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We report the case of a 21-year-old female patient with unilateral acute macular neuroretinopathy (AMN) two days after the administration of the Oxford-AstraZeneca COVID-19 vaccination.

International audience; Background: For normally sighted readers, word neighborhood size (i.e., the total number of words that can be formed from a single word by changing only one letter) has a facilitator effect on word recognition. When reading with central field loss (CFL), however, individual letters may not be correctly identified, leading to possible misidentifications and a reverse neighborhood size effect. Here we investigate this inhibitory effect of word neighborhood size on reading performance and whether it is modulated by word predictability and reading proficiency. Methods: Nineteen patients with binocular CFL from 32 to 89 years old (mean ± SD = 75 ± 15) read short sentences presented with the self-paced reading paradigm. Accuracy and reading time were measured for each target word read, along with its predictability, i.e., its probability of occurrence following the two preceding words in the sentence using a trigram analysis. Linear mixed effects models were then fit to estimate the individual contributions of word neighborhood size, predictability, frequency and length on accuracy and reading time, while taking patients’ reading proficiency into account.Results: For the less proficient readers, who have given up daily reading as a consequence of their visual impairment, we found that the effect of neighborhood size was reversed compared to normally sighted readers and of higher amplitude than the effect of frequency. Furthermore, this inhibitory effect is of greater amplitude (up to 50% decrease in reading speed) when a word is not easily predictable because its chances to occur after the two preceding words in a specific sentence are rather low.Conclusion: Severely impaired patients with CFL often quit reading on a daily basis because this task becomes simply too exhausting. Based on our results, we envision lexical text simplification as a new alternative to promote effective rehabilitation in these patients. By increasing reading accessibility for those who struggle the most, text simplification might be used as an efficient rehabilitation tool and daily reading assistive technology, fostering overall reading ability and fluency through increased practice.

Immunosuppressants are prescribed for pediatric uveitis in cases of severe involvement affecting the prognosis for vision or life, in cases of recurrent or chronic uveitis to achieve corticosteroid sparing, or in cases of corticosteroid resistance. Immunosuppressants used in children include antimetabolites (methotrexate, mycophenolate mofetil, azathioprine), cyclosporine, tacrolimus, and biologics, including infliximab, adalimumab, anakinra, canakinumab, and tocilizumab. The mechanisms of action and indications of the various immunosuppressants are described in this review.

Resume Introduction Les keratoprotheses offrent une alternative therapeutique aux patients ayant une cecite corneenne bilaterale et ne pouvant pas beneficier d’une allogreffe de cornee. Le but de ce travail etait d’evaluer l’interet et les limites de la keratoprothese de Boston. Materiel et methodes Sept patients ont beneficie de l’implantation unilaterale d’une keratoprothese de Boston de type I entre decembre 2012 et novembre 2016. Les donnees suivantes ont ete recueillies : l’indication chirurgicale, l’acuite visuelle preoperatoire, postoperatoire a J1, J7, J30, 6 mois et 12 mois, les complications et le traitement postoperatoire. Resultats L’âge moyen d’implantation etait de 58,7 ± 23,4 ans. L’indication chirurgicale correspondait a 1 cas d’aniridie bilaterale congenitale, 2 cas de brulure chimique et 4 decompensations du greffon apres keratoplasties multiples. L’acuite visuelle preoperatoire etait limitee a « perception lumineuse positive » dans 6 cas et « voit bouger la main » dans un cas. Un gain d’acuite visuelle a ete observe chez 4 patients, ce qui correspondait a un gain moyen de 1,53 logMAR au dernier controle. L’acuite visuelle postoperatoire etait en moyenne de 2,33 logMAR. Tous les patients ont constate une amelioration de leur qualite de vie et de leur autonomie. Discussion La selection des patients doit etre faite avec soin, en privilegiant les patients ayant un potentiel fonctionnel conserve et un suivi postoperatoire rapproche possible, afin de garantir la meilleure reussite possible du traitement. Conclusion La keratoprothese de Boston permet un gain de vision et une meilleure qualite de vie pour des patients souffrant d’une cecite corneenne bilaterale.

Resume Introduction La secheresse oculaire est une pathologie plurifactorielle de la surface oculaire dont la frequence elevee, le retentissement significatif sur la qualite de vie et sur la vision, ainsi que le cout financier, en font un veritable probleme de sante publique. Si le traitement des formes minimes a moderees est generalement simple et efficace, celui des formes severes est souvent decevant. L’utilisation de collyres a base de serum autologue (CSA) represente une alternative therapeutique envisageable pour les cas les plus severes. L’objectif de notre etude est d’evaluer l’efficacite du traitement par CSA a long-terme chez des patients presentant des syndromes secs isoles refractaires aux traitements conventionnels ou secondaires a d’autres pathologies generales telles que le syndrome de Gougerot-Sjogren et la maladie du greffon contre l’hote (GVH), ou a des pathologies oculaires telles que les keratites neurotrophiques, les brulures chimiques et les pemphigoides cicatricielles oculaires. Patients et methodes Il s’agit d’une etude observationnelle retrospective monocentrique menee sur 47 patients, soit 83 yeux traites par collyre de serum autologue a l’Assistance Publique-Hopitaux de Marseille entre avril 2014 et avril 2017 pour syndrome sec oculaire severe isole ou secondaire. Les symptomes subjectifs des patients (score ocular surface disease index [OSDI]), leur degre de satisfaction ainsi que les effets secondaires ont ete recueillis a l’aide de questionnaires. Le break up time (BUT) et le score de Schirmer ont ete notes. Une evaluation clinique fondee sur un test de coloration corneenne a la fluoresceine (score Oxford) est realisee avant le traitement par CSA a P0 puis selon 5 periodicites : P1 (entre 1 et 3 mois), P2 (3 et 9 mois), P3 (9 a 15 mois) et P4 (15 mois a 24 mois), P5 (> 24 mois). Resultats Sur les 83 yeux traites, l’âge moyen etait de 54,39 ans ± 21,56 dont 20 hommes (42,55 %) et 27 femmes (57,44 %), les indications de traitement comprenaient principalement 25,53 % de GVH, 21,27 % de syndromes secs oculaires severes primitifs et 19,14 % de syndrome de Goujerot-Sjogren primaire. Le suivi moyen a ete de 9,82 mois ± 15,50. La variation du score OSDI entre P0 et P1 montre une diminution de 19,32 points ± 29,37 (p Discussion Des analyses biologiques complementaires sur la composition des CSA sont en cours afin de mettre en evidence des facteurs predictifs d’efficacite. Ainsi, les patients non repondeurs au traitement par CSA pourraient repondre aux collyres de serum allogenique, fabriques a partir de sang peripherique preleve chez un donneur sain a partir de sang de cordon. Conclusion Sur cette premiere serie de 83 yeux traites par CSA, une efficacite clinique a ete notee chez la majorite des patients. Aucune complication infectieuse n’a ete rapportee et le taux de satisfaction a ete tres eleve.

Dichoptic movie viewing has been shown to significantly improve visual acuity in amblyopia in children. Moreover, short-term occlusion of the amblyopic eye can transiently increase its contribution to binocular fusion in adults. In this study, we first asked whether dichoptic movie viewing could improve the visual function of amblyopic subjects beyond the critical period. Secondly, we tested if this effect could be enhanced by short-term monocular occlusion of the amblyopic eye. 17 subjects presenting stable functional amblyopia participated in this study. 10 subjects followed 6 sessions of 1.5 hour of dichoptic movie viewing (nonpatched group), and 7 subjects, prior to each of these sessions, had to wear an occluding patch over the amblyopic eye for two hours (patched group). Best-corrected visual acuity, monocular contrast sensitivity, interocular balance, and stereoacuity were measured before and after the training. For the nonpatched group, mean amblyopic eye visual acuity significantly improved from 0.54 to 0.46 logMAR (p<0.05). For the patched group, mean amblyopic eye visual acuity significantly improved from 0.62 to 0.43 logMAR (p<0.05). Stereoacuity improved significantly when the data of both groups were combined. No significant improvement was observed for the other visual functions tested. Our training procedure combines modern video technologies and recent fundamental findings in human plasticity: (i) long-term plasticity induced by dichoptic movie viewing and (ii) short-term adaptation induced by temporary monocular occlusion. This passive dichoptic movie training approach is shown to significantly improve visual acuity of subjects beyond the critical period. The addition of a short-term monocular occlusion to the dichoptic training shows promising trends but was not significant for the sample size used here. The passive movie approach combined with interocular contrast balancing even over such a short period as 2 weeks has potential as a clinical therapy to treat amblyopia in older children and adults.

International audience; People with central field loss (CFL) use peripheral vision to identify words. Eccentric vision provides ambiguous visual inputs to the processes leading to lexical access. Our purpose was to explore the hypothesis that this ambiguity leads to strong influences of inferential processes, our prediction being that increasing word frequency would decrease word reading time. Individuals with bilateral CFL induced by macular diseases read French sentences displayed with a self-paced reading method. Reading time of the last word of each sentence (target word) was recorded. Each target word (in sentence n) was matched with a synonym word (in sentence n+1) of the same length. When using absolute frequency value (Analysis 1), we found that reading time of target words decreased when word frequency increases, even when controlling for word length. The amplitude of this effect is larger than reported in previous investigations of reading with normal subjects. When comparing the effect of relative frequency (low vs. high) within each pair of synonyms (Analysis 2), results show the same pattern as the one observed in Analysis 1. Our results demonstrate clear-cut frequency effects on word reading time and suggest that inferential processes are stronger in CFL readers than in normally sighted observers. These results might also help design text simplification tools tailored for low-vision patients.

Background/ purpose: Diffuse subretinal fibrosis and uveitis syndrome is an inflammatory disease rarely reported. The purpose of this article is to describe a rare case of diffuse subretinal fibrosis syndrome in an 8-year-old child. Methods and results: The patient initially presented with a loss of vision in his right eye, with a visual acuity of 20/200. The visual acuity of the left eye was normal. Clinical examination showed bilateral anterior and posterior inflammation while the fundus revealed on the right eye an inter maculopapillar fibrosed lesion with a discrete retinal hemorrhage and a similar but smaller lesion on the left eye. The optical coherence tomography showed hyper-reflective material compatible with pre-retinal and subretinal pigment epithelial fibrosis and associated subretinal fluid. The angiography facilitated the diagnosis of neovascularization that was associated with the fibrotic lesion. The rest of the clinical pediatric examination remained negative and a diagnosis of diffuse subretinal fibrosis syndrome complicated with neovascularization was made. Treatment with systemic corticosteroids at the dose of 1 mg/kg/day for 1 month with a progressive decrease of 5 mg per month allowed for both anatomical and functional improvement. The visual acuity of the right eye improved from 20/200 to 20/63 at 1 month, 20/32 at 2 months, and 20/20 at 4 months. Conclusion: To our knowledge, this is the first reported case of bilateral diffuse subretinal fibrosis complicated by neovascularization. General corticosteroid therapy proved to be effective in this case and appears to be a viable option in first-line treatment.

Keratoprostheses offer a therapeutic alternative to patients with bilateral corneal blindness who cannot undergo corneal allograft. The goal of this work was to evaluate the indications and limitations of Boston keratoprosthesis.Seven patients underwent unilateral implantation of a Boston type I keratoprosthesis between December 2012 and November 2016. The following data were collected: surgical indication, preoperative visual acuity, postoperative visual acuity at D1, D7, D30, 6 months and 12 months, complications and postoperative treatment.The mean age of implantation was 58.7±23.4 years. The surgical indications included 1 case of congenital bilateral aniridia, 2 cases of chemical burn and 4 graft decompensations after multiple keratoplasties. Preoperative visual acuity was limited to "light perception" in 6 cases and "hand motion" in one case. A gain in visual acuity was observed in 4 patients, which corresponded to a mean gain of 1.53 logMAR at last follow-up. Postoperative visual acuity averaged 2.33 logMAR. All patients experienced an improvement in their quality of life and independence.Patients should be selected carefully, favoring patients with a remaining functional potential and able to engage in close postoperative follow-up, in order to ensure the best possible treatment success.Boston keratoprosthesis provides improved vision and improved quality of life for patients suffering from bilateral corneal blindness.

Dry eye disease is a multifactorial pathology of the ocular surface. The high incidence of this pathology, as well as its significant impact on quality of life and vision and its financial cost, makes it a real public health problem. While the treatment of mild cases is generally simple and effective, treatment of severe forms is often disappointing. The use of autologous serum tears (AST) represents a therapeutic alternative for the most severe cases. The purpose of our study is to evaluate the efficacy of long-term AST treatment in patients with severe dry eye disease refractory to conventional treatment or secondary to systemic diseases such as Sjögren's syndrome or Graft versus Host disease (GVH), or ocular pathologies such as neurotrophic keratitis, chemical burns and ocular cicatricial pemphigoid.This is a monocentric retrospective observational study conducted on 47 patients, with 83 eyes treated with autologous serum eye drops for isolated or secondary dry eye disease at the Marseille Public Hospitals between April 2014 and April 2017. The patients' subjective symptoms (ocular surface disease index [OSDI] score), their degree of satisfaction and the side effects were collected using questionnaires. Tear Break Up Time (BUT) and Schirmer scores were noted. A clinical evaluation based on fluorescein staining (Oxford score) was carried out prior to treatment with AST at P0 followed by 5 periods: P1 (between 1 and 3 months), P2 (3 to 9 months), P3 (9 to 15 months), P4 (15 months to 24 months), and P5 (24 months).Out of the 83 eyes treated, the mean age was 54.39±21.56. There were 20 males (42.55 %) and 27 females (57.44 %); treatment indications consisted mainly of 25.53 % GVH, 21.27 % severe dry eye disease and 19.14 % Sjögren syndrome. The mean duration of follow-up was 9.82 months±15.50. The OSDI score decreased by 19.32 points±29.37 (P0.05) between P0 and P1 and by 23.06 points±18.41 (P0.05) between P0 and P4. The Oxford clinical score showed a significant decrease by the third month of treatment, between P0 and P2, by 1.32 points±1.76 (P0.05). The Schirmer test and the BUT also showed an improvement in dry eye symptoms over time with AST, significantly at P1 (P0.05).Complementary biological analyzes on the composition of AST are under way in order to identify predictive factors of effectiveness; patients not responding to AST treatment might respond to allogeneic serum from healthy donor cord blood.On this first series of 83 eyes treated with ASD, clinical efficacy was noted in most of the patients. No infectious complications were reported, and the satisfaction rate was very high.