Panorama des altérations limbiques cornéennes

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Panorama of limbal changes

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Traitement des sécheresses oculaires sévères secondaires à la maladie du greffon contre l’hôte chronique par lentilles sclérales perméables à l’oxygène

International audienceIntroduction: Graft-versus-host disease is a major complication of allogeneic hematopoietic stem cell transplantation. Severe keratoconjunctivitis sicca is common in patients with chronic GVH disease. The goal of this study was to evaluate the safety and efficacy of a gas-permeable scleral lens in the management of severe dry eye disease associated with chronic GVH.Patients and methods: This is a retrospective study from June 2009 to November 2013. Patients fitted with scleral lenses for severe keratoconjunctivitis sicca associated with chronic GVH were included. The main outcomes measured were best-corrected visual acuity and quality of life (OSDI and NEI-VFQ25) composite scores before and six months after scleral lens fitting.: ResultsSixteen patients were included. The mean age was 52 years (19–69 years). Mean follow-up was 20 months (3–48 months). All patients reported improvement of their ocular symptoms. Best corrected visual acuity improved from 0.21 ± 0.26 to 0.1 ± 0.14 logMAR (P = 0.002), OSDI score improved from 92.1 ± 11.3 to 23.5 ± 11.2 (P = 0.002) and NEI-VFQ25 improved from 41.3 ± 7 to 83.1 ± 15.9 (P = 0.003), 6 months after scleral lens fitting. No serious adverse events, infectious, hypoxemic or allergic complications attributable to the scleral lens occurred.Conclusion: Gas-permeable scleral lens use appears to be safe and effective in patients with severe dry eye related to chronic GVH.Introduction: La maladie du greffon contre l’hôte (GVH) est une complication majeure de la greffe allogénique de cellules souches hématopoïétiques. Une kératoconjonctivite sèche est fréquemment observée. Le but de cette étude est d’évaluer l’efficacité et la tolérance des lentilles sclérales perméables à l’oxygène dans le traitement des sécheresses oculaires sévères secondaires à une GVH chronique.Patients et méthodes: Il s’agit d’une étude rétrospective menée de juin 2009 à novembre 2013. Les patients présentant une sécheresse oculaire sévère associée à une GVH chronique et adaptés avec des lentilles sclérales ont été inclus. Les critères de jugement principaux ont été l’acuité visuelle et les scores de qualité de vie (OSDI et NEI-VFQ25) après 6 mois de port.Résultats: Parmi les 16 patients inclus, l’âge moyen était de 52 ans (19–69 ans). Le recul moyen était de 20 mois (3–48 mois). Tous les patients ont présenté une amélioration de leurs symptômes oculaires. L’acuité visuelle s’est améliorée de 0,21 ± 0,26 à 0,1 ± 0,14 logMAR après 6 mois de port (p = 0,002). Le score OSDI moyen s’est amélioré de 92,1 ± 11,3 à 23,5 ± 11,2 (p = 0,002) et le NEI-VFQ25 de 41,3 ± 7 à 83,1 ± 15,9 après 6 mois de port (p = 0,003). Aucune complication infectieuse, hypoxique ou allergique n’est survenue.Conclusion:L’utilisation des lentilles sclérales perméables à l’oxygène semble efficace et bien tolérée dans la prise en charge des sécheresses oculaires sévères secondaires aux GVH chroniques

Tacrolimus ointment in the management of atopic keratoconjunctivitis

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Tacrolimus pommade dans la prise en charge de la kératoconjonctivite atopique

International audienceIntroduction: Atopic keratoconjunctivitis is associated with eyelid eczema. It may require the use of local corticosteroids which if prolonged can be a source of ocular complications. Tacrolimus is an immunosuppressant used in cutaneous application in atopic dermatitis. The aim of this study was to measure the efficacy and tolerance of tacrolimus 0.1% ointment in palpebral application in atopic keratoconjunctivitis.Patients and methods: This retrospective, single-center study was conducted between June 2014 and February 2017. Patients with atopic keratoconjunctivitis not controlled by first-line medical treatments were included. The primary endpoint was the evolution of functional signs as assessed by the NEI-VFQ25 and OSDI quality of life scores. Secondary endpoints were visual acuity and local corticosteroid use.Results: Among the 18 patients included, the mean age was 37.9 ± 16.8 years. The first follow-up visit was on average 68.3 ± 55.3 days after initiation of treatment. The NEI-VFQ25 score was significantly improved for seven of its sub-scores (P Conclusion: Tacrolimus ointment 0.1% in palpebral application appears to be an effective treatment for the management of atopic keratoconjunctivitis.Introduction : la kératoconjonctivite atopique est fréquemment associée à un eczéma palpébral. Elle peut nécessiter le recours aux corticoïdes locaux dont l’utilisation prolongée est source de complications oculaires. Le tacrolimus est un immunosuppresseur, utilisé en application cutanée dans la dermatite atopique. Le but de cette étude est d’évaluer l’efficacité et la tolérance du tacrolimus 0,1 % pommade en application palpébrale dans la kératoconjonctivite atopique.Patients et méthodes : il s’agit d’une étude rétrospective, monocentrique, réalisée entre juin 2014 et février 2017. Les patients présentant une kératoconjonctivite atopique non contrôlée par les traitements médicaux de première intention ont été inclus. Le critère de jugement principal a été l’évolution des signes fonctionnels évaluée par les scores de qualité de vie NEI-VFQ25 et OSDI. Les critères secondaires ont été l’acuité visuelle et la consommation de corticoïdes locaux.Résultats : parmi les 18 patients inclus, l’âge moyen était de 37,9 ± 16,8 ans. La première consultation de contrôle survenait en moyenne 68,3 ± 55,3 jours après l’initiation du traitement. Le score NEI-VFQ25 était amélioré significativement pour sept de ses sous-scores (p Conclusion : le tacrolimus pommade 0,1 % en application palpébrale semble être un traitement efficace dans la prise en charge de la kératoconjonctivite atopique

Efficacy and safety of pre-Descemet's membrane sutures for the management of acute corneal hydrops in keratoconus

International audienceAims The aim of this study was to assess the efficacy and safety of pre-Descemet's membrane (DM) sutures associated with intracameral air injection for management of acute corneal hydrops associated with keratoconus. Methods We carried out a retrospective interventional study of seven consecutive cases. Three to seven pre-DM sutures with 10-0 nylon were applied perpendicularly to the tear as close as possible to DM, under general anaesthesia. An air bubble was injected into the anterior chamber at the end of each procedure. Results Corneal oedema began to decrease from day 1 after surgery in all our patients. Best-corrected visual acuity progressed from 2.13 to 1.65 logMar (p=0.031) 1 month after surgery, and from 2.13 to 0.84 logMar (p=0.016) 2 months after surgery. The mean corneal thickness measured by anterior segment optical coherence tomography decreased from 1472 mm (range 689-2770 mm) on day 0 to 909 mm (range 484-1640 mm) on day 1 (p=0.016), 716 mm (range 484-1380 mm) on day 15 (p=0.016) and 528 mm (range 404-618 mm) 1 month after surgery. Conclusions Our results suggest that intrastromal pre-DM sutures and intracameral air injection could promptly restore imperviousness of posterior stroma. This technique seems to be a safe and useful procedure to shorten acute corneal hydrops

Disabling ocular sequelae of epidermal necrolysis: risk factors during the acute phase and associated sequelae

International audienc

Dark skin phototype is associated with more severe ocular complications of Stevens–Johnson syndrome and toxic epidermal necrolysis

International audienc

Scleral lenses for severe chronic GvHD-related keratoconjunctivitis sicca: a retrospective study by the SFGM-TC

International audienc

Management of ocular involvement in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: french national audit of practices, literature review, and consensus agreement

International audienceAbstract Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) can lead to severe ophthalmologic sequelae. The main risk factor is the severity of the initial ocular involvement. There are no recommendations for ocular management during acute phase. We conducted a national audit of current practice in the 11 sites of the French reference center for toxic bullous dermatoses and a review of the literature to establish therapeutic consensus guidelines. We sent a questionnaire on ocular management practices in SJS/ TEN during acute phase to ophthalmologists and dermatologists. The survey focused on ophthalmologist opinion, pseudomembrane removal, topical ocular treatment (i.e. corticosteroids, antibiotics, antiseptics, artificial tear eye drops, vitamin A ointment application), amniotic membrane transplantation, symblepharon ring use, and systemic corticosteroid therapy for ophthalmologic indication. Nine of 11 centers responded. All requested prompt ophthalmologist consultation. The majority performed pseudomembrane removal, used artificial tears, and vitamin A ointment (8/9, 90%). Combined antibiotic-corticosteroid or corticosteroid eye drops were used in 6 centers (67%), antibiotics alone and antiseptics in 3 centers (33%). Symblepharon ring was used in 5 centers (55%) if necessary. Amniotic membrane transplantation was never performed systematically and only according to the clinical course. Systemic corticosteroid therapy was occasionally used (3/9, 33%) and discussed on a case-by-case basis. The literature about ocular management practice in SJS/ TEN during acute phase is relatively poor. The role of specific treatments such as local or systemic corticosteroid therapy is not consensual. The use of preservatives, often present in eye drops and deleterious to the ocular surface, is to be restricted. Early amniotic membrane transplantation seems to be promising