emission wavelengths and discuss the role of the QW strain, band-offset and active region composition on laser performance.

We demonstrate for the first time to our knowledge a Q-switched Ho:YAG laser in-band pumped by a 1.9 μm semiconductor disk laser (SDL). 3.3 mJ of pulse energy were achieved in a compact setup.

A gallium antimonide-based semiconductor disk laser (SDL) emitting 17 W of continuous wave output power at a heat sink temperature of 20°C and an emission wavelength of 2.02 μm are presented. This high-output power is achieved by optimising the thermal management and reducing the quantum deficit of the SDL structure.

Purpose We aimed to evaluate long-term efficacy of interferon alpha 2a (IFNα2a) in severe Behcet disease(BD)-related uveitis. Methods Our retrospective study includes all patients with severe uveitis treated with IFNα2a for at least 18 consecutive months at Pitie Salpetriere Hospital between 05/1995 and 07/2013. Before, during and after treatment, best corrected visual acuity (VA), ophthalmologic examination and fluorescein angiography were performed to evaluate the number of acute uveitis. The main evaluation criteria was the number of uveitis relapses per person per year before, during and after treatment. Results 33 patients, 12W/21M, with a mean age of 30,5 years and with mainly panuveitis (74.2%) were included. The mean observation period was 8,82 years. We followed 33, 25, 20 and 18 patients for 2, 4, 7 and 9 years respectively. The relapse rate decreased from 1,36 before treatment to 0,045 relapses/patient/year during IFNα treatment. After IFNα discontinuation (possible for 64% of all patients), it increased to 0,057 relapses/patient/year and the mean period between discontinuation and relapse was 24.2 months. Average VA improved from 0,49 to 0,27 and from 0,55 to 0,39 LogMar for the patients with a followed-up of 4 and 9 years respectively. During 4 years following IFNα2a initiation, we observed rapid decrease of anterior inflammation, hyalitis, vasculitis, macular and papillary edema. Mean oral prednisone consumption decreased from 22,8 mg at IFN initiation to 5,5 mg per day at 9 years. Conclusion IFNα2a is efficient to treat severe BD-related uveitis. For initial responders allowing discontinuation of IFNα2a, the long-term remission was confirmed with our study.

Purpose Swept source OCT (SS-OCT) is currently the best visualization technique of the choroid. The aim of our study is to describe its thickness and vascular structures in patients with choroiditis. Methods We have completed a choroidal map with SS-OCT, using 12-mm horizontal vertical scans through the macula, for a group of patients with choroiditis, referred to Pitie Hospital, from October 2012 to March 2013. Results Eight patients have been included with a sex ratio of 1, an average age of 56.5 years : 5 birdshot retinochoroidopathies (BRC), 1 multifocal choroiditis , 1 Vogt-Koyanagi-Harada (VKH) disease, 1 acute posterior placoid chorioretinitis concomitant with a syphilitic seroconversion. In four active BRC, the average choroidal thickness was increased to 339 µm (389 µm ±41.93), among whom one BRC patient experienced a decrease of 30 µm in choroidal thickness immediately after corticotherapy. On the contrary the fifth patient, an advanced form of BRC, showed signs of atrophy with a choroidal thickness of 194 µm. Choroidal thickness in the VKH patient was unchanged in both eyes. There was a significant asymmetry in the patient with syphilitic chorioretinitis, with a choroidal thickness of 334 µm in the affected eye versus 387 µm in the contralateral eye. Yet, we observed that Haller’s layer of the affected eye was harder to visualize, due to possible inflammatory infiltrations Conclusion These choroidal maps are among the first choroiditis cases explored by SS-OCT, first step of a mapping project which we wish to amplify in order to determine a possible threshold of choroidal thickness indicating a subclinical relapse. This could make SS-OCT an additional tool besides ICG angiography for the exploration of the choroid.

Introduction Notre objectif est d’evaluer l’efficacite a long terme de l’interferon alpha pour le traitement de l’uveite severe associee a la maladie de Behcet. Patients et methodes Dans cette etude retrospective, ont ete inclus tous les patients souffrant d’une uveite severe associee a la maladie de Behcet resistante aux immunosuppresseurs conventionnels et/ou a des doses de corticoides > 10 mg/j et traites par interferon alpha a la Pitie-Salpetriere entre mai 1995 et juin 2013. Tous les patients ont ete initialement traites par interferon alpha a la dose de 3 millions d’unites internationales (MUI) 3 fois par semaine, augmentee a 6 MUI 2 fois par semaine en cas de rechute ou arrete en cas d’examen clinique stable. Avant, pendant et apres traitement, pour chaque patient, ont ete systematiquement effectues la mesure de la meilleure acuite visuelle corrigee, un examen ophtalmologique complet, une OCT et une angiographie a la fluoresceine a intervalles reguliers afin de caracteriser et de quantifier le nombre d’episodes inflammatoires. Resultats Trente-six patients, d’âge moyen egal a 30,5 ans, 13 femmes et 23 hommes, principalement atteints de panuveite (75 %) ont ete inclus. La periode moyenne d’observation a ete de 8,2 ans. Parmis ces 36 patients, 33, 25 et 18 patients ont ete suivis respectivement pendant 2, 4 et 9 ans. Sur 36 patients (67 yeux), 31 (86,1 %) ont ete repondeurs a l’interferon. Vingt et un des 36 patients ont pu l’arreter et 76 % d’entre eux n’ont jamais rechute en moyenne 5 ans apres. L’incidence des rechutes a significativement diminue de 1,39 a 0,0496 (p = 1,82*10^-10) et a faiblement re-augmente a 0,057 rechutes/personne/an respectivement avant, pendant et apres la periode de traitement par interferon alpha. La duree moyenne entre l’arret de l’interferon et la premiere rechute a ete de 24,2 mois. Sur la periode de suivi, l’acuite visuelle est restee stable ou s’est amelioree pour 90,3 % des patients. Durant les 4 ans suivant l’initiation de l’interferon, nous avons observe une diminution rapide de l’inflammation oculaire et en particulier de la prevalence des vascularites, des œdemes maculaires et des papillites. Conclusions L’interferon alpha semble efficace pour traiter les uveites severes associees a la maladie de Behcet. La possibilite d’une remission a long terme pres arret de l’interferon alpha pour les patients repondeurs semblent etre confirmee par notre etude.

The incidence of uveal melanoma, in particular that of the ciliary body, is very low in black people, including West Indians. When symptomatic, it manifests as decreased or impaired visual acuity and seldom, if ever, pain. We report a case of ciliary body melanoma that is of scientific interest for two reasons: 1) a West Indian melanoderm patient being affected, 2) presentation as a recurrent uveitis with a transient increase of intraocular pressure, and without any decline in visual acuity. We recommend that in any case of uveitis, black patients included, a ciliary body tumor should always be excluded by pupillary dilation.

Primary cutaneous mucinous carcinoma, a tumor of the sweat glands, is a rare tumor localized to the eyelid in 40% of cases. We report a case of a primary cutaneous mucinous carcinoma of the upper eyelid in a 53-year-old Caucasian male who appeared to have a chalazion. Histology showed rows and lobules of epithelial cells with discretely anisonucleotic nuclei and few mitotic figures scattered throughout the tumor cells, surrounded by a mucoid substance. Immunohistochemical analysis was cytokeratin 7 positive and cytokeratin 20 negative, and imaging and endoscopic screening were negative for metastasis, favoring the diagnosis of primary cutaneous mucinous carcinoma. Despite a high recurrence rate of about 35%, this type of tumor displays an indolent course, and metastatic spread is very rare.

We report on novel low-noise QWIP focal plane arrays (FPAs) which allow us to improve the thermal resolution of infrared sensors in the long-wavelength infrared (LWIR) atmospheric window. Our concept uses detector structures with a small photoconductive gain in order to achieve simultaneously a high internal quantum efficiency and a small responsivity. In comparison to conventional QWIPs where each period consists of a quantum well and a thermionic barrier, our approach involves additionally a combination of a narrow quantum well and a tunnel barrier. Due to these additional layers, a high emission probability of the photoexcited carriers and an efficient capture into the ground subband of the subsequent period are simultaneously achieved. FPA cameras using these detectors show an extremely low noise- equivalent temperature difference (NE(Delta) T) and a high dynamic range. In particular, NE(Delta) Ts of only 7.2 mK and 5.2 mK (at 20 ms and 40 ms integration time, respectively) are observed for a 256x256 FPA camera system which we have realized using low-noise QWIPs. This value is the best temperature resolution ever obtained for thermal imagers operating in the LWIR.