Osmolarité du film lacrymal (intérêt chez le porteur de lentilles de contact)

DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Long-term outcome after topical ciclosporin in severe dry eye disease with a 10-year follow-up

Aim To report a 10-year follow-up of patients suffering from severe dry eye syndrome (DES) initially treated with topical ciclosporin A (tCSA) for 6months. Methods The charts of 26 patients with severe DES related to keratoconjunctivitis sicca (KCS) and followed for a minimum 10-year follow-up were retrospectively reviewed. All of them were treated initially with tCSA for 6months. The Schirmer I test, fluorescein and lissamine green staining scores and tear film break-up time (TBUT) were recorded to assess clinical symptoms before, during and after treatment. The subjective signs were evaluated with the ocular surface disease index (OSDI) questionnaire. Prolongation and reintroduction of tCSA after the initial treatment and combined treatments were also noted. Results Overall the median (IQR) duration of tCSA treatment was 23 (7-51) months after a prolonged induction treatment lasting 20 (8-41) months during the 10-year follow-up. For symptoms, a statistically significant difference in the OSDI between baseline and the end of the 10-year follow-up was not found (p=0.67). We noted a statistically significant improvement in all clinical signs after the initial treatment period, still present at the end of follow-up. Only 6.5% of the patients needed reintroduction of tCSA after their prolonged induction treatment. Conclusions The improvement observed after an initial tCSA treatment was sustained after a long-term follow-up with few cases requiring additional tCSA treatment. A prolonged induction treatment to decrease initial inflammatory local signs is a promising option in KCS

[An iris metastasis revealed a bronchopulmonary cancer]

We report the case of a 53-year-old patient referred by his ophthalmologist for a red, painful eye. On exam, he demonstrated findings of granulomatous uveitis with ocular hypertension (38 mm Hg) and a whitish, vascularized iris tumor with invasion of the irido-corneal angle. As our first hypothesis was an iris metastasis, a systemic work-up was carried out, which revealed moderately differentiated broncho-pulmonary carcinoma with multiple metastases (brain, cerebellum and adrenal). Emergency radio-chemotherapy was initiated, and the outcome was good, with rapid regression of the iris metastasis and good efficacy against the primary cancer. After one year of follow-up, the patient developed a metastasis at a new site, and his general condition deteriorated

Long-term outcome after topical ciclosporin in severe dry eye disease with a 10-year follow-up

International audienceAim: To report a 10-year follow-up of patients suffering from severe dry eye syndrome (DES) initially treated with topical ciclosporin A (tCSA) for 6months.Methods: The charts of 26 patients with severe DES related to keratoconjunctivitis sicca (KCS) and followed for a minimum 10-year follow-up were retrospectively reviewed. All of them were treated initially with tCSA for 6months. The Schirmer I test, fluorescein and lissamine green staining scores and tear film break-up time (TBUT) were recorded to assess clinical symptoms before, during and after treatment. The subjective signs were evaluated with the ocular surface disease index (OSDI) questionnaire. Prolongation and reintroduction of tCSA after the initial treatment and combined treatments were also noted.Results: Overall the median (IQR) duration of tCSA treatment was 23 (7-51) months after a prolonged induction treatment lasting 20 (8-41) months during the 10-year follow-up. For symptoms, a statistically significant difference in the OSDI between baseline and the end of the 10-year follow-up was not found (p=0.67). We noted a statistically significant improvement in all clinical signs after the initial treatment period, still present at the end of follow-up. Only 6.5% of the patients needed reintroduction of tCSA after their prolonged induction treatment.Conclusions: The improvement observed after an initial tCSA treatment was sustained after a long-term follow-up with few cases requiring additional tCSA treatment. A prolonged induction treatment to decrease initial inflammatory local signs is a promising option in KCS

Retinal Detachments Following Successful Idiopathic Macular Holes Surgery

Purpose: : To evaluate long term outcome of successfully operated idiopathic macular holes (IMH).Methods: : We conducted a comparative retrospective case series in two academic centers. IMH were operated with pars plana vitrectomy, intravitreal gas and internal limiting membrane peeling between 2002 and 2005. All these macular holes were analyzed with Stratus OCT before and after the surgery. We divided them into 4 groups: group 1: vitrectomy in pseudophakic eyes; group 2: vitrectomy and cataract extraction as a combined procedure; group 3: vitrectomy followed by cataract extraction; group 4: vitrectomy in pseudophakic eyes. We noted the anatomical and functional results and we studied serious posterior segment complications. Patients with previous or concurrent rhegmatogenous retinal detachment (RD) were excluded from the study.Results: : 135 eyes of 130 patients were included: group 1=22 eyes; group 2=49 eyes; group 3=53 eyes and group 4=11 eyes. The stages of IMH were as follows: stage 2, n=19; stage 3, n=101 and stage 4, n=15. Mean follow-up was 37±9 months (range, 30-67), and mean preoperative IMH diameter was 454±191 µm. We did not observe any recurrence of macular hole during the follow-up. The following posterior complications were noted: 17 peroperative retinal breaks, 8 peroperative and 10 (7.4%) postoperative retinal detachments (6 women, 4 men). Lens status did not influence the rate of RD. Mean time of postoperative retinal detachments was 10±15 months. In 3 eyes with RD, the retinal tear has been already treated during the initial IMH surgery by retinocryopexy and gas. Excepted for one eye which has been treated with silicone oil, 9 out of 10 eyes had a mean improvement of visual acuity from 0.87±0.28 to 0.37±0.39 LogMAR.Conclusions: : We did not find any reopening of successfully operated IMH during a three year follow-up. Retinal detachment remains the most common serious complication of macular surgery. Careful intraoperative examination and immediate treatment of the breaks may prevent the development of retinal detachment. However a careful and long follow-up is needed to detect new retinal detachments

Type 2 retinal arteriovenous malformations: Case report

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Efficacy of tocilizumab in two patients with anti-TNF-alpha refractory uveitis

PURPOSE: To report on two patients with refractory uveitis treated with tocilizumab; a new humanized monoclonal antibody against the interleukin-6 receptor (IL-6R). DESIGN: Retrospective interventional case series. METHODS: Both patients received a monthly infusion of tocilizumab 8 mg/kg; associated with corticosteroids. Outcome measures were visual acuity and central retinal thickness evaluated with optical coherence tomography. RESULTS: An improvement in visual acuity and a decrease in macular edema were observed in these two patients. CONCLUSIONS: Tocilizumab seems to be a promising treatment in refractory uveitis. A prospective study is needed to evaluate the role of this new agent in the management of refractory uveitis

Severe corneal complications following vitreoretinal surgery

Severe corneal complications following vitreoretinal surgery. annual meeting of the association-for-research-in-vision-and-ophthalmology (ARVO

Anatomical and functional macular changes after rhegmatogenous retinal detachment with macula off

PURPOSE: To evaluate the correlation between morphologic changes in the outer retina and visual function after successful repair of rhegmatogenous retinal detachment with macula off. DESIGN: Observational case series. METHODS: SETTINGS: Dijon University Hospital. PATIENTS: Thirty patients (30 eyes) with successful repair of rhegmatogenous retinal detachment after macula off and a minimum 6-month follow-up after surgery. MAIN OUTCOME MEASURES: Spectral-domain optical coherence tomography (SD-OCT) of the outer retina, fundus autofluorescence (FAF), and microperimetry. RESULTS: Twenty of 30 eyes presented microstructural changes within the photoreceptor layer (66.7%). Of these, half of the patients (50%) had more than 1 lesion. Disrupted inner segment/outer segment (IS/OS) junction was noted in 16 out of 30 eyes (53.3%), irregular hyporeflectivity in the photoreceptor outer segments (PROS) was observed in 17 eyes (56.7%), external limiting membrane was discontinued in 10 eyes (33.3%), and hyperreflective spots in the outer nuclear layer were observed in 5 eyes (16.7%). FAF changes were detected in only 5 eyes (16.7%). Abnormalities in the IS/OS junction were significantly associated with lower foveal and macular sensitivity, thinner PROS, and global photoreceptor changes (P = .014, P = .003, P = .006, P < .0001, respectively). Patients with a normal foveal profile showed similar findings. CONCLUSIONS: SD-OCT and microperimetry seem to be appropriate tools to determine the visual and the anatomic recovery of the macula after surgery

Utilisation de l’ocular surface disease index (OSDI°) pour les études cliniques sur la sécheresse oculaire : facteurs à prendre en compte

National audienc