Modifications de la composition en acides gras du meibum et de la surface oculaire de patients souffrant de dysfonctionnement meibomien après traitement par minocycline

DIJON-BU Médecine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Outcome of exudative aged-related macular degeneration (ARMD) after 3 intravitreal injections of bevacizumab

Purpose: To evaluate the efficacy of intravitreal injections of bevacizumab in exudative ARMD. Methods: Retrospective study including naive patients suffering from exudative ARMD whatever the type of neovascularisation. All the participants were treated with three monthly 1.25 mg intravitreal injections of bevacizumab.The primary objective was far and near visual acuity (VA) 1, 3 and 6 months after the third injection. The secondary objective was the residual activity of neovascularisation assessed with fluorescein and ICG angiography and retinal thickness evaluated with OCT3. Results 71 eyes of 66 patients were included. Neovascularisation was occult, visible or combined in 65%, 20% and 15% of the cases, respectively. A statistically significant improvement between pre and post‐injection VA (LogMAR) was observed one month after the third injection, 0.88±0.57 and 0.77±0.60, respectively, p=0.001). An active neovascularisation was still present at that time in 57.7% of the eyes and 34% at 6 months needing further bevacizumab injections (3.85±0.96 per eye). VA was similar at 1, 3 and 6 months (F71,2=1,54 ; p=0,46). A complication occurred in 3 eyes. Conclusion: Three bevacizumab intravitreal injections led to a significant VA improvement. However, more than half of the eyes had an active neovascularisation after these 3 injections

Analyse de la composition en acides gras du film lacrymal chez des patients souffrant de blépharite chronique, de syndrome sec et chez des patients normaux

National audienc

002 Évaluation de la toxicité des acides gras branchés sur des cellules conjonctivales en culture

Communication orale lors du 113e congrès de la Société Française d'Ophtalmologie.International audienc

265 Modifications de la composition en acides gras du meibum et de la surface oculaire de patients souffrant de dysfonctionnement meibomien après traitement par minocycline

International audienc

Enophtalmie révélatrice d’un cancer du sein

National audienceIntroduction.– Hormis le classique syndrome de Claude-Bernard-Horner, les énophtalmies sont généralement en rapport avec des anomalies anatomiques de la région orbitaire (atélectasie du sinus maxillaire, varices orbitaires, aplasie de la grande aile du sphénoïde) ou avec des réductions du contenu orbitaire (lipodystrophie, atrophie de la graisse orbitaire, postradiothérapie, atrophie de l’hémiface et sclérodermie linéaire). Les métastases orbitaires font partie des étiologies plus rares. Patients et méthodes.– Nous en rapportons ici une observation. Observation.– Une femme née en 1947, sans antécédent, est vue en consultation pour une énophtalmie droite apparue progressivement, sans autre signe clinique associé, mais responsable d’une gêne esthétique. Il n’y a pas de baisse de l’acuité visuelle et le bilan orthoptique révèle une atteinte réfractive du muscle supérieur droit sans retentissement fonctionnel. Elle décrit depuis plusieurs mois des douleurs des cuisses au repos. L’IRM met en évidence une atrophie de la graisse orbitaire sans autre anomalie. On note la présence d’ANA mouchetés M1 à 1280 sans anti-ADN ni anti-ENA et d’anticorps anti-TPO sans dysthyroïdie biologique. Le CH50 et les fractions C3 et C4 sont normaux. Il n’est toutefois noté aucun autre élément en faveur d’une maladie auto-immune ; dans le cadre de l’enquête étiologique, le scanner thoraco-abdominopelvien découvre des remaniements du cadrant inféro-externe de la glande mammaire gauche et des ganglions infracentimétriques du creux axillaire. La mammographie et l’échographie révèlent un nodule mammaire gauche de 9 mm. La biopsie confirme un adénocarcinome canalaire infiltrant. La patiente bénéficie d’une segmentectomie mammaire gauche avec curage ganglionnaire puis d’une chimiothérapie adjuvante. À deux mois de la chirurgie, l’énophtalmie persiste. Discussion.– Une localisation orbitaire de différents cancers peut être à l’origine d’une énophtalmie, en revanche celle-ci est exceptionnellement, comme dans cette observation, la première manifestation du cancer. L’origine primitive mammaire est la plus fréquente et doit donc être systématiquement évoquée devant une énophtalmie inexpliquée. L’infiltrat rétrobulbaire métastatique aurait un potentiel rétractile expliquant l’enophtalmie. L’évolution est le plus souvent insidieuse, l’énophtalmie apparaissant très progressivement. La motricité oculaire est progressivement altérée, en relation avec l’infiltration intracônale et la diplopie est une cause fréquente de consultation. L’IRM orbitaire ne permet pas toujours de visualiser l’infiltration intracônale, en arrière du pôle postérieur de l’œil. La biopsie n’est utile que lorsque le bilan est négatif. Elle permet alors le plus souvent de mettre en évidence les cellules néoplasiques. Conclusion.– Ainsi, devant une énophtalmie unilatérale d’apparition progressive, il faut savoir évoquer une origine néoplasique, et chez une femme, rechercher en premier lieu un cancer du sein. Pour en savoir plus [1] Hamedani M, et al. Surv Ophthalmol 2007;52:457–73

Differences in meibomian fatty acid composition in patients with meibomian gland dysfunction and aqueous-deficient dry eye

International audienceTo evaluate the differences in meibomian fatty acid composition in healthy subjects and in patients suffering from meibomian gland dysfunction or aqueous-deficient dry eye

The contribution of tear osmolarity measurement to ocular surface assessment in contact lens wearers

Purpose: To determine whether tear osmolarity using the TearLabTM Osmolarity System contributes to the assessment of the ocular surface in contact lens (CL) wearers.Methods: Data were collected from 44 CL wearers (28 tolerant and 16 intolerant) and 34 healthy subjects. Every patient underwent a thorough ophthalmic examination and tear osmolarity test, conjunctival impression cytology and meibomian lipid sampling. Symptoms, break-up time (BUT), tear osmolarity, conjunctival expression of HLA-DR and meibomian fatty acid composition were evaluated.Results: Tear osmolarity was significantly higher in the controls compared to tolerant and intolerant CL wearers (p=0.0007). Flow cytometry results expressed in antibody-binding capacity (ABC) units and percentage of positive cells revealed a significant difference between intolerant CL wearers group and control group (p<0.0001). Furthermore, comparisons between tolerant and intolerant CL wearers showed only a significant difference for mean fluorescence levels expressed in ABC (p<0.0001). Moreover, impression cytology analysis showed similar values in the tolerant CL wearers and the control group. Material of CL (hydrogel) was significantly correlated with the percentage of positive cells both in tolerant and intolerant CL wearers. BUT was significantly shorter in intolerant and tolerant CL wearers subjects than in healthy subjects (p<0.0001), whereas there was no significant difference in meibomian fatty acid composition (p=0.98) between groups.Conclusions: CL wear is responsible for ocular surface alterations whose patterns are very similar to those reported in dry eye syndrome. However, the yield of tear osmolarity with TearLabTM in assessing ocular surface disorders in CL wearers deserves further investigation

Ocular surface assessment in soft contact lens wearers; the contribution of tear osmolarity among other tests.

Purpose: To determine whether tear osmolarity contributes to the assessment of the ocular surface in soft contact lens (CL) wearers. Methods: Prospective, case-control series in 44 CL wearers (28 tolerant and 16 intolerant) and 34 healthy subjects. Every patient underwent a thorough ophthalmic examination with a tear osmolarity test (TearLab System), conjunctival impression cytology and meibomian lipid sampling. Symptoms, break-up time (BUT), tear osmolarity, conjunctival expression of HLA-DR and meibomian fatty acid composition were evaluated. Results: Tear osmolarity did not differ between controls and CL wearers (p = 0.23). Flow cytometry results expressed in antibody-binding capacity (ABC) units and percentage of positive cells revealed a significant difference between the intolerant CL wearer group and the control group (p < 0.0001). Comparisons between tolerant and intolerant CL wearers showed only a significant difference for mean fluorescence levels expressed in ABC units (p < 0.0001). The BUT was significantly shorter in intolerant and tolerant CL wearers subjects than in healthy subjects (p < 0.0001), whereas there was no significant difference in meibomian fatty acid composition (p = 0.99) between the two groups. Conclusion: Contact lens wear is responsible for ocular surface alterations whose patterns are very similar to those reported in early dry-eye syndrome. However, tear osmolarity was not modified in these selected CL wearers. The yield of tear osmolarity with TearLab™ in assessing ocular surface disorders in CL wearers deserves further investigation

Ocular surface response in contact lens wearers

 Purpose: To evaluate the ocular surface changes induced by contact lens wear. Methods: Data of 7 tolerant contact lens wearers, 7 non-tolerant contact lens wearers and 7 healthy subjects were collected. Every patient underwent a thorough ophthalmic examination and tear osmolarity test, conjunctival impression cytology and meibomian lipid sampling. Symptoms, Break-Up Time (BUT), tear osmolarity, conjunctival expression of human leucocyte antigen (HLA) DR and meibomian fatty acid composition were evaluated. Results: Twenty one subjects (8 men and 13 women) were included (42 eyes). Symptoms reported by tolerant and non-tolerant contact lens wearers were as follows: superficial foreign body sensation (29% vs 21%), burning (14% vs 21%) and ocular dryness (28% vs 78%). No symptoms were reported by healthy subjects. There was no significant difference in tear osmolarity (p=0.63) and meibomian fatty acid composition (p=0.97) in both groups. Break-up time was significantly lower in tolerant (p<0.05) and non-tolerant (p<0.0001) contact lens wearers than in healthy subjects. The HLA-DR expression was significantly higher in non-tolerant (50%) contact lens wearers than in healthy subjects (16%) (p<0.01). Conclusions: Contact lens wear is responsible for ocular surface alterations which lead to intolerance. These patterns are very similar to those reported in dry eye symptoms