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Resume But L’objectif de cette etude etait d’evaluer l’efficacite et la securite d’utilisation de l’implant intra vitreen de dexamethasone (ID) chez les patients atteints d’œdeme maculaire diabetique (OMD) en vraie vie. Methodes Il s’agissait d’une etude monocentrique, retrospective, etudiant l’evolution apres injection d’ID de l’acuite visuelle et de l’epaisseur maculaire centrale (EMC) au pic d’efficacite (2 mois apres injection) ainsi que le rythme de reinjection et les complications chez des patients atteints de baisse de vision liee a un OMD. Resultats Quarante yeux de 33 patients etaient inclus avec une duree moyenne de suivi de 12,6 mois. 30 % des yeux ont presente un gain de leur meilleure acuite visuelle corrigee (MAVC) > 15 lettres pendant leur suivi au pic d’efficacite apres chaque injection d’ID (p 25 mmHg au pic d’efficacite, et 12,5 % des yeux ont necessite une chirurgie de la cataracte pendant le suivi. Conclusion L’ID a une bonne efficacite fonctionnelle et anatomique chez ces patients avec un bon profil de tolerance. Les patients naifs avec un OMD moins ancien ont un gain d’acuite visuelle (AV) plus prolonge apres les injections et une meilleure recuperation visuelle a 6 mois, ce qui encourage a initier un traitement par ID precocement en cas d’inefficacite des anti VEGF.

Ischemic microangiopathy was clearly identified in sickle cell disease (SCD) using fluorescein angiography. A prospective observational clinical study was conducted to assess the foveal avascular zone (FAZ) area and explore perifoveal microvasculature changes in the superficial (SCP) and deep (DCP) capillary plexus using optical coherence tomography angiography (OCTA) and compare two genotypes—HbS/HbS (HbSS) and HbS/HbC (HbSC)-to control. All consecutive patients with electrophoretic confirmation of SCD were included. Swept-source OCTA scans (Triton Plus, Topcon, Tokyo, Japan) with a 3 × 3-mm scanning area and ultra-wide field (UWF) retinography (California, Optos, Fife, Scotland) were recorded for all patients. For OCTA analysis, preset parameters were used to segment the SCP and DCP. The FAZ area was manually assessed. The number of vascular branching points was automatically assessed based on the vascular skeletonization using ImageJ software. Eyes were staged based on Goldberg’s classification of SCD retinopathy (SCDR) using UWF imaging. Forty-six eyes of 24 patients were included in the HbSS (n = 27) and HbSC (n = 19) groups and 16 eyes of 8 unaffected patients in a control group. In the DCP, the FAZ was significantly larger in the HbSC (p = 0.0001) and HbSS (p = 0.0004) groups compared to controls. The FAZ area in the SCP, CRT and number of superficial vascular branching points did not significantly differ between both genotypes. There were less branching points in the HbSC (p = 0.034) and HbSS (p = 0.0014) groups than in controls. The Goldberg stage was significantly higher in the HbSC group than in the HbSS group (2.21 vs. 1.22, p = 0.0062). OCTA provides useful information on macular microvasculature and structural alterations associated with SCDR. Ischemic abnormalities are more predominant in the DCP in case of SCDR and no difference was found between genotypes of patients visually asymptomatic.

Purpose: To report the real-world effectiveness and safety of ranibizumab 0.5 mg in patients with visual impairment due to diabetic macular edema (DME). Methods: This is a French, 36-month, multicenter, observational cohort study. Between December 2013 and April 2015, ophthalmologists enrolled diabetic patients aged ≥18 years with DME-related visual impairment and for whom ranibizumab 0.5 mg was initiated. Here, we present the 12-month results from this cohort. The primary endpoint was the mean change in best-corrected visual acuity (BCVA); sample size calculations were based on RESTORE trial data (BCVA mean change = 6.8 letters, precision = 0.7 letters). Secondary endpoints included the change in central subfield thickness (CSFT), number of visits, number of injections received, and frequency of ocular and nonocular adverse events and serious adverse events. Results: Between December 2013 and April 2015, a total of 290 patients with DME were enrolled by 84 ophthalmologists; 12-month data are available for 242 patients (due to low recruitment rates, precision was recalculated for 242 evaluable patients: the precision was then of 1.0 letters). Mean age (± standard deviation) was 66.1 ± 11.0 years and 56.6% were male. The mean baseline BCVA and CSFT were 59.2 letters (95% confidence interval [CI] 57.3, 61.0) and 457 μm (95% CI: 438, 476), respectively. At month 12, the mean gain in BCVA from baseline was 7.4 letters (95% CI: 5.4, 9.4), with 36.8% of patients with BCVA >70 letters versus 13.2% at baseline. Mean change in CSFT was −125 μm (95% CI: −146, −103). The mean number of ranibizumab injections was 5.1 ± 2.3 over an average of 10.4 ± 3.0 visits. No new safety findings were identified. Conclusions: The BOREAL study confirms the effectiveness and safety of ranibizumab for the treatment of DME-related visual impairment in routine clinical practice with fewer injections than reported in clinical trials.

Resume But Evaluer l’efficacite precoce lors du pic d’efficacite 2 mois apres injection d’un implant intra-vitreen de 0,7 mg de dexamethasone (OZURDEX ® ) chez des patients presentant une baisse d’acuite visuelle secondaire a un œdeme maculaire diabetique (OMD). Patients et methodes Etude retrospective et monocentrique. Les criteres d’inclusion etaient une meilleure acuite visuelle corrigee (MAVC) maximale ≤ 70 lettres ETDRS et une epaisseur retinienne centrale (ERC) ≥ 300 μm (Cirrus 2, Carl Zeiss Meditec, Inc, Dublin) secondaire a un OMD. Les patients inclus pouvaient etre naifs de tout traitement ou non (apres echec d’une photocoagulation au laser et/ou d’un traitement anti-VEGF). La duree du suivi etait d’au moins 6 mois. Notre critere de jugement principal etait le gain de MAVC a M2 apres injection. Les criteres secondaires etaient la meilleure acuite visuelle corrigee a 2 et 4 mois, l’epaisseur retinienne centrale a 2 et 4 mois, l’intervalle moyen entre 2 injections, ainsi que les effets secondaires du traitement. Resultats Dix-neuf yeux de 19 patients ont ete inclus dans cette etude. L’âge moyen etait de 67,45 ans, le sex-ratio etait de 2,17 hommes/1 femme et les patients etaient tous diabetiques de type 2. Trois patients sur 19 etaient naifs d’injection intra-vitreenne d’anti-VEGF et 52,3 % etaient pseudophaques (10 patients sur 19). Le gain de MAVC a M2 etait de +7,7 lettres. La MAVC moyenne etait de 51,1 lettres ETDRS a l’inclusion et 58,8 lettres a 2 mois (M2). L’ERC moyenne etait de 568,9 μm a l’inclusion et 291,2 μm a M2 (–277,7 μm). Une hypertonie ≥ 25 mmHg a ete retrouvee chez deux patients, traites et controles medicalement. Aucune chirurgie filtrante de glaucome n’a ete realisee. Conclusion L’implant intra-vitreen de dexamethasone (OZURDEX ® ) permet une amelioration anatomique et fonctionnelle chez les patients souffrant de baisse de vision en rapport avec un OMD. Dans cette serie, cet implant est bien tolere.

Purpose To assess the correlation between lens thickness (LT) measured by ultrasonography and duration of surgery as well as complications. Setting The study was conducted in a hospital in the Parisian suburb of Bobigny, France. Design A prospective and monocentric study was conducted. All patients undergoing surgery for hypermature cataract between January 2013 and March 2014 were included. Methods Morphological features, including LT, axial length, anterior chamber depth and vitreous length were assessed using A-scan ultrasonography. The other parameters assessed were the duration of surgery, occurrence of complications during surgery, visual acuity (VA) and corneal edema score one week after surgery. Results Thirty eyes of 29 patients were included. Mean LT was 4.11±0.64mm (median: 3.89mm). Mean surgery duration was 24.2±8.7min. Three patients experienced complications during surgery: 2 capsular breaks and 1 posterior lens dislocation. At one week, the mean decimal VA was 0.49±0.34 and the mean corneal edema score was 0.76±1.09. The Pearson correlation coefficient was r=0.27 (P>0.05) between LT and surgery duration while it was r=-0.53 (P=0.01) between VA and LT. No correlation was found for the other parameters studied. Discussion In this study, the linear correlation between LT and the surgery duration was low. The visual recovery at day 7 appeared inversely correlated with the LT. Conclusions LT did not seem to be a marker for longer surgery duration but appeared related to the visual recovery at one week.

Objectif : Evaluer les pratiques d’exercices dans l’œdeme maculaire diabetique (OMD) en France. Methodes : un questionnaire de 31 items a ete envoye a des retinologues membres de la Societe Francaise d’Ophtalmologie et du Club Francophone des Specialistes de la Retine. Les questions portaient sur leurs pratiques habituelles dans l’OMD au niveau diagnostic et bilan pretherapeutique, le choix et la strategie de mise en œuvre du traitement par injection intravitreenne (IVT). Resultats : Sur les 95 retinologues repondeurs, 25%, 36% et 32% d’entre eux instauraient un traitement de l’OMD a partir d’une acuite visuelle (AV) en dessous de respectivement 7/10e, 6/10e, et 5/10e. Les trois facteurs principaux influencant le choix du traitement etaient le gain d’AV, l’amelioration anatomique et la possibilite d’un suivi mensuel. Le traitement de premiere intention pour un OMD focal extra-central etait le laser focal pour 94%. Pour un OMD central chez le phaque, le ranibizumab, l’aflibercept et l’implant de dexamethasone etaient choisis en premiere intention dans respectivement 55,8%, 25,3% et 12,3% des cas considerant que tous les traitements ayant l’AMM etaient rembourses. Chez le pseudo-phaque, le ranibizumab, l’aflibercept et l’implant de dexamethasone sont choisis respectivement dans 41%, 16,5% et 35,6% des cas. 85% des specialistes commencaient par 3 IVT mensuelles d’anti-VEGF suivi d’une strategie en ProReNata (37%). 42% des specialistes ne prescrivaient pas d’antibioprophylaxie pour une IVT. Conclusion : Les anti-VEGF restent le traitement de premier choix dans l’OMD. Le niveau d’AV a partir duquel un traitement est introduit est meilleur que les 5/10E recommandes

The goal of this study was to investigate the safety and efficacy of the intravitreal dexamethasone implant (DI) for patients with diabetic macular edema (DME) in real life.We conducted a monocentric retrospective analysis of the change in visual acuity and central macular thickness (CMT) after intravitreal injection of the DI at peak efficacy (2 months after injection) as well as the timing of reinjections and complications in patients with a loss of vision due to DME.Forty eyes of 33 patients were included, with a mean follow-up of 12.6 months. Thirty percent of the eyes experienced an increase in best corrected visual acuity (BCVA)15 letters at peak efficacy (P0.05) after each ID injection. Treatment-naive patients had a sustained response after Ozurdex injection, with better visual acuity at 3 months (P=0.02) and 4 months (P=0.04) than non-naïve patients and better visual acuity at 6 months despite identical baseline visual acuity (P0.05). Anatomical efficacy was good, with approximately 60% of patients with CMT300 microns at peak efficacy after each injection of ID. Thirty percent of eyes demonstrated ocular hypertension (OHT)25mmHg at peak efficacy, and 12.5% of eyes required cataract surgery during follow-up.The DI has good functional and anatomic efficacy in these patients, with a good safety profile. Treatment-naïve patients with more recent DME had a more sustained increase in visual acuity after the injections and better visual recovery at 6 months. This encourages us to initiate DI therapy early if there is no response to anti-vascular endothelial growth factor (anti-VEGF) treatment.

Summary Purpose To assess in a real life setting the progression of central retinal thickness (CRT) during the first month after surgery in diabetic patients without previous diabetic macular edema (DME) and to identify potential risk factors for DME leading to increased postoperative follow-up. Methods We conducted a prospective study of diabetic patients without history of DME who underwent uncomplicated cataract surgery . Best-corrected visual acuity (BCVA) and SD-OCT were performed 7 days and 1 month after surgery. We assumed absence of preoperative DME when there was no edema of SD-OCT at D7. Our primary endpoint was the central retinal thickness (CRT) variation between 7 days and 1 month after cataract surgery in patients without previous history of DME. Results We included 55 eyes of 42 patients. BCVA was 0.57 ± 0.72 logMar (20/80) prior to surgery and increased significantly to 0.11 ± 0.17 (20/25) at one month (P = 0.001) post-surgery. The mean baseline CRT was 209 ± 35 μm and 229 ± 69 μm (P = 0.06) one month after surgery. Four eyes (7.4%) developed macular edema at one month. We found no linear correlation between HbA1C and CRT. Discussion/Conclusion We found no link between a high level of HbA1C and postoperative increase in CRT. We found that cataract surgery in diabetic patients without previous DME has no negative impact on CRT, and visual outcomes are good. We suggest that in diabetic patients without complete visual recovery at 1-month post-cataract surgery, OCT examination should be performed in order to detect an early stage of DME.

We assessed the relationship between visual acuity (VA) recovery and a qualitative criterion - complete retinal fluid resorption (CRFR) - among patients treated with ranibizumab for diabetic macular edema (DME) METHODS: All consecutive diabetic patients with central DME received a loading dose of 3 monthly injections of ranibizumab 0.5mg, followed by retreatments on an as-needed basis as determined by monthly follow-up. Patients were divided into 3 groups: CRFR (defined as a CRT300μm and restoration of the foveolar pit) with BCVA≤70 letters (group 1: G1), CRFR with BCVA70 letters (20/40) (G2), and persistent retinal fluid throughout the follow-up (G3).Forty eyes were included. Mean baseline VA was 48.7 letters and no patient had VA70 letters. Twenty-four (60%) eyes achieved CRFR: 12 (30%) in G1 and 12 (30%) in G2. In 16 patients (40%), the efficacy of the treatment was partial without CRFR (G3). At the time of the initial CRFR, VA was 57.4 letters in G1 (min-max: 30-65) and 77.5 letters in G2 (71-85). In G3, maximal VA during follow-up was 55 letters (25-70) and no patient achieved a VA70 letters.In this study, CRFR was required but not sufficient to achieve a VA70 letters.

Resume Introduction L’œdeme maculaire diabetique (OMD) est la principale cause de baisse d’acuite visuelle chez les patients diabetiques. Sa survenue est correlee a la duree d’evolution du diabete, a la qualite de l’equilibre glycemique et tensionnel et a la severite de la retinopathie diabetique (RD), ce qui necessite un acces aux soins optimise. Nous avons voulu etudier si l’œdeme maculaire diabetique etait plus severe en Seine-Saint-Denis, departement presentant a la fois un faible niveau moyen de revenu par habitant et une faible demographie medicale. Patients et methodes Nous avons inclus tous les patients diabetiques ayant un OMD traite par injections intra-vitreennes de ranibizumab et examines entre novembre 2012 et avril 2013. Afin d’apprecier la severite de l’OMD et la qualite de la prise en charge systemique du diabete, les parametres suivants ont ete recueillis : epaisseur maculaire centrale mesuree a l’OCT, acuite visuelle, stade de la retinopathie diabetique (RD), valeur de l’HbA1 C, duree d’evolution du diabete, type de diabete, traitement par insuline, antecedent de traitement ophtalmologique de l’OMD et comorbidites. Resultats Nous avons inclus 25 patients (8 femmes et 17 hommes) diabetiques de type 2 âges en moyenne de 64 ± 8,1 ans. L’epaisseur maculaire centrale moyenne etait de 523 ± 145 μm. L’acuite visuelle moyenne a l’inclusion etait de 45 lettres (Compte les doigts-70 lettres), 22 patients (88 %) presentaient une RD proliferante ou non proliferante severe. L’HbA1c moyenne etait mesuree a 7,8 (± 2,3 %). En moyenne, les patients etaient diabetiques depuis 13,1 ans. Dans 23 cas (92 %), le diabete etait associe a une hypertension arterielle et 64 % des patients etaient insulinorequerants. Discussion et conclusion Les patients diabetiques de cette serie presentent un OMD plus severe notamment en terme d’epaisseur maculaire centrale et d’acuite visuelle, que les patients issus des autres etudes publiees dans la litterature. Cette severite pourrait etre la consequence d’une prise en charge suboptimale de leur diabete. L’OMD pourrait donc etre un indicateur de sante temoin d’un acces aux soins limite.

Objectif Evaluer les modalites d’utilisation et l’efficacite en vie reelle du traitement par injection intravitreenne (IVT) de ranibizumab chez des patients presentant une baisse de l’acuite visuelle (BAV) due a un œdeme maculaire secondaire a une occlusion veineuse retinienne (OM-OVR) qu’elle soit de branche (B) ou centrale (C), a la demande de la Haute Autorite de sante. Methode Etude de cohorte observationnelle nationale de patients initiant un traitement par IVT de ranibizumab pour une BAV due a un OM-OVR, inclus et suivis pendant 24 mois par des retinologues. Le critere principal d’evaluation est la variation de la Meilleure acuite visuelle corrigee (MAVC) a six mois par rapport a l’inclusion. Les criteres secondaires sont la variation de la MAVC, celle de l’epaisseur de la zone centrale de la retine (ECR), la description des modalites du suivi ophtalmologique et les evenements indesirables au cours des 24 mois de suivi. Resultats Entre decembre 2013 et avril 2015, pour les cohortes B/C, 226/196 patients ont ete inclus dans l’etude et 162/139 (71,7/70,9 %) presentaient des donnees de suivi analysables a 24 mois. Les caracteristiques des patients etaient un âge moyen (e-t) de 70,9 ans (11,1)/70,4 (14,3) ans avec 48,7/51,5 % d’hommes, une MAVC moyenne a l’inclusion de 55,2 ans (18,7)/40,4 (25,6) lettres ETDRS et une ECR moyenne de 550 (175)/643 (217) μm. A 6 (± 1,5) mois de suivi, la variation moyenne de la MAVC [IC 95 %] par rapport a l’inclusion etait de +14,1 [11,7 a 16,5]/ + 9,5 [5,5 a 13,5] lettres. Cette evolution se stabilisait au cours du temps avec +13,0 [10,2 a 15,9]/ + 9,2 [4,5 a 13,9] lettres a 12 (± 1,5) mois et +11,4 [7,7 a 15,2]/ + 8,3 [3,7 a 12,8] lettres a 24 (± 1,5) mois, avec 53,1/38,9 % des patients presentant une MAVC superieure a 70 lettres. La variation moyenne de l’ECR etait de −223 [−254 a −192]/−267 [−314 a −220] μm a 6 (±1,5) mois, −225 [−260 a −191]/−284 [−334 a −233] μm a 12 (±1,5) mois et −211 [−251 a −170]/−305 [−356 a −255] μm a 24 (±1,5) mois. A 24 mois, le nombre moyen d’IVT etait de 7,2 (4,3)/7,1 (4,4) par œil etudie et 85,8/85,6 % des yeux etudies ont eu au moins une interruption des IVT de ranibizumab (72,6/62,5 % pour amelioration de la pathologie et 15,2/26,7 % pour manque d’efficacite). A 24 mois, 69,8/62,6 % des yeux etudies ont recu seulement un traitement par ranibizumab et 30,2/37,4 % un autre traitement intravitreen (premier switch : 15,4/12,2 % par dexamethasone, 13,6/20,9 % par aflibercept, 1,2/0 % par triamcinolone et 0/4,3 % par bevacizumab). Aucun nouveau signal de pharmacovigilance n’a ete detecte. Conclusion Les resultats obtenus en vie reelle a 24 mois chez des patients initiant un traitement par IVT de ranibizumab dans l’OM-OVR montrent une relative stabilite par rapport a ceux observes a six mois. Ces resultats sont un peu plus faibles que ceux des essais cliniques a 24 mois avec une intensite plus faible d’injections en vie reelle (7,2/7,1 dans BOREAL contre 11,4/13,1 dans BRIGHTER/CRYSTAL).

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

The relationship between genetics and age-related macular degeneration is well established. Heritability has been estimated to be up to 70%. Recent studies have identified several chromosomal regions that are likely to contain susceptibility loci. Common variations in three genes (CFH, LOC 387715 and C2-FB) strongly influence the risk of age-related macular degeneration. New findings in the field of the genetics of age-related macular degeneration are a starting point toward understanding the causes of AMD and for future therapeutic studies.

Age-related macular degeneration and antivascular endothelial growth factor: a review F. Fajnkuchen, S.-Y. Cohen We provide an overview of new anti-VEGF treatments for exudative age-related macular degeneration. We reviewed the current literature on this topic (including randomized controlled trials, nonrandomized and noncontrolled trials, and case reports). The efficacy and safety of anti-VEGF therapies for AMD are reported. We discuss combined therapy approaches, treatment frequency, and emerging therapies for exudative AMD. Therapies that target VEGF greatly improve treatment for exudative AMD. However, many questions are still being debated.

To assess early efficacy of dexamethasone intravitreal implant 0.7mg (OZURDEXRetrospective monocentric study. Inclusion criteria were best-corrected visual acuity (BCVA)≤70 letters (20/40) due to DME and central retinal thickness (CRT)≥300 microns (Cirrus 2, Carl Zeiss Meditec, Inc, Dublin). Enrolled patients could be treatment naive or not (after failure of laser photocoagulation and/or anti-VEGF therapy). Follow-up was at least 6 months. Our primary endpoint was BCVA gain at M2 after injection. Secondary endpoints were best-corrected visual acuity at 2 and 4 months, central retinal thickness at 2 and 4 months, mean interval between 2 injections, and adverse events.Nineteen eyes of 19 patients were included in this study. The mean age was 67.45 years, sex ratio was 2.17 men/women, and the patients were all type 2 diabetics. Three of 19 patients were treatment naive for anti-VEGF intravitreal injection, and 52.3% were pseudophakic (10/19 patients). The mean gain of BCVA at M2 was +7.7 letters. The mean BCVA was 51.1 ETDRS letters at baseline and 58.8 at M2. Mean CRT was 568.9μm at baseline and 291.2μm at M2. Treatment with dexamethasone implant was mainly a second-line treatment after failure of other treatments (macular laser photocoagulation and/or intravitreal injection of anti-VEGF). Three patients were naive of anti-VEGF treatment. Intraocular pressure≥25mmHg was found in 2 patients, and controlled medically. No glaucoma surgery was performed.The dexamethasone implant (OZURDEX

To assess French practice patterns in the treatment of diabetic macular edema (DME).A 31-item survey investigating practice patterns in the diagnosis and management of DME was e-mailed in March 2015 to retina specialist members of the French-speaking Retina Specialist Society. During this time frame, only ranibizumab was reimbursed for this indication. For each question concerning the choice of treatments, respondents were asked to assume that all treatments having market approval were also reimbursed. Answers were analyzed anonymously by Evalandgo software.Ninety-five specialists answered the survey. Two thirds of them initiated an intravitreal treatment for DME for a loss of vision greater than 0.5 (Monoyer scale). The three determining factors for treatment choice were potential VA improvement, expected retinal anatomic improvement, and patient availability for monthly follow-up. For central DME in phakic or pseudophakic eyes, the first choice of intravitreal (IVT) treatment was ranibizumab, even assuming that all drugs approved by French authorities (HAS) were reimbursed by the health care system. Eighty-five percent of retinal specialists propose bilateral intravitreal injections the same day for the same patient.Most of the specialists initiate DME treatment for a VA0.5 in France. Eighty-five percent of them perform bilateral intravitreal injections on the same day in the case of bilateral DME.

Purpose To evaluate the efficacy and safety of ranibizumabin patients with vision loss secondary to diabetic macular edema (DME). Methods Retrospective analysis of a cohort of patients withvision loss (VA) due to DME and treated by ranibizumab. Patients were examined before treatment and during treatment every 4–6 weeks. Ophthalmologic examination included:measure of the best corrected visual acuity (BCVA) on the ETDRS scale, examination at the slit lamp, fundus, and SD-OCT (Cirrus 5000, Carl Zeiss Meditec). All patients receiveda loading dose of 3 monthly injections followedby re-treatments on an as-needed basis (PRN regimen) The primary endpoint was the change in visual acuity at 12 months. The other criteria assessed were central retinal thickness (CRT) after loading dose, and at 12 months, and the number ofintravitreal injections (IVT) during the first year of follow-up. Results 109 eyes of 79 consecutive patients treateded since November 2012 have been included. At baseline the mean BCVA was 48.77 letters, the CRT was 517 microns. At 12 months the average BCVA was of 60.80 letters (p 70 letters. The mean CRT after 3 injections was 344.32 microns (p 300 .microns was 57.39 letters (p

Objectif Evaluer les modalites d’utilisation et l’efficacite en vie reelle du traitement par injection intravitreenne (IVT) de ranibizumab chez des patients presentant une baisse de l’acuite visuelle (BAV) due a un œdeme maculaire secondaire a une occlusion veineuse retinienne (OM-OVR) qu’elle soit de branche (B) ou centrale (C), a la demande de la Haute Autorite de sante (HAS). Methode Etude de cohorte observationnelle nationale de patients initiant un traitement par IVT de ranibizumab pour une BAV due a un OM-OVR (320 patients attendus par pathologie, pour avoir une precision de ± 2 lettres), inclus et suivis pendant 24 mois par des ophtalmologistes specialistes de la retine (retinologues). Le critere principal d’evaluation est la variation de la meilleure acuite visuelle corrigee (MAVC) a six mois par rapport a l’inclusion. Les criteres secondaires sont la variation de la MAVC, celle de l’epaisseur de la zone centrale de la retine (ECR), la description des modalites du suivi ophtalmologique ainsi que les evenements indesirables au cours du suivi. Resultats Entre decembre 2013 et avril 2015, pour les cohortes B/C, 223/196 patients ont ete inclus dans l’etude et 207/180 (92,8/91,8 %) presentaient des donnees de suivi analysables a six mois. Les caracteristiques des patients etaient un âge moyen (ET) de 70,3 (11,1)/70,5 (14,4) ans avec 47,8/50,6 % d’hommes, des premiers symptomes apparus en moyenne depuis 4,4 (12,6)/3,0 (6,0) mois, 9,2/8,3 % des patients deja traites pour leur OM-OVR (4,8/0,0 % par laser maculaire, 6,3/7,8 % par corticotherapie intravitreenne, 1,0/1,1 % par un autre anti-VEGF), et 3,9/2,8 % avec une atteinte bilaterale. A l’inclusion, la MAVC moyenne etait de 54,7 (18,9)/40,5 (25,7) lettres d’ETDRS avec 13,5/8,3 % des patients qui presentaient une MAVC superieure a 70 lettres. L’ECR moyenne etait de 558 (178)/649 (216) μm. Au cours des trois premiers mois, 80,7/76,1 % des patients avaient recu les trois IVT recommandees (traitement d’induction). A 3 (± 1,0) mois de suivi, la variation moyenne de la MAVC [IC 95 %] par rapport a l’inclusion etait de 14,7 [12,4 a 17,1]/16,0 [12,1 a 19,8] lettres et l’evolution de l’ECR etait de −240 [−269 a −211]/−323 [−371 a −275] μm. A six mois de suivi, le nombre moyen d’IVT etait de 3,8 (1,2)/3,6 (1,2) par œil etudie et 59,4/56,1 % des patients avaient eu au moins une interruption des IVT de ranibizumab (52,7/38,3 % pour amelioration de la pathologie et 7,2/15,6 % pour manque d’efficacite). A 6 (± 1,5) mois de suivi, la variation moyenne de la MAVC par rapport a l’inclusion etait de 13,9 [11,5 a 16,3]/9,5 [5,5 a 13,5] lettres avec 43,5/30,6 % des patients presentant une MAVC superieure 70 lettres. En parallele, l’evolution de l’ECR etait de −223 [−254 a −192]/−264 [−311 a −217] μm. Conclusion Cette etude en vie reelle chez des patients initiant un traitement par IVT de ranibizumab dans l’OM-OVR montre une amelioration de l’acuite visuelle a trois mois proche de celle des essais cliniques pre-AMM (BRAVO/CRUISE), et un peu plus faible a six mois mais avec une intensite plus faible d’injections en vie reelle (3,8/3,6 dans BOREAL contre 6 dans BRAVO/CRUISE).

Purpose Diabetic macular edema (DME) is the main cause of loss of vision over the course of diabetes. In this study we sought to know whether DME was more severe in Seine st Denis, a french area, where the poverty is higher than in other french plac Methods We enrolled all patients suffering from DME and treated by ranibizumab intravitreal injections between November 2012 and April 2013. In order to evaluate the severity of DME and the medical management of diabetes of these patients, we collected the following parameters: central macular thickness measured by SD-OCT, the best corrected visual acuity, diabetic retinopathy severity, HbA1c, diabetes duration, and associated diseases. Results We included 25 type 2 diabetic patients (8 women and 17 men), the mean age was 64± 8,1 years. Mean central macular thickness was 523 ± 145 μm. The best corrected visual acuity was 51 letters at baseline (counting fingers- 70 letters). 22 patients (88%) had a severe non proliferative diabetic retinopathy or a proliferative diabetic retinopathy. Mean HbA1c was 7,8% (+/- 2,3%). For 23 cases (92%), diabetes was associated with high blood pressure, and the average was 14,5±2 /8,5 ± 1,3 mmHg. Diabetes lasted for 13,1 years at baseline. Conclusion Diabetic patients, in this case series, had a more severe DME regarding macular thickness and visual acuity than patients from large randomized studies found in the literature. This severity could be due to a sub optimal management of their diabetes. DME may become a tool to witness a limited access to good medical cares.

DME is the main cause of loss of vision over the course of diabetes. DME incidence is correlated with diabetes duration, high glycemic levels, high blood pressure, and the severity of diabetic retinopathy. To prevent DME, patients need to have access to medical care. In this study, we sought to know whether DME was more severe in Seine-Saint-Denis, a French area, where the poverty is higher than in other french places, and where the number of physicians is lower.We enrolled patients suffering from DME and treated by ranibizumab intravitreal injections between November 2012 and April 2013. In order to evaluate the severity of DME and the medical management of diabetes of these patients, we collected the following parameters: central macular thickness measured by SD-OCT, best corrected visual acuity, diabetic retinopathy severity, HbA1c, diabetes duration, type of diabetes, insulinotherapy, previous DME treatment and associated diseases.We included 25 type 2 diabetic patients (8 women and 17 men), the mean age was 64±8.1 years. Mean central macular thickness was 523±145μm. The best corrected visual acuity was 45 letters at baseline (counting fingers-70 letters). Twenty-two patients (88%) had a severe non-proliferative diabetic retinopathy or a proliferative diabetic retinopathy. Mean HbA1c was 7.8% (±2.3%). For 23 cases (92%), diabetes was associated with high blood pressure. Sixty-four percent were treated by insulin. Diabetes lasted for 13.1 years at baseline.Diabetic patients, in this case series, had a more severe DME regarding macular thickness and visual acuity than patients from large randomized studies found in the literature. This severity could be due to a sub-optimal management of their diabetes. DME may become a tool to identify patients with a limited access to good medical cares.

To determine whether cataract surgery increases macular thickness in diabetic patients without preoperative retinopathy or macular edema.In a prospective, non-controlled study, we compared preoperative macular thickness as measured by OCT to that measured 3 and 6 months after cataract surgery.Thirty-six eyes of 21 patients (ten men and 11 women) were included in the study from November 2008 to May 2009. Mean foveolar thickness measured preoperatively was 198 μm (± 18.5 μm) compared with 202 μm (±17.2 μm) 3 months postoperatively and 212 μm (± 18.9 μm) 6 months postoperatively.In our study, we do not show a significant increase in central foveolar thickness 3 months after cataract surgery; however, we do measure a significant increase at 6 months. This increase in thickness is similar to that found in the literature after cataract surgery in a non-diabetic population.Cataract surgery in diabetic patients without preoperative retinopathy does not appear to induce significant macular thickening compared to non-diabetic patients. The period prior to any diabetic retinopathy or maculopathy seems to be the most amenable to cataract surgery when necessary.

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

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

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

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

The relationship between genetics and age-related macular degeneration is well established. Heritability has been estimated to be up to 70%. Recent studies have identified several chromosomal regions that are likely to contain susceptibility loci. Common variations in three genes (CFH, LOC 387715 and C2-FB) strongly influence the risk of age-related macular degeneration. New findings in the field of the genetics of age-related macular degeneration are a starting point toward understanding the causes of AMD and for future therapeutic studies.

We provide an overview of new anti-VEGF treatments for exudative age-related macular degeneration. We reviewed the current literature on this topic (including randomized controlled trials, nonrandomized and noncontrolled trials, and case reports). The efficacy and safety of anti-VEGF therapies for AMD are reported. We discuss combined therapy approaches, treatment frequency, and emerging therapies for exudative AMD. Therapies that target VEGF greatly improve treatment for exudative AMD. However, many questions are still being debated.

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

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

To study the progression of visual acuity (VA) and retinal abnormalities in patients with age-related macular degeneration (AMD) after cataract surgery.Forty eyes of 25 patients with AMD who had had cataract surgery were included in the study. They were divided up into two groups according to AMD stage: the first group with drusen and retinal pigmented epithelium abnormalities and the second in the severe stages of age-related macular degeneration with atrophy and neovascularization.In the first group (15 eyes), we found an improvement in VA in 93.3% of the eyes. New manifestations of neovascularization appeared in only one eye (6.7%) 1 year after surgery. In the second group (25 eyes), we found atrophy in 80% of the eyes and neovascularization in 20% of the eyes before surgery. There was an improvement in VA after cataract surgery in 68% of the eyes, and in three eyes (17%) VA worsened.In our study, patients with AMD improved VA and quality of life after cataract surgery. The same results of VA improvement after surgery can be found in the literature. However, no conclusions can be made concerning the progression of fundus lesions on a short term, though it seems that cataract surgery may accelerate the progression of AMD lesions 5 years after surgery.

We report a case of a fifty-year-old women suffering from acute multifocal posterior placoid pigment epitheliopathy (AMPPPE), very atypical in terms of clinical appearance and course. From this observation, we provide a progress report on the usual course of AMPPPE as well as atypical features of this affection through reports in the literature; finally we detail disorders ressembling both AMPPPE and serpiginous choroidopathy, the main differential diagnosis.

Retinal vasculitis is a common finding and occurs in 10% - 83% of patients with sarcoidosis. In most cases, there are bilateral, peripheral and nonischemic periphlebitis. In contrast, periarterial involvement is rarely observed. We report a case of retinal vasculitis associated with sarcoidosis and its differential diagnosis. Sarcoidosis should not be excluded in case of periarteritis.

Checking visual results and progression after cataract surgery in uveitis patients.Fourteen eyes of 13 patients were retrospectively studied after cataract extraction from December 1993 to April 1997. We describe the surgical procedure followed by the visual outcome of cataract surgery, complications, and treatment.Specific uveitic syndromes were determined in eight patients. Fuchs' heterochromic iridocyclitis was the cause in three cases, ankylosing spondylitis in one case, sarcoidosis in two cases, toxoplasmosis in one case and Birdshot chorioretinopathy in one case. Phacoemulsification was performed in 10 eyes and a manual extracapsular procedure in four eyes. Posterior chamber implantation was performed in 13 cases. Final visual acuity improved in 64% cases, from 1 to 8 lines (average 3.5). Eight eyes had visual acuity worse than 5/10, attributed to posterior segment abnormalities, in particular macular edema, which is the main limiting factor of optimal visual recovery. Capsular opacification was the most frequent complication in the anterior segment. Endophthalmitis was described in one patient.Visual results of cataract surgery depend on different uveitic entities and on posterior segment abnormalities. Results are generally successful when uveitis is not severe and the posterior segment can be carefully observed after cataract surgery. Extracapsular cataract extraction and posterior chamber implantation seem to be well tolerated if inflammation is perfectly under control before surgery.

To describe the characteristics of retinal vasculitis related to sarcoidosis, and to study the radio-clinical findings of sarcoidosis in case of retinal vasculitis.We performed a retrospective study on 33 cases of retinal vasculitis associated with sarcoidosis. Our patients had a complete ophthalmological examination and a systematic fluorescein angiography was performed. Recorded data included clinical, biological and radiological evaluation of sarcoidosis.Retinal vasculitis were and remained asymptomatic in almost a third of the patients (n = 10). In 11 patients (33%) a decreased visual acuity of more than 3 lines was observed. Periphlebitis was observed in all cases, and 75.7% were of non ischemic forms. Thirty patients out of 33 (90.9%) were treated with systemic steroids in whom 17 were treated for ophthalmological reasons. The presence of anterior or posterior uveitis, more than one attack of vasculitis, and significant hyalitis were statistically associated with visual acuity decrease. Ninety percent of patients regained their initial visual acuity, only three patients at the end of the medical follow-up remained with a visual acuity below or equal to 2/10. Thirty one patients (91%) presented with mediastinal and pulmonary signs concordant with sarcoidosis on chest x-rays. Extrapulmonary localisations were common in case of retinal vasculitis (91% of patients).Retinal vasculitis associated with sarcoidosis are often asymptomatic. In most cases, there are bilateral, non ischaemic periphlebitis. They seem to have a relatively better prognosis than in other etiologies of vasculitis and they are part of an evolutive multisystemic sarcoidosis. Most of the time treatment with systemic steroids was indicated for ophthalmological or extra ophthalmological reasons.

To evaluate factors influencing early post surgical ocular hypertension after phacoemulsification.Records were collected for patients who had uncomplicated phacoemulsification with IOL implantation in the bag. Aspiration of the viscoelastic was performed at the conclusion of surgery. Patients with previous ocular surgery, high myopia, or glaucoma were excluded. Intraocular pressures were measured at six hours (+/-2) postoperatively. Following factors were analysed26% of the patients had an ocular pressure equal or higher than 21 mmHg. Among the factors we analysed, pilocarpine injection was the only one to produce significant decrease in postoperative ocular pressure.The acute postoperative IOP increase following phacoemulsification is presumably the result of trabecular obstruction by viscoelastic material. However it can occur despite meticulous evacuation of viscoelastic, which could be dependent upon the material's viscosity, and IOL material and design. Postoperative ocular hypertension is not related to ultrasonic duration. Intracameral injection of pilocarpine significantly reduces the incidence of postoperative intraocular pressure increase.Early postoperative ocular hypertension can be observed with different kinds of viscoelastics and IOL. Meticulous evacuation of viscoelastic from anterior chamber, although necessary does not always prevent this early complication. Intracameral injection of pilocarpine can reduce its incidence.

We report two cases of candidal chorioretinitis occurring to two friends who abused of intravenous crack using the same syringe . An endophthalmitis "a minima" due to a therapeutic delay arose in one patient, when a rare spontaneous healing happened to the second patient. In both cases, an epiretinal membrane is noted after the lesions scarred. Ocular candidal infection is a typical complication occurring to intravenous drug addicts. The visual prognosis depends not only on early diagnosis and treatment, but also on a strict follow-up because late complications are frequent in spite of the healing of initial lesions.