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Purpose: To evaluate the effectiveness of vitreoretinal surgery combined with antivascular endothelial growth factor therapy to treat florid diabetic retinopathy, a rare and severe form of diabetic retinopathy in young patients., Methods: Retrospective observational case series including 61 eyes of 45 patients operated on for florid diabetic retinopathy over the past 5 years, with preoperative or intraoperative intravitreal injection of bevacizumab. Cases were classified into three stages of disease severity, according to the extension of the fibrovascular membranes. Main outcome measures were mean change in visual acuity, anatomical outcome, and surgical complications., Results: After a mean follow-up of 20.3 months, the mean visual acuity significantly increased from +1.7 logMAR before surgery to +0.8 logMAR after surgery (P < 0.01). The visual gain was significant in Stages I and II (P < 0.05) but not significant in Stage III. A flat retina without silicone oil was achieved in 84% of eyes. Eight eyes (13%) progressed to neovascular glaucoma and/or phthisis despite repeated surgeries., Conclusion: Vitrectomy combined with antivascular endothelial growth factor therapy allows both favorable visual and anatomical outcomes in this rapidly evolving disease. Prognosis remains poor in severe stages, suggesting that the earlier the surgery performed, the better is the visual prognosis.

Retinal prostheses are being developed to restore vision in blind patients with photoreceptor degeneration. Electrodes arrays were subretinally implanted in transgenic P23H rats with their photoreceptors degenerated. Electrical stability of the implants was evaluated by long-term monitoring of their impedance changes. Electrode impedances were found to increase by two log units over a three weeks period whereas no impedance increase was noted when the implants were located in the vitreous. In case of hemorrhage or major fibrous reactions, the impedance continued to increase steadily. After explantation, it recovered its initial value indicating no deterioration of the implant. Although the glial cell layer at the surface of the subretinal space was slightly larger, no major glial reaction was seen in direct contact to the implant. These results indicate that no functional testing should be considered before at least three weeks post implantation.

We present a finite element based simulation and analysis method to describe the spatial extent of stimulation and the effects of electrode-tissue interactions in subretinal prostheses. In particular, we estimate the threshold stimulation current needed to depolarise and evoke action potentials in the ganglion cells to be stimulated at a particular distance from the electrode. This is achieved through the application of a threshold electric field to a spherical neuronal soma model of a retinal ganglion cell under consideration. Threshold stimulation currents and the lateral extent of the stimulation zone were computed for disc microelectrodes in subretinal stimulation mode. Recent evidence indicates a decrease in threshold charge with time following subretinal implantation. Consequently, to explain the variation in threshold stimulation currents, we propose a hypothesis based on an electrode-tissue gap. Threshold stimulation currents and impedances for different electrode-tissue gaps were computed. We validate the hypothesis with our simulation results that the changes in impedance observed with time in vivo can be mainly attributed to the varying distance of the ganglion cells from electrodes due to changes in electrode-tissue gap. Our simulation framework proposes a convenient and practical method applicable for studying different electrode geometries used for retinal stimulation., (Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.)

Purpose: The authors recently used topical endoscopy to image the mouse eye fundus. Here, they widened the field of application for this ophthalmologic tool, imaging both the posterior and the anterior eye segments in larger animals commonly encountered in research laboratories and veterinary clinics., Methods: Pupils were dilated, and local anesthetic and gel were applied to the animal cornea. The endoscopic probe was placed in contact with the cornea of conscious rats, sedated cats and dogs, anesthetized sheep, and nonhuman primates., Results: High-resolution digital images of the eye fundus were obtained in all investigated animals using the endoscopic probe along the eye axis. Arteriovenous filling time was monitored with fluorescein angiography in pigmented rats. The retinal periphery and ciliary bodies could be visualized with the probe placed at an oblique angle. The probe was inclined further to observe the iridocorneal angle such that the pectinate ligaments could be seen at high resolution in cats. The authors used the probe on eyes with retinal detachment, luxation of a cataractous lens, and pigment infiltration in the iridocorneal angle, demonstrating its potential use in eye diseases., Conclusions: This topical endoscopic technique provides a unique tool for single eye examinations. The authors obtained a circular view of the anterior (iridocorneal angle) and the posterior (fundus) eye segments from all animal species studied. This technique is inexpensive and easy to use. It can be easily moved to the eye of the patient who cannot move to stand in front of classic apparatus, offering new opportunities in ophthalmology.

Purpose: To analyze high-resolution color photographs of the mouse fundus., Methods: A contact fundus camera based on topical endoscopy fundus imaging (TEFI) was built. Fundus photographs of C57 and Balb/c mice obtained by TEFI were qualitatively analyzed., Results: High-resolution digital imaging of the fundus, including the ciliary body, was routinely obtained. The reflectance and contrast of retinal vessels varied significantly with the amount of incident and reflected light and, thus, with the degree of fundus pigmentation. The combination of chromatic and spherical aberration favored blue light imaging, in term of both field and contrast., Conclusions: TEFI is a small, low-cost system that allows high-resolution color fundus imaging and fluorescein angiography in conscious mice. Panretinal imaging is facilitated by the presence of the large rounded lens. TEFI significantly improves the quality of in vivo photography of retina and ciliary process of mice. Resolution is, however, affected by chromatic aberration, and should be improved by monochromatic imaging.

In the field of ophthalmology, indications for high-dose corticotherapy are various. This paper reports the case of a Caledonian man who presented with intestinal strongyloidiasis, discovered 25 years after he had left the endemic area. A checkup before corticotherapy for traumatic retina edema provided the diagnosis of the infection. The authors emphasize the importance of searching for Strongyloidiasis stercoralis larva before initiating corticotherapy, as it is the main treatment responsible for parasitic dissemination. The most severe form of strongyloidiasis, the disseminated form, has a high mortality rate: 70%-90%. The definitive diagnostic test is enhanced larva recovery, which should be proposed to every patient returning from endemic area, people with precarious hygiene or with high eosinophilia or intestinal symptoms of chronic infection. Delay in diagnosing strongyloidiasis frequently results in death, despite vigorous treatment.

Background: In age related macular degeneration and inherited dystrophies, preservation of retinal ganglion cells has been demonstrated. This finding has led to the development of various models of subretinal or epiretinal implant in order to restore vision. This study addresses the development of a polyimide subretinal electrode platform in the dystrophic P23H rat in vivo., Methods: A technique was developed for implanting a subretinal electrode into the subretinal space and stabilising the distal extremity of the cabling on the rat cranium in order to allow future electrical stimulations of the retina., Results: In vivo imaging of the retina with the scanning laser ophthalmoscope demonstrated reabsorption of the surgically induced retinal detachment and the absence of major tissue reactions. These in vivo observations were confirmed by retinal histology. The extraocular fixation system on the rat cranium was effective in stabilising the distal connector for in vivo stimulation., Conclusion: This study demonstrates that a retinal implant can be introduced into the subretinal space of a dystrophic rat with a stable external connection for repeatable electrical measurements and stimulation. This in vivo model should therefore allow us to evaluate the safety and efficacy of electrical stimulations on dystrophic retina.

Muir-Torre syndrome is an autosomal dominant hereditary condition predisposing to cancer. It is characterized by cutaneous tumors (such as sebaceous adenomas, epitheliomas, or carcinoma, and/or keratoacanthomas) and internal malignancies. A 47-year-old male patient with cancer antecedents consulted for two tumors of the eyelid. Histological study of the exeresis biopsies of the eyelid lesions showed a sebaceous adenoma and an epidermoid carcinoma with sebaceous differentiation. With the suspicion of Muir-Torre syndrome, a genetic consultation was requested. The geneticist found a mutation of the MSH2 gene, which was not classified as pathological. Cancer screening was begun for the patient and his descendants. The clinical outcome was death from urothelial carcinoma. Eyelid sebaceous tumors require complete medical check-up in search of carcinoma. Demonstrating Muir-Torre syndrome allows the medical team to propose early cutaneous and visceral carcinoma screening for patients, their collaterals, and their descendants.

Purpose: To highlight the advantages of conjunctival biopsy in order to confirm the diagnosis of sarcoidosis., Case Report: A 78-year-old woman presented with unilateral vitreitis. The examination of the conjunctive of right and left eyes revealed multiple, translucent, pale yellow nodules the size of millet grains located in the lower fornix. The diagnosis of sarcoidosis was suspected by an increased level of angiotensin-converting enzyme and bilateral hilar lymphadenopathies. A biopsy from conjunctival nodules showed noncaseating epithelioid and gigantocellular granulomas, confirming the diagnosis of sarcoidosis., Conclusion: Although underused, conjunctival biopsy seems to be both a safe and effective tool in the diagnosis of sarcoidosis.

We report the case of a patient with cystic fibrosis who suffered severe bilateral uveitis, with hypopyon, retinal vasculitis, and polyarthritis when he was 6 years old. No etiology could be found. Multiple sclerosis began when he was 22 years old. This panuveitis was clinically very different from the uveitis usually associated with multiple sclerosis. Polyarthritis and skin vasculitis have been reported in the course of cystic fibrosis, but no uveitis nor retinal vasculitis have been described. This raises the question of the role of multiple sclerosis and cystic fibrosis in the pathogenesis of this case of uveitis.

Stage IV hypertensive retinopathies in children have been described, but their incidence appears to be rare. Most etiologies are nephropathies. The authors present a clinical case of malignant high blood pressure in a young girl whose ophthalmological tests detected an unusual nephropathy, the Ask-Upmark kidney, illustrating the importance of determining high blood pressure chronicity and using Kirkendall's classification. Systematic fluorescein angiography and NMR on atypical subjects prevents the diagnosis of Leber neuroretinis, the main differential diagnosis. Early treatment of high blood pressure can avoid complications such as macular exudes.

The OPA1 gene, encoding a dynamin-related GTPase that plays a role in mitochondrial biogenesis, is implicated in most cases of autosomal dominant optic atrophy (ADOA). Sixty-nine pathogenic OPA1 mutations have been reported so far. Most of these are truncating mutations located in the GTPase domain coding region (exons 8-16) and at the 3'-end (exons 27-28). We screened 44 patients with typical ADOA using PCR-sequencing. We also tested 20 sporadic cases of bilateral optic atrophy compatible with ADOA. Of the 18 OPA1 mutations found, 14 have never been previously reported. The novel mutations include one nonsense mutation, 3 missense mutations, 6 deletions, one insertion and 3 exon-skipping mutations. Two of these are de novo mutations, which were found in 2 patients with sporadic optic atrophy. The recurrent c.2708&#95;2711delTTAG mutation was found in 2 patients with a severe congenital presentation of the disease. These results suggest that screening for OPA1 gene mutations may be useful for patients with optic atrophy who have no affected relatives, or when the presentation of the disease is atypical as in the case of early onset optic atrophy., (Copyright 2003 Wiley-Liss, Inc.)

We report a case of a 27-year-old man who developed major exophthalmos associated with ophthalmoplegia occurring 48 hours after head trauma. CT scan showed an orbital roof fracture and a subperiosteal hematoma. Surgical evacuation of the hematoma and reconstruction of the orbital roof was performed via a frontal craniotomy. Two months later, the ophthalmologic examination was normal. We stress the importance of early diagnosis and prompt surgical treatment in such an unusual complication of head trauma.

The authors report a case of amaurosis fugax treated first by systemic fibrinolysis and then by antiplatelet treatment. A 47-year-old suffering from transient amaurosis due to recurrent occlusion of retinal arterial branches improved after treatment and showed no recurrence. This protocol appears effective in cases of probable embolus in a young patient with no contraindications and when flow is not reestablished (amaurosis fugax), or when the required 6-hour time delay is respected.