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To assess the utility of UBM in the management of primary angle closure (PAC) and assessing the predictability of peripheral iridotomy (PI) in re-opening the closed angle.Retrospective clinical study.Patients with suspicion of PAC.This study obtained the consent of all patients and adhered to the Declaration of Helsinki. It was conducted in two ocular imaging centers and based on patients with suspected PAC. Each patient underwent UBM and Visante OCT at each visit, before and after PI when PAC was confirmed.Irido-corneal angle.Out of 202 eyes (101 patients) with a mean age of 62 years and 69.3% female predominance, we found 186 eyes with PAC. In most cases (77.4%), the iridocorneal angle was open after a single PI at the second visit, and only 14% eyes remained closed at the third visit, regardless of any additional treatment performed (complementary PI, iridoplasty, surgical lens extraction). Mechanisms involved in persistent angle closure after PI were: imperforate PI (45.2% of eyes), iris plateau syndrome (8.6% of eyes), significant lens vaulting (30.9% of eyes) and mixed mechanisms (2.3% of eyes).PI remains effective as a first-line treatment in most cases of PAC, even when associated with mechanisms other than pupillary block. Nevertheless, the PI must be completely patent, and UBM can help in understanding underlying mechanisms, hence guiding the treatment in these eyes.

Intravitreal administration of anti-VEGF agents, available in France since 2007, allows stabilization and improvement in visual acuity in wet age-related macular degeneration (AMD). In the past few years, the management of this disease has evolved in terms of both diagnostic methods and treatment schedules, which have been adapted to the pathophysiology of AMD. The goal of this survey, performed in a representative sample of French ophthalmologists, was to describe the evolution of medical practices one year after a similar survey (Massé et al., J Fr Ophtalmol 2016; 39: 40-7).The survey was performed from December, 2014 to March, 2015 in 191 ophthalmologists (53 general ophthalmologists and 98 retina specialists) with an on-line questionnaire. This questionnaire was designed by a committee of ophthalmologists to describe practices concerning screening, diagnosis, treatment and follow-up of wet AMD.An initial intravitreal injection of an anti-VEGF agent was usually performed within 10 days after the diagnosis of wet AMD by 98% of ophthalmologists and within 5 days by 63%. The treatment protocols favored by retina specialists were pro re nata (PRN) for 58%, Observe and Plan for 25% and Treat and Extend for 17%. Bilateral intravitreal injections were performed on the same day by 46% of retina specialists, mostly for the convenience of the patient and because of the low infectious risk. The initial protocol was maintained by one third of retina specialists throughout the course of treatment, while two thirds of them reported that they reassessed the protocol on average after 5 months.This survey on the practices of the ophthalmologists in wet AMD highlights an improvement in the time course of patient management and an evolution of treatment schedules toward individualized protocols.

To evaluate the role of a fast track for management of patients with neovascular age- related macular degeneration (nARMD) treated by intravitreal injection of anti-VEGF.The records of 100 patients in the chronic maintenance phase of intravitreal anti-VEGF followed in the fast track and 63 patients followed in the standard protocol for at least 12 months were retrospectively analyzed.Patients in the fast track underwent visual acuity (VA) testing by ETDRS, optical coherence tomography (OCT) and a physician assessment. The injection was performed the same day whenever possible. The primary endpoint to evaluate patient adherence was the time between the ideal date of visit or injection prescribed by the physician and the actual date of administration.The mean time between the ideal date of visit or injection prescribed by the physician and the actual date of administration was 4.1±7.5 days for the patients followed in the fast track and 5.6±18.7 days for the patients followed in the standard protocol. Mean VA remained stable for the patients followed in the fast track: 20/50 (20/800 to 20/20) at baseline vs. 20/50 (20/800 to 20/16) at the conclusion of follow-up. It dropped from 40/50 at baseline to 20/63 at the conclusion of follow-up for the patients followed in the standard protocol.In the context of a fast track, it was possible to improve the adherence of nARMD patients and maintain their VA gain or stabilization achieved after the induction phase.

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.

Evaluation of the Ocular Response Analyzer in ocular hypertension, glaucoma, and normal populations. Prospective study on 329 eyes M. Streho, R. Dariel, J.-M. Giraud, C. Verret, J.-R. FenollandO, Crochelet F.May, J.-F.Maurin, J.-P.Renard. Objectives: (1) Evaluate and analyze the Ocular Response Analyzer (ORA) in three groups of patients: glaucoma, intraocular hypertension, and normal; (2) study corneal hysteresis values in the three groups according to age; and (3) compare intraocular pressure values measured with the ORA with intraocular pressure measured with Goldmann (IOPGoldmann) and pulsed air (IOPair) applanations. Materiel and methods: This prospective, single-center study included 329 eyes divided into three groups: normal (n=207), intraocular hypertension (n=55), and primary angle glaucoma (n=67). Corneal hysteresis (CH), IOP corneal-compensated (IOPcc), and Goldmann correlated IOP (IOPg) measurements were provided by the ORA device for all patients. Ultrasonic central corneal thickness (CCT US), and intraocular pressure measured with Goldmann and pulsed air tonometry were also assessed in each eye. Results: The mean values were: IOPGoldmann 14.4±3.4 mmHg, IOPair 15.5±3.6 mmHg, CCT 542.1±36.6 µm, CH 10±1.7 mmHg, IOPcc 16.6±4.1 mmHg, and IOPg 15.7±3.9 mmHg. All the IOP measurements (IOPGoldmann, IOPair, IOPg, IOPcc) were strongly correlated into the three age groups. The mean CH in the glaucoma (9.8 mmHg) and intraocular hypertension (9.6 mmHg) groups was lower than in the normal group (10.3 mmHg), but there was no difference between the three groups for the CH values, with an age-related analysis of the three groups. The CH was correlated with CCT US in the three groups. IOP measures were not strongly correlated with CH except for IOPcc. There was a negative correlation (−0.79) between CH and IOPcc. Discussion/Conclusion: In our study, the mean ORA, CCT US, and IOP values in the normal group were similar to those found in the literature. These are the first CH values reported for a normal group according to age. We confirm the good correlation between all the IOP measurements. The mean corneal hysteresis value was low in glaucoma and intraocular hypertension, but there was no difference between the three groups for the CH values, when the three groups were analyzed according to age. There was a correlation between corneal hysteresis and central corneal thickness. Moreover, IOPcc seems to be the best evaluation of IOP with no influence from corneal biomechanical factors. The Ocular Response Analyzer and corneal hysteresis should be considered a useful parameter for patients with intraocular hypertension and/or glaucoma.

Pseudoexfoliation syndrome in cataract surgery. Retrospective study of 37 cases M. Streho, C. Rohart, B. Guigui, F. Fajnkuchen, G. Chaine Purpose: 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. Methods: 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. Results: 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. Conclusion: 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.

Purpose To compare visual acuity and complications in phacoemulsification in eyes with white cataract and in eyes with immature senile cataract. Patients and methods 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). Results 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)). Discussion 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. Conclusion The results of phacoemulsification in white cataracts are satisfactory in spite of a high rate of posterior capsule rupture in our study.

Wet AMD is characterized by the formation of choroidal neovascularization, mediated by vascular endothelial growth factor (VEGF) and responsible for a decrease in visual acuity and metamorphopsia of sudden onset. Intravitreal anti-VEGF can stabilize or even improve visual acuity. Although there is a consensus among ophthalmologists about the induction phase injection of anti-VEGF, there appear to be differences in practice regarding therapeutic treatment modalities. The goal of this work was to explore this hypothesis and to better understand real life practices.The Ipsos institute conducted a qualitative survey of 16 retinal specialists and 9 general ophthalmologists in September and October 2013, using a questionnaire developed by a scientific committee of experts. Fifteen telephone interviews and 4 face-to-face meetings with a retina specialist and an ophthalmologist were conducted. This qualitative study allowed the development of a quantitative survey of 200 retina specialists and general ophthalmologists, conducted between November 2013 and January 2014, to describe practices in diagnosis, treatment and follow-up of wet AMD.A distribution of roles between the ophthalmologist making the initial diagnosis and the retinal specialists responsible for treatment and follow-up was noted. Treatment was initiated within 10 days of diagnosis as recommended by the HAS in only one third of patients. After the induction phase of treatment, i.e. three monthly injections of anti-VEGF, treatment and monitoring practices were heterogeneous with 74% of physicians using a PRN treatment protocol, 22% a bimonthly protocol (with monthly monitoring in 19.4% of cases) and 4% a "treat and extend" protocol. There was little change in the protocol chosen in the case of recurrence.Three quarters of ophthalmologists report using a PRN protocol, and over 90% report seeing their patients monthly, either for injection or for a check-up. This apparent uniformity is in reality more complex: for the large majority, they prefer to closely follow the patient so as to treat the slightest recurrence, but with great variability in practices with regard to individualization of treatment.

Resume Les urgences ophtalmologiques arterielles sont principalement representees par les occlusions de l’artere centrale de la retine (OACR), ou d’une de ses branches, et par les neuropathies ischemiques anterieures aigues (NOIAA). Ces deux affections partagent de nombreux points communs : apparition brutale d’une baisse d’acuite visuelle severe ou d’une amputation du champ visuel, pronostic visuel tres souvent pejoratif, et mecanismes physiopathogeniques. En effet, si l’arteriosclerose est la cause la plus frequente des OACR et des NOIAA, il est imperatif de toujours rechercher une maladie emboligene et surtout une arterite gigantocellulaire de Horton. Dans ce dernier cas, il convient au moindre doute de debuter un traitement par corticosteroides intraveineux a fortes doses pour eviter l’atteinte de l’œil controlateral ou des occlusions arterielles dans d’autres territoires.

Resume Le glaucome chronique a angle ouvert (GAO) est un probleme de sante publique par sa frequence et sa potentielle gravite. La prevalence du GAO augmente avec l’âge pour atteindre 5 % des patients de plus de 75 ans. Il s’agit d’une neuropathie optique chronique evolutive dont l’hypertonie intraoculaire est le principal facteur de risque. La prise en charge therapeutique consiste a faire baisser la pression intraoculaire (PIO) jusqu’a une PIO cible. Les differents effets indesirables systemiques et locaux des medicaments topiques proposes dans le GAO sont detailles en fonction des familles de medicaments : beta-bloquants, analogues des prostaglandines, inhibiteurs de l’anhydrase carbonique et alpha-2-agonistes. Il est indispensable de bien comprendre l’interet des traitements du GAO, et de ne pas meconnaitre leurs effets indesirables ainsi que leurs interactions chez les personnes âgees, souvent polymedicamentees.

Resume Introduction. – Le retrovirus HTLV-1 est responsable d'uveite et de thyroidite auto-immune en zone endemique. L'association pathologie auto-immune thyroidienne et uveite chez des sujets infectes par HTLV-1 est une entite peu decrite, encore moins en zone non-endemique. Exegese. – Nous rapportons deux observations de malades porteurs du virus HTLV-1 compliquees d'une atteinte oculaire et d'une pathologie thyroidienne auto-immune simultanee, sans autre atteinte viscerale liee a HTLV-1. L'evolution ophtalmologique est favorable dans les deux cas. Conclusion. – Cette association hyperthyroidie–uveite–HTLV-1 n'est probablement pas fortuite. L'origine auto-immune de l'atteinte thyroidienne et oculaire declenchee par l'infection HTLV-1 peut etre evoquee.

We present a case report on a young man complaining of transient myopia following a blunt trauma. Clinical and paraclinical (ultrasound) follow-up allowed us to discuss the different physiopathological mechanisms involved. We observed anterior lens displacement, increased lens thickness probably due to lens edema, choroidal detachment, and ciliary body edema. Progression was positive with full regression of the myopia. Ultrasound analysis also underlined an iridocorneal angle closure that could have led to angle-closure glaucoma (preventive peripheric iridotomy was discussed). The spontaneous progression showed spontaneous angle reopening on the main meridians.

La maladie de Behcet est une vascularite systemique se manifestant essentiellement par une aphtose buccale et/ou genitale et une uveite, l'ensemble constituant le trepied d'appel du diagnostic ayant conduit a sa description initiale. Mais ses manifestations cliniques sont proteiformes avec d'autres signes cutanes quasi specifiques et tout un panel d'atteintes pouvant concerner presque tous les organes, les formes syndromiques compliquees etant l'entero-, l'angio- et le neuro-Behcet. Son diagnostic est parfois difficile en l'absence de signes cliniques ou biologiques specifiques, notamment lorsque le trepied diagnostique est incomplet. Le pronostic de cette maladie reste lourd sur le plan fonctionnel, notamment ophtalmologique, du fait de l'absence de traitement curatif specifique, son etiologie restant a ce jour meconnue. Cependant, des progres therapeutiques sont en cours pour les formes severes et refractaires aux immunosuppresseurs conventionnels avec l'avenement des anti-TNFα dont la place precise dans l'arsenal therapeutique encore mal codifie et l'efficacite a long terme restent a etre precisees.

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.

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.

The oncovirus HTLV-1 is aetiologically associated with uveitis and autoimmune thyroiditis in endemic areas. The association of uveitis with autoimmune thyroiditis in HTLV-1 carriers is less common moreover in non-endemic area.We report two original cases of simultaneous uveitis and autoimmune thyroiditis in HTLV-1 carriers, without other disease due to HTLV-1. The visual outcome was favorable in both cases.A significant correlation exists between hyperthyroidism, uveitis and HTLV-1, but still needs to be confirmed. The autoimmune or immune mediated mecanism of HTLV-1 may be involved in the uveitis and the thyroidits.

But Etudier les risques de la chirurgie de la cataracte par phacoemulsification chez les patients presentant un syndrome pseudo-exfoliatif ainsi que les caracteristiques cliniques de ces patients. Materiels et Methodes Les patients inclus dans l’etude ont tous beneficies d’une chirurgie de cataracte par phacoemulsification entre 2006 et 2008. Il s’agit d’une etude retrospective, comparative de 2 groupes de patients. Un premier groupe de 50 patients presente une pseudoexfoliation capsulaire (groupe PEC) et un deuxieme groupe de 50 patients (groupe temoin) ne presente pas de pseudoexfoliation, ni autre pathologie favorisant les complications operatoires. Les caracteristiques cliniques de chaque patient sont egalement etudiees. Les complications per et post-operatoires de la chirurgie de cataracte sont notees dans les 2 groupes. Resultats L’etude regroupe 100 patients repartis dans deux groupes distincts et comparatifs (groupe PEC et groupe temoin sans PEC). Une phacoemulsification a ete realisee dans 100 % des cas avec 1 seul cas d’implant de chambre anterieure pour le groupe PEC. Dans le groupe PEC, il existe une predominance de forme unilaterale (61 %) et un glaucome chronique a angle ouvert est associe dans 11 cas (22 %) versus 2 cas (4 %) dans le groupe temoin. Une mauvaise dilatation est observee dans 8 cas (16 %) dans le groupe PEC versus 1 cas (2 %). Il y a eu 2 complications operatoires dans les 2 groupes (4 %). Aucune complication post-operatoire n’est retrouvee a 1 mois. En termes d’acuite visuelle, la recuperation est identique dans les deux groupes. Discussion Le syndrome de pseudoexfoliation capsulaire est associe a des risques accrus lors de la phacoemulsification lies a une mauvaise dilatation et une fragilite zonulaire. Cependant dans notre etude, le taux de complications est identique. Les caracteristiques des patients presentant une PEC sont une atteinte plutot unilaterale, une mauvaise dilatation, une hypertonie oculaire voir un glaucome plus frequent et plus severe que pour le reste de la population. Cette population aurait egalement un risque cardiovasculaire plus eleve. Conclusion La chirurgie de cataracte avec PEC ne presente pas un taux de complication accrue.

But Nous presentons les criteres d’evaluation valides dans la chorioretinopathie de type Birdshot. Materiels et Methodes Conference de Consensus (2 e International Workshop, Oct. 2006, Paris). Resultats Au total 20 experts internationaux ont participe a la conference de consensus. Les parametres cliniques retenus par plus de 40 % des participants sont l’œdeme maculaire (94,1 %), le champ visuel (100 %), la diffusion vasculaire (88,2 %), l’aspect en tomographie en coherence optique (OCT) (58,8 %), l’inflammation intraoculaire posterieure (41,2 %) et la classification des taches au fond d’œil (41,2 %). Le classement de ces criteres par ordre decroissant de pertinence est l’œdeme maculaire (rang moyen 1,4), le champ visuel (rang moyen 2,6), Tyndall-hyalite (rang moyen 3,6), la diffusion vasculaire (rang moyen 3,7), l’aspect en OCT (rang moyen 3,8), l’aspect des taches (rang moyen 5,1). L’œdeme maculaire et la perte en champ visuel sont des criteres suffisants pour instaurer un traitement dans la maladie de Birdshot pour 100 % des experts, la presence d’inflammation du segment anterieur et/ou posterieur pour 62,5 %, la diffusion vasculaire pour 56,25 %, l’aspect en OCT et l’aspect des taches de Birdshot pour 37,5 %. Discussion Des criteres diagnostiques ont deja ete etablis a l’occasion de la premiere conference internationale de consensus sur la chorioretinopathie de type Birdshot. La deuxieme conference internationale reunissant un groupe d’experts a permis de proposer des criteres d’evaluation des patients dans la chorioretinopathie de type Birdshot. Les criteres d’evaluation retenus sont l’œdeme maculaire, le champ visuel, l’inflammation intra-oculaire (segment posterieur), la diffusion vasculaire, l’aspect en OCT et l’aspect des taches au fond d’œil. L’œdeme maculaire et l’alteration du champ visuel ont ete retenus par les experts comme etant des criteres principaux d’indication therapeutique. Conclusion Cette etude a permis de determiner les criteres d’un systeme d’evaluation des patients dans la chorioretinopathie de type Birdshot. Il s’agit d’un outil qui devrait etre tres utile pour la mise en place d’etudes cliniques internationales, notamment pour la constitution de groupes homogenes de patients.

Introduction Nous rapportons les cas de 2 patients seropositifs pour le VIH ayant presente une blepharite seborrheique particulierement severe avec complications corneennes sous tritherapie anti-retrovirale. Materiels et Methodes Le 1er cas est celui d’un homme de 42 ans avec 310 CD4/mm3 et une charge virale (CV) indetectable sous traitement antiretroviral comportant de l’Indinavir (Crixivan®) comme anti-protease. A l’examen il presente une blepharite seborrheique severe dans le cadre d’une dermite seborrheique, avec une cicatrice bilaterale d’ulcere corneen inferieur avec une cornee tres amincie. L’acuite visuelle est de 6/10 P2 OD et 8/10 P2 OG. L’evolution est favorable sous traitement associant soins des paupieres, cyclines orales et ciclosporine 2 % locale. Le patient decrit une nette amelioration au relais du Crixivan® par Telzir-Fos- Amprenavir. Le 2e cas est celui d’un homme de 41 ans avec 250 CD4/mm3 et CV indetectable. A l’examen il presente une blepharite seborrheique importante dans le cadre d’une dermite seborrheique, et une ulceration corneenne unilaterale droite avec un amincissement corneen. L’acuite visuelle a droite est de 10/10 P2. L’evolution est favorable sous traitement par soins des paupieres et cyclines par voie orale. Discussion La dermite seborrheique est une dermatose souvent retrouvee chez le patient VIH + [1]. Elle entraine frequemment une blepharite chronique. Dans les 2 cas presentes, la blepharite et les complications corneennes etaient particulierement severes. L’antiprotease Indinavir (Crixivan®) a peut-etre favorise cette evolution, de par son effet « retinoid-like » [2]. Conclusion La blepharite seborrheique du patient VIH peut etre severe et entrainer des complications corneennes majeures. Le role des antiproteases reste a determiner.

But Etude et comparaison des resultats d’examens en ERG multifocal et en OCT parmi une population de patients atteints de chorioretinopathie de type Birdshot. Materiels et Methodes Etude transversale de 87 patients. Les enregistrements de l’ERGmf ont ete realises a l’aide d’un appareil Metrovision selon les recommendations de l’ISCEV. Les resultats des amplitudes et des temps de culmination de 1er ordre kernel avec normalisation ont ete recueillis sur les 61 hexagones de stimulation. Nous avons retenu les valeurs des amplitudes et temps de culmination pour l’onde N1 et P1 sur les 2°, 5° et 10°. Les mesures de l’epaisseur maculaire et du volume maculaire en OCT ont ete repertoriees. Resultats L’âge moyen des patients est de 56,4 +/- 11,3 ans [24-81]. Le sex-ratio femme/homme est de 1,5. L’acuite visuelle moyenne corrigee est de 8/10 +/- 4 lignes. Les temps de culmination de N1 sur 2° et 5° sont significativement correles a l’epaisseur maculaire en OCT (N1/2°, p = 0,004 ; N1/5°, p Discussion L’interet de cette etude est d’apporter les valeurs des amplitudes et des temps de culmination pour les ondes N1 et P1 sur les 2°, 5° et 10° centraux dans une cohorte de BCR. Les temps de culmination de N1 sur 2° et 5° sont significativement correles a l’epaisseur maculaire en OCT. Le temps de culmination de N1 sur 10° est significativement correle au volume maculaire en OCT. Conclusion Ces resultats suggerent que le temps de culmination de l’onde N1 est le parametre de l’ERG multifocal le plus pertinent dans la chorioretionapthie de type Birdshot.

Objectif Comparer en terme d’acuite visuelle et de complications per- et post-operatoires un groupe de patients operes de cataracte blanche par rapport a un groupe temoin opere de cataracte senile « non blanche ». Materiels et Methodes Nous avons analyse de facon prospective 36 yeux de 34 patients operes de cataracte blanche (groupe 1) et 36 yeux de 36 patients operas de cataracte senile « non blanche » (groupe 2). Resultats Dans le groupe 1, l’acuite visuelle pre-operatoire moyenne etait de 1/100 et de 5/10 en post-operatoire a un mois. Quatre interventions (11 %) ont ete compliquees de rupture capsulaire posterieure. Dans le groupe 2, l’acuite visuelle pre-operatoire moyenne etait de 2/10 et de 7/10 en post-operatoire a un mois. Aucune rupture capsulaire n’a ete observee. L’acuite pre-operatoire du groupe 1 etait inferieure de facon significative par rapport au groupe 2 (p 0,05). Le gain d’acuite visuelle etait significativement plus important dans le groupe 1 (p Discussion Notre etude montre que la cataracte blanche n’est pas un facteur de risque de mauvaise recuperation visuelle et que le benefice en termes d’acuite visuelle est plus important en cas de cataracte blanche qu’en cas de cataracte « non blanche ». Conclusion Les resultats des patients operes de cataracte blanche sont satisfaisants malgre un taux de ruptures capsulaires plus important dans notre etude.